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Home My WebLink About08-6973CHRISTINE L. SWARTZ, Plaintiff VS. MARK L. SWARTZ, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. DB - 09'13 Cvi 1 Tern CIVIL ACTION - AT LAW - IN DIVORCE/ NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you, and a decree of divorce, or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for 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, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 Y CHRISTINE L. SWARTZ, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : No. MARK L. SWARTZ, CIVIL ACTION - AT LAW - IN DIVORCE/ Defendant DIVORCE COMPLAINT The Plaintiff, Christine L. Swartz, by and through her attorneys, the Law Offices of Patrick F. Lauer, Jr., L.L.C., makes the following Complaint in Divorce: COUNT I - NO-FAULT DIVORCE - §§ 3301(c) or 3301(d) 1. The Plaintiff, Christine L. Swartz, is an adult individual who currently resides at 109 North Humer Street, Enola, Cumberland County, Pennsylvania 17025. 2. The Defendant, Mark L. Swartz is an adult individual who currently resides at 109 North Humer Street, Enola, Cumberland County, Pennsylvania 17025. 3. The parties have been bona fide residents of the Commonwealth of Pennsylvania for at least six months immediately prior to the filing of this Complaint. 4. The parties were married on July 20, 1985, in Dauphin County, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. The Plaintiff has been advised that counseling is available and that the Plaintiff may have the right to request that the court require the parties to participate in counseling. 8. This action is not collusive. WHEREFORE, the Plaintiff requests this Honorable Court enter a Decree of Divorce in this matter. COUNT II - EQUITABLE DISTRIBUTION - § 3502(a) 9. Paragraphs one (1) through eight (8) of this Complaint are incorporated herein by reference as if set forth specifically below. 10. During the course of the marriage, the parties acquired property and incurred debt, titled jointly, individually, or both, which remains in the possession of the individual parties. WHEREFORE, the Plaintiff respectfully requests the Court to equitably divide, distribute or assign the marital property between the parties without regard to marital misconduct in such proportion as the Court deems just after consideration of all relevant factors and thereby enter an order of equitable distribution of marital property pursuant to § 3502(a) of the Divorce Code. COUNT III - SPOUSAL SUPPORT AND/OR ALIMONY PENDENTE LITE, AND ALIMONY 11. Paragraphs one (1) through ten (10) of this Complaint are incorporated herein by reference as if set forth specifically below. 12. Plaintiff is unable to sustain herself during the course of litigation. 13. Plaintiff lacks sufficient property to provide for her reasonable needs and is unable to sustain herself through appropriate employment. 14. Plaintiff requests the Court to enter an award of spousal support and/or alimony pendente lite until final hearing and thereupon to enter an order of alimony in her favor pursuant to Section 3701(a) and 3702 of the Divorce Code. WHEREFORE, Plaintiff respectfully requests the Court to enter an award of spousal support and/or alimony pendente lite until final hearing and thereupon to enter an order of alimony in her favor pursuant to Section 3701(a) and 3702 of the Divorce Code. Respectfully submitted, Date: `,,Marli arkley, Esquire Law Offi s of Patrick F. Lauer, Jr., L.L.C. 2108 Market Street, Aztec Building Camp Hill, Pennsylvania 17011-4706 ID# 84745 Tel. (717) 763-1800 CHRISTINE L. SWARTZ, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : No. y 73 c )?/ f 4ef#A- MARK L. SWARTZ, CIVIL ACTION - AT LAW - IN DIVORCE/ Defendant I verify that the statements made in this Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unworn falsification to authorities. Date: Signature: f? xxi? 7 C ine L. Swartz -+? C .. h1 C c=7 O ,, rJ -? IN Q r -ea P c? CHRISTINE L. SWARTZ, Plaintiff VS. MARK L. S WARTZ, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 08-6973 CIVIL ACTION - AT LAW - IN DIVORCE AFFIDAVIT OF SERVICE TO THE PROTHONOTARY: I, Marlin L. Markley, Esquire, verify the Complaint in Divorce has been served upon the Defendant on December 4, 2008, indicated above by first class, certified mail # 7008- 0150-0003-6464-2354, restricted delivery, return receipt requested, prepaid postage, pursuant to the requirements of Pa. R.C.P. 1930.4. ¦ oofnpieie Items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ¦ Pant your name and address on the reverse so that we can return the card to you. ¦ ANsch J.WWrd to the back of the mailpiece, or 4)n if space permits. -.' ;loq iv. /4u&m. Std ?r 1'A I Wo2S 11. Xeg?? E3 Agent ? Addm B. Received by (Printed Name) C. Date of De! A it L (5;tia /ft- iz - V D. Is delivery address different from Item 1? ? Yes If YES, enter delivery address below: ? No 3. S ice Type ertlfied Mail ? Express Mail ? Registered ? Return Receipt for MercherxNe ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) ? Yes 2. ArMe Nun*w 7008 0150 0003 6464 2354 MWAWftMMVWc0ftW Ps Form 3611, Febru 2o64 Domsstlo Retum Receipt 102595-o -WI51o arlTin L. squire l auer, Jr, LLC 2108 ztec Building Camania 17011-4706 Date: ID# ) 763-1800 oft 4= x r'7rt i }«h?r h , 1i0 C T 2I F ill 12: C'," CI..'MBERLAt4D COU?tT( 0 E?11SYL.VA IA In Re: The marriage of § IN THE COURT OF COMMON PLEAS OF CHRISTINE L. SWARTZ, § CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff § §NO. 08 - 6973 CIVIL TERM V. § MARK L. SWARTZ, § CIVIL ACTION - LAW Defendant § IN DIVORCE STATEMENT OF INTENT TO PROCEED TO THE COURT: Defendant, Mark L. Swartz, intends to proceed with the above-captioned matter. Respectfully submitted, Tabetha A. Tanner, Esquire Attorney for Plaintiff Supreme Court I.D. No.: 91979 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSY LVANIA Christine L. Swartz , Plaintiff ~? r~A VS. N0.6973 2^rn 1"",~rg 'Ti cn r-- Mark L. Swartz t "E~'' ~ Defendant ~ MOTION FOR APPOINTMENT OF MASTER x' c~ _ Mark 1. Swartz Defendant ,moves the court to appoint a master wi t~ect to the following claims: OX Divorce OX Distribution of Property _. `. ,.,,_ ^ Annulment OX Support ^X Alimony ^ Counsel Fees OX Alimony Pendente Lite ^ Costs and Expenses 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 i n the action (personally) (by his atorney,_ Tabetha A. Tanner ,Esquire). 3. The staturory Around (s) for divorce sELECT oNE No Fault 4. Delete the inapplicable paragraph (s): A OX BOX C ^ a. The action is not contested. b. An aereement has heen reached with resnect t~ the follywine claims: C. The action is contested with respect to the following claims: Divorce, Alimony, Alimony Pendente Lite, Property Distribution 5. The action does not involve complex issues of law or fact. b. The hearing is expected to take ~ hours 7. Additional information, if anv, relevant to the motion: Dater /~ _ ~~z~1/LIAI Attorney for Defendant Tabetha A. Tanner Print Name ORDER APPOINTING MASTER AND NOW , 20 Esquire, is appointed master with respect to the following claims: By the Court, c .,.. ~ TC: , f'~'7 '~s ~ . ;.>y J. CHRISTINE L. SWARTZ, Plaintiff V. MARK L. SWARTZ, Defendant § IN THE COURT OF COMMON PLEAS OF § CUMBERLAND COUNTY, PENNSYLVANIA §NO. 08 - 6973 CIVIL TERM § 3 § -a r.t v § CIVIL ACTION - LAW § IN DIVORCE C'o r V1. < INCOME STATEMENT OF MARK L. SWARTZ -j w r-, _„ --r ,s ZI I, Mark L. Swartz, verify that the statements made in this Income Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to falsification to authorities. Date: Mark L. Swartz, Defendant INCOME STATEMENT OF MARK L. SWARTZ, DEFENDANT Employer: Modern Handling Equipment Co. Address: 2501 Durham Road, Bristol, PA 19007 Type of `York: Pay Period (weekly, biweekly, etc.): Bi-Weekly Gross Pay per Pay Period: $2,076.92 Itemized Payroll Deductions: Federal Withholding $250.45 FICA $83.48 Local Wage Tax $31.75 Manchester Township Tax $2.00 State Income Tax $60.92 Mandatory Retirement Health Insurance $75.20 Dental $12.84 Life Insurance $3.29 Vision $4.60 PA Child Support $184.60 Federal U.C. $1.66 Medicare $28.82 Net Pay per Pay Period: $1,337.31 OTHER'INCOME: WEEK MONTH (Fill in appropriate column) Interest $ $ Dividends N/A Pension Distributions N/A Annuity _N/A Social Security N/A Rents _N/A Royalties N/A Unemployment Compensation N/A Workers Compensation N/A Employer Fringe Benefits N/A Other: Spousal Support N/A YEAR $_42.00 TOTAL TOTAL INCOME $ PROPERTY OWNED Description Value Ownership H W J Checking accounts Members 1 st $65.00 _ Post-maitital Members 1 st $275.00 Savings accounts Members 1st $1,500.00 _ (post marital) $1,000.00 Stocks/bonds N/A _ Real estate (marital residence) $200,000.00 Other INSURANCE Company Policy No. Coverage H W J Hospital'. Other Medical Independent Blue Cross Other Dental - United Concordia Health/Accident Disability Income Dental _QCB6015852200 -X- 117253942001 _ _X_ Other (Vision) VSP X ^r+ rn -N-wiely Pie 1 Cf 1 current Pay Statement this is a statement of earnings and deductions. This pay statement is non-negotiable. • Modern Handling Equipment Co Pay Statement 2501 Durham Road Period Start Date 06/23/2012 Period End Date 0710612012 Bristoi, PA 19007 Pay Date 07/12/2012 215 949-9314 Document 100860 Net Pay $2,485.55 Pay Details MARK L SW ARTZ 109 NORTH HUMER ST. ENOLA, PA 17025 USA Earnings Employee Number SSN Job Pay Rate Pay Frequency 019057 xxx-xx-6430 SERVICE MANAGER $25.96 Biweekly GL Base Comm Pers. Code K - Service Branch/Manager Pay Group Modern Federal Income Tax S2 Handling Equip °State Income Tax (Residence) S2 (02) State Income Tax (Work) S2 Location York Branch Department 190070 - York Service Data F - Control Office/Manager Deductions Pay Pay Type Hours Rate Current YTD Bonus 0.0000 $0.0000 $0.00 $1,726.99 Car 0.0000 $0.0000 $0.00 $380.79 Allowance Commission 0.0000 $0.0000 $1,776.80 $1,776.80 Group Term 0.0000 $0.0000 $3.29 $23.60 Life Deduction Pre-Tax Child Support No Core PPO Med Yes United Concordi Yes GTL No VSP Vision Yes Other 0.0000 $0.0000 $0.00 $10,164.55 ? Taxes Earnings s._.