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Home My WebLink About01-6237 Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel For Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. '6'1 01- t,? Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - 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 may proceed without you and a decree of divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for 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, Cumberland County Courthouse, South Hanover Street, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM, YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 1-800-990-91 08 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. BY THE COURT: J. 2 Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel For Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. 01- t.,J.31 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE/CUSTODY COMPLAINT IN DIVORCE Count I - Divorce 1. Plaintiff is Mary Ann Shutty (SS# 176-52-6717) who currently resides at 59 Windsor Way, Camp Hill, Cumberland County, Pennsylvania since in or around 1990. 2. Defendant is Robert M. Shutty (SS# 189-42-0639) whose current residence is unknown, but whose mailing address is 59 Windsor Way, Camp Hill, Cumberland County, Pennsylvania. 3, The parties have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. The parties were married on July 23, 1977 in Glassport, Pennsylvania. 5. There have been no prior actions for divorce or annulment between the parties. 6. The grounds for divorce are: a. the marriage is irretrievably broken. b. Defendant has committed adultery. c. Defendant has offered such indignities to Plaintiff, the innocent and injured spouse, as to render her condition intolerable and life burdensome. 7. Neither party is a member of the armed forces of the United States or its allies. 8. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. Wherefore, Plaintiff requests the Court to enter a Decree in Divorce under sections 3301(c) and 3301 (a)(6) of the Divorce Code. Count II - Equitable Distribution 9. Plaintiff incorporates by reference paragraphs 1 through 8 above. 10. During the marriage, Plaintiff and Defendant acquired real and personal property. Wherefore, Plaintiff requests the Court to enter an Order equitably dividing all the marital property. Count III - Alimony 11. Paragraphs 1 through 8 are incorporated by reference. 12. Plaintiff lacks sufficient assets to provide for her reasonable needs and is unable to support herself fully through appropriate employment. 13. Defendant has sufficient assets to provide continuing support for Plaintiff. Wherefore, Plaintiff requests the Court to enter an order granting her alimony. 2 Count IV - Alimony Pendente Lite, Counsel Fees and Expenses 14. Paragraphs 1 through 8 are incorporated by reference. 15. Plaintiff lacks sufficient assets to provide for her reasonable needs and is unable to support herself fully through appropriate employment. 16. Defendant has sufficient assets to provide continuing support for Plaintiff, 17. Plaintiff enjoys medical benefits under Defendant's employment benefits. 18. Plaintiff does not have medical coverage independent of Defendant's coverage and cannot afford to purchase it privately, 19. Plaintiff has retained counsel to pursue this action and has agreed to pay her attorney a reasonable fee. 20. Plaintiff lacks sufficient funds to meet the costs and expenses of pursuing this action, including counsel fees and the costs to retain experts to value the marital assets. 21. Defendant has sufficient assets to provide alimony pendente lite, counsel fees, costs and expenses for Plaintiff, Wherefore, Plaintiff requests the Court to enter an order: a. directing Defendant to maintain Plaintiff's medical coverage during the pendency of the divorce; and b. awarding Plaintiff alimony pendente lite, interim counsel fees and expenses; and 3 c. thereafter awarding Plaintiff such additional counsel fees and expenses as the Court deems just and appropriate, Count V - Custody 22. The plaintiff is Mary Ann Shutty, residing at 59 Windsor Way, Camp Hill, Cumberland County, Pennsylvania, 23, The defendant is Robert M. Shutty, whose current residence is unknown. 24, Plaintiff seeks custody of the following child: Name Present Residence Date of Birth Kevin Shutty 59 Windsor Way Camp Hill, Pennsylvania 04/30/85 The parties adopted the child during their marriage. The child presently is in the custody of Plaintiff, who resides at 59 Windsor Way, Camp Hill, Pennsylvania, During the past five (5) years, the child has resided with the following persons at the following addresses: Name Address Dates Mary Ann Shutty 59 Windsor Way 10/03/01 to Camp Hill, PA present Mary Ann Shutty 59 Windsor Way 1990 to Robert M. Shutty Camp Hill, PA 10/03/01 The mother of the child is Mary Ann Shutty, currently residing at 59 Windsor Way, Camp Hill, Pennsylvania. 4 She is married. The father of the child is Robert M. Shutty, whose current residence is unknown. He is married. 25. The relationship of plaintiff to the child is that of mother. The plaintiff currently resides with the following persons: Name Kevin Shutty Relationship Son 26. The relationship of defendant to the child is that of father. Defendant currently resides with the following persons: Name Relationship Unknown Paramour Plaintiff has not participated as a party or witness, or in another capacity, in other 27. litigation concerning the custody of the child in this or in another court. Plaintiff has no information of a custody proceeding concerning the child pending in a court of this Commonwealth. Plaintiff does not know of a person not a party to the proceedings who has physical custody of the child or claims to have custody or visitation rights with respect to the child. 28. The best interest and permanent welfare of the child will be served by granting the relief requested because Plaintiff has been the child's primary caregiver and nurturer. 29. Each parent whose parental rights to the child have not been terminated and the person who has physical custody of the child have been named as parties to this action, 5 Wherefore, Plaintiff requests the court grant her custody of the child. L~I1r.L Theresa Barrett Male, Esquire Supreme Court # 46439 513 North Second Street Harrisburg, Pennsylvania 17101 (717) 233-3220 Counsel for Plaintiff Date: October 29, 2001 6 VERIFICATION I, Mary Ann Shutty, state upon personal knowledge or information and belief that the averments set forth in the foregoing document are true. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904, relating to unsworn falsification to authorities. M~hu~j~ Date: /tJ/30/~1 p p r;) f:. I( --- ~ ~ LV ~ f' --- fl- --- --- ~ ..l\ ()i ~ ''''IQ., --0 0'> ~ :D ~ P-'1-I(J~~ ~ob~C"1 DCCO:CO I I I I P!P~ ~ ~t?: "-.(~ ,... ~ (') a c:: ~ ::::> "'t:G::7 c') n'r:;, ---f 2.::';:' .2:'r- :.., en, ::""'("....",> !=:C.J :no ~'C) ""'0 S::"') :h'c:: 2 ,"-> ::< r", ~- ",,) "I -~.~' :p ~-.;I\:;:; :--~nl ~ ";~ :.::0 -< 1'= 2': ::::>< ~:?~ -.'."" r,1~ :}j{a (;JO_ ''''''::;' --) o t.il -' <: ~~ 8~ 0:: 0:: 0:: 0 <: .J CQ.~ <: ~ ~8 0:: t.il ~ o t:ir::: "'- i= :$ ~~ 8 ~ ~ ffi ~.~ 0", z ~ '" - "'~ '.''''.', ". ... .', )'''lfij~ . ~ ......J'm~,q.lil1lllqrlniJ . L, ,.n jll~'JlPll\\1':"~':' , , " -..--- __.1> MARY ANN SHUTTY PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA v. 01-6237 CIVIL ACTION LAW ROBERT M. sm DEFENDANT IN CUSTODY ORDER OF COURT AND NOW, Wednesday, November 07, 2001 , upon consideration of the attached Complaint, it is hereby directed that parties and their respective counsel appear before Melissa P. Greevy, Esq. at 214 Senate Avenue, Suite 105, Camp Hill, PA 17011 on Mouday, December 03, 2001 , the conciliator, at 1:00 PM for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older may also be present at the conference. Failure to appear at the conference may provide grounds for entry of a temporary or permanent order. The court hereby directs the parties to furnish any and all existing Protection from Abuse orders, Special Relief orders, and Custody orders to the conciliator 48 hours prior to scheduled bearing. FOR THE COURT, By: Isl Melissa P. Gree'QJI. Esq. OV'^ Custody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court, You must attend the scheduled conference or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 Telephone (717) 249-3166 .' ~!v?-~ ~ -h~ ~ ~JJ; ~ P$/~'~'f~/W /rJ.}.J/ I tJ } II IrJ)'/1 )JNr)VIN\I}~fSNN3d ,oJ 'J:',n"!~,('''''n .., ",::"i\]{'t 0 ~(' 0,,;7 !'id 9 , r; I' - lION 10 AI:i\I.LCJ;\jn; , ;' j~)~i:-:'t),:~'S+"i:.1 .' THEBESA BARBETI MAI..E COUNSELOR AT LAW 51 3 NORTH SECOND STREET HARRISBURC, PENNSYLVANIA 171 0 I (717) 233-3220 Theresa Barrett Male Suprelllc Court # 46439 513 ~'()rth Second Street Harrishurg, PA 17101 (717) 233-3220 Counsel for Plaintiff COURT OF COMMON PLEAS Of CUMBERLAND COUNTY. PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. 01- 6237 Civil Tcrm ROBERT M. SHlITTY Defendant CIVIL ACTION - DIVORCE/CUSTODY AFFIDA VIT OF SERVICE PURSUANT TO RULE 440 Document Complaint in Divorce and Custody Date of Service N ovembcr L 200 I Place of Service 4415 Lewis Road, Harrisburg, PA l711 I Manner of Service Personal service per the proof of service attached as Exhibit I If',' -1 . 'r- /:. .1/./ 1/ //) Ii. J.{(.-t.,/.<---,,/<I[Id_ttr/// "'. Theresa Barrett Male, Esquire Counsel for Plaintiff {L-- Dale: November 7. 2001 Exhibit 1 , PROOF OF SERVICE (Requesting Agent) THERESA BARRETT MALE COUNSELOR AT LAW 513 NORTH SECOND STREET HARRISBURG, PENNA 17101 (Type of Document) COMPLAINT IN DIVORCE; AND CUSTODY AND SERVICE LETTER. (Witness Fee) '~. (Case No. & Jurisdiction) CUMBERLAND COUNTY, PA NO. 01-6237 (Plaintiff) MARY ANN SHUTTY (Defendant) , ROBERT M. SHUTTY . ,'. .' (To Be Served On) ROBER! 'M. SHUTTY 441,5 LEWIS ROAD HARRISBURG, PA 17111 (Accepted By) t< c \a r--t M. S h.u.. tt.:J Lftf/5 LeW;5 f<d H (l rr-I'o hu"), ~ , , (Date Served) ffilHrn hey /. ".700 / (Process Server's Report) (Time) , I: 010 ;>;v, (Process Servers Name) LzrrJ J k/or:ru. Description: Wvtale []Female MY<hite Skin [ ]Black Hair []Black Skin [ ]Brown Hair [ ]Brown Skin [ ]Blonde Halr [ ]Yellow Skin [ ]Gray Hair [ JRed Skin ' ~ed Hair Ld/'I'v A1;;;/I~ being duly sworn according io law, deposes and says that helshe is process server herein named; and that the fact herein set forth above are true and correct to the best of their knowledge, information and belief. ~1,J.ss~k []WhiteHalr [ ]Balding [ ]Moustache [ ]Beard [ ]Glasses [ ]14-20yrs HZI-35yrs [ ]36-50yrs []51-65yrs [ lOver 65yrs [JUnder 5' [ ]5'0",5'3;' []5'4"-5'8" ~'9"-6'O" []Over6' . [ ]Under 100lbs [ ]IOO,BOIbs [ ]131-1601bs 'H:!.6t-2001bs [ lOver 200lbs Sworn to and subscribe before me this ---.&~day of 0 0<00-1-. ijAA.4~' n~A~ N ary Public Commission Exp. ?V T -r- 'J ~ c '" '" r- ~ 2 ,. ~ '0 ~ ""!"'E~ L !:{.!fr 7C (/)" -< ~r::. e" ~c: ~..;~-CI ..-.>c: 2:: ~ - ::!2 .... <=) ,"':::) ~. ;., j ~ (~ ..r._ I cD c- ';j :;:'1 -<. \ , STIPULATION FOR ENTRY OF CUSTODY ORDER This Agreement is entered into on December /0 t ,2001 by Mary Ann Shutty ("Mother") and Robert M. Shutty ("Father"). RECITALS Whereas, Mother is the plaintiff and Father is the defendant in a divorce and custody action filed in the Cumberland County Court of Common Pleas and docketed to # 01-6237; and Whereas, Mother and Father are the parents of Kevin Shutty (dob: 04/30/85); and Whereas, Kevin currently resides with Mother in the marital residence located at 59 Windsor Way, Camp Hill, Pennsylvania; and Whereas, by order dated November 7, 2001, the court, per Custody Conciliator Melissa P. Greevy, set the custody conference for December 3,2001; and Whereas, the parties desire to resolve the custody action by agreement in advance of the conciliation conference. Now Therefore, Mother and Father each intending to be legally bound, covenant and agree as follows: 1. Legal Custody, The parties will share legal custody. 2. Physical Custody. Mother will have primary physical custody, subject to Father's periods of partial custody, which shall occur at such times and under such circumstances as Father and Kevin arrange. Mother shall encourage and facilitate Kevin's relationship with Father. 3. Holidays. The parties will share custody on Thanksgiving, Christmas Day, and Easter Sunday, Details such as times and transportation shall be as agreed by the parties, with .. input from Kevin. Mother's Day weekend is reserved to Mother. Father's Day weekend is reserved to Father. 4. Summer Vacation. Each party shall be entitled to two (2) non-consecutive weeks, beginning and ending on a Friday, for summer vacation. 5. Entry of Order. The parties agree to submit this stipulation to the Conciliator for entry of a custody orders. In Witness Whereof, the parties have set their hands and seals the day and year first written above. Witness: idw.lt., (j~A~Q '-;I2~u;*71l, f#.~ Robert M. Shutty 2 ..~ 0 0 C) c: -q S.: 8 " 8-~ i"lj no C) -? ~ .". 2: 5 </; -< L r- " :<;:;; z C) ...., \) C) :> 0 N (j nO) c:: :':-tc-:! :z: .:,.;., =< :TI (Jl -< "-ARY ",j-1Y ii ~ r ,-~ '1 ~ '. l: \ (' ~; Do:\-~ (je.r~r\;u:A 01 DEL I AM I LAW OFFICES OF RAYMOND T. LE BON, BY: Raymond T. Le Bon, Esquire I.D. No.: 49384 1819 J.F.K. Boulevard Suite 300 Philadelphia, PA 19103 (215) 569 9860 P.C. ATTORNEY FOR DEFENDANT VOLKSWAGEN OF AMERICA, INC, KEVIN S, BAKER COURT OF COMMON PLEAS CUMBERLAND COUNTY v. CUMBERLAND VALLEY MOTORS AND VOLKSWAGEN OF AMERICA, INC. NO.: 01-6252 DEMAND FOR JURY TRIAL TO THE PROTHONOTARY: Volkswagen of America, Inc, hereby demands a trial by jury. LAW OFFICES OF RAYMOND T. LE BON, P.C. By: ~ -f-#ASc>- RAYM T. LE BON, ESQUIRE C"'''-' -.T' '--Uf'TY V,'.{;'~rk, ;,,''-''LJ I 'i)- " .>1..-'....,,'-,'. v.... " PENNSYLVAi~IA o OF DEe Ai > bEG 1 2 2001 Vj! < Theresa Barrett Male Supreme Coun # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel For Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. 01-6237 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE/CUSTODY ORDER OF COURT AND NOW, December / 1 ' 2001, it appearing to the court that Plaintiff, represented by Theresa Barrett Male, Esquire, and Defendant, represented by Gary L. Kelley, Esquire, have executed a Stipulation for Entry of Custody Order which resolves the Complaint for Custody filed by Plaintiff, the Court ORDERS and DECREES that: 1. The parties shall share legal custody of Kevin Shutty (dob: 04/30/85). 2. Plaintiff shall have primary physical custody subject to Defendant's periods of partial custody as more particularly set forth in the attached Stipulation, which is incorporated into and made a part of this Order of Court. jYopU:3 f0 alJ f.l3.. -13-0" ~.s ( J. > "?i; .<I' ?i .Cl. N y::, (!, ?d, ~~\\~:~" (J:=:- :':.:.. ()~ ,.', .':3 :3 " ,,'- ~. () \.-- /% I ('"'l SiJ}. t'-' ;.< \..<,( - CcZ et t-O I.J\..u It) -J)C'- 0 :;i. \,!-., - -) 0 Cl (.) JMi 1 7 22e2 ~ Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARYANN SHUTTY, vs. NO. 01-6237 Defendant CIVIL ACTION - LAW CUSTODY ROBERT M. SHUTTY, ORDER TO RELINQUISH JURISDICTION AND NOW, this 4th day of January, 2002, the Conciliator, having received a Request for Continuance on November 30, 2001, and having granted a thirty-day Continuance on that date, having received no additional requests for a Custody Conciliation Conference, hereby relinquishes jurisdiction of the above-captioned matter. FOR THE COURT, Melis eel Greevy, Esquire Custody Conciliator 'p\ ;D ~ ~. ""'< ~ ~ao ~r- o~ s:> ......;. Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel For Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. 01-6237 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE PLAINTIFF'S APPLICATION FOR SPECIAL RELIEF PURSUANT TO PA> R.C.P. 1920.43 AND 23 PA. C.S.A. ~3505 1. Plaintiff Mary Ann Shutty ("Wife") filed her complaint in divorce on October 31, 200 1, and raised economic claims for distribution of property, alimony, alimony pendente lite and counsel fees and expenses.l 2. Defendant Robert M. Shutty ("Husband") is represented in this proceeding by Attorney Gary L. Kelley. 3. The parties were married on July 23, 1977, and have one son, Kevin (dob: 04/30/85) who resides with Wife at the marital residence located at 59 Windsor Way, Camp Hill, Cumberland County, Pennsylvania, 4. Husband currently resides at 157 Rosedale, Hershey, Dauphin County, Pennsylvania with his "fiancee" and her child. 1 Wife also filed for custody, which the parties resolved by stipulation, 5. Wife is 44 years old, and works whenever she is called from a substitute teacher's list. 6. Husband is 49 years old and works as a pharmacist fof CFI. 7, On January 7,2002, this Court's Domestic Relations Section entered an order for child and spousal support, which Husband has appealed, 8. As of February 8, 2002, Wife has not received any support payments. 