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HomeMy WebLinkAbout04-1892IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. Q y- l g 9 2 V. : CIVIL ACTION -LAW JEFFREY A. EVANS, DIVORCE Defendant NOTICE TO DEFEND AND CLAIM RIGHTS AVISO PARAGRAPH DEFENDER Y RECLAMAR DERECHOS 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 ifyou 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. USTED HAD SIDO DEMANDADO EN LA CORTA. Si desea defenderse de las quejas expuestas en las paginas siguientes,debetomaraccionconprontitud. Se le avisa que si no se defiende, el caso puede proceder sin usted y decreto de divorcio o anulamiento puede ser emitido en su contra por la Corte. Una Decision puedda tambien ser emitida en so contra por cualquier otra queja o compensacion reclamados por el demandante. Usted puede perder dinero, o propiedades u otros derechos importantes Paragraph usted. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, COUNSEL FEES OR EXPENSES BEFORE THE FINAL DECREE OF 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 S. BEDFORD STREET CARLISLE, PA 17013-3302 (717) 249-3166 Cuando la base Paragraph el divorcio es indignidadas o rompimiento irreparable del matrimonio, usted puede solicitar consejo matrimonial. Una lista de conjeros matrimoniales esta disponible en la oficina del Prothonotary, en I a Cumberland County Courthouse, Carlisle Pennsylvania 17401. SI USTED NO RECLAMA PENSION ALIMENTICIA, PROPIEDAD MARITAL, HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE QUE EL DECRETO FINAL DE DIVORCIO O ANULAMIENTO SEA EMITIDO, USTED PUEDE PERDER EL DERECHO A RECLAMAR CUALQUIERA DE ELLOS. USTED DEBE LLEVER ESTA PAPEL A UN ABOGADO DE INMEDIATO. SI NO TIENE O NO PUEDE PAGAR IN ABOGADO, VAYA O LLAME A LA OFFICINO INDICADA ABAJO PARAGRAPH AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013-3302 (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. 0 y- I X9a2- 0&4 ? V. CIVIL ACTION -LAW JEFFREY A. EVANS, DIVORCE Defendant COMPLAINT AND NOW, this 1?9_11day of n q 2004, comes the Plaintiff, Angela L. Evans by her attorney, Diane G. Radcliff, Es ire, and files this Complaint in Divorce of which the following is a statement: COUNTI DIVORCE 1. The Plaintiff is Angela L. Evans, an adult individual who currently resides 279 Alpat Drive, Dillsburg, York County, PA 17019 since 1989. 2. The Defendant is Jeffrey A. Evans, an adult individual residing at 823 A. Pear Street, Lemoyne, Cumberland County, PA 17043 since February 1, 2004. 3. Plaintiff and/or Defendant have been bona fide residents in the Commonwealth for at least six (6) months previous to the filing of this Complaint. 4. Plaintiff and Defendant were married on February 15, 1985 at Grantham, Cumberland County, PA. 5. There have been no prior actions of divorce or annulment between the parties. 6. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the Court require the parties to participate in counseling. -2- 7. Defendant is not a member of the Armed Services of the United States or any of its Allies. 8. Plaintiff avers that the grounds on which the action is based are: a. Section 3301(c) Mutual Consent No-Fault: The marriage is irretrievably broken; b. Section 3301(d) Non-Consent No-Fault: The marriage is irretrievably broken and the parries are now living separate and apart. Once the parties have lived separate and apart for a period of two years, Plaintiff will submit an Affidavit alleging that the parties have lived separate and apart for at least two (2) years and that the marriage is irretrievably broken. C. Section 3301(a)(2) Adultery: Defendant has committed adultery. d. Section 3301(a)(6) Indignities: Defendant has offered such indignities to the person of the Plaintiff, the innocent and injured spouse, as to render her condition intolerable and life burdensome, and that this action is not collusive. 