-------..-_.___ _----------_----.__ ._-. Salary 80.0000 $25.9615 $2,076.92 $25,036.96Taxes Employee Medicare Federal Income Tax MANCHESTER (Total Hours 80.0000 MANCHESTER TWP PA State Income Tax fPA Unemployment Employee (Social Security Employee Tax Paid Time Off Net Pay Distribution Emplo yee i Current YTD j $184.62 $2,584.68 r $75.20 $1,052.80 $12.84 $1/9.76 $3.29 $23.60 $4.60 - -------- - $64.40 --------- - Current YTD $54.58 $548.28 $697.50 $6,145.87 $60.18 $604.62 $2.00 $28.00 $115.47 $1,160.16 i $3.08 $31.29 $158.10 $1,588.13 Account Number xxxxx3000 Total Pay Summary Gross Current $3,857.01 YTD $39,109.69 Originally printed in English FIT Taxable Wages $3,764.37 $37,812.73 Account Type Savings Taxes Deductions $1,090.91 $280.55 $10,106.35 $3,905.24 Amount $2,485.55 $2,485.55 Net Pay $2,485.55 $25,098.10 https//my2.chedcpoir)thr.oorrUpledit/EeSSNPreFerenoeaspx?USPARAM?PK=ESS 7/22/2012 CHRISTINE L. SWARTZ, § IN THE COURT OF COMMON PLEAS OF Plaintiff § CUMBERLAND COUNTY, PENNSYLVANIA §NO. 08 - 6973 CIVIL TERM V, § § I MARK L. SWARTZ, § CIVIL ACTION - LAW r rim co5 ? . Defendant § IN DIVORCE r Cn EXPENSE STATEMENT OF MARK L. SWARTZ 77 r -? ca M; I, Mark L. Swartz, verify that the statements made in this Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to falsification to authorities. Date: ejf,? Z ?Wdt4e- L. Swartz, Defendant EXPENSE STATEMENT OF MARK SWARTZ DEFENDANT Monthly Monthly Monthly EXPENSES Total Children Parent HOME Mortgage or Rent $ 1,230.00 Dent $ 400.00 UTILITIES Electric $ 12.00 - Gas N!A_ Oil N/A_ - Telephone (CELL) _ 68.28_ Water - 14.50_ Sewer* _ $46.00 (combined) Trash/Recycling* - * Combined Cable TV** _ 75.00 (combined) - Internet** ** Combined EMPLOYMENT Lunch N/A_ - ? t TAXES Real Estate Personal Property INSURANCE Homeowners/Renters Automobile Life Accident/Disability Health Long-Term Care AUTOMOBILE Lease or Loan Payments Fuel Repairs Memberships MEDICAL Doctor Dentist Hospital Monthly Monthly Monthly Total Children Parent 210.59_ -RI-99- $448.20 _ _ 276.00 N/A N/A 12.50 45.17 N/A t Medicine - 60.00! - Counseling/Therapy N/A_ Vitamins/ Supplements _100 Orthodontist _N/A - Special Needs (glasses, etc.) _$29.17 - Monthly Monthly Monthly Total Children Parent EDUCATION Tuition (School loan) -$25.00-- Room/Board - Other - PERSONAL Credit Card _ 125.00 Clothing _ 100.00_ Food _ 600.00 Toiletries _$25.00 Haircare 60.00_ Memberships _ 63.33_ - MISCELLANEOUS Child Care Household Summer Camp Papers/Books/Magazines Entertainment 200.00 Pay TV - moved to Utilities N/A Pet Expenses 50.00_ Vacation 41.67 Gifts $125.00 Legal Fees/Prof. Fees Children's Parties Monthly Monthly Total Children Children's Allowances Other Child Support/PA Child Alimony Payments OTHER AOL Laundromat Accountant N/A Lawn Care $160.00 Church Contributions $20.00 Monthly Parent { i TOTAL MONTHLY EXPENSES $4,600.40 It _?+' !LED-rlf I' I 12 SEP -6 PM 1: 31 CUMBERLAND COUNTY PENNSYLVANIA CHRISTINE L. SWARTZ, § IN THE COURT OF COMMON PLEAS OF Plaintiff § CUMBERLAND COUNTY, PENNSYLVANIA §NO. 08 - 6973 CIVIL TERM V. § MARK L. SWARTZ, § CIVIL ACTION - LAW Defendant § IN DIVORCE INVENTORY OF MARK L. SWARTZ, DEFENDANT Defendant files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years. Defendant verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: o2P l- 0(. Mark L. Swartz, Defendant Page 1 of 5 Y ASSETS OF THE PARTIES Defendant marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. (X) 1. Real property (X) 2. Motor vehicles () 3. Stocks, bonds, securities and options O 4. Certificates of deposit (X) 5. Checking accounts, cash (X) 6. Savings accounts, money market and savings certificates O 7. Contents of safe deposit boxes O 8. Trusts () 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries) 10. Annuities 11. Gifts 12. Inheritances 13. Patents, copyrights, inventions, royalties 14. Personal property outside the home 15. Business (list all owners, including percentage of ownership and officer/director positions held by a party with company) Page 2 of 5 () 16. Employment termination benefits - severance pay, worker's compensation claim/award (X) 17. Profit sharing plans O 18. Pension plans (indicate employee contribution and date plan vests) (X) 19. Retirement plans, Individual Retirement Accounts O 20. Disability payments O 21. Litigation claims (matured and um-natured) O 22. Military/V.A. benefits O 23. Education benefits (X) 24. Debts due, including loans, mortgages held (X) 25. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) (X) 26. Other - credit card debts/cash advances MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced: Item Number Description of Propert v Names of All Owners 1. Marital Residence Husband and Wife 109 N. Humer St. Enola, PA 17025 2. Members 1 St Checking Husband and Wife Page 3 of 5 C 3. 4. 5. 6. 7. 8. 9. 10. 11. Members I` Saving ESOP - Modern Group Retirement Account - IRA, Ameriprise Vanguard 401(k) 2007 Trailblazer 2006 Chevy Uplander Son's car 1997 Monte Carlo 1986 Pontiac Fiero Household furnishings at home - $51000.00 Husband and Wife Husband Wife Husband Husband Wife Wife Husband Husband and Wife Page 4 of 5 NON-MARITAL PROPERTY Defendant lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property. Item Number Description of Property Names of All Owners I . Members 1St Checking Husband 2. Members I" Savings Husband PROPERTY TRANSFERRED Item Number Description Date of Consideration Person to Whom of Property Transfer Transferred LIABILITIES Item Number Description of Property Names of Names of All Creditors All Debtors I . Mortgage Bank of America Husband and Wife 109 N. Humer Street, Enola PA 17025 2. Members 1St for Trailblazer Members 1St Husband 3. Visa credit card Visa Husband and Wife Page 5 of 5 ABRAHAM LAW OFFICES. LLC 45 East Main Street. Hummelstown, PA 17036 717-566-9380 CHRISTINE L. SWARTZ Plaintiff V. MARK L. SWARTZ Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 08 - 6973 CIVIL TERM CIVIL ACTION - LAW DIVORCE PRAECIPE TO WITHDRAW APPEARANCE AND ENTER APPEARANCE r ? Cif u F 3- C'7 - - ?r y? Please withdraw the appearance of the Law Office Of Patrick F. Lauer, Jr. and enter the appearance of James W. Abraham, Esquire, Abraham Law Offices, LLC, as attorney for Plaintiff, Christine L. Swartz in the above-captioned action. Respectfully submitted: Lauer, Jr., Esquire tat9ce Of Patrick F. Lauer, Jr. 2108 Market Street Camp Hill, PA 17011 717-763-1700 Attorney for Plaintiff, Christine L. Swartz DATE: 1,7 j Respectfully submitted: James W. Abraham, Esquire Abraham Law Offices, LLC 45 East Main Street Hummelstown, PA 17036 717-566-9380 Attorney for Plaintiff, Christine L. Swartz DATE: l ?"'? CERTIFICATE OF SERVICE I, James W. Abraham, Esquire, the undersigned, hereby certify that I have served a true and correct copy of the foregoing document by first class mail upon the following person(s) on the date stated herein: Tabetha A. Tanner, Esquire Tanner Law Offices, LLC 3507 Market Street, Suite 300 Camp Hill PA 17011 DATE: 10/10/12 James W. Abraham, Esquire AE~RAF{~M l ,~W OFFI('GS. LLC ` 4~ Cast Main ~+t.. Numrnelstown, PA 17036 7I?->66-93f~0. Fay X66-985; abelaw@comc•ast.net Attornr~ tur I'I,~intift,_Chr~stine L. Swartz _- - ._. _____----_--_-_-_-- _ _ _ - _ CHRISTINE L. SWARTZ : IN THE COURT OF COMMON PLEAS Plaintiff :CUMBERLAND COUNTY, PENNSYLV ANIA v : NO. 08 - 6973 CIVIL TERM ~ - ~~ --~ . _~~,r r~ °;- ; ;.,, p _, r~=s --n MARK L. SWARTZ :CIVIL ACTION -LAW ='~ `~ ~ .~ ~ -a `~, Defendant :DIVORCE ``' C~ ...~ ~~ w ' ~ ~ `~ '~ ..-.