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Home My WebLink About08-1353Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW KAZIMERZ R. KACZERSKI, 08 - /353 k- r -T Defendant IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed against you and a decree in divorce or annulment may be entered against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation with your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania, 17013-3387. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 I L BY Andrew C. Sheely, Esq e PA. I.D. No. 62469 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 717 697-7050 Attorney for Plaintiff Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 IN DIVORCE NOTICE OF RIGHT TO COUNSELING YOU are one of the parties in the above-captioned action in divorce. By virtue of Section 202 of the Pennsylvania Divorce Code, it is a duty of the Court to advise both parties of the availability of counseling and upon request of either provide both parties with a list of qualified professionals who provide such services. Accordingly, if you desire counseling a list of marriage counselors if available in the office of the Prothonotary at: Office of the Prothonotary Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013-3387 Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353;{ IN DIVORCE DIVORCE COMPLAINT 1. Plaintiff is SUSAN K. KACZERSKI, an adult individual who currently resides at 1864 Hunter Drive, Mechanicsburg, Hampden Township, Cumberland County, Pennsylvania. 2. Defendant is KAZIMERZ R. KACZERSKI, an adult individual who currently resides at 18 Montasere Drive, Dillsburg, York County, Pennsylvania. 3. Plaintiff and Defendant were residents of the Commonwealth of Pennsylvania for at least six (6) months immediately previous to the filing of this Complaint. 4. Plaintiff and Defendant were married in Mechanicsburg, Pennsylvania, on October 15, 1988. 5. There have been no prior actions of divorce or annulment between the parties. 6. Neither party is a member of the armed forces of the United States of America. 7. Plaintiff has been advised of the availability of marriage counseling and understands that he may have the right to request that the court require the parties hereto to participate in counseling. COUNT 1 - DIVORCE - IRRECONCILABLE DIFFERENCES 8. Paragraphs 1 - 7 are incorporated herein as if set forth at length. 9. The marriage between the parties is irretrievably broken. 10. After ninety (90) days have elapsed from the date of filing the divorce complaint, Plaintiff intends to file an affidavit consenting to a divorce and Plaintiff believes Defendant may also file such an affidavit. 11. This divorce action is not collusive. 12. The parties separated on or about August 8, 2007. WHEREFORE, if both parties file affidavits consenting to a divorce after ninety (90) days have elapsed from filing of this Divorce Complaint, Plaintiff respectfully requests the Court to enter a Decree of Divorce pursuant to Section 3301(c) of the Pennsylvania Divorce Code. COUNT II - DIVORCE - 3301(d) 13. Paragraphs 1 - 12 are incorporated herein as if set forth at length. 14. After a period of two (2) years has elapsed from the date of separation, Plaintiff intends to file his affidavit of having lived separate and apart. WHEREFORE, if two (2) years have elapsed from the date of separation and Plaintiff has filed his affidavit of consent, Plaintiff respectfully requests the Court to enter a Decree of Divorce pursuant to Section 3301(d) of the Divorce Code. COUNT III CLAIM FOR EQUITABLE DISTRIBUTION OF MARITAL PROPERTY UNDER SECTION 3502 OF THE DIVORCE CODE 15. The allegations in Paragraphs 1 - 14 are incorporated herein and made a part hereof. 16. Plaintiff and Defendant are the owners of various personal property, motor vehicles, bank accounts, retirement accounts, retirement assets and insurance policies acquired during their marriage. 17. Plaintiff and Defendant are the owners of real property acquired during their marriage. 18. Plaintiff and Defendant have acquired various marital debts during the period of their marriage. 3 WHEREFORE, Plaintiff requests your Honorable Court equitably distribute the parties marital property, including marital debt, and including any such further relief as the Court may determine equitable and just. COUNT IV. ALIMONY, ALIMONY PENDENTE LITE 19. The allegations in Paragraphs 1 through and including 16 are incorporated herein and made a part hereof. 20. Plaintiff lacks sufficient property to provide for her reasonable means and is unable to support herself through appropriate employment. 21. Plaintiff requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. WHEREFORE, Plaintiff requests your Honorable Court to enter an award of alimony pendente lite until final hearing and hereafter enter an award of alimony permanently thereafter. pectfully submitted, Res Date: 02-1 Z-'J / 2008 a 0? 0 drew C. Sheely, Es Attorney for Plainti PA ID No. 62469 P.O. Box 95 127 S. Market Street Mechanicsburg, PA 17055 717-697-7050 4 VERIFICATION I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. Date: ?rNBi? 2008 jj??, Susan K. Kaczerski Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - IN DIVORCE AFFIDAVIT Susan K. Kaczerski, being duly sworn according to law, deposes and says: (1) I have been advised of the availability of marriage counseling and understand that I may request that the Court require that my spouse and I participate in counseling. (2) I understand that the Court maintains a list of marriage counselors in the Domestic Relations Office, which list is available to me upon request. (3) Being so advised, I do not request that the Court require that my spouse and I participate in counseling prior to a Divorce Decree being handed down by the Court. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. S;dsan K. Kaczers o (Al .r. „? c s SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 CIVIL TERM IN DIVORCE ACCEPTANCE OF SERVICE OF DIVORCE COMPLAINT I, LINDSAY D. BAIRD, ESQUIRE, hereby accept service of the Divorce Complaint docketed to the above-captioned matter on behalf of Kazimerz R. Kaczerski, Defendant, and further state that I am authorized to do in accordance with the Rules of Civil Procedure. Date: March !? , 2008 - ---_1 'ndsay D.; air Esquire ? `=' cao ? ? a vr ? , ?: ?. ? `.. ? ?? 'y t y . ~ ? ?.8.? ?p.? Y_ y, f ?i ?? ' v ? R ??rryy Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff vs. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE PLAINTIFF'S MOTION TO COMPEL DEFENDANT TO ANSWER PLAINTIFF'S INTERROGATORIES AND REQUEST FOR PRODUCTION OF DOCUMENTS Plaintiff, Susan K. Kaczerski, by and through counsel of Andrew C. Sheely, Esquire, hereby files this Motion to Compel Defendant to answer Plaintiff's discovery requests and in support thereof Plaintiff respectfully states as follows: 1. Plaintiff, Susan K. Kaczerski, filed a divorce complaint containing economic claims on February 29, 2008. 2. Defendant, Kazimerz R. Kaczerski, by counsel of Lindsay D. Baird, Esquire, accepted service of the Complaint on March 6, 2008. 3. Plaintiff served Written Interrogatories and Request for Documents upon Defendant through his attorney on April 18, 2008. 4. By letters dated May 22, 2008, July 30, 2008 and September 19, 20008, counsel for Plaintiff has repeatedly written to counsel for Defendant requesting Defendant's response or answer to the written interrogatories and request for production of documents. 5. Plaintiff's complaint contains economic claims for equitable distribution and alimony. 6. Defendant's refusal to answer the Interrogatories and Request for Production of Documents is in violation of Rules of Court regarding discovery. 7. The information requested by Plaintiff is in the sole control of Defendant. 8. The information requested by Plaintiff is necessary for resolution of the pending claims and for preserving and protecting Plaintiff's interest in the marital estate. 9. Defendant's refusal to Answer Plaintiff Interrogatories has caused Plaintiff to incur unnecessary attorney fees and costs which could have been avoided by answering the discovery requests in timely fashion. WHEREFORE, Plaintiff, through counsel, respectfully Requests the entry of a Rule upon Defendant through his counsel to show cause why he should not be required to Answer Plaintiff's discovery requests in the above- captioned matter, or in the alternative, Plaintiff requests the scheduling of a hearing for the entry of appropriate 2 sanctions, including an award of attorney fees, for Defendant's failure to comply with Plaintiff's requests. ?//; ele I Respectfully submitted, An rew C. Sheely, Esqu' Attorney for Plaintiff PA ID 62469 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 717-697-7050 717-6997-7065 (fax) andrewc.Qheely@verizon.net 3 VERIFICATION I, Susan K. Kaczerski, verify that the statements made in these Motion to Compel Defendant's to Answer Plaintiff's Interrogatories and Request for Production of Documents are true and correct to the best of my knowledge and belief. Date: January 200? A/ Susan K. Kaczerski 4 CERTIFICATE OF SERVICE I, Andrew C. Sheely, Esquire, hereby certify that I am this day serving the foregoing Motion to Compel Defendant to Answer Interrogatories Propounded on Behalf of Plaintiff to Defendant and Request for Production of Documents First Set upon the following named individual this day by depositing same in the United States Mail, First Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed as follows: Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 Date: January 13 Z 2009 Andrew C. Sheely, Esquire s e 77 e'i.? ^^.,ry SUSAN K. KACZERSKI, Plaintiff V. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 08- 1353 CIVIL TERM IN DIVORCE MOTION TO WITHDRAW COUNSEL AND NOW COMES, Lindsay D. Baird, Esquire, hereinafter referred to as attorney for the defendant, Kazimerz R. Kaczerski, who moves this Court to grant her motion to withdraw as counsel and in support thereof respectfully represents the following: 1. On October 12, 2007, the client contracted with Lindsay D. Baird, Esquire to represent him in divorce and support actions. 2. On March 6, 2008, counsel accepted service of the Divorce Complaint on Defendant's behalf and copied him the same. 3. In April 2008, Plaintiff informally requested answers to interrogatories. The same were mailed to Defendant on April 22 with the request to fill them out and meet with counsel in two weeks. 4. After more than one prompt by Plaintiff, Defendant was mailed another request to meet in August 2008. The August letter to Defendant's P.O. Box (his preferred address for correspondence) was returned to this office. 5. On October 1, 2008, a letter was sent to Defendant's home address stating that if did not respond to me by October 10, 2008, a Withdrawal of Counsel Motion would be filed and Plaintiff s counsel was so advised. Defendant has not responded to these requests. 4. Continued representation is not possible under the circumstances. 5. Lindsay D. Baird, Esquire seeks to withdraw as counsel of record for the client. WHEREFORE, Lindsay D. Baird, Esquire prays this Honorable Court to grant her motion to withdraw as counsel in the above-captioned matter. Respectfully submitted, n say D. Baird, squire J37 f S. Hanover S et Carlisle, PA 17013 (717) 243-5732 Attorney for Defendant CERTIFICATE OF SERVICE I, Lindsay D. Baird, Esquire, hereby certify that I am serving the foregoing upon the following individuals at the following addresses by U.S. First Class Mail: Andrew C. Sheely, Esquire 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 Mr. Kazimerz R. Kaczerski 18 Montsere Drive Dillsburg, PA 17019 ,X Date: r` Aindsay D. Bai d, qui ? _. -? ?33 f r ? ==? _ ? -? _ °?°? ? ?o °.., Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE CERTIFICATE OF CONCURRENCE OR NON-CONCURRENCE I, Andrew C. Sheely, Esquire, hereby certify that I served a copy of the attached Motion to Compel Answers to Discovery Requests upon Lindsay D. Baird, Esquire, by fax transmission on January 15, 2009. I further state that I was advised by Lindsay D. Baird, Esquire, that she did not concur with the attached Motion prior to its filing on the date set forth below. Date: January 15, 2009 d" ev r S' ? ndrew C. Sheely, Esqu' e Attorney for Plaintiff 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 717-697-7050 Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE PLAINTIFF'S AMENDED MOTION TO COMPEL DEFENDANT TO ANSWER PLAINTIFF'S INTERROGATORIES AND REQUEST FOR PRODUCTION OF DOCUMENTS Plaintiff, Susan K. Kaczerski, by and through counsel of Andrew C. Sheely, Esquire, hereby files this Amended Motion to Compel Defendant to answer Plaintiff's Discovery requests and in support thereof Plaintiff respectfully states as follows: 1. Plaintiff, Susan K. Kaczerski, filed a divorce complaint containing economic claims on February 29, 2008. 2. Defendant, Kazimerz R. Kaczerski, by counsel of record, Lindsay D. Baird, Esquire, accepted service of the Complaint on March 6, 2008. 3. Plaintiff served Written Interrogatories and Request for Production of Documents upon Defendant through his Attorney on April 18, 2008. A copy of the Discovery request is attached hereto as Exhibit "A". 4. Counsel for Plaintiff wrote to counsel for Defendant on May 22, 2008 requesting information as to when the discovery request would be completed. A copy of the letter date May 22, 2008 is attached hereto as Exhibit "B". 5. By way of follow-up, counsel for Plaintiff again wrote to counsel for Defendant on July 30, 2008 requesting information as to when the discovery request would be completed. A copy of the letter date July 30, 2008 is attached hereto as Exhibit "C". 6. Thereafter, on September 19, 2008, counsel for Plaintiff advised counsel for Defendant that a Motion would be filed seeking a Court Order to compel answers to the discovery requests. A copy of the September 19, 2008 letter is attached hereto as Exhibit "D". 7. As a result of Defendant's failure to respond to the Interrogatories and Request for Production of documents and repeated written requests, Plaintiff, by counsel, filed a Motion to Compel Defendant to Answer Plaintiff's Interrogatories and Request for production of Documents on January 13, 2009. A copy of the Motion to Compel is attached hereto as Exhibit "E". 8. On January 15, 2009, counsel for Plaintiff received written notification by facsimile transmission from the office of the Court Administrator advising counsel for Plaintiff of his failure to comply with certain local 2 rules of Court by failing to seek the concurrence or non- concurrence with counsel for Defendant prior to filing the Motion attached as Exhibit "F", and for failing to state whether any Judge had previously ruled upon any issue in the same or any related matter. 9. The Honorable Kevin A. Hess issued an Order of Court dated November 6, 2007 confirming an agreement between the parties in child and spousal support action docketed to PACSES NO. 051100364, Docket Number 552 Support 1991, a copy of which is attached hereto as Exhibit "G". 10. Counsel for Plaintiff is not aware that any other Judge has ruled on any matter in the above-captioned Divorce action docketed to 08-1353. 11. A time stamped copy Exhibit "E" was served upon counsel for Defendant by letter and certificate of service dated January 12, 2009. 12. This instant amended Motion to Compel was faxed to counsel by Defendant on January 15, 2009 as evidenced by the attached fax cover sheet and receipt attached hereto as Exhibit "H". 13. Counsel for Plaintiff placed a telephone call to counsel for Defendant on January 15, 2009 for the purpose of seeking concurrence or non-concurrence with the Amended Motion and original motion but was unable to speak with 3 counsel for Defendant. 14. Thereafter, counsel for Defendant called counsel for Plaintiff to advise that counsel for Defendant was withdrawing from the case and could not concur with the original or the amended motion to compel Amended Motion to Compel Answers to Plaintiff's Interrogatories and Written Request for Production of documents, and a Certificate of Non-Concurrence is submitted to the Court together with this Amended Motion. 15. Plaintiff's complaint contains economic claims for equitable distribution and alimony. 16. Defendant's refusal to answer the Interrogatories and Request for Production of Documents is in violation of Rules of Court requiring Answers to Discovery. 17. The information requested by Plaintiff is in the sole control of Defendant. 18. The information requested by Plaintiff is necessary for resolution of the pending claims and for preserving and protecting Plaintiff's interest in the marital estate. 19. Defendant's refusal to Answer Plaintiff Interrogatories has caused Plaintiff to incur unnecessary attorney fees and costs which could have been avoided by answering the discovery requests in timely fashion. 4 WHEREFORE, Plaintiff, through counsel, respectfully Requests the entry of a Rule upon Defendant through his counsel to show cause why he should not be required to Answer Plaintiff's discovery requests in the above- captioned matter, or in the alternative, Plaintiff requests the scheduling of a hearing for the entry of appropriate sanctions, including an award of attorney fees, for Defendant's failure to comply with Plaintiff's requests. Respectfully submitted, Andrew C. Sheely, Esquire Attorney for Plaintiff PA ID 62469 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 717-697-7050 717-6997-7065 (fax) andrewc.sheely@verizon.net 5 Exhibit "A" Andrew , Esquire 127 S. Market ket Street P.O. Box 95 CO P Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW KAZIMERZ R. KACZERSKI, 08 - 1353 Defendant IN DIVORCE INTERROGATORIES PROPOUNDED ON BEHALF OF DEFENDANT TO PLAINTIFF AND REQUEST FOR PRODUCTION OF DOCUMENTS FIRST SET TO: Kazimerz R. Kaczerski, Defendant and Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 PLEASE TAKE NOTICE that you are hereby required pursuant to the Pennsylvania Rules of Civil Procedure, Rules 1930.5 (b), 4005 and 4006 to file the original and serve upon the undersigned a copy of your Answers and objections, if any, in writing and under oath, to the following Interrogatories within thirty (30) days after service of the Interrogatories. The Answers shall be inserted in the space provided. If there is insufficient space to answer an interrogatory, the remainder of the answer shall follow on a supplemental sheet clearly identified with reference to the questions being answered. These shall be deemed to be continuing interrogatories. If, between the time of your answers and the time of the Divorce Master's hearing in this case, you, or anyone acting in your behalf, learn of any further information not contained in these answers, you shall promptly furnish that information to the undersigned by supplemental answers. For questions that request Production of Documents, this request is made pursuant to Pa.R.C.P. No. 4009 and you are requested to produce a copy of the mentioned documents with the understanding that the undersigned shall reimburse you for copying cost. In the event you are unable to make a copy of the requested documents or items, please provide the mentioned items for inspection and copying at the office of Andrew C. Sheely, Esquire, 127 South Market Street, Mechanicsburg, Pennsylvania, within thirty (30) days from the filing of this request. DATE: April 2008 Andrew C. Sheely, Esquire PA ID # 62469 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 717-697-7050 717-697-7065 (Fax) 2 INSTRUCTIONS AND DEFINITIONS Answer every Interrogatory. No question is to be left blank. If the answer to an Interrogatory is "none" or "unknown", such statement must be written in the answer. If the question is inapplicable, "N/A" must be written in the answer. Whenever a date, amount or other computation or figure is requested, the exact date, amount, computation or figure is to be given unless it is unknown. If so, give the best estimate or approximation thereof and note that such answer is an estimate or approximation. Whenever the word "identify" or "identity" is used in reference to a person, corporation or other entity, this means to state, if appropriate, his, hers or its full name, present address and business affiliation. 3 1. EMPLOYMENT A. State the full name, date of birth, address and telephone number of each and every employer with whom you have worked for the past three (3) years: B. State fully your gross salary per hour, week or month with each and every employer within the past three (3) years, and provide a copy of evidence (W-2, 1099) of total earnings for the years 2005, 2006 and 2007: 4 2. DEBTS OWED TO YOU If any person, corporation, partnership, or any other entity owes you any money, state the name and address of the name and address of the debtor, the amount of debt and the date the obligation became due and owing. 5 3. PERSONAL PROPERTY If you own any furniture, household goods, jewelry, furs, artifacts, motor vehicles, boats, furniture, works of art, other personal property, state a complete description, the date of purchase of such item of personal and identify its present value: 6 4. OTHER INCOME Itemize the source, terms and amounts of all income benefits, cash and non-cash, not already included in your Answers to any preceding Interrogatory, such as, but not limited to, pension plans, annuities, inheritances, retirement plans, estimated Social Security benefits, lottery prizes, bank interest, dividends, military benefits, and other assets. 7 5. Identify any and all liabilities or obligations of whatever nature, including a list of credit card accounts, that you may have, which are not disclosed in a prior Interrogatory, and for each, please state: A. The nature of the liability or obligation: B. Date acquired: C. The outstanding balance, if any: D. The account numbers: 8 6. List and identify all life insurance policies, including policy numbers and face amounts, in which you are the owner, insured, or beneficiary, and for each please state: 9 7. Please state any benefits not already listed in the preceding Interrogatory that you receive from each and every employer: 10 8. As to each checking, savings or investment account maintained by you or in which you had power of signature at the time of the separation, state the name and address of the banking or other financial institution, and the value in the account presently and the amount in the account as of the date of separation: 11 9. As to any and all savings accounts, certificates of deposit, money market funds, savings clubs, money market funds, savings certificates (all hereinafter called "Account") or similar items thereto, maintained by you or over which you had power of signature or any interest in, or deposited monies into, or withdrew monies from, currently and as of the date of separation, state the name and address of the banking or other financial institution, the value in the account presently and the amount in the account as of the date of separation: 12 10. Set forth a list of all stocks and bonds and the value of each, including U.S. savings bonds, securities, including but not limited to stocks, debentures, mortgages, treasury bills, mutual funds (hereinafter called "Security") owned, held, acquired, sold, exchanged, disposed of by you in the past year. 13 11. As to any real estate in which you now have or have had an interest during the marriage, whether individually, jointly, or otherwise, set forth: A. Its address: B. Purchase price: C. Name and address of grantor: D. Name and address of all holders of encumbrances; description of and amount of each encumbrance at date of acquisition of title: E. Whether any portion of purchase price is still due by way of note, bond, mortgage, or in any other manner; the amount yet owed: F. The fair market value of each parcel of real property. 14 12. If not previously identified, identify each and every retirement account, pension benefit, retirement plan, profit sharing plan, IRA's, annuities, Keough plans, estimated social security benefit, military retirement benefits or other investment plans earned by you or which accumulated any interest during marriage, whether or not such pension or retirement benefit presently exists and the value of asset as of the date of separation and at the current time. A. If such retirement account, savings plan or pension benefit exists, state the present value of such account and attach supporting documents to the extent such exist verifying such values. B. In the event such retirement account, savings plan or pension benefit was withdrawn, distributed, paid under penalty or liquidated during the course of marriage or during the separation period, state the amount of such distribution, payment, withdrawal and the value of such account when such was received. 15 13. what is the condition of your health? If you are suffering from any problems with your health, please state the nature of your problems and the names and addresses of you treating physicians, hospitals or other health care facility. 16 14. Do you claim that any of the assets or property disclosed in your Answers to these Interrogatories is non-marital property? If you Answer is yes, please identify said assets of property, state the fair market value thereof, and state your basis for exclusion of each asset or property as your non-marital property. 17 15. Are you the owner of any joint accounts with any other person other than Defendant? If your Answer is yes, please identify each joint account, the date it was created, the names of all joint owners and their respective interests. 18 Exhibit "B" AN1)R1,'W C. SHEELY 717.697-7050 Attorney at Law 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 May 22, 2008 Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 Re: Kaczerski v. Kaczerski 08- 1353 Dear Lindsay: ,Cppy Please provide me with a status update on the interrogatories I forwarded to you last month, as well as the date which they will be completed. If you have any questions, please call. Very truly yours, ANDREW C. SHEELY FILE 717-697.7065 (fax) andrewc.sheely@verizon. net ACS/bmk c: Susan K. Kaczerski Exhibit "C" ANDREW C. SHEELY 717.697-7050 Attorney at Law 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 Dear Lindsay: July 30, 2008 Re: Kaczerski v. Kaczerski 08- 1353 COPY I previously wrote to you on May 22, 2008, requesting a status update on the interrogatories that were forwarded to you. To date I have not received any response to the interrogatory request. Please contact me to discuss upon receipt of this letter. Very truly yours, ANDREW C. SHEELY IiAman- 717- 1'7 f ft andrewc.sheel @v '-' y eruon.net ACS/bmk c: Susan K. Kaczerski Exhibit "D" ANI)R] W C. SHF,'E1,Y ' 717.697-7050 Attorney at Law 717-7-7065?(fix? - 127 S. Market Street andrewc.sheely@verizon.net P.O. Box 95 Mechanicsburg, PA 17055 September 19, 2008 Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 ic , e Re: Kaczerski v. Kaczerski 08- 1353 Dear Lindsay: In light of the fact that no answer, reply or objections have been filed to the Interrogatories served in April of this year, and subsequent written follow-up requests for a reply have been unanswered, Susan has directed me to pursue an Order of Court compelling an answer to the discovery requests, together with other requested relief, including attorney fees. If you have recently obtained the information necessary to complete the discovery request, please contact me as soon as possible. Very truly yours, ANDREW C. SHEELY ACS/bmk c: Susan K. Kaczerski Exhibit "E" Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE ORDER OF COURT AND NOW, this day of , 2009, upon consideration of the attached Motion to Compel, a hearing is scheduled for the day of 2009, at .m., in Courtroom No. of the Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, J. Andrew C. Sheely, Esquire Attorney for Plaintiff Lindsay D. Baird, Esquire Attorney for Defendant Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant AND NOW, this IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE RULE TO SHOW CAUSE day of , 2009, a Rule is issued upon the Defendant, Kazimerz R. Kaczerski, to show cause why Defendant should not be required to answer Plaintiff's written Interrogatories and request for production of documents. Rule returnable within days of service upon Lindsay D. Baird, Esquire, counsel of record for Defendant. BY THE COURT, J. Andrew C. Sheely, Esquire Attorney for Plaintiff Lindsay D. Baird, Esquire Attorney for Defendant Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant COP" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE PLAINTIFF'S MOTION TO COMPEL DEFENDANT TO ANSWER PLAINTIFF'S INTERROGATORIES AND REQUEST FOR PRODUCTION OF Plaintiff, Susan K. Kaczerski, by and through counsel of Andrew C. Sheely, Esquire, hereby files this Motion to Compel Defendant to answer Plaintiff's discovery requests and in support thereof Plaintiff respectfully states as follows: 1. Plaintiff, Susan K. Kaczerski, filed a divorce complaint containing economic claims on February 29, 2008. 2. Defendant, Kazimerz R. Kaczerski, by counsel of Lindsay D. Baird, Esquire, accepted service of the Complaint on March 6, 2008. 3. Plaintiff served Written Interrogatories and Request for Documents upon Defendant through his attorney on April 18, 2008. 4. By letters dated May 22, 2008, July 30, 2008 and September 19, 20008, counsel for Plaintiff has repeatedly written to counsel for Defendant requesting Defendant's response or answer to the written interrogatories and request for production of documents. 