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Home My WebLink About85-1730ROGER J. PERSIK, Petitioner v JULIA PERSIK, : Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION - LAW N0. 1730 CIVIL 19 ~~ IN DIVORCE COURT ORDER AND NOW this ;~/ day of November, 1997, upon consideration of the attached Petition for Modification of An Alimony Order, it is ordered and directed as follows: 1. A hearing is scheduled in Court Room No. 4 of the Cumberland County Court House on the ~ ~l ~ day of ~~ ,~'.~ ~~Yy D,~,J 199 ~ , at ~ %~(~ ,0, m. at which time testimony will be taken on the Petition of Roger J. Persik to terminate or modify the Alimony Order entered in this case. 2. Pursuant to Pennsylvania Rules of Civil Procedure 1920.22, either party may proceed with discovery in advance of the mentioned hearing date. 3. Counsel for the Petitioner shall accomplish service of this Court Order and the attached Petition upon the Respondent, Julia Persik. BY THE COURT: ~ ~L._- ~~ J Kevin A. ess cc: Hubert X. Gilroy, Esquire Julia Persik ~ .~? 730 Opposum Lake Road Carlisle, Pennsylvania ~!"! ~ i •'`~ F \1 ~ r ~ u ~. ..~ .. i .,i ~ .. .-. ~ . ..., ROGER J. PERSIK, IN THE COURT OF COMMON PLEAS OF Petitioner CUMBERLAND COUNTY, PENNSYLVANIA v CIVIL DIVISION - LAW JULIA PERSIK, NO. 1730 CIVIL X9'3'' Respondent f~j~'S IN DIVORCE PETITION TO MODIFY ALIMONY Petitioner, Roger J. Persik, by his attorneys, Broujos & Gilroy, P.C., sets forth the following: 1 Petitioner, Roger J. Persik, is the Defendant in the above action and is an adult individual residing at 209 East Yellow Breeches Road, Carlisle, Cumberland County, Pennsylvania. 2 Respondent, Julia Persik, is the Plaintiff in the above action and is an adult individual residing at 730 Opposum Lake Road, Carlisle, Cumberland County, Pennsylvania. 3 Petitioner and Respondent were previously husband and wife and were divorced by virtue of an Order entered at the above captioned term and number on December 11, 1987. A copy of said Order is attached hereto and marked Exhibit A. 4 By Order of Court in the above matter dated August 14, 1992, copy of which is attached hereto and marked Exhibit B, the Petitioner was to pay alimony to the Respondent in the amount of One Thousand Three Hundred Fifty and no/100 ($1,350.00) Dollars per month commencing August 1, 1992. 5 Since August of 1992, Petitioner has made all alimony payments as required by the mentioned Court Order. 6 At the time of the entry of the alimony order, Petitioner was employed full-time with F.W. Woolworth Company (Woolworths). 7 As a result of a reduction in force with Woolworths, Petitioner was recently terminated from his position at Woolworths. 8 The Petitioner's loss of his employment constitutes a changed circumstance of a substantial and continuing nature which merits a modification and/or termination of the alimony order. 9 Petitioner has had no contact with the Respondent since the mentioned alimony Order of August 1992 and there may be other circumstances that exist, which may be determined through discovery, that offer further justification to indicate that there are changed circumstances of a substantial and continuing nature which merit a termination or modification of the alimony order. 10 This Court has jurisdiction to modify or terminate an existing alimony order pursuant to 23 P.S. Section 3701(e). WHEREFORE, Petitioner requests your Honorable Court to schedule a hearing at which time testimony may be taken on Petitioner's request for termination or modification of the Alimony Order in this case. BROUJOS & GILROY, P.C. By HUBERT X. GILROY, squire Attorney for Peti Toner 4 North Hanover treet Carlisle, PA 17 13 717 - 243-4574 I verify that the statements in the foregoing pleading are true and correct. I understand that false statements herein are made subject to the penalties of 18 PaCS 49Q4 relating to unsworn falsification to authorities. 1 DAT RO ER' J. SIK i- ;, I N THE COURT OF COMMON PLEAS .. OF CUMBERLAND COUNTY :. STATE OF PENNA. ,~ ~ i JULIA PERSIK I ~ ;•; ........................................ .................................. l ,•, -------- Nc)..........1730.... S 19 85 >•: !~ • Versus II ~! i RQ.GAR.-.J.,..-.PE.RS.I.K ............ ................................... -,> ~~ _ ii ti r ~ ~'f ~.rt ~i i. i~ ~, ~~ DECREE IN r, :. DIVORCE V ' ~ Y. `' AND NOW, December 11 .. , 19 87.... , it is ordered and f; Y ...... • decreed that JULIA PERSIK , . , , .. plaintiff, ROGER J. PERSIK ~ ~: and ... .................. .defendant, y, are divorced from the bonds of matrimony. _ - - The court retains jurisdiction of the following claims which have been raised cf record in this action for which a final order has not yet ~. .• ::. been entered; .. Al~mnX Pendente, Lite, Alirr-~ny,,. Equitable Distribution,. , , , , , . , , , ....... Counsel, Fees, and,Costs....... ........ ......................... ; • ~ ,. t , ~~~ y IIy The Court: r /s/ Harold E. Sheely Attest: ~~ P.7~ j. ~ ~~ ,.. ~- ......... .. .. ,-roc ...:...... ............ .._.. Deputy Prothonotar Certified Copy issued Dec 17, 1987 EXHIBIT ~'~Gri, % t . . '~Qr:•: )415; ''41A.. i4R:•. `•SIt+. <-;~. •S~ . ti's . :,Ay: ~~ • . 'l/r:•. >ilE! ?CA •,:•:A • :•~- •' > ~ •. ; NO. 1730 Civil 1985 (B.F. from pg. 1006-A) Persik vs. Persik August 14, 1992, Order, filed. AND NOW, this 14th day of August, 1992, the matter of the plaint:iff's alleged contempt in this matter having been called for hearing, and counsel for the parties having previously acknowledged to the court that the within order should be entered to reflect the parties agreement in this case, IT IS HEREBY ORDERED AND DDCREED, that: 1. Defendant shall be permitted to remove the items of personal property listed on Exhibit "A", which is attached hereto and incorporated herein by reference, from plaintiff's residence on Saturday, August 15, 1992 at 9:30 a.m. 2. Plaintiff shall file to refinance her home and remove defendant from the home's current encumbrances, no later than July 15, 1992, and shall provide all necessary documentat and assistance to the refinancing institution so as to complete her refinancing within 60 days of this date. 3. Plaintiff shall pay to defendant the sum of four thousand nine hundred and xx/100 ($4900.00) dollars within sixty (60) days of this date, reflecting they one hundred and xx/100 ($100.00) dollars per month due from plaintiff to defendant for "rental" of the former marital residence from the date of the Master's Report (being June 28, 1988) to an including July 1992 rent. 4. Plaintiff shall pay to defendant the sum of sixteen thousand twc> hundred eighty three and 48/100 ($16283.42) dollars within sixty (60) days of this date, reflecting the ten thousand and xx/100 ($10000.00) dollars plus interest at the rate of twelve (120) percent per annum due from plaintiff to defendant pursuant to the Mast:er's Report confirmed in this action. 5. Defendant shall pay to the plaintiff the sum of fourteen thousand eight hundred sixty (60) days of this date, reflecting the difference between the monthly amount of alimony to be paid by defendant to plaintiff pursuant to the Master's report confirmed in this action ($1350.00 per rrpnth) and the total amounts paid by defendant to or on behalf of plaintiff since entry of the Master's Report. 6. Defendant shall pay to the plaintiff the sum of One Thousand Three Hundred fifty and xx/100 ($1350.00) dollars per month in alimony beginning August 1, 1992, and continuing each and every month thereafter until husbanbd's death, until wife's death, until cohabitatIo~ - - .. ... ,- , . --,-- -r -----~-- .~~ ~~y ROGER J. PERSIK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v CIVIL DIVISION - LAW JULIA PERSIK, NO. 1730 CIVIL 1-9.9~- l4 ~"'.S Defendant IN DIVORCE COURT ORDER AND NOW, this Z ~~ day of ftiG~~~ 1998, the hearing scheduled in the above referenced case for March 6, 1998, is cancelled and rescheduled to Monday, April 27, 1998, at 9:30 a.m. in Court Room No. 4. BY THE COURT, Kev' A. Hess cc: Hubert X. Gilroy, Esquire - ~ Sandra L. Meilton, Esquire ~ C~4`~<..~,~ '~"~"`~1'' ~~ '~ ~~ < ~ ,~" . ".~ .. r`~' .' ROGER J. PERSIK, Petitioner v. JULIA PERSIK, Respondent TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION -LAW NO. 1730 CIVIL 1985 IN DIVORCE PRAECIPE Please enter the appearance of Sandra L. Meilton, Esquire, and the law firm of Hepford, Swartz & Morgan, as attorneys for Respondent, Julia Persik, in the above matter. HEPFORD, SWARTZ & MORGAN By: ~ ~~ Sandra L. Meilton No. 32551 P.O. Box 8$9 Harrisburg, PA 17108 (717) 234-4121 Attorneys for Respondent DATED: December 16, 1997 CERTIFICATE OF SERVICE AND NOW, this day of ~ c ~~~G~ ~'~ , 1997, I, Gloria M. Rine, Legal Assistant to Sandra L. Meilton, Esquire, for the firm of Hepford, Swartz & Morgan, hereby certify that I have this day served a copy of the within document, by first class mail, postage prepaid, addressed as follows: Hubert X. Gilroy, Esquire 4 North Hanover Street Carlisle, PA 17013 ~ L Gloria M. Rine ~~ ~` `J c''~ ~~ ~~ ~, G HEPFORD SWARTZ & MORGAN LAw OFFICES 111 NoR~rI-I FRONT STREET PO. Box 889 HARRISBURG, PA 17108-0889 TELEPHONE 717-234-4121 FAx 717-232-6802 TOLL FREE 800-257121 EMAIL: hsandm@aol.com PLEASE RESPOND TO HARRISBURG OFFICE. To: SANDRA L. MEILTON April 29, 1998 The Honorable Kevin A. Hess Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-33897 RE: Persik v. Persik Dear Judge Hess: H. JOSEPH HEPFORD, P.C. LEE C. SWARTZ JAMES G. MORGAN, JR. SANDRA L. MEn.TON STEPHEN M. GREEa-IER, JR. DENN(S R. SHEAFFER RIQiARD A. ESCAQO ANNE M. RB;GLE ** $USAN M. SEIGHMAN STANLEY H. SIEGEL OF COUNSEL *C~xr~n AS A Clva TlttAt, AnvocAre sY ~ NnTioNAL Bogen of TeuL Anvocncr "'ADtYmTio ONLY AI ~..~ • Vl1L> This correspondence is to confirm the instructions given by your chambers regarding the admission of evidence at the hearing before your honor in the above matter on April 27, 1998. It is my understanding that you are considering the exhibits introduced by me on behalf of Plaintiff, Julia Persik, as moved and admitted into evidence, unless objected to by Hubert Gilroy on or before Friday, May 1, 1998. Very truly yours, HEPFORD, SWARTZ & MORGAN Sandra L. Meilton LEWLSTOWN OFFICES 12 SOUTH MAIN STREET P.O. Box 867 LEWISTOWN, PA 17044-0867 TELEPHONE 717-248-3913 SMS cc: Hubert X. Gilroy JULIA CATHERINE PERSIR, Plaintiff v. ROGER J. PERSIR, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA N0. 1730 S 1985 CIVIL ACTION - LAW IN DIVORCE NOTICE OF FILING MASTER'S REPORT NOTICE IS HEREBY GIVEN that the Report of Thomas J. Williams, Esquire, Master appointed in this matter, has this date been filed with the Prothonotary. Pursuant to R.C.P. 1920.55 you are notified that exceptions to said Report may be filed within ten (10) days from the date set forth herein. If no exceptions are filed within said period, the same shall be submitted to the Court for review and consideration of the entry of a final decree . Dated : June Z $ , 19 8 8 COPIES T0: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Ronald Turo, Esquire GRIFFIE, TURD & GRELL 200 North Hanover Street Carlisle, PA 17013 MARTSON, DEARDORFF, WILLIAMS & OTTO Thomas J. W' liams, Esquire Ten East H' h Street Carlisle, PA 17013 (717) 243-3341 LAW OFFICES - M.4RT50~. pEARDORFF, aL'ILLIAMti X OTT( JTJLIA CATHERINE PERSIR, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. N0. 1730 S 1985 CIVIL ACTION - LAW ROGER J. PERSIR, . Defendant IN DIVORCE MASTER'S REPORT Findincrs of Fact 1. The Plaintiff, Julia Catherine Persik, is presently age forty-seven (47), having been born November 17, 1940 in Brooklyn, New York. She presently resides at the marital home, R.D.#9, Box 205, Carlisle, Pennsylvania, and has been a bona fide resident of the Commonwealth of Pennsylvania for a period in excess of twenty (20) years, and of the County of Cumberland for a period in excess of eight years. 2. The Defendant, Roger J. Persik, is presently forty- eight (48) years of age, having been born May 14, 1939 in the state of Wisconsin. He presently resides at 430 Quaker State Road, York Springs, Adams County, Pennsylvania, and has done so since the separation of June 7, 1985. Previously he resided at the marital home described in paragraph 1, above. 3. The parties were married February 19, 1960 in Elizabeth City, North Carolina. It was the first marriage for both. Wife's maiden name was Urgola. 4. The parties lived together as husband and wife approximately twenty-five (25) years until they separated on June 7, 1985. LAW nFFICF,ti-M4RTSt1N. DF.ARD(1RFF. WILLIAMti ft (1TT(l 5. Five children were born of the marriage: Catherine, Regina, age 27; Christine Suzanne, age 26; Deborah Lynn, age 23; Raymond Charles, age 21; and Sandra Elizabeth, age 18. All of the children are emancipated except Deborah Lynn who is disabled due to mental retardation, epilepsy and cerebral palsy. Deborah Lynn has been institutionalized and receiving SSI benefits since age ten. She is presently living in an Adult Group Home, but spends time during vacations, holidays and summers with the wife who is responsible for her care. 6. The parties were divorced December 11, 1987 by Decree to the above term and number, which Decree reserved jurisdiction over the claims of equitable distribution, alimony, alimony pendante lite, counsel fees and costs. 7. Wife graduated from high school in 1958 with a business curriculum. She is currently unemployed, and has not ~ i had permanent, full time employment during the marriage. Her primary career during the marriage has been as homemaker, although she has occasionally taken temporary employment. She has no education or training since graduating from high school in 1958. 8. Husband is a high school graduate. He is currently employed as a systems analyst for Kinney Service Corp., a division of F. W. Woolworth Co., and has been so employed since January 1, 1958, a total of approximately thirty (30) years. He presently earns a salary of $48,500.00 per year, payable monthly LAW OFFICES - MARTS(l~, DF,ARD~~RFF. WILLIAMS LE OTTO in the amount of $4,041.67. After deduction of $1,076.61 for taxes, husband's net pay is $2,965.06 per month. The Master finds this sum, to be his present earning capacity. In addition Husband receives VA disability benefits in the amount of $29.21 per month. This is in connection with anyinjury he received in military service following high school and before his present employment with Rinney Service Corp. 9. Wife is disabled due to various medical conditions including: underactive thyroid, tachycardia, conductive hearing loss (a permanent, hereditary condition due to damaged nerves), and chronic back problems. The back problems originated in 1969 as a result of a broken back suffered when she was assaulted by Husband. The cause of Wife's present disability, however, is an auto accident occurring after the separation on July 20, 1985 which markedly exacerbated her prior problems and resulted in three hospitalizations. The Master adopts the conclusion of Douglas R. Sanderson, M.D. in his report dated January 8, 1987 (Plaintiff's Exhibit 14) that Wife is disabled from pursing normal housewife activities and from pursuit of even part-time, very sedentary employment, and that this will continue for an indefinite period of time, perhaps permanently. Accordingly, the Master finds as a fact that the Wife's earning capacity at the present time is zero. As she has no employment history, she is not entitled to, and does not receive, social security. LAW OFFICES - MARTSON, DF.ARDORFF, R'ILLIAMti 3 OTTO 10. Prior to the separation, Husband committed several assaults upon the person of the Wife that constitute marital misconduct within the definition of Section 501(b)(14) of the Divorce Code. The Master specifically finds that this misconduct led directly to the separation.+ i 11. Husband is in apparent good health with no apparent ~ physical disabilities. 12. The parties have no source of income other than Husband's salary and VA benefits. 13. Neither party has any expectancy of a substantial inheritance. 14. Prior to the separation, the parties enjoyed a standard of living commensurate with Husband's income. Husband began working for his present employer as a shoe salesman earning $4,200.00 per year. His income has steadily risen since that time, and the parties standard of living reflected the increases in that income. There are no substantial savings. 15. Neither party brought any substantial property into the marriage. 16. By Order dated December 4, 1987 (entered by stipulation of the parties) Husband is required to pay alimony pendante lite in the amount of $420.00 a month plus current payments on the mortgage for the marital house in the approximate amount of $650.00 per month. He had also been LAW OFFICES-MARTSOK, DEARDORFF. WILLIAMS d OTTO paying $60.00 per month in child support for Sandra Elizabeth who is now emancipated. 17. The following marital property is subject to equitable distribution: a. The marital home, presently in the possession of Wife. a This is an eleven room, approximately 86 year old restored farm house situate on approximately two and a half acres in Lower Frankford Township, Cumberland County, Pennsylvania. On June 7, 1985, the date of separation, the said property had a fair market value of $90,000.00 and a mortgage balance of $32,133.58, resulting in a net equity of $58,860.42. The Master finds that the date of the separation is the best valuation date for the marital home, and, therefore, finds that the marital home net ~ equity of $58,860.42 as of that date is marital property, subject to equitable distribution. b. The value of Husband's pension, as of the date of separation, June 7, 1985, was $19,601.40. This was determined through interpolation from the dates and amounts provided on Defendant's Exhibit 1. The Master specifically rejects the Wife's contention that the value of Husband's pension should include anticipated increases in value until Husband attains the age of 65 on May 14, 2004. The Master does accept the coverture fraction of 92~ as asserted in Plaintiff's Exhibit 2. Accordingly, the value of Husband's pension plan that is marital property subject to equitable distribution is $18,033.28. LAQ' OFFICES-MARTSON, DF.ARDnRFF, wILUAMS R OTTO c. The following items of miscellaneous personal property were marital property subject to equitable distribution as of the date of separation, June 5, 1985, with the values indicated: 1. farm tractor: $4,000.00 2. Dodge pickup: 1,800.00 3. Dodge Dart: 1,230.50 4. contents of outbuildings: 2,000.00 ~-- $9,030.50 5. Case tractor: 6. Chevrolet Cavalier: 7. cemetery plots: 8. PSA stock: 9. Woolworth stock: 10. gold and silver coins: 11. York Federal accounts: 12. CCNB accounts: 500.00 3,700.00 500.00 1,254.00 4,295.89 320.00 712.30 431.42 12. contents of marital residence: TOTAL PERSONAL PROPERTY $11,713.61 35,000.00 $55,744.11 18. Both parties contributed equally to the acquisition of the marital property, Husband through his income and Wife through her services as homemaker; except that Husband contributed approximately $30,000.00 that he received as an inheritance from his father toward the renovations to the marital home. 19. Neither party contends that the chose-in-action created by Wife's automobile accident on July 20, 1985 is I~ marital property, nor has either party attempted to establish a value thereof. The Master finds that this is Wife's separate LAW OFFICEti - MART50~, DEARDORFF, WILLUMS d OTTO property since it occurred after the date of separation, June 5, 1985. 20. Wife would have been able to work full time at minimum wage had it not been for the injuries she suffered from the accident of July 20, 1985. (Dr. Sandersq~'s report, July 10, 1985, contained in Plaintiff's Exhibit 14.) The Master accepts as credible Husband's testimony that Wife was not disabled from normal activities and employment prior to the date of ~ separation, June 5, 1985. On the date of separation, the minimum wage for full time employment was $134.00 per week. 21. Husband has minimal opportunity for the future acquisition of capital assets and income. Wife's opportunity is none. 22. wife lacks sufficient property, including property recommended to be distributed to her pursuant to this action, to provide for her reasonable needs and is unable to support herself through appropriate employment at this time. 23. Wife incurred counsel fees and costs in connection with this divorce action in the amount of $8,773.47 which amount is found to be fair, reasonable and necessary, and accurately represents the scope, nature and value of the work performed by Wife's counsel. 24. The following, remaining, unsecured marital debts are still outstanding: LAW OFFICES - MARTSOK, DE.4RDORFF, WILLIAMS & OTTO Creditor Amount Purpose Diane G. Radcliff, Esq. $1,228.17 legal services perform in connection with arbitration/magistrate hearing pertaining to the sale of the parties' real estate Orthodontist 2,000.00 Sandra Elizabeth DAFCU 500.00 joint debts Gene Paulus 500.00 cabinet work VISA 500.00 joint debts $2,728.17 Conclusions of Law and Recommendations: 1. Wife shall become sole owner of the marital property described in paragraph 17(c) lines 1 through 4 of the Findings of Fact, having a value of $9,030.50. 2. Husband shall become the sole owner of the marital property described in paragraph 17(c) lines 5 through 12 of the Findings of Fact, having a value of $11,713.61. 3. Each of the parties shall become sole owners of the household contents presently in their possession. The value of said contents previously distributed to Wife is $29,000.00, and the value to Husband is $6,000.00. (See Stipulation previously filed.) 4. Husband shall become sole owner of his pension plan at Kinney Service Corp., having a value of $18,033.28. LAW OFFICES-MARTSON. DEARDORFF, WILLIAMS d OTTO 5. Wife shall become sole owner of the marital home described in paragraph 17(a), having a value of $58,860.24; subject, however, to the payment to Husband of the sum of $10,000.00 as hereinafter provided. If Wife elects to take title to the property she shall make said payment concurrently therewith. Alternatively, Wife may substitute a mortgage and bond for all or any part of the said payment, which shall be amortized monthly over a period of not more than ten (10) years at a rate of twelve percent (12$) per annum. Upon tender of such payment and/or mortgage, Husband shall execute and deliver to Wife a general warranty deed of the marital real estate in the usual form. Wife shall thereupon become the sole owner of I: said real estate, having a value of $58,860.24. Until such transfer of title, Wife shall pay to Husband the sum of $100.00 per month as his share of the fair rental value of the property w$ich~4bliga~on shall continue so~'long_as Wife has an ownership interest'~~the ~r.operty. The rights and obligations in this paragraph shall not be affected by the death of either party, and their respective estates shall be fully substituted in that event. 6. It is the intention of the above distribution to award Wife approximately sixty-five percent (65$) and Husband approximately thirty-five percent (35$) of the marital property as described in paragraph 17 as follows: LA~V OFFICES - MARTSO\, DEARDORFF, WILL-AMS & OTTO Description. Husband Wife Marital residence $10,000.00 $48,860.42 Pension $18,033.28 -0- Miscellaneous personal $11,713.61 $ 9,030.50 Contents of residence $ 6,000.00 $29,000.00 Totals $45,713.89 $86,890.92 34.5$ 65.5 7. Wife is entitled to indefinite alimony. The Master finds that the sum of $1,350.00 per month is adequate and reasonable, and that is his recommendation. It is also recommended that Husband have the right to use any payments made pursuant to paragraph 5 as a set off or credit in lieu of the actual payment being made to Husband by Wife. In arriving at the amount of alimony in all of the facts set forth above, as well as the other recommendations contained herein were considered; however, the main competing factors considered were that Wife was receiving the greater share of the marital property, and that she has no income from any source and is indefinitely disabled. If Wife were not receiving the greater share of the marital property at her specific request, the alimony award would have been greater. If she were not disabled, or if she had received a full and fair tort recovery as financial compensation for her disability, then the alimony award would have been less. However, the tort action is still pending as of this writing and so it was not considered for any purpose and had no bearing on any of these recommendations. LAp OFFICES - MART50\, DEARDORFF, WILLIAMS 6c OTTO While the Master recognizes that the breakup of this marriage will necessarily cause financial hardships to both parties, it is specifically intended that the financial hardship to Wife be i no greater than Husband's, since he has been found to have been at fault for the breakup. Accordingly, it is the specific i intent of this alimony award to have comparable after-tax incomes in both households with consideration given to the Wife i having greater property. 8. Wife shall be entitled to exclusive possession of the marital home. until it is sold. Wife shall be responsible for all obligations associated with the real estate, including, but not limited to, mortgage, taxes, insurance and maintenance. As long as the property remains in joint names, or encumbered by a mortgage to Husband, Wife's right to exclusive possession shall be terminated upon her failure to timely pay all obligations associated with the real estate, or -her failure to maintain the real estate and its improvements in good condition or both. In that event, Husband shall be entitled to partition or foreclosure upon which the full payment described in paragraph 5 plus any accrued interest or rent shall be made. 9. The Master believes that alimony pendante lite has been adequately provided by the Court's Order of December 4, II 1987, which was entered by Stipulation of the Parties, and no additional award is justified under the circumstances. LAW OFFICES - MARTSON. DEARDORFF. WILLIAMS ~ OTTO .. 10. Wife shall pay the orthodontist bill and one half of the $1,228.17 owed to Diane G. Radcliff, Esquire for matters pertaining to the sale of the parties jointly held real estate. 11. Husband shall pay the other half of the amount owed to Diane G. Radcliff, Esquire and also the amounts owed to DAFCU, VISA and Gene Paulus. 12. Each of the parties has been provided with sufficient property or earning capacity to pay their respective counsel fees, costs and expenses of litigation in connection with this divorce action, and no award will be made regarding same. 13. The Master specifically rejects Wife's request for a ~ lump sum cash payment by Husband as being unauthorized by law. Respectfully submitted, MARTSON, DEARDORFF, WILLIAMS & OTTO Thomas J. illiams, Esquire Ten East igh Street Carlisle, PA 17013 (717) 243-3341 LAa' OFFICES-MARTSON. DEARDORFF. W(LLIAMS & OTTO ~~ ~~ f~ ,,,,,, ~ /v///~/' LA,/W OF~FioCfS2/~~/% J//,~~~ c.~~Zl.(//`LlK//v, ~JiPiQ/~ti~G~Y,~~fY, //'I/~t~l~~~!'~'~ V A PROFESSIONAL//CORPORATION TEN EAST HIGH STREET CARLISLE. PENNSYLVANIA 17013 June 28, 1988 The Honorable Harold E. Sheely Cumberland County Courthouse Carlisle, PA 17013 ------------------------------------------------------------ i RE: Julie Persik vs. Roger J. Persik 3/5/87 Review file .7 TJW 3/10/87 Review wife's income and expense statement and inventory and appraisement .5 " 3/26/87 Conference with counsel for both parties 1.0 " 3/26/87 Draft letter •5 " 3/26/87 Draft notice of hearing .2 " 4/13/87 Review correspondence and Teribery case .5 " 4/29/87 Attend hearing 6.0 " 5/6/87 Draft praecipe RE: Payment of reporter .5 " 5/28/87 Ebener appraisal •4 " 6/10/87 Conference with prothonotary RE: Steno's fee; Draft petition for extension of time etc. .8 " 8/24/87 Telephone conference with attorney Turo .2 " 9/10187 Telephone conference with attorney Radcliff .2 " 9/18/87 Draft petition and proposed order; Check status of file •8 " 10/9/87 Draft letter RE: Master's fee .2 " 10/19/87 Telephone conference with attorney Radcliff .1 " 2/9/88 Review of wife's proposed findings and conclusions; Draft letter .5 " 3/1/88 Telephone conference with attorneys from both parties; Draft report 3.0 " 3/2/88 Telephone conference with attorneys for both parties; Draft reply 3.0 " 6/24/88 Draft report 2.0 " TJW 21.1 hrs. x $50.00----------------$1,0 0 ~~ LAW OFFICES n PROFESSIONAL CORPORATION TEN EAST HIGH STREET CARLISLE, PENNSYLVANIA 17013 June 28, 1988 The Honorable Harold E. Sheely Cumberland County Courthouse Carlisle, PA 17013 RE: Julie Persik vs. Roger J. Persik 3/5/87 Review file .7 TJW 3/10/87 Review wife's income and expense statement and inventory and appraisement .5 " 3/26/87 Conference with counsel for both parties 1.0 " 3/26/87 Draft letter •5 ~~ 3/26/87 Draft notice of hearing •2 ~~ 4/13/87 Review correspondence and Teribery case .5 " 4/29/87 Attend hearing 6.0 " 5/6/87 Draft praecipe RE: Payment of reporter .5 " 5/28/87 Ebener appraisal •4 ~~ 6/10/87 Conference with prothonotary RE: Steno's fee; Draft petition for extension of time etc. •8 ~~ 8/24/87 Telephone conference with attorney Turo .2 " 9/10/87 Telephone conference with attorney Radcliff .2 " 9/18/87 Draft petition and proposed order; Check status of file -8 ~~ 10/9/87 Draft letter RE: Master's fee .2 " 10/19187 Telephone conference with attorney Radcliff .l " 2/9/88 Review of wife's proposed findings and conclusions; Draft letter .5 " 3/1/88 Telephone conference with attorneys from both parties; Draft report 3.0 " 3/2/88 Telephone conference with attorneys for both parties; Draft reply 3.0 " 6/24/88 Draft report 2.0 " TJW 21.1 hrs. x $50.00----------------$1,0 0 Total Balance Due ----------------- $868.50 ~. ~ COSTS 02/19/87 Master's Fee Deposit $700.00 12/28/87 Master's Fee Deposit S300.00 Balance: $1,000.00 a 07/07/87 Stenographer's costs -$100.00 Prothonotary poundage -$21.00 Treasurer -$10.00 Law Library -.50 Balance: $868.50 06/28/88 Master's Fee -S868.50 Balance: - 0 - LAW OFFICES - MARTSON, DEARDORFF, WILLIAMS & OTTO ~~ WOOLWORTH ~ HUMAN RESOURCES 3543 SIMPSON FERRY RD ~~ CORPORATION CAMP"~~~~ PA i7o11 TE[,717-972-5357 FAx 717-972-2913 W. F. HORNING MANAGER OF HUMAN RESOURCES Apri121, 1998 Sandra L. Meilton, Esquire 111 N. Front Street, P.O. Box 889 Harrisburg, PA 17108 Dear Ms. Meilton: The enclosed information is accurate and true copies of employee files regarding Roger Persik. Thank you, W. F. Horning Manager of Human Resources WOOLWORTH =~ CORPORATION SHIRLEY PECHr\RT ASShTaNT iV1.~N~GE,: OF HU~I?,?~ RESv~R~E~ '" BENEFITS .AD~~tIVISTIi:~TIC,~. TO: Dennis Hodgson FROM: Shirley Pechart HU~I?A R~~GURCEJ P O BC:i _~>'r H.~~~zsz~.a~ r-.a ~~ios TE~71--0-?-~35a Fa;< <I ~-~y-,.,ol 3 DATE: December 9, 1997 COPY: T. Ross W. Horning W. Sprague Please produce a severance, supplemental severance, and vacation check for the following associate in company 20020 as soon a possible. Roger Persik - SS# 357-30-9065 Severance Weeks 40.50 x 1,369.14 - $55,450.17 Supplemental Severance Weeks 4.00 x 1,369.14 - 5,47b.~6 Vacation Days 1.50 x 273.83 - $ 410.75 ~~~„',~ . ~~t1J~ Release ~~-- I, ' Ct'~ ~' _JoN,~ ~ ~'"~ ~ ~ (print name), enter into this Re- lease knowingly and voluntarily, and I fully understand each of the terms set forth below. 1. I am, or have been, employed by F.W. Woolworth Co., or by another subsidiary of Woolworth Corporation (in each case, my "Employer"), and have been advised that my employment will be terminated in connection with the 1997 Reduction-in-Force involving, principally, the closing of F.W. Woolworth Co.'s general merchandise business. 