@ r', _' ~r t,..,j `~ y _ ~-J -' C...J ~ '~ s^`" PLAINTIFF'S INCOME & EXPENSE STATEMENT ""` ~~ - Plaintiff, Christine L. Swartz, files the following Income & Expense Statement in the above-captioned action in divorce in accordance with Pa.R.C.P. 1920.31 as verified by Plaintiff pursuant to the Verification attached hereto and made part hereof. ABRAHAM LAW OFFICES, LLC James W. Abraham, Esquire 45 East Main Street Hummelstown, PA 1.7036 (717) 566-9380 Attorney for Plaintiff, Christine L. Swartz DATE: November 30, 2012 INCOME Employer: Hi~hmark Inc. Gross pay per period: $35 987 00 gross annual Deductions: (see attached pay stub dated 10/19/12) Federal Withholding: Social Security: Medicare: Local Wage Tax: State Income Tax: Unemployment: Retirement: Savings Bonds: Credit Union: Health Insurance: Life Insurance: Union Dues: Other (Specify): Local taxes, specific amount t/b/d. Net Monthly Income: $ 2,025.00 Other Income (Net Amounts): Month Year Interest: Dividends: Annuity: Social Security: Rents: Royalties: Expense Account: _ Gifts: _ Unemployment compensation: Worker's compensation: _ Other (Specify): _ Spousal Support: 400.00 _ Total: $ $ TOTAL NET INCOME: $ 2,425.00 $ 29,100.00 2 Hiphmark Inc 1800 Center Street Camp Hill PA 1701 1 Pay Group: PSS 3"1.801Von-exempt Check #: QQ2739728 Pay Begin Date: 09/29/2012 Pa Eod Date: 10/12/2012 Check Date: 10/19/2012 ' S~wartz,Christine L Employee 1D: 013457 TAX DATA: Federal State 5 Hillcrest Road Cost Center: OSCAR & [CIS Product Solutions Marital Status: SINGLE Not applic Enola PA 17025 Location: CHSEN Allowances: ] 0 Job 'title: Administrative Asst -Manager Addl. Pct.: Pay Rate: 35,988.000000 Annual Addl. Amt.: HOURS AND EARNINGS TAXES :': Current *:* ,<* YTD **• Description Rate Hours Earnln Hours Earni Description Current VTD Regular Pay 18.455385 75.00 1,384.15 1450.50 26,315.23 FED OASDUDisab 53.58 1,172.95 Premium Incenti 46.15 0.00 969.15 FED F[CA Med Ho 18.50 404.95 Empl Non-Smoker 34.b2 0.00 727.02 FED Withholding 129.93 3,028.34 Incentive Comp 0.00 0.00 1 553.22 PA Withholding 39.12 856.41 Flex Time Off 0.00 30.00 53236 PA Unemploymen 1.02 22.32 Floating Holida 0.00 7.50 138.42 PA E PENNSB T 2.00 42.00 Personal Paid T 0.00 34.50 636.72 PA EAST PENNS 2039 446.39 Vacation 0.00 52.50 958.2b I Total: 75.00 1,464.92 1,575.00 31,89038 Total: 264.54 5,973.36 BEFORE-TAX DEDUCTIONS AFTER-TAX DEDUCTIONS EMPLOYER PAID BENEFITS Description Current YTD Descri don Current YTD Descri lion Current YTD 401K 69.21 1,509.72 Life -Child 0.54 1134 401K 5537 1,207.85 Dental-Pre Tax 8.40 176.40 Supplemental Li 4.47 92.91 Life -Imputed 1.52 30.80 FSA-Health Care 69.23 1,453.83 Medical-Pre Tax 113.02 2,363.50 I III Total: 259.86 5,503.45 Total: 5.01 104.25 *Taxable _~I TOTAL GROSS FEDERAL TAXABLE GROSS TOTAL TAXES TOTAI. DEDUCTIONS NET PAY Current: 1,464.92 1,206.58 264.54 264.87 S 935.51 YID: 31,890.38 26,417.73 5,97336 5,607.70 20,309.32 MESSAGE: Highmark Inc 1800 Center Street Camp Hill PA 17011 DEPOSIT NOTICE ONLY -- NON-NEGOTIABLE DATE 10/19/2012 No. 002739728 DEPOSIT AMOUNT 935.81 Swartz,Christine L 5 Hillcrest Road Enola PA 17025 BAG 4 LOCATION CIiSEN DEPT OSCAR & ICIS Product Solutions DIRECT DEPOSIT DISTRIBUTION Account Type Account Number Deposit Amount Savings 178164000 935.Si T°tal: $ 935.51 DEPOSIT NOTICE ONLY -- NON-NEGOTIABLE EXPENSES Residence: Mortgage/Rent Real Estate Taxes Maintenance Homeowners insurance Month n~ c nn Year Utilities: Electric Gas Telephone Water/Sewer/Trash Oil Personal: Food Clothing Other Automobiles: Payments: Insurance: Repairs/Maintenance/Fuel Medical: Doctor: Dentist/Orthodontist Hospital Medicine Special Needs (eye care, etc.) Education: Private/Parochial School College: Credit Payments: Credit cards Charge accounts Memberships 100.00 o~.vv A n nn 300.00 100.00 nnn nn 20.00 5.00 12.50 80.00 ~.,...,. 3 Month Year Outstanding Loans: Creditor: Miscellaneous: Household help: Child care: Pay/Cable/TV/Computer Legal Fees: Charitable contributions Vacation Entertainment Gifts Other (specify) Support/Alimony TOTAL EXPENSES: 82.00 200.00 $ 2,209.50 $ 26,514.00 4 VERIFICATION I, Crttit~ T /N r ~- `~-~T~, the undersigned, hereby verify and confirm that the foregoing document and the statements made therein are true and correct to the best of my knowledge, information and belief. i further understand that any false statements made herein are subject to the penalties of Title 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: J ~'"' -~ ~ -- ~ °Z' CERTIFICATE OF SERVICE I, James W. Abraham, Esquire, the undersigned, hereby certify that I have served a true and correct copy of the foregoing document by first class mail on the following person(s) at the following address(es) on the date stated below: Tabetha A. Tanner, Esquire Tanner Law Offices, LLC 3507 Market Street, Suite 300 Camp Hill PA 17011 DATE: November 30, 2012 James W. Abraham, Esquire ABRAHAM LAW OI-FICES, LLC -~~ East Mlain St.. Hummelstown. PA 17036 ~` 17-5(d~-938t)~. Fax 566-9385; abelaw a~,comcast.net AT[Orllc"v' for Plaintiff. Christine L. Swartz CHRISTINE L. SWARTZ : IN THE COURT OF COMMON PLEAS Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 08 - 6973 CIVIL TERM . ;_ ._ , _ ~_,, E-, MARK L. SWARTZ :CIVIL ACTION -LAW r V ~• r ~ c~ ,- _.. Defendant :DIVORCE ~" .~~ ~~ ~_~'--~~. --C ~_ C. ~ ,.--~, ,,,~ ~ 1= ~~ ~k~ 'r'i ::.i PLAINTIFF SINVENTORY --~ --~:: ,~ _. Plaintiff, Christine L. Swartz, files the following Inventory of all of the property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years as verified by Plaintiff pursuant to Plaintiff's Verification attached hereto and made part hereof. ABRAHAM LAW OFFICES, LLC ~.~.. - James W. Abraham, Esquire 45 East Main Street Hummelstown, PA 17036 (717) 566-9380 Attorney for Plaintiff, Christine L. Swartz DATE: November 30, 2012 ASSETS OF THE PARTIES Plaintiff marks on the following list those items applicable to the above-captioned action and itemizes the assets on the following pages. ( x) 1. Real Property (x) 2. Motor Vehicles ( x) 3. Stocks, bonds; securities and options ( ) 4. Certificate of Deposit ( ) 5. Checking accounts, cash ( ) 6. Savings accounts, money market and savings certificates ( ) 7. Contents of safe deposit boxes ( ) 8. Trusts ( ) 9. Life Insurance policies (face, cash surrender value/ beneficiaries) ( ) 10. Annuities ( ) 1 1. Gifts ( ) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties ( ) 14. Personal property outside the home ( ) 15. Business (owners, percentage of, positions held) ( ) 16. Employment termination benefits/severance pay, workers comp. ( ) 17. Profit sharing plans (x) 18. Pension plans (employee contributions/date plan vests) (x) l 9. Retirement Plans, IRAs ( ) 20. Disability payments ( ) 21. Litigation claims (matured/unmatured) ( ) 22. Military/V.A. Benefits ( ) 23. Education benefits ( ) 24. Debts, including loans, mortgages ( x) 25. Household furnishings and personalty (include as total category; attach itemized list if distribution of assets is disputed. ( ) 26. Other: 2 MARITAL ASSETS ITEM NO. PROPERTY DESCRIPTION 1 Marital Residence: 109 N. Humer St., Enola (approx. gross value $280,000) 2 2007 Chevy Trailblazer 1986 Pontiac Fiero 2006 Chevrolet Van 1997 Chevrolet Monte Carlo 3 Stock -Husband's employer 18 Husband's Vanguard retirement account/401(k) 18 Wife's 401(k) - PNC Bank 19 Ameriprise IRA (approx. $13,200) 25 Power & Heavy Tools (approx. $20,000) 25 Household furnishings (approx. $10,000) MARITAL DEBTS ITEM NO. DESCRIPTION CREDITOR 1 Mortgage Bank Of America (109 N. Humer St. CampHill PA) 2 Credit Card VISA ALL OWNERS Joint Joint Joint Joint Joint Husband Husband Wife Wife Joint Joint DEBTORS AMOUNTS Joint $92.750.00 Joint $3,000 3 NON-MARITAL ASSETS Plaintiff states that the following are non-marital assets, either pre-marital or direct gifts from grandparent(s): Dry Sink, Buffet, End tables (3), Antique digging iron and few other household items. NON-MARITAL DEBTS Plaintiff is not aware of any non-marital debts for purposes of equitable distribution. PROPERTY TRANSFERRED Plaintiff has not transferred or converted any property and is not aware of any transfers or conversions by Defendant. Plaintiff reserves her rights as to any claim or defense as to property transferred or converted by Defendant, particularly as to personal property. 