5. Plaintiff's complaint contains economic claims for equitable distribution and alimony. 6. Defendant's refusal to answer the Interrogatories and Request for Production of Documents is in violation of Rules of Court regarding discovery. 7. The information requested by Plaintiff is in the sole control of Defendant. 8. The information requested by Plaintiff is necessary for resolution of the pending claims and for preserving and protecting Plaintiff's interest in the marital estate. 9. Defendant's refusal to Answer Plaintiff Interrogatories has caused Plaintiff to incur unnecessary attorney fees and costs which could have been avoided by answering the discovery requests in timely fashion. WHEREFORE, Plaintiff, through counsel, respectfully Requests the entry of a Rule upon Defendant through his counsel to show cause why he should not be required to Answer Plaintiff's discovery requests in the above- captioned matter, or in the alternative, Plaintiff requests the scheduling of a hearing for the entry of appropriate 2 sanctions, including an award of attorney fees, for Defendant's failure to comply with Plaintiff's requests. Respectfully submitted, Andrew C. Sheely, Esquire Attorney for Plaintiff PA ID 62469 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 717-697-7050 717-6997-7065 (fax) andrewc.sheely@verizon.net 3 VERIFICATION I, Susan K. Kaczerski, verify that the statements made in these Motion to Compel Defendant's to Answer Plaintiff's Interrogatories and Request for Production of Documents are true and correct to the best of my knowledge and belief. Date: January/ L , 2 0 Susan K. Kaczer ski 4 CERTIFICATE OF SERVICE I, Andrew C. Sheely, Esquire, hereby certify that I am this day serving the foregoing Motion to Compel Defendant to Answer Interrogatories Propounded On Behalf of Plaintiff to Defendant and Request for Production of Documents First Set upon the following named individual this day by depositing same in the United States Mail, First Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed as follows: Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 Date: January , 2009 Andrew C. Sheely, Esquire s Exhibit "F" OFFICE OF THE COURT ADMINISTRATOR CUMBERLAND COUNTY COURT OF COMMON PLEAS 1 Courthouse Square • Carlisle, PA 17013 Phone (717) 240-6200 Toll Free 1-888-6970371 x6200 Fax (717) 240-6460 cou rtadminOccpa. net Andrew Sheely, Esquire VIA FACSIMILE ONLY: (717) 697-7065 January 14, 2008 copy RE: Failure to Comply with Cumberland County Local Rule 208.3 (a) Plaintiff i Motion to Compel Defendant to Answer Pfsintiff's Interrogatories... (08-1353 Kaczerski v. Kaezerski) Dear Mr. Sheely, Please note that due to your 1ilure to comply with Cumberland County Local Rule 208.3(a)(2) and/or Rule 208.3(a)(9), your motion will be held in the Court Administrator's Office until an amendment containing the missing information is filed in the Prothonotary's Office. If after two notices no amendment has been riled, your motion will be sent back to the Prothonotary's office and placed in the file and no further action will be taken. Rule 205.3(a), Motions. (2) The motion shall state whether or not a Judge has ruled upon any other issue in the same or related matter, and, ff so, shall sped the judge and the issue. (9) All motions and petitions shall contain a paragraph indicating that the concurrence of any opposing counsel of record was sought and the response of said counsel., provided, that this requirement shall not apply to preliminary objections, motions for judgment,on the pleadings, motions for summaryjudgment, petitions to open or strike judgments, and motions for post-trial relief. Please note that you do not need to file an additional proposed order or provide additional envelopes for service. -Your amendment will be attached to the original inotion. Please feel free to contact me if you have any questions or concerns regarding this matter. Sincerely, Jennifer E, Bray Administrative Coordinator Exhibit "G" j j SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION KAZIMIERZ R. KACZERSKI, PACSES NO. 051100364 ???? Defendant DOCKET NO. 552 SUPPORT 1991 ORDER OF COURT AND NOW, this 6th day of November, 2007, this matter having been scheduled for a hearing de novo before the Support on the Plaintiff's complaint for spousal and child support, and the parties having reached an agreement on all outstanding issues, upon recommendation of the Master it is ordered and decreed as follows: A. The Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as spousal support effective August 13, 2007 the sum of $600.00 per month. Any arrearages resulting from the retroactive effect of the spousal support obligation shall be held in abeyance and resolved in equitable distribution. B. The Defendant shall pay the private school tuition of both children directly to the appropriate school; said payment shall be made from the Defendant's annual net bonus from his employment with any balance of said bonus allocated 19% to the Plaintiff and the remainder to the Defendant. C. The Defendant shall be entitled to claim both children as dependency exemptions for federal income tax purposes commencing with tax year 2007, and the Plaintiff shall execute and deliver in a timely fashion any and all documentation required by the Internal Revenue Code to effectuate said exemptions. D. Except as modified herein the interim order entered October 9, 2007 is affirmed as a final order. M By the Court, C- -1 30 CD Z -n rnrnr z C= ?rn zoCD ?? - rn v' 4evin A. Hess, J. a ?rn D corn -+o -<C w Cc: Susan K. Kaczerski Kazimierz R. Kaczerski Andrew C. Sheely, Esquire For the Plaintiff Lindsay D. Baird, Esquire For the Defendant DRO Exhibit "H" ANDREW C. SBEELY ATTORNEY AT LAW Telephone: (717) 697-7050 127 South Market Street Fax: (717) 697-7065 P.O. Box 95 andrewc.sheely0verizon.net Mechanicsburg, Pennsylvania 17055 FAX TRANSMISSION To: Lindsay D. Baird, Esquire Fax#: 243-8110 From: Andrew C. Sheely, Esquire Subject: Kaczerski v. Kaczerski Date: January 15, 2009 Pages: 46 COMMENTS: ***CONFIDENTIALITY NOTE*** The statements, communications, information and documents accompanying this fax transmission contain information from Andrew C. Sheely, Esquire. These documents and communications are considered confidential and/or legally privileged information. The information is intended solely for the use and benefit of the individual(s) or entity(ies) identified on this transmission cover sheet. If you are not the designated recipient, you are hereby notified that any disclosure, copying, distribution or taking of any action in reliance on the contents of this information is prohibited. If you have received this transmission in error, please notify me by telephone or by fax transmission immediately (collect if long distance) so that I can arrange for the return of the original documents to this office at no cost to you and with reimbursement for the reasonable cost you may have incurred in responding to this notification. Thank you. TRANSMISSION VERIFICATION REPORT TIME 01/1512009 12:42 NAME ACSHEELY FAX 7176977065 TEL 7176977050 DATEJIME 01115 12:35 FAX N0./NAME 2438110 DURATION 00:07:17 PAGE(S) 47 RESULT OK MODE STANDARD ECM CERTIFICATE OF SERVICE I, Andrew C. Sheely, Esquire, hereby certify that I am ?e AjjA this day serving the foregoing Amotion to Compel Defendant to Answer Interrogatories Propounded On Behalf of Plaintiff to Defendant and Request for Production of Documents First Set upon the following named individual this day by depositing same in the United States Mail, First Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed as follows: Lindsay D. Baird, Esquire 37 South Hanover Street Carlisle, PA 17013 Date: January 2009 Andrew C. Sheely, quire C=l c' r JAN 1 6 20096? SUSAN K. KACZERSKI, Plaintiff V. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 08- 1353 CIVIL TERM IN DIVORCE RULE TO SHOW CAUSE AND NOW, day of _ T ZY7 . , 2009, a Rule is issued upon the Defendant to show cause why Lindsay D. Baird, Esquire's Motion to Withdraw as Counsel should not be granted. Rule returnable within days of service . Kacmrsla- Cc: indsay D. Baird, Esquire . ew C. Sheely, Esquire azimerz R. Kaczerski A F ' ? 1 SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW KAZIMERZ R. KACZERSKI, Defendant NO. 08-1353 CIVIL TERM ORDER OF COURT AND NOW, this 22nd day of January, 2009, upon consideration of Plaintiff's Motion To Compel Defendant To Answer Plaintiff's Interrogatories and Request for Production of Documents and Plaintiff's Amended Motion To Compel Defendant To Answer Plaintiff's Interrogatories and Request for Production of Documents, a Rule is hereby issued upon Defendant to show cause why the relief requested should not be granted. RULE RETURNABLE within 30 days of service. BY THE COURT, 1f esley Ole Jr., J. lrew C. Sheely, Esq. 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 Attorney for Plaintiff ndsay D. Baird, Esq. 37 South Hanover Street Carlisle, PA 17013 Attorney for Defendant rc no ? :Z Wd ZZ yr So0Z SUSAN K. KACZERSKI, Plaintiff V. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 08- 1353 CIVIL TERM IN DIVORCE MOTION TO WITHDRAW COUNSEL AND NOW COMES, Lindsay D. Baird, Esquire, hereinafter referred to as attorney for the defendant, Kazimerz R. Kaczerski, who moves this Court to grant her motion to withdraw as counsel and in support thereof respectfully represents the following: 1. On January 21, 2009, a Rule was issued upon Plaintiff and Defendant to show cause why the Motion to Withdraw as Counsel filed January 15, 2009 should not be granted. 2. Neither Plaintiff nor Defendant filed and objection. 5. Lindsay D. Baird, Esquire continues to seek to withdraw as counsel of record for the client. WHEREFORE, Lindsay D. Baird, Esquire prays this Honorable Court to grant her motion to withdraw as counsel in the above-captioned matter. Respectfully submitted, indsay D. Bird, Esquire 37 S. Hanover Street Carlisle, PA 17013 (717) 243-5732 Attorney for Defendant CERTIFICATE OF SERVICE I, Lindsay D. Baird, Esquire, hereby certify that I am serving the foregoing upon the following individuals at the following addresses by U.S. First Class Mail: Andrew C. Sheely, Esquire 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 Mr. Kazimerz R. Kaczerski 18 Montsere Drive Dillsburg, PA 17019 Dater OAdsay D. Bair quire RLED-OFFLE OF ?HE FP`T HIC OTARY 2009 APR 27 PH 1: 06' APR 2-8 ZON SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY PENNSYLVANIA V. NO. 08- 1353 CIVIL TERM KAZIMERZ R. KACZERSKI, IN DIVORCE Defendant ORDER OF COURT 7 AND NOW this 6 ` "daY of c , 2009 upon consideration of the within motion of Lindsay D. Baird, Esquire, the within motion to withdraw from counsel for the defendant is granted. By the Court, J. cc: Anj y D. Baird, Esquire w Sheely, Esquire Kaz Kaczerski ?? 0 c:)? c, tv _ cL ?L•,, ? S.iLU L C. ? N e SUSAN K. KACZERSKI, Plaintiff V. KAZIMERZ R. KACZERSKI, Defendant ENTRY OF APPEARANCE IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 08-1353 CIVIL TERM IN DIVORCE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Kindly enter my appearance on behalf of the Defendant, Kazimerz R. Kaczerski, in the above-captioned matter. otln M.?err 5020 Ritter Road state 109 MecharUcsburg, PA 17055 PHoNF: 717.766.4008 FAx: 717.766.4066 Dated: October 26, 2009 Johin M. Kerr, Esquire Attorney I.D.#26414 Law Office of John M. Kerr 5020 Ritter Road Suite 109 Mechanicsburg, PA 17055 (717) 766-4008 CERTIFICATE OF SERVICE The undersigned hereby certifies that he has served a copy of the foregoing, "Entry of Appearance," on the below-named individuals in the manner indicated: Via Regular Mail Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 (24 d_)?W John M. Kerr, Esquire Law Office of John M. Kerr 5020 Ritter Road Suite 109 Mechanicsburg, PA 17055 (717) 766-4008 Dated: October 26, 2009 9 Lw O?Q T ; cry 5020 Ritter Road Suite 109 Mechardcs", PA 17055 Paom: 717.766.4008 FAx: 717.766.4066 OF THE PROTHONOTARY 2009 OCT 26 PM 4: 03 CUMl'-.,:?:-' ?,..;UNT Y ME'N NSYLVANiA 4 SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA C-) ,,.., VS. CIVIL ACTION - LAW == KAZIMERZ R. KACZERSKI, 08 - 1353 Defendant IN DIVORCE f MOTION FOR APPOINTMENT OF MASTER Susan K. Kaczerski, Plaintiff, moves the Court to appo%it Master with respect to the following claims: (X) Divorce (X) Distribution of Property (X) Alimony ( ) A.P.L, Attorney fees and costs and in support of the motion states: (1) Discovery is complete as to the claims(s) for which the appointment of a Master is requested. (2) The defendant has appeared in the action by his attorney, John M. Kerr, Esquire. (3) The Statutory basis for divorce is 23 Pa C.S.A. § 3301(c). (4) Delete the inapplicable paragraph(s): a. The action is contested. b. An agreement has been reached with respect to the following claims: None c. The action is contested with respect to the following claims: Equitable Distribution, Alimony. (5) The action does not involve complex issues of law/fact. (6) The hearing is expected to take 1 day (7) Additional information r levant to t None Date: Ate l(( l J/ nd ew C. Sheely, Esqui Attorney for Plaintif ORDER APPOINTING MASTER AND NOW, , 2011, E. Robert Elicker, Esquire, is appointed Master with respect to the following claims: Divorce and all claims raised in the action. By the Court: J. CERTIFICATE OF SERVICE I, Andrew C. Sheely, Esquire, hereby certify that I am this day serving the foregoing Motion for Appointment of Master upon the following named individual this day by depositing same in the United States Mail, First Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed as follows: JOHN M. KERR, ESQUIRE LAW OFFICE OF JOHN M. KERR 5020 RITTER ROAD SUITE 109 MECHANICSBURG, PA 17055 Date: March 7, 2010 A drew C. Sheel , Esquire 2 SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW- rT" KAZIMERZ R. KACZERSKI, 08 - 1353 =rte- ' - i Defendant IN DIVORCE -,.j MOTION OR APPOINTMENT OF MASTER Susan K. Kaczerski, Plaintiff, moves the Court to appoint* Master with respect to the following claims: (X) Divorce (X) Distribution of Property (X) Alimony ( ) A.P.L, Attorney fees and costs and in support of the mo ion states: (1) Discovery is co plete as to the claims(s) for which the appointment of a Master is requested. (2) The defendant has appeared in the action by his attorney, John M. Kerr, Esquire. (3) The Statutory b sis for divorce is 23 Pa C.S.A. S 3301(c). (4) Delete the inap licable paragraph(s): a. The action is contested. b. An agreement has been reached with respect to the following claims: None c. The action is contested with respect to the following claims: Equitable-Distribution, Alimony. (5) The action does not involve complex issues of law/fact. (6) The hearing is expected to take 1 day (7) Additional information r levant to t Norms - & r yy.: ? ? w Date: nd ew C. Sheely, Esqui Attorney for Plaintif -- F ORDER APPOINTING MASTER -- AND NOW, 2011, E. Robert Elicker, Esquire, is appointed Master with respect to the following claims: Divorce and all claims raised in the action. By the Court: r Andw 0 . Sheel y, &q- --?'f P J . v John M . Kerr Esq- 01 Odd ? o? OF I, Andrew C. Sheel , Esquire, hereby certify that I am this day serving the foregoing motion for Appointment of Master upon the following named individ al this day by depositing same in the United States Mail, Firs. Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed LAW Date: March 7, 2010 follows: IN M. KERR, ESQUIRE FFICE OF JOHN M. KERR 5020 RITTER ROAD SUITE 109 ANICSBURG, PA 17055 A drew C. Sheel , Esquire 2 SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYL`@NI)!,:? V. NO. 08-1353 r+?w .7C- KAZIMERZ R. KACZERSKI, IN DIVORCE -<> J Defendant >c, DEFENDANT KAZIMERZ R. KACZERSKI'S PRE-TRIAL STATEMENT BACKGROUND Plaintiff Susan K. Kaczerski (hereinafter, "Wife") and Kazimerz R. Kaczerski (hereinafter, "Husband") were joined in marriage on October 15, 1988. The marriage has been punctuated by three separations, with the Wife leaving on each occasion, usually as a result of disagreements over her lack of financial responsibility and fiscal discipline. The first separation occurred in 1991-1992 and was also occasioned by an extramarital affair Wife engaged in with a superior at PHEAA which Husband learned about following reconciliation. At that time, she was a Team Leader/Manager in Collections. Prior to the marriage, the parties agreed that Wife would be employed after children were born (seven to eight months after birth), and that her earnings would be earmarked for the purchase of a home. After reconciliation six or seven months later, Wife refused to return to PHEAA without explanation. The parties again separated in 2003 and were subsequently reconciled. In 2007, the parties separated for a final time when Husband refused to retire her r separate credit card debt.' In 2007, Wife had accumulated $32,000 in separate credit card debt Y, , 1 ,/ I I ; 1( 1 6020 Ritter Rode Suite 104 Mechanicsburg. PA 17075 P 11 Irvc: 717 766.4008 FAx 717.766.406H 'I i 1Wife's credit cards were the focal point for each separation. Her separate credit card debt was the result of debt she accumulated for non-marital expenses. During the course of the marriage, Husband paid all household bills and none of Wife's separate debt were for family or household obligations. Early in the marriage, Husband encouraged Wife to attend and to receive financial counseling. unrelated to marital or family obligations. Husband had paid $4,000.00 to Debt USA, in an effort to have a third party negotiate resolutions with various of his Wife's credit card companies. Ultimately, Wife obtained (March 26, 2007) a loan which was collateralized by Husband's non-marital funds on deposit at Member's First from an inheritance he had received after the death of his parents. Payments were being deducted directly from Wife's account, which had just begun at the time of separation. Following separation, Wife defaulted and the $32,000 owing was taken directly from Husband's separate funds remaining from his inheritance (see, Exhibit "A" appended to this Pre-Trial Statement, Members First Loan and Security Agreement, indicating that it was paid off on June 17, 2008). See, also, the Members First document indicating that $603.34 was to be deducted from Susan Kaczerski's account Husband's total inheritance was approximately $115,000. He utilized approximately half :i)20 Ritter RWa I Suite 104 Medl-irlilSburg. PA 17055 Pii m,: 71 7.766.4008 F,,, 717-766.406( of these funds to build the marital home located at 18 Montasere Drive , Dillsburg, Pennsylvania 17019'. He purchased the lot for $52,000 which was paid in cash and not financed. The lot was utilized as collateral for a "bridge" loan. The parties' former home was owned by Husband prior to the marriage. Husband had intended to have Wife's name on the deed and mortgage. At the mortgage interview with Chase Mortgage, he was presented with a document which delineated his Wife's asset/liability ratio and told that the loan would not be made if her name was associated with the mortgage documents3. Because his Wife was nevertheless required to execute a document due to their marital status, she was able to demand the payment of $20,000 or she would not sign the document. Attached is the Settlement Statement and receipt `Accordingly, Husband is requesting that this sum be deducted from any calculations of the net equity in the marital home. 3This was the first time in which Husband became aware that these credit card bills of Wife existed. Many of them proved to be fraudulent in that she had forged Husband's signature. One PSECU loan document for $14,000 was forged, among many others. Wife had the credit card companies forward all billing statements to her mother's address in order to conceal them from her husband. (Exhibit "B"), evidencing that Wife received $20,000.00 due Seller on January 25, 2005. Husband does riot know what Wife did with these funds. Husband received the net after this disbursement of $63,484.36. Husband requests that he be given a credit against any division of marital assets, as a result of this dissipation of funds from the non-marital asset4. In addition, on or about March 29, 2003, following reconciliation after the second separation, Husband arranged for Wife to borrow the sum of $35,171.50 from PNC Bank (see, Exhibit "C" appended to this Pre-Trial Statement). When the former marital home was sold in 2005, the sum of $31,061.00 was paid from settlement proceeds of this non-marital asset to order to satisfy Wife's separate loan resulting from credit card purchases unrelated to marital or household obligationss. Accordingly, during the course of the marriage, Wife received the benefit of $20,000.00 cash from a non-marital asset, as well as having a total of $63,061.00 in debt retired all of which was unrelated to any purchases on behalf of the marriage6. Following her departure from the position with PHEAA in the early 1990s, Wife has refused to work on a full-time basis as promised before the parties' marriage'. She cleaned houses for a time, and was employed by Nathaniel Patterson of Pay Check Corporation as a nanny and housekeeper at the rate of $16.25/hour on a full-time basis. She was asked to be full- time, but subsequently resigned her employment because she did not like Mr. Patterson's wife. Nevertheless, prior to the parties' marriage, Wife's expertise3was in warehousing, customer 4 In addition, Husband received a loan in the amount of $12,000 for post-separation improvements to -1L0 Ritter Roar i s?,ite 104 the marital home. This loan was retired by Husband on September 1, 2010. Mc(hanicsburg, PA 17055 V, M iom : 7 17.766.4008 Fnx 717.766.4066 ji 5 In 2003, Wife also took $12,000 which was earmarked for the parties' daughters college funds. 6 It bears mentioning that during the course of their marriage, Husband wrote numerous checks to Wife to cover her personal, as well as the household expenses. These checks remain extant. 7 During her first marriage, Wife was employed at Smith Klein Beecham in Pittsburgh. service and transportation working for Dauphin Distribution. She currently is employed by Messiah College. Husband is an immigrant from Poland who came to the United States when he was two years of age. Reared by hard working parents involved in rehabbing homes, he has risen to be the Vice President for Corporate Sales of NFI Transportation. He earns slightly over $100,000 annually. ll. Statement of Assets and Liabilities The principal asset of the marriage is the marital home located at 18 Montasere Drive, Dillsburg, Pennsylvania. An appraisal was recently conducted by Wife utilizing Mark Heckman of New Cumberland, Pennsylvania, who determined that the home was worth $265,000 as of October 24, 2011.8 There was a mortgage balance of $79,476.00 as of October 6, 2011. At the Pre-Hearing Conference, there was much discussion of various Certificates of Deposit in Husband's name as of 2007. These were monies he received as an inheritance from both parents' deaths in 2004 and are non-marital assets. The amounts he had on deposit have been dissipated over the past four years to approximately $6,000.00 remaining as of this date. These funds were taken when Wife defaulted on her 2007 loan to Members First; a $12,000 loan to make renovations to the marital home; for a Lexus automobile ($17,160) which he needed post-separation (could not utilize his company car for personal purposes); and to purchase an automobile for the parties' elder daughter (Mazda 3) ($10,000). However, these were non-marital assets (see, Exhibit "E," appended to this Pre-Trial Statement, which includes ??, / various Members First Statements, detailing the flow of funds consistent with the above 12() Ritter Roar Suite 104 r, Memoni(=5burg. PA 17055 717.766.4008 commentary). F717 766.4066 8 The appraisal report, appended as Exhibit "D" to this Pre-Trial Statement, notes that older comparables had to be utilized in order to more accurately relate to the marital home. Husband has a PNC NFI Industries, Inc. Employee Retirement Savings Plan which, as of March 31, 2011, had a vested account balance of $138,004.09 (see, Exhibit "F," PNC Plan Account Information Summary, with Defendant's handwritten notations). In addition, Husband has an IRA through Waddell & Reed with a portfolio balance as of September 30, 2011 of $48,568.86 (see, Exhibit "F"), as well as American Funds for his daughter Joanna in the amount of $5,673.00 as of September 30, 2011 and for his daughter Alexandria in the amount of $7,943.22 (see, Exhibit "F"). III. LAY WITNESSES Kazimerz Kaczerski will testify as to the transactions identified above and will identify all exhibits offered, with the exception of the Heckman Appraisal Report. IV. EXPERT WITNESSES Other than Mark Heckman testifying concerning his appraisal report, Defendant does not envision calling any expert witnesses. V. EXHIBITS A. Appraisal of real property located at 18 Montasere Drive, Dillsburg, Pennsylvania 17019; B. All exhibits appended to this Pre-Trial Statement; C. Defendant reserves the right to amend this exhibit list prior to any Hearing. VI. PROPOSED RESOLUTION OF ECONOMIC ISSUES Given the fact that Wife has already received over $80,000 in direct cash payments or in retirement of separate credit card debts unrelated to the household or marriage, and given the 5720 Ritter Roar SL11e1O4 ',. Mech.ulirsburg. vn 170;, fact that she has been receiving spousal support of approximately $1,000 monthly for over four P ONI-_: 717 766.4008 FAX 717.766-406f, years, Husband proposes no more than a fifty (50%) percent share of the marital assets for Wife. Husband suggests that the equity in the marital home be divided evenly, after proper deductions of a) $83,061, as detailed above for the pay-outs Wife has already received the benefit of; and b) $65,000, representing cash payments for the lot and for a down-payment from idusband's own inheritance. Respectfully submitted, John M. Kerr, Esquire Attorney I.D. # 26414 John Kerr Law, P.C. 5020 Ritter Road Suite 104 Mechanicsburg, PA 17055 (717) 766-4008 Dated: November 16, 2011 5020 Ritter Road S Lte t?)4 Me(hani(sbUrPA 1 705, PnoNe: 717.766.4008 'I F'Ax 717,766 400, CERTIFICATE OF SERVICE The undersigned hereby states that he has served a copy of the foregoing, "Defendant's Pretrial Statement," on the below-named individual in the manner indicated: Hand-Delivered Andrew C. Sheely, Esquire 127 S. Market Street Mechanicsburg, PA 17055 ?14 e aZ Joh M. Kerr, Esquire John Kerr Lw, P.C.r 5020 Ritter Road Suite 104 Mechanicsburg, PA 17055 (717) 766-4008 Dated: November 17, 2011 iJ020 Ritter Roar1 Swte 104 Mecha nicsburg, PA i-,os5 " Pnoi, _: 717.766.4008 F \x 7 17 766.41166 - r l CLOSED-END NOTE, N Ist 5000 Louise Drive, P.O. Box 40 Mechanicsburg, PA 17055 MEMBF_RS 1' BORROWER'S NAMEAMP-1 KAZIMIERZ KACZERSK) O FIAEO Lj VARIADLE Lf w." Amount Financed: The amount of TOlat 11 Payments: The credit provided to you or on your you volt have paid after you led behalf. r -ode all payments as schetiduled. M> MSERS 1st Federal Credit Union JUN ? 7 2000 yearly rate. S 32 000.00 S 38,200.03 S 4,200.03 __- 0,95 % Variabh Rau: If your ban has a vaAPab rate os ntlkabtl ebovn the AeIrMIe1 Pt-menu0e Ratp may inasaae during V,e term d Nis Uensactian II dao (Index) dunpea, The credit union wYl edtl a rnerpin of wmeWde vabe. TM 14 cnan00 troNtsy m the Ont day or Ina mooch. The rote If never be Iwahar Own U+e maxirrMm rate allowed by _ is of me same amount For Example, if your loan vvas for $5,000 al 15% for se mon0ud? the Mn rU Perce-9. R b inuaesod)by 2% MM 63 anal year, Itlro Ierm or yar loan world Lxrease by Mo months atlc : Wed month evougn on autotnaUe deducua+M1om eras Gnor!!^7/5°vl^Da •Prorarred Rate: If checket Dd,hctheounlot,tW ;;;;g eppYes to your loan . ,I b. AE [? AiAr7m P.Y^wn Rau: Oarause You curve a0r?pey!e?d to nwKO your rep h PoYmmu .. isr AcsounL Ywr ANNUAL aFSRCnC n ?ARau This rate vrdl increase a 20%2l0 you c =NU auwnwuc peYr^onl e?raen0emu+l u lal b melnlaiwKacnt funds In your eccounb is Ne Aul Peymen cover NeornaGC eutyruUC payments. In sue+ ° osa. Ne effect of Me Increase enanpemen your rat will iroirona a to to 2096, rtwlmp lI ?tadditional Payment ntad Rote Is tOx one 55.1)00.00 Wan for BO months and you mesa the aubmatia pay Venable Rsu Pnlamd Loena. If your loon is a variable, ata teen end you 9uoYfy fora pMOnad rata, your Prole Red tllscounl Is taken al the Utne you take al your ben. a Ne IrWea (es dladosed above). For esalnpl<, d o vaAade mlo loan's initial ANNUAL our initial Dlefrxaad ANNUAL PERCENTAGE RATE All be WA%. Your initial preloRCd ANNUAL PERCENTAGE initial Protcrred ANNUAL PERCENTAGE RATE will then n ary according to changes PERCENTAGE RATE B 1296 at the time you lake loo be, y In RATE will then very accon3in0 fo the Index. as disclosed In the -VBrittDW Rate- provision obove. Pburd AGESRATE dLsdozeld above irx l ea Imp s your preferred talus iernalnsp N eneamte. your ANNUAL PERCENTAGE RATE wiY be the poforrod ANNUAI, rty le to P men! Frequency When Paymenb Am Due Property Irasumnee: You fnaY btain propemtJtO Number ofPaymenb Amount of Paymmu aY insurance from net yt%1 WantOthat Is acupla0510112007 the credit union. If Our get the in5trrar3ce fro v 59 $603.34 Monthly - BoginniM OSl01 credit union you Svt I pay p+ rd sd..a°'• f 5602.97 Final Due -Oct 04101/2012 S N/A w a: Other SacuAry: CWalorar sewrlnp otnor loons vritn ma cmdil urdm dre paotls or property (Describe): being purauced. '1-, J 11 also sown tlus bon, You arc r ivrd seventy int-St in CX _ your. ares and/or deposit W ?y,e credit union, end: ln II° payment is l=_-- not to d poit Balanff: Thea ?? Ithden?it If .y. SIMAFe eaS Non NfAlllrIn-re-1 ee t as°'e L•Ia CMIga: Clanged a late fc0 of 5% 01 not lake In ryrnant nNnda and Paru.na. p?v K GUI d dale ".W ITEMIZATION OF S 32 OtX).OC Amount Paid to others on your behalf (Describe) - AMOUNT FINANCED Sooo To Am..aaL;N S To ,4MOUNT GIVEN TO YOU ?.)IREC rLY $ 32.000.00 sow To umna.nN Lea S To S To S To Ah10UNT PAID ON YOUR QCCO!1NT7, To To F.a. -- --- 5 a"d sowenr S ?REPAID FINANCE Ch(AR3E To U6.d S.IUnr To 5 _ -' RI ----- -- SECURITY INFORMATION _.