2. I have been advised that in connection with the termination of my employment, I may be eligible for benefits under the Woolworth Supplemental Management Severance Pay Plan for the 1997 Reduction-in-Force (the "Supplemental Plan"). I acknowledge that I have received a copy of the combined Supplemental Plan and Summary Plan Description, and that I have read and understand the Supplemental Plan's provisions. I also acknowledge that I have received an individualized statement setting forth the benefits I may be eligible to receive under the Supplemental Plan. I acknowledge my understanding that, pursuant to the terms of the Supplemental Pian, ii is a requirement that I sign this Release in order to receive benefits under the Supplemental Plan. I ~artr~er acknowledge that the benefits to be provided to me under the Supplemental Plan exceed any amount to which I may otherwise be entitled under any applicable company policy or law. 3. I have decided that I would like to receive benefits under the Supplemental Plan. Accordingly, I hereby knowingly, voluntarily and willingly release and forever discharge my Employer, as well each of its parents, subsidiaries and affiliates (including, without limitation, Woolworth Corporation, F.W. Woolworth Co. and Woolworth Specialty Corporation), together with their respective officers, directors, partners, shareholders, associates and agents, and ~~~ nn ~~~ each of their predecessors, successors and assigns (collectively, my Employer and its Related Persons), from any and all charges, com- plaints, claims, promises, agreements, controversies, causes of action and demands of any nature whatsoever which against them I or my executors, administrators, successors or assigns ever had, now have or hereafter can, shall or may have by reason of any matter, cause or thing whatsoever arising prior to and including the time I sign this _ Release. This Release includes, but is not limited to, any rights or claims relating in any way to my employment relationship with my Employer or the termination thereof, or under any statute, including without limitation, the federal Age Discrimination in Employment Act, Title VII of the Civil Rights Act of 1964, the Civil Rights Act of 1991, the Americans with Disabilities Act, the Worker Adjustment and Retraining Notification Act or any other federal, state or local law, or common law or judicial proceeding. I understand and agree that this Release releases all claims, if any, which I may have and which I do not now know or suspect to exist in my favor against my Employer or any of the Related Persons, arising prior to and including the time I sign this Release, and that this Release extinguishes those claims. 4. I represent that I have been advised that this Release does not require me to waive any claim to any vested pension or right to an interest in a 401(k) plan, which rights shall be determined by the applicable plan documents. I also understand that I do not have to sign this Release to obtain the opportunity to purchase continued medical benefits under COBRA or related state or local laws or plan provisions that may be applicable, and that I will receive, as applicable, my pen- sion, 401(k), COBRA benefits and pay for unused vacation days earned through the date of my termination, even if I do not sign this Release. I further understand that I do not have to sign this Release to receive benefits under the Woolworth Special Severance Pay Plan for the 1997 Reduction-in-Force (the "Special Plan"), and that benefits under the Supplemental Plan exceed the benefits under the Special Plan. I under- stand that this Release does not pertain to any claims which may not be waived under applicable federal, state or local laws. /1 , 2 ~ ~11 5. I acknowledge that my Employer has, by presenting this Release to me, advised me to consult with a lawyer of my choosing before signing it. I further understand that I have up to 45 days to decide whether to sign this Release and, once I have signed it, an addi- tional seven (7) days to revoke my consent to this Release. I agree to notify Patricia A. Peck, Vice President -Human Resources, Woolworth Corporation, 233 Broadway, New York, NY 10279, telephone (212) 553-2287, within such seven (7) day period if I decide to revoke. In connection with my signing of this Release, I also hereby acknowledge that I received and had the opportunity to review Schedule A to this Release which, among other things, sets forth the job titles and ages of persons in my organizational unit who are eligible to receive benefits under, and subject to the terms and conditions of, the Supplemental Plan as well as, if applicable, the ages of all individuals in the same job classification or organizational unit who are not eligible. WHEREFORE, I have signed this Release before a notary public on the date set forth below. Signed: ~ ti ~~ - ~~, Prin Ass ciate Name Below: ~e~~ .~' +- r~l ~~~ ~ K Date Signed: jam! q y'7 A ttP c t _~ , - State of ~`'' l ,~ :SS. County of ~ G°~-~~~~, ~~ ~ ~~ On the~~"~~day of ~,~-~ 199 7, before me came ~?fJy r, ',~: /,,, ,~~', .~ ,~ /~ (print associate name), known to me, anc~ie~/she ~;~ o ~ r~= (circle as applicable) before me executed the within instrument. ~ lv~ -"+n;,,~ ~~~,•~ '. Notarial Seat ~ ` ~~;~3 ~ ~ ~ a ~~' ry . ,'-~ ,~ .,. Deborah E. Wimor, Nota Public Carlisle Born, Cumborland County _ i - - ~ ~ ;~`r~.~ ~~ 1 My Commissicn Expires Dec. 30, 1997 ~ / ~,.~ ~, ,_ - -~j-> > ~ _..~a r ~'~ ~`~' ~ Manger, enr~syhania fLssoaa5on of Notaries '~ - `~ r,~'~y ~ ~ ~ 'ti Notary Public ,~- ~' ~;.. ~- ~~7d J i T ~ ,-a RETURN TO THE SENIOR VICE PRESIDENT -HUMAN RESOURCES '' 3 SCHEDULE A TO THE RELEASE Supplemental severance payments and benefits are being provided pursuant to the Woolworth Corporation Supplemental Management Severance Pay Plan for the 1997 Reduction-in-Force (the "Plan"). All Covered Associates, as that term is defined in the Plan, are eligible for Plan benefits. Covered Associates, in general, refers to the Associates whose employment will be terminated in the 1997 Reduction-in-Force, which involves principally the closing of F.W. Woolworth Co.'s general merchandise business. Please read the Plan for the exact definitions and description of the benefits available. Eligibility Factors: Payments pursuant to the Plan will be available to Covered Associates who meet the eligibility requirements set forth in Article III of the Plan, including signing the enclosed Release. Time Limits Applicable: Covered Associates will have 45 days from receipt of the enclosed Release to elect to receive severance payments and benefits pursuant to the Plan. The chart that is included on the following pages provides the job titles and ages of each Associate eligible for benefits, as well as, if applicable, the ages of all individuals in the same job classification or organizational unit who are not eligible. A it~c~ rn~~ ~ R Woolworth Corporation Ages of Eligible Ages of Ineligible Title Q,SSOciatPS A.c~~r_iateS President 60 N/A Director 55, 52, 53 N/A Asst. Director 62 N/A General Manager 56 N!A Senior Manager 56, 46, 39 N/A Manager 54, 53, 55, 57, 48, 49, 45, 43, 53, 63, 58, 47, 43 N/A Entry Level Manager 58, 45, 34, 50, 57, 32, 50, 68, 51 N/A Associate Buyer 51 N/A Supervisor 51, 42, 41, 49 N/A Industrial Engineer 25 N/A Dated: 10/20/J7 ~~ '~. ~ tZ t}-t: ti NI G ~ ~ ~ • TERMINATION STATUS CO.#: 20020 STATUS: Full Time DATE: 10-27-97 NAME: Roger J. Persik SS# 357-30-9065 ADDRESS: 209 East DOB 05-14-39 Yelllow Breeches Road H.D.: 03-30-57 Carlisle, PA 17013 CSD.: 03-30-57 TERM TYPE: Remove from payroll LDW.: 10-24-97 REASON: Position elimination TERM DATE: 10-24-97 COMMENTS Overpayment of one week on check date 10-30-97 will be adjusted on vacation entitlement INTIATED BY: Shirley Pechart DATE: 10-27-97 DMDBVD03 VIEW DOCUMENT Page 1 of 1 FORM 10/24/97 10:18:09 Line 1 to 17 <........1.........2.........3.........V.........5.........6.........7......... EXEMPT TERMINATION NOTICE NAME: Roger Persik ss# 357 / 30 / 9065 DATE: 10 / 24 / 97 REMOVE FROM ACTIVE STATUS ON 10 / 24 / 97 UDERID UKBDV02 COMMENTS: Immediately ADDITIONAL INFORMATION COMPANY # 20020 BADGE ID # 1017 SUPERVISOR Steve Heinmiller COMMENTS PF1=Help PF7=Backward Immediately 2= 8=Forward COST CENTER # Camp Hill ACTUAL ID # 1386 3= 4=Main Menu 5=Cmd Line 6=Fast Path 9= 10= 11= 12=Quit ___> RET WOOLWORTH CORPOR4TION PERSIK ROGER J 401(K) PLAN 357-30-9065 .fictive ____~ Pa~c 1 of 2 For the perio~ 07102!97 to 1 0106 19 7 1' ASSITALLOCA`I'ION ~1 Stable Value 48n~ ~ Stocks 52 l0U r 1007 54tiRCH St1MMAIl~. Market Value on 10/06,'97 Crnttributious Vested Vested Sourre Name Iuceptiou-To-Date Investments I_oau Total Percent Total Salary Reduction $5,219.OS $5,98i.Oti $O.UO $5,981.06 100--; $x,981.06 Company Match 469.41 303.02 0.00 305.02 100 ~ 305.02 Totals $5,688.49 $6,286.08 $0.00 $6,286.08 '~tAI2KHT ~?ALtt~; SUMMAitI' Investment Options 1 Stable Value Eund 2 Stork Index Fund 2 Growth and Income Fund 2 Global Fund 2 Woolworth Corp Stock Fuud TOTAL Market Value can 07/01/97 Shares I'riee 'Total Market Vahie on 1Ot06/97 Shares Price Total 2,103.300 $1.00 $2,103.30 2,989:910 $1.(1O $2_,989.91 0. Li00 24.07. _ 0.00 0. (~0 26.37 0.00 /• 75.292 27 . i4 2 , 43.42 99.705 30. (>D 2 , 991.15 ~/ .0:000 33.94 O.OU 0.000 35.70 U.-00 14.270 24, fi3 35 L 39 14.270 21 .38 305.02 $4 , 498.12 $6 286 ~8 As of 10/16/97 your contributions will be invested as follows: 55~. Stable Value Fund; 45~/ Growth and Income Fund SitM1~IAR'S' ACCOUNT AC~'~'fV)<Tl' STI3VL GrInc WwCStk Total Market Value-07;01/97 $2,103.30 $2,043.42 $351.39 $4,498.12 CDlllrlbnllOn 848.41 694.15 0.00 1,42.56 Earnings 38.20 11.72 0.00 49.92 Market Value-10/06/97 $2,989.91 $2,991.15 $305.02 $6,286.08 -!~ Woolworth Corporation 401(k) Plan EXHIBIT NOTES TO THIRD QUARTER STATEMENTS 1. ~ ~j 1f you have a CHANGE OF ADDRESS, please notify your store manager or payroll support group. ~J 2. To enter the PILOT access system, which is a toll-free automated service that allows you 24-hour access to your 401(k) account, you will aced your Plau number, which is 541, Social Security number (SSN), and Personal Identification number (PIN). You may change your PIN as often as yon like to a number you will easily remember. • D01 nu WOOLWORTH SCUDDER - I I ~ CORPORATION ~-~ I IIIIII VIII (IIII VIII VIIIIIIIIIII - WWCI 10191 OOMIOnI 10)91 )59) 111 00000000 THIS IS YOUR GROSS TO NET BREAKDOWN LOYEE NAME: ROGER PERSIK SOCIAL SECURITY NUMBER: 357 - 30 - 90 65 rAY TYPE: WEEKLY BI-WEEKLY X MONTHL Y PAY FREQUENC Y: 90 STATE CODE: 39 LOCAL CODE: O1 TAX UNIT: 03 LABOR CODE: XXXXXXX YES NO CALIFO RNIA BANK MESSAGE -------- --- --------------------- HROC USE - CHECK NUM -------------- BER: -- ---------- CHK DT: --- 12 / 31 / 97 --------------------- COMPANY NAME: KINNEY -------------- SERVICE EXEC COMPANY NO.: 20020 BEGIN DATE: 12 / O1 / 97 ENDING DATE: 12 / 31 / 97 GROSS PAY S 61337.48 TOTAL DEDUCTIONS S 17249.09 NET PAY S 44088.39 EARNINGS TAXES SP.PAY~k HOURS RATE DESCRIPTION AMOUNT ------- DESCRIPTION --- ------------- AMOUNT - ------- --- ------- ----- ----- -- - ----------- REGULAR - FEDERAL 8544 30 -- OVER TIME FICA 808 70 60 VACATION 410 75 STATE 1717 45 52 SICK(TXBLE) DI • 43 SEVERANCE 55450 17 LOCAL 613 37 43 SUPP SEVER 5476 .. 56 B4 TAX DEDUCTIONS VOLUNTARY DEDUCTIONS -------------------- ------------------- DED.~k DESCRIPTION AMOUNT DED.~ DESCRIPTION AMOUNT 63 B4 401K -5565 27 ~. ADDITIONAL INFORMATION: REPLACING MANUAL DATED 12/30/97. ~u ~, y f'4 ~ ~~ i ,c~~ THIS IS YOUR GROSS TO NET BREAKDOWN LOYEE NAME: ROGER PERSIK SOCIAL SECURITY NUMBER: 357 - 30 - 90 65 rAY TYPE: WEEKLY BI-WEEKLY X MONTHL Y PAY FREQUENCY: 90 STATE CODE: 39 LOCAL CODE: O1 TAX UNIT: 03 LABOR CODE: XXXXXXX YES NO CALIFO RNIA BANK MESS AGE --------- --- --------------------- HROC USE - CHECK NUM -------------- BER: -- - ---------- CHK DT: --- 12 / 31 / 97 --------------------- COMPANY NAME: KINNEY ------------ SERVICE EXEC COMPANY NO.: 20020 BEGIN DATE: 12 / O1 / 97 ENDING DATE: 12 / 31 / 97 GROSS PAY S 61337.48 TOTAL DED UCTIONS S 17249.09 NET PAY S 44088.39 EARNINGS TAXES SP.PAY~k HOURS RATE DESCRIPTION ----- AMOUNT - ------- DESCRIPTION --- ------------- AMOUNT - ------- --- ------- ----- ----- -- - ------ REGULAR FEDERAL 8544 30 -- OVER TIME FICA 808 70 60 VACATION 410 75 STATE 1717 45 52 SICK(TXBLE) DI 43 SEVERANCE 55450 17 LOCAL 613 37 43 SUPP SEVER 5476 56 B4 TAX DEDUCTIONS VOLUNTARY DEDUCTIONS -------------------- ----------------- DED.~k DESCRIPTION ----- -------------- AMOUNT - --------- DED.~ ----- DESCRIPTION --------------- AMOUNT ---------- 63 B4 401K - 5565 27 ADDITIONAL INFORMATION: REPLACING MANUAL DATED 12/30/97. ~p~~~vice:,,,~ FQ~~~~~~ THIS IS YOUR GROSS TO NET BREAKDOWN LOYEE NAME: ROGER PERSIK SOCIAL SECURITY NUMBER: 357 - 30 - 9065 rAY TYPE: WEEKLY BI-WEEKLY X MONTHL Y PAY FREQUENCY: 90 STATE CODE: 39 LOCAL CODE: O1 TAX UNIT: 03 LABOR CODE: XXXXXXX YES NO CALIFO RNIA BANK MESS AGE -------- --- --------------------- HROC USE - CHECK NUM -------------- BER: --- -- ---------- CHK DT: --- 12 / 31 / 97 --------------------- COMPANY NAME: KINNEY ----------- SERVICE EXEC COMPANY NO.: 20020 BEGIN DATE: 12 / O1 / 97 ENDING DATE: 12 / 31 / 97 GROSS PAY S 61337.48 TOTAL DED UCTIONS S 17249.09 NET PAY S 44088.39 EARNINGS TAXES SP.PAY~k HOURS RATE DESCRIPTION AMOUNT ---- DESCRIPTION --- ------------- AMOUNT - ------- --- ------- ----- ----- -- - ----------- REGULAR - --- FEDERAL 8544 30 -- OVER TIME FICA 808 70 60 VACATION 410 75 STATE 1717 45 52 SICK(TXBLE) DI 43 SEVERANCE 55450 17 LOCAL 613 37 43 SUPP SEVER 5476 ._ 56 B4 TAX DEDUCTIDNS VOLUN ----- TARY DEDUCTIONS --------------- ----------------- DED.~k DESCRIPTION - ------------ AMOUNT - --------- DED.~ ----- DESCRIPTION --------------- AMOUNT ---------- 63 64 401K - 5565 27 ADDITIONAL INFORMATION: REPLACING MANUAL DATED 12/30/97. ~nyf~NCe:,,,~ £4r n ~,~~ -,~ e~ y~ -..wo ~ ~c , rr cG l ~.-~--~ - ~ 9P~ ` ~ 1040 Department of the Treasury-Internal Revenue Service ~g95 "' LL ~ U.S. Individual Income Tax Return ( IRS ~~ ~-~ ^a ~~ ~ ~~ ~ ~ ~~ For the year Jan. 1-Dec. 31, 1995, or other tax year beginning , 1995. ending , 19 OMB No. 1545-0074 Label Your first and initial last name Your nodal necurlty rn,mber ~ 357 3a go 6 ~ ~ ' inSttUCtIOnS ~ g K a jo etu 's i me initial Spouse's social security number on page ,,.) to ~ / ~ of ~ ~~ 7grioC7 Use the IRS label H d (n street). K you ve a .o. box, see page t. ~t• "~• For Privacy Act and Otherwise, a ~- " Paperwork Reduction please print H ~~,, town or post ot(ice, state, and ZIP code. H you have a foreign address, see page 11. Act Noticer see page T. or type. Presidential Yes No Note: Checklny 'Yes' Election Campaign ' Do you want 53 to go to this fund? . ,,,~ r,~ ~,ar,~ y,~,r tax orn3duce your (See page 11.) K a joi nt return, does your spouse want 53 to go to this Lund? . ~>~• 1 Single Filing Status 2 Married Tiling joint return (even it only one had income) • (See page 11.) $ Married filing separate return. Enter spouse's social security no. above and full name here. - Check only 4 Head of household (with qualifying person). (Seepage 12.) If the qualifying person is a child but not your dependent, one box. enter this child's name here. - 5 oval n widow(er1 with dependent child (year spouse died - 19 a e 12.) 6a Yourself. K your parent (or someone else) can claim you as a dependent on his or her tax No. of hams Exemptions retlurt, do not check box sa. But be sure to t~tedc the box on line 33b on page 2 cbedced oa 6a 1/ (~ page 12.) b Spouse . and 6b c K more than six dependents, see page 13. Dependents: (1) first name Last name (2) DependeM's social ~mY number. K born in 1995 see a 13. (3) Dependent's relationship to (q No. at momhs Wed h your home in 1995 ~__~ No. of yam ebildrea an 6e rrho: '~- • ilvod nrilb yon • IIda11M xlth yon dne to Ihrotca or saparatloa teen papa 14) Oependents oa 6c - aot entered aboro d It your child didn't live with you but is claimed as your dependent under apre-1985 agreement, check here - ^ Add numbers entered oa e Tntal number of exemptions claimed Ilnet ~6ere - salaries tips etc. Attach Form(s) W-2 7 Wages 7 /O ~$ ~ , , , Income ga Taxable interest income (see page 15) Attach Schedule B K over 5400 ~ ~ ¢~ 9 . . Attach b Tax-exempt Interest (see page 15). DONT include on line 8a 8b ~A~/ 1 ~7 a Copy B of your 9 Dividend income Attach Schedule 8 if over 5400 9 ~, . . or offsets of state and local income taxes (see page 15) credits ~ 10 Taxable refunds W Gs 10 , , a 11 Alimony received . 1099 R h 11 . . - ere. 1 Business income or pass). Attach Schedule C or C-EZ 12 if you did not 13 Capital gain or pass). If required, attach Schedule D (see page 16) 13 get a W-2, see page 14. Other gains or posses). Attach Form 4797. 14 15a Total IRA distributions 15a b Taxable amount (see page 167 15b Enclose, but do 16a Total pensions and annuities 16a b Taxable amount (see page iby 16b not attach, your partnerships, S co~ratio~s, trusts, etc. Attach Schedule E royalties 1T Rental real estate 17 , , payment and payment 18 Farrn income or pass). Attach Schedule F 18 voucher. See 19 Unemployment compensation (see page 17) 19 Page ~~ 20a Social security benefits ~ 20a ~ ~^ ~ b Taxat>fe amount (see page 1 B) 20b 21 Other Income. Ust type and amount-see page 18 .........................C__._~__. 21 22 Add the amounts in the far right column for lines 7 through 21. This is our total income - ~ a ~p 23a Your IRA deductbn (see page 19) 23a Adjustments 23b ' b Spouse s IRA deduction (see page 19) . to Income 24 Moving expenses. Attach Form 3903 or 3903-F 24 25 One-half of self-employment tax . ~ 26 Self-employed health insurance deduction (see page 21) ~ 2T Keogh &self-employed SEP plans. If SEP, check - ^ 2T 28 Penalty on early withdrawal of savin s ~ ~ 29 Alimony paid. Redpient's SSN - ~ 6 : 3~-: ~-y30 29 Y00 OQ /' ~ 30 Add lines 23a through 29. These are your total adjustments - 30 Q l~ ~d0 OU Adjusted 3t Subtract line 30 from line 22. This is your adjusted gross Income. It less than 526,673 and a child lived ' " " `~GO r J f~ Gross Income with you (less than 59,230 if a child didn t live with you), see Earned Income Credit on page 27 - 31 ~J Cat. No. 113208 Form 1040 (1995 c,,,.., rnan n4as 32 Amount from line 31 (adjusted gross income) 32 ~J~ (00 ~ ~ TeX Compu- 33a Check if: ^ You were 65 or older, ^ Blind; ^ Spouse was 65 or older, ^ Blind. ~ tation Add the number of boxes checked above and enter the total here . . - 33a b If your parent (or someone else) can claim you as a dependent, check here - 33b ^ ~~ Page c If you are married filing separately and your spouse itemizes deductions or ^ 23 ) you are adual-status alien, see page 23 and check here. - 33c • itemized deductions from Schedule A, line 28, OR 34 Enter Standard deduction shown 6elow•for your filing status. But H you checked the arty box on Ilse 33a or b, go to page 23 to find your standard deduction. larger It you checked box 33c, your standard deduction is zero. ~~O~1 ~~. of ~ T your: • mangle-53,900 • Married filing jointly or Qualifying widow(er}-56,550 • Head of household~5,750 • Married filing separately-53,275 ' ' ~ a ~ 35 Subtrac t Ilne 34 from line 32 ~ ~ ~t line32 js S8s,o25orJ:lnultipy.5z;~,by~ut s~I~u~b•r~!.~te~pti«ts aelrf,ed«r - 5ao 0 oa 1 line 6e.'alfUne is over 586, , seethe worksheet~ort oi;tge 23"f is amounf'to eritdr~ . ~ , 3T Taxable Income. Sub line 36 from line 35. If line 36 is more than line 35, enter -0- If you want ~ the IRS to 38 Tax. Check H from a Tax Table, b ^ Tax Rate Schedules, c ^ Capital Gain Tax Work- 13 6 ~ ~ a fl figure your or d ^ Form 8615 (see page 24). Amount from Fomt(s) 8814 - e ~ 3a , tax, see Check H from a ^ Form 4970 b ^ Form 4972 page 35 39 Additional taxes ~ . . 40 Add lines 38 and 39. - . . . . . . . . . . . . . . . . . . . . 40 / 3 O d Credits 41 Credit for child and dependent care expenses. Attach Form 2441 41 42 Credft for the elderly or the disabled. Attach Schedule R , 42 (See page 43 Foreign tax credit. Attach Fonn 1116 ~ 24.) ,~q Otlter credits (see page 25). Check H tram a ^ Form 3800 b ^ Fonn 8396 c ^ Fonn 8801 d ^ Form (sped ~ 45 Add lines 41 through 44 .. ~ 46 Subtract line 45 from line 40. H fine 45 is more than fine 40, enter -0- . - 4g 47 SeH-employment tax. Attach Schedule SE 4T . - . Other ~ AHemative minimum tax. Attach Form 6251 ~ Taxes 49 Recapture taxes. Check H from a ^ Form 4255 b ^ Form 8611 c ^ Form 8828 49 (See page 50 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 ~ 25.) 51 Tax on qualified retirement plans, including IRAs. If required, attach Fonn 5329. 51 52 Advance earned income credit payments from Form W-2 52 53 Household employment taxes. Attach Schedule H - ~ 54 Add lines 46 thro h 53. This is your total tax . - 54 Payments ~ Federal income tax withheld. H arty is from Form(s)1099, check - 55 / 5 0(~ 56 1995 estimated tax payments and amotmt applied from 1994 return - ~ 57 Earned income credit. Attach Schedule EIC H you have a qualifying Nontaxable earned income: amount - ~ ~ ~ ch~d • Attach Forms W-2, and type - --------------------------------------------------• 57 W-2G, and 58 Amount paid wfth Fonn 4868 (extension request) ~ 1099-R on the front. 59 Excess social security and RRTA tax withheld (see page 32) 59 80 Other payments. Check H from a ^ Form 2439 b ^ Fonn 4136 60 81 Add lines 55 throw h so. These are your total payments - 61 ~~, 56 / o ~ ~ H une s1 is rt,ore titan line sa, subtract Gne s4 from line 61. This Ls the amount you OVERPAID. 82 ?~O O Refund or ~ Amount of line 62 you want REFUNDED TO YOU, , - ~ Amount , You Owe ~ Amount of line 62 you want APPLIED TO YOUR 1996 ESTIMATED TIIX - ~ 65 H line 54 is more than line 61, subtract line 61 from line 54. This is the AMOUNT YOU OWE. For details on how to pay and use Form 1040-V, Payment Voucher, see page 33 - 65 ,~ i r 0o cstrmatea tax pertarry (see page a.~r. ws~ mauun vn nne o~ I 66 I 1 E`\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Under penalties of perjury, I deGare that I have examined this return and accanpanyirp schedules and statements, and to the best of my knowledge and Sign better. they are true. correct. and complete. oeclaretion of preparer (other than taxpayerl is based «, all hrom,ation of which preparer nos any knowledge. Here Your signature Date Y occupation /~j Kee a copy ' 0 ~ / 9(7 ~/a gGTS / "I /tTVIf 25 G of this return for your Spouse's signature. H a joint return. BOTH must sign. Dat Spouse's occupatom A~ L / records. ~ ~`~ 9G ~ /Pcr2onl (G.. f'11At~ /~~~~f t T rG fi7 -' Paid ~P ors' Date C~k ~ ^ Preparer's social securtyy ra. Pre arer's ~°"-°"' °~ p Fkm's name (a yours EIN Use Only a~ ~- mod' ,~P ® Prrrr.d on r.ryad wwr ~ 2s Z,,(C~D , 0 ~ Pape 2 SCHEDULES A&B Schedule A-Itemized Deductions VM6 n0. la4o-oo74 (Form 1040) (Schedule B is on back} ~~95 Dspartir»nt of tta Trsasury ~~ a,,,~ ~,,,b, Quq - Attach to Form 1040. - See Instructions for Schedules A and 8 (Form 1040). AttaChfilent Sequence No. 07 Name(s) shown on Forrn 1040 J ~ ~rs~l~ ~ Your social sst:urity number 357 :30 1o6S . .~-l2at i G T. -r Medical Caution: Do not indude expenses reimbursed or paid by others. enses (see page A-1) dical and dental ex d 1 M 1 . p e an Dental 2 Enter amount from Form 1040, line 32. 2 075) 5% ( Expenses 3 Multiply line 2 above by 7 3 . . . 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0 - 4. Taxes You 5 State and local income taxes 5 d ~ 9 ~ 6 ~ ~ o Paid 6 Real estate taxes (see page A-2) ! (See 7 Personal property taxes 7 Sah k p ~~ ~~ : . . r page A-t.) 8 Other taxes. List typ and amount - gg ,~ 8 X78' 7~ ~~::~~::: ~.~ , QQ r _ _ _ . . - - . . . . . . . . . . . . . . . . . 9 Add lines 6 thrc.~ h 8 . l~q. 9 ~' 7S e interest and points reported to you on Form 1098 t 10 Nome mort a 10 g g Interes You Paid 11 Home mortgage interest not reported to you on Form 1098. H paid (~ to the person from whom you bought the home, see page A-3 page A-2.) and show that person's name, identifying no., and address - ---' t N 1 1 e: -------------------------------------------------- ..-----... o PersOn~ 12 Points not reported to you on Form-1098. See page A-3 ~ interest is for s ecial rules 12 . p not deductible. 13 Investment interest. If required, attach Form 4952. (See page A-3.) 13 4 (~ 57 to ~ I 14 Add lines 10 throu h 13 . 1 Gifts to 15 Gifts by cash or check. If you made any gift of $250 or ~ ~ Charity more a e A-3 see 15 ~ O g p , If you made a 16 Other than by cash or check. If any gift of $250 or more, gilt and got a see you MUST attach Form 8283 tf over $500 e A-3 a 16 ~~ d~ //,,'/ ~ `7~ ` d , . p g benefit for k. 17 Carryover from prior year 17 see page A-3. 18 Add lines 15 throu h 17 18 Casualty and Theft Losses 19 Casualty or theft loss(es). Attach Form 4684. (See page A-4.) 19 Job Expenses 20 Unreimbursed employee expenses-lob travel, union and Most dues, job education, etc. If required, you MUST attach Other Form 2106 or 2106-Q. (See page A-5.) - .............. Miscellaneous -------------------------------------•-------------------------- Deductions 20 21 Tax preparation fees •21 (See 22 Other expenses-investment, safe deposit box, etc. List page A-5 for type and amount --•----------•----------- ----------------- expenses to ~ deduct here.) ..-----•---------------------------------------•---------------- 23 Add lines 20 through 22 23 . 24 Enter amount from Form 1040, line 32. 24 25 Multiply line 24 above by 2% (.02) 25 ~/ 26 Subtract line 25 from line 23. if line 25 is more than line 2 3, en ter -0- 26 Other 27 Other-from list on page A-5. List type and amount - .............................. Miscellaneous ~ ,~/ Deductions 27 Total 28 Is Form 1040, line 32, over $114,700 (over $57,350 if married filing separately)? itemized NO. Your deduction is not limited. Add the amounts in the far right column Deductions for lines 4 through 27. Also, enter on Form 1040, tine 34, the larger of - 2g this amount or your standard deduction. YES_ Your deduction may tie limited. See ~aae A-5 for the amount to enter. For Paperwork Reduction Act Notice, see Form 1040 Instructions. Cat No. 1t330x Schedule A (Form 1'040) 1995 ~~ Schedules A68 (Form 1040) 7995 OMB No. 1545-0074 Page 2 ame s) shown orrn 040. Do not enter name and social security number if shown on other side. Your social security number 3,~~7 3 a ; ~J ol~~ Schedule B-Interest and Dividend Income ~~ ~e No. os Part I Note: If you had over $400 in taxable interest income, must also complete Part 111. Interest 1 last name of payer. If any interest is from aseller-financed mortgage and the Amount Income buyer used the property as S personal residence, see page B-1 and list this (~ interest first. Also, dhow that buyer's social security number and address - pages t5 /t'1 eM~g.~S~l21T .--~~.~?~-_.~~~D/~_• UNio/1~-- 3 3 ..... ~ Note: If you •- - ~. C . ~ DID ~6 ~? C ~ ~ ~ ~ received aForm -...~ ...-•-------rr ,. ------------------------P---a F..~ ~~.~ ~ ...--------.... ~/ 1099-INT, Form ls~nls..r~-'.~.~.~nP.t`~----------------------•---....-----------•----------•-- ~ v~ 1099-0ID, or substitute ----------------------•---•-----....---........----•---------...--•------------•-------..... 1 statement from --------------•---•------------.....-----.._...------....------•--•-•-----•-••-------------- abrokerage firm, ----------------•----..........._.........----...-------...--------------•--.._.......------ list the firm's name as the .....-•------------------------------------------------------------------------------------- payer and enter ............................................................................................ the total interest ...........................••---------._...----..........--------.........................-- shown on that form. ...-----•--------------------------------------------------------------------------------- 2 Add the amounts on line 1 2 ~ 3 Excludable interest on series EE U.S. savings bonds issued after 1989 from Form 8815, line 14. You MUST attach Form 8815 to Form 1040 S ~/ 4 Subtract line 3 from line 2. Enter the result here and on Form 1040 line 8a - 4 6 ~s g Vt Part II Note: If u had over $400 in ross dividends and/or other distrrbutions on stock, ou must also complete Part 111. Dividend 5 List name of payer. fncfude gross dividends and/or other distributions on stock ,Amount Income here. Any capital gain distributions and nontaxable distributions will be ded te~V _ tit" (See ~ ~ 73 on lines 7 and 8 - -------- ---------------------- r-• -- ~ pages 15 ----S~4S..~t.~,~ .:........................~---.....---------•--------------- and8-1.) ~~.D~ •.~~ ~~ C_~IDA-_6D ,j?~y~ ~/VD5 _~WOdL~U~t7~1_fr~~ '~~ Note:lf You ----•----~ ..............tom..--------------- ~-----------...-----..'~_.._..-------~~-•~ Y Y~ received a Forrn •.._._...-•-----•--•----------------------------•------------ 5 1099-DN or substitute ----------------------------------------------------------•-----...-----•------------------- statement from .........................•----......----------••---------.._._._...__..__......--------...-- a brokerage firm, Ilst the firm's name as ------•------••--------------------------------------------------------------------•-------- •the payer and -------------------------------------------------------------------------------------------- enter the total dividends -------•------------------------------- -------._...---...._..---.........------- •`~w shown on that ---•---------------------------••-------•--!__~ -----.....---------•-- 6 Add the amounts on line 5 6 ' form. : " . .. 7 Capital gain distribution~.Fnter here and on Sch~le D' . 7 - 8 Nontaxable distributions. (See the inst. for Form 1040, line 9.) 8 : ~ ~ 9 9 Add lines 7 and 8 10 Subtract line 9 from line 6. Enter the result here and on Form 1040, line 9 - 10 A- lf you do not need Schedule D to report any other gains or losses, see the instructions for Form 1040, fine 13, on page 16. Part III Foreign Accounts and Trusts (See page B-2.) If you had over $400 of interest or dividends or had a foreign account or were a grantor of, or a transferor I Yes I No to, a foreign trust, you must complete this part. 11 a At any time during 1995, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See page B-2 for exceptions and filing requiremF~ts for Form TD F 90-22.1 - b If "Yes," enter the name of the foreign country - ..._..__rr_VV...R ............................•_•_____.•__ 12 Were you the grantor of, or transferor to, a foreign trust that existed during 1995, whether or not you have any beneficial interest in itT If "Yes," you may have to file Form 3520, 3520-A, or 926 . For Paperwork Reduction Act Notice, see Form 1040 instructions. ® r~red on ,.~~ wwr Schedule B (Form 1040) 1995 • V ~ Profit or Loss From Business (FOn71 1040) (Sole Proprietorship) - Partnerships, Joint ventures, etc., must file Form 1065. Oepertment or the Treasury Internal aevenue Service ~) - Attach to Form 1040 or Forth 1041. - See Instructions for Schedule C ~ Namet~ ~QrN~ ~~~~ , `/ OMB No. 15~$-QQ74 .- ~~95 ,, Forth 1040. At~nchment ) Sequence No. 09 Social security number (SSN) ~S 7 3v . 9o G .~"' A Princip mess or profession, in~cl~ing roduct or servic (see pl3tje C-1) B Enter principal business code / ~~?~G- S Tfl 7L' . ?~ T ~9-/ N i n (~ X98 ~ - _ _ C Business name. ff no separate business name, leave ~btank D Employer Io number (Elt~, M any ~, r'~~iJ r ss o e ~ ~s - i7~.t,~ fats 1 3 ~- o ~ ~ 3 ~ E Business address (ncluding suite or room no.) - _(_ .:: ~--_.. _ -:.: _~ :~:?