4 VERIFICATION I, Cif~j S TJN ~ ~~ ~ cvh~~'~' ,the undersigned, hereby verify and confirm that the foregoing document and the statements made therein are true and correct to the best of my knowledge, information and belief. I further understand that any false statements made herein are subject to the penalties of Title l8 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: ~ ~ _ ~2, j -- ~ ~ CERTIFICATE OF SERVICE I, James W. Abraham, Esquire, the undersigned, hereby certify that I have served a true and correct copy of the foregoing document by first class mail on the following person(s) at the following address(es) on the date stated below: Tabetha A. Tanner, Esquire Tanner Law Offices, LLC 3507 Market Street, Suite 300 Camp Hill PA 1701 l DATE: November 30, 2012 James W. Abraham, Esquire TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 0 P4 IT12QcC try 20 P14 l: $ 7 n"'kfgERLANo G?UNTY Pt&;'NS YLYgNIA CHRISTINE L. SWARTZ, § IN THE COURT OF COMMON PLEAS OF Plaintiff § CUMBERLAND COUNTY, PENNSYLVANIA §NO. 08 - 6973 CIVIL TERM V. § MARK L. SWARTZ, § CIVIL ACTION - LAW Defendant § IN DIVORCE PRE-TRIAL STATEMENT OF MARK SWARTZ, DEFENDANT Date of Marriage: Date of Separation: Divorce Complaint Filing Date: July 20, 1985 November 25, 2008 November 25, 2008 1. ASSETS A. Marital Property Description Value 1. Real Property Marital Residence $200,000 109 N. Humor Street Enola, PA Date of Is any portion Valuation non-marital 11/2010 No Lien $92,000 Page 1 of 7 Description 2. Motor Vehicles Value Date of Is any portionLien Valuation non-marital 2007 Trailblazer $9,866 7/2012 No $6,503 1986 Pontiac Fiero $0 No $0 2006 Chevy Uplander $11,785 11/2010 No $0 1997 Monte Carlo Son's car No No 3. Stocks, bonds, securities None 4. Certificates of Deposit. None 5. Checking accounts, cash. DOS balanc es. a) Members 1 st No 6. Savings accounts, money market and savings certificates. a) Members 1st No 7. Contents of safe deposit boxes. None 8. Trusts. None 9. Life Insurance Policies Yes, but no cash value 10. Annuities. None 11. Gifts. None 12. Inheritances. None 13. Patents, copyrights, None inventions, royalties. Page 2 of 7 14. Personal Property outside home. None 15. Business. None 16. Employment termination benefits None 17. Profit sharing plans ESOP - Modern Group $44,912 10/31/08 $35,183 10/31/11 18. Pension plans None 19. Retirement Plans a) Wife Ameriprise IRA $13,200 b) Husband Vanguard 401K $56,091 c) Wife PNC $20,686 20. Disability Payments. None 21. Litigation Claims. None 22. Military/VA benefits. None 23. Education benefits. None 24. Debts due from third parties. None 25. Household Furnishings and Personalty. $5000 26. Other. None No 12/31/08 No 9/30/09 No No Page 3 of 7 B. Non-marital Property of Wife 1. None. C. Non-marital Property of Husband 1. None II EXPERT WITNESSES To be determined at a date closer to the trial date. Husband reserves the right to supplement this response and provide reasonable notice in advance of trial. III. SUMMARY OF TESTIMONY OF NON-PARTY WITNESSES To be determined at a date closer to the trial date. Husband reserves the right to supplement this response and provide reasonable notice in advance of trial. IV. EXHIBITS 1. Kelly Blue book printouts showing valuation of marital vehicles; 2. Ameriprise account statement showing IRA valuation; 3. Bank statements; 4. ESOP statement; 5. Vanguard 401K statements showing value; 6. Real estate appraisal report; Page 4 of 7 7. Husband's pay stubs Husband reserves the right to supplement this response and provide reasonable notice in advance of trial. V. NET INCOME A. Plaintiff/Husband - Husband is employed by Modern Handling Equipment Co. He earns a salary of $54,000 annually and is no longer on commission and does not receive periodic bonuses as he did in the past. B. Defendant/Wife - To be provided by Wife. VI. EXPENSES A. Plaintiff/Husband Please see Expense Statement, a copy of which has previously been filed. VII. PENSIONS/RETIREMENT A. Plaintiff/Husband - Husband maintains a retirement benefit in the nature of a 401 K through his employer as well as an ESOP. Such benefits have been referenced under Marital Assets. B. Defendant/Wife -Wife has a 401(k) with PNC Bank and an IRA with Ameriprise. Such benefits have been referenced under Marital Assets. VIII. COUNSEL FEES A. Defendant/Wife - N/A. IX. PERSONAL PROPERTY DISPUTE A. Plaintiff believes that the parties will be able to agree on the distribution of personal property. Page 5 of 7 X. DEBTS A. Defendant/Wife and Plaintiff/Husband- Creditor Debtor Description Bank of America Members 1 S` Visa Bank of America Mortgage Loan for Trailblazer $3,200 as of DOS Wife's 2006 Chevy Uplander was refinanced into the mortgage that Husband is currently paying. Husband believes that the debt was approximately $10,000. XI. INDIGNITIES A. None alleged. XII. PROPOSED RESOLUTION Plaintiff/Husband - Husband proposes that Wife immediately cooperate in listing the property for sale and once the house is sold, the parties shall equally divide the equity in the marital home. Husband proposes that the parties' respective retirement accounts are divided equally. Husband proposes that Wife's equity in the home be reduced by the date of separation value of the vehicle loan that was refinanced into the mortgage as well as the mortgage payments that Husband has been snaking since the date of separation and that he continues to make despite the fact that Wife is currently residing in the marital residence. Husband proposes that the parties equally share in the credit card debt as of the date of separation. Husband proposes that he pay no alimony to wife. Page 6 of 7 Respectfully submitted, Date: a By: A Tabetha A. Tanner, Esquire Attorney I.D. #91979 TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 Telephone (717) 731-8114 Page 7 of 7 'ABRAHAM LAW OFFICES, LLC 4? Last Main Street, Hummelstown, PA 17036 17-566-9380: Fax 566-9385; abelaw(a?comcast.net Attorney for Plaintiff Christine L. Swartz CHRISTINE L. S WARTZ : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLU dIA -? Fri v V. : NO. 08 - 6973 CIVIL TERM w ?... MARK L. SWARTZ : CIVIL ACTION - LAW Defendant : DIVORCE =~ ' - PRE-TRIAL STATEMENT OF PLAINTIFF CHRISTINE L. SWARTZ AND NOW, comes Plaintiff, Christine L. Swartz, by and through his attorney, James W. Abraham, Esquire, Abraham Law Offices, LLC, Hummelstown, Pennsylvania and files the following: 1. Plaintiff, Christine L. Swartz (hereinafter "Wife" ) is an adult individual who currently resides at 109 North Humer Street, Enola, Pennsylvania, which is the former marital residence (hereinafter "marital residence") and is forty-seven (47) years of age. 2. Defendant, Mark L. Swartz (hereinafter "Husband") is an adult individual who resides in Cumberland County, Pennsylvania and is fifty (50) years of age. 3. The parties have been married for twenty-three (23) years from the date of the marriage on July 20, 1985 through their date of final separation on November 25, 2008, when Wife filed for divorce. The parties physically separated on or about October 10, 2009 when Wife moved out of the marital residence due to Husband's indignant conduct. 4. Husband is employed with Modern Handling Equipment in Bristol, Pennsylvania as a sales person and according to his Income & Expense Statement, earns $54,000.00 gross per year, however, in 2008, the year Wife filed for divorce, Husband earned approximately $65,000.00 gross per year as stated on the parties' final earned income tax return, attached hereto as Exhibit "A". 5. Wife is employed with Highmark Blue Shield and earns $36,000.00 gross per year. 6. As of November 15, 2010, Husband has been paying $400.00 in spousal support pursuant to the Domestic Relations Order entered on said date, which was effective November 1, 2010. Said Order is attached hereto as Exhibit B". 7. Throughout the course of the twenty (23) year marriage, Husband's income was significantly greater than Wife's income. 8. The major assets of the marital estate are the marital residence which Wife submits has marital equity of approximately $150,000 to $200,000 and Husband's pension and stock accounts, which are believed to have marital value in excess of $70,000.00. Wife has a 401(k) account with an approximate marital value of $20,000.00 to $25,000.00. Wife has an IRA with a marital value of approximately $13,000.00. 9. There are additional personal property items as listed in Wife's Inventory, e.g., power tools of Husband. Wife does not anticipate having said items appraised but reserves the right to do so. 10. EQUITABLE DISTRIBUTION: A. The marital residence shall be sold at fair market value and Wife shall receive sixty-five (65%) percent of the net sales proceeds, unless Wife is able to refinance the existing mortgage and remove Husband's name and provide Husband thirty (35%) percent of the equity through equitable distribution of other assets and/or through the refinancing. 2 B. Wife shall receive sixty-five (65%) percent of the difference in the marital value of Husband's 401(k) account and stock through his employer and the marital value of Wife's 401(k) account with her employer and Wife's IRA. If there are other retirement benefits of Husband, e.g., a defined benefit plan, Wife shall receive sixty (65%) percent thereof. C. The vehicles of the parties shall remain as their sole and separate property. D. Husband shall be responsible for any debts in his name and Wife's shall be responsible for any debts in her name. E. Wife's entitlement to sixty-five (65%) of the aforesaid assets, in consideration of the Section 3502(a) factors and in consideration of Section 3102(a)(6) of the Divorce Code, is also in consideration of the more valuable personal property assets in Husband's possession, including but not limited to, the power tools. 