9. With the exception of personalty which is of nominal value, the only assets available for equitable distribution are the marital residence and Husband's 401 (k) plan which is administered through or by the National Prescription Administrators Union. 10. On or about January 24,2002, Husband disclosed that he borrowed $39,000 from his 401(k) plan in October 2001, which he claims to have used, in part, as follows: a, he purchased a 1975 Corvette for approximately $10,000. b. he paid about $7,300 to satisfy the loan on his fiancee's Dodge Intrepid. c. he purchased a new vehicle for himself, a portion of which he has financed through Chrysler Financial. 11. Net of the loan, the 401(k) balance is approximately $53,000, 12. Wife estimates the value of the marital residence, net of the first and second mortgages, at $45,000. 13, Through his counsel, Husband has advised Wife that he will not agree to freeze the remainder of the 401(k) account. 2 . . . . \ j 14. There are insufficient other assets to offset Husband's dissipation of his 401(k) plan, 15, The Court has authority to enter an order prohibiting Husband from further dissipating the 401(k) under Pennsylvania Rule of Civil Procedure 1920.43, which provides: At any time after the filing of the complaint, on petition setting forth facts entitling the party to relief, the court may, upon such terms and conditions as it deems just, including the filing of security, (1) issue preliminary or special injunction neces- sary to prevent the removal, disposition, alienation or encumbering of real or personal property in accordance with Rule 1531(a), (c), (d) and (e); or (2) order the seizure or attachment of real or personal property; or (3) grant other appropriate relief, 16. The Court also has authority to enter an order prohibiting Husband from further dissipating the 401(k) under 23 Pa. C.S.A, ~ 3505 which provides in relevant part: Where it appears to the court that a party '" is about to dispose of, alienate or encumber property in order to defeat equitable distribu- tion, alimony pendente lite, alimony, child and spousal support or a similar award, an injunction may issue to prevent the removal or disposition and the property may be attached as prescribed by general rules. 3 Wherefore, Plaintiff requests the Court to enjoin Husband from borrowing or otherwise removing any additional monies from his 401(k) account. /L~~ Theresa Barrett Male, Esquire Supreme Court # 46439 513 North Second Street Harrisburg, Pennsylvania 17101 (717) 233-3220 Counsel for Plaintiff Date: February 8, 2002 4 VERIFICA nON I, Mary Ann Shutty, state upon personal knowledge or information and belief that the averments set forth in the foregoing document are true. I understand that false statements herein are made subject to the penalties of 18 Pa. C,S. ~ 4904, relating to unsworn falsification to authorities. N~.s:::t4 Mary Shutty Date: 2..\<3\0'2.. PROOF OF SERVICE I hereby certify that I am this day serving the foregoing document upon the persons and in the manner indicated below which service satisfies the requirements of Pa. R.C.P. 440: Service by first-class mail addressed as follows: Gary L. Kelley, Esquire 132-34 Walnut Street Harrisburg, PA 17101 Attorney for Defendant /l",~~ Theresa Barrett Male, Esquire Supreme Court # 46439 513 North Second Street Harrisburg, Pennsylvania 17101 (717) 233-3220 Counsel for Plaintiff Date: February 8, 2002 (") r..;; "1J::>, rqrf Z:Tl' :;:; r- ~ .~~~~-: ~C ::e '-.. .c:::::.'-~ <--'CJ ..J>C: :2 ::3 " a r...) '""'1 ;-11 UJ "_i .l....-,,'"' - - ,,) (1'> MARY ANN SHUTTY, PLAINTIFF V. ROBERT M. SHUTTY, DEFENDANT AND NOW, this 1"1 day of February, 2002, upon consideration of IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : 01-6237 CIVIL TERM ORDER OF COURT plaintiff's application for special relief, and pursuant to 23 Pa.C.S. ~ 3503, defendant is prohibited from borrowing, withdrawing or otherwise removing any funds from his 401(k) plan pending a further order of this court which he may seek. ~resa Barrett Male, Esquire For Plaintiff ~ary L. Kelley, Esquire ") / F~r Defendant :saa . ~ ?;:;::t'>Y V/N\'/nASNN3d /JNnc),') C~!\1\r;I::;i]fivno g,) ://i{V I} / OJ.:} 20 LLl ..J ~ :E~ S ~ 0::: <c 0::: ex: ~ g cow ~~ ~ ::> 0::: 8 LLl ~ o ....- "'..... oJ- ~ ;!; Cl ~ ~ 50 u '" oJ z en i5 j::o.. '" . o a1 z ;0 '" :Jl - ii2 '" '" <: :I: fEB~002 .''t..\._~ Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01.6237 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE INCOME AND EXPENSE STATEMENT OF PLAINTIFF I verify that the statements made in this inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. !l 4904, relating to unsworn falsification to authorities. M~,~~~ Plaint" In the Court of Conunon Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 OCTOBER 20, 2003 Plaintiff Name: MARY A. SHUTTY Defendant Name: ROBERT M. SHU1'TY Docket Number: 00900 S 2001 PACSES Case Number: 430103963 Other State ID Number: Phone: (717) 240.6225 Fax: (717) 240-6248 Please note: All correspondence must include the PACSES Case Number. Income and EXDense 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 part, you must also fill out the Supplemental Income Statement which appears on page two of this income and expense statement. ) INCOMESTATEMENTOF .A1,,~y ANN SHUTI'!' Section I: Income and Insurance INCOME: Employer r.Aft-le 'De~K 'PAlfi S14 01=- ST. "PiQTRlLt< Address L 12. STI'l~ c;TUi.T Type of Work PA~\ SH MINI ""1~v AM ~ i?€Lll~:dD(AS' EuU'A t IDIU r4c.loS€ IV Payroll No. Gross Pay per Pay Period $ Pay Period (wkly., bi~wkly., etc.) tTTAq-t~D Itemized Payroll Deductions: Federal Withholdimz $ Social Security $ Local Walle Tax $ State Income Tax $ Retirement $ ,/ Savin2s Bonds $ ..-- Credit Union $ -- Life Insurance $/ Health Insurance $ Other Deductions (specify) $ $ $ $ Net Pay per Pay Period $ OTHER (Fill in Appropriate Column) INCOME WEEK MONTH YEAR Interest $ $ $ Dividends Pension Annuity Social Security Rents Rovalties Exnense Account Gifts Unemployment Workmen's Comnensation Other Other TOTAL 1$ $ .~ TOTAL INCOME $ Service Type M PROPERTY Ownership ... OWNED DESCRIPTION VALUE H W J Checking Accounts I?w;~\E~'1k,~ $ ./ Savings Accounts ~ I""I:<:<IS 31,-/,31<1 V 1l6lt.~ fNl\\J(,.S Credit Union --- Stocks/Bonds ..-- Real Estate \.\OLlSE I"q, 000 ../ Other TOTAL 1$ . H=Husband; W=Wife; J=Joint Form IN-OOS Worker ill 21200 Income and Expense Statement PACSES Case Number 430103963 Coverage ... INSURANCE H W C COMPANY POLICY # Hosoital ti\ol^~/,\{l(.e,\u S';r 1@,1",t. !)j()("r-"" r,F HA"",S&'IKOo AM 11 "'5'L& 1 n V V. ~ Blue Cross Other Medical 5\""Sl,..,<.\& f'ia",318 ,/ V Blue Shield Other Health! Accident Disability Income Dental 1A",\eJ (r "'-0 rd ,,,,- (,7/7 V t/ Other SE'I;: NCTt ,q.TTACt1E./). . H=Husband; W~Wife; C=Child Section IT: Supplemental Incom Si,,+ Covey~ I) ObS, 7S per 'l"a,,+c.- a, This fann is to be filled out by a person o (1) who operates a business or practices a profession, or o (2) who is a member of a partnership or joint venture, or o (3) who is a shareholder in and is salaried by a closed corporati( Attach to this statement a copy of the fOllowing documents relating to the corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement F"""\"\i~W~ d. I, q dfo ,J'i f"'W ? u.~ 8ECf<U5E. I<EV/f' WI'IS d~f'ped ~,." B06'5 h~il'-Tli INS., f1y Bt>S.5 P;<~Et:> Up 7HF- CO,! €/i''lGE, SO liE is 1'''''(11016 clt8S7. Wpe.e (;IUI'l"''7'E~ iD COve,! kEuiJI LlNTIL. ::I GfOr 'MY <lfE serrLe~. TH/5; 15 NOT Ii BENEFiT. /tlL t!7k& EMPloYef'S /I.i'<5T /"1'1'1 1iJt'. f':*I/lI( C.ovE-KA6E ;All-f>.. b. c. Name of business: Address and telephone number: Nature of business (check one) o (I) partnership o (2) joint venture o (3) profession o (4) closed corporation o (5) other Name of accountant, controller or other person in charge of financial records: e. 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: Service Type M Page 2 of3 Form IN -ODS Worker ill 21200 1-1 Ou SE Income and Expense Statement Section ill: Expenses PACSES Case Number 430103963 Instructions: Only show extraordinary expenses in this section unless you fIlled out Section II on page two. The categories in BOLD FONT are especially important for calculating child support. If you are requesting Spousal Support/APL or if you assert your case cannot be determined according. to the guideline grids or formula, this section must be fully completed. (FilI in Appropriate Column) EXPENSES EXPENSES (continued) WEEK MONTH YEAR Home Education MongagelRent $ $1,2. 95.co $ Private School Maintenance 'i 00 .00 Parochial School Utilities College Electric $ $J:~5 $ Religious Gas 150 Personal Oil ----- Clothing Telephone 7$ Food Water .30 BarberI Sewer :=1$1 Credit Paymenu: Emolovment Credit Card Public Transport. $ $ $ Charge Lunch ;;>'0.00 Memberships Taxes ITN MnerGA6"~ Loans Real estate $ $ $ Credit Union Personal Property Insurance Homeowner's $ $ $ Automobile gs-,OtJ Miscellaneous Life 2.5"'00 Household Help Accident Child care Health Paperslbooks Other Mai!azines Automobile Entertainment Payments $ $ a:51, '0 $ Pay TV Fuel I J,S, ov Vacation Repairs ? Gifts Medical Legal fees Doctor $ $ $5oo.q} Charitable Dentist Other Child Orthodontist _ ~ Om ,,., Aliniony Hospital Pavments Medicine 1$, 00 Other I Specl81 nee"" X€oJoJ-8I:?f(.2; G<M~/;5 (glasses, braces, /Et-TH ~7'50, uq orthonedic devices 7i;)Jt'\6"'O /lv6. 1'\\16. S1\~ $ $/'0,"" $ G(~ "to,te FoR WO~ 3q. ,) 000.'0 1,()()o,PJ 3 OOO{);'; SO,Q."" $ $ $ I Total I WEEK MONTH YEAR! . Expenses: .. $ $ $ =.J I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are subject to the criminal penalties of 18 Pa. C.S. ~ 4904, relating 1:0 unsworn falsification to authorities. /I, n. 03 Date ~l:l~,,^^-5?dJt;- Plainti or Defendant 3 Service Type M Page 3 00 Form 1N-008 Worker ID 21200 ""'( SON IS IN SEf.-lINl'liC'l'. T Hfi.DTb 'PAY Fore 2 $u', T5, I eA-SSoc.K, 1~ o ,.. I1D""t~tO \00' G 'I c.l~V"ic.. Ski vis) s....v..plus ?J(),OO 3 po:ic b\a.c.\L p",,,,,;tS(%i\)'To.II) (losT: &~so{.. k: 3 7S. ,"0 Il.....~...& ~D "",~~l.V~' $..d-s to 0 c. SI,,\..1s I Is, o. (10 113'::',"" ) \? 0.00 _ Sc<rpl.s ~ , '2 I ..,.,. tJO I, ,~() ~qC7 I, R [; 1\1'1 - Income and Expense Statement Section III: Expenses PACSES Case Number 430103963 Instructions: Only show extraordinary expenses in this section unless you filled oU[ Section II on page two. The categories in BOLD FONT are especially important for calculating child support. If you are requesting Spousal Support/APL or if you assert your case cannot be determined according to the guideline grids or formula, this section must be fully completed. 'i~~nses: I $ WEEK $ MONTH $ YEAR I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are subject to the criminal penalties of 18 Pa. C.S. ~ 4904, relating to unsworn falsification to authorities. .':d~ r Defendant .......---(j (Fill in Appropriate Column) EXPENSES WEEK MONTH YEAR Home Mortgage/Rent $ sB/o.oo $ Maintenance Utilities Electric $ $ I..; 0.00 $ Gas Oil Telephone J50,og Water Sewer Emolovment Public Transport. $ $ $ Lunch :;t;.oo Taxes Real estate $ $ $ Personal Property Insurance Homeowner's $ $ $/65,@ Automobile 3q4'~ Life .25', 00 Accident Health Other Automobile Payments $ $.J37,O!J $ Fuel IdS."" Repairs ? Medical Doctor $ $ $ 1VD,og Dentist Orthodontist - ? Hospital Medicine ~ped", ne.... ScN - BIf'I'k'-5 GI."!66 (glasses, braces, f'flfTI< ",~n '{51;. '" orthnlU dic devices I2f1'~e.O Rbl~ EXPENSES (Fill in Appropriate Column) (continued) WEEK MONTH YEAR Education Private School $ $ $ Parochial School College n,"1)O't!J. Religious sm.'" Personal Clothing $ $ $i, ~lI?O!J Food 81).(!!2 BarberI 7S-,~E H,;,ri,.<<" Credit Payments Credit Card /50 ,os. Charge Memberships Loans Credit Union $ $ $ Miscellaneous Household Help $ .30,1)9 $ $ <'J. Child care Papers/books '"IO.'~ MaO~7ines Entertainment Pay TV 2..5.00 Vacation 2, QOO.i'g Gifts II ooo.~ Legal fees 13 000, 't + Charitable t Other Child Alimony Pavments Other $ $ $ see /JoTE ON nf- ?""'IOu' " RJ:;:....,.,."J e.....- t/lN/Nt. 11,/7'a3 Date Service Type M Page 3 00 Form IN -008 Worker ill 21200 <' (.~ r=(.{' -;7 iC._ ".' 7" ~~:': :;~~. ,-" j;~.. "'<~ ..1 -< .:~ <',) .\ () ',j "--;) .~-... :i~ 01 .:fI I" c") .;-n --j: ~)J r<. Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel for Piaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Pia i ntiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY Defenda nt CIVIL ACTION - DIVORCE PLAINTIFF'S MOST RECENT TAX RETURN AND PAYSTUB PURSUANT TO Pa.R.C.P. 1920.31(a)(1) dTo1lllllUlllberol _............... _ _... _........... _........ 7 W8Q88,-,lIps.elc.-'-Fonn(sIW-2.................. _............ 'aTllullle~~Sc:heduIeBftrequlrsd_........................ _ _... b Tax-exempt IntIlresL Do _Include on line Sa. - . . - . . . _ . . l.!!o II ORIJnarydlvldends. _~BIf__... _.... . _... . .... .. . _...... . 10 Tmbferelu1ds,CIIdils,...ofIseIsolstale8llllIocali......_(...inslruc:Iloos}............... 10 11 AI/mony-............ _.......,..... _........... _.......... 11 12 ~Incomeor(loss).-'- Schedule C orc-EZ ..... . ... _ .... ._. _...:... . 12 13 CapIlIgain...(Ioss}AIISd10ftreqd.ftnotreqd.dchere.... _.............. ~D 13 14 ~galnsor(lossesI_-'-Fonn4797................................. 14 1SalRA dIslrIbu1Ions. . . . . . . . . W I Ii T_ amounICseelnmr).. 15 1l1<1.PeI_. and amu_. . . .lJ!!I .b T_ amount C--I.. 18b 17 RenlaII88IIllIlaIe. roxaJIIes.l!8/lI1llItIhIRS. S oo.po........, 1JusI8, ate. -'- SchecNIe E. . .. 17 1. FannInClllll8or(loss}-'-ScheduIeF....... _.......................... 18 1. UnempIoymenlCOlllp8l_......... _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. lIlIa'Soda!18I:IIiIrbnllls'.. -. ~ I b T_lUIlOUIItCsee_I.. lIlIb 2:1. 0dla--21 22 Add 1he emiiiiiiis -111...... - iii COiiiiiin -fIi iinii8"7 - - - - 21.-""*, IS - - _ 'ii.Cciine.-: -:- ~ 22 ZI Educ:ekrr_Csee~I......_...._..... 23 24 IRA deduction (..... 1i18IrucIIOns) .. . . . . . . . . .. . . . . . _ .. 24 215. SludentIoenInlere9l__Csee~l. _.. _..... 215 215 TuIIIon and Ieee dadllctlon (seeln8lrucllonsl. . _ . . . . . _ . . .. ,215 %7 ArIlher MSA deduction. -'- Fonn 8853 . . . . . . . . . . . . .. %7 28 MoIllng_AlIachFonn3903......... _........ 28 28 0n&-heII 01 eelf-employment tax. -'- Schedule SE. . . . . . _ 28 ao SeII-empIo\'lld heaIlh insurance deductlon Cseelnslructlonsl. .. ao 31 SelHmplo\'lld SEP, SIMPlE, and quellled plens. . . . . . . . _. 31 32 Pena!tyona8r1y__Ofsavlngs................. 32 aaa A1~ pailt' b Recipienl'a SSH. . . ~. 3ail 34 Add lines23~33a. . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . line Is ........ ~ BAA For DI_ure, Prlveey Act, and P&p8IWOrk ReclucUan Act Nollce, _ In81ructlan.. 1'01A0112 ,_ Fonn1040 Label (See-I Uea the IRS labeL 01herwI8e, p1eaae prfnt or type. r-... Electlan Campaign (Seo---'l Filing Statue Check only one box. ExempUona ft more then lIII8 depandenls, see_ Income ~FOl'III. W-2 _ W-2G '*'" AIeC>_ Fonn(a) 1-.R I\' tax _ wllhbeld. ft you did not get.a.W-2,._ r_. Enclose, but do not_. ony patmenl. Also, ~=.1:'V. Adjusted. Or088 Income _oIIIloT_-___ U.S. Individual Income Tax Return F...tI1e .lln1.Pee31 ...otI1ertll YoII'flllllIIRle MI lAlII... MARY AID' .a""__ItaI..... SIIUT'l'Y III ..... ..... 118_ -Doncc....or InIl1la 20 OWl No. 154500074 YOIA'eoaIII......, __ 176-52-6717 ---- _no. A ~ntl A Yw mll8l_yoursoclal .... ZIP..... ll8CUI\\y number(sl above. PA 17011 tIoma .....(IUIber...theI).. PhBw. P.o.bo:lr._1In8InI::Iar& 59 WIIIDSOR WAY CIy,_."'pooI_.W,.._a____ CAMP BILL ~ Nal8:ChecIdng'Y....wlllnot )'llIlI'laxor 1lIduce)lllW_. You Spouee Do ,or ft /8Il.In _$310 tolhlsfund?......... ~ x Yea No Yea 1 SIngle Headolhoo~~penonl.CSee 2 MlI1ied filing Wiliiy C- W ooly 000 had income) InstrucIIons.) ft!he g penon.. a c:hIIiI ,.. but not)lllW _1hIs chid.. 3 IIlIried filing sepa_. EoIw spouse'. SSH ...... & fufl nama _. ., DVIII\" S SBtITTY - 1m. . ~ II 0 CluaIIylng ~81) wIIh dependentc:hlld C_ &PO_ died .. ~ } cSee 1n8tructIons.) 8a @YCIlIIlI8If.I)'llIlI'P88dCor__IC8nclalm\lOllasadependentonhleor }:t:..,- hertaxreluriJ,dO__boxSa................... ... _.......... _. .....,........ b .. .. . . . .. . . .. . . . . - . . .. . . . .. . . .. . - . . . .. . . . . . . . . . . . . . . . :t:.. (2)2)"-'denl's ~~ (4). ....._, CU.plnclent6: eOciaf~ ,.~ ~...... IIUIIIber III you ...':a.. __... 1 Ant name Laol name _ _ . lid not ...-- .....- :..~. ND 1 0..11...... ... It ... -- -- :::-...... 13 324. 100. 14 247. 27 671. 270. 210. 7 1. Fonn 1040 (2002) ----- --- ------ . -.... ._.- .