-. _ ~ % ~ - ° ~ . " ' ~ ' - - f _ . _ _ _ _ .. City, town or post office, state, and ZIP code /~y 1i(/QS ~ /T/ 6 N S''l , ~~ ~1 LlSC. ~ /I'R / rf©/3 F Accounting method: (1) (Cash (2) ^ Accrual (3) ^ Other (specify) - ..............................................„_. G Method(s) used to Lower of cost Other (attach Does not apply (if value closing inventory: (1) ^ Cost (2) ^ or market (3) ^ explanation) (4) ^ checked, skip line M Yes No H Was then: any change in determining quantities, costs, or valuations between opening and closing inventory? If "Yes," attach explanation . Did you "materially participate" in the operation of this business during 1995? If "No," see page C-2 for limit losses. J If you started or acquired this business during 1995, check here /S/p .C1,9 9' ~ - ^ Income 1 Gross receipts or sales. Caution: If this Income was reported to you on Form W-2 and the 'Statutory employee" box on that loan was checked, see page C-2 and check here - ^ 1 2 Returns and allowances 2 ""~ 3 Subtract line 2 from line 1 3 4 Cost of goods sold (from line 40 on page 2) 4 ~"' 5 Gross profit. Subtract line 4 from line 3 5 6 Other income, including Federal and state gasoline or fuel tax credit or refund (see page C-2) 6 "' 7 Gross income. Add lines. 5 and 6 , - 7 Expenses. Enter expenses for business use of our home only on line 30. 8 Advertising 8 19 Pension and profit-sharing plans 19 9 Bad debts from sales or 20 Rent or lease (see page G4): services (see page C-3) 9 a Vehicles, machinery, and equip ent , • 20a 10 Car and truck expenses ~ Y. ~'s - 0 b~Other business property~~ 20b A (see page C-3) ~' '~%~ 21 Repairs and maintenance 21 11 Commissions and fees. 11 22 Supplies (not included in Part Iln ~ ~ O ~ ~ 12 Depletion. 12 23 Taxes and licenses ~ 13 Depreciation and section 179 ~t~ ~ ~ 24 Travel, meals, and entertainment: expense deduction (not included r ~ a Travel . 24a ~~ 3 Y In Part III (see page G3) b Meals and en- / 14 Employee benefit programs tertainment . (other than on line 19) . 14 c Enter 50% of 15 Insurance (other than health) , 15 ~8,3 SQ line 24b subject t Ii it ti / ~ ~/ ~ 16 Interest: 16 o oru m a (see page C-4) . O a Mortgage (paid to banks, etc.) . a d Subtract line prom 1 4b b Other , 18b ~ ~~ 25 Utilities ~ nw 17 Legal and professional / , . / ~r 26 Wages (less empk>yment credits) 26 / , 0 J ~0 services . . ~ 17 27 Other expenses (from line 46 on 1/,. ~r- 18 Office expense ~/ 18 Cf page 2) 27 ~ , ~.~ 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns. - ~` 29 Tentative profit (loss). Subtract line 28 trom line 7 _ _ 29 ~ ~=' ~ ~ >~` ° 30 Expenses for business use of your home. Attach Form 8829 _ _ 30 31 Net profit or (loss). Subtract line 30 from line 29. ~ • If a profit, enter on Form 1040, line 12, and ALSO on Schedule t t E d SE, line 2 (statutory employees, ~~ j / i ~ s a es an trusts, enter on Forth 1041, line 3. see page C-5). 31 J _ • If a bss, you MUST go on to line 32. .... 32 If you have a toss, check the box that describes your investment in this activity (see page C-5). • If you checked 32a, enter the bss on Form 1040, Tine 12, and ALSO on Schedule SE, line 2 32a~.•All investment is at risk. (statutory employees, see page C-5). Estates and trusts, enter on Form 1041, line 3. 32b ^ Some investment. is not • If you checked 32b, you MUST attach Form 6198. at risk For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 1133aP Schedule C (Form 1040) 1995 • $CneOUle ti t ~V1v - J "~~ Pape Q / ~m Cost of Goods Sold (see page C-5) 33 Inventory at beginning of year. If different from last year's closing inventory, attach explanation 34 Purchases less cost of Hems withdrawn for personal use . 35 Cost of labor. Do not include salary paid to yourself 36 Materials and supplies . 37 Other costs 38 Add lines 33 through 37 . 39 Inventory at end of year 39 ~ 40 Cost of goods sold. Subtract line 39 from line 38. Enter the result here and on page 1, Gne 4 40 • information on Your Vehicle. Complete this part ON, LY if vou~ i i ~gcar or truck exc~enses on line 10 and are not required to file Form 4562 for this business. See a instructions for line 13 on page C-3 to find out if you must file. - ~~~fClEfs) 41 When did you place your ~RICI~'in service foJ purposes? (month, day, Year] ~ -~~ . ~ ..a~ ~ / 42 Of the total nu ber of miles you drove vehicle during 5, enter the num r of miles you used your vehicle !" X0.00 h~ a rn I !r- p s S a• p - --- -c Other 20 -- I? = -r'~-q c_ ~ o J 9 ~ 7 43 Do you (or your spouse) have another veh a available f rsona! use? . Yes ^ No 44 Was your vehicle available for use during off-duty hours? ~ YeS 45a Do you have evidence to support your deduction? Yes b K "Yes," Is the evidence written? . . ~ Yes Other Expenses. List below business expenses not included on lines 8-26 or line 30. ~5 ~ ...p1~F/C ~_~vX ~ vrrn ~- -~~ d ~ ~u>< ~~'3 /~'I ~c~1 ~ l7oSS q ~(~,,, l~~ ~ t~R-4 Tb l~ .S /1>5~ pl-!_ ~1 f~~..=.~ ~` "' ~f~-T/OIVA2- _ .ll.. S ?~ ~PNP//f ~ ,•t~ k'i N G ~fCf ~Ss7 r ._. _..._.--iN~-... `/ .. ,~ _ .._.l~-~`----~=~--~~,r S-- ----~~-~C~~~ ~~p'c !V2 Ys r~prR Tlon/S ^ No ^ No ^ No ~o oa ~ 7 ~o ~ ~ ~S Otl ~-7 g8 ~ ~ ~~ ~ / / ~ D vl G7 3v 46 Total other expanses. Enter here and on page 1, line 27 ~ V r~ / b ~~~ ® Prirtrd on ncycNd p~ps~ Your ,~~ '~ Depreciation and Amortization OMB No. 1545-0172. °_ - (Including Information on' Usted Property) ,~, ~~~'~uato ~c° 9~ ~ n o ( the T ,,,,e serer (10) - See separate instructions. - Attach this form to your r@turn. ~°~ ~ ~ Sequence No.' 67 (e b ~d1 lr return 8 'Hess or to which forth relates `~' i~ - ~ Q S ~ ~ number ~~' ~ -9 ~ f ~ I r ~ b~ ~1 o . c . Election To pense Certain Tangible Property (Section 179) (Note: If you have any "Listed Property; corn fete Part V before ou corn lete Part l.) - - - - Maximum doNar (imitation. If an enterprise zone business, see page 1 of the instructions . 1 17 500, ', ~ Total cost. of section 179 property placed in service dunng. the tax year. See -page 2 of the 2 ~ y~, '~f`~' .. instructions ... - 10 Threshold cost of section 179 property before reduction m limitation . ~ . ~ ~ . ' 3 ~ 200 000 '• Reduction in limitation. Subtract line 3 from line 2. If zero or less;' enter -0- 4 5 bollar limitation for tax year, Subtract line 4 from line 1' If hero or:Iess, enter -0-. If married ' ' ~ / 7 '~ ~~ 5 ~~'~ - ~ ~ ,filin se aratel ,see a e 2 of the instructions . ~ ~~ ~ j . (al (ascription of aroa~y ,: t 4 .; (bi cost (c) Elected cosc s f :. , ,~ - ,~,:.~~. - . ........ 7:: i' { f .~ ,~ T .. •- : G y ;Listed property. Enter amount from line 27. . x ,~ ~ 7 ~ . ~, ~ . y r~ lutes 6' slid 7 - ~ - ~ 8 Add amounts in column (c) Total elected cost of section 179 property - ' ~ 8 ~ ' ` X f'o 3 ~ Y'3r . , . _, ; ~ :. ~~ Enter the smaller of line 5 or line 8 • -~ ~'~~> ~ t;~ - ~~ ~ 1 ~ ~ ~9 ' entaUve deduction ! 7 - - :? 3 YY . . 1 .:. ~ 1.-. . ~ pa e~~2;of the instructions .~~ ~ ' ~: ~ over o lsa ow uction 1994 -~ ' '~ - . ~~ w i. ; ~" 11 Taxable income (imitation. Enter the smaller of taxable income (/x~tless than zero) or.Gne 5 (see irtshvctions) 11 I OG ,; x•12 ~ 'on 179 expensed uction. fines .no er more. me 12 / 3, :~ = ( ~.13 . vec of disallowed deduction to 1996. Add lines 9 and 11T, _less.line 12 - "13- ~ sr>. ~ . ~ ;Note: Do not usePart ll or Part 111 below-for Nsteof property. aufomobtles; ,certain otfiep vetalcles, cellular te . lephones, '" ~._ r certain computers, or property u~d for entertainment, rec ~oilr,..yramusement) /nstead, use Part V,forl ' , isted property ^r~ ~~MNVr1 . '''Listed ~. _ Y` p , !ij( t 4 i. i j 14 Depreciation. For Assets Placed Service ONLY During Your 1995 Tax Year (Do Nat IncludE .Section A--General Asset Account Election ` ~ ` If you are making the election under section 11i8(~(4) to group artK~assets placed rn servce dunng the tax year into one ormore ' general asset~accourlts, check this box. See ge 2 of. the (nstivctlon`s` ;: ~ '':" °'_ . . " .: : ~ ..~ - ' ^ (b) Month and. (c) Basis for depredation (~ R~~y ' ~, (a) Classification of property year placed in .(business/investment trse '~.~~ (s) Convention (Q Method (g) Depreciation deduction tenAce on~1 r--3ee instructions Section fB-General Depreciation S ystem (GDS)- (See page 2 o f the instnuctions.) 15a 3-year property •---- b 5-year prop2 - :----- c 7-year property _ ~---.- d 10-year Property - ~_ e 15-year property _ -_ ~ ~---~ f 20-year property -• ^~ g• Residential rental - 2 7 .5 s . MM S / L r--~ ro 27.5 yrs. MM S/L h Nonresidential real 3 9 yrs . - ' - ' lit S / L ~ ' r"~' ro r-MM S / L ~-~ Section C-Alternative Depreciation System (ADS ) (See pa e 4 of the instructions.) • 16a Class life S/L - b 12-year ~ 12- yrs ... S/L c 40-t'e'ar 4 0 s. ~ IKNI S/ L rill Other. Depreciation tDO Not Include Listed Property.) (see page 4 of the instructions. i 17 GDS and ADS deductions for assets placed in service in tax years beginning before 1995. 17 - - 18 Property subject to section 168(()(1) election - : ~ 18 """'~ ....~-~ 19 ACRS and other de iation - - 19 Summa See. a e 4 of t o instructions. 20 Listed ro Enter amount from line 26. ~ ~^ P PertX 21 Total. Add deductions on line 12, lines 15 and 16 in column (g), and lines 17 through 20: Enter here !_ and on the appropriate lines of your return. Partnerships and S corporations see instn~ctions . 21 ~lv - yv 22 For assets shown above and placed in service during the current year, enter the rtion of the basis attributable to section 263A costs 22 For Paperwork Reduction Act Notice,-see page 1 of the separate instructions. Cat. No. 12906N Form 4562 (199F Fom, asst (t9ssl rLt r9.' ~" . ~. 3D ~ o u„o j I ~ ~._ ~~ Listed Property Automobiles, Certain Other Vefiicles, Cellular Telephones, Certain Co Property Used for Entertainment, Recreation, or Amusement Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, co ' 23a, 23b, columns a thaw h c of Section'A, all of Section B, and Section C if ~ on O g (.) applicable. Section A-Depreciation and Other Information (Caution: See page. 5 of the instructions for limitations for automobiles wa vu u nave ovruea~ro w su un ure uusuressrurvesuneni use eiarmea r Yes u no lib It -Tes ~- IS Tne evlaence wnttenz Yes <] No Type of property gist vehk~es first? ~ Date placed In service - ~. investment' uae ~. 'Cost a other. basis . Basis for depredation (twsiness/investment use ~~. ~: Recovery period Method/- Convention Depredation deduction Elected section 179 cost 4 Pro -used more than 50% in a ualified ..business use See a e S of the instructions.: .~ % ~ ~ '7 0' 0 3 o Lint ~ ~- /b 3 Pro used 50% or le in a ualified business use See a e 5 of the instructions.: _ _.. -y S L - Add amourrts in colum ~ .:Errter.the total here and.on line 20;-page.l," .~ 26 - -~"` 1 r b .~ ,., y k Add•amounts i n "I .Enter the total here 8nd On line 7, a e1 - ~ 27 .•y y _ ., -__. .,,;_'" ; :" Section.B-hformation on Vehicles :.. ; . -' -; .: ~. >~. Complete this section. for vehicles used by a sol ropryetor partner, yr ofher _ ore tit 5% owner,' or related person . • lfyntrpmvided trehic~es b your employees; fiist answer nie q~bora Jn~section a to ~e~lf yrxi, _ andcceptiau~to completing this section for.trj~ hides ` ~~' fi ~ • ' . _ •~ ~ ~a.., _ . 28 .;Total businesslinvestmeld miles driven d np ~ /. ~ ~ ' .NehldB Veh 4 Vehlde 5 - F -the year (DO NOT include commtttin~ mi /( /.?Q~l ~ ~ x 2!('. ~ Total ctimmt~ing,mlle~ driven dunng tfie rear ~• ~ •~- + ~>~ 3 p _ . 30 : Total•.other personal (noncommtiting) '` •~'`(`~ - '~S ~ ~ :"' " ~ F 1~` ~g 2 0 ~ - - ~` ,` ~ ~"Y3 L~? ~ ~. -• ,- ,~ miles drnren 1 . . J 3t Total miles driven dunng the year - ~ T `' ~ ~ -~ > ! k3$" r~. ~ ~~ ~~ ~y7 ~y y,^. •~ ~ ~ 50 ~ , 3 ! o•0 7, ~ • Add .lines 28 through 30.. ~ ~ _ - , .. . ~` - °fN ~ ~ ' ~ ~` •. ., -,> Yes: '•No ~' -Yes Noy: Yes- No Yes • No Yes No , . 32 Was the vehicle available for personal ~ '~ ~~ ~y+7. . ~ ~-' `~ '' use during off-duty hours? . z, ~ `x~,,~ ~ ~:-._.. -. .~_.. 33 • Was the vehicle used .primarily by :a 'm o r. -• ' ` ~,~~.~ ~` '~ 4 .- ; ' ore than 5% wner or related person?; !, ~ ~ - 34 " Is another vehicle available for personal ,, ~ t'~~ ~" ~;: "' _ _ e A I~ \ Section C-questions for Einployers.•Wh o Provide ehicles for Use by Their Employees. ` Mswer these questions to determine ff you meet an exception to completing Section 8 for vehicles used by employees who are not more than 5% owners or related persons .. r . ~ ~ ~ _ ~ -, ~ - . .= . r _ Yes No 35 Do you.maintai~ a written policystatement~that prohibits all personal use of vehicles, including commuting , by your employees? .. ~ L . , ~ .... - , 36 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See page•6 of the instructions for vehicles used by corporate officers, directors, or 1% or more owners •' . ; ~ 37 Do you treat all use of vehicles by~employees as personal use? r:,~ •, , ' 38 Do' you provide more than five vehicles to your employees, obtain information from your employees about . the use of the vehicles, and retain the information received? ,' 39 Do you meet the requirements concerning qualified~automotHle demonstration use? See page 6 of the instructions . Note: d r answer to 35, 36, 37, 38, or 39 is "Yes;" need not corn ete Section B for the covered vehicles. Amortization ~l DacxipUon cf costs - rol Date amortization begins , ~ fcl Mrortizable. amount tai Code section Arno (rU~zatlon ~ A`rrortizMation for this year 40 Amortization of costs that ins Burin our 1995 tax ear: 41 Amortization of costs that an before 1995 41 . 42 Total. Enter here and on "Other Deductions" or "Other i=xpenses" line of your return 42 ry ~ ~ . _~-_-_. .r.- - scHEOULE o Capital Gains and Losses . (FOrm 1040) - Attach to Fonn 1040. - See Instructions for Schedule D (Form 1040). auru~~r~va,us~s«~ h~ - Use Mes 20 and 22 for more space to list transactions for lines 1~ and "9. Name() stwwn •on Form 1040.. - ' N J~ ~1 I 1 -. -• _ OMB'No: 1545-0074 ~1~95- Attachment sequence No. 12 Your social security number 33 ~ v: a bS Short-Term Ca ital Gains and Losses-Assets Hel d~One Year or Less al Des«i~. property rol Data , acquired ~ ~~) Dace soa ~o day na i~ sales price ~~ ~ ~) ce) costa. ~ other basis ~ . m joss -ir ce) is~more then ~~' tai ~iA1N K ~~ ~ rrwre than ce), ,oo en. xYZ coa ~,o.,:. .) ., , . ~~ ~ o-~ subtract cdi rnM, subiract ei tror„ c~ 1 - • ,- 2 Enter your short term totals, if any, from line 21 . 2 ~ - r . - • . ;. - 3 Total short-term sales price amounts.: t~ _ Add column (d) of lines' 1 and 2 . ~ : .: 3 ' 4 .Short-term gain from Forms 2119 arid 6252,~and short-term-gain or from - - ' - ~ ~~ 6781 and 8824 ° is ' ~`~ Forms 4684 4 ~ '` - , . , Y , ~ 5 Net short-term gain or loss from partnerships, S c es; and trusts from Schedule(s) K 1 ~ _'.,. `~ ~ ar _ h 6 ,Short-term capital .loss carryover Enter the . ,from line ~ _ ~ '~ - Capital Loss Canyover 1fJorfcsheet ` 1994 6 ., _ (g)~ , Aaa unes 1 tlir+ougn s ~~~-coi d T , , ~- ~ - 8 e'~ inlet snort-tern, cap a ns if I' ' ~ . • .Lon -T Gains es=aAssets. ore`Th •One Year -- lTe~~ ~,.. r - _- l l _ .;._ -3 ~... j , L`~{i 10 ~ -1;er , from ~ ~ ~:. ~. ~~.;,... _ . .. - .~:-.~: 11 I long term sales pace m ~ "~ ' ~ ~ , Add column (d) of lines,9 10 . - :11 !./~ ~ . 12' Gain from Form d797; t gain from Forms :2119, 2439, and6252; ~ ~; . - - m Forms 4684„6781 and 8824 ~ and long-term gain or I 12 "'-'~' , 13 et long-term gairi or loss from partnerships, S corporations, estates, and ' ~.:., _ ~, +`_,,, .. ~: ~ is from Schedule(s) K 1 13 . ; ;F t - Capital gain distributions ' ~:. 14- 14 . . . 15 -Long-term capital loss carryover. Enter the amount, ~if any, from line 14 of ~ your 1994 Capital Loss Carryover Worksheet : 15 ~ ' . . 4 - ~ _ ~ ~ ~ : through 15 in columns (f) and (g) 16 Add lines 9 16 " - _ 17 Net Ion -term ca ital , ain or oss). Combine bolumns f) and O of line 16 ~ - 17 - ~~ ~'v i ~y Summary of Parts I and II • - 18 Combine lines 8 and.17. If a loss, go to line 19. If. a_gain,•enter the gain on Form 1040, line 13. Note: if both fines 17 and 78 are gains, see the Capital Gain Tax Worksheet on page 24 . 19 If line 18 is a loss, enter here and as a (loss) on Form 1040, line 13, the smaller of these losses: a -The loss on line 18; or ' b ($3,000) or, if married filing separately, ($1,500) . ' .. Note: See-the Capita! Loss Carryover Worksheet on page D-3 if the loss on line 18 exceeds the loss on line 19 or if Form 1040, line 35, is a loss. - For Paperwork Reduction Act Notice. see Form 1040 Instructions. Cat. No. 11338H 19~ Schedule D (Form 1040) 1995 , m ~ ~om+ '~ ` n K w ..~~ N ~ _ N O .r~ ~ ~ m ~~ `'~~ mce y ~~ ~ u x ~ " .~ iii n 'lu~l ~ H c ~'~' N m o 2` m ~ t ~ ~~~~ amo~.. v;o ~ N ~r47N rrmo~ M O7000~ NE Z1 mb+~.m W W 3 m ~ y ~ mw~~- ~ n ~ ~ ~~~a ~ DnN~~ m x ~"'~ w x rm~o alt ~ ~ V Vf O $ a ~ O O $ Wa r ~ rr WO O D V ~ ~ .R~ ~ O ~ f d o r ~ • N o _ a ~o ~ ~ r $ N~ N m I ~~ N ~ W a H ~ B -i B X N b V A W N ~ D~ s G~ ~ 3 ~ v ~ ~ ~ o m i ~... O~ ~ ~"'~ N ~ ! r.. ~ V _ 1 V N V N W ~~\~ c i P rt= 2 x I a N~ ~m ro nO Ea mE o~ mm o >E ~ c ~ .-, z ~ ~ wm =~ N ~ O W 70 b ~i~ ~ n ~~r^ Z m ~. A z~ ~~ ,x i~ ~~~~ I~ I~, ~C 'r ~~ ~C 1~ :'.I > ~„ ~ ,r r., ,:, I ~, j,. ~~ i Iii ~--,r!~~1,1~I11~ i Il's ~ !i ~ ~ 1 s .I ~ s~. :~. ::.ill- + +~.~~1;~;'~~+~~ ~ 111 II +~ I I ~~~~~~ ~!~ ~ I~~~ , I~I +Ii~II~ .~ i x~ ~~ ~t'ihe T "~ •~'_ `.Reverxie Savice.'-r@~- ~ O qq ~ d i eT S..Ini ua in com lvl~ ax .Return ; ;.. nog ~ ~~ ~~ no+ ~e a s~ ~, ma ~~. the; ~"I` °.or ,tax' . `.... - _ _ X1996, ending: x';'%18 AMB No. 1545-0074 Label • 'Your: seauity number X ~ ~ .,r..,.... r ~ ~s7 :3©: gOtour' 11.) a65 ~i-34-rS6a s~8 ~s ~ 3sr-3!]- ~ ~ s social suety number ~ _ ROt,ER ,! S: CAROLYN A PERS1l~ I ~ ~ ~~~he IRS D9 E YELLOIJBREECHES RD R , ~~.«;.:: v ~ othen~vise; H E CARLISLE PA 17[113-r'~7Ci ~ help f1g me ~ °- , see pages ~ please print R E S ' 3 to ills booldet. ~ ~ or type. ;,~ ,~,:x , . .,, , ...»:, . , Presidential ---- - --- - des: "No NotKQt~eciany Election Campatgrt '~'~ ~ ~ - ~~~ - X .'Yes~wdrnot ` ~ ~ ~ ^ t See a e 11. :go, tvnd? :' ,. .. fw d. -,; _ . - Filing Status ~- e ea,~iy~ a.. wnna~' Check only ~ ,.._ .. a child but not~ax one box. ~ ~, __ _ '~~~ ,spolJSe;~ a3d~`ti'; ~~ ~tt UCt ~ iOt1S.~ `~ `~Sr+r~~rr7ca+a ~i~f.. You ".. -,<~as-aJ"de Exemptions ~ enf on`.~,,,, ,r~,taz, ~ ~ No ~el eom ' `t.~--.; ~. a~eane ea ~~ 2. ~ sae ab ,. ,;~-~' ta~~,~: ~ ~ ~.. . eMtldna sa Itsa~"~ - _ .:'see iraG . ... , ... "' J ~ ~ ~ ~ pn - ~ qd wt IMn.tilm ff more than six ~ - ~ .ta ~a M elrortt dependents. ~ •itseftarttloa ,~' - see the sit ~ instructions for line 6c ` f of ie: . aabrsd ailors ``uu 7W F1 .. Income attach Copy B of your Forms W-2, w-2c, and 1099-R here. H you did not get a W-2, see tfie instructions for line 7. Enclose, but do not attach, any payment. Also, please enclose Forth 1040-V {see the instructions Yor line 62). Adjusted Gross Income ff line 31 is under 528,495 (under $9,500rf a child did not live with You), see the instructions for line 54. For Privacy-Acts t .......r .3..~~" ~ -~ ~r-orm ioao hsssl .~ ~ Tax- Compu- tation If you want the IRS to figure your tax, see the instructions for line 37. Credits Other Taxes &sa~~iies° ~~ sz"~ ~ ~~ae Payments ~ ~~, ~~~~~ ~` Attach Forms W-2, W-2G, and 1099-R on the front. n ,.t .. , Refund ., n ~~ Have R sera a`~' directly to ~, ;: ' ~ ,3 u" S y W . ~ COtrnt. ee ac ;j inst. and till in ~ ~ ~ ~' - 60b, c; and d. .;8i~ 's 'i : Amount :mss.,- .ts- ry' -~' You Owe ~~ -~ ' , ., Sign ; « '~ «' Here sknature Keep a copy . of this return for your se's sig re. If a joint records. Q'i~.i~~.._/ Paid ~eparer's' - t ure gna Preparer's 4jFn,,,$ f18171e nor yours Use Only d eu"'p'°"~- ~ , ~if a~ ~2 i il5oS~ Q i i 7367/ 8 ~. s (,Sioo 00 ) /3 ~ oa ~tt i e - f s , I I 3 i / ~~~ z3. 3. ;PS? Z 3 D imp= -,:.. ~. - ~ e~ Date r occupation r ,~`' d~ ~3~97 / KoT~'z'15 /1'~~rv Qi' urty~OTFi must date Spouse's occupation r// `f 1 y 1 P {-fa r- t~ ~i4~L ~~'1 ~3 ~u y I ate Preparer's social security no. ~. Check if e-- ~ ^ .. - N ~- ~ sail-employed o -- aN J .--.~~-~ Cp 1 1 A~~o SCHEDULES AB:B Schedule A-Itemlzea ueiaucilons '~°-W,4 ••~ ~~ ~ (Form-1040) ~ (Schedu{e B is on back) (( 00~~ ~cJ96 klloeew ,~ (10) - Attach to Form 1040. - See Instructions for Schedules A and B orm 1 ~ ~• ~No.07 N s) shown on Forth 1040 nn - ~ - ~ ' Your sodel sapaity numbs 3 3 Pr.S i A~4o N . O~G C 0 06. Medical Caution: Do not h~clude es reimbursed or paJd by others. age A-1) ' enses (see d - 1 Medical and'denta! ex •1 . . p p an Dental 2 Enteramount from Form 1040, line"32. 2 ~ . Expenses ~3 Multiply line 2 above by 7 075) 5% ( . . . 4 Subtract line 3 from line 1. ff line 3 is more than line 1, ent er -0 - 4 Taxes You 5 State and local .income taxes 5 ~ O ~ _ Paid 6 Real estate. taxes (see page A-2) . 6 . . .(See 7 Personal property taxes .. .. 7 ~ f ~ - ~ t5[!*t!~._5 page A-1.) 8 Other taxes. Ust type and amount - 9 Add lines 5 throw h 8. • . ' 9 (2 0 t 10 Home mortgage interest and points reported to you on Form 1098 I 10 ~' ~` nteres You Paid 11 Home mortgage.inten~t not reported to you on Form 1098. ff paid ~ - (~ t0 the person from whom you bought the home. see page A-2 _ ~ - page A-2.) and show that 's name, identifying no., and address - ~ . ,. _ ~ = --- . t N = 11 .. ~ 75 -----._......---. o ...--- e: •------------ - ------•--------... 12 Points not reported to you on Form 1098. See page A~ ~ ecial rules - fw s 12 . p not . . attach Form 4952. (See- deductible. 13 Investment intdrest. If•required, page A-3.) • . • - - - 13 . . - 14 7 ` h 13 14 Add lines 10 throw Gifts to 15 Gifts by'cash or check If you made any~gfft of $250 or ~ - Charity more, see page A-3 . ~ ~. 15 Z B you made a 16 Other than by cash or che:ck.lf any gift of $250 or more, Z 16 _ . 2 9~ and 9~ a see page A-3. ff over $500, you MUST attach Form 8283 -• 17 . 17 Carryover from prior year -- 3 - . see Page 18 Add lines 15 throw h 17 . 18 Casualty and ~ - - ~ : Theft Losses 19 • Casualty or theft loss(es). Attach Form 4684. (See page A-4.) 19 Job Expenses 20 Unreimbursed employee expenses--job travel; union and Moat dues, job education, etc. If required, you MUST attach Other Form 2106 or 2106-EZ. (See page A-4.) ----=---------- ~- Miacellaneoua ~ ........:.:.... ~ - Deductions ' ' - - ~ ~ aration fees re 21 Tax 21 . • . p p . (See 22 Other expenses-investment, safe deposit box, etc. List - ~ -~' - a A-4 for P 9e type and amount ----------------------------=------------- expenses to - 22 . ----------------- --------------- -..._ deduct here.) ..----•----------- h 22 23 Add lines 20 throu 23 g . -- ~ 24 ~ Enter amount from Form 1040; line 32. 24 02) ... - 25 Multiply line 24 above by 2% ( ~ . 26 Subtract line 25 from line 23. If line 25 is more than line 2 3, en ter -0- . 26 - OtheC 27 Other-from list on page A-4. List type and amount - ______________________________ Miscellaneous ~ ' . Deductions ~ Total 28 Is Form 1040, line 32, over x117,950 (over-$58,975 if married filing separately)? . - Itemized NO. Your deduction is not limited. Add the amounts in the far right column ~ Deductions for lines 4" through 27. Also, enter on Form 1040, line 34, the larger of • ~. 28 this amount or your standard deduction. vie v......~n.~l.v.ti.,., .,,~.. F.n cmifnr~ Con n~na O_5 for thA amount to entAr- ....... .................. ~ .................-- r-a- • • - •-- ---- -------- -- - -- CQ\\\\O ~~~.~.~.~~... For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 1t330X Schedule A (Form 1040) 19! C~ SChedtdes Aif~B (Form 1040} 1996 OMB No. 1545-0074 Page Name(s) shown on Form 1040.Oo rat enter name arW social secxuity Wombat it shown on other side. Your social seautty numb. Schedule B-Interest and Dividend Income Na. c Part 1 Note: N ou had over $400 /n taxable Interest Income, must also com Isle Part lll. Interest 1 List name of a er. If ~OUm income p y ~Y interest is from aseller-financ@d mortgage and the buyer used 'the property as a personal residence see page 6~1 and list this interest first. Also, show that buyer's social security number and address - (See page B-1.) ~ d....As.~.o~.~ ..................•---..::.----... y.-4x~. Crate..S~tJ•_:i' Xo~r_'K-~Gdec~ec.._.:~~x_ + 1.otinl....Asso,r~...--------=-=--- Note: If you _ _... ---.~:~to~~errx..t~.._~.L ~ - .....---••-------------- ------------:....... received a Form . ~ .. ..: : : h- etra t°C ~ ~= i ~ ~ ~(~ ------------------------•---- ~- 1099-INT, Form ........ . ... .. ..._ . . -------.._ --- ... . ......... substitute ---- statementfrom ---------------------------------- --- ..._._...... ---------- ---------- a brokerage flriil, .......................................................................•...._._....._...:._1 I'at the firm's - ~ ---...:__:. name as the . . .._ .. . •------•---------...---- -=--- - - payer and enter . .. -----•----....----------- - - --------------------- ---- : the total interest _..~..-- --------------------------------------------------------------------- ..... shown on that ------------------------•-------- --....._.:_.._. ...------ ---------- ----•--_.. forrrr. 2 Add the amounts on line 1 3 Excludable interest on series EE U.S. savings bonds issued after 1989 from Form 8815, Gne 14. You MUST attach Form 8815 to Form 1040 .. 4 Subtract line 3 from line 2. EFtter the result here and on Form 1040, line 8a - '1 Part II • Note: K had over ~4001n dividends and/or other dfsMbuflons on stock must also c om lets Part lll. Dividend ~ t di ib tio . c d/ th t d d Amount Income 5 - on s k er u ns o s an or o s r en List name of payer. Include gross divi here. Any capital gain distributions and nontaxable distributions will be deducted : : on lines 7 and 8 - - - - - - (See page B-1.) .. .__ -.. _... ._ - ~-------------- ---------- ----- ----- -- ~RRQ ~KD- = - - F 1cr ~!1 n~ a~l LS ~ Q ---------- --- . --- ... ... _ _ ~ _ _ ...- ----- j~~rRP N Fts C) aLrr 1~ ~0 l~ -~ ~ . _ --.._. u .-- - _.. ---- ixe~l:uY~c~lC'arni° F~cN '~D `:::'~k~r?~ R e:~a~ p X14 R ~ - Nota:tfyou - . ._. . __ l. - - -----. f~,•ct~ ~~~ ::~ QonA ~ ~RP ~ ~~~ ~~o ' .3 received a Forth __ - _._.. _... . . .. . - ------- = = - - - 1099-0N a b it t ---------- ----------- -------------------------------- --------------------- -•-- ---- - - --.. - u su st e statement from -----------.._....----- _..... ...----•------- , --- ----------• --------- - - - - 5 a brokerage ----------------- - -----.....------ --- ------------- ---- ------ ----- - • --- fum; ist the fi ' ................................... ............... ----- ------------- - : - - --- rm s name as the payer acrd ~ ........-- ----------------- ---- -...----- --._.. _---- --- ---- ---- -- -------------------- , . • , --- - enter the total r - - dividends t th h -_------------- ----------------------------------------------------------------------- - ---- r own on s a forrrt. ~ ----------------•----..._..---- - ----------..~----- .. - --- -- - - ---- .. - - --- 6 ......... ... •_ Add the amount§ on line 5. ----- -- .. ..._. . 6 7 8 9 . . , _ . . Capital gain distributions. Enter here and on Schedule D' . .7 . . Nontaxable disMbtrtioru. (See the inst. for Fonn 1040, fine 9.) 8' \ Add lines 7 and 8 • ' 9 . 10 , ..... . _. - Subtract line 9 from line 6. Enter the result here and on Form 1040 line 9 10 , , 7f you do not need Schedule D to report any other ga/ns or losses, see the lnstnrctions for Form 1040, line 13. Part III Foreign Accounts and Trusts (See page B-1.) You must complete this part if you (a) had over $400 of interest or dividends; (c) received a distribution from, oc were a grantor of, or a tnansferor to, a fon had a foreign account; oc I Yes ~ No trust. 11a At any time during 1996, did you have an interest in or a signature or other authority over a finandal account in a foreign country, such as a -bank account, securities accourrt, or other finandal . account? See page B-1 for exceptions and filing requirements for Form TD F 90-22.1 . b 'If "Yes," enter the name of the foreign country - --------------- ' 12 During 1996, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? ff "Yes." see pane B-2 for other forms you may have to file For Paperwork Reduction Act Notice, sea Forth 1040 instrucdona. Schedule B (Porto 1040) 195 rr7 ~ SCHEDULE C . ~ Profit or Loss From Business °""B ~- ~~ (FORiI 1040) _ ~ ~ (Sole Proprietorship) ~ ~ o.pertrn.~x a us rrwuy (1 - Partnerships, joirrt ventures, etc., moat file Form 1065. ~ ~~9 6 Intame~ Rsvenw Service ~ - Attach to Form 1040 or Form 1041. - See Instnrctlons for Schedule C (Form 1040). ~~nce~plo t Name of a ~ 8oda1 ' d G ttD ~ nl / a~s ~ ~ ~ _ r rxa„ber fss~n ~ 0~5~ A Principal business or profession, ~tchxiing product or service see page C-1) B Enter prirrdpal business c C Business name. K no separate .bus name, leave blank. _ O Errrployer ro number tent, e F G. L, EBFN ss ~ 3': o~ 3 5 E easiness address (ndudng suite or room no.) - ..!_~- ---~°id.t_-_.! /1.. tC.e~T ............... -------------------- City, town or post office, state, and ZIP code ~ t^~R LI.s L tf . Q- ~ ^~ D /3 - 'Y 9 Y~ . - F Accounting method: (1).~Cash . (2) ^ Aaxual (3) ^ Other (specify) - .....-----•------------------------ ..._.. G Did you 'materially participate' h the operation of this business during 1996 If "No,' see page G2 for imit on losses. Yes [ H K you started or acquired this business during 1996, check here - il~/(,1d. E Q•9 t~ ~ - [ 1 Gross receipts or sales. Caution: If this Income was reported to you on Form W-2 and the 'Statutory 1 _ 0 ` employee' box on that fom- was checked, see page G2 and check here ~- ^ 2 Returns and allowances . ~ 2 3 Subtract line 2 from fine 1 ~ . " 3 4 Cost of goods sold (from line 42 on page 2) .. 4 ti Grose profit. Subtract line 4 iromline 3 : ... . ~ . ti 8 Other income. including Federal and state gasofuie or fuel tax credit or refund (see page G2) ~ 8 7 Gross income. Add fares 5 and 6 ~ - 7 ~ ~ • f1SeS. Inter a nse S TOf bUSIneSS l1Se OT OUf hOm@ OA On one sU. 8 Advertising , - •. 8 ~ ~ 19 Pension and profit-sharing plans 19 9 Bad • debts from sales or 2D Rent or lease (see page G4): services (see page C-3) ~. 9 a Vehides, machinery. and equiprtient . 20a 10 Car and truck expenses ~ ~. r'~ ~`3 b Other business property 20b (see page C-3) . ~ . • 10 ~"~ a 21 Repairs and maintenance '. 21 t1 Commissions and'fees ~• 11 22 Supplies (not included in Part IIQ ~ 12 DepieGon 12 ~ 23 Taxes and lic~rues . 23 13 Depreciation and section 179 1(~C'fI~2 24 Travel, meals, and erttertainmertt: expense deduction (not included a Travel . 2~ in Part Ilq (see page G3) 13 3 / a b Meals and en- ~ 8,v _ 14 Employee benefd programs tertainment . (other than on line 19) . 14 c Enter 5096 d 15 Insurance (other than health) . 15 ine 24b subject _ L '" to irritations ~ ~ ~ 18 Interest: (see page G4) . , a Mortgage (paid to banks. etc.) . 16a d Subtract ine 24c from ine 745 24d b Other . : 16b 25 utilities C ~l~`~"'a '~ ~ _ 17 Legal and professional • 26 Wages (less ernployrnen~redits) 28 services ' 17 27 Other expenses (from line 48 on ~~II • 2 91 D 18 Office a lsi14~j7roN 18 ) Page 27 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns - ~ , .- l . 29 Tentative profit (loss). Subtract line 28 from.ine 7 .. . ~ . ~ v 30 Expenses for, business use of your home. Attach Form 8829. 30 31 Net profit or (loss). Subtract irte 30 from line 29. • H a protR, enter an Forth 1040. lure 12, and ALSO on Sdredule SE, line 2 (statutory employees, ~/, 6 see Page C-5). Estates and trusts, enter on Form 1041, line 3. 31 'rb • K a k~sS, you MUST go onto fine 32. 32 H you have a loss, check the box that describes your investment in this activity (see page C-5). • K you checked 32a, enter the loss ort Forth 1040. Qne 12, and ALSO on Sd-edule SE, line 2 All investment is a' (statutory employees. see page G5). Estates and trusts, enter on Forrn 1041, line 3. 