9. Plaintiff requests the Court to enter a decree of divorce. WHEREFORE, Plaintiff requests this Honorable Court to enter a decree in divorce, divorcing the Plaintiff and Defendant. COUNT II EQUITABLE DISTRIBUTION 10. Paragraphs 1 through 9 are incorporated by reference hereto as fully as though the same were set forth at length. 11. Plaintiff and Defendant have acquired property, both real and personal, and incurred debts during their marriage during the period from February 15, 1985, the date of their marriage, until January 29, 2004, the date of their separation, all of which are "marital property" or "marital debts". 12. Plaintiff and/or Defendant have acquired, prior to the marriage or subsequent thereto, "non- marital property" which has increased in value since the date of marriage and/or subsequent to its acquisition during the marriage, which increase in value is "marital property". -3- 13. Plaintiff and Defendant have been unable to agree as to an equitable division of the marital property and marital debts as of the date of the filing of this Complaint. WHEREFORE, Plaintiff requests this Honorable Court to equitably divide all marital property and debts of the parties. COUNT III ALIMONY PENDENTE LITE, ALIMONY 14. Paragraphs 1 through 9 are incorporated by reference hereto as fully as though the same were set forth at length . 15. Plaintiff lacks sufficient property to provide for her reasonable means and is unable to support herself through appropriate employment. 16. Plaintiff requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. WHEREFORE, Plaintiff requests this Honorable Court to enter an award of alimony pendente lite until final hearing and hereafter enter an award of alimony permanently thereafter. COUNT IV COUNSEL FEES, COSTS AND EXPENSES 17. Paragraphs 1 through 9 are incorporated by reference hereto as fully as though the same were set forth at length. 18. Plaintiff has employed legal counsel in this case, but is unable to pay the necessary and reasonable attorney's fees for said counsel. 19. Plaintiff has or will incur costs in this action including, but not limited to, costs for various experts to appraise the parties' marital assets, and does not have the funds to pay the necessary and reasonable fees , costs and expenses. -4- WHEREFORE, Plaintiff requests this Honorable Court to enter an award of interim counsel fees, costs and expenses and to order such additional sums hereafter as may be deemed necessary and appropriate and at final hearing to farther award such additional counsel fees, costs and expenses as are deemed necessary and appropriate. The child/children is/are presently in the custody of Plaintiff who resides at 279 Alpat Drive Dillsburg, PA 17019. 20. Paragraphs 1 through 9 are incorporated by reference hereto as fully as though the same were set forth at length. 21. Plaintiff seeks custody of the following child/children: NAME PLACE OF RESIDENCE AGE D.O.B. Courtney L. Evans 279 Alpat Drive 10 2/15/1994 Dillsburg, PA 17019 Ryan J. Evans 279 Alpat Drive 5 7/22/1998 Dillsburg, PA 17019 22. The child/children were not born out of wedlock. 23. 24. COUNT V CUSTODY During the past five years, the child/children has/have resided with the following persons and at the following addresses: PERSON Plaintiff and Defendant ADDRESS 279 Alpat Drive Dillsburg, PA 17019 Plaintiff 25. 279 Alpat Drive Dillsburg, PA 17019 DATES 1998 to 1/29/04 1/29/04 to present The mother of the child/children is Angela L. Evans currently residing at 279 Alpat Drive, Dillsburg, York County, PA 17019. -5- 26. The mother is married to Defendant, Jeffrey A. Evans 27. The father of the child/children is Jeffrey A. Evans currently residing at 823 A. Pear Street, Lemoyne, Cumberland County, PA 17043. 28. The father is married to Plaintiff, Angela L. Evans. 29. The relationship of Plaintiff to the child/children is that of mother. 