---- VALUE ----- --'-- YEAR I. D. NUMOER TfPE MODE -- ). n!ANE `- __.._.. R - = PERCENTAGE FINANCFCHARGE- RATE' The cost of yotr credit as a The douar »mount the credit will cost YOU. OTHER (Describe): You rie°yc ??..?. - 127395100 antl/or DeOOSns of J2000.00 _--_1_ YoU agfee Nat Ne Im^s and COndiYOnS in No Oill7awrv atalemdnr end Ure bon nr Ma Nan one partower, wo ogrtt Nal all Iho mndidma of the IOan and sewM1y aQreomd received a coDY of No bsn one security aprooments untl tl?sdosue stntornent Co-sign contdnad m pope?? _ fir- f'? O OVd R ? -'COSIGNER DA (SEAL) (SEAL) ryy ea r ec: Ints lowwd on page Y or IA sl?ducumOrn sti II avnly to H+i: ?oanii Inar s room vomin0 des loan srtuil aDDIY b coin Ninny and severaly. You ocknoMedoe Hal you have If you we signing 33 co-signer, you ackrw.Medge rtceipt of the notice to co-signer TIER pv?µER f1 - 0-SIGNER O; -7 D •OTH -,R OOWMN 7? -CO ER (S DATE I Q CO.MAILER O -OTHER OWNER O 'CO-SIGNER (SEAL) YE X w?+.•nL...w..o«.w.?roradm,aa•b Pln.a e.er. ?u.e? s+r rn.. r+ib<...nr^+s.nOr en+r..r.4n..r. n...e,.. rad.la p.rnenr na+w DUr+Maaan vw IdFF Jn*d'n any Saw. wo>•aWa.arr?.rw Wnr ].nary a'r't-eoalcveAua?w..•,.w..aea adr?^n.a•+iw ?? p?.v.wiv ral? a• neon' Mon r . edv'rraa a rYY+d ay Nr. __ -- -- APPLICATION FOR GROUP CREDIT INSVRANCE nn. oa In.a mv«p. m ma C,.d? a ..i.a.a. We arw .pne N o.r w raau:ae Ivan:.e I M) u+a.raund m•t w.. m.r n. wed W In. ri.+r••;1 d Nr E .),',,,a.p for m. areon..aYr.np. eee•r+ra> ••?a+:• a ?e.n,N k.t aM omn. (oral Y?arrahn Baal ulpkrl We N.-or tat iy pwWaa 01 N;a inawab u vomnaary and or neuhd N prd•r b aouin read! •nd Vial l lWI rr'aY i' A p _%NNT GO?pPL'00 m,nwio'vrry and'viOvbY.ry sore e^akr .nev.n mapn«s.ro lNanRas •n ?bt.4ieN for :+Yr.ne. p U 13 U oMnp R,a++dom, i and ; nu+t M +nn.•?+d IY dahrmina my four) ellplD:lity ran c sue+c.: (AapYCaai+ b 6l. inav+nca cwernT oey) wu yeti M under ae• 70.>n n• aNW .red mamruy d.u d your Iwna Q I (Mra'rraba m OuD4+y muanP or+I) y`a• aO11 W "^? spa 70 en the aUaduled malurey dN of your ban Arta ab o.?i M•? a •'•'k'nu ? ? Z ?„ba w Mm. Ix `apes w pn61 for ]D boon er roan par wea4 •rN Na. Da•n ao rorm^D ter SO days or Horn a a V in rdar to drtarrrd; aldldDyiryaueka ? bn, Yeur le+n aaeaada 3 7!.000.00 Uw rollowlrra pw.tlen moat Mao a e +nn k naw.nu ar?d wan mayury 0,;.,d e r tw a> unnr. I, Hoek or eoron,rY rl r ]. 'ddpudnp W N,l N.e Hars, Nro You ma OSI a NOS R.Ial.d CaRpiai (ARG)7 pptc. nt er i enawr lap' m eua+km t a 7. w urWralaM W I W a p.nan N rm+akiyaN a rjyheu,, Aopue•d Yranariw D,lu ?5>M?a ry • r1rA Yp b M .Roue net aausd+W S 1.00. My(ron•rd..nmp?,?,,,y w.wmawuefrM?ulune. rnevw?ve11.L1?a1'f•rina.n+ DOn s ac+tlonlulnauvano )lasso pp ..aa tb wurad. Ifm-.ppunl art anrawr YVi moues rid MNint•ntbdafnud any l^auranu company ar e'arWnon TM aeKli+. h?Wmy Iov?Inara•rra niWeu eat. el tlvs aapivUOn Nay Wnen MwknwMnplYa p. in boatdwn{o cer..rJnafrnrdul.nr Inav1-pp°cact grata{ar,mntdvA•kn conYlninp enY m•t•rbW his. inlormaDenucrMKUla lxat•purpow 1mbNadn lermatlon eawminp YlThla apppca»an vlY oath UUdin <oMa.l if all appaDN pp lkapWluden Yana. "&'h M rotab. ah Wank. ?.nkhNacrbr and suty.ch wch panon le criMra,l and elNf pa MIW+. OO rid a(pn tea e+ .;,YUa hze rip; Oran cempNt.d, L+• d•Dror h•a ne, a'p^rd end oaNd rti • •rbn and frtrr •op0 atlas has c Dvn wM1naawd. NOTE: ONLY ONE APpUCA.NT MAY APPLY FOR DISAEitLITY COVERAGE. CREDIT INSURANCE APPLIED FOR: Q No Credit Dlsabilly Tolat Premium Yes No Single Credit Life Total Premium I ? Yes 0 Yes O No joint Credit Life IndkaW vMCI applirantts): ',? Applicant [D C.-APOC nt $ O.oo __.. ?..._ w ..r ee.eraoa IN wb;e? • rnary. V 6eie•1•d on Wa +pplir+den LASER.WDRD F 43169 Rev. Indicate wtich aPPI-I(O AppYCOnt ? Go-APPIGI 5 0.00 CO- PLI rs; SIGNATU DATE OF GIRTH DATE AC PLICANT) SECONDARY EFIWARY ICo-APpLIC )}) Y 3 cnrvRic+i* +9p7 wr.r..aa aaYa„i canvr?•+. YK ..a.nr:u ..,.r»e. EXHIBIT A St Payroll/Auto Transfer Distribution MEMBERS P rruru.?r.cuenrr c?u?? ------- Complete in Blue or Black Ink - Member Name Daytime Phone No. Account Number EFFECTIVE DATE or as soon as possible upon receipt (write ASAP):-...- -_ -, . _- ? -! - (Form must be received at least 5 days prior to date) Program (check one): ? Direct Deposit (whole paycheck deposited)` 'Effective date must agree with your actual paydate Auto Transfer from. check one) Auto Transfer Frequency (check one) Savings (00) jL9 M NTHLY (check one) El Checking (11107) 1st of even' month (901) ? ? MMA (05) ? 16th of every month (916) Supplemental El SEMI MONTHLY - 1 st & 16th of every month (9011916) Employer Name El (01) El EVERY TWO WEEKS - Everv other Fridav (902 or 903' (for Direct Deposit F'ayrc!I Ceduct:cn, Only) Se:ir.Z s ? EVERY FRIDAY (9021903) OFFICE USE ONLY Distri Men I ACC( CHECK CMS. ["l EN DNE?.NF:IE TE B DECREASE 8 ?ECfZEASE -- t ?/ D (Distribution Changes Limited to one per pay period) ndicate all deletions from current distributions as 'delete I hereby request Members 1st to distribute the above funds from my account to the accounts and in the amounts indicated above. For Auto Transfer, ti-e funds to cover these transfers must be in the account (from which the funds will be transferred) before th?> iransfar date. (Automatic Overdraft Protect on Des Not ApplY to the Auto Transfer Frog, ani). ? r?,?phDnoh/ ,rb81 Request Date Member Signature" n ed member is neither a primary nor joint owner. -'Signature required for au distributions involving an account th Ofthe above Use Y For Fk Reviewing Associate Originating Associate Name/Teller ID Name/Teller IC -- '.1BRS 1: S-29 -- - - UM Rev 07r05 i........_.._ --- - - -- - -.._.?.- - 'Dc Not submit a revised distribution form if you have a pending distribution form 00 00 a J J CL Z U O Lu U U Q w CC ? U U w U) F- -co cn aw I zw Z? O U F- 0 z U) O J U W o F- o Q CD F- U) CD W o J ° Q _ W N o Y * W C/) co cj? W J N W G J u Q Y Y Q U co (n ?- Y LIJ Z C J O Q c? cn O D cn D 6 :D a- W C? J UD O W -0 C? U W U Y U Y LLJ ? w 0 Lli . U W - U Q U LO In Y Y U w Q co 0 0 N 0 1: Lo ? co C? O w A N N t W_ F O p co z CD CO = Q O N CO (fl Q U Y U - F» Y ? Q7 a) ai ai c F?- 3 m -0 a 0 0 0>, ou) o QE0 O -01 m E E T - ? L co .n O 0 0 0 0 0 N H4 a) E Q A M v M CC) fA "NO O U O d m O (n ?JJ U 0 LL EXHIBIT B OMB NO. 2502-0265 B. TYPE OF LOAN: 3. aX CONV. UNINS. 4, E 7. LOAN NUME 0001101008 5. (?CONV. INS. r+ tEjFHA 2. U S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 6 FILE NUMBEI GIL376-04 SETTLEMENT STATEMENT 6 p10RTGAGE INS CASE NUMBER: C. NOTE. This form is lumishe:! tc give you a stateme":! c( actual se lit costs. .;n;ouns paid to and by the settare n tot agent are shown. rmalional purposes and are not included in the totals. !!ems marked "jPOC)" were paid outside the closing; they are shown here Inr inln t 0 3nJ8 (GIL376-04 VFOIGIL376-04/8) . D NAMEAND SELLER: 7NAME DRESS OF LENDER: DDRES E. NAME AND AS OF ADDRESS OF BORROWER: EPTANCE KAZIMIRZ R. KACZERSKI and CHRIS TOPHER M. GILLESPIE and SUSAN K. KA('ZFRSKI GREDDA L KUTE 120 SOUTH BALTIMORE STREET ER DRIVE. SUITE 500 33 W. HANOVER STREET DLLSBURG, PA 17019 47 DILLSBURG. PA 17019 _ I. SETTLEMENT DATE: , . H SETTLEMENT AGENT: 25-1619811 G PROPERTY LOCATION 120 SOUTH BALTIMORE STREET I TRI-COUNTY,4BSTRACT SERVICE January 25, 2005 L'ILLSBURG. PA 17019 ?--- o'ORK County, Pennsylvania PLACE OF SETTLEMENT 19 N. BALTIMORE STREET DILLSBURG. PA 17019 K. SUMMARY OF SELLER'S TRANSACTION J. SUMMARY OF BORROWER'S TRANSACTION 400 GROSS AMOUNT DUE TO SELLER: 100. GROSS AMOUNT DUE FROM BORF20WER: 150.000.( . nt(aCt Sales Price 150.000.00 401 CO 101. Contract sales Price .- , - 402. Personal rropeny i 102 Personal Property _ s to borrower (Lute 1400) 7,204.00 403. 103. Settlement Charge 404 104. -- 105 405 adjustments For Items Paid By Seller ir) advance Adjustments For Items Paid By Sel.'er (n advance 40C_ City/Town Taxes to 106. Gil /Town Taxes to u t i 401 Count Taxes 01/25/05 to 07101105 675.68 07. Count Taxes 07/O1/OS ' 01125/05 tO 675.68 408. SCHOOL TAX V)8. SCHOOL TAX - ------ 409 - 109_ __---- - 4 t 0. C -- 110. i 1 1 _ _ -_ - --- - 111. j 412, GROSS AMOUNT DUE TO SELLER 420 150,675.68 720. GROSS AMOUNT DUE FROM BORROWER i 157.879.68 . DUCTIONS IN AMOUNT DUE TO SELLER: 200. AMOUNTS PAID BY OR IN BEHALF' OF BORROWER: 1 000.00 500. RE 5() 1. Excess Deposit (See Instructions) 9 977 86 201 Deposit or earnest money 150 000.00 5O2. Settlement Charges to Seller (Line 1400) ' , , - 202 Principal Amount of New Loan(s) ec.t to 7K 3, Existin loan(s) taken sub 04 85 cn? Fxistir.G !cams) taken subLe l to __-__- - - ---t . _.. avG„ , ;first ivtorgage to PSECU!4: 2 9541867_ LOH^ . _. _.... . nc inn CV°. -_ Jrrti_ 206. ---- 507. (Deposit disb. as proceeds) i? ?. , -/ G' . 20750t 208. - 509. 209. _ - Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid fay Seller _ 47.61 ^t0 City/Town Taxes 01101/OS to 01125/0_ 5, 47.6 1 51 0. City/Town Taxes O1/01!05 to 01/25!05 --}-- 511 County Taxes to 2,11 County Taxes _-10 --- 1O - _ l0 512. SCHOOL TAX 212, SCHOOL TAX ----- 51 215. 216. ------ 5 t 7. 217 518 219 67,191.32 ?20. TOTAL PAID BY/FOR BOFROWER 151,047.61 520. TOTAL REDUCTION AMOUNT DUE SELLER 600. CASH AT SETTLEMENT I FROM SELLER: 150,675.68 300. CASH AT SETTLEMENT FROM/TO BORROWER: _ 191.32 _ 57,879.68 f (i(l1. Gross Amount Due To Seller (Line 420) 301. Gross Amount Due From Borrower (_ine 120) I( 67, ( +51,047.Fi1) { 602. Less Reductions Due Seller (Line 520) 302. Less Arno,-- Pzid l3Y!For_ Bow!"r"Borrow- (Line 220) 83,484.36 X FROM To BORROWER 6,832.07 6()j CASH (x TO) ( FROM) SELLER 303. CASH( ) ( ) The undersigned hereby acknowledge receipt of a romI cte(f copy of pages 1&2 of this statement & any attachments referred to herein IT IS A TRUE AND I HAVE CAREFULLY REVIEWED THE ! UD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, ENTS MADE ACCURATE STATEMENT OF ALL. RECEIPTS AND DISUURSEMT STATEMENT N my F.000UNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAI I HAVE RECEIVED A COPY Of; THE HU JR SE E-MEN- \ \\ ` r Seller :` i...., Borrovvi?.? \,_1\ KAZIMIERZ R KACZERSKI CHR STOPFiER M. GILLESPIE ``) ? -- , _ SUSAN K. KACZERSKI i OF THIS F OF TH T MY GREDDA L KUTE OUNDTHE BE S WHSCH`RO'ERE RECEIVED AND HAVE BEEN TOR WILL BF_ DISBURSE U ri3Yl THE UNDERSIG EDEADS PART OF THEE SETTLEMENT TRANSACTION. 4 ?- _ ... .. SETTLEMENT FFICER SIMILAR Settlement Agent l',)GY MAKE FALSE STATEMENTS T -1 H C PENALTIES UP THIS OR ANY FORM. I CSN RIM D O FNOWFNDLIPAPR SONMENT. FOR DETAILS SLE :( fiLEE 8 UTS. CODE SECTION 1001 &SECTION11010 Page Z 7^0. rOT,11. COMMISSION Based on Price Division of Commission (line 700) as Foflows_ 701.5 7,500.00 to ERA NRT, INC 702. $ to 703. Commission Paid at Settlement _ t 704. TRANSACTION FEE 800. ITEMS PAYABLE IN CONNECTION WITH LO CO 1.8667 BCt. Loan Origination Fee t 802. Loan Discount -___-- to CA 603. Appraisal Fee to 804. Credit Report to - 805. Lender's Inspection Fee _- 806 Mort a e Ins. App. Fee o - 807. Assumption Fee --__- ?o CC SETTLEMENT CHARGES $ 150.000.GO ?a 5 0000 ,% 7,5 811. ITEMS REQUIRED BY LENDER TO E3E PAID IN ADVANCE 00 . 9 Interest From 01!25/05 to 02!01105 1 150( @ . . Insurance Premium for 1 ontris 22 902Morta e to=OMIMUNITY E nce Premium (or -_ 903. Hazard Insura 905. 1000. RESERVES DEPOSITED WITH LENDER rno tt s Cg 5 1001. Hazard insurance months @ $ 1002. Mortgage insurance --- months ((_P5 1003. City/Town Taxes - nonths @ S 1004. Count Taxes - ----- - months @ $ 1005. SCHOOL TAX months O 5 _ 006 -- -- - - $ months CO-) 1007. 1008. AGGREGATE ESCROW ADJUSTMLI mo- ntt- )s (al 5 1100. TITLE CHARGES 1101. Settlement or Closin Fee ING PROTECTION LETTF_R -, to to FIRST AMEBIC, - 1102. CLOS to 1103. Title 1104. Title Insurance Binder -- ODUNTY A TRI C Preparation --- 1105. Document - ?o CASH 1106. Nota Fees - -- tc 1107. Attorney's Fees ?- - nurnhers: PAID FROM I PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT SETTLEMENT i SETTLEMENT C(t ( 7 days 267. u:r month per mo-nth par month per month ?n:r month por month nnr month NTS _ _ 10 I ftl-t,Uul 1112. -- --- 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGE 64.00; Ruleases $ :2.00: MorgRl9t'._?-- ---- 1201. Recording Fees: Deed 5 - 1,500.00 Morkta 1202. City/County Tax/ Stamps: Deed_?- 1 50C.00; Mom'-- 1 106 l Lw. o,c« to YOf.K County Rc4 •?„ ,•• _-.--- 1205.RECORD MORTGAGE RELEASE 1205. RECORD MORTGAGE SATISFACTION to YOFK County Register of Deeds 1300. ADDITIONAL SETTLEMENT CHP,RGES to 40.00 1301SurveY to PENN PEST __-- 1302. Pest Inspection to AON ACCpl1NT 9 1315 20.00 1303. HOME WARRANTY _- - ?-?-EA -AUTHORITY 14.50 1304. TRANSFER/FINAL WATER & SEWER io TRI`COUNTY ABSTRACT 5Cf:vIGE 7,204.00 1305. OVERNIGHT/COURIER FEES 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, section ,n,m?„ co ,y of paT• z of u.,. „o u,,q,• •' ?t SFTTLFMENT "OFFICER Settlement Agent Certified to Le a true COPY. 270 (GIL376-04 / GIL376-04111 ) l'ngo l of 3 Direct Installment Loan Disclosure and Note Borrower: SUSAN K KACZERSKI Lender: PNC Bank, National Association OLNACS # 9671325 G P i BAN( Date: 0312912003 Items preceded by are not applicable unless marked or the egcivalent. ANNUAL PERCENTAGE RATE The cost of the Borrower's credit as a yearly rate. 6.291 % FINANCE CHARGE The dollar amount the credit will cost the Borrower. $12,511.70 Amount Financed The amount of credit provided to the Borrower or on the Borrower's behalf. $ 35,171.50 Total of Pa?ments The amount t e Borrower will have paid after Borrower has matte all payments as scheduled. $117,683.20 P means an estimate The Borrowers Payment ac Number of Payments neuwu wm oe. When Pa ntents Are Due _ Amount of Payments 120 _ $ 397.36 Monthly, heginning 0512812003 Security: Lender is getting a security interest In deposits party held by Lender, and None. ? Goods or property being nurchasa;l Real Fsta:e. O In addition, collateral lother than Borrower'! principal residancel securing other obligations to Lender may also secure this Note. Security Interest Charges: ? None 0 Filing Fees $ 72 bO Late Charge: 0 Not Applicable. LJ If a payment is not pam in full within 15 days of its due date, Borrower may be charged the greater of $20.00 or 5% of the total payment. Prepayment: If Borrower pays off early, Borrower will not have to pay a penalty. Required Deposit Balance: El Not Applicable.0 The Annual Percertage Rate does not take. ato account any required deposit balance. Assumption: If this loan is S;cured by a dwelling, someone purchasing that dwelling cannot assume. the remainder of the loan an the original terns. Variable Rate: ? Not Applicable. ® F This loan contains a variable rate feature. Disclosures about ilia variable rate feature have been provided to you earlier. o The Annual Percentage Rate may increase if the Prime Rate published in The Wall Street Jcernal increases. The rate will not increase more often than once a month. The rate will not increase more than ane percentage prenf in any one month and will not increase more than five percentage points during the term of the loan. The rate will never increase beyond 18%. Any increase in the rate as a result of an increase in the index may cause the number of payments to increase, ands ? the amount of the final payment to change.. The final payment will never he increased to more than 150% cf the regular payment. For example, if your loan were for $10.000.00 at an initial rate of 13 112%, repayable in 48 monthly payments of $270.76, and the rate increased to 14 1'2°/ after 12 payments, increased to 15 112% after the next 12 payments, and then remained the same for the term of the loan, you would he required to pay one additional payment of $254.83. F 1 the amount of the payments to change. The amount of the payments may increase every four years. The final payment will never be increased to more than 150% of the regular payment. Far example, if your loan were for $10,000.00 at an initial rate of 13 112%, repayahle in 72 monthly payments of $203.39, and the rate increased to 14 112% after 12 payments, increased to 15 ti2% after the next 12 nayments, and d,Pn remained the same for the term of t!,c loan ;I!e payment amour! would increase to $227.12 for the 49th through the 72nd paynr,:nts. r7 If Borrower's participation in the automatic payment plan is discontinued for any reason, the A::mmatic Payment Plan Discount of percentage points will terminate and may cause the rate to increase. Any increase in Vie rate vvill cause the amount of the payments to increase. For example, if your loan were for $ 10,000.00 at ac initial rate of 13 112%• repayable in 48 monthly payments of $270.76, and the Discount terminated after 12 paymonts, the payment amount would increase to $ for the remainder of the term of the Note. (Tile payment example assumes Borrower has not elected to purchase Credit Insurance.) f-I If Borrower's participation in the Club or Package flan is discontinued for any reason, the Club Discount of percentage points will terminate and may cause the rate to increase. Any increase in the rate mill cause the amount of the payments to increase. For example, if your loan were for $10,000.00 at an ina,;tl interest rate cl 13 1repayable in 48 nimohly payments of $270.76, and the Club Discount terminated after 12 payments, the payment amount ward increase to $ for the remainder of the term of the Note. (The payment example assumes Borrower has not elected to purchase Credit Insurance) See your contract documents for any additional information about nonpayment, default, any required repayment in full before the scheduled date and prepayment refunds and penalties. Credit Insurance Is Not Pcequirea. norrower iv-y I—- Penalty. Credit Life Insurance and Credit Disability insurance are not required in obtain credit, anti will not he provided unless Borrower signs below and agrees to pay the additional costlsl. Insurance may be purchased nn the life of one or two Borrowers. Credit Disability Insurance may be purchased on only one Borrower. If nbr:h:ed t!vough Lender the co::! of the insuraa?a! for :: e erig!na! term of the credit is stated below. Lender may receive financia: be iefils from the Borrower's purchase of insurance. "Borrower" who is insured may not he a Cc Maker Itemization of Amount Financed Amount Financed $ See Settlement Statement (1) Amount given directly to Borrower $ See Settlement Statement (2) Amount paid on Borrower's account $ See Settlement Statement 13) Amount retained by Lender for $ See Settlement Statement (4) Amount paid to others on Borrower's behalf: (a) to public officials $ See Settlement Statement (b) for credit insurance (c) to See Settlement Statement (d) to (e) to (f) to S (g) to $ (h) to li$ to Prepaid Finance Charge $ See Settlement Statement Itemization of Amounts paid by Borrower at the time the loan is made: Ill $ See settlement statement (2) (3) I want Single Creci; Life Insurance which cost $ _ __. _- _---.-. _ -- - - -- S onzture of Person !a be insured for Single Credit Life Insurance I want Single Credit Oisahihty Insurance which cases ------ :;ignature of Person :c be in:,ured for Single Credit Disability Insurance i. 2. -- - We want Joint Credit Life Insurance which costs $ Signanues OfPerso;:s to 6c insured for Joint Credit Life Insurance Borrower does not desire or is not eligible for credit insurant e, ----- Signaunt. of Borrower Notice to Borrowerisl: The maximum amount of cnveraga which insure;) Bofrowerfal will receive is set forth in the certificate or policy, as applicable. Direct Loan Note Index. The index is for convenience and reference. It shaii not lirnit 0 a meaning or scope of any paragraph or section. The num bers refer to the paragraph numbers of the Note of !tandinq balance 1 ? Application of payments Assignment ..................................... ............. ' ... ......._... - 2 22 fees_ ...................... ........... ....... Attorneys , ..... .......... . Automatic payment plan .............................. .................. 5 Borrower's responsibilities .......................... .. ,14.25,27,31 Changes in interest rate .............................. ..... 13 Closing costs .............................................. ...................... 2 6 Club or Package Plan ................................. .................... Collateral ........................................... .......... 18,20,23 ........ Collection expenses ..................................... ................ 2,22 Communication concerning disputed debts ... .... ............ 29 Computing interest ..................................... ..................... 8 ................................................ Court costs 2,21 .... ........... Credit Insurance .......................................... .................... 26 Credit reports...__.._..._..... .... ................... ....................30 Daily balance ................................. ..................... 4.8 Daily interest rate .................................. 4,8 ....................... Default ................................................. ....................... 14 Dehnitians ............................................ Delay in enforcement ........................... ..................... t ........................ 16 .)epos: t 23 Cisputed debts ...................................... ........................ 29 Lamy payment .............. ........................ .. .... _.................. 19 Finance charges ..................................... .. .._..........._....4,8 Flood insurancs .............................. ........ ..... ...._.... ......... 20 28 Ooveming law ....................................... ........................ 27 Heirs hound ............ ....................... .._.... ........................ 4 Index .................................................... .......................... 26 Insurance ............................................... ........................ 21 insurarce checks ................................... ........................ Interest after maturity and iudgmen :..... ........................13 Interest rate .......................................... .....2,4,5,6.7,8.13 Late charges .......................................... ....................... 10 Legal fees ............................................. .....................2.22 Lender ............................................... ...........................1 .... Lender's right to endorse checks ............ ...... ................ 21 Mamin ......................................................................... ....4 Monthly payment ......... ................................................. 3,7 Monthly payment chahges ........................................... ... 7 Multiple parties ............................................................ 25 Paid in full checks ........................................................ . 29 Payment application ..................................................... .. 9 Payment Due Date ........................................................ .. 3 Payment Schedule ...................................................... .. .3,7 Personal representatives bound .................................... .27 Prepayment .................................................................. 19 Promise to pay .............................................................. . 2 Property insurance ....................................................... 20 Release of borrowers .................................................•. 17 Release of security ....................................................... 17 Remedies ..................................................................... 14 Return Check Charge .................................................... .31 Security interest .................................................IS-- -- Security interest charges ........................................ Security interest in deposits .................................... Variable rate ............................................................ Waiver ...................................................................... EXHIBIT C Page 3 of 3 Direct Installment Loan Disclosure and Note Borrower: SUSAN K KACZERSKI Lender: PNC Bank, National Association Vtix BAM Date: 0312912003 Direct Installment Loan Note - continued it any event described in III• tkl, III• (in) or in) tappens, the entire outstanding balance on this Note shall be immediately due without any prior notice to Borrower, or right to cure, except as may he required by law. A default by Borrower on this Note is a default on every other note, loan or agreement of Borrower with Lender. 15. General Waiver Provisions. Borrower waives presentrnent for payment, demand, protest, notice of protest, dishonor and all other notices or demands in connection with the delivery, acceptance, performance, default or enforcement of this Note. Borrower further waives any right to require due diligence in collection by Lender. 16. Delay in Enforcement. Lender can delay enforcing any rights under this Note without losing any rights. Lender's failure to endorcg any right under this Note shall not act as a waiver of that right or preclude the exercise, of that right in the event of a future occurrence of the same event. Lender can also extend the time allowed for making payments, and such extension shall not affect the ebligarir;os of any Borrower, whether or not that Borrower is given notice of the extension. 17. Release of Some Borrowers or Some Security. If there is more than one Borrower, each agrees to remain bound oy this Note, although Lender may release any other Borrower or release or substitute any property which is security for the repayment of this Note. Borrower waives all defenses based on suretyship and impairment of collateral or security. 18. Security Interest Charges. Corrower agrees to pay any rcording, filing, satisfaction and encumbrance fees which may be charged. The charges are to repay Lender for the fees paid to public officials to protect, continue, or release any security interest given in the security agreement or mortgage. 19. Prepayment. Borrower may prepay, in full or in part, the amount owed on this Note at any time without penalty. If Borrower prepays the loan in part, Borrower agrees to continue to make regularly scheduled payments until all amounts due under this Note are paid. 20. If Lender Obtains a Security Interest to Secure Borrower's Payment of this Note, Borrower Makes the Following Additional Promises to Lender: lal if property insurance is required by a mortgage anchor security agreement securing the repayment of this Note andlor if flood insurance is required by federal law, BORROWER MAY OBTAIN THE INSURANCE FROM ANYONE OF BORROWER'S CHOICE subject to Lender's reasonable approval. If flood insurance is required, Borrower has been separately notified. The property insurance must cover loss of or damage to the collateral and must be in an amount sufficient to protect Lender's interests: flood insurance must he of the type and in the amount required by federal lava; (bl Borrower agrees to provide Lender evidence of required insurance. All policies must name Lender as a loss payeelsecured party and must provide for at least 10 days written notice to Lender of reduction in coverage or cancellation; Icl if Borrower fails to keep in force the required insurance andlor tails to provide evidence of such insurance to Lender, Lendnr may notify Borrower that Borrower should purchase the required insurance at Borrower's expense. If Borrower fails 10 purchase the insurance within the time stated in the no ice andlor fails to provide evidence of such insurance to Lender, Lender may purchase insurance to protect Lender's interest, to the extent permitted by applicable law, and charge Borrower the cost of the premiums acid any other amounts Lender incurs in purchasing the insurance. THE INSURANCE LENDER PURCHASES WILL BE SIGNIFICANTLY MIRE EXPENSIVE AND MAY PROVIOF LESS COVERAGE THAN INSURANCE BORROWER COULD PURCHASE OTHERWISE. Upon demand, Borrower promises to pay Lender the cost of insurance purchased and other amounts incurred by Lender. Borrower agrees that Lender may, if permitted by applicable law, add the cost of the insurance to the amums on which interest is charged at the rate provided in this Note. In certain states, the 'equired insurance may be obtained through a licensed insurance agency affiliated with Lenter. This agency will receive a fee for providing the required insurance. In addition, an affiliate may be responsible for settle or all of the underlying insurance risks and may receive, compensation for assuming such risks. If additional information is required concerning insurance or our affiliate arrangements, i7laar contact Centralized Customer Assistance, 27:30 Liberty Avenue, Pittsburgh, PA 15222: hill to pay all taxes due an the collateral. If Borrower does not pay the taxes, Lender has the option to pay the taxes. Upon demand, Burowe.r promises promptly to repay to Lender any amounts paid by Lender for taxes; lei if Lender gets a security interest in stock or securities, the value of the collateral may become insufficient to protect Lender. II that happens, Borrower agrees to deliver to Lender additional collateral which Lender believes will be enough to protect Lender; If) to allow Lender the right to inspect the collateral at any reasonable time, and to maintain the collateral in good condition antd repair, reasonable wear and tear excepleti: if amm:nis are ad:ancad b, Lc--ar s:dcr tb;s tcte `c: taxes andioi ii:U`miCC, gl Lender may, at its option, if permitted by applicable law, add the, amounts so advanced to the outstanding balance and require repayment with interest by increasing the installment payments so that the outstanding principal balance is repaid in full in substantially equal installments on the due date stated in the payment schedule; and Ihl Borrower's promises made and Lender's rights set forth in this section shall not merge with any judgment in any legal action aid sliail apply untii ;:II amounts owed ate paid in full. 21. Lender May Sign Borrowe's Name to Insurance Checks. Borrower gives Lender the right and power to sign Borrower's name on any check or draft from an insurance company, This is limited to a check or draft in payment of returned premiums, benefits under credit life insurance or credit disability insurance, and claims made under phvsical damage insurance and flood insurance covering pruperty which is security for this loan. Borrower does not have the right o, and agrees that Borrower will not, revoke the power of Lender to make Borrower's endorsement. Lender may exercise the power for Lender's benefit and not for Borrower's benefit, except as otherwise provide[ by law. 22. Costs of Collection. If Lender files suit or takes action to collect this loan or protect tire, collateral or the Lender's security interest in it, Borrower agrees to pay Lender's costs and expenses to do so, if Lender is permitted by applicable law to require Borrower to pay those costs. Unless such action is taken in Ohio, this shall include reasgn:hle atauneys' fees and expenses to the maximum amount permitted by applicable law. 23. Security Interests in Deposits. The Lender may setoff any amounts due and uni tid under this loan against any of Borrower's money on deposit with Lender. This ncludes anv honey which is now or may in the future be deposited with Lender by Borrov,v or with any co-depositor, including Borrower's spouse. This also includes any property, credits, securities, or money of the Borrower, which may at any time be delivered to or in lire possession of the Lender. This may be done without any prior notice to Borrower. 