32b Some investment i • K you checked 32b, you MUST attach Form 8198. ~ at risk. For Paperwork Reduction Act Notice, see Form 1040 fnatructions. Cat. No. 1t334P Schedule C (Form 1040; C~ Schedule C (Forth 1040) 1996 ~ - Page 2 • Cost of Goods Sold (see page C-5) ' 33 Method(s) used to value dosing inventory: a ~ Cost b ^ Lower of cost or market c ^ Other (attach explanation) 34 Was there any diange &~ determining quantities, costs, or valuations between opening and dosing inventory? K 'Yes," attach explanation .. ^ Yea ~ No 35 Irnentory at _beginning of year. If different from last year's closing inventory, attach explanation 35 36 Purdiases less cost of items withdrawn for personal use ~ 3T Cost of labor. Do not include salary paid to yourseK . - .. . - ~ 38 Materials and supplies ~ 39 Other costs ~ • i - 40 Add lines 35 through 39 'a 41 k~ventory at end bf year 41 . 42 Cost of goods sold. Subtract Gne 41 from line 40. Enter the result here and on page 1, line 4 42 Information on Your Vehicle. Complete this part ONLY if you are claiming car or truck expenses or line 10 and are not required to file Form 4562 for this business. See the instructions for line 13 on pagE C-3 to find out if you must file. ~ ~ - • V~2N~cu~Cs~ - - Irg9 f 43 When did you place your,~tehlcle in seance for business purposes? (month, day, Year) -. --d~_ ~ . ~_~ _ ~ __... . 44 Of the total number of mHes you drove your vehicle during 1996, enter the number of miles you used your vehide for. - ~zC~l~2 ~~FO~ - - 2300 3~-~-f Y>I -8 ~rt~ss ------.~ ~1.4_A----- ... b Commutm ~.~~0------------- c Other 3350 - usl __ ..... g ......._.. - ------------------------------- 45 fb you (or your spouse) have another vehicle available for personal use? , ~ Yes ~ ^ No 46 Was-your vehicle available for use `during off-duty hours? - ~ Yes ^ No 4Ta Do you have evidence to support your deduction? - ~ Yss ^ No - --- ~ ~ _ b ff 'Yes," Is the evidence written? . ~ ~ Yes ^ No • Other Ex eases. List below business ex uses not included on lines 8-26 or line 30. • ~o,Sr..a~Frc~.--=~~_x__~_~~t__~lOrno!J.~!?o:~a~c 2~_3,_~9.e~~I~-~?c_t_ ~ 00 ---- ---- - ~_ r f~~ ~/ - I.:QST_e9:~g:f_aK... ~cy.l ~l._~Z... ~,~.. ~ ~ p - ~ SS `i~a~~'-?'`-°----------- ~~ r_ n f ~q6--1 ~~{.a~i-. ..__g~ ~!_9.~Q~'.~l_--.. /1/~-l7on!!YL~_ S?~}~ (o oc ------- /f~--ne. /. /' .?.ltlf_rL~QC•. ~.4? f1!_l..l.:(~4G~f~ .-.i'`~1 r_C _w~ ~T_~! INS sz ~j ~ ~uarfW~~ ~-~ Y ~~ __ /~~k rN ~~ fie.[ Q' 'j. _ , A__-c-----------------~n----------------~--.~rx---~------....-------.- --~-~--~----------=---...------ • ~ 48 Total other expenses. Enter here and on page 1, line 27 148 I ~~D I ~ . _~-- - ~«-~, 45s2 - Depreciation and Amortization ~ ~~-0~72 O1NB " '. (Including Information on Listed Property) nn ~~J96 M R~varNis~Ser~y (10I ~ - See separate instructlons. - Attadi this form to your rattan. Sequence No. 67 Name(s) shown on r ~ Hess or activity to this form ales ' A - ~ ~ ' ~ ' klsntHying number ~ moo ~ P a pi P s i 7" Iwn t~Q r >*rri - 30' 0~ 3 Election To Expense Certain Tangible Property (Section 179) (Note: If you ve any "listed property, com late Part V before u com late Part 1. - ~ ~~ 1 Maximum dollar limitation. If an enterprise zone business, see page 2 of the instructions . ~ $17 , 500 2 Total cost of section 179 property placed in service.. See page 2 of the instructions ... 2 3 Threshold cost of section 179 property before reduction in limitation . ~ 3 200 000 4 Reduction in limitation. Subtract line 3~from line 2. If zero or less, enter -0- ' . 4' ~6'" 5 Dollar limitation for tax year. Subtract line 4 from line 1, If hero or less, enter -0-.•If married ' X7 50 ~ ~ filin separatel ,see a e 2 of the instructions . 5 . - IM ~ s - (b1 cost (iwsinass use only) (c) Elected lost . s - ~ _. 7 Usted property. Enter amount from line 27. .... 7~ - ~ \\\\\\\\\\\\\ 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 . - 8 6 3/. 9 Tentative deduction. Enter the smaller of line 5 or line 8= . . - . : •. 9 10 Canyover of disallowed deduction from 1995. ~ See page 2 of the• instructions . . - . 10 11 Business income Bmitation. Enter the smaller of.business income (not less than zero) or line 5 (see instructions) 11 '?7 4 , c 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line•11 12 /. 13 ver of disallowed deduction to 1997. Add lines 9 and 10, less fns 12 - 13 ---- . Note: Do not use Part ll or Part 111 belowfor listed property (automoW/es, certain other vehides, cellular telephones, certain computers, or property used for entertainment, n3cr+aatlon, or amusement). Instead, use Part V for listed property • MACRS Depreciation For Assets Placed 1n Service ONLY During Your 1996 Tax Year (Do Not Include Listed Property.) ~ ~ ' - ~ - . - Section A--General Asset Accourrt Election ~ - 14 ff -you are making the election under section 168()(4) to group any assets placed in service during the tax year into one or more general asset accounts, check this box. See page 2'of the instructions . - ^ - Section B~`eneral Denneciation System (GDSI (See case 3 of the instructiorLS_l . (a) gasification of ProPartY (b) Month and Y~ Placed in service i (q Basis for depreciation use trrstructions ~ ~~ (e) Convention tR Meted (9) ~ deduction 15a 3- ear props - "^ b 5- ear props ~.. - - - - c 7- ear props d 10- ear props , - - e 15-year props f .20- ear props g 25- ear ro 25 rs. S/L "~ h Residential rental 27.5 rs. MM S/L 27.5 yrs. >!~ S/L ~i Nonresidential real . ~ 3 9 s . MM S / L ro ~ - MNI S/L - . Sec tion C-Attemative Depreciation System (ADS) (See page 4 of the instructions.) 16a Class qfe - S/L ..._ b 12- ear ~ 12 rs . S / L c 40- ear - 40 rs. PSI S/L ^ ether De reclatton Do Not Include Usted Pro a See a e 4 of the.instructions: 17 GDS and ADS deductions for assets placed in service in tax Years beginning before 1996. 17 `- 18 Property subject to section 168(t)(1) election ~ . 18 - - - - 19 ACRS and other de relation - 19 • Summa See a e 4 of the instructions. _ 20 Usted property. Enter amount from line 26. ~ 21 Total Add deductions. on line 12, lines 15 and 16 in column (g), and lines 17 through 20. Eller here and on the appropriate tines.of your return. Partnerships and Scorporations-see instructions . 21 ~0 3~ . 22 For assets shown above and placed in service during the current year, enter the ion of the basis attributable to section 263Ac costs ~ 22 For Paperwork Reduction Act Notice, see page 1 of the separate instructions. Cat No. 12906N r-orm 45162 (ts- (~ J Page Forth 4562 (1996) Listed Property-Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, an Property Used for (Entertainment, Recreation, or Amusement Note: For any vehicle for wh/ch you are using the.standard m/leage rate or deducting lease expense, complete onl, 23a, 23b, columns (a) through (c) of Section A, afl of Section 8; and Section C If applicable. ""''Section A-Depreciation and Other Information (Caution: Seepage 5 of the instructions for limitations for automobiles^.) 'M..~ An Ynu 6nun n.nAenwe fn nunnnrl (fie 6ueinnnn finueefmEnf uee nhimnrr9 V i. ~ I, uw ~Y14. If °Vne " Ie }il0 OViltllflPP Wf;t}Pfl7~Vafc 1 1 u iVO VV VY .IY.V Y.IY Type ofr (aProPertY (Gst ~ vehicles fast) YI.VY lV VY Via Y Date roplaced in service .V YVs(~YesVsJ~W ~ ~vestrne~t . ~ ~~a V.sa~~.V ~.a YVV V~Y~. ~.V Cost (a other. . basis Y. .a.v V. a~vr Basis for (edepreciation ~~ wv ~. R~~ Period . VV .V ...v .. M ~ Convention .......•~~ •.....-...~ ~ .. deduction .~ ~ected section 179 cost - 24 Pro used more than 50% in a ualified business use See a e 5 of t he instructions.: l~L~ lE'~' S ° lr iT o 'fyoo o ' oc.a f/ /99~ 53 4 3 rs iz6.3~ .% 25 Pro a used 50% or less in a ualified business use See e 5 of the instructions.: - % S L - ''.' 96 S /L - _.. S/L - ~ 26 Add amounts in column (h1. Enter the total here and on line 20. page 1. .~ .. 26 V Cr' 27 Add amounts~in column (7. Enter the total here and on line 7,' page 1 ~ 27 ~ 'l(03/ Section f6--(nformation on Use of Vehicles - .. Complete this section for vehicles. used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles to your employees, first answer the questions In Section C to see if you meet an exception to completing this section for those vehid~ t mil s driven durin tr t l b i 28 T r (a) Yeh~ie ~ lb}~ •~ ~vehide 2 (d Vehicle 3 ~ WI Vehicle 4 - (a1 Vehicle 5 M Vehicle 6 g nves nen e us ness o a ear (DO NOT include commuting miles) the o oa - y 29 Total commuting miles driven during the year O D S 0 - 30 Total other personal (noncommuting) • miles driven '~, j~ V ~ y y S 3 3 50 _ . 31 Total miles driven during the year. h 30 Add lines 28 throu ~~ q j y ~p ~d 0 g . - - ~ Yes No Yes No Yes No Yes No Yes No Yes Nc 32 Was the vehicle available for personal ~~ ~ ~ ~ - hours? off-dut use durin y . . _ g 33 Was the vehicle used primarily by _ a ~ - • more than 5% owner or related person? 34 Is another vehicle available for personal k ~~ - use? • • . swr_tinn (`_-Auestiens fer Emel overs Whe Provide Vehicles for Use by Their EmDtoYees Answer these questions to determine If you meet an exception to completing Section B for vehicles used by employees K are not more than 5% owners or related persons. N~ 35 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? . _ ~ • " .' _ 36 Do you maintain a written poky statement that prohibits personal use of vehicles, except commuting, by your employees? See page 6 of the instructions for vehicles-used by corporate officers, directors, or 1 % or more owners 37 Do you treat all use of vehicles by employees as personal use? 38 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the. information received? .. 39 Do you meet the requirements concerning qualified automobile demonstration use? See page 6 of the instructions . Note: K your answer to 35; 36, 37, 38, or 39 is "Yes, "you need riot complete Section B for the covered vehicles. lai Description of costs N- Date amortization ~~ lci " Amortizable amount (M Code section qmo t°fzatan ~~ « ~~~ M Amortization for this year . 40 Amortization of costs that ins durin our 1996 tax ear. - ~ n 41 Amortization of costs that an before 1996 ~. 41 42 Total. Enter here and on "Other Deductions" or "Other Expenses" line of your return 42 ~- - ~p 1 i I/~~ld~~C ~~~ ~ I~-~ ~~ '~ ti~~ ~ 1 Jf ~~~U ~ .,~ t~ ~ ' S ~, ~'" ~\ ~~ t~ ~ ~~ ~~ ~ [~ ~ ~ ~D ~~ -~`~"~ „' ~~ ~~~ "~- EXH~g{T ri r ~- _~~' ~~~~~~ ~L ,,,~, ion I~ ~~- I. 4868 Application for Automatic extension or i ime ~~°~°~~° ~°°°-~~°° Form Individual Income Tax Return S To File U 1997 Department of the Treasury Internal Revenue Service . . For calendar year 1997, or other tax year beginning , 1997, ending , 19 Identification . ividual Taxes vour name(s) 1 Ota lability for 1997 ................. $ 2 7 , 6 3 9 . ROGER J . PERS I K & CAROLYN A . 5 Total 1997 payments ........................... 2 7 , 6 3 9 . Address 8 Balance. Subtract 5 from 4 ............... 0 209 EAST YELLOW BREECHES ROAD City, town or post office, state, and ZIP code Gift/GST Tax - If you are not filing a gift or GST CARL I 5LE , PA 17 013 tax return, go to Part IV now. See the instructions. 2 vour social security number 3 Spouse's social security no. 7 Your ift/GST tax payment ............... $ 357-30-9065 201-3~ se'sgift/GSTtaxpayment ... This form also extends the time for filing a gift or generation-ski in otal transfer (GST) tax return if you file a calendar (not fiscal) year iricome tax return. Check below if requesting a gift or GST tax return extension and enter your tax payment(s) in Part III: - U Spouse - ~ 9 Total liability. Add lines 6, 7, and 8 ... $ 10 Amount you are paying ..................... - U. If line 10 is less than line 9, you may be liable for interest and penalties. LHA For Paperwork Reduction Act Notice, see instructions. Form 4868 (1997) 718711 10-28-97 1040 Label (See L instructions A on page 10.) B E Use the IRS L label. Otherwise, fi please print E or type. E Department of the Treasury -Internal Revenue Service U.S. Individual Income Tax Return 1 (ss) IRS Use Only - Do not write or staple in this space. For the year Jan. 1-Dec. 31, 1997, or other tax year beginning , 1997, ending , 19 OMB No. 1545-0074 Your first name and initial Last name Your social security number ROGER J. ERSIK 357 30 9065 If a joint return, spouse's first name and initial Last name Spouse's social security number CAROLYN A. ERSIK 201:34:7860 Home address (number and street). If you have a P.O. b ox, see page 10. Apt. no. For help in finding line 2 0 9 EAST YELLOW BREECHES ROAD instructions, see pages f dd 10 2 and 3 in the booklet. City, town or post office, state, and ZIP code. If you have a oreign a ress, see page CARLISLE , PA 17 013 Yes Nc Presidential Do ou want $3 to o to this fund. ....................................................... Election Campaign' y g ~ (See page 10.) If a joint return, does your spouse wan 3 to this ? .. ................... Nete: Checking 'Yes' will not change your tax or reduce your refund. Filing Status 1 2 X Single ~ Q Married filing joint return (evert[ ~at r~t~' e~ ~ ~1 I (~ ~ ~ h 3 _ Married filing separate return. Enter spouse's soc. sec. no. above and full name here. ~ 4 Head of household (with qualifying person). If the qualifying person is a child but not your dependent, enter this c hild's Check only name here. ~ one box. 5 Qualifying widow(er) with dependent child (year spouse died ~ 19 ). 6a ~ Yourself. If your parent (or someone else) can claim you as a dependent on his or her tax return, do not No. of boxes Exemptions checked on 6a 2 check box6a......_r__-~ ._. ....~.T.- andsb X b ~ Spou,.e .............................. ....... L.J.......a...... ...... ..-.... ............................... .......... . ... No. of your c Dependents: e s al ( ( ; 3 De endent's F (4 No. of p,o~thsh~ed children on 6c wno: (1) First name Last name _ ri _ - relationship to you m your me ih 19~g ~ lived with you • did not live with If more than six you due to divorce dependents, or separation see page 10. (see instructions) Dependents on 6c not entered above - - Add numbers entered on d Total number of exem tions claims .. ............................. ............ lines above ~ 2 Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ............................... ............................................... 7 15 9 , 5 5 2 . 8a Taxahle interest. Attach Schedule B if required ............................... ............................................. 8a 1, 5 9 8 . Attach b Tax-exempt interest . DO NOT include on line 8a ............................... .. 18b I Copy B of your Forms W-2 g Dividends. Attach Schedule B if required ....................................... ............................ 9 6 12 . , W-2G, and 10 Taxable refunds, credits, or offsets of state and local income taxes ......STMT 1 STMT 2 10 4 7 . 1099-R here. 11 Alimony received .. ._.. ,~,... _ _. ... _.. 11 If ou did not 12 r 11 Business income or loss .Attach h o Z (_,Zl ~~ ~ ~ ~ ~ . l~ _._. .. _.... 12 <6 , 12 0 • > _ 2 255 get a W-2, 13 Capital gain or (loss). Attach ScheduL . ~.-~ _T( _.L~ ... ~ ._ 13 . r see page 12. 14 Other ains or losses .Attach Form 4797 9 ( ) _ ................. ............._....._........................ 14 15a Total IRA distributions ............... 15a b Taxable amount (see page 13) 15b 16a Total pensions and annuities ...... 16a b Taxable amount (see page 13) 16b Enclose but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ........................ 17 not attach any payment. Also, 18 Farm income or (loss). Attach Schedule F ..................................... ............................................... 18 please use 19 Unemployment compensation 1 g 2, 5 6 9. Form 1040-V. 20a ~ Social security benefits .......... 1(a ble amount (see page 14) 20b 21 Other income. List type and amoun ~, n Adjusted Gross Income If line 32 is under $29,290 (under $9,770 if a child did not live with you), see EIC inst. on page 21. 22 Add the amounts in the far right column for lines 7 through 21. This is your total income 23 IRA deduction (see page 16) ......................................................... 23 24 Medical savings account deduction. Attach Form 8853 ........................ 24 25 Moving expenses. Attach Form 3903 or 3903-F ................................. 25 26 One-half of self-employment tax. At e u~~S [s L . 27 Self-employed health insurance ded io e 1 Q _. ~._... _ 7 28 Keogh &self-employed SEP plans and AMP plans ......................_ 2 29 Penalty on early withdrawal of savings ............................................. 29 30a Alimony paid b Recipient's SSN - 0 5 6. 3 4: 2 2 3 0 30a 31 Add lines 23 through 30a. ................................................................... 32 Subtract line 31 from line 22. This is your adjusted gross income . .......................... 21 22 LHA For Privacy Act and Paperwork Reduction Act Notice, see page 38. 710001 10-28-97 16.662. z~,.,~~. Form 1 D4D (1997) ~ ~ '~~rt,~nnnn447t R(1GRR .T _ >r (`AR(1T,VN A _ PRRSTK 357-30-9065 MAR Nn 1546-M74 Paae2 TaX 33 Amount from fine 32 ad'usted ross income .......................... ( 1 9 ) ....... 33 14 3 , 8 51 . Compu- 34a Check if: ~ You were 65 or older, [~ Blind; ~ Spouse was 65 or older, 0 Blind. tatlon Add the number of boxes checked above and enter the total here .......... ... ........... /' 34a b If you are married filing separately and your spouse itemizes deductions or you were adual-status alien, see page 18 and check here ....... ...... ........... /' 34b [] Itemized deductions from Schedule A, line 28, OR 35 Enter the Standard deduction shown below for your filing status. But see page 18 larger if you checked any box on line 34a or 34b or someone can claim you as a f dependent. 35 1 8 0 9 8 . r o your: • Single - $4,150 • Married filing jointly or (lualifying widow(er) - $6,900 • Head of household - $6,050 • Married filing separately - $3,450 36 Subtract line 35 from line 33 _.._........_ ..................._......................._..................._....._............... 36 12 5 , 7 5 3 . 37 If line 33 is $90,900 or less, multiply $2, th J,ota urf>Lber of e~emptio -cla on ~ ",_({~~tit rat r .......... _..._...... _. line 6d. ff line 33 is over $90,900, see the rk a ~~ ge ~ r th '' 37 5 3 0 0 . r 38 Taxable income. Subtract line 37 from li ~ I~ ; ~ e ir! ~6, e t~ - ...... .......................... 38 12 0 , 4 5 3 . 39 Tax. See a e 19. Check if an tax from a Forms 8814 b Form 4972 .............................. ~ 39 2 8 , 7 4 8 Credits 40 Credit for child and dependent care expenses. Attach Form 2441 ....... ........ 40 41 Credit for the elderly or the disabled. Attach Schedule R 41 42 Adoption credit. Attach Form 8839 ........................................................ 42 ............................. .. ..... . 43 Foreign taxcrediLAttach Form 1116 43 .... . ...,,,,, ._ . 44 Other. Check if from a ~ Form 380.. orrr~8 6 ~ c ~ Form 8801 tl [~ Form eci ~ LJ S 45 Add lines 40 through 44 .... . .. ~ . ~........ ~~_ .. ..................._.........._ 45 ............... L_...... .. .. ~_ 46 Subtract tine 45 from line 39. If line 45 is more than line 39, enter -0- ................................................... ~ 46 2 8 , 7 4 8 ............................................................... .... . . . Other 47 Self-employment tax. Attach Schedule SE 47 ............. ..... . ... . .......................................................................... ..... .... TaXeS 48 Alternative minimum tax. Attach Form 6251 48 .... . . 49 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 .......................... 49 50 Tax on qualified retirement plans (including IRAs) and MSAs. Attach Form 5329 if required ........................... 50 51 Advance earned income credit payments For -2 -~ ----~ - -~ 51 52 Household employment taxes. AttachSch ule ~ ~ [~. , .~...... ^ j u.~ ..Lr 11 m..J 52 53 Add lines 46 through 52. This is your tot 1 .. .._ .,.. ~ ~ ............................... i- 53 2 8 , 7 4 8 Payments 54 Federal income tax withheld from Forms W-2 and 1099 ....... 54 2 7 , 6 39 . STATEMENT 4 55 1997 estimated tax payments and amount applied from 1996 return ............ 55 56a Earned income credit. Attach Schedule EIC if you have a qualifying child Attach l d i t ~ ncome: amoun Forms W-2, b Nontaxable earne and and type ~ W-2G 56a , 1099-R on 57 Amount paid with Form 4868 (request for extension,) 7 page 1. 58 Excess social security and RRTA tax withh p ~ ~) , . ~ ...... ~ 59 Other payments. Check if from a [] 4 60 Add lines 54, 55, 56a, 57, 58, and 59. These are your total payments ............... ........ ............................ ~ 60 2 7 , 6 3 9 . Refund 61 If line 60 is more than line 53, subtract line 53 from line 60. This is the amount you OVERPAID ........................ 61 Have it 62a Amount of line 61 you want REFUNDED TO YOU .............................................................................. 1 62a - directly 3eePage27 ~ b Routing number c Type: ~ Checking 0 Savings and fill m 62b, 62c, and 62d. ~ d Account number 63 Amount of line 61 ou want APPLIED TO YOUR 1998 ESTIMATED TAX 63 64 If line 53 is more than line 60, subtract lin 0 ine . T ~ the Amount For details on how to pay see page 27 ~~ [- . ~ ilf4ll 7f ~ J ........ rr ~ WE. ~ ~ . .... 64 1 , 10 9 . , . _ 7 : Yc1u ewe -- - .. .. .. .. t.:.. ....~ ..L. .._ ~ L -~~ ~_~ YJ LJIII,Id IGU ldn pGlln ly. /~JV II V,uuG u„ ,u,~ V~ I "~ - aSl n Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and _ ~~~~ g belief, they are true, correct, and complete. Declaration of preparer (other than Saxpayer) is based on all information of which preparer has any knowledge. Here ' Your signature Date Your occupation Keep a copy NAGER of this return Spouse's signature. If a joint return, BOTH must sign. Date Spouse's occupation for your DMIN I STRATOR records. Preparer's ~ /~ Check if self- Preparei s social security no. Paid signature ' D !-~ employed ® 18 5 3 8 5 9 2 3 Preparer'sFim, s name (or RONALD E. L , E'" 18 5 3 8 5 9 2 3 Use Only yours itself-ern- ,49 SOUTH PIN OAK DRIVE zIP code 17007 ployedl and address BOILING SPRINGS, PA 7fooo2 10-28-97 OMB No. 1545-0074 SCHEDULES A&B Schedule A -Itemized Deductions (Form 1040) 1997 (Schedule B is on page 2) Department of the Treasury Internal Revenue Service - Attach to Form 1040. - See Instructions for Schedules A and B (Form 1040). Attachment sequence No. 07 Name(s) shown on Forrn 1040 Your social security number ROGER J. & CAROLYN A. PERSIK 357:30:9065 MedlCal Caution: Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see page A•1) ........................................................ 1 Dental 2 Enter amount from Form 1040, line 33 .... .................... 2 Expenses 3 Multiply line 2 above by 7.5% (.075) .................................................................... 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter •0• ............................... 4 Taxes You 5 State and local income taxes .............................................................................. 5 6 , 5 82 . Paid 6 Real estate taxes (see page A-2) ~ _ .. L g 1, 5 4 9 . (See 7 Personal property taxes ....... ~ _ ~_ _ _ f 1 ~..... 7 page A-2.) 8 Other taxes. List type and amoun J ~w~~~ f [ l i -PERSONAL TAXES 445. '- .,. OPT--------------------------------20. 8 465. 9 Add lines 5 through 8 ............................................................................................. ...... ..................... 9 8, 5 9 6. Interest 10 Home mortgage interest and points reported to you on Form 1098 ........................ 10 8 , 3 6 8 . You Pald 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see page A•3 and show that person's name, (See ;dentifying no., and address ~ - ~ --\ page A•2.) ~ l1 - ~~~ ~ \ Note: ~1 C~ \~ ~~ - 11 - ---------- ---- ---- Personal 12 points not reported to you on Form 1098. See page A•3 ....................................... 12 interest is not 13 Investment interest. Attach Form 4952 If required. (See page A•3.) ........................ 13 deductible. 14 Add lines 10 through 13 .......................................................................................... _.............__. 14 8 , 36 8 . Glfts to 15 Gifts by cash or check. If you made any gift of $250 or more, charity see page A•3 15 1 , 814 . 16 Other than by cash or check. If a y qif of $25 or o e, s apag A-3__. If you made a 2-. ) ~ g ~-~Lf LJ ~ J . ........1..._.......___.. gift and got a You MUST attach Form 8283 if ov $ ~~. ___ Q......1.... i6 benefit for it, 17 Carryover from prior year ......_..~ ......~ , J ............. ?... J ~ J 7_........_... ~ r~C~...__C 17 _ -- see pageA-3. _ 18 Add lines 15 through 17 ................................................. ....................................... ...... ..................... 18 1 , 814 . Casualty and Theft Losses 19 Casualty or theft loss(es). Attach Form 4684. (See page A-4.) ............................................................... 19 Job Expenses 20 Unreimbursed employee expenses • job travel, union dues, job education, etc. and Most You MUST attach Form 2106 or 2106•EZ if required. (See page A•4.) Oiher - Miscellaneous -----------------_ --- -- - -- =_---- Deductions ~ 20 21 Tax preparation fees .................................... ....~... 21 22 Other expenses • investment, safe deposit box, etc. List type and amount (See ------------------------------------- pageA•5for ------------------------------------- expensesto ------------------------------------- deduct here.) 22 c --------------- 23 Add lines 20 through 22........... - - -- - - - [~... -- - ------ 23 24 Enter amount from Form 1040, lir~ e .. ~ 25 Multiply line 24 above by 2% (.02) ........................................................................ 25 26 Subtract line 25 from line 23. If line 25 is more than line 23, enter -0• ..................... ... ...... ..................... 26 Other 27 Other -from list on page A•5. List type and amount Miscellaneous - ' Deductions ----------------------------------------------- " Total 28 Is Form 1040, line 33, over $121,200 (over $60,600 if married filing separately)? STMT 5 Itemized NO. Your deduction is not limited. Add the amounts in the far right column for lines 4 Deductions through 27. Also, enter on Form 1040, line 35, the larger of this amount or your ~ - 28 18 , 0 9 8 . stanaaro aeoucnon. I YES. Your deduction may be limited. See page A•5 for the amount to enter. J LHA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule A (Form 1040) 1997 719501 11-14-97 Schedules A&B (Form 1040) 1997 OMB No. 1545-0074 Page 2 Name(s) shown on Form 1040. Do not enter name and social security number if shown on page 1. Vour social security number ROGER J. & CAROLYN A. PERSIK 357:30:9065 Schedule B -Interest and Dividend Income Attachment Sequence No. ~8 Part I Interest Income Note: If you received a Form 1099.1 NT, Form 1099.OID, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the totalinterest shown on that form. Note: If you had over $400 in taxable interest income, you must also complete Part lll. 1 List name of payer. If any interest is from a seller•financed mortgage and the buyer used the property as a personal residence, see page B•1 and list this interest first. Also, show that buyer's social security number and address - LENKER RIVERFRONT ASSOC PNC MORTGAGE CO MEMBERS FIRST FED N MEMBERS FIRST FED R N ~ YORK FEDERAL YORK FEDERAL 2 Add the amounts on line 1 ......................................................................................................... 3 Excludable interest on series EE U.S. savings bonds issued after 1989 from Form 8815, line 14. You MUST attach Form 8815 to Form 1040 ..................................................................... 4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a - Part II Dividend Income Note: If you received a Form 1099-DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total dividends shown on that form. Note: If you had over $400 in , 5 List name of payer. Include gross Ivl n ~a Any capital gain distributions an ~ t~l 7and8- AARP GNMA & US TREAS FND AARP HIGH QUALITY BOND FND AARP GROWTH & INCOME FND AARP BALANCED STK & BND FND Amount 700. 15. 383. 69. 228. 1 203. 2 1,598. 3 a 1,598. Part lll. Amount 72. 62. 1,917. 103. 5 6 Add the amounts on line 5 ......... . [~......d ........................................ .......... s 2,154. 7 Capital gain distributions. Enter ~ ~'~T 7 1 , 5 4 2 . ' 8 Nontaxable distributions. 8 9 Add lines 7 and 8 ......................... 9 1, 5 4 2. ............ . 10 Subtract line 9 from line 6. Enter the result here and on Form 1040, line 9 ........._.. __._. - 10 6 12 . Part III You must complete this part if you (a) had over $400 of interest or dividends; (b) had a foreign account; or Foreign (c) received a distribution from, or were a grantor of or a transferor to a foreign trust Yes No ACCOUntS 11 a At any time during 1997, did yo a ~ est ' r a tsigna~r~~er authority over a financial ' and account in a foreign country, suc as r{k~ co ~, sec iti t, or other financial account? .................. X Trusts b If "Yes," enter the name of the foreign ~~ 12 During 1997, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If "Yes " ou ma have to file Form 3520 or 926. See a e B•2 ........................................................................... X LHA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 1997 Eck, you must also stock here. 'd on lines 7z7so1 11-oa-s7 SCHEDULE C Profit or Loss From Business (Form 1040) (Sole Proprietorship) Department of me Treasury - Partnerships, joint ventures, etc., must Tile Form 1065. Internal Revenue Service (99) - Attach to Form 1040 or Form 1041. - See Instructions for Schedule C Name of proprietor E Business address (including suite or room no.) - 2 0 9 E . YELLOW BREECHES RD . -------------------------------------------- City, town or post office, state, and ZIP code CARLISLE , PA 17 013 F Accounting method: (1)0 Cash (2)0 al ~(3 her spa ' G Did ou "material) partici ate" in the o eration of this bu r es u r 97 0," ~imit on losses ,.... _. X Yes H If you started or acouiredphis business during 1997, ch ~~ ~ ~~, ~~~ ['J ~~ 0 - 0 No Income 1 Gross receipts or sales. Caution: If this income was reported to you on Form W-2 and the "Statutory employee" box on thailormwaschecked,seepageC-2 and check here .... ........_._..__ .............._............._...............__....- ~ 1 1,534. 2 Returns and allowances ...... ........................................... ..................................................................................... 2 3 Subtract line 2 from line 1 ................................................ ...................................................................................... 3 1, 5 3 4. 4 Cost of goods sold (from line 42 on page 2) ............. _,... _ _......_.. ._._. 4 5 Gross profit. Subtract line 4 from line 3 .............. _.... . ~ U ~ ~ .... .......... ...........~=3........................................ 5 1 , 5 3 4 . 6 Other income, including Federal and state gasoline or fuel tax credit or refund 8 7 Gross income. Add lines 5 and 6 ......................................... ................................................................................ - 7 1, 5 3 4. Expenses. Enter expenses for business use of your home only on line 30. 8 Advertising _..._......._.....__... 8 19 Pension and profit-sharing plans .................. 19 -- 9 Bad debts from sales or services (see page C-3) .................. 