30. The Plaintiff currently resides with the following persons: NAME RELATIONSHIP Courtney L. Evans Child Ryan J. Evans Child 31. The relationship of Defendant to the child/children is that of father. 32. The Defendant currently resides with the following persons: NAMES RELATIONSHIP None Known N/A 33. Plaintiff has not participated as a party or witness, or in another capacity, in other litigation concerning the custody of the child/children in this or another court. 34. Plaintiff has no information of a custody proceeding concerning the child/children pending in a court of this Commonwealth. 35. Plaintiff does not know of a person not a party to the proceedings who has physical custody of the child/children or claims to have custody or visitation rights with respect to the child/children. 36. The best interest and permanent welfare of the child/children will be served by granting the relief requested because: -6- a. Mother has been the primary caretaker of the children b. Mother can better provide for the emotional, spiritual and physical well being of the children. 37. Each parent whose parental rights to the child/children have not been terminated and the person who has physical custody of the child/children have been named as parties to this action. WHEREFORE, Plaintiff requests the Court to grant legal and primary physical custody of the child/children to the Plaintiff. Respectfully submitted, 0t NE G. DCLIFF ESQUI 48 Tri Road Camp Hill, PA 1701 1 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Plaintiff -7- VERIFICATION I verify that the statements made in the foregoing Divorce Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. ag-Z& C Angela . Evans Date: 71-21-0y -c) -O C41/ e- C ,-UQ C8 Lua N M ?1 9,1- ' # ? 0 T ' 1 s . O IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff V. JEFFREY A. EVANS, Defendant NO.6q-(79a I CIVIL ACTION -LAW DIVORCE CERTIFICATE OF SERVICE I hereby certify that I, Diane G. Radcliff, Esquire, served a true and correct copy of the Plaintiff's Divorce Complaint upon Jeffrey A. Evans, by mailing same by Certified Mail, Restricted Delivery on May 4, 2004, the return receipt for which mailing is attached hereto as Exhibit "A" and made a part hereof: Jeffrey A. Evans 823 A Pear Street Lemoyne, PA 17043 Respectfully submitted, ESQUIRE 3448 Tnndl bad amp ill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 ¦ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: TEFFRE%t K. Eviws a s 3 A _P c„ k smeET LEfrnayrSE PA «oy3 A. Received by (Please Print Clearly) ate of Dellve - ?D C. Signatu ? Agent /?( ? Addressee D. I el!NK address dil?erem from item 17 0 yes I YES, enter delivery address below: ? No 3. Service Type j$ Certified Mail ? Express Mail ? Registered ? Return Receipt for Merchandise ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) byes 2. Article Number (Copy from service label) 1 ?) 49 y 4 T 93 0 pC? 0 3 '1 1 p PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1799 i EXHIBIT "A" CERTIFIED MAIL RETURN RECEIPT CARD n ' o G C it f D n G: Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS Plaintiff, CUMBERLAND COUNTY, PENNSYLVANIA V. JEFFREY A. EVANS, Defendant NO. 04-1892 CIVIL ACTION - LAW DIVORCE PRAECIPE TO WITHDRAW APPEARANCE Please withdraw my appearance on behalf of JEFFREY A. EVANS in the above-captioned matter. Dated: 12004 Respectfully naroara rumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 PRAECIPE TO ENTER APPEARANCE Please enter my appearance Pro Se in the above-captioned matter. Dated: U C, Mechanicsburg, PA 17055 ANGELA L. EVANS, Plaintiff V. JEFFREY A. EVANS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 04-1892 CIVIL ACTION - LAW DIVORCE CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served the PRAECIPE TO WITHDRAW APPEARANCE and PRAECIPE TO ENTER APPEARANCE, in the above-captioned matter upon the following individual(s) by first class