24. Assignment. Borrower may not assign or otherwise transfer his rights under this Note to anyone else. Lender may sell, transfer, or assign this Note, and any security agreement andlor mortgage given to secure this Note, and Borrower's rights and obligations under this Note will continue unchanged. 25. Multiple Parties. If there is more than one Borrower, each agrees to be responsible to Lender, individually and together, for payment in full of this loan. Borrowers agree that payment of all or part of the proceeds of this Note to any Borrower or to anyone else at the direction of any Borrower will be the equivalent of payment to each Borrower and for the benefit of all Borrowers. 26. Credit Insurance. If Borrower has elected to purchase credit insurance, Borrower may cancel that insurance at any time without penalty. In the event of cancellation, the, payment amounts shown in the "Payment Schedule" will not decrease; rather, the loan will he paid off more quickly since more of the payment will be directed to payment of the principal balance of the loan. 27. Heirs and Personal Representatives Bound. The provisions of this Note shall he binding upon the Borrower, and the heirs and personal representatives of the Borrower. 28. Governing Law and Construction. This Note has been accepted by Lender in Pennsylvania and all loans shall be extended by Lender to Borrower in Pennsylvania. Regardless of the state of Borrower's residence or the place to which Borrower submitted an application, Borrower agrees that the provisions of this Note relating to interest, charges and fees shall be governed by and construed in accordance with federal law and, as made applicable by federal law, Pennsylvania law. Unless preempted by federal law, other substantive terms and provisions shall be governed by and construed in accordance with the law of Pennsylvania; procedural matters relating to the enforcement of the obligations evidenced by the Note and matters related to the granting, perfection and enforcement of a security interest securing this Note, if any, snail i.a govaincil by the laws of tits state where the caforcemert, granting or perfection takes place. 29. Corninon ication Concerning Disputed Debts. ALL COMMUNICATIONS BY BORROWER TO LENDER CONCERNING DISPUTED DEBTS, INCLUDING AN INSTRUMENT TENDERED AS FULL SATISFACTION OF THE LOAN, SHOULD BE SENT TO CENTRALIZED CUSTOMER ASSISTANCE, 2730 LIBERTY AVENUE, PITTSBURGH, PA 15222. 30. Credit Reports. BORROWER AUTHORIZES LENDER TO OBTAIN CREDIT REPORTS ON BORROWER FROM TIME TO TIME AT LENDER'S DISCRETION WHILE BORROWER HAS A LOAN OUTSTANDING WITH LENDER. 31. BORROWER ACKNOWLEDGES RECEIPT OF A COMPLETELY FILLED-IN COPY OF THIS NOTE AND DISCLOSURE. BY SIGNING BELOW, BORROWER AGREES TO BE LEGALLY BOUND BY ALL THE TERMS AND CONDITIONS OF THIS NOTE. Each of the Borrowers guarantees ti!at the signature of any Borrower is genuine. Borrower's Slgnat"TO SUSAN K KAC7ER Date Borrower's Signature Date 32. CO-MAKERS SEE NOTICE TO CO-SIGNER BELOW. Any Borrower who is designated as a Co-Maker agrees to be equally responsible with all other Borrowers fcr t'ic pavinew of this loan and performance of all Promises in this Note. Co Maier's Signature Date Co ?Maker's Signature ------ Date NC>'rICI?'1'O CO-SIGNf?12 You are being asked to guarantee this debt. Think cru'efulk, before ,you clo. II'lire Borrower doesn't pay the debt, you will have to. 13e sure you can afford to pay if you have to, and that you want to accept this responsibility. You may have to pay up to the full amount of the debt if the Bonrowcr does not pay. You may also have to pay late fees or collection costs, which increase this amount. The Lender can collect this debt from you without first trying to collect from the Borrower. The Lender can use the same collection methods against you that can be used against the Borrower, such as suing you, etc. If this debt is ever in default, that fact may become a pat't cf your credit record. Mark Heckman Real Estate Appraisers 1309 Bridge Street, New Cumberland, PA 17070 File No. 18 APPRAISAL OF LOCATED AT: 18 Montasere Drive Dillsburg, PA 17019 CLIENT: Susan Kaczerski 20 Richard Road Mechanicsburg, PA 17050 AS OF: October 24, 2011 BY: Mark W. Heckman, Certified General Appraiser Commonwealth of Pennsylvania Certification No. GA000666L EXHIBIT D PH (717) 774-7202 FAX (717) 774-0383 EMAIL necKmanappraise siw_ Single Family Residential Property Mark Heckman Real Estate Appraisers File No. 18 Montasere Residential Appraisal Report The Durpose of this appraisal report is to provide the client with a credible opinion of the defined value of the subject property, given the intended use of the appraisal. --' E-mail Client Name/Intended User Susan Kaczerski - Ciry Mechanicsburg _ Stale PA Zip 17050-___ _ Chen[ Address 20 Richard Road Additional Intended User(s) Possible additional intended users are other parties involved n matter under litigation --- Intended use determine resent market value for use in liti anon _ --------- ------ City Dillsburg_ State PA Zip 17019 pro epl Address 18 Montasere Drive __ --- -County York -- Owner of Public Record Kazimierz R. Kaczerski -- -- - Le al Description Deed Book 1652 Page 5294 Tax Year 2011!2012 R.E. Taxes S 4,671.23 " Assessor's Parcel N 67-20-000-06-0039-00-00000 Neighborhood Name Carroll Townshl Map Reference See Assess Parcel # Census Tracl _ Pro or Pit his A raised X Fee Sim le Leasehold Other (describe) M research did X did not reveal any prior sales or transfers of the subject properly top the three ears mr to the elleclive date of this appraisal. Price NA Source(s) Deed priorSale/Fransfer: Dale NA --- Analysis of prior sale or trail sler history of the subject property (and comparable sales, it applicable) Research did not reveal any transfer of the subject propee for at least L yews prior to the effective date of this appraisal. Research did not reveal an prior sales or transfer(s) of the comparable sales for the veer prior to the date of sale stated on this report_ - - ----- Olferings, options and =t=ads as of the effective date cf the appraisal The appraiser h_as no knowledge of any offerin s options or contracts regarding the subject property as of the effective (late of this appraisal. One-UnitHousinp Pre sent land Use /6 % Neighborhood Characteristics One-UnitHousing Trends Location Urban X Suburban Rural Pro erf Values Increasim in Balance X Over Su I 8000E AGS 204eUnhlt BuiIPU over 75'1% X 2575% Under 25% Demand/Su I Shorla a Multf-Faa", % ro -6mlhs Over 6mths Ham- Commercial -- °/° Gwth Ra id Stable X Slaw Marketin Time Under3mths X 3 Pre d Neighborhood Boundaries See Attached Addendum - -- --- H Pred. i h _ Other ° Neighborhood Descriplinn This suburban neighborhood has most public utilities available relatively easy access to employment centers and=- services,and is competitive with other neighborhoods in the market area. Most have similar amentities Market activity indicates average or Netter acce lance in the market lace. No unfavorable factors were observed which would adversely affect marketability. - Markel Conditions (including support for the above conclusions) See Attached Addeo um-- - - - Area 0.53 acre Shape Rectangular _ view Good Dimensions See Le aq I Description Specific Zoning Classification Res Suburban 2 Zarin Descri lion Prima ermltted use is detached single-family residential Zoning Compliance X Legal Legal Nonconforming Grandtathered Use No Zoning - Ille at describe - __ --- Is the highest and best use of the subject property as improved (op as proposed per plans and specifications) the present use? 7 Yes Nn If No, describe. --- _ Offemen is- Pc -------er (descnhel Public Other describe) sitelmprev T PuUlic Privat uuiies Punr?c Other -- X ?-- Street Paved as halt X Fler.trici X 200 ampere --Water --- - G Sanitary Sewer X Alley None site improvements and services Gas - - Site Comrnenls Site has average site improvements, average landscaping and typical maintenance_ to the site are adequate and acceptable in this market. There are no apparent adverse easements encroachments, or other adverse conditions on this site ----- GENERALDESCRIPTION FOUNDATION EXTERIOR DESCRIPTION materials INTERIOR materials Floors Cer Tile/ Cpt Units X One One wlAce. unil_ Concrete Slab Crawls ace Foundation Walls Concrete - it gtnnni vinvi Sid Walls -D wall .D -- T e X Del At. S Del./End Unit -- 1080 sq. It. Basemen Area 0% Root Surface Aluminum Cutlers 8 Downspouts ath Floor Ceramic Tile Existint Propose Under Cons(. - Basement Finish P m - Double inSUl T 12e Wind Bath Wainscot Fiberglass )_..__ esi n St le 2 S _:o D IX Outside En /Exit X Sum u p water infiltration settlement N __ , n storm Sas_/Insulated No/ Yes - Car SIora e None Year Built 2005 o est infestation observed Screens Yes X Dipivewaya of Cars 2 - Edertive Age (Vrsl'4 or HW Radiant WnndStove s k Amenities ) Ahlt - Attic None Heabnt X FWA Fuel Nat as .-_ X Fire lace s) H 1 Fene ?? Dro Stair Stairs Other X Central Air Conditionin X Patio/Deck Deck Porh Font pl Floor Scuttle Coolin Pool Othr in Finished Healed Individual Other sher/Dryer OIhe W esu ) nces Refpi A fi eralor X Ran a/Oven a X Dishwasher X Oistosal X Microwave oveGraLe latGross tivingAre 2 uFee S a - - . _ ___ 8 Rooms 4 Bedrooms 2 6 Bath(s) _Sq Finished area ahoe±grade contains: Additional Features finished gara?]c e walls -- ----- sig Comments on the Improvements The im rove Orients are of better than average quality frame den and reflect good maintenance. Property ood utdl? design and appeal and should_ d reflects normal physical depreciation_ es g and no deficiencies were noted Floor plan provi r external inadequacies were observed. cceptance in the mark ood i et place. No unusual functional obsolescence. O a ve g rece -- IYidu[aJ r?lne Afl snmrare. . TNC Irtm Cnpylyt1102W5701e 0.f.IpMtinn nl lSp fAakti $ervka,.Ox... Al aim., flelwb. BOe]a<.NR) uwa'.acrxae [nm (ePAR-) General Pose Aph'II 005 1121 A1Rep :par t , P,ee 114 ` Mark Heckman Real Estate Appraisers File No, 18 Montasere Residential Appraisal Report _ COMPARABLE SALE N0.1 COMPARABLE SALE NO. 2 COMPARABLE SALE N0.3 FEATURE SUBJECT _ 430 Whisler Road - 119 Cobblestone Way 18 Montasere Drive 10 Montadale Drive Etters 1287.000 D1lsburg Dlllsbur Address Dillsbur -- 1.37 miles SE 13.84 miles E S 252000 Proximi Io Subject 0.06 miles N -- NA S 252,000 1 .18 Sale Price S _ 20 s . It. . . S _ S 0.00 s . n. s 120.11 s . n. s 92.38 s n Sale Price/Gross Liv Area Data Snurce s LS & Assessment Records MLS & Assessment Records_ MLS & Assessment Records Assessment Records Assessment Records Verification Snurce s Assessment Records - -- -- VALUE ADJUSTMENTS - DESCRIPTION DESCRIPTION III aeluslmem DESCRIPTION __ Hit Ankrsu°?m DESCRIPTION 1 ndlusimein Cash equivalent Cash equivalent Cash equivalent Sale or Financing 1 300 None known Seller assist 7,000 Seller assist 10/29/2010 Concessions 71 11 /201'1 8 /3112010 Date of Salefiime-- Suburban/ Good Suburban/ Good - Location Suburban/ Good Suburban! Goo - Fee Simple Fee Simple _ Leasehold/FeeSim?_Fee Simple Fee simple ---?-- 10,000 1.34 acre 10 000 0.53 acre 0.24 acre _ 1000 0 0.28 acre - --- - - Site Average _- 5 000 Good _ Good _ View Good - - Del 2-Story/ Good _ Desi n St le Det 2-Slory/Good p2t Story_/ Good __ Del 2Sh / Good Better than ave Good -8,000.. Ouali of Construction Better than ave Better than ave 10 000 3 +/- Years 8 +!- Years 6+/ Years 2L+/- Years _-_- -- Actual Aqe Good Good •_ Condition Good Good --- ---- loml flNms. BdOis - Inlal Rnnns Baths Above Grade mil Benns paths _ Total Berms Barns g 4 8 4 2.5 - - 2 5 --- Room Count 8_ 4 2.5 8 4 2.5 2 728 s . n. -15,700 2,388 s q. I. 2 100 Gross Living Area 40.00 _ 2,336 s IL _ 2,098 s It. 9 500 Full, exposed 5,000 Full Basement Basement & Finished Full Basement Full Basement Unfinished Unfinished Rooms Below Grade Unfinished Unfinished Good _ _ Good - - _ EI2CHP/ CA Functional Utiliy--_ _ Good Good GasFA! CA Hearin ICooling_-_ GasFA/ CA _ GaSFA! CA T ical for a e Typical for age -- Ener Efficient items_ -. T Ica! fora e_- Typical fora e 2iCar Gar/ Att 2-Car Gar/ Aft _ Gara e/Car orl 2-Car Gar/ Aft 2-Car Gar/ Att -3 000 Deck Porch Deck,Porch - Porch/Paiin/Deck - Deck Porch Deck 1 fire lace 1 fireplace --? --- --- Miscellaneous 1 freppppe_ 1 -- fireplac--e--- ------ 31 200 . X S _ 5.700 + X - S - 27,100 Ne,Adjuslmenl(lneIs6 _ X + -- S-- -- --- - NetAdi. -9.4°/ iw Adj. 12.4% Nef Atll. -2.3 Adjusted Sale Price t of Com arables 3rossAdj. 13.4% S 283 200 Gross Adj. 14.2% S 246 300 Gross Ad. 9.4°/ S 259 After at h u h_search of all available market data the four sales used are c Summa of Sales Comparison Approach onsidered to be the best val. In order to find comparable sales it was necessary to use less recent sales. Appropriate adjustments have been indicators le ue made for all differences. Comparable sales used are closed sales. Co arable Sales No. 1 and 4 are considered the best indicators of value and are wei hted more heavily than Comparables No. 2 or No. 3 -- C O ST AP PR O A C H TO VALUE Site Value Comments ON R[PROOUCTION OR _EPLACEMENT COST NEW _ OPINION OF SITE VALUE ......_._..... _ --- S FL (7S =S 0 Source of cost data Dwelling 4 CI ...... -- Sq. Ft. vv S = S -- --- - Duality ratio from cost service Elfective date of cost data . . . . .. Comments on Cost Ao oath (gross living area catcula'ions, depreciation, etc. Gara a/Car oil Sq. R. rq? S - ' S The Cost Approach has not been developed because of the __ S 0 difficult inoilybtIm alnin accurate detailed cost data for this t e of Total Estimate ui Cost-New -- --- - Less Ph slcal Functional External residential structure in our market area because of the (I unreliabilit of;3enerarzed cost manuals and software and __ Depreciation __ - -- S 0 ..................... because of the jnabiljt to accuratel measure depreciation. Depreciated Cost of Imp rop vements. Furthermore_atypical purchaser gives little consideration to this "AS is"Value nt Site mprovemen s...._._._ a roach to value. - -- =s INDICATED VALUE BY COST APPROACH... INC OME APPROACHT O VALUE -Indicated Value by Income Approach - Estimated Monthly Markel Rent S _ X Gross Rent Multiplier =S Summaryollncnme Approach(includingsupport formarket rent andGRM) The Income Approach is not valid since few Sin Iq e family residential properties - --- are rented in this market area. __--.- -.-------- IncomeA rnach(ndevrloeadl s NA Indicated Value by -Sales rem Vinson AUUroaeh3265000 Cnst AUDmar.h it develn ed S 0. __ __ --- - See Attached Addendum _,__--_ -- - This appraisal is ma i? "as --(7Suhiecl to completion per plans and specifications on the basis of a hypnthetical condition that the improvements have been completed. C1 subject to the In lowinq repairs or alterations on the basis oI a hypothetical condition that the repairs or alterations have been completed- ? subject to the following - Based on the scope of work, assumptions, limiting conditions and appraiser's certification, my (our) opinion of the defined value, of the real property which is the effective date of this appraisal- that is the subject of this report is s 265 _000_- as of October 24, 2011 _- IYodurnd,,*ij Ant alt"ace, 800.234.8n1 w« w.3-1, mm inc. h+m CoTaium a 20/152010 AC?A?oo General Claim Pati Sm ApOx Highle <.OtO a!'??"1 Pape 2 or 4 PAatp04 10O516D10 Mark Heckman Real Estate Appraisers a .. Par" Mark Heckman Real Estate Appraisers -:A a; r A o i o o I R o n n rt File No. 18 Montasere FEATURE 18 Montasere Dave Address Dillsburg - Proximi to subject Sale Price Sale Price/Gross LN Aree Data Source s-_- Sl18JECT -- A S S 0.00 s g. It. COMPARABLE SALE N0.4 13 Montasere Drive _ Dillsburg (Pending Sale) O.Oo miles NNW 264900 s - - S 107.68 s A. MLS & Assessment Records Assessment Records --__COMPARABLE SALE No. 5 - s S -3n .- COMPARABLE SALE NO.6 -------- 8 _ s - ----------- Verification Sources VALUE AOJUSTMFNT;% Sale or Financing DESCRIPTION DESCRIPTION Discount from List 14%) S Atllnslmeln -10,600 -DESCRIPTION S AeWslmem DESCRIPTION __ _ 44)1 AtlhlslmOm Concessions / Fending Sale --- - - "_-- -- -- -' -- -- iim_ e_- Date of Sale Location Suburban/ Good Suburban/ Good -- Leasehold/Fee Simple Fee Simple 53 acre 0 F ee Simple 0.29 acre - 1000 0 _-- , --- -- Site view Desi n S le Quality of Consauclinn Actual Age Condition Above Grade Room Count GrosstivingArea40.0_ Basement RFinished Rooms Below Grade _ Functional Utili Heating/Cooling Ener Efficient hems- _ Gara a/Car ort _ k . Good Det 2-Sto 1 Good Better than ave 6+/. Years Good ----- tm,l Bar- Rams 8 4 2.5 _ 2,336 s .It. Full Basement Unfinished Good GasFA/ CA T ieal for aage _ 2-Car Gar/ Att Deck Porch __ Good Det 2-Story! Good Better than ave G+/-Years Good - lour/ Banns _ Rams 8 4 2.5 -- 2,4 0 sq. It. Full Basement 12ec Room Den Good GasFA/ CA ry ip cal fora 2 2-Car Garl Att Patio - 5100.0 -12,000 - 3,000 --- lout nano norms, .ft. _- - - ---------- rural Rerms uams - -- --- -- ------ -- - --- ---- T Parch/Pallo/Dec Miscellaneous - X- S 600 14 X+ 1 0 X +_ D Net AtliustmenI To1a1)- Adjusted Sale Price bl s + NelAdl -5.5% 3rossAdi. 15.3% , -- S 250 300 NetAdl. 0.0]., GrossAdi. 0.0 0 , Ne1Ad4 0.0% Gross Adj. 0.0% S 0 of Com para e - ary M Sales Comparisnn Approach Summ ---- IMeueee n:lnq AGi inllware. e00.291 ,822l vw.v.acnvreIN, lour CnrryilpM 020052011ACI DW.I. M ISO Gialnc S-k, Im, Al R1pNS 114-11d. Adtllllonal COmpara6les (OPAR'°I Al GenerNniise Apo,iAanl op 10057ROI0 . par- Mark Heckman Real Estate Appraisers Residential Appraisal Report Fire No. 18Montasere Scope of Work. Assumptions arid Limiting Conditions Scope of work is d.fined in the uniform Standards of Professional Appraisal Practice as' the type and extent of research and analyses in an assignment.' In short, scope of work is simply what the appraiser didand dideno?dtl°dtentof data ?lesearohed?the yl e assignment lexteotof aoalylsesdppl,ed limited to, the e.xtentto which the property is identified and inspected, yp to arrive at opinions or conclusions. The scope of this appraisal and ensuing disco ;Stan in this report are specific to the needs of the client, other identified intended users and to the intended use of the report. This report was pre pared torthe sole and exclusive use ofthe client and other identified intended users for thei denfified intended use and its use by any other parties ie prohibited. the appraiser is not responsible for unauthorized use of the report. The appraiser's certification appearing in this appraisal report is subject to the following conditions and to such other specific conditions as are setlorth by the, ap)raiser inthe report. All extraordinary assumptions and hypothetical conditions are stated in the report and rmghthave affected the assignment results. 1. The appraiser aSSimes no responsibility for mailers of a legal nature affecting the property appraised or Lille thereto, nor does the appraiser render any opinion as lathe title, which is assumed to be good and marketable. The properlyis appraised as though under responsible ownership. 2 Any skelch in this report may show approximate dimensions and is included only to assist the reader in visualizing the property. The appraiser has made no survey of the properly. 3. The appraiser is not required to give testimony or appear m coon because of having made the appraisal with reference to the property in question, unless arrangements have been previously made therr In. 4. Neither all, nor any part of the connector Ihis report, ;opy or other media thereof (including conclusions as to the propertyvalue, the nenlily of the appraiser, professional designations, or the firm with which the appraiser is connected), shall be used for any purposes by anyone but the client and other Intended users as identified in this report, nor shall it be conveyed by anyone to the public Imnugh advertising, public relations, news, sales, or other media, without the written consent of the appraiser. 5. The appraiser will not disclose the contents of this appraisal report unless required by applicable. law or as specified in the Uniform Standards of Professional Appraisal Practice. 6. Informaj estimates, and opinions furnished to the appraiser, and contained in the report, were obtained from sources considered reliable and believed to be true and correct. However, no responsibility lop accuracy of such items lcrnished to the appraiser, is assumed by the appraiser. 7. The appraiser assumes [hat there are no hidden or Unapparenl conditions of the properly, subsoil, or structures, which would render it more or less valuable. The appraiser assumes no responsibility far such conditions, or for engineering or testing, which might be required In discover such factors. This appraisal is not an environmental assessment of the property, and should nor be considered as such. 8. The appraiser spe,ializes in the valuation of real properly and is not a home inspector, building contractor, structural engineer, or similar expert, unless otherwise noted. 1 he appraiser did not conduct the intensive type of field observations of the kind intended to seek and discover properly detects. The viewing at the property and any improvements is lop purposes of developing an Opinion of the defined value at the propti given the intended use of this assignment. Slatemenls regarding condition are based on surface observations only. The appraiser claims no special expertise regarding issues ncluding, but not limited to: Inundation settlement, basement moisture problems, wood desmying (or other) insects, pest infestation, radon gas, lead based paint, mold or environmental issues. Unless otherwise indicated, mechanical systems were not activated or tested. This appraisal report >hould not be used to disclose the condition of the property as it relates to the presence/absence of defects. The client is invited and encouraged in employ qualified experts to inspect and address areas of concern. If negative conditions are discovered, the opinion of value may he affected. Unless otherwise noted, the appraiser assurnes the components that constitute the sunject property lm prove me. nt(s) are fundamentally sound and in working order. Any viewing or the property by the appraiser was limited to readily observable areas. Unless otherwise noted, attics and crawl space areas were hat accessed. The appraiser did not move furniture, flonr coverings or other items that may restrict the viewing of the property. 9. Appraisals involving hypothetical conditions related to completion of new conslpuclion, repairs or alteration are based on the assumption that such completion, alteration or repairs will he competently performed. 10. Unless the intended use of this appraisal specifically includes issues of property, insurance coverage, this appraisal should not be used for such purposes. Reproduction or Replacement cost figures used in the cost approach are lop valuation purposes only, given the intended use of the assignment. The Definition of Value used in this assignment is unlikely to be consistent with the definition of Insurable Value for properly insurance coverage/use. 11. The ACI General Purpose Appraisal Report (GPART")is nat intenod ed for use in transactionsthat require a Fannie Mae 1004/F'eddie Mac70form, also known asthr; Uniform Residential Appraisal Re portiRAR). Acoition al Comments Related To Scope Of Work, Assumptions and Limiting Conditions park n A-d *9 Aci comar<, eoo.z Pape a of 4 The o-.m 011x14201 a AGI 0M 11 nI ISO Cb-S-rv -s, Inc.,"RWtl Ne:wea. MPAll'°I Geeerat Puepose ApvlSSirl R lae5YR010 Mark Heckman Real Estate Appraisers Residential Appraisal Report File No, 18Montasere Appraiser's Certification 'ihe appraiser(s) c;rtlfies that. to the best of the appraiser's knowledge and beIIPI- 1 The statements of [act contained in this report are rue and correct. 2. The reported anaty>es, opinions, and conclusions are limited only by the reported assumptions and limiting conditions and are the appraiser's Dersonal, impartial, and unbiased professional analyses, opinions. and conclusions. 3. Unless otherwise staled, the appraiser has no preser I or prospective inleresl in the property that is the subject of this report and has no personal interest with respect to the parries Involved. 4. The appraiser has Rio bias with respect to the property that is the subject of this report or to the parties involved with this assignment. 5. The appraiser's engagement in this assignment was not contingent upon developing or reporting predetermined results. 6. The appraiser's compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal, 7. The appraiser's analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice. 8. Unless otherwise noted, the appraiser has made a personal inspection of the property that is the subject of this report. 9. Unless noted below, no one provided significant real property appraisal assistance to the appraiser signing this cerlilication. Significant real property appraisal assistance provided by: Additional Certifications. Dellnitionof Value : F?MarketVslue ?OtherValue Source of Definition: The operative definition is from regulations published by federal regulatory agencies pursuant to Title XI of the Financial Institutions Reform, Recovery and Enforcement Act (FIRREA) of 1989 between July 5, 1990, and August 24, 1990, by the Federal Reserve System (FRS), National Credit Union Administration (NCUA), Federal Deposit Insurance Corporation (FDIC), the Office of Thrift Supervision (OTS), and the Office of Comptroller of the Currency (OCC). This definition is also referenced in regulations jointly published by the OCC, OTS, FRS, and FDIC on June 7, 1994, and in the Interagency Appraisal and Evaluation Guidelines, dated October 27, 1994, The definition is also provided as an example definition of Market Value in Advisory Opinion 22 of the 2008-2009 edition of the Appraisal Standards Board's Uniform Standards of Professional Appraisal Practice (Washington, DC' the Appraisal Foundation). ADDRESS OF THE PROPFRTY APPRAISED: 18 Montasere Drive Dillsburg PA 17019 ----- EFFECTIVE DATE ]F THE APPRAISAL: October 24, 2011 APPRAISED VALU'` OF THE SUBJECT PROPERTY s 265,000 APPRAISER Signature: Pii -`, ----- Name Ma VV Heckman, Certified General Appraise_r_ Slate certification # GA-000666-L --- or License # ---_.