----, 38 -Iromlne35(....-groes_I.............."................ IIT.CII.cU OVOlI_65IoIder, 0-; O~was65lolder, OBll1d. Add lhe IlUIIIber 01 00_ checloId lIIloVe end _1118 _ her. . " . . . . . . .. ... lIT_ b. you.. mented lIIna eependIlIy~"lIemIz8edeductlone, 0 or you_ _ duakI8lue eIIen, _ lDI check here . . . . . . . . . .. ... IITb 38 1lolnIaoI..B:U....(framScheduleA).JIIIlI"slamIanI......(...leIImQR).............. 38 SublrectIne38from Ine 36. ............................ ............. 40 . line 311 Is $103,000or.....muIlIpIy $3,000 by 1118 _ nLUllber0l8JOl!ll1lpGonsdelmed on 1ne6d..Ine3618CMl1'$103,OOO.see1h8lMll'1<11he81lnlhelnslructlOrie ............ 40 41 TIIlIIIIe.... SWIlrlIlIIino <<l fram line 39- n..40Is........Iino39,__'O'....................................... 41 42 TIl (... I"""). a.ex.",,1iIl isfram. o Fua(.j'8814 b o fOllll 4972. . ... ............ 42 oW _.lIvudnlmum tIIIl (see fn8InIcIIonsl. AIIIII:h Form 6251. . . . . . . . . . . . . . . . . . .. 43 .... AddIlnes42I11d43.............. ....................................... 45 Fonllgn tax credIl AlIac:h Form 11161 requfred. . . . . . . . . .. 45 48 Credit for cliid ... dependent care __ AttJcb Fu1Il244l . . . . . .. 48 47 Credllfor1heelderlyor1hedlsabled._ScheduIeR..... G' 48 "'.'''cellon........ AlIac:h Form 8863. . . . . . . . . . . . . . . . .. 48 48 ReIIr8ment oavIngs conIrIbuIfons credit. _ Fonn 8880. . .. 48 110, ChIcltaxCl8dl(_~I.................... 110 11 AdopOoncredlt.Alllll:hForm8839................... 11 52 CnldlIsfmm:. Oftrm8396 b 0 form8859......... ... 52 13 0Iher -. Check IppIIcabIe boll(-l: . 0 fmn 3IDl bOIl' c OSpodfJ , 1I3 &4 Add 1iIIOs45111roui1153.lbilseantJlllll"lIIIIcndIlI. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. &4 15 SublreclIIne 54 from line..... H.... 5418 IIIOI8Ihan .... ....,_ -0-. . . . . . . . . . . . . . . . 15 5lI SoIf~,""""I"","" AttJcb SdIeduIe Sf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5lI lS1 Social S8CIIriIJ ... ........1iIl ... tip _ not IIIpllI1lld to 1IqlIojor. AIIadI flll1l1 4131 . . . . . . . . . . .. lS1 15 T....qu.llfiedplans,lnduIInglRAs,...dhorla.IlIuIlnJcI_AlladlFu1Il5329ilroqufnld....... 1I8 110 Adu8noe__CI8dI~fromForm(s)W-2...................... 110 110 HouIehoId~__SdIeduIeH............................ eo 81 Add _55-GI. nais lIIlIIlIl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . 81 82 FederIIhxlmetaxwlthh8ldfromFormeW-2and1099......82 757. . 2IIl2e11lniillldlalll!lllllllllS...lIIlIIUIIIlIPIIIiedframllDl_...... 13 84 EaMdIncameCllldl(EIC)....................... 84 r..811 Exl:oss soclaI S8CIIriIJ IIId tior I RRTA laX lIiINIeId (... instrdms~ . . .. 811 AddIIIon8l_ tax credII. AlIac:h Form 8812. . . . . . . . . . . .. 1I8 lS1 - paldwllh raqueollilredll1Sillltu file (see"'*-) . . . . . .. lS1 15 0Uler pots fmm: . 0 form 2439 . 0 Fu1Il4136 c 0 fOllll888S 88 III 1dI11nos62 68. lbilseant..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 1I8 711 ilU..&9is........Iino61,.'lblrll:ttine61frumline69. naisthaIlllllUlllJllU--"'........... 711 71.AmountolIne70youwantreluncledtoJllll...............,.............. ... 71_ . b RauIIng number. . . . . . . c Type: 0 Cl1ecIdng 0 SavIl9I . d AccaunIIIUIIIbet . . . . . 72 _otline1DJllU_wHitrlD_ZlU........lIl..... o..G!. 73 Amo1IIt""'-.SWIlrlIlIliI.&9fromline61.f...delaiisoo"""topay....,nstruclions........... 74 EsIIm*dtaxP8l1llllvI_1n8lrucllons)............... . I...!!. Do you want,to 8Iiow another person to discuss 1hIs re\um wIlh lhe IRS (see insllucllOns)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Vlia. Campi.... the following. DeIlonoe'a ....... ""_.._ name .. no. .. mIIlbIr(pIN)'" l.bterP8hdlnot PIIPY.ldeclarelhltl haw~thIltntUnendacoo.\==lllhocldelIcnlsbdlImentIJ, olol.....of my~WId -..hoV......._...-..-.d__.... .-...._d__...onv_ -- 0aIe __ ___ ~ ,/ M. "i . a . 63 CHURCH WORK - ..,. 0aIe__ ~ .' Tex and Credits SleI*"' Deduction tor- . Peopl8 who cheoIl8d any box on Ine 37a or 37b or who C8II be ciIImed IS a depeI1d8nI, - Inslrucllone. . All others: ~~ Head of houllllhold, $6,900 Mrinied 1iUng $, $7,850 ManIed ftIIng --Iy, Other Tex.. Payments ilyou_a '~ Schedule EIC. Refund :"~ Ind II In 71b, 710, IIId 71d. Amount You Owe Third Party D88Ignee Sign Here JoInt I81um? see ln8lruc:IIons. Keap a copy for your 18CllIda. Paid Preparer'8 Use Only 27 401. 14 594. 12 807. 3 000. 9 807. 983. 983. 983. 983. 284. 1~41. 58. 58. ~No ........... ~ .......... Self-Prepared ~. ~ _'*:f:!'- liP.... 0aIe ..-. EIN ......In Form 1040 (2002) FDlA01t2 12f.!6J02 ~...~:':J::"Y (99) Name(s) shDWnon Form 1040 MARY ANlf SBll'l'TY IIecIIaII c...aan. Do not 1ncIudll....... reIInbw8ed or paid by olhenI. - 1 MedIcolanddlo1l!lOlpOOSOS(...instnl:tioas)................... DeIaJ 2 Enter lIIlOIIII from Form lIMO, line 36. . . . 2 ex.....- 3 t.YIpIylne2 by 7.5% (.075). .... .......... ..... .. . .. 3 4 SdlIraclIile3InlmHnel.1f1ne3IBmore1han1lne1 _-0,...................... 5 Slallllnd IocaJ Income 1alf88.. . .. .. . .. . .. . .. .. . .. .. .. Ii 548 . 8 __,__C-tnotructlon8)..................... 8 3 047. 7 _81pmperty1alf88............................ 7 8 OIIIer_U81lype..d_~ ____________ other taxes 10. 8 10. ----------------------------- 9 AddIlne85t11n:l1.918................................................. 10 HomemIQinl8rIstandpalnlsf8lllllodfDJIlUOO Form 11BI. ........... 10 9 526. 11 Home ~ ~noll8pOlllldto you 01\ Form 101l8. If paid III 1he person Inlm whom you boughI1he home, _ -- and lIhowthal penoon'8 name.IdeIlIllylng_, and addl1l8B ~ SCHEDULE A (Form 1040) T""""Vou PoId ~) ,- You PIlId SEE S'l'!IT I~) Note. PllIlIOII8I 12 ~IB 13 not ded_ 14 GtIIa to 111 CINlrtly Ifyoum_ 18 a gll and Jl: a benellt n._ InslruclIono. 17 18 Cau'!llY_ TheIl~ 19 Job~ 211 _M_ 0Iher II. r r ....... DlIcI.-a ~ :::- here.) OIlIer ..16 .._ DecI_ T_ IIiomIad DecI_ itemized Deductions CUB No. 1546-0074 .. _toForm lIMO. .. See 1n1lnRltl_ far..-. A (Form 1040). 2002 07 3,605. ------------------------------ ------------------------------ ------------------------------ 11 p*s ni n.;.iicitiJoij 00 r..m lB S; iiish "fur-sPd n.;;. ~:-. -: :-.~ .. 12 --~ - Form485:!1f required. (Seelosb3.)......... .... . ..... ......... ......... 13 Add 1lne81011l11Ugh 13. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GlIIII by CIl8b or cI8K If you _ MY gill 01 $250 or 1IlOI8, _1n8lruc:lIons................................ . OIlIer"" by CIl8b or ct-. If any gill 01 $250 or mol8, _ --.... You __ Form 8283 If .--$500.................................... . CarryIMlrInlm prior year . . . . . . . . . . . . . . . . . . . . . . . . . .. 17 Add_,5throuahl1.............................................. . 10,225. 442. C es._ Fonn4684. Seelnslruc:llons. . . . . . . .. . . . . . . . . . . . . . . UnreIrnIIcnBle""*"""_...... -Iob-' unIon-, lob 8ducoIIOn, lIlc. You mllll_ Filnn 2106 or 21O&-EZ If 18qU1r8d. (See 1n8InicIone.) .. ------------------------------ JI!E!.l'~J;!Il_~lJlH~~~-llL_ _ _ _ _ _ _ _ _ _ _l!.70. 21 Taxpnlp8I'alklhfees.............................. 22 0Iher~ - -...nt, _ depoeIl box, lIlc. U8l lypeand8mOunt.. ____________________ ----------------------------- 23 Add_2IIlhrough22............................ 1I4 Enter lIIlOIIII from Form 10l0, II.. 36. . . . 1I4 27 4 0 1 . 2S MlIllplyImo24 by 2% (.02) .. .... .. ............... ... 25 548. 28 SublraclIne25l1111nllne23.IfIne25IaIllOl81hanIne23 anler-O".. ...... .......... . %1 0Iher Inlm list In \he /n8IructIona. Uallype and amount .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 322. -------~------------------------------------ 28 Ia FOlIlll040, Ine 36, .-- $137.300 (OWl' $88,650 If MFS)? I!J No. Vcu -.caon Ia not 1ImIIad. Add 1he 8IIICUIIa In 1he f. rlahl column lor IInaa 41hrllugh %1. AIao, _Ida IlIllOl8II on Form 1040. line 38. o VA Your deducIIon may be 1mIIed. See InsInDbnslor 1he _Ill enter. BAA FOI'P~ Reduction Act Nll1Ice, _ Form 1040 ~Ion.. FOt\0301 101lMt2 Schedule A (FOlIlll040) 2002 SCHEDULE EIC (Farm 1Q4OA or 1040) =-....:.'::=' (99) Namlt(s) stIDWh on ftltum MARY ANN SBU'l'TY Before you begin: Earl'led Income Credit Qualifying Child Information c~ and _ fo Fotm 1040A or 1040 only If yoo Ira... a qualifying child. 0M8 No. 154&0074 2002 43 low ~.-:urtty number 176-52-6717 Seethe I_lor FOnD 1040A, Hne41,or Form 1040, line 64, fo make 81/re th81 (a) you can take the EIC and (b) you have a qualllyfng child. . K you take the Etc even though you are not eligible, you may not be aHowed to take the credlllor up to 10 )l98/'ll. See the lnatrucltona lor detail.. CAU1IOH: . n will take ualonger to process your return and Issue your refund K you do not !HI In all lines that apply for each qualllylng child. . Be aure the chIId's name on line 1 and aocIaI aecutIIy number (SSN) on line 2 _ with the c:hIld'a aocIaI security carel. O1herwl8e, at the tme we plOCll88 your re1urn, we may IIlduce or d18a1low your Etc. K the name or SSN on the cliIId'8 aocIaI eecurIIy card Is not correct, call the SocIal Secwtty Admlnlalratlon 811.800'772.1213. Qualifying Child Information Child 1 Child 2 1 ChIId'e _ .... ..... LooI_ ....- LooI_ K you have more than two quaIII)Vlg cllIdren, you only ha1I8lollattwolOlNii.the..-numcredt......... .. KEVJ:1II S SBU'l'TY 2 Cllllcl'eSSN The c:hIId must hlMl an SSN .. delIn8d In the Form lQ4OA... Form 1040 -..cuons.- lie child was born 1nI_ In 21102. n your clIIId was born 1nI_1n 2002 and did notha1l8 en SSN, enter 'DIed' on lhI8l1ne and _ e copy 01 the 159-72-3048 chIId'8 birth c.. a_ .. .. .. .. . .. . . . . .. . . .. . .. 3 ChI1d'eyarofbllttt . . . . . . . . . .. . . . . . . . . . . . . . - 1985 - - Itbom_~', tlllU. Itbomallor=',I111U. _ _ 41 and ; lID 10 me 5. __41_ ; lID 10 I/ne 5. 4 Iflhe __ bont beIonIJ....., 2, 1_- . was the chid unde< age 24 aI the 8IId 012002 and Dv- DNa. Dv- DNa. a student? ....................... ..... ... . Gorol'nelli. CGmIn.. Go rol'ne & CGmIn.. b~~th8any~~~~....... . Dv- DNa. Dv- DNa. CGmInue Thechllclle not a -- The child Ie nota queIIyIng cIlIId. cIlIId. 6 ChIld'e~ro,.,.. l:.r"'="8to"r':~~'.~'.~:~: . . Son 6 NIUD_ of IIICIlIlII8 c:ldkl1IWd wIlh you In the IlllIIed Staleadurlng _ . n the chIIcIUwd with you lor more than hIiI 012002 but Ieea than 7 months, enter '7'. . K the chIIcI was born ... _In 2002 and your home was lie chIId'8 home lor the __ h8 or she was aDvemmg2OO2, enter '12'. .............. ~ months months 00110I___'2_ 00 110I_ /IIOI'8111an 12 months. You may also be able \0 take the addIlIonal chIIcI tax credn n your child (a) wee Under age 17 aI the and 012002, Ib) Ie claimed .. TIP your dependent on line flc 01 Form 1040A or Form 1040, and (0) Is a U.S. clIIzen or reeldent alien. For more detallti _ the fnatrucllona lor line 42 01 Form 1040A or Ine Il6 01 FonD 1040. BAA For p..._ Reduction Act N-. _ Form 1040A or 1040 In-.. ScIIeduIe EIC (Fonn 1040A or1D4O} 2002 FD1A7401 10120m2 " Form 21 06-EZ Unrelmbursed Employee Business Expenses OMS No, 1645-1441 MARY ABN 8BUT'l'Y You May IJ8e TIll. Form Only It All ollila F""-Ing Apply. · You are an employee deducllng ordinary and necesaary 8lCJl81Ul8S attrlbutab/e to your job, An ordlnory 8lCJl8nse Is one that II oommon and IIOC8jlted In your fteld of trade, bueln_, or pro'-lon. A necessary expense Is one that Is helpful and appropriate for your business, An expenll8 _ not h8\lll to be required to be c:onsldered necessary, . You do not get relmbur88d by your employer lor any elCp8l\888 (amounts your emplo)<er Included In box 1 of your Form W-2 are not oonskIered reimbursements). · If you are c1a1mlng vehicle expense, you are uslng the at.ndard mDeage rate lor 2002. .. -'-to Form 1_. """-,ll_",,,__ CHURCH WORKER 2002 54A =,"",~l.:"" (99) _nome --- 176-52-6717 Caution: You can use the standarl1 mr.age raJs for 2002 0II1!r /I: (81 ]IOU owned the whIcIe _ used the standBIl1m/l88//fJ raJs tor the - yesr you placed the 'I'BhIcIe In _ or(b) you __Ifls Wlh1c1e and used the standard mHef/(/O ra'" tor the porf/oIj of the 16_ par/od .fI8r 1997. _ Figure Your Expen_ 1 v_ expenll8 using IIle 8Iandard mileage rate. COmplels Pari II and mulllply Roe Sa by 36-112' (.365). . . . . . 1 365. 2 Parldng -. lDIIs, and ~ including -. bus, eIc, 1bal cUd _ _ 0\Wl'IlghI_ or oommUllngtoandlrom-. . . . . . . . . . . . . . . . . . . " . . . . . . . . . . . . . " . . . , . . . . . . . . . . . . . . . . , 2 3 =:==:1'::::"'~~'~~~.~.~:~":~.~:~...."........ , 3 4 __ e~ not incIudad on _, through 3. Do_lncIudemealaand_.....RlIII........ ....... .... .......... ..,..........,..... 4 467. 6 _and_ont......_. $ 75.:x 50" ( .50> (Emp/o)<lIes oubjectlo DepeItment 01 Trail.,,,,,,,,,,,, (DOl) hoursol...-lImIIa: MJIIIpIy_.............. by 85'lfo(.65>_ of SO%. For-..., -"-'cUons.)........ ............ '....... . .. ..... .. '......." . 6 38. G ~Add_' through 5. Enlar_and...._2II"'....-'lI1~1~ 1f.: illite or IocaIlIO\'BIm18III olIIclaIlt = == artIot8,and with : lhe_lotsii8Ci8i_on_ anter amount1",............. .... ..... ...... 8 870. _ Information on Your Vehicle. Complete this part ....Iy II you .... c1sln*1g ""_ expense on line ,. 7 When did you place your vehicle In _lor buaIn8ss U88? (month, day, year). . . . . .. . . , . . . . . . . . . . , . , , . . , . .' ~ 1-~/1-~a!~. 8 Ollhl1olal number of mllas you droII8 your vehicle during 2002, enter IIle number of miles you used your vehicle lor: a__ __________~~~Q b~ ___________~~q cOlhM _j____ _~,~~q · Do you (oryourllJlOlS8lhawonolher__lor--'use? .".......,..........."..., V_ ~ No 10 Wasyour_avallableforptll8Oll8luse-..golJ.du\yhOl88?.......................,........ V.. No 11aDoyou.......e__looupportyourdeducUon?................,......................... V.. No bll'Y....lelhe-.cewrllllln?................................................. ..... V.. No BAA For PIlIII.-lIedUCUon Act NoUc., _.....1lIle In__ Form 2108-EZ (2002) fDJA7601 1111X1i02 .' fOO1I4562 Depreciation and Amortization (Including Informstlon on LI8Ied Property) .. _ Iep ILfIleIMlrUclloRa. .. "*"" to ;;;;';;:ia MUm. OMB No. 1546-0172 ~""'T_ --- NlI1IB(s} shlJm II'IIl!durn MARY ANIIl SBUTTY BltIIr1eea or actMY to whk:h thill loon relates Form 2106 CHURCH WORKER _ Election To ExJ)e!I8e Certain Tangible Property Under Section 179 N....: "you have MY _ proparty, c:ompf6te PSlt V bilfore you c:omp/ate PIUt I. . 1 Maxlmum8lllOllnl See_slorahlgherllmRforcerl8ln_. ... . .... .... . . .. . .... ... 2 TotalC08toleecGon 179 property placed In service 1--1 ............................. 3 ~coeIoI_179~-'reducIIonlnlm_...... ................... ..... 4 Reductlonln Imllallon. &lblrad1lne31rom line 2. I zero or_, _-0-. . . . . . . . . . . . . . . . . . . . . . . . . . 5 =-:'::=i:.~~.~~~.1:.1.~0.~.~.~~.~: ~~~~.~............ 8 (a)"""""*,,,"_. I (b)Colll_- -- 7 ~property. Enter1he lIIflountlnlm line 29. ........ .... ....... .... ..... 7 8 TotaI_costof_l79property.I\4\IMlom\1llnc:olUmnlc).lIne8l1l!1Jlll",...,..."........ II Ten1aIMl dedI_. Enler1he 8III....oUne 5 or line 8 . .. . . . . . .. .. . .. .. . . .. . .. .. .. . . .. . .. .. 10 CllfJ)'lMlI"oId1todoWeddedl_1nIm line 13 01)101II"2001 Fonn4562............................ 11 Busine8SincameRm-.Enter1hesmalerolbusll1llll8lncom8(not_lhanZ8lO)or_S(__I...... 12 SecIIon 179......... _'di<ln. Add IIne8 9 and 10, but do not_1lIOI8 than line 11. . . . . . . . . . . . . . . . . . 13 Cllrryow'oId1sa1oW8ddeduc:llon1D2lI03.Add_Sand10,_....12........ .. 13 _: Do not use PIUt II or PII1l1l1 _wfor~ . Instead, use PII1l II. AllowlInce and Other IIIIlIncIude IIsIed 14 SpecIaI"""-"" _""'lorquslllted property(olherlhan -flIIIlIlIIlYl.,-1n service during 1he laxyearl__S)........................................................ 14 proporty8Ubjec:t1DaectIon 168(t)(1)~(see~""'-..")"""""" .. .... ............... 15 Other ...................................... 11 2002 67 IdInIIyIng nulIIIJIr 176-52-6717 1 2 3 4 24 000. $200 000. InsIrucftons _A 17 MACRSdeducllons lor _ pIaoed In _In laxye818 beginning beIor82002. . . . . . . . . . . . . . . . . ~ 18 ~~ra~~~":et-=ulus~~~~~~.~~~.~.~~.~~~... .. ~ _S-_Placedln....... _TIDe V_ 1he_ CIO ..1".>,,_ ~"::' ~-:,...,.. .:;,.' ~_ ~ ..- - MACRS IatIon IIIIl incIud._ (I) -... (g) D~ rtrl. - 25 27.5 27.5 39 S/L MIl S/L MIl S/L MIl S/L MIl S/L r: i~~~rnc~rT s rs s s 58. 6 000. 2002TlIltY_ 12 40 Su InsIr-.. 2t ~property.Enterarnountlromilne28............................................. 2t 22 ~":r~~....n:tt~~~ ~'::=.~i.n.~.(~~~~.~..~.~~.~~~.~ 22 23 ::--==.==:'toln.=e~.~.~:~...... 23 BAA For P8p....0I1< Raductlon Act NoIIc:e, _1....,._. Fe1ZOB1< .'2112102 Fonn 4882 (2002) .' ~002) MARY ANN SROTTY 176-52-6717 - Listed Property (Include aulomobltes, certain other vehicles, cellular telephones, certain oomputefll, and property used lor entertainment, recreation, or amusement) Note: For any vehicle for which you are using the slandard mileage rate or deducting /esse expense, complete 0II1y 248, 24b, columns (a) through (e) of S8oIIon A, BIt of Si3cI1on B. and SeotJon C "sppl/csbl8. SectlOII A D _lotion and Othar Intonnallon Caldlon: See tnslruotJona for limns for IIS88II or aulomobHes. 