mail, postage prepaid, addressed as follows: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 DATE: October 13, 2004 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Plaintiff y awa[a 3u:mpte-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 f- ?ry 1- 1 ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA JEFFREY A. EVANS, V. Defendant NO, 04-1892 CIVIL ACTION - LAW IN DIVORCE INCOME AND EXPENSE STATEMENT OF ANGELA L. EVANS I verify that the facts set forth in the following Income and Expenses Form, including all attachments thereto, are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904 relating to unsworn falsification to authorities. DATE: /-/0-01-5 LL 6° &?J? ANGE L. EVANS, Plaintiff 1- PART L INCOME A. EMPLOYMENT INFORMATION: Employer: Mechanicsburg School District: Position: Aid Pay Period: Biweekly for 180 days per year. Figures below are annualized. B. INCOME: DESCRIPTION PAY DAY YEAR (180 days) MONTH Gross Income based on $60.34 per day for 180 days $60.34 $10,861.20 $905.10 FICA ($2.94) ($529.20) ($44.10) Medicare ($0.69) ($124.20) ($10.35) Federal Tax ($3.69) ($664.20) ($55.35) State Tax ($1.46) ($262.80) ($21.90) Local Tax ($0.59) ($106.20) ($8.85) Union Dues $0.00 $0.00 Mandatory Retirement ($3.56) ($640.80) ($53.40) NET INCOME $47,41 $8,533.80 $711.15 2- E. OTHER INCOME: DESCRIPTION WEEKLY MONTHLY YEARLY Interest $0.00 $0.00 $0.00 Dividends $0.00 $0.00 $0.00 Pensions $0.00 $0.00 $0.00 Annuities $0.00 $0.00 $0.00 Social Security $0.00 $0.00 $0.00 Rents $0.00 $0.00 $0.00 Royalties $0.00 $0.00 $0.00 Expense Account $0.00 $0.00 $0.00 Gifts $0.00 $0.00 $0.00 Unemployment Compensation $0.00 $0.00 $0.00 Workman's Compensation $0.00 $0.00 $0.00 Income Tax Refunds $0.00 $0.00 $0.00 Support or Alimony Not this Case $0.00 $0.00 $0.00 Commissions $0.00 $0.00 $0.00 Tips $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL OTHER INCOME f- $0.00 $0.00 $0.00 . 3 - PART II. ESTIMATED EXPENSES DESCRIPTION MONTHLY AMOUNT COMMENTS HOME EXPENSES: Rent $650.00 First Mortgage Second Mortgage/Home Equity Loan Maintenance and Repairs Electric $92.00 Gas/maintenance/mowers $10.00 Oil/furnace $55.00 Telephone (home Et cell) $58.00 Water Sewer Trash $12.00 EMPLOYMENT Public Transportation Lunches $45.00 Other Employment Expenses TAXES: Real Estate Taxes Personal Property Taxes Income Taxes Not Withheld Per Capita/ Occupation Taxes $1.00 -4- DESCRIPTION MONTHLY AMOUNT COMMENTS INSURANCE: Homeowners /Renters Insurance $12.00 Automobile Insurance $57.00 Life Insurance $3.00 Accident Insurance Health Insurance Otherlnsurance AUTOMOBILE EXPENSES: Payments Fuel $120.00 Maintenance and Repair $25.00 License and Registration $4.00 MEDICAL EXPENSES NOT REIMBURSED BY INSURANCE: Doctor $20.00 Optical $10.00 Dental $5.00 Orthodontic None currently; however, Courtney will be needing braces in the next year. Hospital Medicine $15.00 Special Needs/Therapy Etc. 5- DESCRIPTION` MONTHLY' AMOUNT, COMMENTS EDUCATIONAL EXPENSES: Private School Parochial School College/Vocational Religious Training or Education Books/Fees and Supplies Other Educational Expenses $15.00 School lunches, field trips, project/report/supplies PERSONAL EXPENSES: Clothing $100.00 Food $430.00 Barber and Hair Dresser $35.00 Memberships Other Personal Expenses $15.00 CREDIT CARDS AND LOANS: MISCELLANEOUS EXPENSES: Household Help Child Care $300.00 Newspapers/Magazines/Books Entertainment $100.00 Pay TV $26.00 -6- DESCRIPTION MONTHLY AMOUNT COMMENTS Vacations $250.00 This is for summer when I will not receive work pay Gifts $120.00 Kids' birthday parties and christmas gifts Legal Fees $225.00 $15 per day for 180 days per year= $2,700.00lyr or $225.00/mo Charitable Contributions Other Child Support (not this action) Other Spousal Support or Alimony (not this action) Courtney - dance $40.00 Dance & recital costume; dance shoes, tap 8 jazz Courtney - flute $25.00 