-- or Other ldescribe): Slate #: State: PA --- Expiration Date of Certilication or License: June 20 2013 Date of Signature and Report: 1 1 /11 /201 1 DateofProperty Vir,wing: 10/24/2011 OX of property viewing: r-1 U Interior and Exterior U Exterior Only Did not personally view par,.. SUPERVISORY APPRAISER Signature: Name: state Certification # or License # ------- State: ------ Expiration Dale of Certification or License: Dale of Signature: ---- Date of Property Viewing: -_-_--_----._-- Degree of properly viewing: Interior and Exterior ? Exterior Only ? Did not personally view -d-d udnp AN ;eR.w,e, 900 2a4.en1 uuw.acwea.a,nNU, 4d4 Mark Heckman Real Estate Appraisers Lei nrMinn nI (5n WON servke, a®., AI IOPAA °) General Purpose ApI,,alaote ADDENDUM _ File No.. 18 Montasere _ Client. Susan Kaverski -`-- - - - Case No.: Property Address: 18 Montasere Dnve Slate: PA Zip: 17019 Neighborhood Boundaries bou ndary of the The subject property is located in Carroll Township in York County which is con may to extend search neighborhood To locate the best comparable sale properties available the appraiser y parameters to similar neighborhoods within the market area. Neighborhood Market Conditions The local housing market in the subje? price range has been weak within the past 24 months Affordable housing (under $200,000) has been selling reasonably well, but above this threshold market activity has been slow. New construction activity also has diminished dramatically. Concurrently the volume of homes for sale has increased resulting in pressure on sale prices. In order to market residential property in this climate, asking prices must be conservative, and seller concessions are very often necessary to entice the few buyers in this slow market. Final Reconciliation The Sales Comparison Analysis reflects recent activity in the market place, and provides a well supported indication of the market value of the subject property. This appraisal assumes a reasonable marketing period for the subject property of four months. This appraisal is based on readily observable conditions and is not to be considered as a thorough home inspection to analyze or wzrrant the subject property and/or its mechanical systems. THE APPRAISER HEREBY CERTIFIES THAT THIS REPORT HAS BEEN PREPARED IN COMPLIANCE WITH THE UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICE (USPAP), THAT THE APPRAISER IS A ACCURATE TO THE BEST OF THE DISINTERESTED R'S AB PART AND THAT THE VALUE STATED IN THIS REPORT IS THIS VALUE HAS NOT BEEN PREDETERMINED. AAPPRAIISE Addendum Page 1 of 1 FRONT VIEW OF SUBJECT PROPERTY Appraised Date: October 24, 2011 Appraised Value: S 265,000 REAR VIEW0F SUBJECT PROPERTY STREETSCENE Diu i, r•i uun Vi-- u 1V PH I I I I) A I) UENUUM IVIarK necKman New CSraie Hppraisers Client: Susan Kaczerski File No.: 18 Montasere Pro ept Addpess_18 Montasere Drive - _ Case No_: _ City: Diiisburg State: PA _ Zip: 17019 Living Room. Dining Room Kitchen PHT310182010 AM-d ul,q AM saRadre, MINIM -x-b.- mark neCKman Keai tswe Appraisers File No.: 18 Montasere Client: Susan Kaczerski _ --- _ Case No._ Property Address: 18 Montasere Drive - - --- State: RA Zi : 1019 City: Dillsburg Family Room Master Bedroom Dressing Room PH8310182010 f1-,W ixhi; ACI s~,, 800.234.8721-n.eA.- Property AddPess:18 Montasere__ Drive _- City: Dillsburq _ iviarK heCKman Keai csiate Hppraisers o.: 18 Montasere N o.: Zlo: 17019 Walk-in Closet Master Bathroom Bedroom PM-dUigACisviWe,W2aa.8rerw acwO.mm TNn,0,820,o iviarK HeCKman Keal tswe Hppralsers File No.: 18 Montasere Client: Susan Ka 2erski Case No.: Property Address: l8 Montasere Drive City: Dillsburg State PA Zip: 17019 1 I Jr t „t k' *1 .i lktir tt ? ?? q 4s .a.' ?X ; A V-A Bedroom Hall Bathroom 1lnd,,,d ii*g AM :nAw-, 800174.872'1 www.a[WeO,- PHT21018201) PLAT MAP File No.: 18 Montasere _ Client: Susan Kaczerski -- Case No.: _ Prokerr? Bess' 18 Montasere Dnve _ ----- ---- - -- State: PA Zip: 17019 City: Dillsburg I I ??a ct \v t 37. :j cr- i i I r'n Ihm CeoJet E-mapping -1. 11.11 I-,r,-, cAV 17171774-n3A3 FMAII heckmanaooraisers(a)comcastnet rnMPAHABLE PHUPEKIYPHU1UAUUENUUM Client: Susan Kaczerski File No.: 18 Montasere Property Address: 18 Montasere Drive Case No.: City: Dillsburq State: PA Zip: 17019 COMPARABLESALE #1 10 Montadale Drive Dillsburg Sale Date: 8/31/2010 Sale PPICe: S 252,000 COMPARABLE SALE #2 119 Cobbiestone Way Dillsburg Sale Date: 7/11/2011 Sale Price: S 252,000 COMPARABLE SALE #3 430 Whisler Road Etters Sale Date: 10/2912010 Sale Price: S 287,000 (:HNANAHAHLE PHUPEHIY PH UI U AUUENUUM ient: Susan Kaczerski File No.: 18 Montasere operty Address_i8 Montasere Drive _ Case No.: ty: Dillsburg -- - -- Stale: PA Zip: 17019 _ COMPARABLE SALE #4 13 Montasere Drive Dillsburg (Pending Sale) Sale Date: Pending Sale Sale Price: S 264,900 COMPARABLE SALE #5 Sale Date: Sale Price: S COMPARABLE SALE #6 Sale Date Sale Price: S LOCATION MAP ocvs'. 67 biflC?" Progress R6 41 West Fairview M? ' Sl Rutherford „?, p 6?a>y St,.: Heights Wormieysburg; Lownton' h?beCSYLb ? °;? t?arrisburg w??ry,.?r,ru _r, w.pa:Rang A"?: ,w ` ? 3 y ? 114 fir. 7v ' 7?, Lemoyne Camp Hill n a,dsk. Piles .. °?y .+ Steehon ? .,ot -dTn SF i ' a.? w ' .. ,dress er C?1r?s1 ?. dt,l? Mew Gumberlarxt .? ?`yliin9 an 10 E w I c,v tr cit,' Es .. 1 _ fiat Shireman?kownPy it, Mechanicsburg v pr- ?.+ o .; e str union. b 4vaa**r',Y Harusbutp irate rn ?liurua°` -,? - ? .:fiva(t-6irt?lelffeld Fairview Park '? ?° Gsgver,anna ?? v P?.,xy 114, 262 ::om rablE gale 3 a 430 rhis ar Road v ?ti Etters, P4173111-8803 aai 113.94 mile, Ej 71, ' Subject 18 hlonra ere Drn e ; Dillsburg, 71A 1?n 14-910-: .. Newberrytown U2 11 ? a 1Compa,able Sala 4 r e1 e OO u x. Drive r v r t. -_t N f 'A 13 MGntasere Dillsburg, PA. 1:'019-9105 L C Da'able Sale 2 119 r:obblestone .hay 'F Dillsburg, PA 17019 11.3' miles SE) Comparable ,ale 1 1C r?lontadale Drive Dillsburg, PG 17 0 1 9-9 1013 (0.06 miles N) C[eel; Rd 114 Gifford Pinchot i :.State., Park Y •.9 P. K r -a k. y 745 ? ' .911: C^ ?a ,.d'cQ Op1arS'.... pavid?,bwV .'id 1.: ., Weigelstown.'- Shiloh ' 44 C9 J; 30 ` York '- ?? c, 1 n<i . s "nI u,omwrteoq Gizone raare4,;nep.rei?eeu,me_` ou 1717% 77e_79n9 FAX 17171 774-0383 EMAIL heckmanappraisers@comcast.net Mark Heckman Real Estate Appraisers dJW&6%M" Mark Heckman Real Estate Appraisers 1309 I3rid;,rc Street, New Cttrnhcrlaud, Pa i:; 070 -?vcw.krt_( l,mstn_tPPr,cicrr<.trntzt MARK W. IIECKNIAN APPRAISAL QUALIFFC ATIONS 14er. ices Provided: Ro,_1 esrn,r> appraisal and ct?naatins; fur all tyl?t:, of real properlj: ?t}n7aar<a,f, residential. nd'usp'ial. oninlpro%cd 1,117(!, ronjorniniurns, riv.xed u,r (i 'rhet;ic?. ?lt?ccdoprnti:nt Istma1. nlc?et[iofl tppraisuls pr(,p})tics] 112sc nn?tnictiiri Lizigation supj)01 and (OUrt t sti.nwn Civil proCeeciin? :, :c}rnictttler }IisUihi it ±n. l??r?}tnrlrtcV. i:'a:r aS;<s srnGnt ai)[wa S. IRS, C11:a•itahlc domitioll, ( 5 Dep arrncni (if H.('.D- FHA Approved Apprutcer All ,,hprat,,,ls irin(,71}''villa Ow t'n %/ rm :m;da rdN _,j f'/??(4.ti.titr/;ur :lrrpretis t1 Pracri[- f,icensc-: and (.ertii9c stttlns: Prttr;s?(irrnl< cerl fled Creraeral:lpjwa"". !9c? -Ccrtihtafirm No. (;-%,(?')CiC,frti-i. PQ'+tr'srlc,vtir; Keu.f F'Starellrt%1?'r jo> 4- C`e.rtille'utitsn <). 12 F3-ia tdFGl heal bstaite ENIX•riertce:: (rih 5 re., !'r+r.r rrr ;LIcn' Heckman Prn1 ! il(ri :1r'rnr 7r.:,''ry, Appr.dsal and Consultirte For C.rrnrnercial. Indusn-ial. Rz.identictl and, invo?ooe w Raaat Estate. Y),?'J OS,S- P/ ri J-s" ru' Af?f'riria'irt;; rrrrx! Narke:ur Nlemherships and Attiliations: t Jt. 1l r,rrrrr,l( Ga.rlitt/te? - gca?r.r ii Associate NkIlImc-, Pie <<rrate r llarris'burg ASSOC. Ault Ot h a(tnrs, inrtner mcml?r, R(>>3n9 of L;irecau5 keallnre ?lsrcrar intin+t aaf Ynrk <,rtd arrn,rt> C r!rt.ruic.c, AI)JlTMSUl COMMit:ec 44uionnt:kss?u7airif'Wo0i'( hol-s ajantaatd.t,nrr9isea'S.4? r.Ci;r7it>rt I,n.ot 'wc R locali<na t.r aaa?.r:i1, C'eitilird RrloC3110 1i YWI( I>amnl i'li ?ai7'r4 '22.x'_ f sV?'P: 7':-U3?1 [:,Ai.aH;1t:,C??]kinrarrtrorfli?.h??a'erxnrma.rwrt P?,e t ?? 2 nicorc (nlrnmrn C} -t t'N (( l/) 1 14-/LVL F- tr II ) I,-.-?.,.,.. ??.,,..?...,.......___?. Mark Heckman Real Estate Appraisers 18 M Pro eAddress., 8 Montas_er_e Drive ---- - Citv: Dillsburg State' PA Zp 1701 Education: fohrrs lronkinz , t .rivers ern;, Barlonnl e, D. ,Nlasrer of Science in Real Estate. Program t",)isrscs tAkcrr t'rhan Econorrticl : Real Estate Enterprise- Real i'_state Aj),Jvsis (8.1.1.1914 -Sii;rrlu Cnllr.+?er. krrrli:t?. I'rn,rst?lvarrip.Srare L'nnver3id}'. 11ia:, rrofl'uhlic aiintinistr=ltirar, Icy? <lpprav,,al Jllo.r ue Apprsisipg. Coat°enienee STOIV.c Appraising Special-Purp.IU'. Prrrf rtiis f3usinuss I'Tactice± and Ethics 1 calutaing Ctnntnercial C.onslf u'.1 Ion I raI f urtc Appraisal 1'1-11)ciPles Real *Fsrate EaSCrM:nt ``OUatloit R sai F,,ui ' Finance. V:110c 'W'd I n, stmextt PCrfprrr "'Ce Resideauril Vahaaliou Self Storasae Ecouarnics Standards of Professional Practice Suhdivi.,ion Analysis The Discounted Crash H O W Nlctdelt Conccpts.. Issues, aid Applications t!nderst:mding l..frniu?l apprliwils tlarti•,`c;.acl:Sssar:icanr..?x c?:1 j31?ra%srrs ,\dvunced Office Buildil}n Analysis Appraising Commercial and lnduo ,Trial Piopeitica Acquisition Right-*f-W°ay Apprai0n Commercial and lndustri tj Real Est ile. Axrverricnts Commercial Rv;-al Property Tax. A.s es rnrnE Apr als NsLional USPAP St andards of Pnw;ioi: A",? Etllict "tJd;;it,ltir! Ciuursesrrrk? l Cioscr Look at llwue Ct)ns'lrtlctiOli a p}?raiss: Recirmt Appraising for FT-1A Insured Lo; n t_oni nercial Rcai Estate Financing ??untvnidc itrtssessnlents, Perncylv:aui 'i?ar In<rirutc 1?n?'irrm ncntal 16,ck Management Lxper: Witness and "lax APIV,4 ti Narrativc, Rejti.rt VA"ritink Real F?Inau DetClol,rwntf orn Ticginning, r<r Emil h sicienlt ;l C'unstructicm Lunn,, atxt Land U,,Q in 1'cnns ierrni:: PI 171777-1-73`4 FAN 7;,7 ).iR± hNvml_n>. .r?narri:rosrnt?cnnx,lslxo t'a`e. 2 of 3 11 ? 11 ,01 - 7nno GAY 1717\ 774-0383 EMAIL heck manappraisers@comcast.net Mark Heckman Real Estate Appraisers Court and Expert !4'tEcress'1'etiEtrunny: Llnitcii States 13anknrpic} Court (:NUddic Utstricti. Hat" III , PA United Stntoi District Court. I•lar*isbure. ]'A Boards of Asse&sment Apjvx its: Cttrnh«.rlnn<a, Dauphin, and York r:'cmnric 4 F?; gat r1ti tf Vie.w: Gmrherland• Dauphin, mti York Count e, C'c,u:t a: Ctrtirnxm Pleas: Curnherlrn (L Nophin, Lancaster, and York Counties, Various nmnicilrtl pl.'IMirlg and Aunin" t•txnnrission!?, artC! ho 6w, bo,t,d5 PA St, ie Board ot'C nlitied Real Estate Appraisers Partial Client List: P ittrantcinl 111stitatiouS: 13PICh i?ee'tt;r,il C'rc',ilit t.'ninr: Raul: of i,cbanon Coo 1(c frorm .rr 1" Bank f afirt:rs Nlatio Y: d ban", of New4 I.ile ir<r Cz-piral T3ark P tr; t llutitt+n ! lone L,)a s Eiisi NzOonul Bank of Nlarv$villa Ftn t :?atiuua; J3:urk ?ottr?n Runk t??rnvcnnr l'.:?ercrIbuk Ha7irax Notional har'l: irrcrrr.y illink Jotot,tnccti F3attl;r?'1't.rst %I&. T R;,nk \h,mhcrs 1" Federal Credit L'air,rt -IeCL.ile Hon-to EC+ar ,lc:tro Bank Nlid 1'onn i3nk vlid%ke-st Ciusine : t?apit. 1 Governinent: N atinn I City Bank;il PC!1!as'Css:1i:t i)t'rcto?+.t? Bu;)k PN( 13ank Sr+ creian mink Go verwaciu: i )S, fJ?narYntenr ?,( 11_U 1 t U.S. Small businu;s Adn.inist W10-1 South F;est r-rnnomi, l7r.wJopmc<ii (o. of PA C arsnxrt:ut ???aiir ut Prans}'lt•arti ?, "c;i>roa;::; i?i• F:arktin;nwn fich:ruiCSburg Bcn-nu?t of $i+a+utr c i CCti' C unbul and Loth er Allen 'vktn cip Autftarity Aliddle.tour. arc:: School D St~fct VurthCM York School Distvicr SUiquchamut 'Tt+wttsNj) Susyuchamta'1'tip `ickwl Oist.ric:t Upper Allen o%vn>n:P :1rlnt,zrrn,r Cn,n/urxiie (:utds4cll Banker ReIncatirrn ( r hatiomridc Relucatic+r, CO. PrIuk-mliul Rchxation CO. l:&Nlax 1101bca(ion C of Valllutinn Adniinistrtttors Su?.?lti?haI Rank pli n j7 77 + _ AX 711 7 i ;i3 R? E U.a tt. hCC zit r?+z>L.d e+*s!>con sa i 21 ni i 7- ?,, won) Goy t717t 774-0383 EMAIL heckmana1)praisers@comr-ast.net Mark Heckman Real Estate Appraisers Client: Susan Kaczerski ---- --- Pro_perty AddresS: 18 Montasere_Drive Ci : Dillsbur State: PA e 1 1 ('onjulollweaith e?i 1'en?ts ivania Department of State Bttrcau ofPft)fessional an Otcuplt#ional Affairs 110 Box 2;4 1ztrrisbuI-, PA 1'7101;5-2049 Certificate '1'}p`- oer'ifiad Genera,' Appraiser 0 Im y MARK WILLIAM HECKMAN Certificate 13H BRIDGE STREET lnmher NEW CUMBERLAND PA 17070 GA000666L i e;Erv i ? i ??,I C?;:C?ip tl iY.l Al F,a? RR` 'f-._J._ ?_'...._..___. 08 0585542 41 I Certificate Stawi ; Active Ii i initial. Ccrtifacatian rate 03M 311992 I i Expiration Date `` 06/30120', 1 ?] PH 17171 774-7202 FAX (717) 774-0383 EMAIL heck man appraisers@comcast.net I Subject Front View Title Subject Rear View I 'i 1 4 Sub'lert Street Scene Extra Photo 1 Extra Photo 2 r Mme- ? 0. R , r .Y?.H y??.Tyn Extra Photo 3 Extra Photo 1 Extra Photo 2 i Exra Photo 3 Extra Photo 1 Extra Photo 2 Extra Photo 3 Extra Photo 1 Extra Photo 2 w } Extra Photo 3 Sales Comp. 1 Sales Comp. 2 Sales Comp. 3 Sales Comp. 4 Sales Comp. 5 Location Map Extra Map Extra Map Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Dec 25, 2006 thru Mar 24, 2007 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 506.66 Certificates: 87, 582.91 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium Are you interested in learning more about Identity Theft, Home Buying, Investing for Retirement or Financial Aid? Visit our web site at www.memberslst.org or ask an associate for more details about these FREE seminars. Congratulations on being a Titanium Level member! Did you know that you are eligible to receive a .10% discount on any of our fixed rate loans and a .10% bonus on our certificate products? Take advantage of these added benefits today! SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Transaction Description --------- Additions Subtractions - --- ---------- Balance Dec 25 Balance Forward ° 43 0 505.41 505.84 io Dec 31 Deposit Dividend 1 . 000 . Annual Percentage Yield Earned 1. 010% from 1210112006 through 1213112006 Jan 31 Deposit Dividend 1 . 0009/ 0.43 506.27 Annual Percentage Yield Earned 1. 010% from 01/01/2007 through 01/31/2007 Feb 28 Deposit Dividend 1 . 000% 0.39 506.66 Annual Percentage Yield Earned 1. 010% from 0210112007 through 0212812007 Mar 24 Ending Balance 506.66 CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 03, 2007 Transaction Description Date Additions Subtractions Balance _ _ Dec 25 Balance Forward 0 172 60 47,593.48 766 47 08 /; Dec 31 Deposit Dividend 4. 270 . , . Annual Percentage Yield Earned 4. 350% from 1210112006 through 1213112006 Jan 31 Deposit Dividend 4. 270%, 173.23 47,939.31 Annual Percentage Yield Earned 4. 350% from 0110112007 through 0113112007 Feb 28 Deposit Dividend 4. 270°/ 157.03 48,096.34 Annual Percentage Yield Earned 4. 360% from 0210112007 through 0212812007 Mar 24 Ending Balance 48,096.34 46 - 11 MONTH CERT Maturity Date - Apr 17, 2007 Date Transaction Description _ Additions _ Subtractions Balance Dec 25 Balance Forward 39,014.26 Dec 31 Deposit Dividend 4. 8909/ 162.03 39,176.29 Annual Percentage Yield Earned 5. 000% from 1210112006 through 1213112006 Jan 31 Depos t Dividend 4. 8900/o 162.71 39,339. 00 Annual Percentage Yield Earned 5. 000% from 0110112007 through 0113112007 Feb 28 Deposit Dividend 4. 8900/0 147.57 39,486.57 --- Continued on following page --- EXHIBIT E ?rx :"j rcmffl NUmber Y-1 9?3tDate Iransaction Descr tiork Addition, Quk)traction= Annual Percentage E nu Pad Earned 5. 000"11c fron? 02101,2007 tti.rough 02/28/2007 Ma ad's YTD SUMMARIES TOTAL DIVIDENDS PAIL) 00 REGULAR. SAVING- 45 12 MONTH C ER-: ' ,'6 11 MONTH E FR ; Date Divicie^r] io -Otal sr8s NOT E: oral includes c , se ' shares Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details.. Send Inqu res to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www,merrtbersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG IDA 17019 Statement of Accounts Mar 25, 2007 thru May 24, 2007 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 32,542.13 Certificates: 55,.747.46 -Loans: 31,531".19. Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium Please read the enclosed insert regarding our FREE seminars. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Transaction Description Additions__ _ _Subtractions Balance ._ Mar 25 Balance Forward 32 000.00 506.66 32,506.66 Mar 31 Deposit Mar 31 Deposit 32,000.00 64,506.66 Loan Proceeds Mar 31 Deposit Dividend 1 . 000%i 2.18 64,508.84 Annual Percentage Yield Earned 1. 000% from 0310112007 through 0313112007 Apr 06 Withdrawal by Check 12,000.00- 52,508.84 Apr 10 Withdrawal by Check 20,000.00- 32,508.84 Apr 30 Deposit Dividend 1 . 000% 33.29 32,542.13 Annual Percentage Yield Earned 1. 000% from 0410112007 through 0413012007 May 24 Ending Balance 32,542.13 CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 03, 2007 Date Transaction Description- _ Additions Subtractions _ Balance Mar 25 Balance Forward 48,096.34 Mar 31 Deposit Dividend 4. 2700% 174.43 48,270.77 Annual Percentage Yield Earned 4. 350% from 0310112007 through 0313112007 Apr 30 Deposit Dividend 4. 270% 169.41 48,440.18 Annual Percentage Yield Earned 4. 350% from 0410112007 through 0413012007 May 24 Ending Balance 48,440.18 46 - 12 MONTH CEERT MONTHLY Maturity Date - Apr 16, 2008 Date Transaction Description Additions Subtractions Balance Mar 25 Balance Forward _ 39,486.57 Mar 31 Deposit Dividend 158.70 39,645.27 Annual Percentage Yield Earned 5. 000% from 9310112007 through 0313012007 c: "Mar 31 Withdrawal :51..? ECG ?"` 32,306. 00- 7,279.27 of, d; Mar 31 Deposit Dividend 4. 890% 0.98 7,280.25 --- Continued on following page --- dnX S 3 .`: 200f, tllr e „- 1 c arar?t Numbe= 273()rf. Date Iransactron Uescnptioe,_ Aclditiorss r,ubtrai rules Annual Percentage Yield Earned 5. 040% from 03f31!,r1007 through 03/3112007 Apr '17 Al 890 Annual Percentage. Yield Earned 5. t?trorn 04101,200, Nirou-gh 04/16,200,' .f Annual Percentage Yield Famed 4 1tSG;? rrorrr 04,117 ;xtrl%" through 04,3012007 May 24 Ending Balance- penalties Assessed Yeto 366, W) LOAN ACCOUNTS 01 - SHARE SECURED Amount Interest Fees Principal `aeon -nt -- - _ - . _ Date Transaction Description Mar 31 Balance Forward Mar 31 Nevv r,r May O r r'w ? ?tis=_; 03 34 1 34 468 KACZERSF r S( , JN May 24 Ending Balance Annual Percentage Rate 4- 950°4,. Daily Rate . u13561 YTD SUMMARIES TOTAL DIVIDENDS PAIL C3TAL LOAN INTEREST PAID 00 REGULAR SAVINGS ? i SHARE SECURED 45 12 MONTH CERT MOH 46 12 MONTH ti?-F- RT M1IVTI-{l otai Year _.clime .as _, NOTE: Total l;lcludes dosf,J sharc_ to Year 7 Date Penalties Assessc Don't forget about our new Member (Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inqu res to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.members1 sLorg Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 Too: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts May 25, 2007 thru Jun 24, 2007 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 32, 397.22 Certificates: 55, 948.45 Loans: 31 ,166.82 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium Are you looking for a way to invest your hard earned money? Consider a certificate from Members 1st. Ask an associate about our monthly specials or visit www.members1st.org for more information. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Transaction _Description Additions Subtractions Balance 32,542.13 May 25 Balance Forward 27 64 32,569.77 May 31 Deposit Dividend 1 . 000'yo Annual Percentage Yield Earned 1. 000% from 0510112007 through 0513112007 Jun 19 Withd,awal Transfer To Loan 01 172. 55- 32,397.22 32,397.22 Jun 24 Ending Balance CERTIFICATE ACCOUNTS 45 - 12 MONTH C:ERT MONTHLY Maturity Date - Oct 03, 2007 Transaction Description Date Additions- Subtractions Balance _ May 25 Balarice Forward ' 67 175 48,440.18 615.85 48 % May 31 Deposit Dividend 4. 270 . , Annual Percentage Yield Earned 4. 350% from 05/01/2007 through 0513112007 Jun 24 Ending Balance 48,615.85 46 - 12 MONTH C:ERT MONTHLY Maturity Date - Apr 16, 2008 - _ Date Transaction Description Additions Subtractions Balance - May 25 Balance Forward 32 25 7,307.28 7 332.60 May 31 Deposit Dividend 4. 080% . , Annual Percentage Yield Earned 4. 160% from 0510112007 through 0513112007 Jun 24 Ending Balance 7,332.60 Penalties Assessed Year to Date 366.00 LOAN ACCOUNTS 01 - SHARE SECURED Date _ Transaction Description _ Amount Interest Fees _ Principal Balance May 25 Balance Forward 31,531.19 --- Continued on following page--- rt ,}, r 1f ?1llERS !' r .?., 1 ?F 00e, ttu . -??. otxnt NIAnbc- Date Transaction Description amount _ Interest € ces Principa3 „<11,11ic?- ----- - - - Jun 01 avmrnts. Transfer 7(1, From KACZERSK,,,:)J Sr ,hin 19 'adments Transfer Frbm Share nn Jun 24 Ending Balance Annual Percentage Rate 4. 950%, i YTD SUMMARIES TOTAL DIVIDENDS PAIL, (OTAL LOAN INTEREST PAIL) 00 REGULAR SAVING:' I SHARE SECURER 10 MOO (--ERT ,0 ?- P t)NTHL ! Giai Yer3 i.)c'1lG rilVluen Palit , . 1. -..!1 NOTE_ Total includes closer; share: Date Pr n?'?It?t-,tS4P.S3eC,- .i-;.r, t Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.meriberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ FCACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jun 25, 2007 thru Jul 24, 2007 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 32,423.93 Certificates: 56,143.66 Loans: 30,817.54 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium Tell anyone you know who isn't a member of Members 1 st that it only takes a $5 minimum deposit in a regular savings account to become a member. Use our Cash4U referral program and when your referral opens an account you'll receive $5! SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date_ . Transaction Description Additions Subtractions Balance ----- ------- _ Balance Forward 32,397.22 Jun 25 __ Jun 30 Deposit Dividend 1 . 0000"o 26.71 32,423.93 Annual Percentage Yield Earned 1. 000% from 0610112007 through 0613012007 Jul 24 Ending Balance 32,423.93 CERTIFICATE ACCOUNTS 45 - 12 MONTH C:ERT MONTHLY Maturity Date - Oct 03, 2007 _Date Transaction Description ___ Additions Subtractions Balance Jun 25 Balance Forward 48,615.85 Jun 30 Deposit Dividend 4. 270%0 170.62 48,786.47 Annual Percentage Yield Earned 4. 3-50% from 0610112007 through 0613012007 Jul 24 Ending Balance 48,786.47 46 - 12 MONTH CERT MONTHLY Maturity Date - Apr 16, 2008 Date Transaction Description AdditionsSubtractions Balance Jun 25 Balance Forward 7,332.60 Jun 30 Deposit Dividend 4. 080°io 24.59 7,357.19 Annual Percentage Yield Earned 4. 160% from 0610112007 through 0613012007 Jul 24 Ending Balance 7,357.19 Penalties Assessed Year to Date 366.00 LOAN ACCOUNTS 01 - SHARE SECURED Date Transaction Description__ _ Amount Interest Fees Principal Balance Jun 25_ Balance Forward 31,166.82 Jul 01 Payments Transfer 400.00 50.72 0.00 349. 28- 30,817. 54 --- Continued on following page --- : G,41lliSll" Date 1'ransacticn DescriAtlt?r F nm KAC7_ERSK1. r.; X Jul 24 rnding Balancc Annual Percentage Rate 4. 950% € ,111y Rat<° YTD SUMMARIES -out WlrnboF 1 I"' ?Mnount Interest i cu,-. 'rlrr?awa, .??, TOTAL DIVIDENDS PAID OTAL LOAN INTEREST PAID 66 REGULAR SAVING 1 SHARE SECURED 45 12 MONTH CER i .a6 12 H 01a 3?E as G' ^,IOTE: "otai includes closed 3hf,r' . Total Year 'To Date Penalties` Assessed E i 0 Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our, branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Send Inquires to: 5000 Louis;e Drive PO Box 40 Mechanicsburg, PA 17055 www.membersist.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 Too: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jul 25, 2007 thru Sep 24, 2007 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 31,671.99 Certificates: 56,549.23 Loans: 30,292.41 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium At Members 1st your security is our top priority. Please read the enclosed insert for more details. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS ti i AdditionsSubtractions _ Balance Date _. __ _ on_ p .__ Transaction Descr 32,423.93 Jul 25 Balance Forward 203. 34- 32,220.59 Jul 25 Withdrawal Transfer To Loan 01 50 32,248.09 27 Jul 31 Deposit Dividend 1 . 000% Annual Percentage Yield Earned 1. 000% from 0710112007 through 0713112007 . Aug 23 Withdrawal Transfer To Loan 01 603.34- 31,644.75 24 31,671.99 27 Aug 31 Deposit Dividend 1 . 000°0 Annual Percentage Yield Earned 1. 000% from 08/01/2007 through 0813112007 . 31,671.99 Sep 24 Ending Balance CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 03, 2007 Date Transaction Description f _ Additions Subtractions Balance 48,786.47 Balance Forward Ju125 93 176 48,963.40 Jul 31 Deposit Dividend 4. 270% Annual Percentage Yield Earned 4. 350% from 0710112007 through 07/31/2007 . Aug 31 Deposit Dividend 4. 270% 177.57 49,140.97 Annual Percentage Yield Earned 4. 350% from 0810112007 through 0813112007 49,140.97 Sep 24 Ending Balance 46 - 12 MONTH CERT MONTHLY Maturity Date - Apr 16, 2008 Date Transaction Description Additions Subtractions - Balance Jul 25 Balance Forward 49 25 7,357.19 7,382.68 Jul 31 Deposit Dividend 4. 080% . Annual Percentage Yield Earned 4. 160% from 0710112007 through 0713112007 Aug 31 Deposit Dividend 4. 0800i0 25.58 7,408.26 Annual Percentage Yield Earned 4. 160% from 0810112007 through 0813112007 7,408.26 Sep 24 Ending Balance 366 00 Penalties Assessed Year to Date . --- Continued on following page --- ?' ? '007 t#ir,; Srw, LOAN ACCOUNTS 09 - SHARE SECURE) _ a??• Date transaction Descnptiov, Amount interest Fees_ Princal - - -- - - Jul 25 Balance Forward Jul 2S ?ayments Tra ncfer 1-r Aug ?ayr eits . ransfer ( 4 E> Sep 24 Ending Balance Annual Percentage Rate 4- 950° U.wy Ratc, €7 } 56! YTD SUMMARIES TOTAL DIVIDENDS PAID i OTAL LOAN INTEREST PAID +70 REGULAR SAVINGS 01 SHARE SECURED 45 12 MONTH CERT MG'S I ii, 6 12 W)NITH CER ! IMONi.Hl Jr-,Tr ;ncludY cinsr SI:1- c , Date Pen<Ylties Assess,,- Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send inquires lo: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.merrr bersl st.org Main switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 Too: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Sep 25, 2007 thru Dec 24, 2007 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 29, 939.12 Certificates: 57,141.88 Loans: 28,937.60 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium 10991NT's are not included in this statement. You will be receiving them in a separate mailing in early January 2008. SAVINGS ACCOUNTS//V 00 - REGULAR SAVINGS Date Tra ion Description- Additions _Subtractions _ Balance --- - 31,671.99 Sep 25 glance Forward 603.34- 31,068.65 Sep 27 Withdrawal Transfer To Loan 01 0009) 25.97 31,094.62 Sep 30 Deposit Dividend 1 . I0 Annual Percentage Yield Earned 1. 000% from 0910112007 through 0913012007 Oct 23 Withdrawal Transfer To Loan 01 603.34- 30,491.28 517.54 26 30 26 Oct 31 Deposit Dividend 1 . 000% , . Annual Percentage Yield Earned 1. 000% from 10/01/2007 through 1013112007 Nov 21 Withdrawal Transfer To Loan 01 603.34- 29,914.20 939.12 92 29 24 Nov 30 Deposit Dividend 1 . 000°10 , . Annual Percentage Yield Earned 1. 000% from 1110112007 through 1113012007 Dec 24 Ending Balance 29,939.12 CERTIFICATE ACCOUNTS 45 - 12 MONTH GERT MONTHLY Maturity Date - Oct 02, 2008 ___ Date Transaction Description Additions Subtractions Balance ___-___ Sep 25 Balance Forward 49,140.97 Sep 30 Deposit Dividend 4. 270°0 172.46 49,313.43 Annual Percentage Yield Earned 4. 350% from 0910112007 through 0913012007 Oct 03 Deposit Dividend 4. 2709/ 11.54 49,324.97 Annual Percentage Yield Earned 4. 360% from 10/01/2007 through 1010212007 Renewed at 4. 170% to mature 10/02/08 Oct. 31 Deposit Dividend 4. 1709/ 163.42 49,488.39 Annual Percentage Yield Earned 4. 250% from 1010312007 through 10/31/2007 Nov 30 Deposit Dividend 4. 1709a 169.62 49,658.01 Annual Percentage Yield Earned 4. 250% from 1110112007 through 1113012007 Dec 24 Ending Balance 49,658.01 --- Continued on following page --- t ?nur f Numb '39',' 46 - 12 MONTH CERT MONTHLY Maturity Date Apr 16. 20013 Date ransactionuescriptioK. Additioa?z. 6Ubtractivns baian-q, Sep 25 Balance Forward 403 c. Sep 30 ?,ep < _ Jivi ± v ,. Annual Percentage Yield Earned 4. 460 ;roar 1)910 `r1U0 " rtarough 0 013 0/2 0 0 4` _- Oc` 31 _)aposi. ,)wide: 4 Wlill' Annual Percentage Yield Earned 4 160 , troop 1010112007 throa9h 10/311200;" vtw 3G U?epo if Divi te Annual Percentage Yield Earned 4 ' ? or F r r)1r2Gr77 +larounir t 1;3012007 Dec 24 Ending Balance 361; 1111 Penalties Assessed Yea., ii: LOAN ACCOUNTS 01 SHARE SECUREL° Date 1 ransaction Description Amount Sep 25 Balance Forward Sep 27 ?ayme i' s Transfer i or Oct 23 layments T-ansfer From -.hay 03 54 Nov 21 r'ayment<. Transfer .;4 Dec 24 Ending Balance Annual Percentage Rate 4. 950% Daily Rate . 013561' interest fees 105 30 Principal_ i3hian x 4(')7 87 - 9:> ar i YTD SUMMARIES TOTAL DIVIDENDS PAID i OTAL LOAN INTEREST PAID 00 REGULAR SAVINGS 1 SHARE SECURED 45 12 MONTH CERT, MON 1.111. 46 12 MONTH CE R 17I ON !-ii_ ;DOTE Total includes closed share; n+ , ??r T -ate Penalties Assessect 6 Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. O MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.meml3erslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Dec 25 , 2007 thru Mar 24 , 2008 Account Number: Account Balances Checking: Savings: Certificates: Loans: 273951 at a Glance: 0.00 27,598.83 57,736.31 27,072.37 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium Membership has its advantages! Your FREE VIP pass for Carlisle Events accompanies this statement. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Additions Subtractions Balance .---_-_---.._- Date Transaction Description 29,939.12 Dec 25 Balance Forward 43 25 29,964.55 Dec 31 Deposit Dividend 1 . 0000/o 000% from 1210112007 through 1213112007 Yield Earned 1 t . . age Annual Percen 603.34- 29,361.21 Jan 03 Withdrawal 603.34- 28,757.87 Jan 25 Withdrawal Transfer To Lean 01 24. 85 28,782.72 Jan 31 Deposit Dividend 1 . 0000/ al Percentage Yield Earned 1. 000% from 0110112008 through 0113112008 n A 38 u n Feb 25 Withdrawal Transfer To Loan 01 22 79 603. 34- 28,179. 28,202.17 Feb 29 Deposit Dividend 1 . 0000/'. al Percentage Yield Earned 1. 