24a 00 u have evidence to su rt the business/investment us. claimed? . . . . . .. X Yea No 24b If 'Yes' is the evidence written? . .. X (a) (b).J:;) (d) (a) (I) (lI) (h) Type cA proplJrtv (1IsI Date placed '--~t COI! or BasJs tor depreciation Recovery Metl1od/ OepreclaUon vehlClei nrsl) In service ""'-'11;II other basis (buslnessllrivestmenl period Convention dedudfon use use only) Page 2 No (Q Elected section 179 .... 25 SpecIal depreciation allowance lor qualified listed property placed In service during the tax yea' and used more than 50% In a qualllied business use (see instructions). . . . . . . . . . . . . . . . . . . . . . . . .. 25 · --r--r~r-"r E 'Z1 Pro e used 50% or less In a uall1led business use see Instructions : 8U'",,1 SIOBl<ICa.. 1Z/15/93 H). 00 28 Add amounts In oolumn (h), lines 25 through 27. Enter here and on line 21, page 1. . . . . . . . . . . . . . .. 28 29 Add smountsln column I Hne 26. Enter here and on line 7, 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section B - Informatlon on U.. 01 Vahlclaa Complete this secllon 10' vehicles used bye sole proprtetor, pBrlner, or other 'more than 5% owner,' or related person. II you provided vehicles to you< employees, lIrsl answer !he l!II88l/OIIS In SectIon C to see ~ you meel an eXGSplIon to compIe1lni this section for _ vehicles. Total buslnessilnvestment mUss driven (II} (I>} ('* 00 (a) (l)- 30 Vehicle 1 Vehicle 2 Vehicle a Vehicle 4 Vehicle 5 Vehicle 6 during the year (do not include commuting miles -see Instructions). .......... ... 31 Total commuting miles driven during the year. . . . . . 32 Total other personal (noncom muting) miles driven . . . . . . . . . . . . . . . . . . . . . . 33 Total mUes.drbl9lt dul!nll the year. Add lines 30 1I1rough 32. . . . . . . . . . . .. . . . .. Yea No Yea No Yea No Yea No Yea No Yea No :M Was 1I1e vehicle available lor personal use durlngoll-dutyhoUl"?. .... .. ..... .. . 36 Was the vehicle used .r.rtmarllY by a more than 5% owner or ref dperson?'..'.'.. 38 Is another vehicle available lor pe,sonaluse? . .. . . " . . . .. . .. .. . . . SectIon C - Quaatlone lor Employen Who Provide Vehlcleelor U.. by Thalr Employeaa Answer these question. to determine II you meet an excepUon to oompfeUng SectIon B 10' vehicles used by employees who are not more thsn 5% owners or ,elated persons (s.. 1nslructIons). Yea 37 Do you maintain a wrlllen policy statement that prohibits all personal use at vehicles, Including oommutlng, byyounmployees? .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . .. . . . . . . . . . . . . .. . . . . .. . .. . . . . . No 38 Do you maintain a written policy lIlateO"",d 1hat prohlbno personal use- of '<8hIcIe8; except comrntl1Ing, byyou' employees? Seelnslructlonstor vehicles used by oorporste olllcers, directors, or 1% or more owners. . . . . . . . . . . . . . . . . . 38 00 you treat all use 01 vehicles by employees se personal use? ......................................... 40 ~h~:'~~,%~~reth~~lg:=~~=~~mplo~~s'.O.btaI~lnlo~aUonlro~.~~emp~ye~~oU1~.e.~.o~the...... 41 00 you meet the requifemente """""*'1ln quaflfle<l automobile demonstlatkm u8&1 (see _llCIlons). . . . . . . . . . . . . . . . . . Nota: If your answer 10 37, 38, 39, 4(), or 41 Is 'Yes,' do nol complete Section B for the covered vehicles. Amortization (a) DescrtpIIon of costs (a) AmorIIZaIlon _or - 42 AJ"OIUzattOl, of costs1hat ~dtn1ngyour 2rtsx year (see Tons): E ~. 43 Amortlzal1on of oosts that began betoreyour2002tsxyear. .................................. 43 44 Totel. Add amounts In oolumn (0. See Instrucllons lor where to report . . . . . . . . . . . . . . . . . . . . . . . . . . .. 44 FDIZ0812 12/12.tl2 (b) Date amortization begins (e) Amorlllable amount (d) Cod. ....100 (f) AmoI1Iza!loo lotthl9year Fonn 4562 (2002) .' MARY ANUSHUTTY .- Explanation Statement H6-52.6717 l Form!t.ine: Expianatiofl ol: Schedule A FOJ:m lO!}8 Name/Address 11 ROBERT SIIUT1'Y 189-42-0639 NO ADDRESS KNOWN I!~ ~ ij !I~ · ri.. f!;j i. H 9.ih,; h f;;Jh eGj mill a... i 8 ....(') ~ It g = . ~ w z f 11 lru r~ lru ~J I fJ f II f ~ m r ~f ~ ~ ~ .. r f If ~ .. [ f J ~ N ":!:;: c. tr . ~tn~ . 0. ~~~ff i f >0; ><1 ent<~. f i ~ ~ ~ .' b:I'H r:l J .H I ~ ~ t' t"' Ul a' t< 0 ~ Glt<o.t ' ::>:l I ' t'l ~ :;l~ ~ en . i >0,", >< i i :>' 0"1 ~ ~O .... ~El~l ..., 0 .... .... ~l .... CIl l O#H ~ I INO \.DNZ "'"0 ><:. (D "'" .""i ....ft ....i....Di f . if [ ;;; il ~ f CD ... UI Co! f I f I .[ll J i.! I I i 1~ i . 0 r ~ ~~ I r..~1 ~ iT- . O>H , ogg. , fJ ::e , H.' tzj , e; ID",~mf , OJ~ f , t< ~~!i!liJ , .t< :; 1 ; ,,,, ,,,, . :;:~f " ,,,, ~~~l :~ ~ i<i ~ ,.. J ei ,,,, ... Hgj ,,,, ..,. >l OJ ,,,, 6 "'~ OJ +-: ~ '" ~" ~ $ i j ... J .., 0 ... '''' ... 11 '0 f '~ i '''' - '~ , ,. '0 '''' g , fl f , ~A I , I ... .. , .., I , .'" '" _. ~ '", , , If f . '", '" ... f :'" '" .. '" , '" ,. '" .. lJ '- ,,,, .., .., I ,,,, ... '" T-: .., ... , . , . , I :...." I . f '0 ') ~ I . j '''' i :~I i J '0 6: ~f6l fl" ~iE "'- ~l o. ~ ~ I , .., , ..... ... ..... .... . I... fi ~ Ii I i: ,,, ,0> - l- I r I' i I ~. ,,,, ,,,, l . +-- I I '~ I , ,., , ... ~'I . ~i& ! '" I .. ... { li :!2l ~ ~ ~ i o !l' m l:: "0 ~ OJ ~ Copy C For EMPLOYEE'S RECORDS J 2002 OM. /(S.. Notice to E'!Jloy.. on back 0' Co~ B. . 1545. a Control number 1 Wages. t1pa, other comp. 2 Fed8f1lllncome tax withheld 48.00 b Employer ID number 3 SocIal security wages 23-2948222 48.00 !Ii MedIcare wages and tips 48.00 6 Mecicaretaxwfthhekl 4 SocIa/88ClIrlty tax withheld 2.9 o Employer's name, addrea8, and ZIP code, KENNETH H HICKOK STAMP EXPRESS 1104 CARLISLE RD CAMP HILL PA 17011 d Employee.. soclaJ securfty number 176-52-6717 . Employee" name, addreas, and ZIP COde 0.7 MARY A SHUTTY 59 WINDSOR WAY CAMP HILL PA 17011 7 Social security tIpI: 8 A11ocated.tlps II Advance Ere payment 10 Dependent ~ benellt8 11 Nonqualffled plans 128 Code Seelnst.forboX12 13 Statutory employee 14 Other 12b Code . nO.,"""", p,en l'hJi<>.oariY....pay OPT 12c .......... 12d Cocfe P-f. 15Sl8ie Emplr:a8tatel.D.I 181.oeal wages. Ups. etc. 48.00 48.00 I . '8~8S.~etc. 1,7Silit6lncometax 19l.oca11ncome tax 20 L.ocaIfty Flame , 0.48 JAN'-JUN ~Wli:" 1.'34 F:orm W-2 W.". and Tax staMm.nt Depr. of the lhtasury . IRS This Infonnatlon Ie l;leJng l'l:mllhed 10 Ihe IRS. It yOu tlI'II requlredto 11/. a tax ~~J al'l8Ql/Qenoe penalty/other lIIanc1km may be Impoead on you It Ihllllncome Ie taxable and you 1811 to report IL 131804 Office of Financial Administration Diocese of Harrtsburg PO Box 3651 Harrisburg, Pennsylvania 17105 Phone (717) 657.4804 Fax (717) 657-8757 Name MARY ANN SHUTTY Soc See /I 176-52-6717 Qlumn! Year to Date UniVDept 131 804 GROSS PAY 769.23 6153.84 FEDERAL W/H 71.13 569.04 FICA TAX 58.85 470.80 STATE TAX 21. 54 172.32 CITY TAX 12.31 98.48 UCTAX NET PAY: $605.40 '10~ """I h"v~ +t.,i S Cof"!' 1-1.11.:>. Pertod Ending 4/09/2003 Check Number 893236 Pay Date 4/16/2003 Marital status s Dependenfs Claimed 01 Addltlonai Withholding .00 Federai .00 State REGULAR HOURS 60.00 REGULAR EARN 769.23 Office of Financial Administration Diocese of Harrisburg PO Box 3651 Harrisburg, Pennsylvania 17105 Phone (717) 657-4804 Fax (717) 657-8757 TO TIlE ORDER OF: PAY *****605 131 804 MARY ANN SHUTTY 59 WINDSOR WAY CAMP HILL PA 17011 60.1273/313 DATE CHECK NO. PNC Bank, N. A. Southcentral PA 4/16/2003 893236 'Dollars aruf 40 Cents $605.40 NON-NEGOTIABLE -.:.. r!'" ~< -::. ~-- r-- F (> s-;:: ," :} P c.) 8 ---1 .-~) j 'n . ..~J ,") f".) .~: -;:-.'" '- -q \--"') }; n '.:1,) < ~.i' Iv "';J -< Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Pia i ntiff NO. 01-6237 Civil Term v. ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE INVENTORY OF PLAINTIFF 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. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa. C.S. !l4904, relating to unsworn falsification to authorities. -L~ ,,^~i~v?li~ Plainti ' ASSETS OF THE PARTIES Plaintiff 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 ( ) 7. Contents of safe deposit boxes ( ) 8. Trusts ( ) 9. Life Insurance policies (indicate face value, cash surrender value and current beneficiaries) ( ) 10. Annuities ( ) 11. Gifts ( ) 12. Inheritance ( ) 13. Patents, copyrights, inventions, royalties ( ) 14. Personal property outside the home ( ) 15. Businesses (list all owners, including percentage of ownership, and officer/director positions held by a party with company) 16. Employment termination benefits' severance pay, workman's compensation claim/award ( ) 17. Profit sharing plans ( ) 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. MilitaryjV.A. benefits ( ) 23. Education benefits ( ) 24. Debts due, including loans, mortgages held ( ) 25. Household furnishings and personalty (include as a total category and attached itemized list if distribution of such assets is in dispute) 26. Other 2 MARITAL PROPERTY Plaintiff 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 Property Name of All Owners 1 59 Windsor Way, Camp Hill Joint 2 1990 Hyundai Excel GLS Husband 2 1994 Suzuki Sidekick Wife 2 1999Hyundai Excel Husband 5/6 PSECU Accounts Joint 19 National Vision Administrators, Inc. 401(k) Husband 3 NON-MARITAL PROPERTY Plaintiff lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property: Item Number Description of Property Reason for Exclusion 1 139 Laurel Drive, Fredericksburg, PA Husband acquired post- separation 2 2002 Dodge Stratus Husband acquired post. separation 2 2002 Dodge Ram Husband acquired post. separation 2 2003 Suzuki Vitara Wife acquired post-separation 5 Allfirst Bank accounts Husband acquired pos. separation 4 PROPERTY TRANSFERRED Item Description of Date of Consideration Person to Number Property Transfer Whom Transferred 1 59 Windsor Way 04/19/02 $1.00 Wife 2 1994 Suzuki Sidekick 04/03/03 $1,000.00 Trade-in 2 1999 Hyundai Excel Unknown Unknown Trade-in 19 National Vision 401(k) 10/01/01 $39,000.00 Husband withdrew 5 LIABILITIES Item Number Description Names of All Names of All of Property Cred itors Debtors 1 Mortgage VMB Mortgage services Joint 1 Mortgage PSECU Joint 1 Mortgage TBM, Esquire Wife 2 Car loan Charter One Wife 25 Visa PSECU Wife After separation, Husband filed a Chapter 7 bankruptcy petition docketed to In re Robert M. Shutty, #-03-02298. The U.S. Middle District Court entered a discharge order dated 08/14/03. 6 h c.:> 0 C C..J -n ~ :! <:1 L; 5 n .~ ':l~i ::-::: , >':" : t'>, i"-~'I l-:--J C"; ; - C) ~-~-~ i ?:: "1-; -, "1 ;;~5 8:) ,Tl , , :''1 :..:; --, C.) -< JENNIFER L. GRIMES, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO 2001 - 6839 CIVIL TERM JOSEPH D. GRIMES, Defendant : CIVIL ACTION - LAW : IN CUSTODY AFFIDAVIT OF SERVICl<~ AND NOW, this November 20, 2003, I, Jane Adams, Esquire, hereby certify that on or about November 13, 2003, a certified true copy of the CUSTODY COMPLAINT was served, via certified mail, return receipt requested, addressed to: Jennifer Grimes 285 Shed Road Newville, Pa. 17241 DEFENDANT Respectfully Submitted: l~ J e Adams, Esquire .D. No. 79465 36 South Pitt Street Carlisle, Pa. 17013 (717) 245-8508 ATTORNEY FOR PLAINTIFF 0 c:., n "_.J ~ v:~ -0 .0. ,'''-.~ -vl<' :::::> rnr' >1:;: Z":: :--.) :;.::r: ~. ..- ~L ~-- ~\:~ i);) '-, ./--- ::J :<- $- SENDER: COMPLETE THIS SECTION . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: ~~ L,6y;~ d 'D~5AecJ~ fV0.-V V)' II e.- / fit /l;}lf/ 2. Article Number (Tr~nsfer from selVice label) PS Form 3811, August 2001 . . . A. Signature o Agent X ~, ' ~(' jO Addressee 'il Received by (Printed Nae) C. Date of Delivery UVlS +,,~, JZICES II - /3 ,03 D. Is delivery address different from item1? 0 Yes \f YES, enter delivery address below: 0 No 3. Service Type I5iiI Certified Mail ........d Registered o Insured Mail o Express Mail o Return Re09ipt for Merchandise o C.O.D, 4. Restricted Delivery? (Extra Fee) DYes 7001 2510 0001 4137 2060 Domestic Return Receipt 102595.o2-M-1035 11111/ , First-Class Mail Postage & Fees Paid USPS Permit No. G-10 UNITED STATES POSTAL SERVICE . Sender: Please print your name, addmss and ZIP+4 in this box. JANE ADAMS ATTORNEY AT UV/ ^~6 S. PITT S1 REFT ....RLlSLE, PA 17013 ~ ~ . - 1...111..,111,.....11.,11...11...1,1.,1,1./,1,1.1../,/..1.,1., Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY Defenda nt CIVIL ACTION - DIVORCE PLAINTIFF'S MOST RECENT TAX RETURN AND PAYSTUB PURSUANT TO Pa.R.C.P. 1920.::il(a)(1) Fonn 1 040 Label (Seelnstru::llons.) Uaethe IRS label Otherwise, please print or type. P....Iden1I.1 EI_ Campelgn (...,""..........) Filing Status Check only one box. Department 01100 Treasury - Inlernal Revenue SerVIce llS. lridlvlduallncome Tax Return Fortlle r Janl- Dec-31 2003 or other tax ear 'nnin Your first name MI Last name IRS Use 20 MARY ANN If a IoInl rettJTl, spouee's firs! name SHUTTY Ml L.asI: name Spowe's eocJat aecurfty nwnblir Home acldress (number and8lreet), If you have aP,O. boX. see InslructlOns. Apartment no. ! Importantl ! You mU81 enter your social security number(.) above. cry, town 01" post oIIlOe. If you ha\lle a torelgn address, see instructions. :91818 ZIP code ~ NOIe: Checl<ing 'Yes' will not change I"lur tax or reduce \'OUr refund. You Spouae 00 or ur. ouae if fili a 'olnt ratumwant to 0 to this fund? . . . . . . . . . . ." Yea No Yea 1 Single Head of household (with qualifying person). (See 2 Married filing J'ointfy (even if only one had income) Instructione.) If the qualifying person is a child but not your dependent, enter this child.. 3 Married filing separately. Enter spouse's SSN above & full name hare. .. name here. . .. I ~ilying wldow(er) wlfl1 dependent child. (S.. instructions.) hI!] Youraelf.lfyourparent (or someone else) can olalm I"lu as a depl.ndent on his or } ~o:..""" her tax retum1 do not check box 6a. . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . ltI:nd8bon. . . b S OUM. .. . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . " . .. . .. . . ... . . . . . . . ~:'-I3:'n (2) Dependenfs (3) Dependenrs (4). on "'Who, C D",-_: social seou~ty relationship ..'!.""I~~ a "... . number to you . taxCl9dft with you . .". . see InsInt . did not live With you dIN to d1voroe or_on (... rn..). . . Depend..... on8enot,._: . enllnd above . No Exemptions If more than five dependents, see Instructlons. Income AlIach Fomtl W.... and W-2G he... AIao _ FOnn(I)1oet-R 11 10 wee wlthhlkl. If yo~ did not .. "'li.~,..,t,f~.;"I"'1;~'r" InStruCtio"ns~"'- Enclose, but do not attach, any payment. Also, olease use ~"'t'!"""'''''^\I 1 1 First name KEVIN S SHUTTY 1 Last name Son .' " A.....m_ I I . , ',' "- ',- "", .- , ' ',_0_ Jln.. '... " . d."total numtlef o'te1<emlllldhs Claimed. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . = . . . '2 7 Wages, salaries, tlps. etc. Attach Fonn(s) W-2. ..... -........................ .~,..,,;._ 23,?~. 8aT_Ia'nlerest.AttachSchedUleBlfreaUlred............... ................ _8 ," 199._ b TO-lIXempllnterest. Do not Include on line Sa. . . . . . . . . . .' L..!!!l . 8aOrdlnarydlvldends. Attaoh Schedule Bff required. .. ....... .... ..... ... ... ..... hOllltlh1rlll1R I -.....J. ^ltlljlttlfi::AI'tI)........,.............................~ 10 Taxable refunds, credits, or offsets of state and local Income taxes (see instructions). . , . . . . . . . . . . . . . . 11 Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 11 12 t:l.' us,nes.. Inoom. e Or(IOSS). Attacn.~cneaUle(;.Orl..:_t:L . . . . . . . . . . . . . . . . . , . . . . . . . '. W. 2 . 13aCapltaigainOr(loss).AttSChOifreqd.lfnotreqd,ckhere................... .. 0 13a b,.~~~f~..~~~~~~~~~~~t;.",_,. . .. . ." . .. . .. _ ... _ . . . '. '.. ,1,1:t~1 , 14 Other gains or (Iossas). Attach Form 4797 . . . . . . . . . . . . . . . . . . . 168 IRA d.istrlbutlons . . . . . . . . ~ I b Taxable 18.-PenSibns aI\d-ahritiities, . " . 16'.' b'Taxabre 17 Rental real estate, royallles, partnerships, S oorporatlons, trusts, eta. Att. 18 Fann Inoome or (io..). Attach Schedule F. . . . . . . . . . . . . . . . . . . . 18 Unamploymentoompensatlon........................... 20a Social secllrlty benefits. . . . . . . W I b Taxable "'II n+I......;.."^"'"^ 42. 13 384. 205. 14 llmount (see instrs). lib lllTiotinf'(See lit.ltt9): . 18'bl :ch Schedule E 17 18 18 amount (see instrs). 20b 4. 22 Add the amountsln-th"faf rI- hi coiUmn lor line;, '7 iii, - h 21.riiisl. - ur ioi., 'jj,Cciii,; :-. -: -.. 23 Eduoator expenses (see Instructions) . . . . . . . . . . . . . . . .. 