9 ____ _ U 24 eIlt9 a g(~e page C-4): V viol a r ry, and equipment ......_..... 20a 10 Car and truck expenses ~~(~usir~~roperty _ ...................... 20b (see page C-3) 10 r 21 Repairs and maintenance .......................... 21 11 Commissions and fees _. _.._....... 11 22 Supplies (not included in Part III) _._ ._._..... 22 12 Depletion ..... . ........................ 12 23 Taxes and licenses .......................,........,... 23 13 Depreciation and section 179 24 Travel, meals, and entertainment: expense deduction (not included in a Travel ................................................... 24a Part III) ................ ........... 13 2 , 52 8 . b Meals and _ 14 Emptcyee benefit programs (other 1 (] ~n\ er~ta~ than on line 19) _ . ............... 14 D d L`1 -~1~ tai 0% 15 Insurance (other than health) ..... _._ 15 24b subject to 16 Interest: limitations (see page C-4) ... a Mortgage (paid to banks, etc.) ........ 16a d Subtract line 24c from line 24b .................. 24d b Other ......................................... 1fib 25 Utilities ................................................... 25 17 Legal and professional 28 Wages (less employment credits) ............... 26 services 17 27 Other ex enses from line 48 on 18 Office expense .............................. 18 1 e .. .. ...................................... 27 5 0 2 . 28 Total expenses before expenses for business use of ho I ' e~ fug ,' ~d) mn~ .._. ___ .............._.....,...,_„ - 28 7 , 65 4 . 29 Tentative profit (loss). Subtract line 28 from line 7 ............................................................. 30 Expenses for business use of your home. Attach Form 8829 _.._.._.._. .............................................................................. 31 Net profit or (loss). Subtract line 30 from line 29. . If a profit, enter on Form 1040, line 12, and ALSO on Schedule SE, line 2 (statutory employees, see page C-5). Estates and trusts, enter on Form 1041, line 3. • yf a loss, you MUST go on to line 32. y ~ (] 32 ii ou have a loss, check the box that describes our inv ~ i t i ~-5 . ~ If you checked 32a, enter the loss on Farm 1040, line 12, and ALSO on Schedule SE, line 2 (statutory employees, see page C-5). Estates and trusts, enter on Form 1041, line 3. • If you checked 32b, you MUST attach Form 6198. LHA For Paperwork Reduction Act Notice, see Form 1040 Instructions 1991 Attachment 104U). Sequence No.09 Social security number (SSN) ROGER J. PERSIK 357-30-9065 A Principal business or profession, including product or service B Page prs)cipal business code (see REAL ESTATE SALES AGENT C - 5520 C Business name. If no separate business name, leave blank. ~ EmployerlD number(EIN), if any ROGER J. PERSIK 35-7309065 <6,120.> <6,120.> 32a ~ All Investment is at risk. 32b 0 Someinvestment is not at risk. Schedule C (form 1040-1997 7zoool 10-2397 ScheduleC Form 1040 1997 ROGER J. PERSIK 357-30-9065 Paget Cost of Goods Sold (see page C•5) 33 Method(s) used to value closing inventory: a ^ Cost b ^ Lower of cost or market c ^ Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If "Yes.' attach explanation ........_........_ ..................................._........_.........................................._..........__........... ^ Yes ^ No 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation .................................... 35 36 Purchases less cost of items withdrawn for personal use 36 37 Cost of labor. Do not include salary paid to yourself .r--- .....: ... .. .._ E_._-..... - ________..,__,....____._..... 37 1[~~°~~~J~~~~-1~ 38 Materials and supplies ......._ .. ..._.. ..........[._..-. [_~~ ~F ~:_. F ~~..... ~ :_~_ .... .......... ........... 38 39 Other costs ................................................................................................................................................... 39 40 Add lines 35 through 39 ................................................................................................................................ 40 41 Inventory at end of year _........._.._..._..........._.~-........_ ...................................._......................... 41 ~ Q ^---- 42 Cost of Dods sold. Subtract line 41 from line 40. En r~r s I~ , ine ~ ...................................... 42 Information on Your VehlCle. Complete this part ONLY if you are claiming car or truck expenses on line 10 and are not required to file Form 4562 for this business. See the instructions for line 13 on page C•3 to find out if you must file. 43 When did you place your vehicle in service for business purposes? (month, day, year) ~ / / 44 Of the total number of miles you drove your vehicle d ring- 99~, e~r thy--n mbeEof~il~$ynu usgd your vehicle for: t ~ ~ L ~J c Other a Business ~ __ 45 Do you (or your spouse) have another vehicle available for personal use? ............................................................................. ^ Yes ^ No 46 Was your vehicle available for use during off-duty hours? .................................................................................................. ^ Yes ^~ No 47 a Do you have evidence to support your deduction? _.. -.-.-. ......- .....................---- ........ .._..........._................_._.... ^ Yes ^ No b If "Yes,' is the evidence written? _.........._ ...........................~............... - IJ ^IJ.........._................................ Yes No Other Expenses. List below business ~ ' i es 8- r line 30. TELEPHONE------------------------------------------------~ 502. -------------------------~-j-~~ ~ o r~~r~ -------------------------~J~~ 5--~~------------- 48 Total other expenses. Enter here and on page 1, line 27 ........................... 48 502. 7zoaoz 10-23-97 SCHEDULED Capital Gains and Losses (Form 1040) Department of the Treasury - Attach to Form 1040. - See Instructions for Schedule D (Form 1040). Internal Revenue Service (99) - Use Schedule D-1 for mores ace to list transactions for lines 1 and 8. OMB No. 1545-0074 1997 Attachment Sequence No.1 2 Name(s) shown on Form 1040 Your social security number ROGER J. & CAROLXN A. PERSIK 357 30!9065 Short-Term Capital Gains and Losses -Assets Held One Year or Less (2) Description of property (b) Date ac wired (11) Sales price (e) Cost or other basis tt (f GAIN Or LOSS OR ENTIR YEAii (Example; 100 sh. XYZ Co.) (C) Date sold (See page D-3) (See page D-4) Subtract (e) from (d) 1 -- LJ ~ / ~_ ~~ `_ 2 Enter your short-term totals, if any, from ... ..... .. line 2 Schedule D•1 2 ...... . , 3 Total short-term sales price amounts. Add column (d) of lines 1 and 2 ............. -- - _ I -=-- - 4 Short-term gain from Forms 2119 and 6252, and sh~r~•te ~ (I ~ ~~ ~ ~ ` '' ------- from Forms 4684, 6781, and 8824 ...... I ~~- ~ j..F~. (-j......t .. .... 4 ..... .. ........ . _ . ._. 5 Net short-term gain or (foss) from partnerships, S corporations, estates, and trusts from Schedule(s) K•1 5 ..... ..................... 6 Short-term capital loss carryover. Enter the amount, if any, from line 9 of your 1996 Capital Loss Carryover Worksheet __, __. .._,.._. _....... 6 ( ) 7 Net short-term capital gain or (loss). Combine lines 1 through 6 in column ............. .......... ................................ - 7 ' • Long-Term Capital Gains and Los s ~ s d ne Year (8) Description of property ) Da ~_~a e[~- - - ~) Cost or ~ her basis (1 GAIN Or LOSS ~OR ENTIR~ YEA (g) 28% RATE GAIN Or (LOSS) (Example: 100 sh. XVZ Co.) (C) Date sold (See page D 3) (See page D-4) Subtract (e) from (d) * (see lost,. below) a 75 SHS WOOLWORTH CORP 06 01/94 05/28/97 1,746. 1,033. 713. I - [-~ ~ f 9 Enter your long-term totals, if any, from Schedule D•1, line 9 . ._, . ., ......, 9 .. _... . 10 Total long-term sales price amounts. Add column (d) of lines 8 and 9 ...... ......... ........... 10 1 , 7 4 6 . 11 Gain from Form 4797, Part I; longterm gain from F 1 9-2 9 ~I 6 52•-an ~~~ 11 Ion term ain or loss from Forms 4684, 6781, and 24 ...~ ......... \ 9' 9 \rt (1 12 Net longterm gain or (loss) from partnerships, S c o ~ ~~,r3 rtr$ts from Schedule(s) K•1 . ................................................ 12 .. 13 Capital gain distributions .. ..................................._..........................................._............... 13 1 , 542 . . 14 Long-term capital loss carryover. Enter in both columns (f) and (g) the amount, if any, from line 14 of your 1996 Capital Loss Carryover Worksheet _ .._ _. ____ ................ 14 ~ ( ) 15 Combine lines 8 through 14 in column (g) . ....... ~ ~~ .. ~ .. [s~J I:~ )~ ~ ~ ~ ~ ~ 15 _ _ ~ j -' ~ j ~ 16 Net long-term capital gain or (loss). Combine lin~_l8 1~ i column (f) - 16 2 , 2 5 5 . _ * 28% Rate Gain or Loss includes all gains and losses in Part II, column (f) from sales, exchanges, conversions (including installment payments received) either: • Before May 7, 1997, or • After July 28, 1997, for assets held more than 1 year but not more than 18 months. it also includes ALL "collectibles gains and losses" (as defined on page D•4). LHA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule D (Form 1040) 1997 72os1 v11-2s-s7 Schedule D (From 1040) 1997 Fage 2 Summary of Parts I and II 17 Combine lines 7 and 16. If a loss, go to line 18. If a gain, enter the gain on Form 1040, line 13 17 2 , 2 5 5 . Next: Complete Form 1040 through line 38. Then, go to Part IV to figure your tax if: • Both lines 16 and 17 are gains, and • Form 1040, line 38, is more than zero. 18 If line 17 is a loss, enter here and as a (loss) on Form 1040, line 13, the smaller of these losses: • The loss on line 17; or • (3,000) or, if married filing separately, (1,500) 1.8 ( _ ) Next: Complete Form 1040 through line 36. Then, complete the Capital Loss Carryover Worksheet on page D•4 if: ~ --- • The loss on line 17 exceeds the loss on lir~~1 ,„ ~ Q • Form 1040 line 36 is a loss II ~~ Tax Computation Using Maximum Capital Gains Rates 19 Enter your taxable income from Form 1040, line 38 ................................................................ 20 Enter the smaller of line l6 or line l7 ._......__.__ .............................._........._.. 20 21 If you are filing Form 4952, enter the amount from Form 4952, line 4e .................. 21 22 Subtract line 21 from line 20. If zero or less, enter-= - _E/~ ~~ 23 Combine line 7 and 15. If zero or less, enter -0• ................. ~ J Lr U n i].. 24 Enter the smaller of line 15 or line 23, but not Ies~Frarf r~~~_ ~~..~_~F.. ~~... 25 Enter your unrecaptured section 1250 gain, if any (see page D•4) ........................ 25 26 Add lines 24 and 25 ................_........_............._...._._._.........._............_........ 26 27 Subtract line 26 from line 22. If zero or less, enter •0• _......._._._._ ........................._......_.... 28 Subtract line 27 from line 19. If zero or less, enter •0• ............................................................. 29 Enter the smaller of line 19 or $41,200 ($24,650 if single; $20,600 if married filing separately; $33,050 if head of household) --- ...................................................................................... 30 Enter the smaller of line 28 or line 29 ............... ~ ~ G 31 Subtract line 22 from line 19. If zero or less, enter __ 5~__. I .... ~ .......~_ ~ ....... . 32 Enter the larger of line 30 or line 31 ..................................................................................... 33 Figure the tax on the amount on line 32. Use the Tax Table or Tax Rate Schedules, whichever applies ........ _..._ _.._......_ .............._...._._.__...._........................._.........._.._.-_.. 34 Enter the amount from line 29 .............................................................................................. 35 Enter the amount from line 28 .............................................................................................. 36 Subtract line 35 from line 34. If zero or less, enterl= - 37 Multiply line 36 by 10% (.10) ~ ~~ l~ _.......-.... -L_,....L .................~ ........__I ...... 38 Enter the smaller of line 19 or line 27 .................................................................................. 39 Enter the amount from line 36 .............................................................................................. 40 Subtract line 39 from line 38. If zero or less, enter •0• ............................................................. 41 Multiply line 40 by 20% (.20) ............................................................................ 42 Enter the smaller of line 22 or line 25 ................ . ... ........ . 43 Add lines 22 and 32 ................................................... ~ ......~...... C1 1 [~ ~-~ [~ 44 Enter the amount from line 19 ......_._........._. { .........U.... ~..~... ~.1... 45 Subtract line 44 from line 43. If zero or less, enter •0- ..... ................................. 46 Subtract line 45 from line 42. If zero or less, enter •0• ........................................... 0. 0. 47 Multiply line 46 by 25% (.25) 48 Enter the amount from line 19 49 Add lines 32, 36, 40, and 46.. 50 Subtract line 49 from line 48 - - jai ~ 451 . & t 120,453. 120.453. i ,-i, 51 Multiply line 50 by 28% (.28) ............................................................................................................. 52 Add lines 33, 37, 41, 47, and 51 ............................................................ ........................................ 53 Figure the tax on the amount on line 19. Use the Tax Table or Tax Rate Schedules, whichever applies Tax. Enter the smaller of line 52 or line 53 here and on Form 1040. line 2,255.'; 2,255. 0.' 120.453. 27~ 2, 255 . ~R 118.198. 29 41,200. 30 41,200. 31 118,198. s~ 118,198. _.__... - 33 28, 297 . 3a _ 41,200. 35 118,198. 36 ~ - X37 - I47 - X51 53. 53. 748. 996. 28,748. 7zoslz 01-05-98 ` RbGER J. & CAROLYN A. PERSIK 357-30-9065 FORM 1040 STATE AND LOCAL INCOME TAX REFUNDS STATEMENT 1 1996 1995 1994 PENNSYLVANIA GROSS STATE/LOCAL INC TAX REFUNDS 47. LESS: TAX PAID IN FOLLOWING YEAR NET TAX REFUNDS PENNSYLVANIA LI n C> ~ ~1 f 1 1 f_J ~n J L `~ 1 l_ TOTAL NET TAX REFUNDS 47. ~~ ~~~r~ ~'~ Jy ~~ ~ ~~~~~ i;" STATEMENT(S) 1 'ROGER J. & CAROLYN A. PERSIK 357-30-9065 FORM 1040 TAXABLE STATE AND LOCAL INCOME TAX REFUNDS STATEMENT 2 1996 1995 1994 NET TAX REFUNDS FROM STATE AND LOCAL INCOME TAX REFUNDS STMT. 47. LESS:REFUNDS-NO BENEFIT DUE TO AMT 0. 1 NET REFUNDS FOR RECALCULATl~~(N1 ~- l l~ ~- _ J~~ L~~L~ ~ ?- JL J I / ~ I 2 TOTAL ITEMIZED DEDUCTIONS BEFORE PHASEOUT 15,054. 3 DEDUCTION NOT SUBJ TO PHASEOUT 7,468. 4 NET REFUNDS FROM LINE 1 47. 5 LINE 2 MINUS LINES 3 AND 4 - ~... 7L,~ 7 PRIORPYEARIAGI5 BY 80 0 ( . 8(~)~~ ~C~~ J~ 6 ~D 6 ~ ~~ L_~ f L_~ 8 ITEM. DED. PHASEOUT THRESHOLD 1 7,950. 9 SUBTRACT LINE 8 FROM LINE 7 <29,224.> (IF ZERO OR LESS, SKIP LINES 10 THROUGH 15, AND ENTER AMOUNT FROM LINE 1 ON LINE 16 10 MULTIPLY LINE 9 BY 3% .03 ~ ~~ ~ ~ C~~~~1 t~ 11 ALLOWABLE ITEMIZED DEDUCTI~~~ ~°~~~ (LINE 5 LESS THE LESSER OF LINE 6 OR LINE 10) 12 ITEM DED. NOT SUBJ TO PHASEOUT 13A TOTAL ADJ. ITEMIZED DEDUCTIONS 13.8 PRIOR YR. STD. DED. AVAILABLE _ 14 PRIOR YR. ALLOWABLE ITEM. ~~~ ~[~ ~ ~ ~~[1~ ~_} L~- f_7 ~C_J L_ 7 L~7 L.~ 15 SUBTRACT THE GREATER OF LINE 13A OR LINE 13B FROM LINE 14 16 TAXABLE REFUNDS 47. (LESSER OF LINE 15 OR LINE 1) 17 ALLOWABLE PRIOR YR. ITEM. DED. 15,054. 18 PRIOR YEAR 5TD. DED. AVAILAB(L~E ~ 6 700. _ 19 SUBTRACT LINE 18 FROM LINE JLU ~~~ 4 _J 20 LESSER OF LINE 16 OR LINE 47. 21 PRIOR YEAR TAXABLE INCOME 68,572. 22 AMOUNT TO INCLUDE ON FORM 1040, LINE 10 * IF LINE 21 IS -0- OR MORE, USE AMOUNT FROM LINE 20 * IF LINE 21 IS A NEGATIVE IA~M~OUNT NET LINj S 20 AND 21 47. STATE AND LOCAL INCOME TAX ~~ ~ ~~~~0~94 TOTAL TO FORM 1040, LINE 10 47. STATEMENT(S) 2 1 ~ ROGER J. & CAROLYN A. PERS.LK 357-30-9065 FORM 1040 WAGES RECEIVED AND TAXES WITHHELD STATEMENT 3 FEDERAL STATE CITY T AMOUNT TAX TAX SDI FICA MEDICARE S EMPLOYER'S NAME PAID WITHHELD WITHHELD TAX W/H TAX TAX T KINNEY SHOE CORP 121,402. 20,173. 3,688. 1,317. 4,055. 1,898. S KINNEY SHOE CORP 38,150. 7,065. 1,162. 415. 2,538. 594. TOTALS 159,55 7 ~ 8~ ~ ,~50. 1,732. 6,593. 2,492. ~ ~- - - FORM 1040 FEDERAL INCOME TAX WITHHELD STATEMENT 4 T S DESCRIPTION ~I ~~ ~~~~~ ~G~~ ~ Imo] ~ ~ ~ ~ ~_~ T WAGES/SALARIES S WAGES/SALARIES FROM FORM 1099-INT OR 1099-DIV T WITHHOLDING FROM FORM 1099-MISC TOTAL TO FORM 1040, LINE 54 D ~ ~~~~_~~ ~~~ AMOUNT 20,173. 7,065. 16. 385. 27,639. STATEMENT(S) 3, 4 i2OGER J. & CAROLYN A. PERSIK 357-30-9065 SCHEDULE A ITEMIZED DEDUCTIONS WORKSHEET STATEMENT 5 1. ADD THE AMOUNTS ON SCHEDULE A, LINES 4, 9, 14, 18, 19, 26, AND 27 .. 18, 778. 2. ADD THE AMOUNTS ON SCHEDULE A, LINES 4, 13, AND 19, PLUS ANY GAMBLING LOSSES INCLUDED ON LINE 27 0. 3. SUBTRACT LINE 2 FROM LINE 1. IF THE RESULT IS ZERO, STOP HERE; ENTER THE AMOUNT FROM LINE 1 ABOVE ON 4. SCHEDULE A, LINE 28 _ MULTIPLY LINE 3 ABOVE BY 8~0 ( [$~) ~~ ~~-~Ll~ .L~ lg 77g, 15,022. 5 . ~ ~ ENTER THE AMOUNT FROM FORN~ 4~~~~~~, L ~ . ~ ~ 14 3 , 851 . 6. - ENTER $121,200 ($60,600 IF MARRIED FILING SEPARATELY) 121,200. 7. SUBTRACT LINE 6 FROM LINE 5. IF THE RESULT IS ZERO OR LESS, STOP HERE; ENTER THE AMOUNT FROM LINE 1 ABOVE ON SCHEDULE A, LINE 28 22,651. 8. MULTIPLY LINE 7 ABOVE BY • 680. 9. r ~ J~ ENTER THE SMALLER OF LINE N ~ 680. 10. _ LS L~ TOTAL ITEMIZED DEDUCTIONS. SUBTRACT LINE 9 FROM LIN E 1. ENTER THE RESULT HERE AND ON SCHEDULE A, LINE 28 18,098. SCHEDULE B CAPI~AI` C7AI~T ~~ST~IHUTIO~IS STATEMENT 6 AARP GROWTH & INCOME FND AARP BALANCED STK & BND FND 1,491. 51. ~- - ~-- - TOTALS TO SCHEDULE B, LINE 7 l ~~ (7 J~~~ ~l~~l ~L~ 1, 542. r__ ~~~ /~ i r' ~ _- - ._. STATEMENTS} 5, 6 TOTAL NAME OF PAYER CAPITAL GAIN 28% GAIN .~ ~-r ~ ~~~A~S ~r ~~~os i t i ~~v ~~; ~~~ York Bumpy Up ~ ~ ~ 700 - ~ o a $ z ~ - c ~~~/~ilera/ .. Certificate of Deposit BOO ~l~a~ 0 4U s o ~~ _ .Accountholder(s): ,, ~A~OLY~A PER5IK IT/E1 RDGER J, PERSIK ~ , Date of Opening Minimum' Balance Initial Maturity ~ ,Renewal. 'Annual ` percentage ~ Rate'of Earnings per Frequency of Issuance Balance Required Date Term Yield Annum Compounding 11/12/96 1,000. 100.00 11/12/98 r~ 24 MD5 Ob.Ob00 ~ 05.4000 MONTHLY 3017 __ ,: ~ »~~,~- ~. I1VOD UV°UVLSIuJ~~OL~1 o I~~ . ROGER J PER5IK (T/E) 800- 040166 Certificate of Deposit ~ARl1~LE sRANC;N Accountholder(s): ' , CAROLYN A PERSIK Date aj Opening Minimum Initial Renewal Annual Rate of Frequency of /ssuance Balance Balance Maturity Term 'Percentage. Earnings Compounding Required Dale Yield ~ per Annum 01/23/98 2,000.00 1,000.00 *-.,07/23/48 ~• b MONTHS 05.0000 ~- .04.8800 MONTHLY FORM 3008 Yoram ~ • ~~~/~+~rera/ Certi icate o De osit .~ .f p Accountholder(s): NnIOO M~f~CC~OO S~OG~1[3[~C~ . ROGER J PERSIK (T/E), CARDLYN A PERSIK ~~~:~ _800- 040.168. t h''XRtlSI! e~~R~M Dale of Opening Minimum Initial Renewal Annual Rate of Frequency of Issuance Balance Balance Maturity Term Percentage Earnings Compounding Required Date Yield per Anmrm 01/23/98 2,000.00 1,000.00 09/23/48 B MONTHS 05.2500 ~~' 05.1100 MONTHLY `. FORM 3008 e~ r FORM 3008 FORM 3008 FORM 3008 ~... .~. F"r` FERAL CREDIT UNION I/We hereby apply for a Members 1st Certificate in the amount and term Ilsted below. CERTIFICATE APPLICATION AND DISCLOSURE 1 "~/ MATURITY DATE: ~' ~ ~''t~ ACCOUNT # Please Print SOCIAL MEMBERS NAME: ~ cw<~ j4r n ~ - ~~[- ~~~ ~ SECURITY # ~ C? a r~ ?> STREET ADDRESS: ~ °"~ ~ ~ ~~ ~~`~ "~ ~r2Pc ~? °~ t~'~ ' CITY: C -~~ ' ' ~ ~t1`~ STATE: ~_ ZIP CODE: i ~ CJ 1 HOME PHONE NUMBER: WORK NUMBER: JOINT OWNER(S) NAME: ~-~A~ ~~('St .,pFF ICE:U F 0 LY " . ;: CERTIFICATE TERM S AMOUNT ~~i a < w - ~bbE "ANNUAL'' PERCENTAGE "FYI(:LD: ~`*:~ '. ~ ,, ` bIVI~~ND RAPE "~ = ~ ~" ' ~ k•~ SUFFIX i~: 90 DAY CERTIFICATE 3M0 26 WEEK CERTIFICATE 26W 12 MONTH CERTIFICATE 1YR 18 MONTH CERTIFICATE 18M 30 MONTH CERTIFICATE p~ 2 - D ~ 30M,; ~• 20 F .a3 ~E 5 YEAR CERTIFICATE 5YR METHOD OF DIVIDEND Bran~h:~~ l:mpinyee~; DISPOSITIO N ` PLEASE CHOOSE ONE ACCOUNT NUMBER 'T-r;n~(u . ~~ SAME ACCOUNT -DEPOSIT BACK TO CERTIFICATE - DEPOSIT TO SAVINGS ACCOUNT - DEPOSIT TO CHECKING ACCOUNT - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT -MAIL ME A CHECK MEMBERS SIGNATURE: ~?Q~' r+--°""- ~~~ 6 e~1 ~ s~" DATE: (-I$^?~ This Is to certiry Thal the above named person(s) are the owners of a Certificate account at Members 1st Federal Credit Union. This certificate may be redeemed at maturity. The dividend rate and Annual Percentage Yield are shown above. The Annual Percentage Yield and dividend rate assume that the dividend is added to the principal of the certificate. This account is subject to ail terms and conditions stated in the Certificate Account Disclosure, as they may be amended from time fo lime, and incorporate the same by reference into this agreement. Dividends are based on the credit union's earnings at the end of a dividend period and cannot be guaranteed. A substantial penalty Is Imposed if certificate funds are withdrawn before maturity date. The penalty may result in invasion of principal when funds are withdrawn prior to the maturity date of the certificate. The penalty for certlticates purchased before January 1, 1995 wilt be: It the maturity of the certificate Is one year or less, the penaity is a forfeiture of an amount equal io 90 days' dividends based on the dividend rate being paid on the certificate whether earned or not. If the maturity of the certificate is more than one year, the forfeiture is equal to 180 days dividend, based on the dividend rate being paid on the certificate whether earned or not. The forfeiture is calculated at the simple Interest rate being paid on the certificate regardless of how long the funds have remained in the account. The penalty for eertillcates purchased after December 31,1994 will be: If the certificate is one year or less, the penalty is a forfeiture of an amount equal to 90 days dividends, based on the dividend rate being paid on the certificate whether earned or nat. The penalty for certificates with maturities of more than one year will equal the difference between the new dividend rate for the remaining period of time and the existing certificate dividend vale divided by 365 multiplied by the face value of the certificate and multiplied by the number of days remaining on the existing certificate. The minimum penally wiil be the greater of this formula (as shown below) or $25.00. Penalty = (New Raie - ExistinD Rate) X Certificate Face Value X Days Remaining 365 The credit union will give you at least 20 days notice prior to maturity. The certificate will automatically be renewed for another term at the close of business on the initial maturity date or maturity date of any renewal term unless ft is redeemed within seven (7) calendar days. The rate of earnings for any renewal term shall be at the rate the credit union is paying at That time on new Certificates of that term. In the event of the death of the certificate owner, the certificate will be surrendered without incurring the early withdrawal penalty. MBRS 1:98-35 Rev. 12!94 ~~,~.~~~ em er _ ~ s CERTIFICATE APPLICATION AND DISCLOSURE t'-F~" RAL CREllIT UNION UWe hereby apply for a Members 1st Certificate in the ~ MATURITY DATE: ~") 8" ~ amount and term listed below. ACCOUNT # fir-' SU Please Print / SOCIAL MEMBERS NAME: ~- ~l u n ~ -~'f ~ i iC„t SECURITY # 2 c-'I " '7~ - ~ ~' ~' U STREET ADDRESS: z ~//~~~ ~=- ~p ~~~~w r^~Q~ I~~ . ~~ CITY: c_-_cw 1 .5 (.~t.._ STATE: ~' - Z!P CODE: ~ ~G I-~ HOME PHONE NUMBER: Q WORK NUMBER: JOiNT OWNER(S) NAME: - r~'Of~°~ ` "~' S, ~., 'J CERTIFICATE TERM S AMOUNT _ P~i~C~NtAo~ ~`~yI~CD , Y` ~~' x~'~~`;,`a~ ~ '~` Iz{AtE~` ~ , - '`-~'~~~~r; .``,SUi`~'Iksll,: 901)AY CERTIFICATE 3M0 i 26 WEEK CERTIFICATE 26W 12 MONTH CERTIFICATE iYR 18 MONTH CERTIFICATE 18M 30 MONTH CERTIFICATE ~ Z„ . O C~ 30M ' (a. LtJ E',, 0 3 5 YEAR CERTIFICATE 5YR METHOD OF DIVIDEND Brtirich:` ~ ` - ~r»ployBA DISPOSITIO N --- PLEASE CH005E ONE ACCOUNT NUMBER _.---~~. ~ ~~'.~ SAME ACCOUNT -DEPOSIT BACK TO CERTIFICATE - DEPOSIT TO SAVINGS ACCOUNT - DEPOSIT TO CHECKING ACCOUNT - DEPOSIT TO INVESTMENT SAVINGS ACCOUNT - MAtI ME A CHECK MEMBERS SIGNATURE: (~~ -'~-ski-P~f' ('Q4,~~Q-~ DATE: ,~ ~~b This is to certify that the above named person(s) are the owners of a Certificate account at Members 1st Federal Credit Union. This certificate may be redeemed at maturity. The dividend rate and Annual Percentage Yfeld are shown above. The Annual Percentage Yield and dividend rate assume that the dividend is added to the principal of the certificate. This account is subject to all terms and conditions staled in the Certificate Account Disclosure, as they may be amended from time to time, and Incorporate the same by reference into this agreement. Dividends are based on the credit union's earnings at the end of a dividend period and cannot be guaranteed. A substantial penalty is imposed if certiticate funds are withdrawn before maturity date. The penalty may result in Invasion of principal when funds are withdrawn prior to the maturity date of the certificate. The penalty for certificates purchased before January 1, 1995 wilt be: if the maturity of the certificate is one year or less, the penalty is a lorteiture of an amount equal to 90 days' dividends based on the dividend rate being paid on the certificate whether earned or not. If the maturity of the certificate is more than one year, the forfeiture is equal to 180 days dividend, based on the dividend rate being paid on the certificate whether earned or not. The forfeiture is calculated at the simple Interest rate being paid on the certificate regardless of how long the funds have remained in the account. The penalty for certificates purchased alter December 31,1994 will be: Ii the certificate is one year or less, the penally is a forfeiture of an amount equal to 90 days dividends, based on the dividend rate being paid on the certificate whether earned or not. The penalty for certificates with maturities of more than one year will equal the difference between the new dividend rate for the remaining period of time and the existing certificate dividend rate divided by 365 multiplied by the face value of the certificate and multiplied by the number of days remaining on the existing certiticate. The minimum penalty will be the greater of this formula (as shown below) or $25.00. Penally = (New Rate -Existing Rate) X Certificate Face Value X Days Remaining 365 The credit union will give you at least 20 days notice prior to maturity. The certilicale will automatically be renewed for another term at the close of business on the initial maturity dale or maturity date of any renewal term unless it is redeemed within seven (7) calendar days. The rate of earnings for any renewal term shall beat the rate the credit union is paying at That time on new certificates of that term. In the event of the death of the certilicale owner, the certificate will be surrendered without incurring the early withdrawal penalty. MBRS 1:98-35 Rev. 12/94 o~/ ~~~ ~ ~~1V~7~eNi cc~~~~an~r ~c~i ~` o~l~~-~'»-G%5 ~7 ~ - ' ~t 1 ~nr~~~rn~~~nnu~~n~~r~nr~r~t~r~~nr~~rn~~nr~r~n~ur~~ ;AROLYN A PERSIK ROGER J PERSIK JT TEN 209 E YELLOW BREECHES RD CARLISLE PA 17013-7500 01/01/98 - 03/31/98 Page 1 of 2 z 9 9 a For recording of current share prices, yields, and total returns:/-800-631-4636 To talk to a Representative: 1-800-253-2277 Please see the enclosed brochure to {earn how the ' . AARP Bond Fund for Income seeks to provide you :.:with°high current income but with less downside risk than other similar funds... , estimates as of 03/30198 No. OF SHARES OWNED PRICE PER SHARE VALUE PER SHARE TOTAL AARP GNMA & U.S. Treasury 77.443 $15.19 $1,176.36 $15.08 $1,161.51 30-day net annualized SEC yield on 3/30/98 was 6.05% AARP High Qual Short Term Bond 68.911 $16.15 $1,112.91 $15.97 $1, 094.88 30-day net annualized SEC yield on 3/30!98 was 5.56% AARP Balanced Stock & Bond 64.938 $22.06 $1,432.53 $17.65 $1,137.16 AARP Growth & Income Fund 341.909 $59.90 $20,480.35 $38.82 $13,209.85 Tot~IAccount Value as of fl3131 /98, _ -- . ~ ~~. . .. .. . `$24,..202 15:; o For more IMomraUaa on esSmated Avaago ~gt,~ ma bacx at,rl~s,;~:,~~... ~ • SHORT TERM LONGTERM TOTAL DIVIDENDS CAPITAL GAINS CAPITAL GAINS EARNINGS AARP GNMA & U.S. Treasury $19.28 $0.00 $0.00 $19.28 AARP High Qual Short Term Bond $15.90 $0.00 $0.00 $15.90 AARP Balanced Stock & Bond $10.95 $0.00 $0.00 $10.95 AARP Growth & Income Fund $95.29 $0.00 $0.00 $95.29 r _ __ , ~ _r.,, , _ .. Tot8i1"YTD Earnings ~'._... ... -_.. _~ _.` ~. :5 .. _._-. ~ ..~ .$141 :42~ _ _ ,r :°., ,$o.oU.~ . ~ _ 50.00 . ._ ._$1~ti.4z ~ - YALUE ON 01/01/98 + TOTAL ADDITIONS TOTAL WITHDRAWALS'} MARKET VALUE ' CHANGES = YAlUEON 03/31/98 Investment fromSCUDDER AARP GNMA & U.S. Treasury $1,159.41 $19.28 $0.00 $2.33- $1,176.3 AARP High Qual Short Term Bond $1,105.22 $15.90 $0.00 $8.21- $1,112.9 AARP Balanced Stock & Bond $1,324.89 $10.95 $0.00 $96.69 $1,432.5 AARP Growth & Income Fund $18,050.15 $95.29 $0.00 $2,334.91 $20~.~ `TOtal .._ _ .. '- .~... 