000% from 0210112008 through 0212912008 A nnu 603.34- 27,598.83 Mar 19 Withdrawal 27,598.83 Mar 24 Ending Balance - CERTIFICATE ACCOUNTS 45 - 12 MONTH C ERT MONTHLY Maturity Date - Oct 02, 2008 Date Transaction Description- ___ _ Additions Subtractions Balance 658.01 49 Dec 25 Balance Forward 87 175 , 49,833.88 Dec 31 Deposit Dividend 4. 170% Annual Percentage Yield Earned 4. 250% from 1210112007 through 1213112007 . Jan 31 Deposit Dividend 4. 1700/i 176.49 50,010.37 Annual Percentage Yield Earned 4. 250% from 0110112008 through 0113112008 176 06 50 Feb 29 Deposit Dividend 4. 1700/'. 250% from 0210112008 through 0212912008 4 165.69 . , . Annual Percentage Yield Earned 50,176.06 Mar 24 Ending Balance --- Continued on following page--- EtitUi3RS I- -,embers`:; : - 46- 12 MONTH CERT MONTHLY Maturity Date .. Apr 16, 2008 Date 1 ransaetion Descriptior; Dec 25 Balance Forward Dec 31 ? I> ?!t Divide -i i'40111 Annual Percentage Yield Earned 4. 160; ironi a Z01i2uft ,Nbrough ',.2,,3 1r200- Jan 31 ! _ }" si Annual Percentage Yield Earned 4. 960 o ;mum 01/01,%2008 throu}In 6 113112008 7eb 29 Annual Percentage Yield Earned,! 16tt 'Font 021101.)i()08 througti 0212912008 Mar 24 Ending Balanc 'f00_4` thru M,1, 7n ri Nurrmbf t 3,'t Addition, 5ubtractions 24 LOAN ACCOUNTS 01 - SHARE SECURED Date Transaction Description: Dec 25 Balance Forward Jan 03 L'aymen'.:- Jan 25 Paymen s i r , , fr i- Feb 25 h . Payments Transfer Fro?r 01 Mar 1. Mar 24 Ending Balance Annual Pe rcentage Rate 4. 950% Daily Rate 01356V'/„ YTD SUMMARIES Amount interest Fees_ _ Principai Baian(ci: >8 93' s=i iJB r. _ '4 35- } X55 TOTAL DIVIDENDS PAID TO "IAL LOAN INTEREST PAID 00 REGULAR SAVINGS ' SHARF_ SECURED HL r 45 12 NIONTi ? CERT M ION 46 12 (n?l(d "i RT fy4f}NTHL.l' otal ??ar ??atc v=uet,?. ~s ; NOTE Tr)fai irr,ucir > c:!nse l chart Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional towns of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. A MEMBERS 1St FEDERAL CREDIT UNION Send inquires to: 5000 Louise Drive PO Box 40 Mechanicsourg, PA 17055 www.members1st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 Statement of Accounts Mar 25, 2008 thru Jun 24, 2008 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 234.26 Certificates: 41,223.10 Loans: 0.00 KAZIMIERZ KaCZERSKI PO BOX 579 Money Management: 0.00 DILLSBURG F'A 17019 Page: 1 of 2 Your current Member Loyalty Reward level is Titanium With zero origination fees, lower interest rates and flexible repayment options, it's easy to see why our new student loan product is a better way to pay for college. Visit http://memberslst.studentchoice.org for more information. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date_____ Transactio_n_Description___--.-_ ------ --- ---- ----- Mar 25 Balance Forward Mar 31 Deposit Dividend 1 . 000% Annual Percentage Yield Earned 1. 000% from 0310112008 through 0313112008 Apr 28 Withdrawal Transfer To Loan 01 Apr 30 Deposit Dividend 1 . 000% Annual Percentage Yield Earned 1. 000% from 0410112008 through 0413012008 May 23 Withdrawal Transfer To Loan 01 May 31 Deposit Dividend 1 . 000°o Annual Percentage Yield Earned 1. 000% from 0510112008 through 0513112008 Jun 10 Withdrawal Additions Subtractions _ Balance 27,598.83 23.74 27,622.57 603.34- 27,019.23 22.65 27,041.88 603.34- 26,438.54 22.82 26,461.36 16 r4? 26,227.10- 234.26 234 26 Jun 24 Ending Balance . CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2008 Date Transaction Description _-_-_- ---- Additions _ Subtractions Balance 50,176.06 Mar 25 Balance Forward 71 177 50,353.77 Mar 31 Deposit Dividend 4. 1700/6 Annual Percentage Yield Earned 4. 2.50% from 03/0112008 through 0313112008 . Apr 30 Depose Dividend 4. 170% 172.58 50,526.35 Annual Percentage Yield Earned 4. 2.50% from 0410112008 through 0413012008 30 705 50 May 31 Deposit Dividend 4. 1709% 178.95 . , Annual Percentage Yield Earned 4. 2.50% from 0510112008 through 0513112008 14 44 757 50 Jun 10 Deposit Dividend Annual Percentage Yield Earned 4. 260% from 0610112008 through 0610912008 52. . , Jun 10 Withdrawal by Check 17,160.06- Ccv r? 7 -. 33,597.38 33,597.38 Jun 24 Ending Balance 06 160 Penalties Assessed Year to Date . --- Continued on following page --- d? L t I ? 10a 2008 thr - ._., _,] L 3'. ,<I, C,=?IrtP Nurnbe, -395' -twrnber. rt;. 46- 12 MONTH CERT MONTHLY Maturity Date Aor 16 2000 De i ransa ion Descr?pjioro Addition,, at btracuow, Mar 25 Balance - i Forward ?r n Mar 31 nap pit Dividend 4 8, t, Annual Percentage Yield Earned 4. 1"60`,Ia from 03/0112008 ti?irougtr 031311.2008 Apr 1P, Deposit Dividend 4 080'', ;Annual Percentage Yield Earned 4 160`," fronn 04/(?, 2008 through 0411512008 Annual Percentage Yield Earned 2 8"t7 E, from 041 1,12008 through 0 413 012 0 0 8 May Depo., ^ .? Annual Percentage Yield Earned 2, 810`, front 0510112008 through 0513112008 Jun 24 Ending Balan " LOAN ACCOUNTS 01 - SHARE SECURED Date Transaction Descnptio:-? Amount interest I-ees Prinai Balance Mar 25 Balance Forward Apr 28 Payments Transfer F for ,vet :S4 "40 4G May 23 Payments Transfer Fi- -1 3 03. 34 90, 481 8 r Jun 10 Payment,. h "A)'117 "I{ c ; 8 :)( 26,16. > SNARE SECURED Closed -This is the final statement presenting information on this product"' Please retain this final statement for fax reporting purposes YTD SUMMARIES TOTAL DIVIDENDS PAW TOTAL LOAN INTEREST PAID 00 REGULAR SAVING" ?1 SHARE SECURED 45 12 MONTH CERT MONTHL. i 46 12 MONTH CERT MONTH!.` ?t?a e 3azc ?r• ides 156 _ NOTE _ -'al includes closed share Date Penalties Asses e,, Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.merrberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jun 25, 2008 thru Sep :24, 2008 Account Number: 273951 Account Balances at a Glance: Checking: 0.00 Savings: 241.32 Certificates: 41,596.05 Loans: 0.00 Money Management: 0.00 Page: 1 of 2 Your current Member Loyalty Rewards level is Titanium. Access over 25,000 surcharge-free ATMs in the United States. See the enclosed insert for more details. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS ____ Date Transaction Description Additions Subtractions Balance ___ Jun 25 Balance Forward 6 66 234.26 240.92 Jun 30 Deposit Dividend 1 . 000% . Annual Percentage Yield Earned 1. 000% from 0610112008 through 0613012008 Jul 31 Deposit Dividend 1 . 000% 0.20 241.12 Annual Percentage Yield Earned 0. 980% from 0710112008 through 0713112008 Aug 31 Deposit Dividend 1 . 000% 0.20 241.32 Annual Percentage Yield Earned 0. 9.80% from 0810112008 through 0813112008 Sep 24 Ending Balance 241.32 CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2008 Transaction Description Date Additions Subtractions Balance __ Jun 25 B-a anre Forward 33,597.38 Jun 30 Deposit Dividend 4. 1700/(, 80.61 33,677.99 Annual Percentage Yield Earned 4. 2.50% from 0611012008 through 0613012008 Jul 31 Deposit. Dividend 4. 170% 119.28 33,797.27 Annual Percentage Yield Earned 4. 2.50% from 0710112008 through 0713112008 Aug 31 Deposit Dividend 4. 1700/; 119.70 33,916.97 Annual Percentage Yield Earned 4. 250% from 0810112008 through 0813112008 Sep 24 Ending Balance 33,916.97 Penalties Assessed Year to Date 160.06 46 - 12 MONTH CERT MONTHLY Maturity Date - Apr 16, 2009 Date Transaction Description _--_Additions _- Subtractions Balance ------- Jun 25 Balance Forward 7,625.72 Jun 30 Deposit Dividend 2. 770% 17.36 7,643.08 Annual Percentage Yield Earned 2. 8,10% from 0610112008 through 0613012008 Jul 31 Deposit Dividend 2. 770% 17.98 7,661.06 Annual Percentage Yield Earned 2. 810% from 0710112008 through 0713112008 --- Continued on following page --- ?1UEFS? ; n ?? Date i ransaction Description. Aug 31 Deposit Dividend 2 . 770` Annual Percentage Yield Earned 2 8O W", From 0 u? o .)813L20 ,,' Sep 24 Ending Balance YTD SUMMARIES TOTAL DIVIDENDS PAli 00 REGULAR SA\/,W, 45 12 MONITH GERT V"f r-fl 46 12 MONTH ('FP -- r r" 2008 the 4 oo, crNumber- 3 a? Addition,-, ;ubtract1w,s : aian-. 18 !?^ 7 679 t 1.536 Totai includes : sf c' sl;are a Yew , gate Penalties Assess- 1 otal Year o Date Interest ','aid 758 !'DOTE Total includes closed loans Don't forget about our new Member Loyalty Rewards Prograre. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. .. f* A vie MEMBERS 1St FEDERAL CREDIT UNION Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.meriberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranc:h: (717) 795-6049 or(800)237-7288 Statement of Accounts Sep 25, 2008 thru Dec 24 , 2008 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 241.93 Certificates: 41,927.30 . Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Your current Member Loyalty Rewards level is Titanium. 1099-TNT's are not included in this statement. If you earned at least $10 in dividends on your account for 2008, you will receive your 1099-INT in a separate mailing in early January 2009. 1099-INT information will also be available on Members 1st Online in early January. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS _ Date Transaction Descriptiori - ---- ------ Additions Subtractions Balance ___ Sep 25 Balance Forward 20 0 241.32 241 52 Sep 30 Deposit Dividend 1 . 000`/a . . Annual Percentage Yield Earned 1. 010% from 0910112008 through 0913012008 Oct 31 Deposit Dividend 1 . 0000o 0.21 241.73 Annual Percentage Yield Earned 1. 030% from 1010112008 through 1013112008 Nov 30 Deposit Dividend 1 . 000`/0 0.20 241.93 Annual Percentage Yield Earned 1. 010% from 1110112008 through 1113012008 Dec 24 Ending Balance 241.93 CERTIFICATE ACCOUNTS 45 - 12 MONTH GERT MONTHLY Maturity Date - Oct 02, 2009 Date Transaction Description Sep 25 Balance Forward Sep 30 Deposit Dividend 4. 1709% Annual Percentage Yield Earned 4. 250% from 0910112008 through 0913012008 Oct 02 Deposit Dividend 4. 170% Annual Percentage Yield Earned 4. 260% from 1010112008 through 1010112008 Renewed at 2. 820% to mature 10/02/09 Oct 31 Deposit Dividend 2. 8200/'D Annual Percentage Yield Earned 2. 860% from 1010212008 through 1013112008 Nov 30 Deposit Dividend 2. 8201,10 Annual Percentage Yield Earned 2. 860% from 1110112008 through 1113012008 Dec 24 Ending Balance Penalties Assessed Year to Date Additions Subtractions Balance 33,916.97 116.25 34,033.22 3.89 34,037.11 78.89 34,116.00 79.07 34,195.07 34,195.07 160.06 --- Continued on following page --- 1t 11b:P:? ,icr51 ,: n 46 - 12 MONTH CERT MONTHLY Maturity Date- Apr 16. 2009 Date i ransaction Description Sep 25 Balance Forward Sep 30 p s t Dividon, i Annual Percentage Yield Earned 2. 800`'£, from 09101,'2008 through 0 9/3 012 0 0 8 Oct 31 5epos,t Dividend :. Annual Percentage Yield Earned 2. 810°%« trorn 101011;2008 through 10;.39!2008 Nov 3G Deposit Dividend %: Annual Percentage Yield Earned 800' goon : 1/t17,`2008 through ? 1/3012008 Dec 24 Ending Balanc r, YTD SUMMARIES TOTAL DIVIDENDS PAIL 'i0 REGULAR SAVING`: ,!5 12 MONTH GERT MONTHL:? 11 1 r ,a CERT MONTH! \' p e,008 thrI? tit).' .:aunt Numbei 3C` 'ter Additions Subtractions da-IjiI: ii -A Una r r:a? Sate ,' Ide< <? .a?d 1,868 a0 ?-- TMai nci dos r;los ; -share Otal (ear To Date Penalties Assesse, 16o `-otal Year To Date Interest Paid 758 ` 'JOTS. of ! •,clu<i, ?;s? 1 <; Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Sep 25, 2009 thru Dec 24, 2009 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 243.39 Certificates: 31 ,071 .50 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of December 1st is $88,886.54. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. 1099-INT s are not included in this statement. If you earned at least $10 in dividends on your account for 2009 you will receive your 1099-INT in a separate mailing in early January 2010. Online early in information January. be available on s 1 SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Additions Subtractions Balance Transaction Description_________----- -- --- - -- pate - - -- 243.14 _____ Sep 25 Balance Forward 0.10 243.24 Sep 30 Deposit Dividend 0. 500% 500% from 0910112009 through 0913012009 Annual Percentage Yield Earned 0. 0.08 243.32 Oct 31 Deposit Dividend 0. 350% 390% from 1010112009 through 1013112009 Annual Percentage Yield Earned 0. 0.07 243.39 Nov 30 Deposit Dividend 0. 350°/6 Annual Percentage Yield Earned 0. 350% from 1110112009 through 1113012009 243.39 Dec 24 Ending Balance CERTIFICATE ACCOUNTS 0045 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2010 Date Transaction Description`-_ _-_-._.-- Sep 25 Balance Forward Sep 30 Deposit Dividend 2. 8200% Annual Percentage Yield Earned 2. 860% from 0910112009 through 09/30/2009 Oct 02 Deposit Dividend 2. 8209/ Annual Percentage Yield Earned 2. 860% from 1010112009 through 1010112009 Renewed at 1 . 390% to mature 10/02/10 Oct 31 Deposit Dividend 1 . 3900/) Annual Percentage Yield Earned 1. 400% from 1010212009 through 1013112009 Nov 02 Withdrawal Nov 30 Deposit Dividend 1 . 390°,/0 Annual Percentage Yield Earned 1. 400% from 1110112009 through 1113012009 Dec 24 Ending Balance Penalties Assessed Year to Date Additions Subtractions Balance -- - 34,925.81 80.95 35,006.76 2.70 35, 009.46 40.00 35,049.46 4,013.57- 31,035.89 35.61 31,071.50 31,071.50 13.57 --- Continued on following page --- 5000 Lowse Lr ,.. t? Box P 115)3 :_009 thru 0,. -a Lejo`_t ec a, . mount Number '7395' UEKS I' ; t 1,1 YTD SUMMARIES TO-I AL DIVIDENDS PAIL' 0000 REGULAR SAVIN" , 0044 G C f F' I N NOTF )tal ((,,dudes `)sc, * s,i Total Date P,i llti ASS( ;1•..' Nate - ;tere Pd Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch, (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jun 25, 2009 thru Sep 24, 2009 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 243.14 Certificates: 34,925.81 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your current Member Loyalty Rewards level is Titanium. We are celebrating International Credit Union Day on October 15, 2009. Please see the enclosed insert for more details. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Transaction Description Date _Su_b_tractions __ _Balance _ Jun 25 Balance Forward 10 0 242.84 242.94 Jun 30 Deposit Dividend 0. 500% . Annual Percentage Yield Earned 0. 500% from 0610112009 through 0613012009 Jul 31 Deposit Dividend 0. 500% 0.10 243.04 Annual Percentage Yield Earned 0. 490% from 0710112009 through 0713112009 Aug 31 Deposit Dividend 0. 500% 0.10 243.14 Annual Percentage Yield Earned 0. 490% from 0810112009 through 0813112009 Sep 24 Ending Balance 243. 14 CERTIFICATE ACCOUNTS 45 - 12 MONTH CE RT MONTHLY Maturity Date - Oct 02, 2009 Descriptigp___ Transaction Date Additions Subtractions Balance _ _ Jun 25 Balance Forward 34,678.73 Jun 30 Deposit Dividend 2. 820% 80.38 34,759.11 Annual Percentage Yield Earned 2. 860% from 0610112009 through 0613012009 Jul 31 Deposit Dividend 2. 820% 83.25 34,842.36 Annual Percentage Yield Earned 2. 860% from 0710112009 through 0713112009 Aug 31 Deposit Dividend 2. 820% 83.45 34,925.81 Annual Percentage Yield Earned 2. 860% from 0810112009 through 0813112009 Sep 24 Ending Balance 34,925.81 46 - 12 MONTH CERT MONTHLY Date Transaction Description Additions Subtractions Balance Jun 25 Balance Forward 4,790.92 Jun 30 Deposit Dividend 1 . 740% 6.85 4,797.77 Annual Percentage Yield Earned 1. 750% from 0610112009 through 0613012009 Jul 31 Deposit Dividend 1 . 740% 7.09 4,804.86 Annual Percentage Yield Earned 1. 750% from 0710112009 through 0713112009 Aug 31 Deposit Dividend 6.87 4,811.73 --- Continued on following page--- / n a r.count Number ?3951 Date T ransaction Descrs tiosa Additions bubtraction . -- - Annual Percentage Yield Earned 1. 750% trona 08/01, 2009 through 08/3 012 0 0 9 Aug 1,T:t" , .,.. 12 MONTH CER I MON7l-l . Y C: 10S -This is the final statement presenting rnforma tkarr 0ri this product.. Please retain this final statement for tax reporting purposes Penalties Assessed Yea to Date YTD SUMMARIES TOTAL DIVIDENDS PAiI_ 00 REGULAR SAVINGS 45 12 MONTH CPR-1 %111 ()N Ht +? . 46 12 M 0 N T rv?(,)PJTNt `i otal Year 'o mate Div lends Haml NOTE: Total includes closed shares Total Year To Date Penalties Assessed 39 Date interest Paid otal Ye ',dOTE_ Tot3i includes " losed ;can:, Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersist.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jun 25, 2009 thru Sep 24, 2009 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 243.14 Certificates: 34, 925.81 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your current Member Loyalty Rewards level is Titanium. We are celebrating International Credit Union Day on October 15, 2009. Please see the enclosed insert for more details. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Transaction Description _ ---------- Jun 25 Balance Forward Jun 30 Deposit Dividend 0. 500% Annual Percentage Yield Earned 0. 500% from 0610112009 through 0613012009 Jul 31 Deposit Dividend 0. 500% Annual Percentage Yield Earned 0. 490% from 0710112009 through 0713112009 Aug 31 Deposit Dividend 0. 500% Annual Percentage Yield Earned 0. 490% from 0810112009 through 0813112009 Sep 24 Ending Balance Additions Subtractions _ Balance 242.84 0.10 242.94 0.10 243.04 0.10 243.14 243.14 CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2009 Description Date Transaction Additions Subtractions Balance . - Jun 25 Balance Forward 34,678.73 759.11 38 34 80 Jun 30 Deposit Dividend 2. 820% , . Annual Percentage Yield Earned 2. 860% from 0610112009 through 0613012009 Jul 31 Deposit Dividend 2. 820% 83.25 34,842.36 Annual Percentage Yield Earned 2. 860% from 0710112009 through 0713112009 Aug 31 Deposit. Dividend 2. 820% 83.45 34,925.81 Annual Percentage Yield Earned 2. 860% from 0810112009 through 0813112009 Sep 24 Ending Balance 34,925.81 46 - 12 MONTH CERT MONTHLY Transaction Description Date Additions Subtractions Balance _ _ Jun 25 Balance Forward 6 85 4,790.92 4 797.77 Jun 30 Deposit Dividend 1 . 740% . , Annual Percentage Yield Earned 1. 750% from 0610112009 through 0613012009 Jul 31 Deposit Dividend 1 . 740% 7.09 4,804.86 Annual Percentage Yield Earned 1. 750% from 0710112009 through 0713112009 Aug 31 Deposit Dividend 6.87 4,811.73 --- Continued on following page --- h2` _ : xo nt NumbE' 11fb1L3iRS f' a_ce?s? Date Transaction uescn tiw, Additiorjt, Sudtractoow-, a= Annual Percentage Yield Earned 1. 750'X? trorn 08,101,2009 throaph 0813012009 '\uq 31 Q MONTH CERI MONIH a -This is the final statement ,oresentrnct Rrlorrn.ftrur, .:an mis product" Please retain this final statement fot .? , report_irsg purzposes 'onalties Assessed Yea 39 66 YTD SUMMARIES TOTAL DIVIDEND: PAR 00 REGULAR SA'VING'- 45 12 MONTH CF,-_1.T f',: 8 iF i2 Mo1`T r:s N N otai I ea) i o Date D'ividFinds PaG NOTE- Total includes closed shares Tr 4'f'ar To Date Penalties Assesseo z utal ear v (? -,)ate Interest Paid r.c:\JOTF. J it rcl{ de: a !Oa• Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquirers to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG FA 17019 Statement of Accounts Mar 25, 2009 thru Jun 24, 2009 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 242.84 Certificates: 39,469.65 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your current Member Loyalty Rewards level is Titanium. Would you like to receive a full calendar month statement? Sign up for eStatements today! See the enclosed insert for more details. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Subtractions Additions Balance TransactionDescrpti oon_____ ---- - -------- gate -- ---- - 242.49 Mar 25 Balance Forward 0.15 242.64 Mar 31 Deposit Dividend 0. 750°/ l Percentage Yield Earned 0. 730% from 0310112009 through 0313112009 A 74 nnua Apr 30 Deposit Dividend 0. 500% 0.10 242. Annual Percentage Yield Earned 0. 500% from 0410112009 through 0413012009 84 242 May 31 Deposit Dividend 0. 500°io 490% from 0510112009 through 0513112009 ld Earned 0 Yi 0.10 . . e Annual Percentage 242.84 Jun 24 Ending Balance CERTIFICATE ACCOUNTS 45 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2009 Date-` _ Transaction Descn tp ion -- - Additions Subtractions Balance 34,433.40 Mar 25 Balance Forward 47 82 34,515.87 Mar 31 Deposit Dividend 2. 8209/ Annual Percentage Yield Earned 2. 8610% from 0310112009 through 0313112009 . Apr 30 Deposit Dividend 2. 820% 80.00 34,595.87 Annual Percentage Yield Earned 2. 850% from 0410112009 through 0413012009 73 678 34 May 31 Deposit Dividend 2. 82010 nual Percentage Yield Earned 2. 850% from 0510112009 through 0513112009 A 82 86 . , n 34,678.73 Jun 24 Ending Balance 46 - 12 MONTH CERT MONTHLY Maturity Date - Apr 16, 2010 Date Transaction Description - __ _ Additions Subtractions Balance 5,767.04 Mar 25 Balance Forward 57 13 5,780.61 Mar 31 Deposit Dividend 2. 7700/D nual Percentage Yield Earned 2. 810% from 0310112009 through 0313112009 A . n 1,006.53- 4,774.08 Apr 13 Withdrawal 35 6 4,780.43 Apr 16 Deposit Dividend 2. 770%. Annual Percentage Yield Earned 2. 810% from 0410112009 through 0411512009 . --- Continued on following page --- , C Box 11 tic Date i ransaction Description Renewed at p .;t t d, 1 'W Annual Percentage Yield Earned 1. 75 u x'009 ttiro jgh 174;"3012009 May 31 r it vivider?., 74C Annual Percentage Yield Earned ' 71jC1?<i trorn 05ru412o09 through 05131/2009 Jun 24 Ending Balance Penalties Assessed Year i t,,,at YTD SUMMARIES TOTAL DIVIDENDS PAIL 00 REGULAR SAA•itNC:' 115 T?_ MOE?lT1 (FR- I?-}r,i-rl_, =6 h1t1r: ? F . , f ,_ otal Year I o Date Dividends Paid 462 NOTE, T includes closed share: ,iii `r' e?? - To Gate Penalties Assess` t<, gate inte t Paid Ri,)Tt ? '7. ,tF7-13 Add Your Photo For Security i 9 . i `., Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. 1 21309 th u !.r f Addition, ciiibtractiun:s ; In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memt)ersist.org Main switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Sep 25, 2010 thru Dec 24, 2010 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 244.13 Certificates: 15, 366.50 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of December 1st is $79,010.36. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. 1099-TNT's are not included in this statement. If you earned at least $10 in dividends on your account for 2010, you will receive your 1099-INT in a separate mailing in early January 2011. 1099-INT information will also be available on Members 1st Online early in January. SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date Transaction Sep 25 Balance Forward Sep 30 Deposit Dividend 0. 300% Annual Percentage Yield Earned 0. 300% from 0910112010 through 0913012010 Oct 31 Deposit Dividend 0. 300% Annual Percentage Yield Earned 0. 290% from 1010112010 through 1013112010 Nov 30 Deposit Dividend 0. 300% Annual Percentage Yield Earned 0. 300% from 11/01/2010 through 1113012010 Dec 24 Ending Balance Additions Subtractions Balance -- . -,- _ 243.95 0.06 244.01 0.06 244.07 0.06 244.13 244.13 CERTIFICATE ACCOUNTS 0045 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2011 Transaction Description Date Additions Subtractions Balance __ Sep 25 Balance Forward 24 16 20,325.23 20 349.39 Sep 30 Deposit Dividend 1 . 390% . , Annual Percentage Yield Earned 1. 400% from 0910112010 through 0913012010 Oct 02 Deposit: Dividend 1 . 390% 0.77 20,350.16 Annual Percentage Yield Earned 1. 390% from 1010112010 through 1010112010 Renewed at 0. 900`/o to mature 10/02/11 Oct 31 Deposit: Dividend 0. 900% 15.05 20,365.21 Annual Percentage Yield Earned 0. 900% from 10/02/2010 through 1013112010 Nov 09 Withdrawal by Check 5,011,06- 15,354.15 Nov 30 Deposit Dividend 0. 900% 12.35 15,366.50 Annual Percentage Yield Earned 0. 900% from 11/01/2010 through 1113012010 Dec 24 Ending Balance 47 62 15,366.50 Penalties Assessed Year to Date . --- Continued on following page --- `?iFhlBt:kS P YTD SUMMARIES TOTAL DIVIDENDS F'Ai 0000 REGJi_AR S, "O., )04` f,"C?i _ C'tQ . 7 1; 1 r? Date P' ..? Itie7Assesse::. 'Da' Ir Add Your Photo For Security .'.:, 0 s U r}5 r a`} r, f-cocwt Numbe" '3 Your personal safety and financial security are top priorities at Members 1st, As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms o3 identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Send Inquires to: 5000 Loui<..e Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 Too: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jun 25, 2010 thru Sep 24, 2010 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 243.95 Certificates: 20,325.23 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of September 1st is $82,791.04. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. Visit any of our branch locations on Thursday, October 21, 2010 and join us in celebrating International Credit Union Day. SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Transaction Description _.__ Date Additions-- Subtractions _ Balance _ -- _ - Jun 25 Balance Forward 0 06 243.77 83 243 Jun 30 Deposit Dividend 0. 300% . . Annual Percentage Yield Earned 0. 300% from 0610112010 through 0613012010 Jul 31 Deposit Dividend 0. 300% 0.06 243.89 Annual Percentage Yield Earned 0. 290% from 0710112010 through 0713112010 Aug 31 Deposit Dividend 0. 3001% 290% from 0810112010 through 0813112010 d 0 0.06 243.95 . Annual Percentage Yield Earne Sep 24 Ending Balance 243.95 CERTIFICATE ACCOUNTS 0045- 12 MONTH CERT MONTHLY Maturity Date- Oct 02, 2010 Transaction Description __ Date Additions Subtractions Balance _____ Jun 25 Balance Forward 25,254.98 Jun 30 Deposit Dividend 1 . 390% 28.85 25,283.83 Annual Percentage Yield Earned 1. 400% from 0610112010 through 0613012010 Jul 31 Deposit Dividend 1 . 390% 29.85 25,313.68 Annual Percentage Yield Earned 1. 400% from 0710112010 through 0713112010 Aug 02 Withdrawal 1,504.72- 23,808.96 Aug 31 Deposit Dividend 1. 390% 28.16 23,837. 12 Annual Percentage Yield Earned 1. 400% from 0810112010 through 0813112010 Sep 08 Withdrawal 3,511.89- 20,325.23 Sep 24 Ending Balance 20,325.23 Penalties Assessed Year to Date 36.56 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.49 --- Continued on following page --- Li r,> C, Nurgh? i ;a Exp.. y nm . 1C L,r .,_ ta! )ate r Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Mar 25, 2010 thru Jun 24, 2010 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 243.77 Certificates: 25,254.98 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of June 1st is $85,830.97. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. Weve made it easier for you to manage your accounts online! See the enclosed insert for more details. SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Date Transaction _Description _______________ Additions Subtractions Balance Mar 25 Balance Forward 243.59 Mar 31 Deposit Dividend 0. 300% 0.06 243.65 Annual Percentage Yield Earned 0. 290% from 0310112010 through 0313112010 Apr 30 Deposit Dividend 0. 300% 0.06 243.71 Annual Percentage Yield Earned 0. 300% from 0410112010 through 0413012010 May 31 Deposit Dividend 0. 300% 0.06 243.77 Annual Percentage Yield Earned 0. 290% from 0510112010 through 0513112010 Jun 24 Ending Balance 243.77 CERTIFICATE ACCOUNTS 0045 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2010 Transaction Description Date Subtractions Balance __ .__ Mar 25 Balance Forward 30,174.26 Mar 31 Deposit Dividend 1 . 390% 35.62 30,209.88 Annual Percentage Yield Earned 1. 400% from 0310112010 through 0313112010 Apr 19 Withdrawal by Check 5,016.90- 25,192.98 Apr 30 Deposit Dividend 1 . 390% 32.22 25,225.20 Annual Percentage `field Earned 1. 400% from 0410112010 through 0413012010 May 31 Deposi: Dividend 1 . 390% 29.78 25,254.98 Annual Percentage Yield Earned 1. 400% from 0510112010 through 0513112010 Jun 24 Ending Balance 25,254.98 Penalties Assessed Year to Date 19.95 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.31 0045 12 MONTH CERT MONTHLY 166.75 --- Continued on following page --- Lr tE11D}ILS!" ,r,, x,iiutNumbe 9?} a4, Don't forget about our new Memoer Loyalty Rewards Program. The more products you have with us. the more benefits you'll receive. Ask an associate for details or visit our website at www.memberslst.org for details. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.meniberslst.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Dec 25 , 2009 thru Mar 24 , 2010 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 243.59 Certificates: 30,174.26 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of March 1st is $91,125.67. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. We have once again partnered with Carlisle Events to provide you with a 2010 VIP Pass! Your free pass is enclosed. SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Transaction Descri tion Date Additions _Subtractions Balance _____ Dec 25 Balance Forward 243.39 Dec: 31 Deposit Dividend 0. 3500/ 0.07 243.46 Annual Percentage Yield Earned 0. 3,10% from 1210112009 through 1213112009 Jan 31 Deport Dividend 0. 3500/c 0.07 243.53 Annual Percentage Yield Earned 0. 3,10% from 0110112010 through 0113112010 Feb 28 Deposit Dividend 0. 3000% 0.06 243.59 Annual Percentage Yield Earned 0. 320% from 0210112010 through 0212812010 Mar 24 Ending Balance 243.59 CERTIFICATE ACCOUNTS 0045 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2010 Date Transaction Description _Additions S_ubtractions_ Balance Dec 25_ ___Balance Forward 31,071.50 Dec 31 Deposit Dividend 1 . 390% 36.68 31,108.18 Annual Percentage Yield Earned 1. 400% from 1210112009 through 1213112009 Jan 31 Deposi, Dividend 1 . 390% 36.72 31,144.90 Annual Percentage Yield Earned 1. 400% from 0110112010 through 0113112010 Feb 08 Withdrawal 1,003.05- 30,141.85 Feb 28 Deposit Dividend 1 . 390% 32.41 30,174.26 Annual Percentage Yield Earned 1. 400% from 0210112010 through 0212812010 Mar 24 Ending Balance 30,174.26 Penalties Assessed Year to Date 3.05 YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.13 0045 12 MONTH CERT MONTHLY 69. 13 --- Continued on following page --- count Numbe '-3V Add Your Photo For Security Your personal safety and financial security are top priorities at Members ist. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting oui branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number o1 attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Send inquires to: 5000 Louise Drive Po Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Jun 25 , 2011 thru Sep 24, 2011 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 244.59 Certificates: 9,444.11 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of September 1st is $11,693.08. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. sporting event tickets! Enter for your chance win enciose PENN STATE details! See the SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Additions Subtractions___ - Balance • Transaction_Descnp_tion__ -_.__.____-.----- -------- --" Date 244.44 4 ____ 0.05 Jun 25 Balance Forward 244.4 Jun 30 Deposit Dividend 0. 250% e Yield Earned 0. 250% from 0610112011 through 0613012011 0 ta OS 244. 54 g . Annual Percen Jul 31 Deposit Dividend 0. 250% l Percentage Yield Earned 0. 240% from 0710112011 through 0713112011 0 05 A 244.59 . nnua Aug 31 Deposit Dividend 0. 2501% 240% from 0810112011 through 0813112011 59 244 Annual Percentage Yield Earned 0. . Sep 24 Ending Balance CERTIFICATE ACCOUNTS 0045 - 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2011 Date Transaction Description-__- Jun 25_ Balance Forward Jun 30 Deposit Dividend 0. 9009 Annual Percentage Yield Earned 0. 900% from 06/01/2011 through 06/30/2011 Jul 31 Deposit Dividend 0. 900% Annual Percentage Yield Earned 0. 900% from 0710112011 through 0713112011 Aug 31 Deposit Dividend 0. 9000/6 Annual Percentage Yield Earned 0. 900% from 0810112011 through 0813112011 Sep 19 Withd-awal Sep 24 Ending Balance t D to Additions_ __ Subtractions _ Balance 11,422.31 8.70 11,431.01 8.74 11,439.75 8.74 11,448.49 2,004.38- 9,444.11 9,444.11 13.07 Penalties Assessed Year o a _ YTD SUMMARIES TOTAL DIVIDENDS PAID 0.40 0000 REGULAR SAVINGS --- continued on following page --- vc'41Ntr..i hJ€Mll1t7E Add Your Photo For Security; Your personal safety and financial security are top priorities at Members `ist. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main switchboard: (717) 697-1161 or (600) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (117) 697.5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 KAZIMIERZ KACZERSKI PO BOX 579 DILLSBURG PA 17019 Statement of Accounts Mar 25 , 2011 thru Jun 24 , 2011 Account Number: 273951 Balances at a Glance: Checking: 0.00 Savings: 244.44 Certificates: 11,422.31 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Reward: 0.00 Page: 1 of 2 Your aggregate balance as of June 1st is $13,671.09. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. You can now Sepersonaze our debit card with your e the enclosed insert for more details. picture! SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS _ Subtractions Additions _ Balance Balance _ _____-- - --------- -- Transaction Descriltion_-__ Date ___. - " - 244. _ Mar 25 Balance Forward 0.05 244.34 Mar 31 Deposit Dividend 0. 250% l Percentage Yield Earned 0. 240% from 0310112011 through 03/31/2011 05 0 244.39 Annua Apr 30 Deposit Dividend 0. 250% l Percentage Yield Earned 0. 250% from 0410112011 through 0413012011 . 0 05 244.44 Annua May 31 Deposit Dividend 0. 250°0 al Percentage Yield Earned 0. 240% from 0510112011 through 0513112011 A . 244.44 nnu Jun 24 Ending Balance -- CERTIFICATE ACCOUNTS 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2011 0045 - Additions Subtractions-- --- Balance _-___.-._-._-._--------------.- Date Transaction Description _-------- -----. 13,396.23 Mar 25 Balance Forward 10. 24 13,406.47 Mar 31 Deposit Dividend 0. 900°b l Percentage Yield Earned 0. 900% from 0310112011 through 03/31/2011 92 13,416.39 9 Annua Apr 30 Deposit Dividend 0. 900° l Percentage Yield Earned 0. 900% from 04/01/2011 through 04/30/2011 . 26 13,426.65 10 Annua May 31 Deposit Dividend 0. 900`/0 l Percentage Yield Earned 0. 900% from 05/01/2011 through 05/31/2011 A . 2,004.34- 11,422.31 nnua Jun 06 Withdrawal 11,422.31 Jun 24 Ending Balance Penalties Assessed Year to Date - 8.69 -- _? YTD SUMMARIES TOTAL DIVIDENDS PAID 0 25 . 0000 REGULAR SAVINGS --- Continued on following page --- Add Your Photo For Security lw . , 20 .hl li _a;i?tlrr± NC1mbe, Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional torrns of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Statement of Accounts Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www,membet-sl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or(800)237-7288 Dec 25, 2010 thru Mar 24, 2011 Account Number: 273951 Balances at a Glance: Checking: Savings: Certificates: Loans: KAZIMIERZ KACZERSKI Money Management: PO BOX 579 Swipe 5 YTD Reward DILLSBURG PA 17019 Page: Your aggregate balance as of March 1st is $74,392.00- An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. National Credit Union Youth Week is April 17-23. Celebrate the week with us! See the enclosed insert for more details. 0.00 244.29 13,396.23 0.00 0.00 0.00 1 of 2 SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Balance Subtractions 244.13 Date Transaction Descriation Additions 244.19 67W25 Balance Forward Dec 31 Deposit Dividend 0. 300°h U. 06 1210112010 through 12/31/2010 24 244 l Percentage Yield Earned 0. 290% from . 0.05 Annua Jan 31 Deposit Dividend 0. 2509/> 240% from 01/01/2011 through 01/31/2011 244.29 Annual Percentage Yield Earned 0. 0.05 Feb 28 Deposit Dividend 0. 250% Annual Percentage Yield Earned 0. 270% from 0210112011 through 02/28/2011 244.29 Mar 24 Ending Balance CERTIFICATE ACCOUNTS 12 MONTH CERT MONTHLY Maturity Date - Oct 02, 2011 0045 - Balance Subtractions Additions Date Transaction_Descrption - -- - 15,366.50 378.25 15 - al Dec 25 6 Balance Forward , 11.75 Dec 31 Deposit Dividend 0.900"/° l Percentage Yield Earned 0. 900% from 1210112010 through 12/31/2010 15,390.00 11.75 Annua Jan 31 Deposit Dividend 90.9 l Percentage Yield Earned 0. !)00% from 01/01/2011 through 01/31/2011 2,004. 35- 13,385.65 Annua Feb 28 Withdrawal 13,396.23 10.58 Feb 28 Deposit Dividend 0.900'/0 l Percentage Yield Earned 0. 900% from 0210112011 through 0212812011 13,396.23 Annua Mar 24 Ending Balance s Assessed Year to Date lti 4.35 -- e Pena YTD SUMMARIES TOTAL DIVIDENDS PAID 0.10 0000 REGULAR SAVINGS --- Continued on following page --- ti??? ? rJOU u? c , 1.1. illfilbL: 73 9., 39., Add Your Photo For Security Your personal safety and financial security are top priorities at Members I st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number o! attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information In addition to having your photo in our files, you may be required to show additional forms of identification based on the type of transaction you are seeking. This is for your protection and security and we appreciate your ongoing cooperation and understanding. Ad m H a J a N UZ Z? N W F" _LU H -1 LLA Z W W M Z Ul W 0 5a W v \" (V ? L¢o Q?z Z A tD C: O ? 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V m w Q ai Q = t!1 ZE ° 0 0 0 0 O C y ?E . ? ` Y o EXHIBIT F O ? c= w O O ?? ?? o E o ED ° a r a ?- ° >- W V 0 w d o r WAI,)DELL z REID an, ?'' i (i ) AT 02 007241 79442H 47 A"3DGT I++IIIII+lllmllll...I1},+}Ilm?tllm}+l?llllr},I}}mmf,}I,I?IE,ull FIDUCIARY TRUST CO NH CUST IRA FBO KAZIMiERZ R KACZERSKI 18 MONTASERE: DR DILLSBURG PA 17019-9104 Information from Waddell & Reed Waddell & Reed, Inc. is undertaking a comprehensive update of the information and records we maintair for our clients. The collection and maintenance of this information is required of all brokerage firms by Financial Industry Regulatory Authority (FINRA) Rules 2310, 2090, 2111, 3110, and Securities and Exchange Commission (SEC) rules 17a-3 and 17a-4. Taking these steps ensures that we have the most updated information, so we may continue to best serve your financial needs. Your financial advisor will be reaching out to you to discuss this information in the coming months. Summary of Accounts Quarter-to-Date Statement Report July 1, 2011 - Pa( September 30, 2011 1 of Your Financial Leroy J Jones Jr Advisor 5027 E Trindle RD Mechanicsburg, PA 17050-3622 (717) 697-6659 Branch Office Waddell & Reed, Inc. 4230 Crums Mill RD. Suite 200 Harrisburg PA 17112-2898 C'lientSeniees 1,888.Waddell Internet Services www.waddell.com Total Portfolio Value $48.568.86 Dividends and Capital Gains Summary Categorl, Year-to-Date Dividends $0.00 Short Term Capital Gains 0.00 Long Term Capital Gains 0.00 Total $0.00 Year-to-Date Summary of Investments by Account Account Account Account Market Value Additional Category Nannellndieator Number on 1213112010 Net Exchanges" IRA Plan Kazimierz Kaczerski 35954592 - 565,326.31 Total Portfolio Value YTD bfarket Marker Yale Withdrawals .4ction/l:arnings on 091301201. (16,757.45) 548,568.81 565,326.31 "F,xclmanges between fimncUaccounts are all shown together in the "Additions" column. As a result, the totals disphyed for the "Additions" and "Withdrawals" coluinns should represent true net additions or withdrawals fir the accounts listed. (16,757.45) S48-%8.9 16 007241 16 'ne right choice for the long terri' .American FundsR PC) Box 2280 Norfolk VA 23501-2280 F° 02 064568 61895 H 259!! `A ?ilel?i?leil?l??lli,l?l?l?l?il'f?l?ll?`l?ll??llllitlllll?llll?l(i KAZIMIERZ R KACZERSKI CUST FBC) JOANNA M KACZERSKI PAM MA U N1 IL AGE 21 18 MONTASERE: DR DILLSBURG PA 17019 9104 Since initial investment on Year-to-date since 09/01/2005 01/01/2011 $5,000.00 55,244.49 F,eg!nnin g value $0.00 SC.OO Additions 5aea 5a.ou - witpdrawals 573.20 $ 7! 29 -! Investment gain,'de-line 673.20 $5 $5,673.20 Ending value as of 09/30/2011 , -5c722(? $^ 7i 2c: i,,ta' ..narrge va ,;e $i:./ t l g=, t.ty $4,1 ,n $r e. , s! 55.000 15.190 S6.293 S7.132 54.636 $5.818 $6.241 Net lnvestrnent s?he total amount you invested M!11US the total amm.l you wi hdrew. 1-AF1-021794:17 ;92047 064560 1 ?, _4 )Ii n,1 S5.673 Quarterly Statement September 30, 2011 Page 1 of 3 Primary account number: 75270481 Making a new and improved statement Welcome to your redesigned quarterly statement based on valued input from you and financial advisers. By providing you with more detailed information, you can better monitor your American Funds investments. See the enclosed guide for details about the enhancements. Pave the way to buy shares online Say goodbye to mailing in investment checks. Link your bank and American Funds account today with our sirnple two-step process. Learn more at americanfunds.com/onlineinvesting. mgr _=- Growth-and-income 49.13% Equity-income 50.87% 100.00% How to contact us Through your financial adviser -IMOTHY WILKINS (717' 854-1215 ext.6654 INVEST FINANCIAL '1uRPORATION C110 MEMBERS 1ST FEDRAL:;REDIT UNION 2145 WHITE ST YORK PA 17404-4954 americanfunds.com FundsLine® 24-hour automated service 800x325-3590 Shareholder Services Representative 8001421-0180 (M-F 8 a.m. V-) 8 p.rn. Eastern time? Mail Amer;can Fu ds SeMce Company PO Box 2280 Norfolk VA 23501-2280 Overnight courier American Funds Service C omaanY 530(1 Robin Hood Road Norfolk VA 2SE1S-2430 Questions about your statement a mericanfurids .oom/statement Value of accour:t --- Net investrrnent* r The right choice for the long term • ` American Funds" PCB Box 2280 Norfolk VA 23501-2280 i=P 02 064566 61895 H 259 A rlllllllllhlrltllllrl?r`?Illlll?llillllllllt?llo,llrltllil?l?l,l KAZIMIERZ R KACZERSKI CUST FBO ALEXANDRA E KACZERSKI PA/UTMA UNTIL AGE 21 18 MONTASERE DE ?ILLSBURG PA 1 7019 9104 Since initial investment on . $7,000 00 uegnining value $0.00 .- Addit',nns SG.Ou - wlT; dr. is $943.22 -r. 'qvestmentgamrdeclinA Ending value as of 09/3012011 $7,943.22 +$943.22 Total r-I•ange m val-ie $9 9K Year-to-date sinca 01/01!2011 $8,74299 50.00 $0.00 -.$70-9.77 $7.943.22 S79?.7 7 sr 57000 57.266 SS.E10 59.985 56,491 58.145 S8.743 x^;6''.f'V S, le l1- .. ?fi.: a ?GLlllt VOu invested 'T'I'lUS th_ tOta: ar110?J(li SOU WItI1dfEW 1) :M Ii S7.943 Quarterly Statement September 30, 2011 Page 1 of Primary account number: 75270503 Making a new and improved statement Welcome to your redesigned quarterly statement, based on valued input from you and financial advisers. By providing, you with more detailed information, you can better monitor your American Funds investments. See the enclosed guide for details about the enhancements. Pave the way to buy shares online Say goodbye to mailing in investment checks. Link your bank and American Funds account today with our simple two-step process. Learn -more at americanfunds.com/onlineinvesting. w =x "- Growth-and-income 49.13% Equity-income 50.87% 100.00°0 How to contact us Through your financial adviser TIMOTHY WILKINS '.7; 854-121 6, eXi.'o%754 NVEST FINANCIAL CORPORATION C;/0 MEMBERS 1ST FHC RAL CREDIT UNION 2145 WHITE ST YC7RK PA 17404-4,954 americanfunds.com FundsLine(R) 24-hour automated service 800;325-359',0 Shareholder Services Representative 800;421-0180 (M-F 8 a.m, to 8 p.-n. Eastarn time! Mall Ansel'can Fuf"Kis J2-Vi B, l,Gf Da;iV a(J 3 ) 22K Nort(A VA 23501 2230 Overnight courier Anre Ica- r..`i cs Ur7 ce Company ,301; Rot:n huo? Zoa?i Norfolk VA 235'.3-2430 Questions about your statement a-?iericantcnds,cor-`!s-aternen? -- Value of aCCOUrIt Net Investlrle7t"._. CERTIFICATE OF SERVICE The undersigned hereby states that he has served a copy of the foregoing, "Defendant's I Pretrial Statement," on the below-named individual in the manner indicated: Hand-Delivered Andrew C. Sheely, Esquire 127 S. Market Street Mechanicsburg, PA 17055 Joh M. Kerr, Esquire John Kerr Lw, P.C.r 5020 Ritter Road Suite 104 Mechanicsburg, PA 17055 (717) 766-4008 Dated: November 17, 2011 j >(>?a Ritter Rc,ad Sure 104 rl anwShurg, PA 1 70. , 717.766.40()8 nx: 717,766.4066 Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. KAZIMERZ R. KACZERSKI, Defendant CIVIL ACTION - LAW 08 - 1353 IN DIVORCE AFFIDAVIT OF CONSENT MCC r-n ,. te r. 0 7 cz- -- P CD _? 1 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on February 29, 2008. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to the authorities. DATE : 337 / 0 12 '4"' /C /C Susan K. Kaczerski ' Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS., KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 08 - 1353 IN DIVORCE X -~ Z? , t _-U C); C Cv' WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER §3301 (C) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce decree is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to the authorities.l DATE : 3 ? 9L-k of ;.-, r Su an K. Kaczerski Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff vs .. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA AFFIDAVIT OF CONSENT CIVIL ACTION - LAW ?• ?- 08 - 1353 > ?:rj IN DIVORCE L? ap c ? Z C C` Cr =r. v. 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on February 29, 2008. Counsel accepted service of the divorce complaint on March 6, 2008. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to the authorities. J DATE?,? c? ? z, ??--?? i.m rz R. Kacz ki Andrew C. Sheely, Esquire 127 S. Market Street P.O. Box 95 Mechanicsburg, PA 17055 PA ID NO. 62469 717-697-7050 (Phone) 717-697-7065 (Fax) SUSAN K. KACZERSKI, Plaintiff VS. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW KAZIMERZ R. KACZERSKI, 08 - 1353 Defendant IN DIVORCE te WAIVER OF NOTICE OF INTENTION TO REQUEST ter` r' ENTRY OF A DIVORCE DECREE UNDER §3301 (C) OF THE DIVORCE CODE < C 1. I consent to the entry of a final decree off` dl-Ero ?e without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce decree is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to the authorities. r DATE: l / a m Az Kaczers SUSAN K. KACZERSKI, Plaintiff Vs. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 08 - 1353 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this /6 day of s , 2012, the parties and counsel having entered into an agreement and stipulation resolving the economic issues on March 7, 2012, the date set for a Master's hearing, the agreement and stipulation having been transcribed, and signed by the parties and counsel, the appointment of the Master is vacated, and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, ?• /4/, - -; 54, - Kev' A. Hess, P. J. cc: .,-Andrew C. Sheely Attorney for Plaintiff c.e? gym. ---'John M. Kerr , Attorney for Defendant= =' SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant THE MASTER: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 08 - 1353 CIVIL IN DIVORCE c Today is Wednesday, Ma=9,'7i- 2012. This is the date set for a hearing in the T. above-captioned divorce proceedings. Present in the hearing room are the Plaintiff, Susan K. Kaczerski, and her counsel Andrew C. Sheely, and the Defendant, Kazimerz R. Kaczerski, and his counsel John M. Kerr. This action was commenced by the filing of a complaint in divorce on February 29, 2008, raising grounds for divorce of irretrievable breakdown of the marriage. The Master has been provided affidavits of consent and waivers of notice of intention to request entry of divorce decree signed today by both parties. The affidavits and waivers will be filed with the Prothonotary's office by the Master's office. The divorce can, therefore, conclude under Section 3301(c) of the Domestic Relations Code. The Master has been advised that the parties have reached a comprehensive agreement with respect to the the outstanding economic claims. The divorce complaint raised claims of equitable distribution, alimony, and 1 C] • alimony pendente lite. No claims have been raised by either party for counsel fees and expenses. Based on the agreement reached between the parties today, counsel are going to put the agreement on the record in the presence of the parties. The agreement as stated on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. Consequently, when the parties leave the hearing room they are bound by the agreement even though there is no subsequent signing of the agreement by the parties affirming the terms of settlement. The agreement is going to be transcribed and sent to counsel for review for typographical errors and we will make corrections, as necessary, of those errors, if any. Otherwise, the agreement will be sent to counsel for them to review the agreement with their clients for signature and the parties will sign the agreement affirming the terms of settlement as stated on the record today. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment and counsel can then file a praecipe transmitting the record to the Court requesting a final. decree in divorce. 2 • The parties were married on October 15, 1988, and separated on August 8, 2007. They are the natural parents of two children. One of the children is emancipated, although in college, and the other child is a minor living with wife. Mr. Sheely. MR. SHEELY: 1. Husband and wife agree that husband shall transfer an amount of $65,000.00 in cash to wife within a period of forty-five (45) days from today's date. The payment to wife shad be made in check form payable to wife and her attorney Andrew C. Sheely, Attorney at Law. 2. Husband and wife agree that husband shall transfer an amount of $100,000.00 to wife from husband's retirement accounts. Husband and wife agree to cooperate in the completion of any and all required QDROs to accomplish this transfer. Counsel for the parties shall contact the appropriate plan provider or providers to accomplish the transfer as contemplated herein. These transfers shall occur no later than forty-five (45) days after this date. 3. Husband and wife agree that husband shall pay wife alimony, commencing the first month following the entry of a decree in divorce in accordance with the following terms: a) Husband shall pay wife alimony in the amount of $1,000.00 per month for a period of twenty-four (24) consecutive months and; b) thereafter, husband's payment of alimony shall be reduced to an amount of $800.00 per month for an additional twenty-four (24) consecutive months and; c) thereafter, husband's payment of alimony shall be reduced to an amount of $600.00 per month for an additional twenty-four (24) months at which time alimony payments shall cease. d) Husband and wife agree that all alimony payments herein shall be reported as income to wife and deductible to husband for income tax purposes. 3 ?J • e) Plaintiff's attorney shall reduce the terms of this alimony agreement to a Court order to be entered simultaneously with the divorce decree in this matter. f) Plaintiff's attorney shall notify the Domestic Relations Office as to the entry of a decree in divorce within a period of seven (7) days after the decree is entered. g) Husband and wife agree that the payment of alimony, as contemplated herein, shall be paid through the Cumberland County Domestic Relations Office. h) The payment of alimony, as contemplated herein, shall be non-modifiable; however, alimony payments shall cease upon the death of either party, upon wife's remarriage or upon wife's co-habitation with a person of the opposite sex. 4. Husband and wife agree that wife shall be responsible for all debts presently in her name including but not limited to those debts as forth in her pretrial statement. 5. Husband and wife agree to mutually cooperate with the signing of any and all documents necessary to assist with husband's refinancing and completing the cash transfer as agreed to in Paragraph 1, including wife's agreement to sign any spousal waivers or other documents necessary to permit husband to refinance as deemed necessary. 6. Husband and wife agree that husband shall meet with wife at an agreed upon location to transfer the title to the fgg8.1"8 Dodge Caravan presently titled in both names, if SKK necessary. 7. The real estate which has been a part of the discussion in these proceedings is in husband's name only and wife waives any claims that she has in said real estate. It is also understood that the debt (current mortgage) against the real estate is husband's obligation only and will remain husband's obligation without any obligation on wife. 8. Wife, aside from the transfer as provided herein, waives any and all interest in husband's retirement plan. 9. The parties have previously distributed between themselves all the tangible personal property and each party retains what that party has received as his and her sole and separate property. 4 • • 10. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual. waiver and relinquishment of all such interest, rights, and claims. MR. SHEELY: Susan, were you present during the reading of the terms of the agreement as recently set forth? MS. KACZERSKI: Yes. MR. SHEELY: Do you have any questions about the terms of the agreement? MS. KACZERSKI: No. MR. SHEELY: Are you fully agreeable to the terms and conditions as have been read into the record? MS. KACZERSKI: Yes. MR. SHEELY: Are you under any type of medication or influence which would render you unable to understand the agreement? MS. KACZERSKI: No. MR. SHEELY: And is it your intention to enter into this agreement today? 5 • MS. KACZERSKI: Yes. i MR. KERR: Mr. Kaczerski, were you present when the proposed agreement was dictated into the record? MR. KACZERSKI: Yes, I was. MR. KERR: Do you understand the terms as they were read into the record? MR. KACZERSKI: Yes. MR. KERR: Are you agreeable to those terms? MR. KACZERSKI: Yes. MR. KERR: Are you under the influence of any medication or anything which would limit your ability to understand and make reasonable decisions? MR. KACZERSKI: No. THE MASTER: Thank you for your efforts here counsel and parties. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be 6 • • imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: Andrew C. Sheel Susan K. Kaczers Attorney for Plaintiff ?l Jo M. Kerr i r aczerskP At orney for Defendant SUSAN K. KACZERSKI, Plaintiff VS. KAZIMERZ R. KACZERSKI, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - CUSTODY 08 - 1353 CIVIL TERM _ C:k PRAECIPE TO TRANSMIT RECORD ?°? m__ TO THE PROTHONOTARY: M?? ?r N Kindly transmit the record, together with the followin, -s information to the Court for entry of a divorce decree ?n 3 CD 1. Ground for divorce: Irretrievable breakdown uncFe3301() 2. Date and manner of service of the complaint: Acceptance by Lindsay D. Baird, Esquire on March 6, 2008. 3. Complete either paragraph (a) or (b). a. Date of execution of the affidavit required by 3301(c) of the Divorce Code: by plaintiff 03/07/12; by defendant 03/07/12. b. (1) Date of execution of the affidavit required by 3301(d) of the Divorce Code N/A (2) Date of filing and service of the plaintiff's affidavit upon the respondent: N/A 4. Related claims pending: Division of retirement benefits, alimony and payment of cash. 5. Complete either (a) or (b) a. Date and manner of service of the notice of intention to file praecipe to transmit record, a copy of which is attached: b. Date of plaintiff's waiver of Notice in 3301(c) Divorce was filed with the Prothonotary: 03/08/12 Date defendant's Waiver of Notice in 3301(c) Divorce was filed with the Prothonotary: j 03/08/12 AAdrew C. Sheely,-Ts-quire Attorney for Plaintiff 127 South Market Street Mechanicsburg, PA 17055 (717) 697-7050 SUSAN K. KACZERSKI IN THE COURT OF COMMON PLEAS OF CAUMBERIAND COUNTY, PENNSYLVANIA V. KAZIMERZ R. KACZERSKI : NO, 03 - 1353 DIVORCE DECREE AND NOW,. kC4-AA 20-12 it is ordered and decreed that SUSAN K. KACZERSKI plaintiff, and KAZIMERZ R. KACZERSKI . defendant, are divorced from the bonds of matrimony. Any existing spousal. support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: The Court retains jurisdiction over the payment of rash, division of retirement accounts and alimony payments as set forth in the March 7. 2012 Property Settlement Agreement which is incorporated but not merged into this Divorce Decree. By the Cou A St. m o Pleas Judde Prothonotary 5.7' l2 opI? eofy ma". &-/ 7'10 ?vfjC e ? C°1° y ?'It9fl t°? 7?' P*`41111?-ll r-'1 E U-G FPU Andrew C. Sheely, Esquire 127 S. Market Street {? p y P.O. Box 95 R!2 MAY -8 PM h: 17 d Mechanicsburg, PA 17055 I NO. 62469 (Phone) 717-697-7050 CUMBERLAND COUNTY 717-697-7065 (Fax) PENNSYLVANIA SUSAN K. KACZERSKI, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA Vs. CIVIL ACTION - CUSTODY KAZIMERZ R. KACZERSKI, 08 - 1353 CIVIL TERM Defendant ORDER OF COURT IN RE: ALIMONY AND NOW, this day of , 2012, it is hereby Ordered and Decreed that Defend t, Kazimerz R. Kaczerski, shall pay Plaintiff, Susan K. Kaczerski, alimony in the amounts agreed upon in accordance with the terms of paragraph 3 of their Agreement dated March 7, 2012. Alimony payments as required by this order and the agreement of the parties shall be paid through the Cumberland County Domestic Relations Office. COURT Thoma common •?Andrew C. Sheely, Esquire Attorney for Plaintiff, Susan K. Kaczerski ?jJohn M. Kerr, Esquire Attorney for Defendant, Kazimerz R. Kaczerski ?Op;e5 jua, led N. Macey J. leas Judge ?Wt INCOME WITHHOLDING FOR SUPPORT Q ORIGINAL INCOME WITHHOLDING ORDERINOTICE FOR SUPPORT (IWO) !1/„ i l R E) AMENDED IWO 1 1 1 N 1353 C of i 1 Q ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT r-s.x G? 1 n TERMINATION OF IWO Date: 06/05/12 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE:,T",1WQr.mW6t be, lar on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions hfp://www acf hhs gov/programs/csetnewhire/em looyer/publication/publication htm - forms). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/TriberTerritory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): b7431uuiui City/County/Dist.rTribe CUMBERLAND Order Identifier: (See Addendum for ordeNdocket lnformaiton) Private Individual/Entity CSE Agency Case Identifier, (See Addendum for case summary) NATIONAL FREIGHT INC* 71 W PARK AVE VINELAND NJ 08360-3508 Employer/Income Withholder's FEIN 210586910 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: KACZERSKI, KAZIMIERZ R. Employee/Obligor's Name (Last, First, Middle) 157-50-5471 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions httg;llw%w acf hhs qov/programs/cse/newhireJ emplover/publication/publication.htm - forma. If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2105869100 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from the employee/ obligor's income until further notice. _ c r? $ 809.00 per month in current child support $ 0.00 per month in past-due child support - Arrears 12 weeks or greater? tno $ 0.00 per month in current cash medical support M c rl r- $ 0.00 per month in past-due cash medical support $ 1,000.00 per month in current spousal support --5 $ 0.00 per month in past-due spousal support $ 0.00 per month in other (must specify) cam,, _ ? for a Total Amount to Withhold of $ 1,809.00 per month. AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the OrWr Irtfdrmation. If your pay cvcle does not match the ordered payment cycle, withhold one of the following amount: $'j, L?] per weekly pay period. $ 904.50 per semimonthly pay period (twice a month) $ d ?,4, 143 per biweekly pay period (every two weeks) $ 1,809.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten 10 working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 551/6 of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/contact maw htm for the employee/obligor's principal place of employment. Document Tracking Identifier OMB No.: 0970-0154 Form EN-028 06/12 ? Return to Sender [Completed by Employer/Income Withholder). Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal law): Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: InV7 If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-96M for instructions. PA FIPS CODE 42 000 00 Make Rernitt rice Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O.