11. ALIMONY & ATTORNEY FEES: A. Wife submits that in consideration of the Section 3701(b) factors, particularly as to the length of the marriage of twenty-three (23) years, Wife is entitled to a total spousal support and alimony in the amount of $500.00 for a period of ten (10) years, crediting Husband for two (2) years of spousal support, for a total of eight (8) additional years of alimony. B. In consideration of receipt of sixty-five (65%) of the marital estate, each party shall be responsible for their own attorney fees. VERIFICATION the undersigned, hereby verify and confirm that the foregoing document and the statements made therein are true and correct to the best of my knowledge, information and belief. I further understand that any false statements made herein are subject to the penalties of Title 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: , g -,2- a - 1 ;2, 6?e? I - FINAL EARNED INCOME TAX RETURN ATTACH APPRf)PWATE =t, ??0 SHORE TAX BUREAU COPIES OF STATE f1 C`?? ids 717-761-4900 sCHMUL S AND/OR ALL w . s Soars fit, j?tTE: WWW.WESTAB.ORG TAX YEAR 2-ON %"T 1REOVIR` D MY Li '^t TO FILE -i IiS PETI.t'1,1 ON OR SE=C -_ Ar-!?IL 15th EVEN IF NO TAX IS DUE OR IF Ai_L 7r ? r ac ,..,/ ,CEPI WVIT^-IHELD :f .L YEAR RESIDENT YES M NO ? MUNICIPALITY East PennSboro Township ."dark L & Christine L Swartz 109 North Humer Street IEnola, PA 17025 East Pennsbom Township (054) - East Pennsboro School D-isdict IF YOU MOVIED DURING THE TAX YEAR COMT??t•?' Okhusbandandwifernaybothfileonthisforin howev CWCUIations URW be reporbd in separate cohsnns. filing (combining of kmxm a or expenses) Is ttotnarmi TOTE FOLLOWING MOVING INFORMATION; 12131 YOU MUST Taxpayer A SS 183-50-6430 COMPLETE Ta>Fpi3yer B SS 207-60-7350 1. Gross Earnings from Employment: Enclose W-2s 2, Other Earned Income Enctose iO96•dusC r 1G99-R Excluding CODES a, a a 7 / 1039-C 3. Allowable Non-Reimbursed Employee Business Expenses Enclose PA Sch LIE 4. Taxable Earnings Add Lines 1 s 2 Subtract Une 3 5. Net Loss Atiach PA Sch C, F, RK-1 and/or NRK-1 NOTE: PA Sch C-F is not acceptable. 6. Subtotal Subtract Una 5 from Una 4 7. Net Profits !`.ttach PA Sch C, F, RK-1 and/or NRK-1 NOTE: PA Sch C-F is not acceptable. 8. Total Earned Income Line 6 + Line 7 DO NOT ROUND Past iris poir' 9. Tax Liability Line 8 multiplied by tax rate 1.60 (See bads of Return for tax rates) 10. Quarterly Estimated Payments/Credit From Previous Tax Year 11. Earned Income Tax Withheld Generally the amount is shown in Box 19 of attached w 2s 12. Misc Credit See worksheet on back of form for calculating Ptn?delphWOut of State Credit 13. Total of 10, 11, 8r 12 14. REFUND/CREDIT Subtract Line 9 from Line 13 NOTE: NO Refunds under $1.00 15. CREDIT TO NEXT YEAR/CREDIT TO SPOUSE No ne N( Next Year ? Snow n 16. TAX DUE If Line 9 is greater than Line 13Subtract Una 13 from Una 9 v. V V 16 113.92 17. Interest + Penalty (1 °s par trhonth seer April 15tH) 17 0.00 18. TOTAL AMOUNT DUE Line 16 + Line 17 NOTE: Amounts Less than $1.00 med not be paid. MAKE CHECKS PAYABLE TO 1MEST SHORE TAX BUREAU. A FEE OF $20.00 WILL8?3E CHARGED FOR RETURNED CHI I declare under penalties of perjury that 1 have examined phis return and to the Signatstre-T XpaVer A best of my krhOwletl9e and belief, it is a true, accurate and complete realm. /777 .aT „ --,-.- - -_ Date n„_..-?.-- _ - - EXHIBIT 44B99 In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION CHRISTINE L. SWARTZ ) Order Number 00946 S 2010 Plaintiff ) Vs. ) PACSES Case Number 389112026 MARK L. SWARTZ ) Docket Number 00946 S 201.0 Defendant ) Other State ID Number ORDER OF COURT ® Final O Interim O Modified AND NOW, 16TH DAY OF NOVEMBER, 2010 based upon the Court's determination that the Payee's monthly net income is $ 0 . 00 and the Payor's monthly net income is $ 0. 00 , it is hereby ordered that the Payor pay to the Pennsylvania State Collection and Disbursement Unit FOUR HUNDRED AND XX/100 Dollars ($ 900.00 ) a month payable BIWEEKLY as follows: first payment due NEXT PAY DATE. The effective date of the order is 11 / 01 / 1 o . Arrears set at $ 2 0 0 . 0 0 as of NOVEMBER 16, 2 o 1 o are due in full IMMEDIATELY. All terms of this Order are subject to collection and/or enforcement by contempt proceedings, credit bureau reporting, tax refund offset certification, driver's license revocation, and the freeze and seize of financial assets. These enforcement/collection mechanisms will not be initiated as long as obligor does not owe overdue support. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all the means listed above. For the Support of: Name Birth Date CHRISTINE L. SWARTZ 02%24/65 Form OE-518 Rev.8 Service Type M Worker ID 2100S SWARTZ V- SWARTZ PACSES Case Number: 38911.2026 The monthly support obligation includes cash medical support in the amount of $250 annually for unreimbursed medical expenses incurred for each child and/or spouse. Unreimbursed medical expenses of the obligee or children that exceed $250 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31st of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 0.00 % by defendant and 100.00 % by plaintiff. (? Plaintiff is ordered to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the ®Plaintiff ODefendant shall submit to the other party and to the Domestic Relations Section written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of : 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. Other Conditions: THIS ORDER IS BASED UPON AN AGREEMENT OF THE PARTIES. DEFENDANT IS GIVEN CREDIT IN THE AMOUNT OF $200.00 FOR A DIRECT PAYMENT TO THE PLAINTIFF ON THIS DATE. THE PARTIES AGREE THAT THERE WILL BE NO ADDITIONAL SUM FOR ARREARS AND THAT ANY ARREARAGE WILL BE RESOLVED IN EQUITABLE DISTRIBUTION. Defendant shall pay the following fees: Fee Total Fee Description $23.50 for JUDICIAL COMPUTER FEE $ 25.00 $ 0.00 S 0.00 S 0.00 for COLLECTION FEE for for for Payment Frequency Payable at $ 0 .00 Payable at $ 0 . 00 Payable at $ 0 . 00 Payable at $ 0 . 00 Payable at $ o . o o per ONE TIME per ONE TIME per per per Page 3 of 4 Form OE-518 Rev.8 Service Type M Worker ID 21005 CERTIFICATE OF SERVICE 1, James W. Abraham, Esquire, the undersigned, hereby certify that I have served a true and correct copy of the foregoing document by first class mail, upon the following persons at the following addresses on the date stated herein: E. Robert Elicker, II, Esquire Office of Divorce Master 9 North Hanover Street Carlisle, PA 17013 Tabetha A. Tanner, Esquire Tanner Law Offices, LLC 3507 Market Street, Suite 300 Camp Hill PA 17011 DATE: 12/20/12 James W. Abraham, Esquire CHRISTINE L. SWARTZ : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY,PENNSYLVANIA V. : NO. 2008 - 6973 CIVIL rn co MARK L. SWARTZ : CIVIL ACTION—LAW , Defendant : DIVORCE `' D ry n - CD 3 :7: AFFIDAVIT OF CONSENT >C7, 1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code was f Ted on T- November 25, 2008. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90)days have elapsed from the date of service and filing of the Complaint. 3. I consent to the entry of a Final Decree of Divorce after service of notice of intention to request entry of the Decree. I verify that the statements made in the 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 the unsworn falsification to authorities. DATE: May 13, 2013 Kristine wartz WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE UNDER SECTION 3301(c)OF THE DIVORCE CODE 1. 1 consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver 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 the unsworn falsification to authorities. DATE: May 13, 2013 Khristine L.6xartz CHRISTINE L. SWARTZ : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 2008 - 6973 CIVIL MARK L. SWARTZ : CIVIL ACTION—LAW �rQ3n �,w Defendant : DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301 (c)of the Divorce CodeAras fined oz ' November 25, 2008. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90)days have elapsed from the date of service and filing of the Complaint. 3. 1 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 the 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 the unsworn falsification to authorities. DATE: May 13, 2013 ark L. Swartz WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver 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 the unsworn falsification to authorities. DATE: May 13, 2013 Mark L. Swartz CHRISTINE L. SWARTZ, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 08 - 6973 CIVIL MARK L. SWARTZ, . Defendant IN DIVORCE ORDER OF COURT AND NOW, this J1 6 day of Qlj--" _e_� , U 2013, the parties and counsel having entered into an agreement and stipulation resolving the economic issues on May 13, 2013, the date set for a conference, the agreement and stipulation were transcribed and subsequently signed by the parties and counsel, the appointment of the Master is vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, nx' . "0. '44, / Kev' A. Hess, P.J. cc: James W. Abraham Af torney for Plaintiff -off t-ir ✓Tabetha A. Tanner ' Attorney for Defendant cn3 p . , CO -0 C:)P _.T M.-7-ILL CHRISTINE L. SWARTZ, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 08 - 6973 CIVIL r.