Courtney - soccer $15.00 Ryan - soccer & baseball $15.00 Cleats, balls, clothing Cat - vet $5.00 TOTAL EXPENSES $;!,910.00 -7- PART III. PROPERTY OWNED PROPERTY OWNED OWNERSHIP TYPE DESCRIPTION VALUE H W JT - Checking Varies TBD X Savings Credit Union Stocks/bonds Real Estate Marital Home See Inventory X Other Retirement Plans 8 Other See Inventory x X TOTAL 0.00 PART IV. INSURANCE INSURANCE INFORMATION COVERAGE TYPE COMPANY POLICY NO. H W C Hospital (through wife) Capital Blue Cross YWP18350651400 d Medical (through wife) Capital Blue Cross YWP18350651400 Hospital (through Husband) Blue Shield SBR102728440001 ? ,? ,? Medical (through Husband) Blue Shield SBR102728440001 Health Accident Disability Income Dental (through Wife) Delta Dental 1225 f Dental (through Husband) Delta USA 2217-0001 178584097 Vision Highmark BlueShield ZAX110606226001 Other-Specify Prescription - Capital Blue Cross ME183506514 -H=Husband; W=Wife; J=Joint; C=Child . 8 - PART V. SUPPLEMENTAL INCOME STATEMENT [ I ] CHECK HERE IF NOT APPLICABLE (a) This form is to be filled out by a person: (1) Who operates a business or practices a profession, or (2) Who is a member of a partnership or joint venture, or (3) Who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or si mi lar entity (check block to indicate the document is attached): (1) The most recent Federal Income Tax Return. [ ] attached (2) The most recent Profit and Loss Statement. [ ] attached (c) Name of Business: Business Address: Business Telephone: (d) Nature of Business (check one) [] 1. Sole Proprietorship [] 2. Partnership [ ] 3. Joint Venture [ j 4. Professional [ ] 5. Corporation [ ] 6. Other (e) Name of accountant, controller or other person in charge of financial records: (f) Business Income: Annual income from business: 2. How often is income received: 3. Gross income per pay period: 4. Net income per pay period: 5. Specify deductions, if any: r17 MECHANICSBURG AREA SD - 500 SOUTE( BROAD STREET - MECHANS?BURG, PA 1705' _ Employee Name - Check Date ' D0004071 EVANS, ANGELA L 12/10/2004 Reg Hrs OT`Hrs Days - 'Other...Marital.Exempts Tot Salary Tot Hourly Total Gross 49 .00 0.00 0.00 0.00 Single 0 0.00 422.38 422.38 Gross Pay -Federal' Tax '. Soc See Tax Medicare :Tax State Tax .- _.i Unemp Tax Pay YTD 422.38 3,685.05 29.76 309.35 26.19 228.47 6 53 .12 .43 12 113 .97 .12 0.38 3.31 Not .Pa Local Tax .`Retirement Adwsnced E IC OPT Deductions - Pay YTD 310.00 5.28 46.06 31.68 276.39 0 0 .00 .00 0 0 .00 .00 0.00 0.00 '.Direct`-Deposit-Information MEMBERS 1ST FEDERAL CREDIT UNI Savings 310.00 Voluntary, Deductions ':Wage 'Detail Reg. OT Fctr Rate Type 49.00 0.00 8.62 HOUR .'Absen6e`7Bala6ees es''af ;rll/2 6(2004 , _., ._,. FISS PSSS SISS 1. 875 D 2.875 D 6.000 D MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 22 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 Direct Deposit Receipt D0004071 12/10/2004 r- k MECHANICSBURG AREA SD - 500 SOUTH BROAD STREET - MECHANICSBURG, PA 17055 .Employee Name '""CheeklDate' 50004517 EVANS, ANGELA L 12/24/2004 Aeg Hrs OT Hrs :Days Ather Marital . :Exempts ,, Tot"Salary 70t ,Hourly Total Gross' 63.00 0.00 0.00 0.00 Single 0 0.00 543.06 543.06 °<GrosasPay`.'e, ';Bed®ral'^,Tax .''So?C ;Sec Tax ' .Medea=e:hTax. ;k :'State,.fiaii4i! ,Unemp` ll, Tax Pay 543.06 46.50 33,67 7.87 16.67 0.49 YTD 4,228.11 355.65 262.14 61.30 129.79 3.80 Net Pa Iocal^Tax ,'.Rebirament `AdvzLncac EIC OpT 'Deductions` Pay 390.34 6.79 40.73 0.00 0.00 0.00 YTD 52.85 317.12 0.00 0,00 0.00 Airect-Deposit"Informataon,° MEMBERS 1ST FEDERAL CREDIT UNI Savings 390.34 MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 Happy Holidays!!!! Direct Deposit Receipt D0004517 12/24/2004 22 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSEURG PA 17019 MECHANICSBURG AREA SO - 500 SOUTH BROAD STREET - MECHANICSBURG, PA 17055 Employee Name '+ a Check Date D0004960 EVANS, ANGELA L 