23 24 IHA deducnon (see instruCtIOns). . . . . . . . . . . . . . . . . . . . . ~4 21 Student loan inferest deduction (see instructions). . . . . . . . .. 2S 'R Tllitlnn Rnrl fA~rlArlll~nn (APiA inRtrllrmnnr:::\ 'R 27 Moving expenses. Attach Form 3903. . . . . . . . . . . . . . . . . . [jL[ 2S One-half of seff~mployment tax. Attach Schedule SE. . . . . . . ~ :; -;:~=:;~~:I::li;:~~~:~~:;:~(~;~~~."Oi: : : : : : : I:~- ~ 32aAiimonypa/d b Recipient's SSN. .. .. ~ 33 Add lines 23 through 3Za. .. . ..... . .... " ....... ... .. .... . ... '" ... ... ... 33 34 Subtract line 33 from line 22. This Is your edIullillil'li_ "ncome. . . . . . . . . . . . . . . .. ., -34 . BAA For D1lc'oaure, Privacy Acf, and P8p"'-'I< R8clucllon Act NotIce, _ln81l1lctlo.... FClA0112 01N.... A~r.._.._... . ._,--~-- Gross .Income 3,7 438. Form 1040 (2003) 37 438. ~,,;,';';';';;';; ;;:c;;~; . Tax, and Cre1iltA [ StandII'd I p"~~cllon o peoJ>e who checked any box . ,on IinA.3RA or ~6b or who can be claimed as a dependent, see Instructions. _ o'Ali-others. , ; Single or Married "I TIling separatelY, $4,750 . ,,_,~$trio.rtfi.lJOC1. J jointly or - QuaUtyin ;~.Ld~(e8, I~o'~v Head of hnllRAhold . 1$7.000 Other Taxes Payment8 II you have a quelifylng child, attach Sctiedule EIC: 'i:tfii~ Direct deposit? See Instru<;1lons "'-"";"'''''"-!--"~-,,,,,., dllu Ilu III lVU. 700. and 7Cd. .........';..,.,-:~, .....--.... You Owe Third Party Designee Paid Preparer'8 U8e Only ~~..-......~.. -'~-"" ,--~ ' .:....~ ..-~\,... &'&0,.... ........u...... ._...~ ,~.. ,....... 35 Amount from line 34 (adjusted gross income) ................................ 38",1':",""" ~ n You were born before January 2, 1939, . n ,Blind. TOIl' boxal . .: If: L U Spouse was born before January 2, 1931l, U Blind. checked ~ 3e I I b if you are married filing separa, tely and your spouse itemizes deductions, n ." or. vou were a dual-status alien. see Instructions and check here. . . . . . . _ . . . . ... 38 b.. . 37 """,Ized deductions (from Schedule A) or your standard deduction (see left mar,~n) . . . . . . . . . . . . . . . [38~~b".~II':e..~~.'r~mli~35. '::'~:.:.:.::':','.','.:' ::.. '.:'" ........:. .;..... '. ~.;.- II IlllGo,hJ 10 o,j)IV"'r,V'... VI IO~, IIIUILI....' .P..>,V...V 1./1 I.IIICJ ~vu:u IIUIIII.lOl VI O.ll.OI'ltJ~IVIIO ""aUlIOU on line 6<1, If line 35 is over $104,625, see the worksheet In the instruo::tlons. . . . . . . . . . . . . . 40 Taxable iJlc:ome. SulYact line 39 from line 38. 11.lin"39i.morethaRline~enter,.()... ... . .. ... . .. ... ... ... .. ... ... ... ... ... 41 Tn (see ins..). Check if any tax i. from I 0 Form(s) 8814 b 0 Form 4972. . . . . . . . . . . . . . . . . . 42 AlternlllvamlnlmumtlX(SeeinstructionS).AttschForm6251....................:. Aoa lines 41 ana 42 . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . . . . . . . . . . , . . . Foreigntsxcredit~ttachForm1116ifrequired........... 144 I .1:'~L.,",.....+.;.\d.,..<Vl:4~~"......._....,o.q."'."""..~.f:l~-'lh,I;..,.>:,.....~.u.., . ~:i" C~~itio;~~~d;';;~'~;~~di~~~i.;;j.~~~~hi;cI1;dule~: .:.. ~ Education credits. Attach Form 8863. . . . . . . . . . . . . . . . . . ...G!. Retirement savings contributions credit Attach Form 8880. . . . ~ Chllcl tsx credit (see Instructions) .. . . . . . . . . . . . . . . . . . . ~ ~:~=:~~~~~:~b::g::;~'a8s9~jji~~:~:: :.~~, b U ~"i' c USllOCify: I 52 63 Add i1nes44lhrough 52. These are your tOlIll credlte. . . . . . . .. . ,. . .. . . . . . . . . . . . .. 53 54' Sdbtraclline 63 from line 43. ~ line 53 is more than line 43, enter .()-. " . . . . . . . . . . . . . . 'Sot 55 Self-employmeottax.AttachScheduleSE....................................... 55 58 Sooa! socurlIY and Medicare tax on tip income not reported to employer. Attach Fo"", 4137. . . . . . . . . . . . ., 5e 57 Tax 00 qualified pians, including IRAs, and other tax.favored accoonts. Attach Form 5329 if required. . . . . . . " 57 58 Advance earned income credit payments from Form(s) W-2 . . . . . . . . . . , . . . . . . . . . . .. 55 58, Householdemploymenttaxes..AttachSdleduleH,.. . .. . .. .... ... .............. 58. eo Add lines 54-59. This is urlolaltu....................................... ~ 50 e1 Federaiinoome tsx withheld from Forms W-2 and 1099. . . . .. 81 1 944.' 82 2003 estimated tax /lIlYl11nolS and amount applied from 2002 return. . . . .. 82 83 Eemed Ino;omecredft(EIC~. . .. . .. . .. . .. . . . . . . . .. 83 M ExcesssocialsecurllYand tier 1 RRTA tax withheld (see instructions). . . .. 84 85 Additional child tsx credit Attach Form 8812. ............ 85 ee Amount paid with request for extonsioo to file (see instructions) . . . . ... ee 87 0lIt0r pmts from: a' 0 Form 2439 b 0 Form 4136 c 0 Form 8885 87 ee Add linos 61 tI1rough67. Those are your IMal p_nb. ................... .'......... ~ 88 ~.. :Jf..Ji,oAl;,R,~~,~t<>;~~',!~m"It~~r-l".Ji~A'\f>o4rp:i~.f;~..T~If)"',f.bA~v?t~i,",,~,;..I,. ~'''. 701 Amount 01 i1ne 69 you want refunded to you .. . . .. ...... ........ ... ... .... ~ . b Routing number. . . . . . ..1231381116 I . c Type: [lg,h"cklng I!J Savings. . dAooountnumber...... 0453316101 71 Amount of line 69 want lied to our 2004 ostimaled tu . . . . . ; ,~ 37 438. 27 563. 9 875. 6 100. 3 ,7J5~'" 378. I,;. I: I:: 'I'~ 62 Jlts. 378. O-~ o. 1 944. );...'O,d'i'.~. 1 944. . Preparets .... s~...... ... Firm's name ''''>'OOfS' .. sew;.employed), " _and ZIP code Self"-Prepared EIN Phone no. FDIAo112 01116,04 Form 1040 (2903) 0._" 0"" T....." (99) Irtemat Revel'l.le Service Name(s) srown on Foon 1040 MARY ANN SHUTTY !:,~lcaI . ~~~',~ ~~ Include ,expen~ rel,:,bursed or paid by others. ~~ ~-:::... ~ ;;;-;;"~~';;;fu;;iD;o~o~~'3s:o.-~~"lij""""""""., 3 Multiply line 2 by 7.5% (075)..... .. ... ..... .. . .. . .... UI 4 Subtrecl line 3 from ilne 1. If ilne 3 Is more than ilne 1, enter-Q-. . . . . .. .. . . . . . . . . . . . . .. . 5 State end local inoome taxes. . . . . . . . . . . . . . . . . . . . . . . . . Pi 1 043. _ ;:0':: 00:::':0 :':;:00 ::00 :c::cco::oc:; . . . . . . . . . . . . . . . . . . . . . ~ :' : :::. 7 Personal property taxes . .. .. .. .. .. .. .. .. .. .... . .... . 7' 8 Other taxes. Us! tvPe and amount ~ . . . ~Qe~_~a~!~____________________u~L1 11. 9 Add lines 5 through 8. .........................................,....... , SCHEDULE A (Fonn 1040) Tlnl You PAid (See instructions.) u..__. You Paid (See l......+........r.........\ Note. ~ersonaJ Interest is not ...l..............U..I_ GllIlto "lIlImy If~m'!'le "'::1"'-'''' got a benefit for I~ see instructions. 2,II!"!IlY Ind ...........--- Job Expeneea Ind MOIl ulner MI_lIneoul Deduction. (See instructions.) Miace.llneoua Deduction. TCltII Uomlzed Deduction. Itemized Deductions OMS No. 1546-0074 ~ AUoch to Fonn 1040. ~ See Inltructlonl for Schedule A (Form 1040). 2003 07 Your eoclll tl'tCUrtty number 1 .. . ..- .... 1I1.111ltllll~Y UIW!v,n allu ,^,1II~ 11l1^'I~ ~v IV", VII r VIII! 1v.N . . . . . . . . . . . . 11 Home mortgage Interest not reported to you on Form 1098. if paid to the person from whom you bought the home, see i.......... ..-.+j........ ......", ...~....... fh...+ ..................'... ............. ;...........,.01....... ...,,""'h..... 9,901. 4,205. and address ... ------------------------------- ------------------------------- ------------------------------- 11 12 P~nts not reportedtoyoo on Form 1008. Seelnstrsforspcl rules. . . . . . . . . ~2 13 Investment Interest. Attach Form 4952 If requir'!'l. 1('...... :"M.-'- .... ,...........;. ................................~ 14 Add lines 10 through 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . 15 Gifts bv cash or check. If \IOU made any oltt of $250 or more. see Instructions . .......... .... .. . ....... .. . .. '" 821. 18 Other than by cash or check. If any gill of $250 or more, see Insvucuons. YOU mUll attam t"orm tf~tf;j IT over $500. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250. 17 Carrvover from orior vear. . . . . . . . . . . . . . . . . . . . . . . . . . .. 17 18 Add lines 15 through 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '1.1LJ 1V ltBSU or men lOSS as . 1\nacn t'orm "JOtli4. ;:)88 InSUUCIlons. . . . . . . . . . . . . . . . . . . . . . .. 1" 1,071. 20 Unreimbursed emplowe expenses - job trevel, union dues, I....... ~.,.....+i....1"I ""t... "'.;........ e...."""' ?1M ",r 'J1n~.C7 if 12 386. required. (See Instructions.) ~ --------------- ------------------------------- E~~E~~t~~n~__________________1~~~0 21 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21 ..." '" ,. ... .... .......~....~~.....~~t :..--..".......' .......,.... .......,........... ........". ......... ~..., . ..-:" ~ -------------------- . . See Statement 12.784. 22 23 Add lines 20 through 22 ..................,......... i..!!...23 24 Enter amount from Form 1040, line 35. ... W 37.438.~ ;;II!::) MUltiPlY line C:4 oy ~'70 \.U~} . . . . . . . . . . . . . . . . . . . . . . . . . . 1..!2.. '''' '::J . 26 Subtractllne25fromllne23.lfllne25lsmorethanllne23,enter.o,......,............. 11)'7 ~""r _ frr.rn liot i... th"" 1...C>tr, '....1......,., I lot tun"" "'..."" .........., '.-w .. 351. 12.784. 13 135. ---------------- --------------------------------------------- 26 Is Form 1040. line 35, over $139,500 (over $69,750 If MFS)? 27 1Vl...... V...'.r ;i...;ol"....ti...... I~........ U...........;i A;i;i th... ........."',....u.. i.... th... f...r ril"lht .......11,........ for ilnes 4 through 27. Also, enter this amount on Form 1040, line 37. o V... Vour d'!'luction may be limited. See Instructions for the amount to enter. --, -' ~~~ BAA For Pap_OJlc Reduction Act Notice, see Fonn 1040 Instruction.. FbIA0301 10116103 Schedule A (Form 1040) 2003 SCHEDULE D (Fonn 1040) Cepltel Gelne end Loeees . Attach 10 Form 1040. . See Inatructlona lor Sche~ule 0 (Fonn 1040). . Uae Schedule 0..110 1181 addltlOlUlI tranaactlona lor lineal and 8. OMB No. 1545-0074 ~ofltleTr888tIry IntemlIl Aev81lU8 Service (99) Name(S) shown on Form 1040 MARY ANN SHUTTY Short-Term Ce Itel Gelne end Lones Aesete Held One YEtar or Lese (a) """"'pIlOn 01 (b)oal&acqu'rod (Clll6lesokl (d)......_ (e)CooIo'oIher_ (1)001.0.<_) ~~ewm~ (Mo,day,yr) (Mo,day,yr) (seelnstructlonsl' ~ (seelnStructICIOS) =-:ar~) 1 2003 12 (g)_sgol. or_r ... be"" 2 Enter your short-term totals, /I any, from SohaduleD-1, line 2. . . . . ... . . .. ~ 1011I1 .non-lOflD ..._ prK<O lUI1oume. Add lines 1 and 2 inoolumn (d).. . . . . . . 4 Short-term galn from Form 6252 and short-term galn or (loss) from Forms 4684. 6781, and 8824.. . . . .. . . . . . . . .. . . .: . . . . . . . . . . .. . . .. . . ; . .. . .. . . . 5 Net short-term gain or (loss) from partnerships, S oorporetiOns, estates, and trusts from ~rhArltdA(~YI<~1 6 Short.term oapitalloss carryover. Enter the amount, if any, from line 8 of your 2OO2CapllalLossCarryoverWorksheet................ c.:.............. 7 a(;omD'~e lines 1 through 5 ,n oo'umn (g). If the result ,a a losa. enter the result. Otherwtae,entar-O'.DOnolentermorethanzero.......................... . bNat ehort-lenn c801l8l aeln or 110881. Combine lines 1 throuoh 81n oolumn (I) . . . . . . . . b Lon -Term Ce Itel Gelne end Lones - Aeeete Held More TIlen One Yesr (1I)0e0ctlpII0n0l (b)O....cqo'rod (C)oal&sokl (d)......_ (e) 0001..0111.._ (1)081'0'<_) (Xq)8rty (EXample: (Me. day, yr) (Mo. day. yr) (see InslnJCtlonl) (see Instructlons) for lheenUreyear 100 8h8nt8 XYZ 00 SlbIracl: e lrom d 8 Home Sale ain Reali ed 08/01/90 12/01/03 199 000.00 25 024.00 Section 12 Exclusio (g)_..o..,. or(loel.r see below ... ,..._.._~ .._..~ 1___ .._~_ "_"_1_ 14' _~.. J.::1::1 vvv. 24 819.00 -24 819.00 -24 819.00 ifoms'ctificiuie'O:i:ii;,e9~'.'. -::: . . . . . . 10 TolsIIOllll-Ienn _ price amount.. Jo\uu IIl1tmo tulU 'd IIIWIUIrHl \U) . . . . . . . . ........ 11 Gain from Form 4797, Part I, long-term gaJn from Forms 2439 and 6252; and 'i long-farm galn or Qoss) from Forms 4684 6761, and 6824. . . . . . . . . . . . . . . . . . . . . 12 Net iong-term galn or (loss) from partnersl1lps, S oorporetions, estates, and trusts/rom Scheduie(s) K-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Capitalgaindistributions.Seeinstrs....................................... 14 Long-term capital loss carryowr. t:.nter the amount, It any, trom line 13 ot your 2002 Capital Loss Carryover Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Combine lines 6 thrOUQh 13 in ooIumn (a). If zero'or lees, enter -0. . . . . . . . . . . . . . . . . 16 Nellong-term capital geln or (l08a). Combine iines 6 through 141n oolumn (I). . . . . . . . nUI:l;JUlUj'l:l.llJllUIJ tl.c::. ~Include In column (g) all gains and losses from column (I) from sales, exchanges, or con_ions (including insta/lm..~ payments received) IflIr May 5, 2003. H..evar, do not mclude gain attribtrtibl. to unrecapl...ed section 1250 gai~ 'coIlectibles gains and losses' (os defined in the Instruction,,) or ~Igible gain on quaiified smail business stock (seeinstrs). BAA For Pop8lWOl1< Reduction Act Notice, - Fonn 1040 In8lructlona. Schedule 0 (Form 1040) 2003 FOIA0612 01NeA:l4 :..;,.....;...:...';; ';-...,,,,-,;~' ;,.:;~ ~,;;,.;;.-;..- .$;-'; :~";<.L:":: Taxable Gain or Deductible Loss 17 e Combine lines 7bana-16 and enter the result. If a loss. enter -0- on line 17b and 00 to line 16. II a oain. j -~ J enter lI1e gain on ~orm 1040, line 1311, and go to line 170 below. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . b Combine lines 7a and 15. If zero or less, enter -0-, Then oomplete Form 1040 through line 40 . . . . , , , , , , , , , , , N..vt.. If IIn'::! 1A nf ~,+u:w'illl~ n iCl l:i! nlllin nr \lnll hl:i!\1A nllJ:lUfij:llrl rlivlrlj:llnrlCl nn i=nrm 1n.tn Iln~ Qh rY"Imnlp,tj:ll Pert IV below, 8 otherwise, skip the rest of Sohedule D and complete the rest of Form 1040, - , ............. 4. If Ii........ 17.. i..... 1.-.-. .......+"".. n..-....... ............... c.......... -tn"^ It....... ,,>:I... *'.... .._..n.......f I.~\ +"'....1........ ....../1...\ fd.'>:l ''''In\ (or, ~ married flling'separately, ($1,500)) (see instructions)', . , , , . . . . , : : ' . . . . . . .", ~ :'. '. , .". . , . . . . , , , Nexl:81lyou have quaiified dillidends on Form 1040, line 9b, oomplete Form 1040 through line 40, and then oomolete P8IIIV below (but skiD lines 19 and 201. 8 otherwise, skip Pert IV below and oomplete the rest of Form 1040, __ Tax Computation Using Maximum Caphal Gains Rates ~U:>. o. If line 18 or IIne17elezoroor leae, oklp linea 18 end 20 end golo line 21. Otherwlee, go 10 line 18. 18 Enleryourunrecapturedseotion 1250 gain, ifany,lromline 18 of the worksheet in the in stnJctlons.""...... .illJ 205., 20 Enter your 28% rete gain, il any, from line 7 of the worksheet in the Instructions. . . . . ' . . . . , , . . . . . . , . , , , .l!i.:1 . ....n _. 4" --...... --.- ---.. .- - ... n__. ..... _..... ____... _ _ ______. _... .._ _ un_"._'. . _'" .__ ...._ _ ... ....__._... _.. _ A. ___n__ ..._ _ ___ _____...._ ___..... __. ..__ _ _ .... iiriCi'5i bitOiN: iiili'kijleil Oih.r iiii;'-';;"-;,w~""-~ nu'r'_''''''_ ..-.......--. ... ..... .......--.........- ...-.- .U_ _...__m._ _U._ _U ...._ n 21 EnteryourtaxableinoomefromForm104O,line4O,.."",...""",."",.,;"....."".,.. 21 22 t:nteflne emelleror line lborllnella, OUlnOtless lnan zero. """"""" 122 23 Enter your qualified dividends from Form 1 040, line 9b. . . , , . . . . , , , , , , . . , " 23 ... A..vlli............,'l ......... "':l'=' lIt. 25 Amount from line 4g of Form 4952 (investment Interest expense). . . , , , , , , . . . , ~J 28 Subtrsct line 25 from line 24, II zero or less, enter -0-, , , . . . , , . . . , , , . , , . . . , , . . , , , , , . . . . . . , , , , , . 'El Subtractline26fromiine21,IIZeroorless,enler-Q_.,...."....."""...."",....."."... 28 Enter the smaller of line 21 or: . ~-- ---.. .. .. --, ~ ;;:;~;;~i'~~";~;'~;:I;';~i;~:;;=~~.:~m\""" k... ....... ! 8 ~,050 If head 01 household I . , If line 'Ella greater Ihen line 28, eklp linea 28 Ihrough 38 end go 10 line 40. 28 ~ntertheamounlfrom iine27:,... ,'.,'... '....,... ....: ' ,.. ., , .. 28 .,., ....lol...~''"''~ illig "-~ IIU,., ""....e.u. II ","C'Vvt '....00, O'I~I:;" -v- Qlll.l IllV l.V IUle 'TI".l. . . . . . . . . .. ~ I 31 Add lines 17b and 23", ,. . . . , , . . , . . . , . . . . . .l1LJ . , ' 32 FntArthA.m.II"oflinAMorlinA~1........... 32 33 Mulliply line 32 by 5% (.05). , , , , . . , , . , , . . , . . . , . . . , .. , , , , . . . . , , . , , , , . . . , , . . . . , , ~ linea 30 end 32 ere the 88me, skip linea 34 Ihl'OUllh 38 snd go 10 line 40. I I ;; ~~:~;~~~u;~I~;a;~~i~,'ff'~~:~~~;i~e'~" 'f" ',""""""'" _.~" " oflheworksheel In the instructions. ..,.".."..~ III 36 Enlerthe emallerolllne 34 or line 35 '. ." .. .,.., , .., .,. .. . '.. '.., , ~i 37 Multiply line 38 by 8% (,08). .. , . . . . . . , , . . , . . , , . . . , , . . . . , . . . , . . , . . . , , . . . , . , . . , . , . . . . . , -- -..,......."