� MARK L. SWARTZ, C° c w Defendant IN DIVORCE r-nCo C— j-Y; '_ iV 7j<�i "43> C:) C-1 THE MASTER: Today is Monday, May 13 c2Og ,Y This is the date set for a conference with counsel ar tk parties. Present in the hearing room are the Plaintiff, Christine L. Swartz, and her counsel James W. Abraham, and the Defendant, Mark L. Swartz, and his attorney Tabetha A. Tanner. The divorce complaint was filed on February 25, 2008, raising grounds for divorce of irretrievable breakdown of the marriage. With respect to the grounds for divorce, the parties have signed affidavits of consent and waivers of notice of intention to request entry of divorce decree so that the divorce can conclude under Section 3301 (c) of the Domestic Relations Code. The Master understands that the Master will not vacate his appointment until certain conditions have been met with respect to the sale of the house and that will be addressed in the agreement. Consequently, the Master will keep his appointment in effect until such time he as he is notified by counsel that he can vacate his appointment . The affidavits and waivers, however, will be filed with the 1 Prothonotary so that they do not get stale. The complaint also raised economic claims of equitable distribution, alimony, alimony pendente lite. No claims were raised for counsel fees and costs by either party. The agreement as placed on the record is going to 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. Therefore, when the parties leave the hearing room today they are bound by the agreement. If any typographical errors need to be made, the Master' s office will be notified by counsel when they have had a chance to review the agreement for typographical errors. Otherwise, the agreement will be the substantive agreement of the parties and the parties will be asked to sign the agreement affirming the terms of settlement stated on the record. Upon receipt by the Master of a completed agreement, and upon notification from counsel, the Master will prepare an order vacating his appointment and counsel can, at that time, prepare a praecipe transmitting the record to the Court requesting a final decree in divorce. The parties were married on July 20, 1985, and separated on October 10, 2009 . The parties are the 2 natural parents of two children, both of whom are emancipated. Mr. Abraham. MR. ABRAHAM: The parties have reached the following agreement as to equitable distribution of property: 1. In regard to the former marital residence located at 109 North Humer Street, Enola, Pennsylvania, the parties agree and have entered into an agreement of sale, and the parties agree to sell the property pursuant to said agreement. As to the equitable distribution of the property, husband shall receive $20, 000 .00 in net sale proceeds and wife shall receive the remainder of those net sale proceeds which we believe should be approximately $55, 000 . 00 . In the event that there are any repairs to be made at the property, wife agrees to be responsible for the first $500. 00 of those repairs and the parties agree to equally divide any cost of repairs over and above that amount as agreed upon between the buyer and the seller. It is the parties' understanding that settlement on the sale of the house shall take place on or before June 14, 2013 . The parties agree that the mortgage payoff is approximately $89, 000 . 00 resulting in the aforesaid net sales proceeds. 2. in regard to wife ' s 401 (k) , wife shall retain that asset as her sole and exclusive property. In regard to wife' s IRA account, wife shall retain that as her sole and separate property. 3 . In regard to husband's 401 (k) and/or ESOP retirement benefits, wife shall receive $55, 500 . 00 from husband' s 401 (k) to be transferred by QDRO, the costs of which shall be paid by wife. Husband shall keep any and all remaining ESOP or 401 (k) assets as his sole and separate property. The QDRO shall be prepared and signed by the parties within thirty (30) days after the entry of the final decree in divorce. 3 4 . The parties shall keep as their sole and separate property any and all personal property items in their current possession including but not limited to financial accounts, vehicles, household furnishings, and any other personal property. In the event that there is any requirement for the parties to sign any documentation in order to implement the division of the personal property or as to any other division of assets, both parties agree to mutually cooperate in doing so upon the request of the other. 5 . There shall be no alimony and each party shall be responsible for their own attorney fees. The parties have signed affidavits of consent and waivers. 6 . The finalization of the divorce shall not take place until after the sale of the property, the former marital residence, pursuant to the agreement of sale. Further, this agreement as to equitable distribution, alimony, attorney fees, and all economic claims, is contingent upon the sale of the house pursuant to the contract . In the event the sale of the house does not take place pursuant to the agreement of sale and/or the parties ' s understanding, this agreement as to equitable distribution, alimony, and all economic claims shall be rendered null and void, and each party reserves their rights as to any and all economic claims. 7. In regard to the marital debt of the parties, there are no joint marital debts and each party shall be responsible for their own individual debts which may be in their name other than the mortgage. 8 . Husband agrees to make the May mortgage payment and the parties agree that the June 1 mortgage payment, again contingent upon the sale on or before June 14, will simply be included in the mortgage payoff . 9 . The parties further agree as to the mortgage, that any escrow money distributed upon settlement of the property, for real estate taxes and/or homeowner' s insurance, shall become the sole and separate property of husband_ 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 4 . f 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. ABRAHAM: Christine, you heard the statement as to the distribution of the property and all conditions relating to alimony and all of our economic claims, do you understand everything that was stated here today? MS. SWARTZ: Yes. MR. ABRAHAM: Are you in agreement with equitable distribution of property and the resolution of the claims in this case as stated in this order? MS. SWARTZ : Yes. MS. TANNER: Mark, did you hear everything that was discussed as far as the distribution of the marital property? MR. SWARTZ : Yes. MS. TANNER: Do you have questions or concerns that we have not addressed with regard to the distribution? MR. SWARTZ : No, I do not. 5 F 1 die i MS. TANNER: And is it your agreement that the property be distributed as we just put on the record? MR. SWARTZ: Yes. THE MASTER: Thank you. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: James W. Abraham Chris ine w Attorney for Plaintiff Tabetha A. Tanner Mark L. Swartz Attorney for Defendant 6 CHRISTINE L. SWARTZ, VS. MARK L. SWARTZ IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION • No. 2008 -6973 PRAECIPE TO TRANSMIT RECORD CIVIL TERM To the Prothonotary: r c rn try Transmit the record, together with the following information, to the court for entry of a d ive'ce decree: cam, r --a 1. Ground for divorce: Irretrievable breakdown under § (3301(c)) and § (3301(d)(1)) of the Divorce Code. (Strike out inapplicable section.) 2. Date and manner of service of the complaint: U.S. Certified Mail, Restricted Delivery on 12/4/08 as evidenced by the Affidavit of Service filed on 12/11/08 3. Complete either paragraph (a) or (b). (a) Date of execution of the affidavit of consent required by § 3301(c) of the Divorce code: by plaintiff May 1, 2013 ; by defendant May 13, 2013 (b) (1) Date of execution of the affidavit required by § 3301(d) of the Divorce Code: c..v cff (2) Date of filing and service of the plaintiff's § 3301(d) affidavit upon the respondent opposing party: 4. ReJ.ated claims pending; None. All economic claims have been resolved via the May 13, 2013 agreement and stipulation which is to be incorporated but not merged with the Decree. 