01/07/2005 Reg Hrs OT;Hrs Days'-:,; 0 ther Marital-Exempts ;" ,`;,_ `".Tot.:Salary Tot•Hourly Total Gross 56.00 0.00 0.00 0.00 Single 0 0.00 482.72 482.72 :`Gross"vPay ° ;Feder'al'Tax , ' Sdc'"Sec' Tax ' % •Mediicar'e "Taxi." .State Tax : ,Unemp:'Tax Pay YTD 482.72 37.93 482.72 37.93 29.93 29.93 7.00 7100 14.82 0.43 14.82 0.43 Net _ "Local''.'Tax =• _? .Retirement =; `Advanced EIC • OPT ' Deductions Pay YTD 350.38 6.03 6.03 36.20 36.20 0.00 0.00 0.00 0.00 0.00 0.00 :Direct DepositIlnfor'mat on MEMBERS 1ST FEDERAL CREDIT UNI Savings 350.38 g9luntaiy Dednotionss,a `? n a f a a J? U 7 Ue M.2 * i >` ,;Wage .Detax&1?, Reg. OT Fctr Rate Type 56.00 0.00 6.62 HOUR xmm Absence'a13a463 iaS of 'i2 j21 f.200& 4 r k? Irr ?i =? ,Si`. g t a` s ?i?. i, FIBS PSSS SIBS 1.875 D 2.500D 6.000 D MECHANICSBURG AREA SO 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 22 Direct: Deposit Receipt D0004960 3??L?a ^Da?e??, 01/07/2005 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 DELTA DENTAL' Blue Shield* P 0 `Ip HMRH00 D11, ixmui . r Idcohealth 1-W-11 Subx(riber I.D. Card G100j, Number 1225 Gnpluycc N:unc I_f /' a ?' L. EmployccS.S.N _ (Thiti card for inf, atiuuonly - It is not a guarantee of bcmafits.) -C.Bv1 EXPRESS SCRIPTS- .. www.rxpress-scripis,cam RN91N 003858 Rx 81 N A4 Capital B1ueCross RxGrp 8C2A •.. ____.._____________ _ 155VM ID ME183506514 i Name ANGELA EVANS ' pREAUTHopaATION Capital Bluecross : ? i PM MECHANICSBURG AREA SCHOOL DISTRICT ANGELA L EVANS ~18350651400 115001380000 361 38O Id,utt, tlwr xumbw amp ID 36 CUSTOMER SERVICE 1-866-8023711 OV420 ER450 `r r Dim Shield" 12R378 T ' & DELTAU )' A® GROUP NO. SUBSCRIBER NO. 2217-0001 X4097 JEFF EVANS 1 JC-L r..? V l?? 7) 11 n HMRK001 l PP? il medcobealtho .I T?1 ?, HMRK001 Blue Shield° PPQ medcohealth ^° I`IIGHMMK. C a BLUE SHIELD v. 4µ?y,ilyyMNl4 n??fIwLW Y?Y/Y? Ole, Y l l`` V? saw ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. . NO. 04-1892 JEFFREY A. EVANS, CIVIL ACTION - LAW Defendant IN DIVORCE MOTION TO COMPEL DISCOVERY AND/OR FOR SANCTIONS AND NOW this day of March, 2005, comes the Plaintiff, Angela L. Evans, by her Attorney, Diane G. Radcliff, Esquire, and files the above referenced Motion and represents that: 1. Plaintiff is Angela Evans (hereinafter "Wife"). 2. Defendant is Jeffrey A. Evans, (hereinafter "Husband"). 3. Wife is represented by Diane G. Radcliff, Esquire 4. Husband is pro se, having terminated the services of his prior legal counsel. 5. The divorce complaint was served on Husband on May 4, 2005 as set forth on the Certificate of Service filed of record in this action. 6. In the divorce complaint, Wife raised claims for Equitable Distribution, Alimony Pendente Lite, Alimony, Counsel Fees and Expenses. 7. Pa.R.C.P. Rule 1920.33 requires a party to file an Inventory within 90 days after service of a pleading or petition containing a claim for distribution of property. 8. Pa. R.C.P. Rule 1920.31 requires a party to file an Income and Expense Statement within 30 days after the service of a pleading or petition containing a claim for APL, alimony or counsel fees and costs 9. Wife has filed her Inventory and Income and Expense Statement. 10. Husband has failed to file his Inventory and Income and Expense Statement as required by the PA. Rules of Civil Procedure. 11. Pa. R.C.P. Rule 1920.33(c): provides that If a party fails to file either an Inventory as required by subdivision (a) or a Pre-Trial Statement as required by subdivision (b), the Court may make an appropriate Order under Rule 4019(c) governing sanctions. 12. Pa. R.C.P. Rule 1920.31(a)(2) provides that if a party fails to file the documents required under Rule 1920.31(a)(1) [Income and Expense Statement] the Court upon motion may make the appropriate order under Rule 4019 governing sanctions 13. The parties marital assets and debts are comprised of the assets and debts set forth on Exhibit "A" attached hereto and made a part hereof. 