<Box 69112, Harrisburg, Pa 17106.9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACS,ES MEMBER ID (shown above as the Emp/oyle#106 lggor's Case Identifier) OR SOCIAL SECURITY NUM R IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State-specific contact and withholding information can be found on the Federal Employer Services website located at: http:/ www acf hhs oov/Qroarams/csWnewhire/a yer'cont?^t?? on A ?maa.htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USG 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOsi: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honorall IWOs to the greatest extent possible, giving priority to current support before payment of any past-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments tothis employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary ' action against an ernployeelobligor because of this IWO. OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Fnrm FN-r17R nRll? w Employer's Name: NATIONAL FREIGHT INC' Employer FEIN: 210586910 Employee/Obligor's Name: KACZERSKI, KAZIMIERZ R. 6743100101 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you a no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2105869100 O This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known address: Last known phone number: Final Payment Date To SDU/Tribal Payee: New Employer's Name: New Employer's Address: Final Payment Amount: CONTACT INFORMATION: To Employer/Income Withholder' If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST. P.O. BOX 320, CARLISLE PA 17013 (Issuer address). To Employ ligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsugport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.: 0970-0154 Form EN-028 06/12 0__ n n _Ir ADDENDUM S ummary of Cases on Attachment Defendant/Obligor: KACZERSKI, KAZIMIERZ R. PACKS Case Number 051100364 PACKS Case Number 448113293 Plaintiff Name Plaintiff Name SUSAN K. KACZERSKI SUSAN K. KACZERSKI Docket Attachment Amount Docket Attac hment Amount 00552 S 1991 $ 809.00 08-1353 CIVIL $ 1,000.00 Child(ren)'s Name(s): DOB Chitd(ren)'s Name(s): DOB JOANNA MARIE KACZERSKI 03/05/96 PACKS Case Number PACKS Case Number Plaintiff Name Plaintiff Name Dolt Aachment Amount $ 0.00 pocket Attach $ ment Amount 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACKS Case N im ? (?PA SES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount $ 0.00 Docket Attach $ ment Amount 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 06112 `_J I n Andrew C. Sheely, Esquire T7, 127 S. Market Street P P.O. Box 95 Mechanicsburg, PA 17055 PA ID No. 62469 717-697-7050 (Phone) L All 717-697-7065 (Fax) SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW KAZIMERZ R. KACZERSKI, 08 - 1353 Defendant IN DIVORCE MOTION TO APPROVE ENTRY OF QUALIFIED DOMESTIC RELATIONS ORDER TO COMPLY WITH PROPERTY SETTLEMENT AGREEMENT Plaintiff, Susan K. Kaczerski, by and through counsel of Andrew C. Sheely, Esquire, hereby files this motion seeking the entry of a Qualified Domestic Relations order in accordance with the property settlement agreement reached in the above-captioned matter, and respectfully state as follows: 1. Paragraph 2 of the property settlement agreement entered on March 7, 2012 requires that Defendant transfer a certain amount of retirement funds to Defendant. 2 . Plaintiff and Defendant request the entry of a Qualified Domestic Relations order in form attached hereto to accomplish the intent of the March 7, 2012 agreement. 3. The proposed order applies to a NFI Industries, Inc. Employee Retirement Savings account maintained by Defendant. 4 . This Court maintains jurisdiction over the division of the retirement accounts in accordance with the Divorce Decree entered on May 4, 2012 . 5 . The Honorable Thomas A. Placey has entered prior Orders of Court, including the Divorce Decree in the above- captioned matter. 6 . Counsel for both parties concur with this Motion. WHEREFORE, Plaintiff, Susan K. Kaczerski, by and through counsel of Andrew C. Sheely, Esquire, respectfully requests the entry of a Court Order in the form attached hereto Respectfully submitted, 17 CA Date: March , 2013 Andrew C. Sheely, E uire Attorney for Plaintiff PA ID 62469 127 South Market Street P.O. Box 95 Mechanicsburg, PA 17055 717-697-7050 717-6997-7065 ( fax) 2 Exhibit "A" SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION- LAW KAZIMERZ R. KACZERSKI, 08- 1353 Defendant IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER IN RE: DEFENDANT'S RETIREMENT SAVINGS PLAN AND NOW,this day of 3 2013, the following is approved and entered as an Order of Court in the above-captioned Divorce action. This order creates and recognizes the existence of an alternate payee's right to receive a portion of the participant's benefits payable under an employer-sponsored defined contribution plan, which is qualified under Section 401 of the Internal Revenue Code (the "Code"). This Order is intended to constitute a Qualified Domestic Relations Order ("QDRO") under Section 414(p)of the Code and Section 206(d)of the Employee Retirement Income Security Act of 1974("ERISA") and shall be interpreted and administered in conformity with such laws. This order is entered pursuant to the authority granted under the applicable domestic relations laws of the Commonwealth of Pennsylvania. 1. Plan. This order applies to the NFI Industries, Inc. Employee Retirement Savings Plan 40 1(k) Account Number 157505471 managed by NFI Industries, Inc., as custodian. Any successor to this plan shall also be subject to the terms of the order. 2. Participant The name, address, Social Security number, and date of birth of the Participant are as follows: Name: KAZIMERZ R. KACZERSKI Address: 18 Montasere Drive, Dillsburg,PA 17019 Social Security Number: XXX-XX-5471 Date of Birth: February 5, 1957 3. Alternate Payee The person names as alternate payee meets the requirements of the definition of alternate payee as set forth in Section 4 of this order. The alternate payee's name, address, Social Security number, date of birth, and relationship to the participant are as follows: Name: SUSAN K. KACZERSKI Address: 20 Richard Road, Mechanicsburg,PA 17050 Social Security Number: XXX-XX-1867 Date of Birth: January 24, 1960 Relationship to Participant: Spouse (or former spouse) The alternate payee shall be responsible for notifying the Plan Administrator in writing of any changes in her mailing address subsequent to the submission of this Order. 4. Definitions Alternate Payee-- The alternate payee is any spouse, former spouse, child, or other dependent of a participant who is recognized by a domestic relations order having a right to receive all or a portion of the benefits payable under the Plan with respect to the participant. Liquidation Date-- The liquidation date is the date the amount assigned to the alternate payee is transferred from the participant's Vested Account Balance to a separate account established for the alternate payee in accordance with the terms of the QDRO. An assignment as of the liquidation date assigns a portion of the participant's current Vested Account Balance. Plan Administrator — NFI Industries, Inc., 71 West Park Avenue, Vineland, NJ, 08360-3508, the custodian for the NFI Industries, Inc. Employee Retirement Savings Plan 401(k) Account Number 157505471, has the authority to process domestic relations orders in accordance with the plan requirements. 2 Valuation Date--The Valuation Date is the date on which the participant's Vested Account Balance will be valued in order to determine the alternate payee's designated portion in accordance with the terms of this order. Accounts are valued on a daily basis. Vested Account Balance—The participant's Vested Account Balance is the dollar amount the participant has a nonforfeitable right to receive from the Plan. 5. Benefit Payable to Alternate Payee This order assigns to the alternate payee an amount equal to forty thousand seventy- three dollars and seventy-seven cents($40,073.77), of the participant's Vested Account Balance under the Plan(identified in Section 1) as of May 4, 2012. If the assigned amount as of the Valuation Date is greater than the full vested amount of the participant's account as of that date(after any outstanding loan balances and/or withdrawals have been deducted),the net Vested Account Balance will be the assigned amount. 6. Form of Payment This order directs transfer of forty thousand seventy-three dollars and seventy-seven cents($40,073.77)to the alternate payee. The transaction will transfer to the alternate payee (ex-spouse) without any tax consequence. 7. Commencement The alternate payee shall be eligible to receive payment as soon as administratively reasonable following the determination that this order is a satisfactory Qualified Domestic Relations Order. In no event can the alternate payee begin his or her benefit later than April I following the year in which the participant attains age 70-1/2. 8. Death Procedures If the participant predeceases the alternate payee prior to payment of the alternate payee's assigned benefits under the QDRO, the alternate payee's benefits will not be affected. In the event of the participant's death, the account balance, which remains the property of the participant, will be payable to the participant's designated beneficiary or in accordance with Plan provisions. This order does not require the participant to name the alternate payee as the beneficiary for the benefits not assigned to the alternate payee. In case of the death of the alternate payee prior to distribution of the alternate payee's benefits under the QDRO,the assigned benefits will be paid to the alternate payee's designated beneficiary or, if none, in accordance with Plan provisions. 9. Retention of Jurisdiction 3 This matter arises from an action for divorce or legal separation in this Court under the case number set forth at the beginning of this order. Accordingly, this court has jurisdiction to issue this order. In the event the Plan Administrator determines that this order is not a satisfactory Qualified Domestic Relations Order, both parties shall cooperate with the Plan Administrator in making any changes needed for it to become qualified. This includes signing all necessary documents. For the purpose, this Court expressly reserves jurisdiction over the dissolution proceedings involving the participant, the alternate payee, and the participant's interests in the Plan. 10. Limitations Pursuant to Section 414(p)(3)of the Code and except as provided by Section 414(p)(4),this order: (i) Does not require the Plan to provide any type or form of benefits, or any option, not otherwise provided under the Plan; (ii) Does not require the Plan to provide increased benefits; and (iii)Does not requirement the payment benefits to an alternate payee that is required to be paid to another alternate payee under another order previously determined to be a Qualified Domestic Relations Order. 11. Taxation. For purposes of Sections 402 and 72 of the Code, any alternate payee who is the spouse or former spouse of the participant shall be treated as the distributee of any distribution or payments made to the alternate payee under the terms of the order and, as such, will be required to pay the appropriate federal, state, and local income taxes on such distribution. 12. Construction Receipt If the Plan inadvertently pays to the participant any benefit that is assigned to the alternate payee pursuant to the terms of this order,the participant will immediately reimburse the Plan to the extent the participant has received such benefit payments and shall forthwith pay such amounts so received to the Plan within tent(10) days of receipt. If the Plan inadvertently pays to the alternate payee any benefit that is actually payable to the participant, the alternate payee must make immediate reimbursement. The alternate payee must reimburse the Plan to the extent he or she has received such benefit payments and shall forthwith pay such amount so received to the Plan within ten(10)days of receipt. 4 13. Effect of Plan Termination If the Plan is terminated, the alternate payee shall be entitled to receive her portion of the participant's benefits as stipulated herein in accordance with the Plan's termination provisions for participants and beneficiaries. 14. Certification of Necessary Information All payments made pursuant to this order shall be conditioned on the certification by the alternate payee and the participant to the Plan Administrator of such information as the Plan Administrator may reasonably require from such parties to make the necessary calculation of the benefit amounts contained herein. BY THE COURT, J Approved by: e c 1 6 Wte icipap; ant 3/)- -Z71 3 Susan K. Kaczerski Date Alternate Payee/Plaintiff 5 CERTIFICATE OF SERVICE I, Andrew C. Sheely, Esquire, hereby certify that I am this day serving the foregoing Motion on behalf of Plaintiff to Defendant upon the following named individual this day by depositing same in the United States Mail, First Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed as follows: John M. Kerr, Esquire 5020 Ritter Road Suite 104 Mechanicsburg, PA 17055 Date: March 2013 0 Andrew C. Sheely, Ee<uire SUSAN K. KACZERSKI, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - LAW KAZIMERZ R. KACZERSKI, 08 - 1353 Defendant IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER IN RE: DEFENDANT'S RETIREMENT SAVINGS PLAN AND NOW, this 2 UP day of [-\_VjrjL_ , 2013, the following is approved and entered as an Order of Court in the above-captioned Divorce action. This order creates and recognizes the existence of an alternate payee's right to receive a portion of the participant's benefits payable under an employer-sponsored defined contribution plan, which is qualified under Section 401 of the Internal Revenue Code (the "Code"). This Order is intended to constitute a Qualified Domestic Relations Order ("QDRO") under Section 414(p) of the Code and Section 206(d) of the Employee Retirement Income Security Act of 1974 ("ERISA") and shall be interpreted and administered in conformity with such laws. This order is entered pursuant to the authority granted under the applicable domestic relations laws of the Commonwealth of Pennsylvania. 1. Plan. This order applies to the NFI Industries, Inc. Employee Retirement Savings Plan 401(k) Account Number 157505471 managed by NFI Industries, Inc., as custodian. Any successor to this plan shall also be subject to the terms of the order. 2. Participant The name, address, Social Security number, and date of birth of the Participant are as follows: Name: KAZIMERZ R. KACZERSKI Address: 18 Montasere Drive, Dillsburg,PA 17019 Social Security Number: XXX-XX-5471 Date of Birth: February 5, 1957 3. Alternate Payee The person names as alternate payee meets the requirements of the definition of alternate payee as set forth in Section 4 of this order. The alternate payee's name, address, Social Security number, date of birth, and relationship to the participant are as follows: Name: SUSAN K. KACZERSKI Address: 20 Richard Road, Mechanicsburg, PA 17050 Social Security Number: XXX-XX-1867 Date of Birth: January 24, 1960 Relationship to Participant: Spouse (or former spouse) The alternate payee shall be responsible for notifying the Plan Administrator in writing of any changes in her mailing address subsequent to the submission of this Order. 4. Definitions Alternate Payee-- The alternate payee is any spouse, former spouse, child, or other dependent of a participant who is recognized by a domestic relations order having a right to receive all or a portion of the benefits payable under the Plan with respect to the participant. Liquidation Date-- The liquidation date is the date the amount assigned to the alternate payee is transferred from the participant's Vested Account Balance to a separate account established for the alternate payee in accordance with the terms of the QDRO. An assignment as of the liquidation date assigns a portion of the participant's current Vested Account Balance. Plan Administrator -- NFI Industries, Inc., 71 West Park Avenue, Vineland, NJ, 08360-3508, the custodian for the NFI Industries, Inc. Employee Retirement Savings Plan 401(k) Account Number 157505471, has the authority to process domestic relations orders in accordance with the plan requirements. 2 J Valuation Date--The Valuation Date is the date on which the participant's Vested Account Balance will be valued in order to determine the alternate payee's designated portion in accordance with the terms of this order. Accounts are valued on a daily basis. Vested Account Balance—The participant's Vested Account Balance is the dollar amount the participant has a nonforfeitable right to receive from the Plan. 5. Benefit Payable to Alternate Payee This order assigns to the alternate payee an amount equal to forty thousand seventy- three dollars and seventy-seven cents ($40,073.77), of the participant's Vested Account Balance under the Plan(identified in Section 1) as of May 4, 2012. If the assigned amount as of the Valuation Date is greater than the full vested amount of the participant's account as of that date (after any outstanding loan balances and/or withdrawals have been deducted), the net Vested Account Balance will be the assigned amount. 6. Form of Payment This order directs transfer of forty thousand seventy-three dollars and seventy-seven cents ($40,073.77)to the alternate payee. The transaction will transfer to the alternate payee (ex-spouse) without any tax consequence. 7. Commencement The alternate payee shall be eligible to receive payment as soon as administratively reasonable following the determination that this order is a satisfactory Qualified Domestic Relations Order. In no event can the alternate payee begin his or her benefit later than April 1 following the year in which the participant attains age 70-1/2. S. Death Procedures If the participant predeceases the alternate payee prior to payment of the alternate payee's assigned benefits under the QDRO, the alternate payee's benefits will not be affected. In the event of the participant's death, the account balance, which remains the property of the participant, will be payable to the participant's designated beneficiary or in accordance with Plan provisions. This order does not require the participant to name the alternate payee as the beneficiary for the benefits not assigned to the alternate payee. In case of the death of the alternate payee prior to distribution of the alternate payee's benefits under the QDRO,the assigned benefits will be paid to the alternate payee's designated beneficiary or, if none, in accordance with Plan provisions. 9. Retention of Jurisdiction 3 This matter arises from an action for divorce or legal separation in this Court under the case number set forth at the beginning of this order. Accordingly, this court has jurisdiction to issue this order. In the event the Plan Administrator determines that this order is not a satisfactory Qualified Domestic Relations Order, both parties shall cooperate with the Plan Administrator in making any changes needed for it to become qualified. This includes signing all necessary documents. For the purpose, this Court expressly reserves jurisdiction over the dissolution proceedings involving the participant, the alternate payee, and the participant's interests in the Plan. 10. Limitations Pursuant to Section 414(p)(3) of the Code and except as provided by Section 414(p)(4), this order: (i) Does not require the Plan to provide any type or form of benefits, or any option, not otherwise provided under the Plan; (ii) Does not require the Plan to provide increased benefits; and (iii) Does not requirement the payment benefits to an alternate payee that is required to be paid to another alternate payee under another order previously determined to be a Qualified Domestic Relations Order. 11. Taxation. For purposes of Sections 402 and 72 of the Code, any alternate payee who is the spouse or former spouse of the participant shall be treated as the distributee of any distribution or payments made to the alternate payee under the terms of the order and, as such, will be required to pay the appropriate federal, state, and local income taxes on such distribution. 12. Construction Receipt If the Plan inadvertently pays to the participant any benefit that is assigned to the alternate payee pursuant to the terms of this order,the participant will immediately reimburse the Plan to the extent the participant has received such benefit payments and shall forthwith pay such amounts so received to the Plan within tent(10) days of receipt. If the Plan inadvertently pays to the alternate payee any benefit that is actually payable to the participant, the alternate payee must make immediate reimbursement. The alternate payee must reimburse the Plan to the extent he or she has received such benefit payments and shall forthwith pay such amount so received to the Plan within ten(10) days of receipt. 4 13. Effect of Plan Termination If the Plan is terminated,the alternate payee shall be entitled to receive her portion of the participant's benefits as stipulated herein in accordance with the Plan's termination provisions for participants and beneficiaries. 14. Certification of Necessary Information All payments made pursuant to this order shall be conditioned on the certification by the alternate payee and the participant to the Plan Administrator of such information as the Plan Administrator may reasonably require from such parties to make the necessary calculation of the benefit amounts contained herein. BY THE COURT, Thomas A.Placey J Common Pleas Judge Approved by: 01* e i to icipapt/D a ant 7 / Susan K. Kaczerski Date Alternate Payee/Plaintiff rn co =M -V {_ E.,r 3 i r� N 5 CERTIFICATE OF SERVICE I, Andrew C. Sheely, Esquire, hereby certify that I am this day serving the foregoing Motion on behalf of Plaintiff to Defendant upon the following named individual this day by depositing same in the United States Mail, First Class, postage prepaid, at Mechanicsburg, Pennsylvania, addressed as follows: John M. Kerr, Esquire 5020 Ritter Road Suite 104 Mechanicsburg, PA 17055 Date: March 2013 Jt a v CgQ-,,- Andrew C. Sheely, E uire • INCOME WITHHOLDING FOR SUPPORT o ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) DS 1 1 b i a104 - o AMENDED IWO O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT s mal S "I Q TERMINATION OF IWO t ; 3 D8- 1353 Gm( Date: 04/30/14 ❑ Child Support Enforcement (CSE) Agency ® Court 0 Attorney 0 Private Individual/Entity (Check One) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http://www.acf.hhs.gov/programs/cse/forms/OMB-0970-0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. State/Tribe/Territory Commonwealth of Pennsylvania City/County/Dist./Tribe CUMBERLAND Private Individual/Entity Remittance Identifier (include w/payment): 6743100101 Order Identifier: (See Addendum for order/docket information) CSE Agency Case Identifier: (See Addendum for case summary) NATIONAL FREIGHT INC* 71 W PARK AVE VINELAND NJ 08360-3508 Employer/Income Withholders FEIN 210586910 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) RE: KACZERSKI, KAZIMIERZ R. Employee/Obligor's Name (Last, First, Middle) 157-50-5471 Employee/Obligor's Social Security Number (See Addendum for plaintiff names associated with cases on attachment) Custodial Party/Obligee's Name (Last, First, Middle) NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions htto://www.acf.hhs.gov/orograms/cse/forms/ OMB -0970-0154 instructions.pdf). If you receive this document from someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached. 2105869100 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This document is based on the support or withholding order from CUMBERItAND County, Commonwealth of Pennsylvania (State/Tribe). You are required by law to deduct these amounts from tate eloyee/ obligor's income until further notice. �-- - rn DJ =� 0.00 per month in current child support = x. rn 0.00 per month in past -due child support - Arrears 12 weeks or greater? 0 yes(/' no ' 0.00 per month in current cash medical support to CD'7' 0.00 per month in past -due cash medical support 0.00 per month in current spousal support 0.00 per month in past -due spousal support 0.00 per month in other (must specify) for a Total Amount to Withhold of $ 0.00 per month. za . r — t • to --<' CO AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information. If your pay cycle does not match the ordered payment cycle, withhold one of the following amount: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period (twice a month) $ 0.00 per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. $ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order. REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the pay date. If you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 55% of disposable income for all orders. If the employee/obligor's principal place of employment is not within the Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements, and any allowable employer fees at http://www.acf.hhs.gov/programs/cse/newhire/employer/contacts/contact map. htm for the employee/obligor's principal place of employment. Document Tracking Identifier Service Type M OMB No.: 0970-0154 Form EN -028 11/13 Worker ID $IATT ❑ Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to the sender. Signature of Judge/Issuing Official (if required by State or Tribal I Print Name of Judge/Issuing Official: Title of Judge/Issuing Official: Date of Signature: If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO must be provided to the employee/obligor. ❑ If checked, the employer/income withholder must provide a copy of this form to the employee/obligor. ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. State -specific contact and withholding information can be found on the Federal Employer Services website located at: http://www.acf.hhs.gov/programs/cse/newhi re/employer/contacts/contact_map. htm Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42 §666(b)(7)). If a Federal tax levy is in effect, please notify the sender. Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/ obligor's portion of the payment. Payments To SDU: You must send child support payments payable by income withholding to the appropriate SDU or to a Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO was sent by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form. Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement the withholding and forward the support payments. Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to Federal, State, or Tribal withholding limits, you must honor all IWOs to the greatest extent possible, giving priority to current support before payment of any past -due support. Follow the State or Tribal law/procedure of the employee/obligor's principal place of employment to determine the appropriate allocation method. Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to report and/or withhold lump sum payments. Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and any penalties set by State or Tribal law/procedure. Anti -discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO. OMB Expiration Date — 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use. Form EN -028 11/13 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: NATIONAL FREIGHT INC* Employer FEIN: 210586910 Employee/Obligor's Name: KACZERSKI, KAZIMIERZ R. 6743100101 CSE Agency Case Identifier: (See Addendum for case summary) Order Identifier: (See Addendum for order/docket information) Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in this section. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the Employer should calculate the CCPA limit using the lower percentage. Additional Information: NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you are no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by returning this form to the address listed in the Contact Information below: 2105869100 Q This person has never worked for this employer nor received periodic income. O This person no longer works for this employer nor receives periodic income. Please provide the following information for the employee/obligor: Termination date: Last known phone number: Last known address: Final Payment Date To SDU/Tribal Payee: Final Payment Amount: New Employer's Name: New Employer's Address: CONTACT INFORMATION: To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at: www.childsupoort.state.pa.us. Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST, P,O. BOX 320, CARLISLE, PA. 17013 (Issuer address). To Employee/Obligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name) by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.childsupport.state.pa.us. IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor. OMB No.: 0970-0154 Service Type M Page 3 of 3 Form EN -028 11/13 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: KACZERSKI, KAZIMIERZ R. PACSES Case Number 051100364 Plaintiff Name SUSAN K. KACZERSKI Docket Attachment Amount 00552 S 1991 $ 0.00 Child(ren)'s Name(s): JOANNA MARIE KACZERSKI , PACSES Case Number 448113293 Plaintiff Name SUSAN K. KACZERSKI Docket Attachment Amount 08-1353 CIVIL $ 0.00 DOB Child(ren)'s Name(s): 03/05/96 DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Service Type M Addendum OMB No.: 0970-0154 Form EN -028 11/13 Worker ID $IATT