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 plaintiff's Waiver of Notice was filed with the Prothonotary: May 13, 2013 Date defendant's Waiver of Notice was filed with the Prothonotary: May 13, 2013 Attorney for Plaintif ti CHRISTINE L. SWARTZ, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 08 - 6973 CIVIL MARK L. SWARTZ, Defendant : IN DIVORCE THE MASTER: Today is Monday, May 13, 2013. This is the date set for a conference with counsel and the parties. Present in the hearing room are the Plaintiff, Christine L. Swartz, and her counsel James W. Abraham, and the Defendant, Mark L. Swartz, and his attorney Tabetha A. Tanner. The divorce complaint was filed on February 25, 2008, raising grounds for divorce of irretrievable breakdown of the marriage. With respect to the grounds for divorce, the parties have signed affidavits of consent and waivers of notice of intention to request entry of divorce decree so that the divorce can conclude under Section 3301(c) of the Domestic Relations Code. The Master understands that the Master will not vacate his appointment until certain conditions have been met with respect to the sale of the house and that will be addressed in the agreement. Consequently, the Master will keep his appointment in effect until such time he as he is notified by counsel that he can vacate his appointment. The affidavits and waivers, however, will be filed with the Prothonotary so that they do not get stale. The complaint also raised economic claims of equitable distribution, alimony, alimony pendente lite. No claims were raised for counsel fees and costs by either party. The agreement as placed on the record is going to 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. Therefore, when the parties leave the hearing room today they are bound by the agreement. If any typographical errors need to be made, the Master's office will be notified by counsel when they have had a chance to review the agreement for typographical errors. Otherwise, the agreement will be the substantive agreement of the parties and the parties will be asked to sign the agreement affirming the terms of settlement stated on the record. Upon receipt by the Master of a completed agreement, and upon notification from counsel, the Master will prepare an order vacating his appointment and counsel can, at that time, prepare a praecipe transmitting the record to the Court requesting a final decree in divorce. The parties were married on July 20, 1985, and separated on October 10,2009. The parties are the 2 natural parents of two children, both of whom are emancipated. Mr. Abraham. MR. ABRAHAM: The parties have reached the following agreement as to equitable distribution of property: 1. In regard to the former marital residence located at 109 North Humer Street, Enola, Pennsylvania, the parties agree and have entered into an agreement of sale, and the parties agree to sell the property pursuant to said agreement. As to the equitable distribution of the property, husband shall receive $20,000.00 in net sale proceeds and wife shall receive the remainder of those net sale proceeds which we believe should be approximately $55,000.00. In the event that there are any repairs to be made at the property, wife agrees to be responsible for the first $500.00 of those repairs and the parties agree to equally divide any cost of repairs over and above that amount as agreed upon between the buyer and the seller. It is the parties' understanding that settlement on the sale of the house shall take place on or before June 14, 2013. The parties agree that the mortgage payoff is approximately $89,000.00 resulting in the aforesaid net sales proceeds. ------q---Inegreqardt(5-wife's 401(k), wife shall -retain that asset as her sole and exclusive property. In regard to wife's IRA account, wife shall retain that as her sole and separate property. 3. In regard to husband's 401(k) and/or ESOP retirement benefits, wife shall receive $55,500.00 from husband's 401(k) to be transferred by QDRO, the costs of which shall be paid by wife. Husband shall keep any and all remaining ESOP or 401(k) assets as his sole and separate property. The QDRO shall be prepared and signed by the parties within thirty (30) days after the entry of the final decree in divorce. 4. The parties shall keep as their sole and separate property any and all personal property items in their current possession including but not limited to financial accounts, vehicles, household furnishings, and any other personal property. In the event that there is any requirement for the parties to sign any documentation in order to implement the division of the personal property or as to any other division of assets, both parties agree to mutually cooperate in doing so upon the request of the other. 5. There shall be no alimony and each party shall be responsible for their own attorney fees. The parties have signed affidavits of consent and waivers. 6. The finalization of the divorce shall not take place until after the sale of the property, the former marital residence, pursuant to the agreement of sale. Further, this agreement as to equitable distribution, alimony, attorney fees, and all economic claims, is contingent upon the sale of the house pursuant to the contract. In the event the sale of the house does not take place pursuant to the agreement of sale and/or the parties's understanding, this agreement as to equitable distribution, alimony, and all economic claims shall be rendered null and void, and each party reserves their rights as to any and all economic claims. 7. In regard to the marital debt of the parties, there are no joint marital debts and each party shall be responsible for their own individual debts which may be in their name other than the mortgage. 8. Husband agrees to make the May mortgage payment and the partieBagree that the June 1 mortgage payment, again contingent upon the sale on or before June 14, will simply be included in the mortgage payoff. 9. The parties further agree as to the mortgage, that any escrow money distributed upon settlement of the property, for real estate taxes and/or homeowner's insurance, shall become the sole and separate property of husband. 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 4 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. ABRAHAM: Christine, you heard the statement as to the distribution of the property and all conditions relating to alimony and all of our economic claims, do you understand everything that was stated here today? MS. SWARTZ: Yes. MR. ABRAHAM: Are you in agreement with equitable distribution of property and the resolution of the claims in this case as stated in this order? MS. SWARTZ: Yes. MS. TANNER: Mark, did you hear everything that was discussed as far as the distribution of the marital property? MR. SWARTZ: Yes. MS. TANNER: Do you have questions or concerns that we have not addressed with regard to the distribution? MR. SWARTZ: No, 1 do not. MS. TANNER: And is it your agreement that the property be distributed as we just put on the record? MR. SWARTZ: Yes. THE MASTER: Thank you. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: James W. Abraham Attorney for Plaintiff --z:frol42, 4. Tabetha A. Tanner Mark L. Swartz Attorney for Defendant /L( : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA CHRISTINE L. SWARTZ • • V. MARK L. SWARTZ : NO 2008-6973 DIVORCE DECREE AND NOW, e , 626 i' 1 , it is ordered and decreed that CHRISTINE L. SWARTZ plaintiff, and MARK L. SWARTZ , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente Iite 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: (If no claims remain indicate "None.") All economic claims have been resolved via the May 13, 2013 Agreement and Stipulation, to be incorporated but not merged with the Decree. By the Court, \�t SSSSSSII S,S`4'> e �� = I �1� SC I "/ i S[SZ�°ter.•. / 0///t .—itta_, / _ r _- _ Attest: J. _ it 4 _All 41 ■"I1 f 11% • �. YI-D b :- U.ELL, Prothonota �, CO-c)y mailed -k) a Abrahyrn N Copy r kot-Fo T-nner Mai516e/q//9 Christine L. Swartz ILED- 0 F F I OF THE PRO TI-IONO TA 2011i JUN I 0 PM 3: 3?. COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COLIN FY CUMBERLAND COUNTY, PENNSYLVANIA PENNSYLVANIA VS. IN DIVORCE Mark L. Swartz NO. 08-6973 CIVIL Defendant QUALIFIED DOMESTIC RELATIONS ORDER This Order is intended to be a qualified domestic relations order ("QDRO"), as defined in Section 206(d) of the Employee Retirement Income Security Act of 1974 ("ERISA") and Section 414(p) of the Internal Revenue Code of 1986 ("Code"). This QDRO is granted in accordance with 23 P.C.S.A. §3502, the applicable domestic relations law of the Commonwealth of Pennsylvania, which relate to marital property rights, child support, and/or spousal support between spouses and former spouses in matrimonial actions. SECTION 1. DEFINITIONS (a) "Participant" shall hereafter mean Mark L. Swartz. The Participant's last known address, date of birth and Social Security number are contained in the attached Addendum. (b) "Alternate Payee" shall hereafter mean Christine L. Swartz. The Alternate Payee's last known address, date of birth and Social Security number are contained in the attached Addendum. The Alternate Payee is the former spouse of the Participant. (c) "Beneficiary" shall hereafter mean such person named by the Alternate Payee on the applicable designation form. (d) "Plan Administrator" shall hereafter mean Modern Group Ltd. Investment Committee. (e) "Account Balance" shall hereafter mean the vested portion of the amount held by the Plan in the Participant's account as of the date specified in Section 3 of the Order. "Plan" shall hereafter mean Modern Group Ltd. Employee Savings Plan. Further, any successor plan to the Plan shall also be subject to the terms of this Order. (g) "Custodian" shall hereafter mean the Vanguard Fiduciary Trust Company. SECTION 2. DATE OF MARRIAGE The Participant and the Alternate Payee were married on July 20, 1985, and were separated on October 10, 2009. SECTION 3. AMOUNT OF BENEFIT