521;b3g,67... ' _ , 5141.42 '.. : __ SO.yQo '_ .:$Z.4z1:Oh. r'~$ x,202..1 ~'~~ Scudder Investor Services, Inc., Distributor, confirms any purchases as agent. Account Number: 0402 899 625-7 BRUCE GOODMAN, M.D. 1515 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102 TELEPHONE (717) 234-3203 FAX (717) 234-3935 March 12, 1998 Hepford, Swarta & Morgan Sandra L. Meilton, Esq. PO Box 889 Harrisburg, PA 17108 RE: Julia Persik Dear Ms. Meilton: I have had the opportunity of evaluating this lady on February 20, 1998. At that time, I was given a file from her previous orthopedic surgeon, Dr. Douglas Sanderson which was reviewed in advance of her evaluation. She was admitted to the Polyclinic Hospital for a prolonged course of conservatism and did have back surgery dating back to 1980, at which time, she had been admitted to the Holy Spirit Hospital for operative intervention. About one year following that injury, she did have a cervical discectomy and fusion performed by her attending orthopedic surgeon. Over the years, she had been evaluated and treated by her orthopedic surgeon on numerous occasions in deference to discomfort in the neck and low back. There were noted many abnormalities pursuant to multiple examination and this Lady had been placed on a home course of therapy. RE: Julia Persik March 12, 1998 Page 2 She had no further operative procedures following her aforementioned surgeries, however, did have intervening periods of hospitalization for intensive modalities of physical therapy. She did indicate to me that she had so many hospitalizations that she would be incapable of affording me individual dates pursuant to this visit. In 1985, she had been in a significant motor vehicular accident and in 1990 was involved in an incident where she was struck by a vehicle as a pedestrian and had been admitted to the Holy Spirit Hospital where she was treated in an intensive conservative fashion She presently is capable of performing the activities of daily living as well as cooking, grocery shopping and cleaning. She does have severe cervical discomfort and did attempt to work for about one month in a sedentary role using a computer. She did have complaints, however, referable to neck discomfort associated with pain over both clavicles, upper and mid back areas. In addition, she described some left lower extremity radiculitis. There had been no augmentation of the pain subsequent to increases in intra-abdominal pressure manifested by coughing, sneezing or straining at stool. Physical examination was performed in detail. Her gait pattern was normal. She had a reciprocal heel-toe gait and was capable of toe and/or heel walking independently. There was a well healed mid line incision in the low back area with some increased paravertebral muscle spasm. The posterior spinous processes were nontender to palpation. Her flexion was precluded to seventy degrees with ninety degrees normal, however, extension as well as lateral rotation and lateral flexion were significantly precluded. RE: Julia Persik March 12, 1998 Page 3 Her straight leg raising was restricted at fifteen degrees on the right and ten degrees on the left in the supine position. There was no great toe weakness. Straight leg raising was negative in the sitting position. The patella and Achilles reflexes were present and equal bilaterally. The sensory system was intact. Examination of her cervical area revealed she held her head in the neutral position. There was no increased paravertebral muscle spasm. The posterior spinous processes were nontender to palpation. Her cervical range of motion was significantly precluded in all directions. The biceps, triceps and periosteal radial reflexes were present and equal bilaterally. The sensory system was intact. There was no muscle fasciculation, atrophy or weakness present. I did find tenderness to palpation over the occipital area, anterior aspect of the disc spaces from C5 through C7, supraspinatous muscles near the scapulae, bilateral lateral epicondyles, the upper outer quadrant of the buttocks and the posterior aspect of the greater trochanter as well as the medial fat pad of the knee proximal to the joint line. I did have an MRI performed of both the cervical and lumbar areas. The cervical area revealed a previous cervical body fusion to have been performed at the C4-C5 level. There was mild generalized cervical spondylosis with narrowing of multiple neural foramina by spondylitic changes as well as a mild posterior bulge of the posterior disc at C6-C7. The lumbar MRI demonstrated generalized spondylitic changes with narrowing at multiple neural foramina. This lady has significant degenerative changes of the neck and low back associated with her prior operative procedures. In addition, she is suspect of having a fibromyalgia in view of her multiple specific tender areas compatible with findings of fibromyalgia. r RE: Julia Persik March 12, 1998 Page 4 Despite the aforementioned abnormalities, this lady may be employable using a sedentary-light work activity with a restriction of lifting to twenty pounds and a job which could be performed primarily from the sitting position with the opportunity for positional change as needed. It is quite possible she would require modification of even a sedentary to light job activity if she were to sit and work a computer. If answering the phone was a prime requisite, she would best be served with the use of ear phones and other job site modifications as needed. If she were, in fact, offered a light to sedentary job activity, I would suggest the benefit of a work capacity assessment followed by a job site evaluation by an experienced individual with ergonomics so that certain modifications might be made to permit her the ability to participate in all of the demands of her work requirements. It is quite possible that a course of work conditioning would be necessitated prior to a return to work activities. Initially, she would return to a four hour day with gradual titration as tolerated. These factors would be based upon her prolonged course of inactivity and deconditioning. I believe her prognosis is guarded and would feel her present restrictions regarding a sedentary to light type of job activity should be considered as permanent. Very truly yours, Bruce Go n, .D. BG/ jh ~ ~ April 24, 1998 JULIA PERSIK, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 1730 S, 1985 CIVIL ACTION - LAW IN DIVORCE v. ROGER J. PERSIK, Defendant INCOME AND EXPENSE STATEMENT Attached hereto is the Income and Expense Statement of Plaintiff submitted pursuant to Pa. R.C.P. No..1920.31. -Sandra L. Meil on Attorney for Plaintiff 1 April 24, 1998 THIS FORM MUST BE FILLED OUT (If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the Supplemental Income Statement which appears on pages 8 and 9 of this Income and Expense Statement.) INCOME AND EXPENSE STATEMENT OF JULIA PERSIK INCOME Employer: None Address: N/A Type of Work: N/A Payroll Number: N/A Pay Period (weekly, biweekly, etc.): N/A Gross Pay per Pay Period: $ N/A Itemized Payroll Deductions: Federal Withholding Social Security Local Wage Tax State Income Tax Retirement Savings Bonds Credit Union Life Insurance $ N /A N /A N /A N /A N /A N /A N /A N /A 2 April 24, 1998 Health Insurance Other (specify) Net Pay per Pay Period: Other Income: Interest Dividends Pension Annuity Social Security Rents Royalties Expense Account Gifts Unemployment Comp. Workmen`s Comp. Alimony Total N/A N/A $ None Week Month Year (Fill in Appropriate Column) $ None $ $ None None None None None None None None $1350.00* $ None $ $ TOTAL INCOME $ *Only partial payments made since October 1997. 3 April 24, 1998 Home Mortgage/rent Maintenance Utilities Electric Telephone Water Employment Public Transportation Lunch Taxes EXPENSES Weekly Monthly Yearly (Fill in Appropriate Column) $ 291.04 $ 60.00 700.00 100.00 90.00 35.00 425.00 $ N/A $ N/A Real Estate $ County Personal Income Income on Alimony Insurance Homeowners Automobile * Not included with mortgage $ 73.00 $ 873.16* 17.00 211.37 9.80 100.00 1134.00 30.00 356.00* 48.00 570.20 4 April 24, 1998 Life Accident Health Other Automobile Payments Fuel Repairs Medical Doctor (Dr. Goodman-$350.00) (Dr. Wood - $168.00) (Dr. Grossman - $40.00) Dentist Orthodontist Hospital Medicine Special needs (classes, braces, orthopedic devices) Education Private school Parochial school College Religious Weekly Monthly Yearly (Fill in Appropriate Column) $ N/A $ $ N/A N/A N/A 220.45 2645.40 $ 188.17 $ 50.00 600.00 42.00 500.00 $ 46.00 $ 558.00 100.00 1206.50 15.00 15.00 $ N/A $ N/A N/A N/A 5 April 24, 1998 Personal Clothing Food Barber/hairdresser Credit payments Credit cards Sears Bon Ton Citibank Crestar Loans Credit Union Christine Persik Maas Miscellaneous Household help Child care Papers/booksjmagazines Entertainment Pay TV Vacation Gifts Graduation Showers Funerals Weddings Get Well Birthdays Christmas Weekly Monthly Yearly (Fill in Appropriate Column) $ $ 40.00 $ 450.00 450.00 25.00 19.00 227.22 11.00 237.45 2,336.02 16.00 2,877.39 $ $ $ 45.00 550.00 $ N/A $ N/A N/A 25.00 N/A 6 17.00 200.00 84.00 1000.00 April 24, 1998 Legal fees Charitable contributions Other child support Alimony payments Other R&A Garbage Miscellaneous TOTAL EXPENSES *Mellon Bank (Safe Deposit) Wood Lawn Mower Maintenance Appliances Maintenance Weekly Monthly Yearly (Fill in Appropriate Column) $ $ 150.00 $ 1,780.54 8.00 35.00 N/A N/A 15.00 180.00 45.00 * 546.00 $ 8.00 $ 2,451.00 $ 21.00 100.00 225.00 200.00 7 April 24, 1998 INSURANCE Policy Coverage* Company No. H W C Hospital Blue Cross Other Medical Blue Shield Other Health/Accident Disability Income Dental Other H=Husband; W=Wife; C=Child 8 April 24, 1998 I understand that the statements made herein are subject to the penalties of 18 Pa.C.S. §4904 related to unsworn falsification to authorities. ~., ':, -: ~ .. Ju is Persik' I verify that I have reviewed this form with my client and to the best of my knowledge the answers herein are true and correct. ,~'C/ Sandra L. Meil on Attorney for Plaintiff ~~ ~ ~ .10.40 Lal~ei (S~ L Instructions A on page 10.) B E Use the IRS L label. Otherwise, H E please print R or type. E Presidential Departrnent of the Trodsury - Intemd Revenue 3srvlce 19 9 7 U.S. Individual Income Tax Return (99) IRS Use ony - Do not write or s tapie In this speoh For tM Jan. 1-Dec. 31, 1997, or other tax year bepinnlnp , 1997, ending , 19 OMB No. h545-pp7¢ ., Yourfirst name and intial Last name roursodal aecurlty nurfiber JULIA C ERSIK 056€34:2"230 ff a joint return, spouse's first name and initial Last name spou,e~a „d,, DeC„u~, ~~~ Home address (number and street). tt you have a P.O. box, see page 10. Apt. no. For help in finding Ilne 7 3 0 OPOSSUM LAKE ROAD instructions, tee pages City, town or post office, state, and ZIP code. ff you have a foreign address, see page 10. 2 and 8 in the booklet. CARLISLE, PA 17013 Yes Nc sign' Do you want $3 to go to this fund? .....................................................................•----------...................... X If a joint return, does your spouse want S3 to go to this fund Filing Status Check Dory one box. F~cemptions ff more than six dependents, see page 10. 1 X Single 2 Married filing joint return (even 'd only one had income) 8 Married filing separate return. Enter spouse's soc. sec. no. above and full name here. - 4 Head of household (with qualifying person). ff the qualifying person is a child but not your dependent, enter this child's name here. - Dependents on ec not entered above Add numbers d Total number of exam tions claimed ......................................... .................................................... ............ entxed on linen above - 1 Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 .............................................................................. 7 8a Taxable interest. Attach Schedule 8 if required ......................•••- ..----....-••...••.----_.---.•••...---._--.-••.----. 8a 450 . Attach b Tax-exempt interest . DO NOT include on line 8a 8b <•»:->.->.<•. Cagy B of your Forms W-2, g ..--„-••..•--..-.-.••,..• Dividends. Attach Schedule B if re cared ........ q ~ ......... ......... --.---. .................................................. 9 W-2G, and 10 Taxable refunds, credits, or offsets of state and local income taxes .. .........................................••....--•.. 10 1099-R here. 11 Alimony received ...•••-._-..•..----...••••_--.-...•_..._-.••.---__--.-.••.---_-- ..SEE.-•STATEMENT-..1.... 11 15,462. Ifyou did not 12 Business income or (loss). Attach Schedule C orC-EZ ..,,•••.•_---..•• ••-.•-•-------------•.•--.----..••.•---.......•• 12 getaW-2, 13 Capital gain or (loss). AttachScheduleD ..--_-.••,•-.._---... •.••.---- ----•••_- -----•••• --..••••.--- 18 seepagel 14 Other gains or (losses). Attach Form 4797 ..--._,.•.•----..---..•..---._.. -.••• ...............•••---_---••••_••------••••..... 14 15a Total IRA distributions ............... 15a b Taxable amount (see page 13) 15b 15a Total pensions and annuities .....- 16a b Taxable amount (see page 13) 15b Enclose but do not attach any 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ---•-••••.-.-----.•..-.- 17 payment. Also, 18 Farm income or(loss). Attach Schedule F .----...•-..----..•------------- •.-..-.-.-.---.••..----.---.•••..--.---.-....----.• 18 please use 19 Unemployment compensation ............................................... .................................................... 19 Form 1040-V. 20a Social security benefds .....-..,.., ~ 20a I I b Taxable amount (see page 14) 20b 21 Other income. List type and amount -see page 15 21 22 Add the amounts in the far right column for lines 7 through 21. This is your total Income .......-••._..---. - 22 15 , 912 28 IRA deduction (see page 16) .................. 28 Adjusted 24 ..••.-......................... g ~ Medical savin s account deduction. Attach Form 8853 ................. ...---- ....... 24 >>' -~'•••••~~ Gross 25 Movin e g xpenses. Attach Form 3903 or 3903-F . . 25 ' °~?~~'•<~~~'~`~ Income 25 •,••,, • ...--.•.---..--.- One-half ofself-employment tax. Attach Schedule SE ...•------------- -.••-.- ------- 25 If line 321s 27 Self-employed health insurance deduction (see page 17) 27 under $29,290 (under x9,770 if 28 .---•..--.••.- Ke h &self-employed SEP plans and SIMPLE plans ..-...-•--..••.-- o9 ---..•• -..•••- 28 a child did not 29 Penalty on early wlthdrewal of savings 2g see E Chinst)~ 80a ...................•..--.•..---...---- Alimony paid b Recipient's SSN - ... - - 30a on page 21. 31 Add lines 23 through 30x. -.••_-•.••.--.-..••.••.•-•-.••-. --.---••.-..-- 31 92 Subtract line 31 from line 22. This is your adlusted gross income _ - a~ 15 , 912 LHA For Privacy Act end Paperwork Reduction Act Notice, see page 38. 710001 1o-xa-97 5 17530409 706230 ACB-PERSJ 040 PERSIK, JULIA C 5 ~ ~ Qualifying widow(er) with dependent child (year spouse died - 19 ). 5a ®Yourself. tt your parent (or someone else) can claim you as a dependent on his or her tax return, do not No. or boxes check box 6a .................................. cl,edced on sa 1 b ~ SpeUSe . ...................................... ....................................... ................................................................................................................................... and 6b No.otyour C Dependents: (~ Dependent's nodal (3) Dependent': d ~ chUdron °n ~ (1) Flnt nano Lavt name security number rolatkxrship bo yq~r you ~ 1 moo: • lived with you ~ did not ih%e wlth you due to dNorce oraeparatlon (sea InstmcUons) Note: chedciny 'Yes' will not change your tax or reduce your rotund. Form 1049 (199 ACB-PER1 • ~om,f040(199~ JULIA C PERSIK U5b-34-LL3V O MB No . 1545-0074 ~~ .......................... 33 Amount from line 32 adjusted ions income ................................. .. i ( g ) ~ ............ 33 15 , 912 . , a~ ~Ompu- ;atlon .......... .... 34a Check if: Q You were 65 or older, [] Blind; ~ Spouse was 65 or older, Q Blind. - 34a Add the number of boxes checked above and enter the total here .................................... b H you are married filing separatery and your spouse itemizes deductions - 34b or you were adual-status alien, see page 18 and check here .......................................... <? °:: 0 ~ ~~ >:'•': ,.::x;:» '`:•`x: .::~,..: `~~~~~~~~~~ Itemized deductions from Schedule A, line 28, OR 35 Enter the Standard deduction shown below for your filing status. But see page 18 larger if you checked any box on line 34a or 34b or someone can claim you as a -..,.• .. dependent :> . " ............. ::<::>::<>:: ......... ""~''" 35 , 0 6 9 . . your: • Single -54,150 • Married filing jointry or Oual'Ifying widow(er) -56,900 • Head of household -56,050 • Married filing separatery - 53,450 :: z::<<<:>::>: 36 Subtract line 35 from tine 33 . ......... 36 9 , 8 4 3 . .............. 37 If line 33 is 590,900 or less, muttipty 52,650 by the total number of exemptions claimed on .... .. see the worksheet on page 19 for the amount toenter If line 33 is over 590 900 line 6d ............. '?' 37 2 , 6 5 0 . ......... .. , , . ............. . Subtract line 37 from line 36. ff line 37 is more than line 36, enter-0- 38 Taxable Income ............. 38 7 ,19 3 . . 39 Tax. See a e 19. Check'd an tax from a ~ Form s 8814 b ~ Form 4 . ..... 972 ....................... ....... - 39 1, 0 7 6 . Credits 40 CredR for child and dependent care expenses. Attach Form 2441 .................. 40 ~'~`~~~'~~~~~~~~ :;>s>i::ts: 41 Cred'A for the elderly orthe disabled. Attach Schedule R ........................... 41 ~~~<`-~`•~~~~~>•`•~ >::>:;r::>z: ................ .. 42 Adoption credit. Attach Form 8839 42 :::;:;::,:;;::: ................................... .... ><::>::: ............................ ... 43 Foreign tax credit. Attach Forth 1116 43 ~:::<:::;::; .................... ... 44 Other. Check if from a ~ Form 3800 b 0 Form 8396 .,... c ~ Form 8801 d Q Form (specify) .::44•V: .s;< `~~~~~`"'" ...r ........ . .... 45 Add Ilnes 40 through 44 .............. 45 .... . .................................................................................. 46 Subtract line 45 from line 39. ff line 45 is more than line 39, enter -0- ........................................... ........ - 46 1 , 0 7 6 . Other ................... ... Attach Schedule SE 47 Self-employment tax .............. 47 ... ...................................................... . Taxes ............................... ... . 48 Aftemative minimum tax. Attach Forrn 6251 .............. 48 ....................................... . . 49 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 ............. .............. 49 50 Tax on qualified retirement plans (including IRAs) and MSAs. Attach Form 5329 if required ............ ............... 50 .............................. . ..... 51 Advance eamed income credit payments from Form(s) W-2 ............... 51 ............. .... . .............................. . .. . 52 Household employment taxes. Attach Schedule H ............... 52 ......................... .... . .. 53 Add lines 46 through 52. This is your total tax ..................................................................... ......... - 53 1, 0 7 6 . Payments 54 Federal Income tax withheld from Fomts W-2 and 1099 .............................. 54 y<..rr .:...:::::. 55 1997 estimated tax payments and amount applied from 1996 return ..----.....- 55 Attach Forms W-2, W-2G and 56a Earned Income credit. Attach Schedule EIC'rf you have a qualifying child b Nontaxable eamed income: amount - ~ ~ and type - :•F;. "`^ ~:> ~zL<`~_ . 56a ~ ~~~ : : : , 1099-R on 57 Amount aid with Forrn 4868 re uest for extension .. ................. p ( 4 ) 57 : : : : ~ ~ : page 1. 58 Excess social security and RRTA tax withheld (see page 27) ------------------------ 58 :>:: > < 59 Other payments. Check if from a ~ Fomt 2439 b ~ Form 4136 ...... 59 ,.,.. :.:::::::.;: . 60 Add lines 54, 55, 56a, 57, 58, and 59. These are our total a merits .......................................... ......... - 60 Refund 61 tt line 60 is more than line 53, subtract line 53 from line 60. This is the amount you OVERPAID ......... ............... 61 Have It ............................................... . ... .... g2a Amount of line 61 you want REFUNDED TO YOU .......... - 62a dsa,~~27 ,nl,;,d mod' .... .... ... .. - 6 Routing number c Type: ~ Checking ~ Savings - d Account number 63 Amount of line 61 ou want APPLIED TO YOUR 1998 ESTIMATED TAX - 63 AI11oUnt ~ ff line 53 is more than line 60, subtract line 60 from line 53. This is the AMOUNT YOU OWE. ..................................................................... For details on how to PaY, see page 27 .. .... .......... - fie 1,13 4 , .. . You Owe i 65 Estimated tax Denalty. Also include on line 64 .............................~_. y.....L ~ ::...::: :.....:::......:......:......:............... aSl n Under penalties of perJury, I declare that I have examined this rowm end aooompanyinyy schedules and stetanents, and to the nest of my knowedge and g txllef, they ere >n0. oortect, and complete. Dedaratlon of preparer (other than taxparyeq Is based on ell Informatbn of which preparer has arty knowledge. Here 'Yourslgnature Date Youroocupeitlon Keep a copy ~ OMEMAKER Of this fetum Spouse' t Date 3pouae's ocwpatlon foryour records. Preparor's Dais Check tf self. Preparers nodal aecurlty no. Paid signature ' y~y- ~~ «~~~ 17 2 4 6 3 4 9 7 Preparer'sFl~,.a name (or WA GONER, FRUT IGER & DAUB EIN 2 3 15 8 3 2 4 9 Use Only y~~~lfaelf-er^- `3310 MARKET STREET ~P °°de 17011-4494 pa"~~~~ CAMP HILL PA ~~~ 6 laze-s~ 17530409 706230 ACB-PERSJ 040 PERSIK, JULIA C ACB-PERT Fonn ~ ~ ~ O Department of tha Trsssury Moerrw Revenue service Name(s) shown on tax return OMB No.1545-0140 1997 Attachment sequence No. itifyino number JULIA C PERSIK 1_.056-34-2230 Note: in most cases, you do not need to file Form 2210. The IRS will figure any penalty you owe and send you a bill. File Form 2210 only 'done or more boxes in Part I apply to you. tf you do not need to file Form 2210, you still may use lt to figure your penalty. Enter the amount from line 20 or line 32 on the penalty line of our return but do not attach Form 2210. ' Reasons for Filing - ff 1a, b, or c below applies to you, you may be able to lower or eliminate your penalty. But you MUST check the boxes that apply and file form 2210 with your tax return. ff 1d below applies to you, check that box and file Form 2210 with your tax return. 1 Check whichever boxes apply (d none appy, see the Note above): a Q You request a wahor. In certain circumstances, the IRS will waive all or part of the penalty. See Waiver of Penally on page 1 of the instructions. b ~ You use the annualized Income Installment method. If your income varied during the year, this method may reduce the amount of one or more required installments. See page 4 of the instructions. c ~ You had Federal income tax withheld from wages and, for estimated tax purposes, you treat the withheld tax as paid on the dates lt was actually withheld, instead of in equal amounts on the payments on the payment due dates. See the instructions for line 22 on page 3. d Q Your required annual payment (line 13 below) is based on your 1996 tax and you filed or are filing a Joint return for either 1996 or 1997 but not for both years. Required Annual Payment 2 Enter your 1997 tax alter credits (see page 2 of the instructions) Caution: Also see page 2 for a special rule lt claiming the research credit ......................................................................................•--............---...............--------...........-------..... 2 1, 0 76 . 3 Othertaxes (see page 2 ofthe instructions) ....................•----......--------............---------........................-----...........-------....... 3 4 Add lines 2 and 3 ........................................................................................................ ...........................•-----........ 4 1, 0 7 6. amed ncome credit 5 ::::;..;::: redltfor Federal tax paid on fuels ................................................................................. 5 `•#'~€ 7 Add lines 5 and 6 ................................................................................................................................................... 7 8 Current yeartax. Subtract line 7 from line 4 ............................................................................... ................................. 8 1 , 0 7 6 . 9 Multiply line 8 by 90% (.90) ....................................................................................... 9 9 6 8 . >' 10 Withholding taxes. Oa not include any estimated tax payments on this line (see page 2 of the instructions) -----------------------•••_--- 10 11 Subtract line 10 from line 8. If Tess than x500, stop here; do not complete or file this form. You do not owe the penalty ............................................................................................................................................................... 11 1, 0 7 6 . 12 Enterthe tax shown on your 1996 tax return (110% of that amount'rfthe adjusted gross income shown on that return is more than 5150,000, orrf married filing separetety for 1997, more than $75,000). Caution: See instructions . .....................•,•._- 12 1, 19 6 . 13 Required annual payment. Enter the smaller of line 9 or line 12 .................................................................................... 13 968. Note: ff line 10 Is a ual to or more than line 13, sto here; ou do not owe the ena . Do not file Form 2210 unless ou checked box 1d ab ove. Short Method (Caution: See page 2 of the instructions to find out'd you can use the short method. ff you checked box 1 b or c in Part I, skip this part and go to Part IV.) n er the amount, lt any, from line 10 above 14 :<;::;:;::; 5 Enter the total amount,'rf any, of estimated tax payments you made ------------------------------------ 15 <.>:•>:•:<.>:. 15 Add lines 14 and 15 ......................................................................................................................... .......... 15 17 Total underpayment for year. Subtract line 16 from line 13. If zero or less, stop here; you do not owe the penalty. Do not file Form 2210 unless you checked box 1 d above 17 9 6 8 . 18 Multipy line 17 by .05986 ....................................................................................................................................... 18 5 8 19 • If the amount on line 17 was paid on or after 4/15/98, enter -0-. • If the amount on line 17 was paid before 4/15/98, make the following computation to find the amount to enter on line 19. Amount on Number of days paki :>:::>:::>::::::: line 17 x before 4/15/98 x .00025 ............................................................... 19 0 20 PENALTY. Subtract line 19 from line 18. Enter the result here and on Form 1040, line 65; Form 1040A line 34; , Form 1040NR line 65' Form 1040NR-EZ line 26' or Form 1041 line 27 ........................................................................ - 20 5 8 LHA For Paperwork Reduction Act Notice, see page 1 of separate instructions. Form 2210 (1997) 712501 12-10-97 6.1 17530409 706230 ACB-PERSJ 040 PERSIK, JULIA C Underpayment of Estimated Tax by Individuals, Estates, and Trusts -See separate Instructions. - Attach to Form 1040,1040A,1040NR,1040NR-EZ, or 1041. ACB-PER1 ES A&B L F HmDU Schedule A -itemized Deductions vmo rvo. ~~o-w.~ 1997 04 Q i (Schedule B is on page 2} pepertrtient of Uro Tteseury Interrw Revenue Service - Attach to Form 1040. - See Instructions for Schedules A and B (Form 1040). ntma,menl 3equance No. O7 Name(s) Town on Forth 1040 Your nodal .eG,dty number JULIA C PERSIK 056:34:2230 ::>:: <>< Medical ... Caution: !Jo not include expenses reimbursed or paid by others. :::>: :::>: ... and 1 Medical and dental expenses (see page A-1).,...... SEE--- STATEMENT•__ 5--- 1 3 , 3 3 4 . Dental 2 Enter amount from Form 1040, line 33 .............................. 2 15 , 912.::::: :::;;: Expenses 3 Mufti line 2 above by 7.5% (.075 3 1,19 3 . I~IY ' ) ................................................................... 4 Subtract line 3 from line 1. H line 3 is more than line 1, enter -0- ................................... ......................... 4 2 , 141 . Taxes You 5 State and local income taxes ............................. SEE STATEMENT 2 5 11 . Paid 8 Real estate taxes (see page A•2) ........................................................................... a 1, 0 $ 5 . (gam 7 Personal property taxes ..............................................................-....---................ 7 page A•2.) 8 Other taxes. List type and amount ----------- 8 -------------------------- 9 Add lines 5 through 8.---• .......................................................................................... ......................... 9 1, 0 9 6. {nterest 10 Home mortgage interest and points reported to you on Form 1098 ........................ 10 2 , 0 4 2 . YOU Paid 11 Home mortgage interest not reported to you on Form 1098. H paid to the person ' s name, from whom you bought the home, see page A•3 and show that person (See :; identifying no., and address .::: _ Note: ------------------------------------- 11 Personas 12 Points not reported to you on Form 1098. See page A-3 ....................................... 12 interest is not 13 Investment interest. Attach Form 4952 if required. (See page A-3.) ........................ 13 deductible. 14 Add lines 10 through 13 ........................................................................................... .......................... 14 2 , 0 4 2 . Gifts t0 15 Gifts by cash or check. If you made any gift of 3250 or more, ~ . #~`%:: ... . Charity see page A-3 .....................................................SEE... STATEMENT... 3.... 15 5 9 5 . 18 Other than by cash or check. ff any gift of 3250 or more, see page A-3. - >•`• --- -~ if you made a gift and got a You MUST attach Form 8283 if over 3500 .........--SEE-.. STATEMENT.. 4-.-- ig 19 5 . benefit for it, 17 Carryover from prior year .................................................................................... 17 see page A-3. 18 Add lines 15 throu h 17 .......................................................................................... .. ..................... 18 7 9 0 . Casualty and Theft Losses 19 Casualty or theft loss(es). Attach Form 4864. (See page A-4.} .................................... ........................... 19 Job Expenses 20 Unreimbursed employee expenses • job travel, union dues, job education, etc. and Most You MUST attach Form 2106 or 2108-EZ if required. (See page A-4.) ~:::::: •':.::.`: Other '"''~~~~ Miscellaneous Deductions ------------------------------------- 21 Tax preparation fees 21 22 Other expenses • investment, safe deposit box, etc. List type and amount TO RECEIVE -LEGAL FEES `~`'~~~ (See page A-5 for - ALIMONY ------------------------- ---------- :>?;;» ~~~~" ;:.;;•.; ~ ~~ ~" expenses to ------------------------------------- deduct here.) ------------------------------------- ..................................................... 23 Add lines 20 through 22 ... ?3 ............................. .. , ;;:.;>:. 24 Enter amount from Form 1040, line 33 .............................. 24 ».~.>~ :.~:: . ............................................... 25 MuRipty line 24 above by 2% (.02) - ~ ..... ................•-- 28 Subtract line 25 from line 23. ff line 25 is more than line 23, enter -0• ....................... ...... ...................... 28 Other 27 Other • from list on page A-5. List type and amount Miscellaneous - '`rs ~~--~~ Deductions 27 TOtel 28 Is Fom11040, line 33, over 3121,200 (over 360,800 tf martled filing separately)? Itemized NO. Your deduction is not limited. Add the amounts In the far right column for lines 4 Deductions through 27. Also, enter on Form 1040, line 35, the larger of this amount or your - . - 28 6 , 0 6 9 , standard deduction. J e er. e -5 fo the amount to nt ee A r a be i sled S YES. Your deduction m I m g Y pa ~~# ~' LJiA For Paperwork Reduction Act Notice, sea Form 1040 instructions. Schedule A (Form 1040) 199 719501 •7 11-14-97 7530409 706230 ACB-PERSJ 040 PERSIK, JULIA C ACB-PER1 Schedules A6B (Form 1040) 1997 OMB No. 15450074 Page 2 Name(s) shown on Form 1040. Do not enter name and nodal sewrlty number If shown on paDe 1. JULIA C PERSIK Your social security number 056:34:2230 Schedule B -Interest and Dividend Income "~''r"°nt sequence No. 08 Part I Note: If you had over $400 in taxable /nterest income, you must also complete Part ill. Interest 1 List name of payer. H any interest isfrom aseller-financed mortgage and the buyer used the Amount Income property as a personal residence, see page B-1 and list this interest first. Also, show that buyer's social security number and address - YORK FARM CREDIT 450. Note: If you received a Form 1099.1 NT, Form 1099-0ID, 1 or substitute statement from a brokerage firm, li ' st the firm s name as the payer and enter the totalinterest shown on that form. 2 Add the amounts on line 1 .......................................................•--------.........-•----............-----........- 2 450 . 3 Excludable interest on series EE U.S. savings bonds issued after 1989 from Form 8815, line 14. You MUST attach Form 8815 to Form 1040-----------------------------------------•-•.-.---.••••-------...•.-• 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line Sa .................•---.-.-,• - 4 450 . Part I I Note: ff you had over X400 /n gross dividends and/or other distributions on stock, you must also complete Part ill. Dividend 5 List name of payer. Include gross dividends and/or other distributions on stock here. Amount Income Any capftal gain distributions and nontaxable distributions will be deducted on lines 7and8- 5 Note: If you received a Form 1099•DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enterthetotal dividends shown on that form. 6 Add the amounts on line 5 ......................................................................................................... 8 7 Capital gain distributions. Enter here and on Schedule D .................. 