... M...... "... -. I __ I ...--..-.....-......"...""'''........................................... J......::.::.-' 38 Multiply line 38 by 10% (,10). ",....."."..,....""......".."....",......",... If linea 28 end 30 ere Ihe ssrne, eklp linea 40 Ihl'OUllh 48 end go 10 line to. . : ;~;~:.::;:r:;~n~~~~::;::3~'I~~I~k:~~~;';):::::: :';,: :'f\ :::itf1 : ::-i:~::~~E~::~:;:~i~~32:iS:~la~~~:..~..;.::':""""""'" '1-."-,: 46 Subtract line 44 from line 43. .,....,.,...." .r:-I ;,~.,. 48 Entertheemallerolline420rline45.,....,..",.".,....."..,." 48 IIff JVIUltJprYllne 40 oy 1070 t. ro). ..,...............,..............................,..... 48 Subtract iine 46 from line 42. "",.,..".""",.",.,.,..",." ~ 48 Muitiply line 46 by 20% (.20). . . . , . , . , , . . , , . ' , , , . , , . . , . , , , , . ' , , . . . , , . , , . . , . . , , , . ' , , .. 48 50 F1gurs the tax on the amount on line 'El. Use the Tax Table or Tax Rate Scheduies, whiohe"" applies. . . , . . . " 50 51 Add lines 33, 37, 39, 47, 49, and 50 . . , . , . , , , , . , . , , , . , . . , . , . . . . . ' , . . , . , , . , . , . , , . . , , . , " 51 52 Flgurs the tax on the amount on line 21. Use the Tax Teble or Tax Rate Schedules, whiohe"" applies. , . . . . . .. 52 63 Tax en ell taxeble Income. Enter the smeller of line 51 or line 52 here and on Form 1040, iine 41. . , . , , . . . . . , 'If lines 23 and 25 are more than zero. see instructions lor the amount to enter, FDlA0612 0111e,{14 53 378. Schedule D (Form 1040) 2008 Form 8863 EducatIon CredIts {Hope.and Lifetime Learning Credits) .. See InstructIons. .. Attach 10 Form 1040 or Form 1040,,- OMS No. 1545-1618 De~ntofIheTre88ury Inlamal Revenue 8elVICe Name(S) shown on return 2003 50 Your social securtly number MARY ANN SHUTTY - Caution: You CM'fnot take botII an 9tiJcaf/on CI8d1t andthe tulIon andfeesdeductfon (Form 1040, Ins 28, or Form 1040A, Hm~ 19) for the..",. nHMntfn the same year. nu ~1""li. "lIUIlon: 1UU (;IIIJIKK Itf/{f::1 U/t:l nu (.nlUlt IUt fIIUfr:J U11;1/1 ~ ltuc 'l:Ill:J lur Ult:f """,flI:JI.UUWIl. 1 (lI) Student's name (es shown on page 1 of your lex retum) _____f!'Jl!.n~e_____. Last name l<J1ly'I.!i_~__nn___ SHUTTY (b) Student.. sodal security number (es shown on page 1 of your tax ,eturn) (e) Qualified expenses {see instructions). Do nol enter more than $2,000 lor eacl'1 student (eI) Enter the 8manll' of the amount in oolumn (0) or $1,000 (e) Subtract oolumn (d) from oolumn (e) (I) Enter one-hall of the amount in oolumn (e) 2 -000. 1 000. 1 000. 500. ---------------1 .'. I ".,',.~ .. .'1 " f\UU lIrtf l:UllUUrll.l:l1I1 WIUHlfll:llUj I;Q'IU VI. . . . . . . . . . . . . . . . . . . . . "I ;)uv. 3 Tentative Hope credit. Add the amounts on line 2, oolumns (d) and (I). II you are taking .~~~<<QCIlt.b:.~9b..ld.w::lt...c:lO..to.P.cu:t.J.I:~~..c:lO.io.P.$r.I:J.l1 _ Llflltlme L8lIrnlna Credit 4 1.'iO.1L CeUl takl; and leam lI1e the (e) Studeors name (es shown on page 1 (b) Student's social (e) Qualified 01 your tax retum) seounly number (as expenses Ion: You CMInat shown on p~ 1 of (see instructions) tile = Cf8dit First name Last name your tax re m) the ""' . ing Cf8dit for _e afudfltlt in same yesr. . theamountsonline4,OOIUmn(C),andenterthetotal.................................... . 5 rthee....lerolllne50r$10,000...... .... ..... . .. .... .... ... ...... ... ............ 8 oth.-a,l.i,fQtIJ:r.u;io ,LQ/ilr:r:tir.lr.l'.ocodlt. ,futl.lWr.tl)l.IIr:l".*.l:ul_~.l.'::lf.'l\..t;lr:lr.t.l:lf.'l..tr...,p./ilr.t..w. .... 7 5 Add 8 Ente % T.oQat .... Allowable Educlltlon Credlta 8 Tentative education oredits. Add lines 3 and 7. . . . . . . . . . . . . . . . . . . . . . . . . ',." . . .:..' . . . . . . . . . . . . . . 8 .;~~~~f~~~~~~:).'~I~II.ng!01~tlY;.$5.1:000 If.sin~le: h~a~.ofh~~S~hOld,. . . .. . k- 51 000. ~~::i:'~~;;~';;:~~."I;:;::;'~~,.~~~~~-::~t~:'" . . . . . . . . . . r~. M"~ anveduoationoredlts........................................ ..11 J 13..562.. 12 ';r~~~~g~J~~(:rl~ fliln~.jOI~tl.y; $10:~0()hingle: head 01 ho~ehold,.. .. .... W 10 . 000. 13 II line 11 is equal to or more than line 12, entsrthe amount from line 8 on/lge. 1+.l!AIl ll"t<l:ltrlll 15. If line 11 is less than Iins 12, dillldellne 11 byline 12. Enter the ......l..~ (n:il.II1!8'd to at least three places) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; , . . . . . . . . . . . . . . . . . . . . . .. 13 x 14 Multiply line 8 by line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . .. .. 14 15 Enterthe amount Irom Form 1040, line 43, or Form 1040A, line 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 15 18 Enle'the total, ff any, of ~r credits from Form 1040, lines 44 through 46, or Form 104OA, lines 29 end 30. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18 1 500. 1 500. 378. 17 Subtract line 16 from line 15. II zero or less, atop: you cannot take any education oredlts. . . . . . . . . , . . . . .. ~ 17 378 . 1,8 .Edul;8llon"lidIta.Enter the ilmaJl!!" 01 line 14 or line 17 here andon,Form 1040, line 47, orForml046A,line31... .:...:..,................: .'........................... ~ 18 378. .SeePub. 970 lor the amount to enter il you are flllng Form 2555, 2555-EZ, or 4563 or you an, excluding Inoome from Puerto Aioo. B44 For P.aperwOl\< Recluctlon Act Notice, 8ee In8lructlons. Form 8883 (2003) FDIA3601 11/14toS Form 21 06-EZ= Unrelmbursed Employee Buslnesll Expenses OMS No. 1545-1441 0'_" Of... T..eeury (99) Internal Aeve11l.l8 Service Your name ~ Attach 10 Fonn 1040. OccUpation In which you Incurred expenees 2003 54A I' MARY ANN SHUTTY CHURCH WORKEIR Vou Mey U.. This Fonn Only 11 All oIlhs Following Apply. · yOU are an employee deducting ordinary end necessary expenses attributable to your job. An ordlnery expense is one that is common end accepted in your field of trade, business, or profession. A necessary expense is one that is helpfui and appropriate tor your business. An expenss does not have to be required to be considered necessary. . You do nOl get reimbursed by your employer for any expenses (amounts your employer included in box 1 of your Form W-2 are not considered reimbursements). . If you are claiming vehlcfe expense, you are using the standard mQeage rate for 2003. Caullon: You can use the standard mileage rate lor 2003 onlY I/: (a) you owned the vehicle and used the standard mileage rate lor the flrsf year you placed the vehicle In service or(b} you leased tfle vehicle and used the standard mileage rate for the portton of the lease period alter 1997. __ J-Igure vour t:xpenses Social -.curtly number 1 Vshlcle expense USin.g the standard mileage rate. Compiate Part II and multiply line 8a bya6. (.36). . . . . . . . . . . 1 54. 2 Parking fees, tolls, and transportation, Including train, bus, ate, that did nOIlnvolve overnight travel or commullng to and from work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Travel expense while awey from home ovemlght, Including lodging, elrplane, car rental, eto. Do natlnolude meals andenterteinment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Buslnees expenses not inoluded on lines 1 through 3. Donollnoludemealsandenlertalnment........... ..... ..... ... .. ...... ... .,. .. ....,. .. 4 257. 5 Meals and entertainment expenses: $ 80.x 50% ( . 50) (Employees subject to Department at Transportation (DOT) hours of serllics limite: Multiply meal expenses by 85% (.65) Insteed of 50%. For daten.. see Instructions.) .. . . .. . . . . . . . .. . . . . . . . . .. . .. . .. . . . . . . . . .... .. . . .. . . 5 . 40. S Total ex......... Add lines 1 through 5. Enter here and on line 2001 Schedule A ~onn 11140). (F....basls state or Iocat QOWmment offtoiaIs, quaII1Ied perrol n ,ll,g _, and Indf ale WIth disabilities: .:U::'~ UIl:'"lIle1UU(,,-UUfltf iv. tfUt,uI;t'IIUitn:lUII Wlltllt:l1.V ttllU:1I uiltJ l:UIlVUlll.',. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i . I ~..}.L. -- Information on Your Vehicle. Complete this part only if you are oIalming vehiole expense on line 1. 7 When did you plaoe your vehlole In serllioe tor business use? (month, day, year) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ~ .9!11QJ1Q.Ol. 8 Of the total number of miles you drove your vehicle during 2003, enter the number of miles ~ou used your vehiole for: ._ass ____________lEQ bCommutlng ------_____Jl.QQ cOther _ ~ _____,.. _IL7EQ 8 Do you (or your spouse) have another vehlole aVa/lable for personal use? . . . . . . . . . . . .. . . . . . . . . . . . . . . .. i- Vea ~ No 10 Was l"ur vehiCle avaliable for personal use duMng oTr-dUlyhours? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . Y.. . No 11.00 you have eVidence to support your deduction? . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. ~ V.. ~. No b If 'Yes..' is the evidence ..-llIen.?.... .. .... .. .. .... ...... .. ..... .. _.. .... .. .. .... .. .. .. _ .. .. .. .. .. .. ..... .... . .. .. . .. .... ...... .. .. .. .... x: .Y.. .110 BAA For P.p_OIIl Reduction Act Notice, lee oeparate Inatnlctlona. Form 21OS-EZ (2003) FDtA750t 0M:I71M Schedule A .' Lines 20, 22, .27 Miscellaneous Itemized DeduttioOisStatemellt 2003 ~ Attach to return (afteraIlIRS-fornlS) \ _ Statement '.~ i. :.; ,. rS~~1 secunWNutn)' Name(S)S~w~ on Return MARY ANN SHUTTY Employee Business Expenses - Subject to 2% LimitatIon 1 DeqUClibie expenses from Form 2106, line 10 less deductions for ) -- performlng artists and hendlcapped employees claimed elsewhere. . . . . . . . . . . 1 3a1.00 2,' -Excess. educator expenses from the Educator Expenses Worksheet. . . . . . . . . . 2 3 Union and professional dUes. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Professional subscriptions. . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 Uniforms and protective clothing. . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 j 6 6 Job search costs. . . . . . . . . . . . . _ . . . . . . . . /: . . . . . . . . . . . . . . . . . . . . . . 7 Other: ',,:' , 1-- , , 8 Combine lines 1 through 7 (to Schedule A, line 20) . . . . . . . . . . . . . . . . . . . . . . 8 351. 00 MIscellaneous Expenses - Subject to 2% LimitatIon Inve,stment + Check the box In Investment columf11t 8n Investment expense exp'~nse 9 Depreciation and amortization deductions. . . . . . . . . . . . . . . . . . . . ..... X 9 10 Casualtyllheft losses of property used In services as an employee. . . '-"'- 10 " .-.. - t1 REMIC expenses, from Schedule E. . . . . . . . . . . . . . . . . . . . . . . . "... . .1L t1 12 Investment expenses related to interest and dividend income. . . . . . , .... .1L 12 t3 Expenses related to portfolio income, from Schedule(s) K-l . . . . . . . , -, .. .1L 13 t4 Miscellaneous deductions, from Schedule(s) K.l. . . . . . . . , . . . . . . . . . . . - 14 t5 Excess deductions on termination, from Schedule(s) K-l . . . . . . . . . . . . . . X 15 16 Investment counsel and advisory fees ........................... 16 17 Certain atlorneyand accounting fees. ... . .. ... . . ...... .. ... ..... -=- 17 12,634.00 ~ 18 Safe deposit box rental fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 18 f9 IRA custodialfees . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 19 20 Loss Incurred frorr)'total'd1strlbutionofalHrad~ional'IRAs. . . . . . . . . . . . . . I-- 20 21 Loss incurred from total distribution of all Roth I RAs . . . . . . . . . . . . . . . . . I-- 21 22 Tax preparation software and tax publications. . . . . . . . . . . . . . . . . . . . . , I....- 22 150.00 23 Other: - .-, 23 "- . ... ...... , ,-.'" J~I..... .' .- 24 iii" -..- 24 12,784.00 Combine lines 9 through 23 (to Schedule A, line . ._ . .. . "., ..... . .... . . . . Other Miscellaneous DeductIons - Not SubJectto."lmltatlon 25 Federal estate tax paid on decedenfs Income repc)rted on this return . . . . . . . . . 25 26 Impalrment.related expenses of a handicapped employee, from Form 2106. . . . . 26 27 Amortizable bond premiums on bonds acquired before 10/23/86. . . . . , . . . . . . . 27 28 Gambling losses. . . . . . . . , . . . . . . . . . . . . . , . . . . . . . . . . . . . . . '.. ..... 28 "29 {iasuallyllheftfosses-Ofinoome--producing-property. . . . . . . . . . . . . . ..', "..., 29 30 Other: 30 - ; - 31 Combine lines 25 - 30 (to Schedule A, line 27) . . . . . . . . . . . . . . . . . . . . . . . . . 31 '-~ J'I~. . ,-,(\ . 131 .804 Office of Financial Administration .u,Diocese of Harrisburg PO Box 3651 Harrisburg, Pennsylvania 17105 Phone (717) 657-4804 Fax (717) 657.8757 Period Ending 7/14/2004 Check Number 97.2659 Pay Date 7/2112004 Marital Status S Dependl3nts Ciaimed 04 Additionol Withholding .00 Federal .00 State REGULAR HOURS 80.00 REGULAR EARN 1075.50 Name MARY ANN SHUTTY Sac See # Current Year to Date UniVOeDt 131 804 GROSS PAY 1075.50 15858.46 FEDERAL WIH FICA TAX STATE TAX CITY TAX UCTAX NET PAY: 60.93 82.28 33.02 17.21 872.87 1213 .14 486.85 253.73 $882.06 Office of Financial Administration Diocese of Harrisburg PO Box 3651 Harrisburg, Pennsylvania 17105 Phone (717) 657-4804 Fax (717) 657-8757 60-1273/313 DATE CHECK NO. 7/21/2004 979659 PNC Bank, N. A. Southcentral PA TO THE ORDER OF: PAY *****882 'Do.",rs am[ 06 Cents $882.06 131 804 MARY ANN SHUTTY NON-NEGOTIABLE o c; ~ ...-..,) :r;.- -~ (~:- G':) \ a' :7':. :l q, -.\ ~"l~ ..,., n1 ;;.:-~ -r.l\:.~ ~ ':'.1 \....... '\"'-1(l.-) --j..:;-, "(')';;~}, (' ~~. ".~::"'. -c :::;;. r;-? .:.:-;-; L" cO o ", Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE NOTICE If you wish to deny any of the statements set forth in this affidavit, you must file a counter-affidavit within twenty days after this affidavit has been served on you or the statements will be admitted. AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated in or around October 2001 and have continued to live separate and apart for a period of at least two years. 2. The marriage 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. 9 4904 relating to unsworn falsification to authorities. f\{a Mary An Date: November , \ ,2004 2 -;1 ,\ \,,' --:" o C'- .. 1'--) c:."'.l C.;:l .C'. (...) 'j '( .-1 .....,-< ....,.,. S~~ N -n. ~~ <X\ en w o c,) c r-.;> t;.- .~J , ., J..-:- ,-. , .J -i1 '-- } ",",-Ii': n.J ~- :~ : I ,,._ -;'''1' I . --; r--' \ I ; } N :r:-_l :::~ ~ -. ; I C) :..f -( Ul Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in divorce under S 3301(c) of the Divorce Code was filed on October 31, 2001. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. S 4904, relating to unsworn falsification to authorities. ~~ Date: November 1\ ,2004 r.... --' Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233.3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY: Defendant CIVIL ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 9 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. 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: November ---11-,2004 lio' /1\{A~~ Mary ~~hutty MARY ANN SHUTTY, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 01 - 6237 CIVIL ROBERT M. SHUTTY, Defendant IN DIVORCE ORDER OF COURT /4 tP1. I tL da y 0 f ~~ AND NOW, this 2004, the parties and counsel having ent.ered into an agreement and stipulation resolving the economic issues on November 18, 2004, the date set for a Master's hearing, the agreement and stipulation having been transcribed, and subsequently signed by the parties and counsel, the appointment of the Master is vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, P.J. cc: ~eresa Barrett Male Attorney for Plaintiff )~ ~,o4 \,..\V ~obert M. Shutty Defendant ,\.Ll:"i' - ,\,-,:-, ""J E.., - -' Jv : (:: " ! " , ~ 1 rJ G ti C~.,~ }"jQDZ "'" If l~ _,\,._.... ~i~~:t:.~C)-UJ.ll~.: MARY ANN SHUTTY, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 01 - 6237 CIVIL ROBERT M. SHUTTY, Defendant IN DIVORCE THE MASTER: Today is Thursday, November 18, 2004. This is the date set for a hearing in the above captioned divorce proceedings. Present in the hearing room are the Plaintiff, Mary Ann Shutty, and her counsel Theresa Barrett Male, and the Defendant, Robert M. Shutty. Mr. Shutty is not represented by counsel. This action was commenced by the filing of a divorce complaint on October 31, 2001, raising grounds for divorce of irretrievable breakdown of the marriage. Mrs. Shutty filed her affidavit and waiver with the Prothonotary on November 12, 2004; Mr. Shutty has qiven the Master a signed affidavit of consent and waiver of notice of intention to request entry of divorce decree dated today which will be filed with the Prothonotary by the Master's office. Therefore, the divorce can bE~ concluded under Section 3301(c) of the Domestic Relations Code. The complaint also raised economic claims of equitable distribution, alimony, and counsel fees and expenses. The parties were married on July 23, 1977, 1 and separated on October 3, 2001. They are the natural parents of one child who is emancipated. After discussion this morning, the parties have reached an agreement with respect to the outstanding economic issues. The agreement is going to be placed on the record in the presence of the parties. The agreement as placed on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. The parties will return later today to review the agreement, make any typographical corrections as required and then affix their signatures affirming the terms of settlement as stated on the record. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment and counsel for wife can then file a praecipe with the Court requesting a final dec~ee in divorce. Mr. Shutty, would you give us your address? MR. SHUTTY: 608 Plaza Apartments, Lebanon, Pennsylvania 17042. THE MASTER: Mrs. Shut~y, do you have an address for the record? MS. MALE: We prefer not to disclose her address at this point. 2 THE MASTER: That is fine. Ms. Male, do you want to proceed with the statement of the agreement on the record? MS. MALE: Yes. Thank you, Mr. Elicker. 1. The parties have agreed that the National Vision Administrator's 401(k) plan, which has an account balance as of today's date of $20,342.83 will be awarded in its entirety to wife. We anticipate doing this by a Domestic Relations Order which wife will be responsible for preparing and submitting to the plan administrator. Mr. Shutty will cooperate in signing any documents necessary to effectuate the transfer. It is further understood that the transfer will be free of any tax consequences unless Mrs. Shutty decides to withdraw the funds which will then be her responsibility for penalty and taxes. 2. Mr. Shutty has agreed to pay as alimony to Mrs. Shutty the sum of $750.00 per month for a period of 36 months. This alimony obligation will begin 60 days after the date on which Mr. Shutty secures employment as a pharmacist earning $30.00 an hour or more. These payments will be treated as alimony for federal income tax purposes. Mr. Shutty will make the payments directly to Mrs. Shutty through her counsel. The payments are nonmodifiable. The alimony obligation will terminate upon the death of either party. It will not terminate on wife's cohabitation or remarriage. 3. Mr. Shutty has agreed to pay the sum of $2,000.00 as counsel fees towards Mrs. Shutty's at~orney fees incurred during this divorce proceeding. He agrees to make that payment within 6 months of his securing employment as a pharmacist earning $30.00 an hour or more. He will make the payment or payments directly to wifels counsel. In order to implement the award of counsel fees and the alimony award, Mr. Shutty has agreed to contact wife's attorney when he secures the employment that we have just discussed. Concurrently with entry of the divorce decree, Mrs. Shutty will withdraw with prejudice the support action currently pending in the Domestic Relations section. The arrears to stand subject to any further settlement between the parties either privately or through the Domestic Relations section. 4. Prior to today's proceedings, Mr. Shutty sold a 1990 Hyundai. He will retain the $500.00 proceeds which he received from that. Mrs. Shutty traded in a 1994 Suzuki. 3 She received $1,000.00 as a trade-in value. She will retain that. Mrs. Shutty will retain without any claim by Mr. Shutty the proceeds she received from the sale of the former marital residence which had been deeded from Mr. Shutty to Mrs. Shutty prior to the appointment of the Master. Mr. Shutty will retain without claim by Mrs. Shutty the proceeds he previously had received from the 401(k) plan through National Vision Administrators. 5. Prior to today's proceedings, the parties divided the personal property within the home to their mutual satisfaction and neither party will make any claim with respect to any of those items of personal property. (An off the record discussion was held.) The parties had an agreement off the record regarding some personal property items that Mr. Shutty has an interest in securing. Mrs. Shutty has acknowledged that some items may be in storage from after the house was sold. She will use her best efforts to investigate the contents of storage unit and any and all items that belong to Mr. Shutty, such as books or CDs, CD player, musical instruments or their cases and accessories, Mrs. Shutty will make available to her counsel for delivery to Mr. Shutty. 6. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. 7. If there are any documents which need to be signed to implement the equitable distribution award or the counsel fee or alimony award, both parties will do so within ten days of the request. Specifically if there are any documents that Mr. Shutty may need to execute he will do so within ten days of my requesting him do so. 4 THE MASTER: Mr. Shutty, have you present during the statements on the record? MR. SHUTTY: Yes. THE MASTER: Do you understand the agreement as stated on the record? MR. SHUTTY: Yes. THE MASTER: Do you have any questions about it? MR. SHUTTY: No, except for what we have to talk about, my personal property. THE MASTER: Right. We will do that after we complete the statement on the record. You and Ms. Male can talk about some of those items. Are you satisfied to have this agreement entered as an agreement to resolve all of the economic claims in the divorce action? MR. SHUTTY: Yes. MS. MALE: Mrs. Shutty, have you been present during the recitation of the agreement that we just placed on the record? MRS. SHUTTY: Yes. MS. MALE: Do you understand the agreement as I have stated it? MRS. SHUTTY: Yes. MS. MALE: Do you agree with its terms? 5 MRS. SHUTTY: Yes. MS. MALE: Are you willing to be bound by the agreement that we have reached here today? MRS. SHUTTY: Yes. MS. MALE: Do you understand that once we have this agreement on the record neither one of you will be able to litigate this matter any further - the divorce action, I mean? MRS. SHUTTY: I have one question (An off the record discussion was held.) MRS. SHUTTY: Yes. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: ~~4wr}~ 1//IU.f Theresa Barrett Male ' I ' Attorney for Plaintiff fL.~~~~ ~ 1//I~(Of . ROb~~ 6 /....) '....) .'- ::;: -":''': ' ., r<. ;1 I en Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire,com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Pia i ntiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in divorce under !l 3301(c) of the Divorce Code was filed on October 31,2001. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. !l 4904, relating to unsworn falsification to authorities. ~~{~ Mary n Shutty Date: November 1\ ,2004 [.-.:.1 . I . -- ~ f",' . . Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY: Defendant CIVIL ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER S 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to rne immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. !l 4904 relating to unsworn falsification to authorities. Date: November /I ,2004 ( A ~ ,[ 9 'i,~'. , Mary n Shutty Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civii Term ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in divorce under S 3301(c) of the Divorce Code was filed on October 31, 2001. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. !l 4904, relating to unsworn falsification to authorities. Date: November /4; @,.-!ke~gJ~i Robert M. Shutty ,2004 Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire,com Counsel for Plaintiff COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY: Defendant CIVIL ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER S 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. !3 4904 relating to unsworn falsification to authorities. Date: November 1'i3 ,2004 ?~-I"~ Robert M. Shutty o c ..... Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Term ROBERT M. SHUTTY 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. Ground for divorce: irretrievable breakdown under !l (3301(c)) (3301(d)(1)) of the Divorce Code. (Strike out inapplicable section). 2. Date and manner of service of the complaint: Personal service on 11/01/01 per the affidavit of service filed of record. 3. Complete either paragraph (a) or (b). (a) Date of execution of the affidavit of consent required by !l 3301(c) of the Divorce Code: by plaintiff: 11/11/04; by defendant: 11/18/04. . - (b)(l) Date of execution of the affidavit required by !l 3301(d) of the Divorce Code: N/A. (2) Date of filing and service of the plaintiff's affidavit upon the respondent: N/ A. 4. Related claims pending: All economic claims raised of record are resolved by the agreement reached by the parties before Divorce Master E. Robert Elicker, II, Esquire on 11/18/04. 5. Complete either (a) or (b). (a) Date and manner of service of the notice of intention to file praecipe a copy of which is attached: N/A. (b) Date plaintiffs Waiver of Notice was filed with the prothonotary: 11/12/04. Date defendant's Waiver of Notice was filed with the prothonotary: 11/18/04. !l4/<-/5~)~L Counsel for Plaintiff Date: November 23, 2004 2 r-..;.... \' ',<~ ---; ..0 ./ '"'\ {,.I"'.i ?~~~~~~~~~~~~~+.~~+.~+.~~~~+.~~~+.~~~+.+.+~+.~+~+~~+~~~~~+++~++~~++++.~+++~+~~~~+~+~~+.~ , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . , , , . , . . , . , . . . . , , , . . . . . . . . , . , , . . . . , . . . , , . , . , . , . . . . , . , . , . . . , . . . . . . . . . . . . . . , , , , , . . . . . . . . . . . . . + + + + + . + , + + + + + , . + + + + + . . + + + + + . + , + + + + + + + + + . + + + , + . . + + + , + + + + + + + . + + + + + + + + . + - + ~~~~~~+.+++~~+~++~~~+~~++~~++.~~+~+~+.++.~+.+~+~~++++.++~~+~~~++~ IN THE COURT OF COMMON PLEAS OFCUMBERLANDCOUNTY ~"~' STATE OF ~'" -~ ',' *,'i.'i t~...c. ;\; ;' .". ':*~~:;"~t '. -, ,';,;::,~;c!t!Jf'>" ' MARY ANN SHUTTY No. Plaintiff VERSUS ROBERT M. SHUTTY Defendant DECREE IN DIVORCE AND NOW, ~).ti~ 70 DECREED THAT Mary Ann Shutty Robert M. Shutty AND ARE DIVORCED FROM THE BONDS OF MATRIMONY, PEN NA. 6237 Civil 2001 2004 , IT IS ORDERED AND , PLAINTIIOF, , DEFENDANT, THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN YET BEEN ENTERED; rJo~ THIS ACTION FOR WHICH A FINAL ORDER HAS NOT All economic claims raised of record are resolved by the agreement reached by the parties at the November 18, 2004 Master's Hearing. A true and correct copy of the transcript of ..// I J By THE COURT: / i,,/ proceedings is att<>chE'rl "" Fxhihit 1 PROTHONOTARY J, _ A:7 z r"'r7Y,>/ ~q/-, ~_fr;r ~. /}!pP'# ~?-r-;P . . .J ~. .. ~I I. /J{;/ [' 0' /?{/" " "".'- (.. c! Exhibit 1 MARY ANN SHUTTY, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 01 - 6237 CIVIL ROBERT M. SHUTTY, Defendant IN DIVORCE THE MASTER: Today is Thursday, November 18, 2004. This is the date set for a hearing in the above captioned divorce proceedings. Present in the hearing room are the Plaintiff, Mary Ann Shutty, and her counsel Theresa Barrett Male, and the Defendant, Robert M. Shutty. Mr. Shutty is not represented by counsel. This action was commenced by the filing of a divorce complaint on October 31, 2001, raising grounds for divorce of irretrievable breakdown of the marriage. Mrs. Shutty filed her affidavit and waiver with the Prothonotary on November 12, 2004; Mr. Shutty has given the Master a signed affidavit of consent and waiver of notice of intention to request entry of divorce decree dated today which will be filed with the Prothonotary by the Master's office. Therefore, the divorce can be concluded under Section 3301(c) of the Domestic Relations Code. The complaint also raised economic claims of equitable distribution, alimony, and counsel fees and expenses. The parties were married on July 23, 1977, 1 and separated on October 3, 2001. They are the natural parents of one child who is emancipated. After discussion this morning, the parties have reached an agreement with respect to the outstanding economic issues. The agreement is going to be placed on the record in the presence of the parties. The agreement as placed on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. The parties will return later today to review the agreement, make any typographical corrections as required and then affix their signatures affirming the terms of settlement as stated on the record. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment and counsel for wife can then file a praecipe with the Court requesting a final decree in divorce. Mr. Shutty, would you give us your address? MR. SHUTTY: 608 Plaza Apartments, Lebanon, Pennsylvania 17042. THE MASTER: Mrs. Shutty, do you have an address for the record? MS. MALE: We prefer not to disclose her address at this point. 2 THE MASTER: That is fine. Ms. Male, do you want to proceed with the statement of the agreement on the record? MS. MALE: Yes. Thank you, Mr. Elicker. 1. The parties have agreed that the National Vision Administrator's 401(k) plan, which has an account balance as of today's date of $20,342.83 will be awarded in its entirety to wife. We anticipate doing this by a Domestic Relations Order which wife will be responsible for preparing and submitting to the plan administrator. Mr. Shutty will cooperate in signing any documents necessary to effectuate the transfer. It is further understood that the transfer will be free of any tax consequences unless Mrs. Shutty decides to withdraw the funds which will then be her responsibility for penalty and taxes. 2. Mr. Shutty has agreed to pay as alimony to Mrs. Shutty the sum of $750.00 per month for a period of 36 months. This alimony obligation will begin 60 days after the date on which Mr. Shutty secures employment as a pharmacist earning $30.00 an hour or more. These payments will be treated as alimony for federal income tax purposes. Mr. Shutty will make the payments directly to Mrs. Shutty through her counsel. The payments are nonmodifiable. The alimony obligation will terminate upon the death of either party. It will not terminate on wife's cohabitation or remarriage. 3. Mr. Shutty has agreed to pay the sum of $2,000.00 as counsel fees towards Mrs. Shutty's attorney fees incurred during this divorce proceeding. He agrees to make that payment within 6 months of his securing employment as a pharmacist earning $30.00 an hour or more. He will make the payment or payments directly to wife's counsel. In order to implement the award of counsel fees and the alimony award, Mr. Shutty has agreed to contact wife's attorney when he secures the employment that we have just discussed. Concurrently with entry of the divorce decree, Mrs. Shutty will withdraw with prejudice the support action currently pending in the Domestic Relations section. The arrears to stand subject to any further settlement between the parties either privately or through the Domestic Relations section. 4. Prior to today's proceedings, Mr. Shutty sold a 1990 Hyundai. He will retain the $500.00 proceeds which he received from that. Mrs. Shutty traded in a 1994 Suzuki. 3 She received $1,000.00 as a trade-in value. that. She will retain Mrs. Shutty will retain without any claim by Mr. Shutty the proceeds she received from the sale of the former marital residence which had been deeded from Mr. Shutty to Mrs. Shutty prior to the appointment of the Master. Mr. Shutty will retain without claim by Mrs. Shutty the proceeds he previously had received from the 40l(k) plan through National Vision Administrators. 5. Prior to today's proceedings, the parties divided the personal property within the home to their mutual satisfaction and neither party will make any claim with respect to any of those items of personal property. (An off the record discussion was held.) The parties had an agreement off the record regarding some personal property items that Mr. Shutty has an interest in securing. Mrs. Shutty has acknowledged that some items may be in storage from after the house was sold. She will use her best efforts to investigate the contents of storage unit and any and all items that belong to Mr. Shutty, such as books or CDs, CD player, musical instruments or their cases and accessories, Mrs. Shutty will make available to her counsel for delivery to Mr. Shutty. 6. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. 