TO BE PAID TO THE ALTERNATE PAYEE (f) Alternate Payee's interest in the Plan shall be $55,500.00 of the Participant's Account Balance as of the date the Custodian segregates the Alternate Payee's awarded amount into a separate recordkeeping account under the Plan. Such interest of the Alternate Payee shall be adjusted for earnings and losses subsequent to the date the Custodian segregates the Alternate Payee's awarded amount into a separate recordkeeping account under the Plan. However, the Alternate Payee shall not receive an award that is greater than the value of the Participant's vested account balance, Tess the value of any outstanding loan balance, as of the account segregation date. The Alternate Payee's assigned benefit shall be subtracted from the Participant's contribution sub - accounts (401(k) employee elective deferral, employer profit sharing, employee rollover, employer match, etc.) and investment fund sub -accounts on a pro rata basis. SECTION 4. LOANS The Participant's remaining Account Balance shall contain the entire loan account, if any, including any repayments or defaults, and shall remain as the Participant's separate property with responsibility for all loan repayments resting with the Participant. SECTION 5. FORM AND TIMING OF PAYMENT TO ALTERNATE PAYEE The Alternate. Payee's interest in the Plan, as defined in Section 3, shall be paid as soon as practicable after the Order has been determined to be qualified, as elected by the Alternate Payee. Such payment may be made in the forms elected by the Alternate Payee, subject to the distribution provisions of the Plan. SECTION 6. DEATH OF .PARTICIPANT The Alternate Payee's entitlement to any distribution of benefits from the Plan pursuant to this Order shall not be affected in any mariner by the Participant's death. SECTION 7. DEATH OF ALTERNATE PAYEE In the event the Alternate Payee dies prior to receipt of distribution from the Plan, the Alternate Payee's benefits shall be distributed to the Alternate Payee's designated Beneficiary. Should there be no Beneficiary on record, the benefits shall be distributed to the estate of the Alternate Payee. SECTION 8. MISCELLANEOUS (a) A separate account shall be established for the benefits due the Alternate Payee. (b) The Alternate Payee, if a former spouse, shall not be treated as the surviving spouse of the Participant for any purposes under the Plan. (c) The Alternate Payee's interest awarded pursuant to this Order shall be the sole and exclusive property of the Alternate Payee. (d) The Participant's remaining interest in the Pian shall be the sole and exclusive property of the Participant. (e) This Order does not require the Plan to provide any type or form of benefit, or any option, not otherwise provided for under the Plan. 2 4.1 (f) This Order does not require the Plan to provide benefits to the Alternate Payee which are required to be paid to another alternate payee under another Order previously determined to be a qualified domestic relations order. (g) This Order does not provide increased benefits to the Alternate Payee which are not otherwise available under the Plan. (h) The spousal Alternate Payee is required to report any retirement benefits received pursuant to this Order on all appropriate income tax returns. (i) Should the Participant receive any retirement benefits under the Plan(s) which are rightfully owed to the Alternate Payee, the Participant is designated as constructive Custodian and must pay such retirement benefits to the Alternate Payee within three days after receipt. (j) This Order shall be governed by the rules of the Plan and, in the event of a conflict between the documents, the terms of the Plan shall prevail. (k) This Order shall become effective immediately and shall remain in effect until further Order of this Court. (I) The Participant and/or the Alternate Payee shall have the responsibility to serve a copy of this Order on the Plan Administrator. SECTION 9. RESERVATION OF JURISDICTION This Court reserves jurisdiction to amend this Order for the purpose of establishing or maintaining its qualification as a QDRO, so long as the amendment does not require the Plan to provide any type or form of benefit not otherwise available under the Plan. r,•es- fib.11c,c1 J. iciLaL,ri "r 31Y CONSENT TO ORDER: Attorney for Plaintiff/ Alternate Payee Date BY THE COURT il-e-eeC Judge /0/6/43 efendant/Participant ate 419./.5 Attorney for Defendant/ Date Participant • If you have any questions while completing this form, you may contact a Vanguard Participant Services Associate Monday through Friday, between 8:30 AM and 9:00 PM Eastem time at 1-800-523-1188. If you wish to convert your plan assets to a Roth IRA, please contact Participant Services for the proper form. Modern Group Ltd. Employee Savings Plan (401k) Account InfOrrnation Social Security # Name (Last, First. MI) 1 8 3 5 0 4 0 VISTA # 090692 Direct Rollover T z, % To be transferred as direct rollover 100 % To be paid to me 100% Note: If you are terminating and have an outstanding loan, the loan will be defaulted and the percentages above will be applied to the remaining account balance. Balance Eligible for Rollover If you wish to make a direct rollover directly to an institution, it is your responsibility to open an account before providing the following information. You must make sure that your rollover meets any minimum contribution requirements. Trustee Name Plan/Account Name Plan Number (if applicable) Account Number flRA Qualified Plan (Please show name exactly as check should be made out) Note: If account number is not provided, the Direct Rollover check will be mailed to you. Mailing Address (choose only one) City LMail check to institution at the address below. Mail check to me. State Zip Authorization I hereby certify that the account to which my funds areto be deposited is either a qualified plan or an IRA. Signature of Employee Date (12/29/2007) M345 T10362_122007 1 11,11111J11 11.111 11.111 1111111111111111111!111111111111111 1111111111111111 1 1111 11111 11111iiliii1111 11111 11111 11111 1111 r. ykne • love Ploy ca.Dilype>W4IZIC Ulf 101111, yuU iiiay LLIIIIMA ea v. otgUall, rpo Ve.Spyin e`ttiVLAACILId NMI Way LIIIOVUn rrioey. OCIlleeert 8:30 AM and 9:00 PM Eastern time et 1 -B00 -523-118B. If you wish to convert your plan assets to a Roth IRA/Roth Inherited IRA, please contact Participant Services for the proper form Modern Group Ltd. Employee Savings VISTA # 090692 1 1. Plan (401k) 1 Distribution Request Due to Qualified Domestic Relations Order 1 ccount n orma ion 1 Social Security # 8 3 5 0 — 6 4 3 0 (participant) Name dass, Fro. MI) S WIA R T 1Z, 111\41A R K,I L. Address Pi 2 0 51- 4 1-11-11 1STE _Ell- 1 1 1 _ 11 City SIUMMERID ALE _ 1_ 1 ] State I PIA I Zip 117 0 9 3 Date of birth0 2 —10 2 1 9 6 2 o.rgdayym - 1 —1 Date of hire — Plan entry date 1 1 1_1 1 1_ owdd/wry) 1 1 earniddlYM) 1 .4iAlternate Payee -Information - .- NowSeparate forms are required for each aiternate payee. 12_1( Spouse E Non -Spouse Social Security # 210 7 Date of birth 0 —2 4 — 1 9 6151 6 0 —171315101 (notiesVyyyy) Name 6.841. R.I. kill S 1/11 AR T Z,1 CH RI S T f'4 1E, L. 1 Address Y.71-LC4tstied AO i11 City (,V 0 L /I 1 StateVjZip A 061.1 sr , [-1 Withdrawal Classification i . Data (rnrrildef my) Percentage or dollar amount to alternate payee (41 I — — % OR $ 5 5, 0 0 0 1 0 0 Effective data of Q DR 0 ereivecerrni an RA, or have questions on Vanguard boxes: Note: These options stock. Retirement Plan: IRA or Qualified Plan Rpswes Flan old satin apthar Plano:Wm awn Pm Form of final distribution: (choose one) Set reverse ski° Par adeitlanse Merman.. Direct rollovers: If you have any questions on rolling over your eligible assets to (wollable ID IRA's, please contact Vanguard el 1-600-523-1188. spouse Pedy) If rolling over your eligible as‘etS, please check one of the following apply to ether a Partial or total direct rollover of cash and/or company Vanguard IRA op E Other Eligible `'aur IpV''..LljwiP"c":: .11,1 preprearl'llW (Complet• Dim" necessary IRA Adepaon icremnanl-) remeang inssisaWn) Other: 0...eiviele se ap...e 1 I Lump Sum Cash El Dererrai or osresPassa) lbcome Tax Withholding ! S regulations restrict the abirify to Spouse If transferred In a direct rollover • Federal withholding does not apply. sea If not transferred In a direct rollover Federal withholding ste mese We for adrliaonal information. State Withholding Sec row. side for midalonal Wormetion. LiWithheld state taxes. Where applicable indicate specific 1:1 Ipo not withhold state taxes. . directly roil over a distrrbution to a non -spousal beneficiary. reverse slat for rraditiaroltnformariat dollars $ or percentage %. Authorization Note: Please re you ave re he #e Harbor orIation' prrwid . by your Benefits Office. . . - - - S.400 -len ure of Recipient Dale native of Ran Administrator \s" Date 1 T10361_122007 11 1111111111111111111111111111111111111111111111111111111111111{1111111111111111111111111111111iiiiiiiiiiiiiiiimi iritt