7 8 Nontaxable distributions. ............................................................... 8 9 Add lines 7 and 8 ..................................................................................................................... :»>:«:: :;;:;s:::::;: ~~`~'• ~~~~''''''% 9 10 Subtract line 9 from line 6. Enter the resuR here and on Form 1040, line 9 .............................. - 10 Part III You must complete this part if you (a) had over $400 of interest or dividends; (b) had a foreign account; or Foreign c received a distribution from or were a raptor of or a transferor to a forei n trust. Yes No Accounts 11 a At any time during 1997, did you have an interest in or a signature or other authority over a financial and account in a foreign country, such as a bank account, securities account, or other financial account? .................. •. ,,.X... TrUSts b If'Yes; enter the name of the foreign country - 12 During 1997, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If 'Yes ' ou ma have to file Form 3520 or 926. See a e B•2 ........................................................................... _.... X LHA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 199' rz75ot n-os-97 $ 17530409 706230 ACB-PERSJ 040 PERSIK, JULIA C ACB-PER1 JULIA C PERSIK 056-34-2230 FORM 1040 ALIMONY RECEIVED STATEMENT 1 NAME OF RECIPIENT JULIA C PERSIK TOTAL TO FORM 1040, LINE 11 15,462. SCHEDULE A STATE AND LOCAL INCOME TAXES STATEMENT 2 DESCRIPTION PENNSYLVANIA TAX PAYMENTS TOTAL TO SCHEDULE A, LINE 5 SCHEDULE A CASH CONTRIBUTIONS STATEMENT 3 AMOUNT AMOUNT 15,462. 11. 11. DESCRIPTION MT ZION LUTHERAN MISCELLANEOUS AMOUNT 50$ LIMIT 585. 10. AMOUNT 30$ LIMIT SUBTOTALS TOTAL TO SCHEDULE A, LINE 15 595. 595. SCHEDULE A CONTRIBUTIONS OTHER THAN CASH OR CHECK STATEMENT ~ DESCRIPTION SALVATION ARMY SUBTOTALS TOTAL TO SCHEDULE A, LINE 16 17530409 706230 ACB-PERSJ AMOUNT AMOUNT AMOUNT 50~ LIMIT 30$ LIMIT 20$ LIMIT 195. 195. 195 9 STATEMENT(S) 1, 2, 3, 040 PERSIK, JULIA C ACB-PER1 JULIA C PERSIK 056-34-2230 SCHEDULE A MEDICAL AND DENTAL EXPENSES STATEMENT 5 DESCRIPTION PRESCRIPTION MEDICINES AND DRUGS MEDICAL INSURANCE PREMIUMS PAID TRANSPORTATION DOCTORS, DENTISTS, ETC. TOTAL TO SCHEDULE A, LINE 1 10 17530409 706230 ACB-PERSJ 040 PERSIK, JULIA C AMOUNT 133. 2,645. 111. 445. 3,334. STATEMENT(S) ACB-PER1 PA-40 1997 9700111066 D56-34-2230 PE A 0 FY p B 0 RS R PERSIK JULIA C AC 0 FS S 730 OPOSSUM LAKE ROAD PN CARLISLE PA 17013 SC 21050 1A 0.00 1B 0.00 1C 0.OD 2 450.00 3 0.00 4 0.00 5 D•OD 5A 0.00 6 0.00 7 0.00 8 0.00 9 450.00 10 0.00 11 450.00 12 13.00 -------------------------------------------------------------------- Please Fold Page Along This Line Fiscal Year Filers, Mark this space. If this is an Amended return, Mark this space. 0 5 6- 3 4- 2 2 3 0 P E Option fora 1998 Booklet. ff you do not want a 1998 Tax Booklet next year. Mark this space. If you paid a PERSIK JULIA C Preparer, ask'rf he or she is using this option. Daytime Phone Number: 730 OPOSSUM LAKE ROAD CARLISLE P A 17 013 Local Information. Enter where you lived as of 12/31/97 Residency Status. County: C U M B E R L A N D Fill-in only one choice. Municipality: Type Filer. dill-in only one choice. School District: BIG S P R I N G R X Resident S X Single F Final NR Nonresident M Married Filing ~ ointty Filing School District Code: 21050 Separatety P Part Year Resident D Deceased Date of Death: from: to: SSN, Name or Address Change. If ANY of the above information you entered is different from your 1996 PA tax return on the label, or if you did not file a 1996 PA tax return, mark this space. 1a Gross PA Taxable Compensation from W-2 forms and otherwage statements .................................................. .... 1a 1b Unreimbursed Employee Business Expenses from PA Schedule UE ..-...-.-.. ......... .......... ........ ........... .... 1 b 1c Net PA Taxable Compensation. Subtract line 1b from line 1a ---------------------------------------------------------------------- ----- 1c 2 PA Taxable Interest. Complete and attach PA Schedule Arf over x1,000 ........ ......... ......... ......... ......... ..... 2 3 PA Taxable Dividends. Complete and attach PA Schedule B if over x1,000 ........................................................ .... 3 4 Net Income or [Loss] from the Operation of Business, Profession or Farm .................................................... ..... 4 5 Net Gain or [Loss] from the Sale, Exchange or DisposRion of Property .......................................................... ..... 5 5a Amount of Gain Excluded from PA Schedule PA-19. ,...-,,.-„----------------------------------------------------------------------- --- - 5a 6 Net Income or [Loss] from Rents, Royalties, Patents and Copyrights --------- --------- --------- --------- --------- ----- 6 7 Estate and Trust Income ............... .......................................... ..... 8 Gambling and Lottery Winnings ....................................................................... ..................................... ..... 8 9 Totat Gross PA Taxable Income. Add the Income amounts from lines 1c, 2, 3, 4, 5, 6, 7 and 8. DO NOT SUBTRACT ANY [LOSSES] REPORTED ON LINES 4,5 OR 8 ..............................„.--....-.._--,----.---,.---.. .-... g 10 CONTRIBUTIONS TO YOUR MEDICAL SAVINGS ACCOUNT .......... ......... ......... .......... ........ ......... ..... 10 11 NET PA TAXABLE INCOME.Subtract line 10 from line 9 ......... ......... ......... ........ ......... ......... ..... 11 12 Total PA Tax Liability. Multiply Ilne 11 by 2.8% (0.028). Enter your tax due here and on Llne 13 on page 2. .... ...._ 12 o•aD D•00 D•aD 45x•00 D•aD 0.00 a•oo a•Do 0•DO 0.00 o•Do 450.00 o•oo 450.00 13.00 9700111066 9700111066 naoovo~-os-sa PA-40 1997 9700211064 PAGE 2 PERSIK JULIA C 056-34-2230 13 13.00 14 0.OD 15 0.00 16 0.00 17 0•DO 18 0.00 19 0.00 20A 0 20B 0.00 20C 0.00 21 0.00 22 0.00 23 0.00 24 0.00 25 0.00 26 0.00 27 13.00 28 D•00 29 0.00 30 0.00 31 0.00 32 0.00 33 0.00 34 0.00 35 0.00 13 TotaIPATaxLlablllty. Enteryour taxdue from line 12 on the first page .............. ................................................................. ............ .. 13 13 • D 0 14 Total PA Tax Withheld from W-2 forms ....................................................................................... ............ .. 14 0 • D 0 15 Credit from your 1996 PA Income Tax Retum .................................................................................. ............ .. 15 D • D 0 16 1997 Estimated Installment Payments ................................ ..-... .. 16 0 • 00 17 Payment made with your request for an extension of time to file your 1997 PA-40 .................................. ............ .. 17 0 • 0 0 Line 18 k for nonreslderd partners, shareholders and members onty 16 Taxwfthheld as reported on your PA Schedule(s) NAK-1 ................................................................... ............ .. 18 0 • 00 19 Total Tax Wtthheld, Paymarrts and Credits. Add lines 15 through 18 .............................................................................................................. ............ .. 19 D • DD Lines 20a, b and c are to list information from PA Schedule SP 20a Dependents, Part B, Line 2 .......................................................................................................... ............ .. 20a 0 20b Total Eligibility Income, Part C, Line 11 . ...................••-----...---....................---................................. ............ .. 20b 0 • 00 20c Tax Forgiveness Credit from Part D, Line 16 .................................................................................. ............ .. 20c D • 0 0 21 Total CredR for Taxes Paid to Other States or Countries. Attach your PA Schedule(s) G or PA Schedule(s) RK-1 .......................................................... ............ .. 21 0 • D 0 22 PA Employment Incentive Payment Credit. Attach PA Schedule(s) W or PA Schedule(s) RK-1 or NRK-1 ................................................ ............. .. 22 D ' D 0 23 PA Job Creation Tax Credit. Attach your certificate of credit from the PA Department of Community and Economic Develo ment or PA Schedule s RK-1 or NRK-1 P () ............................................................... ............ 23 ... 0 • D 0 24 PA Waste Tire Recycling Investment Tax Credit. Attach your certificate of credit from the PA Department of Environmental Protection or PA Schedule(s) RK-1 or NRK-1 .............................. ...,.. ...................... ............ ... 24 0 • 00 25 PA Research and Development Tax Credit .................................................................................. ........... ... 25 0.00 26 Total Payments and Credits. Add lines 14,19 and 29c through 25 ...................................................... ............ ... 26 0 • 0 0 27 TAX DUE. Line 13 is more than line 26. Enter the difference here ...................................................... ............ ... 27 13.0 0 28 OVERPAYMENT. Line 26 is more than line 13. Enterthe difference here ............................................. ............ ... 28 0 ' 00 29 Refund -- Amount of line 28 you want as a check mailed back to you .................... .. ............ ... 29 0 ' D D 30 Credit -- Amount of line 28 you want as credit to your 1998 Estimated Tau Account .............................. ............ ... 30 0 • D 0 31 Donation -Amount of line 28 you want to give to the Wild Resource Conservation Fund ........................ ............ ... 31 0 • 0 0 32 Donation -- Amount of line 28 you want to give to the U.S. Otympic Committee PA Division ........... ....... ............ ... 32 0 • D D 33 Donation -- Amount of line 28 you want to give to the Organ Donor Awareness Trust Fund ..................... ............ ... 33 0 • D 0 34 Donation -- Amount of line 28 you want to give to the KoreaNietnam Memorial, Inc ............................... ............ ... 34 D • D 0 35 Donation -Amount of line 28 you want to ghre to Breast and Cervical Cancer Research ........................ ............ ... 35 0 • D 0 The total of Ilnes 29 throw h 85 must a ual Ilne 28. S{gnelu s Under pendties of perjury, dedero that I have examined this rotum, Induding dl accompanying schedules and statements, and to the hest of my Your 3lgnaturo Data Your Occupation ~ HOMEMAK ER Spouse's S ~ a Date Spouse's Occupation Properer or Company Name, other than taxpayer(s), based on dl Infommtbn of whkh the proparer has any knowledge. Proparer or Company Name (Please Print) A GONER , F R U T I G E R & DAUB Date Proparora Telephone Number CAMP HILL PA 17011-4494 `~-`1-~ (717)761-1222 - ~-~_ 9 7 0 0 2110 6 4 Signaturo (optilonaq 9 7 0 0 2110 6 4 naoo2~oi-oa-9a 9701220049 PA SCHEDULE A/BIUE-2 1997 PA- AB (09-97) PA DEPARTMENT OF RF/ENUE Name(s) m shown on your PA tax return: Social SacurHy Numbs PERSIK, JULIA C 056-34-2230 PA SCHEDULE B -TAXABLE DIVIDENDS Total PA Taxable Interest Income PA Schedule UE-2 c~-g~ ALLOWABLE EMPLOYEE BUSINESS EXPENSES 1997 Name of taxpayer claiming these expenses Taxpayer's Social Security Number Employers Name Employer's Address Describe the duties of the job in which you incurred these expenses: ~ Total PA Taxable Dividend Income 450.00 Attach additional schedules if needed. Employer's Federal ID Number See Instructions for each type of expense In your booklet. Expenses must be required as a condition of your employment and are not reimbursed. PART A: UNION DUES. List the name of each Union and amount paid to each Union. Enter total. Name d, Amount Name 6 Amount Name 6 Amount Name 6 Amount A PART B: WORK CLOTHES AND UNIFORMS. Description and amounts paid. clothing must not be suitable for everyday use. B PART C: SMALL TOOLS AND SUPPLIES. Description and amounts paid. Tools and supplies must not be provided by the employer. C PART D: PROFESSIONAL LICENSE FEES, MALPRACTICE INSURANCE, AND FIDEL{TY BOND PREMIUMS. D~PtiP;d "d PART E: TRAVEL AND MILEAGE. Enter arraunt from attached Form 21 Os. if dalming other expenses from une 4 of Norm 2106, describe. V E Total Unreimbursed Employee Business Expenses. Add Parts A through E. Enter here and on Line tb of your Tax Return. ~ b Separate PA schedules UE must be filed ff you have more than one occupation andlor your spouse also incurs employee business expenses. 774121 11-24-97 L~ 9701220049 4 17530409 706230 ACB-PERSJ 040 PERSIK, JULIA C 9701220049 ACB-PER1 PA SCHEDULE A -TAXABLE INTEREST If your PA taxable interest income is over x1,000, complete this schedule. See the instructions in your PA tax booklet for what interest is taxable or exempt. ff additional space is needed, attach separate sheets. ff your PA taxable dividend income is over x1,000, complete this schedule. See the instructions in your PA tax booklet for what dividends must be reported as taxable. ff additional space is needed, attach separate sheets. ~-- WOOLWORTH CORPORATION Roder J Persik Name WOOLWORTH BUILDING 233 BROADWAY NEW YORK, NEW YORK 10279-0003 TEt.2i2-553-2000 ~t~~(PvM r~rR7 IvcrT/ c-C~ The person listed above is a former associate of Woolworth Corporation who was released from employment on or about October 24, 1997, due to the closing of F.W. Woolworth's general',merchandise operations. For employment verification please contact: Woolworth Corporation Human Resources Department 233 Broadway New York, NY 10279 212-553-2000 EXHIBIT P~ WC)C)LW~~R I I-I ~`~` ^~~y `~2re~-rna~~ic~~ `J' .LUUtS4~ ~- KINNEY SERVICE;;~ORPORATION /T~ 213 ~- ~~_~IZI'ORA110N ; '~~~:, OEPOSITOAIE L~~Lf-'0~~~ ~:~>i~ i F 10/30/97 2.,n; t DE('OSIT AMOUtJT 231382241 82286006 rt Ct~l~NION 947.00 , 7p 231375630 0900177502. ;' M~~~~Q~[lOO [~1 3770.14 t ~ !''! ~, ;:;: ,.~, ' x~ir' 20020 MISPAA BF '' ROGER J PERSIK 209 EAST +;~~;g~~j YELLOW BREECHES ROAD I!,~,~,_~ NON-NEGOTIABLE CARLISLE, PA 17013 ...__.r-- V1~~) ~~ L~~~O R-I~ f -i 9100843 ~- ~ ~ 1 I ~ ~ ~ ~ ~ ~Z / \ I I \ l N EMPLOYER NAME PAY PERI00 DEPOSIT DATE - KINNEY SERVICE CORPORATION 10/01/97 To 10/31/97 10/30/97 ASSOCIATE NAME SOCIAL SEC. NO. TAX FEDERAL SYA7E SEQUENCE CURRENT GROSS CURRENT OED. NET PAY ROGER J PERSIK 357-30-9065 STATUS M +S M 8 BF 525 3 - 148 1 S3,77 14 RIRO-OFf POOR-Fl/TURF,Ti01T - 0- - . HOURS RATE DESCRIPTION CURRENT YEAR-TO-DATE DESCRIPTION CURRENT YEAR-TO-DATE 84TXFlX -8 a .'~ I I B4401K -54 2 -393 47 -- ~Q . ' ~ ~~~ I I BONUS i . 11050 I ~ I I I I I I I I . ~~ . . ~ ~ ~ I , I I I I I . . ~ ~ , ~; , '- I 1 I I I 1 I ~ ~ r 1 I I I I I I I I I . I ~ I 1 Ij >.. ., I I ~ , I I I TOTAL I 52573 I 656301 I ~ I ~ ~ ~ • OE TION CURRENT -TO-DAT DESCRIPTION CURRENT YEAR-TO-GATE I SOC;SEC 1045 40548 ' ' MEDICARE 848 10086 PA :TAX 161 19748 CAH TAX 5~3 708 ' I ' I CAH SPL ; 1q0 ; ; OPTi LIFE 11 6 113?~8 ' ' LTD 3964 ~ ACC D80 3 4'~0 BONDS 1 5 0 8540 ; ; STOCK 543 539 ; ; GRUNION 9470 104170 t f9%7 U'LT~/~-3 Ut~ /N~~M EXHIBIT r „ a••_ ~ .. ~,,..~____ DraN~n on ,,,~~"__ ~~1~< ~~ 1I__W~~1~ I ~ ~ GO-lh2~gz1 PNC 13ANK. NA11UNnL ASSOCInIION "'"*'""--- A ~ ' Jeannette, Pennsylvania ~---r- - ( lI n lnt ,... -- ~ ~ ~I ~~~\JJf~r`~ I(~N KINNEY SERVICE CORPORATION~~~Peration wiUi and 357-30-9065 ~ Payable if Desired 13y WELLS FARGO BANK, N. A. r~4759-012214 FORTY FOUR THOUSAND EIGHTY EIGHT AND 39/100 ----------------DOLLARS PAY 20020 ,,, r„f ROGER PERSIK v. - 209 EAST YELLOW BREECHES RD ' - "'~~' ntotti~ „r CARLISLE, PA 17013 06061 c;nECK onre L_12/_311~Z! GnECK AA10UNf _..$44_,088,3 vuroArrr-_it inoonvs 11'540606 L11' ~:D4330 L6 27~: EXHIBIT P3 LO L03 L609711' Q~-e' /~c/~~'!'~/ (acs ivl ~f Fay n . ~~~ r ` WOOLWC~R~1 H _~ (~~~RF'ORnTION --- ~~ M h~~TU ~ l ~1 mvj~ric~v ' ~ 0004 ___ ., BENEFITS ANSITIO INFORMATION ~ ~'. -~• SEVERANCE SUMMARY FORM This sheet shows your estimated severance payment calculation as of 10/24/97. Your actual severance payment will be calculated as of your date of termination. Name: Roger J Persik ~', 20020 Address: Yellow Breeches Road 209 East ' ~ Carlisle PA 17013 ~i Social Security Number: 357-30-9065 Hire Date: 3/30/57 Severance Period: 40.50 Weeks Salary: 5 71,195.04 Annually, or $ 1,369.14 Weekly ,, Your Estimated Severance , Calculation as of 10/24/97: $ 1,369.14 x 40.50 = 555,450.17 Vacation Pay: Your 1997 vacation entitlement less any vacation days taken prior to termination. •, , . ..,,-~, .. ~,.. .L , .~ i _- ~ ~~ . ~ - `~ v .. _ ti . Cpl ,. ., =__~ WO(`7l_WOI~~T~I-I r'~~`~'"~ 0004 BENEFITS RANSITION INFORMATION SUPPLEMENTAL MANAGEMENT SEVERANCE SUMMARY FORM This sheet shows your estimated supplemental severance payment calculation as of 10/24/97. Your actual supplemental severance payment will be calculated as of your date of termination. Name: Address Social Security Number Your Estimated Supplemental Severance Calculation as of 10/24/97: Roger J Persik 20020 Yellow Breeches Road 209 East Carlisle PA 17013 357-30-9065 S 1,369.14 x 4.00 = 5 5,476.56 Refer to the Woolworth Corporation Supplemental Management Severance Pay Plan for the 1997 Reduction-In-Force and Summary Plan Description. C~ ~ ,~ ~ MANUAL CHECK AND/OR STOP PAYMENT REQUEST FORM ~~ PROPPED BY: S FILIPPELLI EXT. 3296 COMPANY NUMBER: 20020 PROPPED DATE: 12/31/97 TIME: 11:44 STORE NUMBER: ANALYST USERID: UKBPY03 EXT. 3296 LEAGUE NUMBER: ANALYST NAME: SANDY FILIPPELLI SOCIAL SECURITY NUMBER: 357 - 30 - 9065 HROC CONTACT: ANDREA EXT. 4261 EMPLOYEE NAME: ROGER PERSIK HROC SENT CHECK: / / DISTRIBUTION (FOR MANUAL CHECK) ------------------------------- FIRST CLASS X NEXT DAY(COURIER ) WORK LOCATION X HOME OTHER ADDRESS: 209 EAST YELLOW BREECHES RD CARLISLE, PA 17013 PHONE NUMBER STOP PAYMENT, CHECK STATUS OR CANCEL REQUEST -------------------------------------------- CHECK NUMBER 5406031 CHECK DATE: 12 / 30 /97 NET AMOUNT: S 47845.04 WEEK ENDING: 12 / 31 / 97 YES NO CHECK IF PAID, THEN CONTACT USER BEFORE CONTINUING YES NO STOP AND CANCEL CHECK IF NOT PAID YES NO REQUEST PHOTO COPY IF PAID YES NO SHOULD CHECK BE REISSUED (IF NOT PAID) YES NO r,HECK SNUULD BF CANCEI._EI) BUT NOT S"POPPED EXPI_ANTION FOR MANUAL AND/OR STOP PAYMENT REQUEST: STOP PAYMEN"f ON MANUAL SENT ON 12/23 AND DATED 12/30. THE EMPLOYEE IS RETURNING THE CHECK AND A NEW ONE MUST BE DONE WITH 401K WITHHELD AND MUST BE DATED 12/31/97. HROC USE ONLY STDP PAYMENT KEYED - HS450 / / INT. VERIFY EDIT: / / INT. HS460 / / INT. VERIFY PYRL: / / INT. UCHO1 / / INT. REKEYED / / INT. MANUAL PAY KEYED / / INT. VERIFY EDIT: / / INT. REKEYED / / INT. VERIFY PRYL: / / INT. 4`Pr~ti~ c.~ ~ l'.~ r i ~C~~ "~~~~~j ~~a~~/~~~~-~~'I ~ -~~~ " THIS IS YOUR GROSS TO NET BREAKDOWN ----- LOYEE NAME: ROGER ---------- PERSIK ---------- SOCIAL ---------- SECURITY NUMBER: 35 7 - 30 - 9065 rAY TYPE: WEEKLY BI-WEEKLY X MONTHLY PAY FREQUEN CY: 90 STATE CODE: 39 LOCAL CODE: O1 TAX UNIT: 03 LABOR CODE: XXXXXXX YES NO CALIFO --------------------- RNIA BANK MESSAGE ------ - HROC USE - CHECK NUM --------------------- - ------ BER: -------------- ---------- ---- --- CHK DT: 12 / 31 / 97 COMPANY NAME: KINNEY SERVICE EXEC ------ --- COMPANY NO.: 20020 BEGIN DATE: 12 / O1 / 97 ENDING DATE: 12 / 31 / 97 GROSS PAY 5 61337.48 TOTAL DED UCTIONS S 17249.09 NET PAY S 44088.39 EARNINGS TAXES SP.PAY# HOURS RATE ------- ----- ----- DESCRIPTION - ----------- AMOUNT - ------- DESCRIPTION --- ------------ AMOUNT - -- REGULAR FEDERAL - ------- 8544 --- 30 -- OVER TIME FICA 808 70 60 VACATION 410 75 STATE 1717 45 52 SICK(TXBLE) DI 43 SEVERANCE 55450 17 LOCAL 613 37 43 SUPP SEVER 5476 56 B4 "TAX DEDUCTIONS VOLUN~~ARY DEDUCTTONS DED.# DESCRIPTION ----- --------------- AMOUNT ------- - DED.# DESCRIPTION AMOUNT 63 B4 401K - - 5565 27 ----- --------------- ---------- . ADDITIONAL INFORMATION: REPLACING MANUAL DATED 12/30/97. ~u~~/~tiC~t~~: (1 tiOf~~Ct7 l; ~l I r~t~;1'w BENEFIT CHECK Claimant's Name Soc. Sec. Acct. No. Week t Amount Week 2 '. Amount Job Ctr. PGM J PERSIK 357-30-9065 11-08-97.312.00 0302^ UC ~~ fa~Z~itG d f ~~ BENEFIT CHECK Glaimant's Name ROGER J PERSIK Soc. Sec. Acct. No. 357-30-9065 Week 1 Amount 11-15-97.312.00 Week 2 Amount Job Ctr. 0302 PGM UC ~~LeV`U 1Pil FNFFIT C'_1-1FCK Claimant's Name ROGER J PERSIK Soc. Sec. Acct. No, 357-30-9065 Week t Amount 11-22-97312.00 Week 2 Amount Job Ctr. 0302 PGM UC INSTRUCT 1 O N S JOB CENTER ADDRESS Attached below is your unemployment compensation check for the benefit week(s) indicated on the check and above. Carefully CARLISLE JOB CENTER detach the check at the perforations and cash promptly if you 1 ALEXANDRA COURT were partially or totally unemployed during the benefit week(s) CARLISLE PA 17013-7667 listed as defined by the PA Unemployment Compensation Law. If for any reason you feel you are not entitled to this check, or the check is for an improper amount, do not cash it, but return it to your Job Center. ATTENTION PAT US~P.S~~ Recently, enhancements to the Pennsylvania Teleclaims--PAT system were made. Beginning on October 23 and continuing until October 26, 1997, the new system was implemented throughout Pennsylvania. During this period, interruptions of PAT service were experienced by some claimants, We are continuing to make refinements to the new system that should alleviate the interruptions in service reported to the Job Centers by claimants. We apologize for any inconvenience you may have experienced and appreciate your patience during this time of transition. Because the certification questions have been re-worded and consolidated, please listen carefully to the questions that are asked. We are aware of two areas that seem to cause confusion and are providing clarification below. ~ • When PAT asks, "Did you have work or decline work or receive holiday or vacation pay during the week you are claiming?" If you received any of these types of compensation, you should answer, "Yes." If you answer yes to this main question, PAT will then ask each question one by one, such as, "Did you work?", "Did you receive holiday pay?" etc., to determine what type of compensation you received or will receive. p, When PAT asks, "Did you work less than your usual number of hours of full time work during the week you are claiming?" If you worked less than your normal full time hours, you should answer "Yes" (yes, I did work less than my usual number of hours of full time work). If you worked your normal full time hours, you should answer "No" (no, I did not work less than my usual number of hours of full lime work). If you find you are not able to access PAT, please try again later the same day or the next day. U ~ 7a-9`'3~ _ ~~rnsl~ ~~` ~~q ~ EXHIBIT FOLD ON PERFORATION, THEN DETACH CAREFULLY V G~c~w `CEt ~ ~1 I -'~ ~~G BENEFIT CHECK Claimant's Name J PERSIK Soc, Sec. Acct. No. Week 1 Amount Week 2 Amount Job Ctr. PGM 357-30-9065 11-29-97 312.00 0302 UC /~G~o ~ G~ ~` rl . BENEFIT CHECK Claimant's Name Soc. Sec. Acct. No. Week 1 Amount Week 2 Amount Job Ctr. PGM 11 ROGER J PERSIK ~ 357-30-9065 X12-06-97 312.00 n/. ~ 0302 RUC ~ V,LC.~r1~11 G~1~ n r ~~4,'C~~t~t E_ BENEFIT CHECK Claimant's Name ROGER J PERSIK Soc, Sea Acct. No. 357-30-9065 Week 1 Amount 12-13-97;312.00 Week 2 Amount Job Ctr. , 0302` ~ PfiM 'UC BENEFIT CHECK Claimant's Name ROGER J PERSIK Soc. Sec. Acct. No. 357-30-9065 Week 1 Amount 12-20-97312.00 Week 2 Amount Job Ctr. 0302 PGM UC INSTRUCT 1 O N S JOB CENTER ADDRESS Attached below is your unemployment compensation check for the benefit week(s) indicated on the check and above. Carefully CARLISLE JOB CENTER detach the check at the perforations and cash promptly if you 1 ALEXANDRA COURT were partially or totally unemployed during the benefit week(s) CARLISLE PA 17013-7667 listed as defined by the PA Unemployment Compensation Law. If for any reason you feel you are not entitled to this check, or the check is for an improper amount, do not cash it, but return it to your Job Center. A REMINDER.. . If during the Holiday Season you obtain part-time or full-time employment, be sure to notify your Job Center. If the employment is part-time, you may be eligible for partial unemployment benefits. Report all wages earned during the week for which you are claiming benefits. Gluestions concerning Holiday Season employment should be directed to your Job Center. - • Have a Safe and Happy Holiday! ~ ,- ~~~~ l i~1 ~~ a ~ ~~ ~~r ~ ~~ ~l ~,~ ` ~ ~f ~ /. ~ --- f/~/J/,/ i ~J ~y - / ~' ~ ~' r ~~ ~. ~ G JULIA PERSIK, Plaintiff v. ROGER J. PERSIK, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 1730 CIVIL 1985 CIVIL ACTION -LAW IN DIVORCE DEPOSITION AFFIDAVIT I, the undersigned, being duly sworn according to law, depose and say that I have the authority to certify the following records on behalf of George L. Ebener & Associates, 139 W. High Street, Carlisle, PA 17013. 1. The records attached hereto are true and correct copies of the records in my custody pertaining to all information which was gathered in connection with respect to the attached subpoena. 2. That, including this certification, all records called for in the attached subpoena which are in my custody, have been photographed at my office, in my presence, at my direction and under supervision of myself T 3. That unless qualified in paragraph 5 hereof, all records produced in my presence were prepared in the ordinary course o~ business by authorized personnel at or near the time of the act, condition, or event. 4. A careful search has been made by me or at my direction for records pertaining to the above identified information and the records produced pursuant to the attached subpoena constitute and are the records so identified. 5. Additional Comments:~QgQr had income of $406 66 for 1996 and $1534.25 for 1997 from the real estate business. If the present co-li sti ncrs ao to set •~ r~mc?ni- before Apri 1 30, 1998 , Roger Kould have projected income of $3483.00. There are no other settlements EXHIBIT P~'" I declare that the foregoing facts as are within my personal knowledge are true and correct and the other facts contained herein are true and correct to the best of my knowledge, information and belief. Position / Administration-Partner `. y H. Mumper Sworn and subscribed before me this ~~ ~ day of ~a.~c~ 1998 ., ~ ~ o y Public Carte Me 8av~ibe~and ~o~qy Yy Camrt~lon E~hes Jan. 4,199 ~.: , ~ C1 ~ CJ ..a O ~ ~ ~ ~' lv B. p ..~ `~~ y ~ eD C ~G r - fi c ~ ~ 3 r'~v N ' ~-• is C7 ~ ~~ o ~ ~ ~ ~ U ~ tt: ~ tiK tJ ~ ~> ITf •' ~_' n ~ n [~ r- ~• x ~ ~ ~ ~ ~ ~ Ci'7 ~ x -- ~ ~ ~ ~ J w: ~ ~ :~ tin bb cJ ~ ~ ^ _ n c: ~? U M / ~ 'rT. ro '"' ~'.' ''~' lJ ~ (1: .~~ ~ G~ ~ ~ ti ~. ~o ~ ~ ~ n b ~ r, .~ o ~ ~. ~~~ ~ ^ ' 7 ^ o g ~ m N EA ~ fA ~ fA, ~ 6A o EA W EA N ~ '~ "'i ~ C1 5 Q a ~ ~ o m m ~ a ~~ ~ ~ ~ s ~& ~ o vg 3 3 ~ c $ r ~ ~ F ~ O g tf! N o °~nr ~ FA •~ fA a ~ 7 ~ m m • n n $3 ~~oy v ~ -- ~ U ~ . a c o ~' 6 /~ W/ _ ~ ~ ~ v T m ~ ~ 3 m ~ /1~~ ~ rl/ 1 ~ b ~ ~ ~ ~ ~~ ( j ~ ~~ ? ~^ ~~ S m 37 ~ ~~ O N ~` O ~ m m ~ .~7 ~~~ Zi2Z a aoo°~~'~a~ ~ C O ~ N rN ~r O ~` iq 3m ~ ~' ~~ o ~ i ~~ ~ `~ K ~ ~ ~ n O ~ m _ n a (A d. ^ VOID ^ CORRECTED PAYER'S name. street address. cay. state, ZIP code. and telephone no. t Rerus ~r01 ~E I ~~TU -~4r/~~~>~r .~ N !U N( OMB No. 155.0115 (~ . Z ~ ,. EB1sNLR & ASSOCS. z Royalties U~J(~~ 139 I~est Iii yh St. ~J~J~~77 C a 1:1 i s l e, P A. 1 7 0 1 3 s tJtt,er Income Form 1099-MISC PAYER'S Federal Iderrtification nunber RECIPIENT'S Identification cumber ~ federal income lax w+tlfietd S Fishing boat proceeds 23-2047359 357 3U 9065 RECIPIENT'S name, address, and ZIP code 6 Medal end treadit care paymerts 7 Norternployee corrrperrsatlon RP4 E R .T . P 1; R S I R t! a p,y~ rn ~„ or 'Payer made drect sales of dvlder,ds « irwerest isaoo « more ar tbrtsrrntx products to a Duya ?.09 E. Ye11oH Breeches Rd. (raiplax)torresale ~ ^ 0 Gop insurance proceeds tt State Income tax whhheld Accourx number (optionaq F«m 1099-MISC ~l / l~~I~ G~i ~n~ 2 StatelPayer's state number ~d / ' Miscellaneous Income State Copy or Extra File Copy. Department of the Treasury • Internal Reverwe Service ,~~ ~, ~~~~~ ~ssoeS. 17-MAR-1998 12:39:25 __________________________________ #1 Single Family BOOK Format Status ACT Sub-Type SF City BOILING SPRINGS LP$ 215500 SO: CLD: FIN: MT: 176 SP$ 1103 SHIRLEY LN Area 007 MLS # 10022069 I I Mun SOUTH MIDDLETON Dev INDIAN HILLS Sch S MI I I Dir FORGE RD TO BOILING SPRINGS TR ONTO SHIRLEY LN HOME ON RIGHT I I No Stories: 2.5 1 i LotSz Acr 0.00 YrBlt+/- 1997 I I Style TRADITIONAL Ext BRICK TotSgFt 002600 i I Bsmt FULL,UNFINISH* Gar ATT,2 CARS,OFF STREET #Firepl O1 I I #Br 4 #Bth:F 2 H 1 #Rms 0 ITax Yr TBA Fee I I Lvl-Bth:F H +----------------------------------+ I Lvl Apx.Sz Lvl Apx.Sz IApl RANGE,MICROWAVE,DISHWASHER I LR M MBR U IOthRm I I DR M BR1 U (Heat FORCED AI R, GAS I FR M BR2 U ICool CENTRAL AIR War Y I I DEN BR3 U IIntF WALK-IN CLOSETS,MASTER BA* I I KIT M BR4 IWtSw PUBLIC SEWER, PUBLIC WATER I I BEAUTIFULLY DESIGNED & WELL CONSTRUCTED 2 STORY HOME. ALL I THE AMENITIES YOUR BUYER WANTS AND MORE. QUALITY CHERRY I I CABINETS, SOLID WOOD TRIM, MASTER SUITE & LOADS OF ROOM. I I COME TAKE A LOOK. I I I I I I Sh CALL LIST* Bsh CALL LIST* LBx CPLB LO EBENER 243-6195 I I LA GILBERT, LINDA 243-3138 SAC 2.5 BAC 2.5 LT ERS I ~ LA OW Sa ~ r ~ ~ ~ (~ w~` l~~ ~~~e~sclc ~ ~, ~, s~~+1 I.e~~ r,~ ~ SQ ~4 (~p oy~' 30~ ~~ ::} . .17-MAR-1998 12:35:59 __________________________________ #2 Single Family BOOK Format Status UCON Sub-Type SF City BOILING SPRINGS LP$ 209900 SO:EBENER CLD: FIN: MT: 62 SP$ 154 S PIN OAK DR Area 007 MLS # 10025197 I I Mun SOUTH MIDDLETON Dev THE OAKS Sch S MI I I Dir FORGE RD TL SPRINGVILLE RD TL LAUREL OAKS TL 5 PIN OAK DR I I No Stories: 1.0 I LotSz 120X104 APPROX Acr 0.45 YrBlt+/- 1992 I I Style RANCH Ext VINYL TotSgFt 001984 I I Bsmt EXPOSED/WALKO* Gar PVD DR,ATT,2 CARS,OFF ST* #Firepl 00 I I #Br 5 #Bth:F 4 H 1 #Rms 11 ITax 2200 Yr 96-97 Fee I I Lv1~Bth:F H +----------------------------------+ I Lvl Apx.Sz Lvl Apx.Sz IApl COUNTERTOP RANGE,WALL OVEN* I I LR M 14.X13.11 MBR M 17.3X11.910thRm GREAT ROOM, FAMILY ROOM,F* I ( DR M 14.X10.10 BR1 M 17.2X11.71Heat FORCED AIR,GAS I FR M 21.7X13.1 BR2 L 13.8X10.91Coo1 CENTRAL AIR,CEILING* War I I DEN BR3 L 17.SX13.811ntF PATIO DOORS,WALK-IN CLOSE* I KIT M 22.4X11.3 BR4 L 13.5X11.61WtSw PUBLIC SEWER, PUBLIC WATER I I ONE OF A KIND. OWNERS WANT SOLD. OVER 3500 SQ. ~'T. ON TWO I I FLOORS. INTERCOM, CENTRAL VAC ~ PROGRAMABLE THERMOSTAT. I I EXTENDED FAMILY POSSIBILITIES. GOURMET KITCHEN WITH PANTRY. I I 24 HOUR NOTICE REQUIRED TO SHOW!! HOT TUB RESERVED. I I MOVE IN CONDITION. A PLEASURE TO SHOW. FEED BACK ON ALL I I SHOWINGS WOULD BE APPRECIATED! I I Sh CALL LIST* Bsh CALL LIST* LBx CPLB LO EBENER 243-6195 I I LA PERSIK, ROGER J _ _ SAC 3 BAC 3 LT ERS ( I LA WILBERT DIEHL OW I ~. , 1~~1~Iv 0~{~3a~gX ::~_ ~...~ 17-MAR-1998 12:57:24 __________________________________ #1 Single Family BOOK Format Status ACT Sub-Type MH City NEWPORT LP$ 52900 SO: CLD: FIN: MT: 21 SP$ 1207 HICKORY RIDGE RD Area 008 MLS # 10026803 I I Mun MILLER Dev Sch NEWP I I Dir NEW BLOOMFIELD 34N PAST CAMPBELLS MOBILES TO RIDGE (RT) I I SHARP** No Stories: 1.0 I I LotSz Acr 3.96 YrBlt+/- 1991 I I Style OTHER Ext VINYL TotSgFt 000000 I ( Bsmt Gar 3+ CARS #Firepl 00 ( I #Br 2 #Bth:F 2 H 0 #Rms 5 ITax 1097 Yr 1997-98 Fee f I Lvl-Bth:F H +----------------------------------+ I Lvl Apx.Sz Lvl Apx.Sz IApl RANGE, DISHWASHER,DISPOSAL,* I I LR M 13'X18' MBR M 14'6X11' IOthRm I I DR M 6'6X12' BR1 M 13'X13' IHeat FORCED AIR, GAS I I FR BR2 (Cool War N I I DEN BR3 IIntF PATIO DOORS,STOVE, WOOD/C* I I KIT M 6`6X12' BR4 IWtSw PRIVATE SEWER,SEPTIC,PRIV* I BRING CLIENTS TO THIS 3.96 ACRE PRIVATE PARADISE WITH 1991 I I REDMAN MOBILE. BEAUTIFUL SPOT. 5 FT ROCK LEDGE AT REAR. I I LARGE SHED WITH LEAN-TO AND WOOD STOVE CONVEYS. FRONT DECK I I 12'X20', REAR DECK 8'X16'. PATIO DOORS TO REAR DECK. I I I I I I Sh CALL LIST* Bsh CALL LIST* LBx CALL O* LO EBENER 243-6195 I I LA PERSIK, ROGER J _ ~ SAC $1500 BAC $1500 LT ERS I I LA OW _ .... I ~~,~ ~ ~~ ~ szt~ (~ ~ ~.