14. On 12/8/04, Wife's counsel sent Husband a letter asking to appraise the marital home. A true and correct copy of the letter dated 12/8/04 is attached hereto, marked Exhibit "B" and made part hereof. 15. On 12/13 /04 Husband sent Wife's counsel an email advising her that he would not permit her to secure an appraisal of the marital home. He later advised Wife that he was having the home appraised instead. A true and correct copy of the email dated 12/13/04 is attached hereto, marked Exhibit "C" and made part hereof. 16, On 1/13/05 Wife's counsel sent Husband a letter asking for a copy of his real estate appraisal as well as other financial documents. A true and correct copy of the letter dated 1/13/05 is attached hereto, marked Exhibit "D" and made part hereof. 17. To ensure that the documents requested in the 1/13/05 letter were provided, Wife's counsel sent Husband a Request for Production of Documents with that letter. A true and correct copy of the Request for Production of Documents is attached hereto, marked Exhibit "E" and made part hereof. 18. In accordance with the Pa.R.C.P. 4009 Husband was to provide Wife's counsel with the requested documents within 30 days of the 1/13/05 date of service being on or before 2/12/05. 19. On or about 1/25/05 Husband sent an email to Wife's Attorney stating that he could not provide her with the documents by the 2/12/05 deadline and needed until 2/28/05 to do so. A true and correct copy of the email of 1/25/05 is attached hereto marked Exhibit "F" and made part hereof. 20. On 1/26/05 Wife's counsel sent Husband an email advising him that she would agree to extend the time to comply with the Request for Production of Documents to 2/28/05 provided that he immediately advised her of the value of the marital home found by his appraiser and agreed to give her a copy of that marital home appraisal by 2/28/05. A true and correct copy of the email of 1/26/05 is attached hereto marked Exhibit "G" and made part hereof. 21. As of the date of the filing of this Motion, Husband has yet to provide Wife with the documents requested in the Request for Production of Documents servied upon him on 1/13/05. 22. Pa.R.C.P. 4019(a)(1)(vii) provides that the court may, on motion, make an appropriate order if a party, in response to a request for production or inspection made under Rule 4009, fails to respond that inspection will be permitted as requested or fails to permit inspection as requested. 23. Pa.R.C.P. 4019 further provides as follows: (c) The court, when acting under subdivision (a) of this rule, may make (1) an order that the matters regarding which the questions were asked, or the character or description of the thing or land, or the contents of the paper, or any other designated fact shall be taken to be established for the purposes of the action in accordance with the claim of the party obtaining the order; (2) an order refusing to allow the disobedient party to support or oppose designated claims or defenses, or prohibiting such party from introducing in evidence designated documents, things or testimony, or from introducing evidence of physical or mental condition; (3) an order striking out pleadings or parts thereof, or staying further proceedings until the order is obeyed, or entering a judgment of non pros or by default against the disobedient party or party advising the disobedience; (4) an order imposing punishment for contempt, except that a party may not be punished for contempt for a refusal to submit to a. physical or mental examination under Rule 4010; (5) such order with regard to the failure to make discovery as is just. Wherefore Wife requests this Honorable Court to enter an order: L Requiring Husband to file his Inventory; 2. Requiring Husband to file his Income and Expense Statement; 3. Requiring Husband to provide Wife's counsel with the opportunity to inspect and copy the documents referenced in the 1/ 13 /05 Request for Production of Documents within 5 days. 4. Requiring Husband to permit Wife to secure an appraisal of the marital home and requiring Husband to give Wife and her appraiser access to the marital home for that purpose. 