7. If there are any documents which need to be signed to implement the equitable distribution award or the counsel fee or alimony award, both parties will do so within ten days of the request. Specifically if there are any documents that Mr. Shutty may need to execute he will do so within ten days of my requesting him do so. 4 THE MASTER: Mr. Shutty, have you present during the statements on the record? MR. SHUTTY: Yes. THE MASTER: Do you understand the agreement as stated on the record? MR. SHUTTY: Yes. THE MASTER: Do you have any questions about it? MR. SHUTTY: No, except for what we have to talk about, my personal property. THE MASTER: Right. We will do that after we complete the statement on the record. You and Ms. Male can talk about some of those items. Are you satisfied to have this agreement entered as an agreement to resolve all of the economic claims in the divorce action? MR. SHUTTY: Yes. MS. MALE: Mrs. Shutty, have you been present during the recitation of the agreement that we just placed on the record? MRS. SHUTTY: Yes. MS. MALE: Do you understand the agreement as I have stated it? MRS. SHUTTY: Yes. MS. MALE: Do you agree with its terms? 5 MRS. SHUTTY: Yes. MS. MALE: Are you willing to be bound by the agreement that we have reached here today? MRS. SHUTTY: Yes. MS. MALE: Do you understand that once we have this agreement on the record neither one of you will be able to litigate this matter any further - the divorce action, I mean? MRS. SHUTTY: I have one question (An off the record discussion was held.) MRS. SHUTTY: Yes. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as ~ contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: Z=~4~1e~/~ Theresa Barrett ale Attorney for Plaintiff 1L/,~&utiC);u!~ !1)r/6 ( f I ~ II;le /0"( ~ 7Jv.~ Robert M. Shutty 6 r...) () C'~ _~';'" 1 ...r._ ~"'') , (.J) L" , i" .} DEe 1 ~ 2005 Theresa Barrett Male Supreme Court # 46439 513 North Second Street Harrisburg, PA 17101 (717) 233-3220 tbm@tbmesquire.com Counsel for Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MARY ANN SHUTTY Plaintiff v. NO. 01-6237 Civil Terrn ROBERT M. SHUTTY Defendant CIVIL ACTION - DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, December "?-O, 2005, it appearing to the Court that: 1. Plaintiff and Defendant were married on July 23, 1977 and were divorced decree of this Court on November 30, 2004. A copy of the decree, which incorporates by reference the parties' settlement agreement placed on the record before this Court's divorce master on November 18, 2004, is attached as Exhibit 1. 2. This is a Court of competent jurisdiction exercised in accordance with the laws of the Commonwealth of Pennsylvania. 3. At all times incident to this proceeding, the Court had jurisdiction over the parties. 4. Defendant ("Participant") is Robert M. Shutty, 608 Plaza Apartments, Lebanon, PA 17042 DOB: 03/29/52, SS #189-42-0639. The Participant shall be responsible for keeping the Plan Administrator apprised of his current address. 5. Plaintiff ("Alternate Payee") is Mary Ann Shutty, 73R Winter Lane, Enola, PA 17025, DOB: 08/20/56, SS #176-52-6717. The Alternate Payee shall be responsible for keeping the Plan Administrator apprised of her current address. 6. In this action, Plaintiff raised claims for, inter alia, equitable distribution of marital property pursuant to the Pennsylvania Divorce Code, 23 Pa. C.S.A. !l!l3101-3707. 7. This Order applies to benefits under the National Vision Administrators, LLC 401 (k) Plan ("Plan"). Changes in Plan Sponsor, Plan Administratol' or Plan Name shall not be deemed to affect any order. 8. This Order is intended to be a qualified domestic relations order ("QDRO"), as defined in section 206(d) of the Employee Retirement Income Security Act of 1974 ("ERISA") and section 414(p) of the Internal Revenue Code of 1986 ("Code"). This QDRO is granted in accordance with the Divorce Code, as amended, and applicable caselaw relating to marital property rights between spouses and former spouses in matrimonial actions. 2 9. The Participant assigns to the Alternate Payee one hundred percent (100%) in U.S. Dollars of the Participant's benefits from the Plan, and any successor or transferee plans will pay benefits to the Alternate Payee as provided in this Order; 10. The Plan will pay to the Alternate Payee one hundred percent (100%) of the Participant's vested accounts, which shall be segregated by the Plan Administrator for the benefit of the Alternate Payee upon receipt of this Order. The Alternate Payee shall be entitled to receive from the Plan the value of this segregated amount, as adjusted for all earnings thereon and all investment gains and/or losses thereon through the date of complete distribution. If the Alternate Payee elects, her benefits shall be paid to her as soon as administratively feasible following the date the Plan Administrator approves this Order as a QDRO, or at the earliest date perrnitted under the terms of the Plan or section 414(p) of the Internal Revenue Code, if later. Benefits will be payable to the Alternate Payee in any form or permissible option available to participants under the terrns of the Plan, including but not limited to a single lump-sum cash payment. The Participant shall not be entitled to any portion of his account. 11. Using the segregated amount provided in the preceding paragraph, the Plan will pay to the Alternate Payee benefits in accordance with the benefit distribution provisions of the Plan, with distribution to be made at any time upon the agreement and consent of the Plan Administrator and the Alternate Payee. Such distribution may be made immediately. Notwithstanding the foregoing, the Alternate Payee may elect, within the applicable period specified in section 402(c) of the Code, to make an eligible rollover distribution to an eligible 3 retirement plan designated by the Alternate Payee in writing to the Plan Administrator or may elect to make a direct trustee-to-trustee transfer to an eligible retirement plan so designated, in accordance with the provisions of section 401(a)(31) of the Code. 12. If the Alternate Payee dies before all the benefits to which she is entitled from the Plan are paid to her under this Order, the beneficiary shall be the Alternate Payee's estate. 13. The assignment of benefits to the Alternate Payee shall not be reduced, abated or terminated as a result of the death of the Participant. Upon the Participant's death, the Alternate Payee will be entitled to all survivor benefits attributable to the Participant's share of benefits under the Plan and the benefit set forth in paragraph 9 above. 14. The assignment of benefits under this Order does not require the Plan to provide any type or form of benefit, or any option, not otherwise provided under the Plan, to provide increased benefits determined on the basis of actuarial value, or to provide benefits to the Alternate Payee which are required to be paid to another alternate payee under another order previously determined to be a qualified domestic relations order. 15. The Participant, the Alternate Payee, and the Court intend this order to be a qualified domestic relations order as defined in section 206 of ERISA and section 414(p) of the Internal Revenue Code of 1986, as amended. The provisions of this Order are to be administered and interpreted in a manner consistent with such provisions. 4 16. After submission to the Plan Adrninistrator, if tl1is Order is held not to be a Qualified Domestic Relations Order as defined in section 206 of ERISA and section 414(p) of the Internal Revenue Code of 1986, as amended, this Court reserves jurisdiction to amend this Order to establish or rnaintain its status as a QDRO under ERISA and the Code. Modified Orders may be entered nunc pro tunc. No amendment or modification of this Order shall require the Plan to provide any type or form of benefit, or any option, not otherwise provided under such Plan. BY THE COURT: ( J. \-cp l\<):~ 5 >: a, ~- >:::;. ( . lll-=-"... ~€~':" t~b ,..t...c.. ti:l"'- ~L1J u..:r: l- '.L- a N ..::r ~ c- o ,,~ u w Cl Ln c-::::> C-~ ,,,, I..' '7 .:, :J () /~~~+.~~+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.+.++++.+.+++.+++++~++++++++++++++++++++++++++~ . . ; IN THE COURT OF COMMONPL ; OJ [T 1~1 or/ l~ II' I'U) ~ i~ If J \~ LS I \1\ ; llu DEe 0 6 2004 \~ ~ PENNA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OF CUMBERLAND COUNTY STATE OF MARY ANN SHUTTY . . . . . . . . . . . . . Pia i ntiff VERSUS ROBERT M. SHUTTY Defendant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . By No. 6237 Civil 2001 DECREE IN DIVORCE 2004 AND NOW, November30 ARE DIVORCED FROM THE BONDS OF MATRI MaNY. 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; J...!t'AlL All economic claims raised of record are resolved by the agreement reached by the parties at DECREED THAT AND --' IT IS ORDERED AND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +++++++++++++~++++++++++++~-+++++++++++++++++++++++++~ Mary Ann Shutty , PLAINTIFF, Robert M. Shutty DEFEN qANT, the November 18, 2004 Master'S Heanng. A true and correcl <':UfJY ur lI,t: lld""",il-'l of . . . . . . . . . . . . . . . . . . . . . . . +.+++++.++.+.++. +. By TH E COU RT: Edgar B. Bayley ATTEST: c~ Certified Copy Issued: December 3,2 . . . . . . . . . . J. Exhibit 1 MARY ANN SHUTTY, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 01 - 6237 CIVIL 2004. ~ () C:~:) -n .J:- -,i'" ..~ ;::~ \ CS ~ :J2 THE MASTER: Today is Thursday, Nov~I1Jl:ier;::%8, :ij21 This is the date set for a hearing in the a~6;~e ;;. '"~S ,~'::. t' .I .~'" ~a (") 'j; ~;; ~A' ~3 rn ~::3 0) -;n -.... (.0) -< IN DIVORCE ROBERT M. SHUTTY, Defendant captioned divorce proceedings. Present in the hearing room are the Plaintiff, Mary Ann Shutty, and her counsel Theresa Barrett Male, and the Defendant, Robert M. Shutty. Mr. Shutty is not represented by counsel. This action was commenced by the filing of a divorce complaint on October 31, 2001, raising grounds for di vorce of irretrievable breakdown of "the marriage. Mrs. Shutty filed her affidavit and waiver with the Prothonotary on November 12, 2004; Mr. Shutty has given the Master a signed affidavit of consent and waiver of notice of intention to request entry of divorce decree dated today which will be filed with the Prothonotary by the Master's office. Therefore, the divorce can be concluded under Section 3301(c) of the Domestic Relations Code. The complaint also raised economic claims of equitable distribution, alimony, and counsel fees and expenses. The parties were married on July 23, 1977, 1 and separated on October 3, 2001. They are the natural parents of one child who is emancipated. After discussion this morning, the parties have reached an agreement with respect to the outstanding economic issues. The agreement is go~ng to be placed on the record in the presence of the parties. The agreement as placed on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. The parties will return later today to review the agreement, make any typographical corrections as required and then affix their signatures affirming the terms of settlement as stated on the record. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment and counsel for wife can then file a praecipe with the Court requesting a final decree in divorce. Mr. Shutty, would you give us your address? MR. SHUTTY: 608 Plaza Apartments, Lebanon, Pennsylvania 17042. THE MASTER: Mrs. Shutty, do you have an address for the record? MS. MALE: We prefer not to disclose her address at this point. 2 THE MASTER: That is fine. Ms. Male, do you want to proceed with the statement of the agreement on the record? MS. MALE: Yes. Thank you, Mr. Elicker. 1. The parties have agreed that the National Vision Administrator's 40l(k) plan, which has an account balance as of today's date of $20,342.83 will be awarded in its entirety to wife. We anticipate doing this by a Domestic Relations Order which wife will be responsible for preparing and submitting to the plan administrator. Mr. Shutty will cooperate in signing any documents necessary to effectuate the transfer. It is further understood that the transfer will be free of any tax consequences unless Mrs. Shutty decides to withdraw the funds which will then be her responsibility for penalty and taxes. 2. Mr. Shutty has agreed to pay as alimony to Mrs. Shutty the sum of $750.00 per month for a period of 36 months. This alimony obligation will begin 60 days after the date on which Mr. Shutty secures employment as a pharmacist earning $30.00 an hour or more. These payments will be treated as alimony for federal income tax purposes. Mr. Shutty will make the payments directly to Mrs. Shutty through her counsel. The payments are nonmodifiable. The alimony obligation will terminate upon the death of either party. It will not terminate on wife's cohabitation or remarriage. 3. Mr. Shutty has agreed to pay the sum of $2,000.00 as counsel fees towards Mrs. Shutty's attorney fees incurred during this divorce proceeding. He agrees to make that payment within 6 months of his securing employment as a pharmacist earning $30.00 an hour or more. He will make the payment or payments directly to wife's counsel. In order to implement the award of counsel fees and the alimony award, Mr. Shutty has agreed to contact wife's attorney when he secures the employment that we have just discussed. Concurrently with entry of the divorce decree, Mrs. Shutty will withdraw with prejudice the support action currently pending in the Domestic Relations section. The arrears to stand subject to any further settlement between the parties either privately or through the Domestic Relations section. 4. Prior to today's proceedings, Mr. Shutty sold a 1990 Hyundai. He will retain the $500.00 proceeds which he received from that. Mrs. Shutty traded in a 1994 Suzuki. 'I She received $1,000.00 as a trade-in value. She will retain that. Mrs. Shutty will retain without any claim by Mr. Shutty the proceeds she received from the sale of the former marital residence which had been deeded from Mr. Shutty to Mrs. Shutty prior to the appointment of the Master. Mr. Shutty will retain without claim by Mrs. Shutty the proceeds he previously had received from the 40l(k) plan through National Vision Administrators. 5. Prior to today's proceedings, the parties divided the personal property within the home to their mutual satisfaction and neither party will make any claim with respect to any of those items of personal property. (An off the record discussion was held.) The parties had an agreement off the record regarding some personal property items that Mr. Shutty has an interest in securing. Mrs. Shutty has acknowledged that some items may be in storage from after the house was sold. She will use her best efforts to investigate the contents of storage unit and any and all items that belong to Mr. Shutty, such as books or CDs, CD player, musical instruments or their cases and accessories, Mrs. Shutty will make available to her counsel for delivery to Mr. Shutty. 6. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mLtual waiver and relinquishment of all such interest, rights, and claims. 7. If there are any documents which need to be signed to implement the equitable distribution award or the counsel fee or alimony award, both parties will do so within ten days of the request. Specifically if there are any documents that Mr. St'.utty may need to execute he will do 20 within ten days of my requesting him do so. 4 THE MASTER: Mr. Shutty, have you present during the statements on the record? MR. SHOTTY: Yes. THE MASTER: Do you understand the agreement as stated on the record? MR. SHOTTY: Yes. THE MASTER: Do you have any questions about it? MR. SHOTTY: No, excep-t for what we have to talk about, my personal property. THE MASTER: Right. We will do that after we complete the statement on the record. You and Ms. Male can talk about some of those items. Are you satisfied to have this agreement entered as an agreement to resolve all of the economic .claims in the divorce action? MR. SHUTTY: Yes. MS. MALE: Mrs. Shutty, have you been present during the recitation of the agreement that we just placed on the record? MRS. SHUTTY: Yes. MS. MALE: Do you understand the agreement as I have stated it? MRS. SHUTTY: Yes. MS. MALE: Do you agree with its terms? 5 MRS. SHUTTY: Yes. MS. MALE: Are you willing to be bound by the agreement that we have reached here today? MRS. SHUTTY: Yes. MS. MALE: Do you understand that once we have this agreement on the record neither one of you will be able to litigate this matter any further - the divorce action, I mean? MRS. SHUTTY: I have one question (An off the record discussion was held.) MRS. SHUTTY: Yes. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a, contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: )t~4't~~/~ Theresa Barrett ale Attorney for Plaintiff ;;/' ,'~ ' ftcU~f'-~w2t~L l/;rj6 <j / I ~ 1(;I~/o'1 ~ ;lJv. ~ Robert M. Shutty 6