^• ~ 17-MAR-1998 12:30:02 __________________________________ #1 Single Family BOOK Format Status NEW Sub-Type SF City NEWVILLE LP$ 76700 SO: CLD: FIN: MT: 7 SP$ 1903 GREEN SPRING RD Area 007 MLS # 10027361 I Mun NORTH NEWTON Dev Sch B SP ( ( Dir RT 81S TO EXIT 11 R/RT 233 INTO NEWVILLE L/RT 641 4.5 MI HSE { I ON RIGHT No Stories: 1.0 1 I LotSz Acr 1491.00 YrBlt+/- 0000 I I Style RANCH Ext WOOD,VINYL,STONE TotSgFt 000000 I I Bsmt EXPOSED/WALKO* Gar 3 CARS,ATT,1 CAR,UNDER #Firepl 00 i I #Br 3 #Bth:F 2 H 0 #Rms 6 ITax 550 Yr 96-97 Fee I ( Lvl-Bth:F M H +----------------------------------+ I Lvl Apx.Sz Lvl Apx.Sz IApl RANGE,DISHWASHER I { LR M 15X16 MBR M 16X12 IOthRm FOYER, FORMAL DINING RM,B* I I DR M 15X7 BR1 11X11 (Heat FORCED AIR,OIL I I FR BR2 11X10 ICool CEILING FAN War I { DEN BR3 IIntF PATIO DOORS,WALK-IN CLOSE* I I KIT M 16X8 BR4 IWtSw PRIVATE SEWER,SEPTIC,PRIV* ------------- ------------------------- I A SHOW STOPPER-NOT A DRIVE BY. CLIENTS MUST SEE THIS UNIQUE I I HOME. FEATURES 3 BDRMS, 2 FULL BATHS (MST W/JACUZZI). I I PROFESSIONALLY RENOVATED & REMODELED. CERAMIC FLOOR IN FOYER I I ~ FRENCH DOORS. VAULTED CEILINGS, NEW WINDOWS, CARPET, DOORS I I CEILING FANS. MST HAS 8X6 WALK-IN CLOSET. COUNTRY LIVING AT I ITS BEST. SHOW t4 SELL! *$1,000 SELLERS ASSISTANCE. I I Sh CALL LIST* Bsh CALL LIST* LBx CPLB LO EBENER 243-6195 ( { LA PERSIK, ROGER J SAC 3.25 BAC 3.25 LT ERS I { LA OW '- ( ~-~j ~~, ,; ~h'-' 17-N1AR-1998 12:46:32 __________________________________ #1 Single Family BOOK Format Status UCON Sub-Type SF City MT HOLLY SPRING LP$ 121900 SO:EBENER CLD: FIN: MT: 203 SP$ 1415 MCLAND RD Area 007 MLS # 10020222 I I Mun SOUTH MIDDLETON Dev HILLTOP HEIGHTS Sch S MI I ( Dir RT 345 TR PINE RD TL MCLAND TO LAST PROPERTY ON RIGHT ( I No Stories: 2.0 I I LotSz Acr 0.64 YrBlt+/- 1991 I I Style TRADITIONAL Ext VINYL TotSgFt 001664 I I Bsmt FULL,CONCRETE* Gar #Firepl 00 ( I #Br 3 #Bth:F 2 H 1 #Rms 5 ITax 1600 Yr 1997 Fee I ( Lvl-Bth:F U H M +----------------------------------+ I Lvl Apx.Sz Lvl Apx.Sz IApl RANGE,DISPOSAL I I LR M MBR U IOthRm FOYER I I DR BR1 U (Heat FORCED AIR,OIL I ( FR BR2 U (Cool CENTRAL AIR War I I DEN BR3 IIntF PATIO DOORS,ALL WINDOW TR* I ( KIT M BR4 IWtSw PUBLIC SEWER, PUBLIC WATER I I CONVENIENT SOUTH MIDDLETON LOCATION. WALK TO RICE ELEMENTARY ( I SCHOOL. BEAUTIFUL LANDSCAPING, WRAP AROUND PORCH ~ LARGE I I ROOMS MAKE THIS AN APPEALING HOME. ELECTRIC TO LARGE SHED AT I I REAR OF PROPERTY. FORCED HOT AIR OIL HEAT WITH CENTRAL AIR. I I HOUSE ALSO HAS CENTRAL VAC SYSTEM. I I I I Sh CALL LIST* Bsh CALL LIST* LBx CPLB LO EBENER 243-6195 I I LA PERSIK, ROGER J ~~" ~~ SAC 3 BAC 3 LT ERS I I LA {-~ i.~(2L~t1 k ~ ~ OW I +-------------I-1----- -----------------------------------------------+ :,~ an. q A V~ v P t~ ~. ~~ w ~ --rte ~+, ~~ ~~~ u~~ ,, ~~~~~ ~.~~v 21 (JtilSe'~ri~ ~ _' l ~i 11 .. f , •n '( U Q ~~~~ L , ~ Q h~ /0 c~V 'v~Q YS I J ~•" i ^ VOID ^ CORRECTED PAYER'S name, street address, city, state, ZIP code, and telephone no. t Rents OMB No. 1545-0115 (~rt)12G1/ L. E$I:NIsI2 & ~155OCS• z Royalties ~n~~ l39 tVest Hi ytt Si;. $~~ c, ~~ f: l i s l e, P A. l 7 01 3 3 Other income ~ N~~M Miscellaneous Income I Fam 1099-MISC PAYER'S federal identification number RECIPIENT'S identification number 1 Federal income tax withheld 5 Fishing boat proceeds 13-7.047359 357 30 9065 $ $ RECIPIENT'S name, address, and ZIP code 6 Medical and health care payments 7 Nonempioyee compensation I2~)~I'sR .1. PrlZSZx "L09 Ii. Yellow Breeches Rd. Account number (optionaq Form 1099-MISC ~l l ICGI ~ ~~ ~/~r~° ~~bm ,~~ ~ ~~~~ ~sso~s. /~ o f` ° r I~8' ~~tiQ ~ U~~ ~ ~~/ 8 Substitute payments in heu oI 8 Payer made direct sales of dividends or interest 55,000 or more of consumer products to a buyer ^ (recipient) for resale - 0 Crop insurance proceeds 111 State income tax withheld StatelPayer's state number State Copy or Extra File Copy. Department of the Treasury -Internal Revenue Service ~- i~~e- 'Dr~~2. ,~-~w~ ,,.~_. FK~eCd~Gt~-tih T~~i~lih~g?p~ia~ C"si~~ 199'= ~~ ~~o. oo (.tirome~ om~-hia~~- .. ~~a„ •' `' / i ~" ~ r ' ~ =`'~t 1 J~HE WOOLWORTH RETIREMENT PLAN ',v:, , , l~ •.: ;•' ; ~ ,'1-~ ,v ~ I'• !- RETIREMENT /. ~' .~ ~~ ~~ '-' ESTIMATED PENSION BENEFITS r _ 1., Name: R~GER J PERSIK Date of Hire ~'~ , > ~ ~ , ~', ,~ ~~ ,~. ; 03/30/57 SS#: 357-30-9065 Normal Retirement Date: 05/01/04 Date of Birth: 05/14/39 Marital Status: X Married _ Single ~~ O Aunual Accnted Benefit as of 11/01/97: $25,112.1 la ~ ~ ~~ ~j~;%~~ , %'~ > Benefit Payment Date: 11/01/97 ~••- ,' ;n ~ e'~, s ,~t"~o _ ~ [ ~L___ / PG A~ Account Balance as of 11L41/97~. S 575.79 ° ~ a y~"~c ~~° ~~~~'~/'' A~~ / - Minimum Lump Sum Interest Rate for 1997: G.55 /° ~- ;'~_ ~ 'ter ~~~.~ ~ .: ~,~ , -; Muiimum Lump Sum as of Benefit Payment Da e: . $161,450.53 `~. ~~;~`~ ~'/°+'3 =~h ~~' '' ~~ ' ~ ~' .~• ~ -- - _.--c PARTICIPANT'S BENEFICIARY'S FORM OF PAYMENT t ~ ~y ~ BENEFIT BENEFIT tS . ~ ~ LUMP SUM ~ ~, ~ '~ $175,575.79___, - $ 0 1~~~9 ~~ ~ 1~ ~a ~G MONTHLY SINGLE LIFE ANNUITY $1,507.15 $ 0 X ~ • gt ~~~~ -~- MONTHLY 50% JOINT AND SURVIVOR ANNUITY $1,371.51 • $685.76 w ~ a~y'~ MONTHLY 75% JOINT AND SURVIVOR ANNUITY $1,311.22 b~ ~ $983.42 MONTHLY 100% JOINT AND SURVIVOR ANNUITY $1,250.93 ~~ /~ $1,250.93 '1-his statement is an estimate and is not a guaranty of benefits. ~~K~ 1! v -~ (~ ~~ ~ (~ ~ Q 71.,p d .r- 'Ihe hunp swn payment indicated above represents the greater of ,vottr accowtt balance or a mutinnun hunp sum. 77~e minimum hmip sum is delennuted by nndliplyntg your atwual accnied benefit by a factor that is based on the morialily table and interest rateut effect on your benefit payment date. IC you do not elect to receive your benefit on the benefit payntcut dale shown above, the ntittinnun Iwnp sutt~ may decrease if the ntterest rate changes in ftltlue years. 71~c lump stmt payment indicated above represents the estimated total value of your account balance on the dale utdicalcd above. If you elect the hunp swn, no fiufher benefits are or will become payable from We Plan. If you are not married, the normal fotnt of payment is a Seigle Life Atutuity. If you elect this fotnt of payment you will receive benefits during yoiu• lifelune only. If you are married, the normal fotnt of payment is the Qualified 50% Jontt and Swvivor Annuity. If you elect this form of pa}'menl you r~•ill receive reduced benefits dtuittg your lifetune, and if you die before your spouse, your spouse will be entitled to receive payments equal l0 50"/" of the amount you were receiving. If you are married and elect the Lwnp Sutu form of payment, spousal consent must be provided. In otrler to provide you with estimates wider the Joird and Survivor Atmuity forms ofpayment, we have asstmted that there is no Wrote than a five year age difference behveen you and your beneficiary. If there is mote tlta» a five year difference ut ages, the benefit t~~ill be alrected accordingly. 71~e beneficiary's benefit indicated above would be payable upon your death. Note: If your account balance is 53,500 or less, the only form of payment available to you is a Ltuup Stmt EXHIBIT 17 6~ `:~. 63 n Date prepared: 10!28197 ? rJ~7, t1~ r' 1'~epared by: - ~ 7 ,f r13 7 I~ UT>„ '. t`t o'T ~ t.~ Y~ t h ~+ J 4 (Z 3 I,Ci (, r~c~ccriCQ = 15 ~, ~ 9 ~ . c~ 9 ,~ ~ w S~ ~_~~ e~cl~cc~- ~H S tt iR a0q,t MASLAND ASSOCIATES, INC. INTERNAL MEDICINE MEDICAL ARTS BUILDING 220 WILSON STREET, CARLISLE, PA 17013 (717) 249-1929 DAVID S. MASLAND, M.D. RETIRED JOSEPH F. BRAZEL, M.D. HEMATOLOGY FRANK P. CASTRINA, M.D. PULMONARY LARRY S. RAN KIN, M.D., F.A.C.C. CARDIOLOGY DEBRA D. TAYLOR. M.D. INTERNAL MEDICINE LESTER L. HIMMELREICH. III, M.D., F.A.C.P INTERNAL MEDICINE April 22, 1998 RE: Roger J. Persik TO WHOM IT MAY CONCERN: TERRY A. ROBISON. D.O. INTERNAL MEDICINE PHILIP A. NEIDERER, D.O. INTERNAL MEDICINE DOUGLAS J. BOWER, M.D. INTERNAL MEDICINE Mr. Roger Persik is a longstanding patient of this practice who has several significant medical problems which require long-term treatment for the remainder of his life. In the past, Mr. Persik suffered a myocardial infarction and required angioplasty in a hospital in Florida and has occasionally since then, while on full medical therapy, experienced chest distress which has surely been exacerbated by emotional stressors in his life. Apparently the major one of these is the financial and emotional difficulties with his former wife in regards to alimony, court settlements, etc. In addition, the patient has lost his longstanding position with Kinney Corporation and this has resulted in a tremendously adverse emotional stress to the patient. Even though he is on the maximum amount of medical therapy for his illness at present, he is still suffering medically, as well as emotionally from the above mentioned difficulties. The patient also suffers from age-related and trauma-related osteoarthritis of his spine involving the neck, lumbosacral area, which is also aggravated by emotional stress with resultant muscle spasm, pain, etc. Surgery is not indicated at this time. The patient also has several metabolic conditions, namely elevation of cholesterol which, although it is primarily a genetic disorder, it is also adversely effected by emotional stress such as was mentioned above. It is well-known that any metabolic disorder such as diabetes, elevated cholesterol, endocrine diseases, etc. all are effected negatively by emotional disorders. In helping to care for his patient, I would request that anything that can be done to lessen the financial distress related to his alimoney, etc, at this most difficult time in this patient's life would be of great benefit to his physical and emotional well-being. From a medical point of view, I feel that the stress that this patient is undergoing at this time is adversely affecting his health and very well could shorten his life, and produce significant complications in his numerous medical problems. JFB/md T: 4/22/98 EXHIBIT ~~ J~ ~'/' razel, 'M D. rco~,~r ~~ ~~ ,~~,fi ~~~~ i~ 6 Q i%~'~'i s "4 /_ .. ~ D Z~/~~'7 /35d ~~ ~~ ~~7 / 3 5 ~ .~~ _ _ ~D7~o~~y'7 /3.~v ` /3~5d -- - ;~~0/~y~ _ _ ____ _ _ _ _ - ~' 3:5 ~ ~ a/o~~~7 p 3 ~ / ~'T s'a _ _ __ __- _ __ - -_ .; i~38~~7 _ _ 3 ~ Y ~ ~-v a ~FrR~t 3a 9 ~ i ~ 1 '', ~ . _ _ _ -__ _ --- _ Via. ,y .}7~ iyr /' - __. ._ _ - - - - '?t ~~ .~ _ ._ ..t_ ~. .~ :., _:}~3/D~ ~~ ~ .~?-~ 5 ~ .~~ • ~ d Pxrnil `ilk ~~ %~-u-2a~-~) 0 0/~9~ ~ ~ y7 ~' ~/~, oo U :.: EXHIBIT ~~~ ~~ ~ ~' ~ .Q ~ ~ ~ 9 o N c c... ~ -~ ~-' o ~V °~a o :~ v z ~~ o ~ i Z ~ r .~- v 'L3 ~ „~,. N N O ~ V Cn ~ ~ ~ N ~ N :Ji ~ ?~ ~ ~ N U ~ N ..~ <L ~ a oo °~ • cA ~. J rn rn rn c3 r -~- o N tt5 N ~ ~ ~ ao O ar z ~ ~ o r r m Q m W 7 U OG O ~'vy T ~ °o ail Z Y ('~ ~ O W ~ ~ ~ry U ~ t~ {Nd ~ ~ r ~ ~ ~~ ~ ~ ~ ~ z ~,° ~ a Q c? ~ o ~ J ~ ~ o ~ r N ~ O ~ ~ O ~ ~ ~ ~. ~ Q. cn 6~ ~f7 ~ ~ ~ -_._ M ~ ~ o N it) p N ~ ~ N ~ ~ 4~ ~ ' `~.._ W C~,,,, -wry JULIA PERSIK, Plaintiff/Respondent vs. ROGER J. PERSIK, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW 1730 CIVIL 1985 IN RE: DEFENDANT' S PETITION TO MODIFY ALIMONY ORDER AND NOW, this '`~ r day of May, 1998, following hearing, the court finding that the defendant/petitioner is no longer employed by Woolworth's and has experienced a substantial diminution in his earnings but is undergoing training as a realtor with Ebener Associates and has a pension as to which he would suffer a substantial penalty in the event that he elected early withdrawal, and that the foregoing represent a substantial change in circumstances, and it appearing further that the plaintiff/respondent is only minimally employable, it is ordered and directed that the defendant/petitioner, Roger J. Persik, pay to the plaintiff/respondent, Julia Persik, the sum of $400.00 per month as alimony, effective November 1, 1997, and pending further order of court. BY THE COURT, Sandra Meilton, Esquire For the Plaintiff/Respondent Hubert Gilroy, Esquire For the Defendant/Petitioner :rlm sI~)4~ ~ ~. f-_. r-,_r~n i" ~,~ ~ ;:. 'fir t ~ :~T` ~sr; aa. i~ (/ -. ..i / v ~~~ ~{J SUITS, 79a' Case # -S 1~3o Date of Entry: Jun 12 19 85 at M. Appearances: Plaintiff: Julia Persik Defendant: Roger J Persik j'oo~ Entry by Summons 1 Complaint Petition Appeal Revival x January 16, 1986, Order, filed. ACtIOn In AND NOW, TO WIT, this 15th day of January, 1986, ASSU m psit ( ) upon consideration of the within Petition and upon motion of Diane G. Radcliff, Esquire, attorney for the Trespass ( ) Petitioner, Julia Persik, IT IS ~IEREBY ORDERED that a Habeas Corpus ( ) hearing is to be held on the 23rd day of January, 1986 at at 3:30 p.m., prevailing time in Court Room No. 3, Divorce ( x ) Cumberland County Courthouse, Carlisle, PA. The Grounds Respondent, Roger J. Persik, shall appear on that date at that time and place preferably with counsel repre- Equity ( ) stinting him. Mortgage It is further ORDERED that in the interim time Foreclosure ( ) between now and the time set for the above mentioned hearing, the Respondent, Roger J. Persik, shall be Ejectment ( ) evicted from the marital residence located at R.D. 9, t Title QUIP ( ) Box 205, Carlisle, PA, and further that Respondent , shall not attempt to cause nor shall intentionally, Replevin ( ) knowingly or recklessly cause any physical contact Condemnation ( ) whatsoever nor harass or inte~re with the Petitioner, L?uli.a Persik, and her children Catherine Persik, ( ) Christine Persik, Debra Persik, Raymond Persik and r ~~`~'~'' Sandra Persik, in any way at their place of residence, Service by SHF: ~- a~-~_ place of employment or anywhere in the Commonwealth of Pennsylvania. Date of ~ Return : (~-as~-~S~ THE RERPONDENT IS HEREBY ADVISED OF HIS RIGHT TO ~~ BE RESRESENTED BY AN ATTORi'~TEY OF HIS OWN CHOOSING. IF THE RESPONDENT DOES NOT HAVE A LAWYER OR CZ3~NNOT AFFORD ONE HE SHOULD GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIwTD OUT WHERE IIE CAN GET LEGAL HELP. By the Court, Kevin A. Hess, J. J an 24, 1986, Order, filed. AND NOW, this 23rd day of Jan 1986 at 4:50 p.m. the above matter having been called for a hearing, the court finds specifically that the plff, Julia Persik and her daughter, Sandra Persik, are in danger from continued abuse at the hands of the deft, and it is ordered and directed: 1. That the deft, Roger J Persik, is enjoined and restrained from abusing oY threatening to abuse the plff, Julia Persik, or her daughter, Sandra Persik. 2. The plff, Julia Persik, is granted possession of the jointly owned marital residence located at RD9 Carlisle, Cumb Cc Penna to the exclusion of the deft. 3. This order shall remain in effect for a period of one year from this date. The Penna State Police Dept will be provided with a copy of this order by the attys for the plff and may enforce this order by the attys for the plff and may enforce this order by arrest for indirect criminal contempt without warrant upon probable cause that this order has been violated, whether or not the violation is committed in the presence of the police officer. In the event that an arrest is made under this section, the deft shall not be taken to jail but shall be taken without unnecessary delay before the court that issued the order. When that court is unavailable the deft shall be arraigned before a dist. magistrate who shall set bail according to the provisions of i, , ~,,, t ~ ' -- ~~. Taxation of Costs Receipt of Fees $65.50 pd atty Diane G Radcliff '7i~ ~y ~~ /~ ~ ~ y ~ / (OVER' .. of ..chapter 4000 of the Penna rules of criminal procedure. ~ By the court, Kevin A Hess, J. -~ -y'` ~~ ~~ /' ~~ ~~ ~~~ March 2, 1987, Inventory and Appraisement of Julia Persil,:. filed Income and Expense Statement of J~.t~~a Persik f3_led. April 15, 1987, Inventory and Appraisement of Roger J. Fersik filed by Bradley L. Griffie, Esq „ Assets of the Parties filed. April 29, 1987, Amended Inventory and Appraisement of Julia Persik filed. May 8, 1987, Praecipe, filed. Please pay the enclosed invoice from the funds on deposit in this action, and returnza copy to my attention marked paid. Thomas J. 4~Iilliams, Master June 30, 1987, Petition to Extend Master Appointment and Order of Court, filed. AND NOW, upon consideration of the within Petition of the Master for an extension of his appointment, and on the joint request of both parties, the i°iaster's appointment is hereby extended an additional 120 days. The Prothonotary is hereby authorized and directed to pay the sum of $100.00 to Hughes, Albright, Foltz & Natale Reporting Service, Inc. from the funds on deposit in this action as proveded on the invoice attached to the Petition. By the Court, Harold E. Sheely J. Oct 8, 1987, Proposed order, filed. AND NOW, this 8th day of October 1987, upon consideration of the foregoing petition by the master in this case, it is hereby ordered and directed that the sum of 1,000.00 be depo:s$ted with the prothonotary on account of masters fees and costs. All proceedings to stay meanwhile. If the aforesaid sum is not deposited within 30 days of the date hereof, the master is ordered and directed to return this matter to the c~ urt without recommendations at which time this commission shall be considered terminated. By the court, Harold E Sheely, PJ Nov 13, 1987, Rule, f filed. AND NOW, TO WIT, this 13th day of November, 1987, upon consideration of the within petition, a rule is entered upon the deft. to show cause why the relief requested in the within petition should not be granted. Rule returnable the 6th day of January, 1988 at 9:30 o'clock a.m. in courtroom 1, Cumb County courthouse, Carlisle, Pa. A?1 proceedings, including the return of the file by the master, to staff pending further order of this court. By the court, Harold E Sheely, PJ Dec 1, 1987, St i.plzlation, filed . December 7, 1987, Stipulation and Order, filed. AND NOf,V, this 4tYi day of December, 19187, upon presentation by Diane G. Radcliff, Esquire, attorney for Plaintiff, Ron Turo, Esquire, Attorney for Defendant, and Thomas J. Williams, Esquire, Divorce Master, and consideration of the Stipulation o~ the parties; IT IS HEREBY ORDERED AND DECREED THAT: 1. The Orders of this Court dated October 8, 1987 and November 13, 1987 respectively pertaining to the payment of the additional Master's Fee Deposit are hereby vacated and superseded by this Order. 2. The Defendant, Roger J. Persik, shall immediately deposit with the Prothonotary a Master's Fee Deposit of $300.00 representing the anticipated costs and expenses of the Master in preparing his recommendations to the Court. 3. The parties legal counsel shall within two weeks of the date of this Stipu- lation file with the Master Proposed Findings of Fact, Conclusions of Law and Proposed Order. 4. Upon submission of said Proposed Findings of Fact and upon submission of the parties' Stipulation pertaining to counsel fees, wages, etc., being entered into simultaneously herewith, the record in this case shall be closed and the Master thereafter shall enter his recommendations to the Court. By the Court, Kevin A. Hess, J. Deoa[ber 7, 1987, Stipulation for Bifurcation of Divorce Action and Order, filed. AND NOW, to wit, this 4th day of December, 1987, upon presentation by Diane G. Radcliff, Esquire, attorney for Plaintiff, and Ron Turo, Esc~_iire, attorney for Defendant, and consideration of the Stipulation of the parties; IT IS HEREBY ORDERED AND DECREED THAT 1. The within divorce proceedings are hereby befurcated so as to allow the immediate entry of a Decree in Divorce with reservation of jurisdiction of this Court over the claims raised by the parties including equitable distribution, alimony, alimony pendente lite, counsel fees, costs and expenses. 2. Pending final resolution of the aforesaid economic issues, either by way of mutual agreement of the parties or by final Court Order, Husband shall maintain the current medical insurance coverage on the wife. 3 Pending the final resolution of the aforesaid economic issues, either by way of mutual agreement or Court Order, Husband shall continue to pay and keep current the mortgage on the marital home and Husband further shall pay Wife the sum of Four Hundred Twenty ($420.00) Dollars per month as alimony pendente lite. By the Court, Kevin A. Hess, J. Deoenber 4, 1987, Plaintiff and Defendant's Affidavits of Consent, filed, Deo~nb~r 7, 1987, Praecipe to Transmit Record, filed. C ~~ ~ ~~- / j ~,-C '" ~Vl.1L_ ~ ~/ ~/ ~~~ Y ~~ GL.1 L E L- _ ~~ ~j~JJJ ~~ ~ ~' ~"~~ c ~ ~ ~L ~,~__ ~~ ,, ~r~a - 0 . ~ ~~ ~~ a°. ~ . ~ c Jul 8, 1888, Notice of filing of supplemental masters report, filed. Jul 8, 1888, Statement of mailing, filed. -Jun 8, lg8g, Exceptions to masters report conclusions of law and recommendations filed. July 12, 19u9, Order of Court, filed. AND NOi~, July 11, 1989, neither party having appeared for the call of the Argument List this date, the above case is stricken from the cases to be argued on July 19, 1989. Counsel may relist the case when ready. By the Court, I'.arold E. Sheely, P.~ J. Aug. 22, 1989, Praecipe, filed. Please withdraw my appearance previously entered on behalf of the Defendant on the Defendant in the above-captioned action. Bradley L. Griffie, Esn. Atty. for Plff. ,. ~~-e-e~~,_ ~l-i.n ~ !- ~ C~ Q C~ -- ~,'L~-~e-c.-~Z~ ~ , ~' ~~~d~t-tit.C--- `~~c~-,~~-t-~~( ~ / // ~/~.19--,~ c-v~ ~ ~ Q~C~'--~~t ~. -~~ Dec. 21, 1990, Petition for Rule to Show Cause, and Order for Court and Rule to Show Cause, filed. AND NOW, this 24th day of December, 1990, upon presentation and consideration of the within Petition, a Rule is issued upon Plaintiff, Julia C. Persik, t:o show cause, if any she has, as to why the Defendant, Roger J. Persik, should not be permitted to file and pursue Exceptions at this time in the above captioned action. Rule returnable 20 days after service. By The Court: George E. Hoffer, J. Dec. 27, 1990, Certificate of Service, filed. Jan. 7, 1991, Reply to Defendant's Petition for Rule to Show Cause and Cross Petition, filed. Jan. 22, 1991, Answer to Cross Petition, filed. March 14, 1991, Praecipe for Listing Case for Argument, filed. Defendant's Petition for Rule to Show Cause and Plaintiff's Cross Petition By: James K. Jones, Esq. for Bradley L. Griffie, Esq. 1 March 25, 1991, Petition to Continue the Argument on Exceptions to Master's Report, and Order, filed. AND NC7W, March 25, 1991, at the request of counsel for the plaintiff, the case is removed from the Argument Court list for April 3, 1991. The Prothonotary shall relist the case for the next day of Argument Court which is May 22, 1991. By The Court: Harold E. Sheely,P.J. May 24, 1991, Order, filed. IN RE: Defendant's Petiton for Leave to File Exceptions to Master's Report, filed. AND NOW, this 23rd day of May, 1991, following argument thereon, the defendant's petition for leave to file exceptions to Master's report is DENIED. By The Court: Kevin A. Hess, J. June 4, 1991, Praecipe, filed. Please enter my appearance in the above captioned matter on behalf of the plaintiff, Julia Persik. By: Cynthia A. Kaylor, Esq. June 5, 1991, Praecipe, filed. Please withdraw my appearance as attorney for Julia C. Persik in the above captioned matter. By: DIane G. Radcliff, Esq. v June 14, 1991, Order Approving Equitable Distribution of Marital Property by Master's Report, filed. AND NOW, this 14th day of June, 1991, pursuant to the report of the Master in equitable distribution, it is hereby ordered that the Master's report on equitable distribution of the marital property shall hereafter be entered as an Order of the Court. By The Court: Kevin A. Hess, J. January 3, 1992, Petition for Contempt, and Order, filed. AND NOW, this 3rd day of January, 1992, upon presentation and consideration of the within petition, a rule to Show Cause is issued upon Respondent, Julia C. Persik, to show cause, if any she has, as to why an attachment should not issue for her failure and refusal to obey the Order of Court dated June 14, 1991, in this matter. IT IS FURTHER ORDERED AND decreed that this Rule is returnable at a hearing to be held on Monday, the 2nd day of March, 1992, at 9:30 o'clock a.m., in Courtroom No. 4 of the Cumberland County Courthouse, Carlisle, Pennsylvania, at which time Respondent, Julia C. Persik is ordered to appear. Respondent, Julia C. Persik, is further advised that her failure to appear will be deemed an admission of contempt and a warrant for Respondent's arrest may be issued. Service of the petition and rule shall be by regualr, first class mail, postage prepaid, to Respondent's counsel of record. By The Court: Kevin A. Hess, J. January 10, 1992, Certificate of Service, filed. March 22, 1992, Order, filed. AND NOW, this 2nd day of march, 192, at the request of counsel for the parties, the hearing scheduled for March 2, 1992, is continued generally pending settlement of the matter. By The Court: Kevin A. Hess, J. May 4, 1992, Order, filed. IN RE: Petition for Contempt. AND NOW, this 4th day of May, 1992, it appearing that the parties have been unable to effect settlement, hearing on the above matter is set for Thursday, July 2, 1992, at 9:30 a.m. in Courtroom Number 4, Cumberland County Courthouse, Carlisle, Pa. By The Court: Kevin A. Hess, J. NO. 1730 Civil 1985 (B.F. from pg. 1006-A) Persik vs. Persik ~ ~ ~ ~ - August 14, 1992, Order, filed. AND NOW, this 14th day of August, 1992, the matter of the plaintiff's alleged contempt in this matter having been called for hearing, and counsel for the parties having previously acknowledged to the court that the within order should be entered to reflect the parties agreement in this case, IT I5 HEREBY ORDERED AND DECREED, that: 1. Defendant shall be permitted to remove the items of personal property listed on Exhibit "A", which is attached hereto and incorporated herein by reference, from plaintiff's residence on Saturday, August 15, 1992 at 9:30 a.m. 2. Plaintiff shall file to refinance her home and remove defendant from the home's current encwnbrances, no later than July 15, 1992, and shall provide all necessary documentatic and assistance to the refinancing institution so as to complete her refinancing within 60 days of this date. 3. Plaintiff shall pay to defendant the sum of four thousand nine hundred and xx/100 ($4900.00) dollars within sixty (60) days of this date, reflecting the one hundred and xx/100 ($100.00) dollars per month due from plaintiff to defendant for "rental" of the former marital residence from the date of the Master's Report (being June 28, 1988) to an including July 1992 rent. 4. Plaintiff shall pay to defendant the sum of sixteen thousand two hundred eighty three and 48/100 ($16283.42) dollars within sixty (60) days of this date, reflecting the ten thousand and xx/100 ($10000.00) dollars plus interest at the rate of twelve (120) percent per annum due from plaintiff to defendant pursuant to the Master's Report confirmed in this action. 5. Defendant shall pay to the plaintiff the sum of fourteen thousand eight hundred sixty (60) days of this date, reflecting the difference between the monthly amount of alimony to be paid by defendant to plaintiff pursuant to the Master's report confirmed in this action ($1350.00 per month) and the total amounts paid by defendant to or on behalf of plaintiff since entry of the Master's Report. 6. Defendant shall pay to the plaintiff the sum of One Thousand Three Hundred fifty and xx/100 ($1350.00) dollars per month in alimony beginning August 1, 1992, and continuing each and every month thereafter until husbanbd's death, until wife's death, until cohabitation of wife with an unrelated member of the opposite sex, or until further order of court; said payments to be made directly unless defendant is in arrears by one month's payment, under which circumstances, plaintiff may request future collection through the Cumberland County Domestic Relations Office. 7. In lieu of the payments to be made in paragraphs 3, 4, and 5 herein, the parties may offset their respective payments such that plaintiff could pay the net difference due to defendant of six thousand three hundred fifteen and 48/100 ($6315.48) dollars, within sixty (60) dyas of this date. 8. Within fifteen (15) days of this date, plaintiff will provide defendant with written or documented confirmation that the orthodontist providing services to the parties has been paid in full, as required by the Master's Report. 9. Within fifteen (15) days of this date, Defendant with written or documented confirmation that the real estate taxes on the former marital residence have been paid for 1988, 1989, 1990, 1991, and 1992. 10. Within fifteen (15) days of this date, defendant shall provide confirmation that the parties' tax refund was distributed pursuant to the parties' Stipulation dated December 1, 1987. Further, defendant shal make every reasonable effort to secure documentation likewise reflecting that the parties' 1986 tax refund was distributed pursuant to the parties' stipulation dated December 1, 1987. 11. Within fifteen (15) days of being .requested to do so by defendant, plaintiff will execute all necessary documents to convey her interest in the parties' jointly held cemetery plots to defendant. 12. Within fifteen (15) days of being requested to do so by defendant, Plaintiff will execute an option to purchase and right the First Refusal Agreement between the parties providing defendant with the right to purchase the parties' former marital residence to any third party at the same terms offered to the third party. FURTHER, the parties acknowledge that plaintiff is in contempt of our order of June 14, 1991, affirming the Master's report in this case. In the event of plaintiff's failure to comploy with this order of court, defendant may request the court to hold a hearing in this matter to set sanctions which shall be imposed upon plaintiff, which sanctions shall include, but not be limited to, the payment of defendant's counsel fees for all service rendered in attempts to enforce this court's order of June 14, 1991. Effectuating and implementing the terms of this order of court may be completed by plaintiff or via Power of Attorney. By The Court: Kevin A. Hess, J. Nclvember 18, 199?, Petition to Modify Alimony, filed. ~o~~~~ Nov~anbes 24, 1997, Court Order, filed. IN RE: Petition to Modify Alvriony AND NOW, this 21st day of November, 1997, upon consideration of the attached Petition for Modification of An Alimony Order, it is ordered and directed as follows: 1. A hearing is scheduled in Court Room No. 4 of the C~unberland County Court House on the 17th day of December, 1997, at 2:30 p.m. at which time testimony will be taken on the Petition of Roger J, Persik to terminate or modify the Alimony Order entered in this case. 2. Pursuant to Pennsylvania Rules of Civil Procedure 1920.22, either_ party may proceed with discovery in advance of the mentioned hearing date. 3. Counsel for the Petitioner shall accomplish service of this Court ORder and the attached Petition upon the Respondent, Julia Persik. By the Court: Kevin A. Hess, J. Copies mailed 11J24j97 December 18, 1997, Praecipe, filed. Please enter the appearance of Sandra L. Meilton, Esquire, and the law firm of Hepford, Swartz & Morgan, as attorneys for Respondent, Julie Persik, in the above matter. By: Sandra L. Meilton, Esq. Febiuaty 27, 1998, Court Order, filed. AND NOW, this 27th day of February, 1998, the hearing scheduled iri the above referenced case for March 6, 1998, is cancelled and rescheduled to Monday, April 27, 1998, at 9:30 a.m. in Court Room No. 4. By the Court: KEvin A. Hess, J. Copies mailed 2/27/98