5. Holding Husband in Contempt; 6. Awarding Wife $1,000.00 in counsel fees and costs and requiring Husband to pay the same within 30 days. Respectfully submitted, ESQU tamp Hill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Plaintiff /Wife CERTIFICATE OF SERVICE 6 ' I, DIANE G. RADCLIFF, ESQUIRE, hereby certify that on '/' I served a true and correct copy of the MOTION TO COMPEL DISCOVERY AND/OR SANCTIONS upon Defendant, by mailing same by first. class mail, postage prepaid, addressed as follows: Jeffrey Evans 279 Alpat Drive Dillsburg, PA 17019 Camp Hill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS: 1/29/04 Prepared: February 1, 2005 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE( GROSS VALUE NET VALUE PROPOSED PROPOSED PROPERTY OR DEBT AGREED/ AFTER LIENS DISTRIBUTION DISTRIBUTION DISPUTE TO HUSBAND TO WIFE REAL E STATE AND REAL ESTAT E MORTGAGE S RE-1 279 Alpat Drive Est. 165,000.00 Value Dillsburg, PA Value RE-1 Members I" mortgage 1.1.05 (74,182.94) Mtg. Update RE-1 Net Equity 90,817.06 90,817.06 90,817.06 Net Comments * 8.26.03 FMV @ $145,000.00 Members I" appraisal I * 1.1.05 mortgage balance @ $74,182,94-( * Mtg. Payments @ $433.20 biweekly l -#The Members I' mortgage was taken out in 2003 to pay off prior mortgage and Blazer and Pickup truck loans. ?k Mortgage balance needs to be updated to distribution date. MOTOR VERICLES AND VEHICLE LIENS VEH-1 Husband's 1998 4.14.04 11,525.00 11,525.00 11,525.00 Chevrolet K1500 pickup Comments * 4.14.04 NADA TIV @ $11,525.001 VEH-2 Wife's 2000 4.14.04 11,325.00 11,325.00 11,325.00 Chevrolet Blazer Comments * 4.14.04 NADA TN @ $11,325.00 S VEH-3 1996 Chrysler 4.14.04 Sold and Sold and Sold and Sold and Concord equal equal equal equal division division division division Comments *4.14.04 NADA ARV @ $4,695.001 * Sold and proceeds divided equally. VEH-4 Husband's Seville 21' 4.14.04 2,500.00 2,500.00 2,500.00 Cuddly Cabin Boat Comments * 4.14.04 NADA ARV @ $4,970.001 * Title is held jointly: Jeffrey A. Evans and Kevin A. Pitt * Believed to have been sold for $5,000.00 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS:1/29/04 Prepared: February 1, 2005 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE/ GROSS VALUE NET VALUE PROPOSED PROPOSED PROPERTY OR DEBT AGREED/ AFTER LIENS DISTRIBUTION DISTRIBUTION DISPUTE TO HUSBAND TO WIFE VEH-5 Husband's 1995 Sell Dr To be sold To be sold To be sold To be sold Palmer Trailer Valae Comments To be sold and proceeds divided equally VEH-6 1998 Husband's 4.14.04 2,830.00 2,830.00 2,830.00 . Yamaha olverine ATV Comments * 4.14.04 NADA AVR $2,830.00, VEH-7 Husband's 2000 4.14.04 1,975.00 1,975.00 1,975.00 Polaris Trail Boss ATV Comments * 4.14.04 NADA ARV $1,975.00,1 VEH-8 Husband's 1998 4.14.04 1,330.00 1,330.00 1,330.00 Yamaha Badger ATV Comments * 4.14.04 NADA ARV @ $1,330.00 d VEH-9 Husband's (Ryan) 8.04 850.00 850.00 850.00 2000 E-ton Youth Est. Four Wheeler Valt Comments * 8.4.04 Est. Based on advertised sales price. CASH. C" CKINGACCOUNTSANDSAVINGSACCOUNTS ACCT-1 Joint Members V 1.31.04 Closed and Closed and Closed and Closed and FCU Savings #2634 equally equally equally equally divided divided divided divided ACCT-1 Joint Members V 1.31.04 Closed and Closed and Closed and Closed and FCU Checking #2634 equally equally equally equally divided divided divided divided Comments Closed and funds divided equally Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS: 1/29/04 Prepared: February 1, 2005 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE/ GROSS VALUE NET VALUE PROPOSED PROPOSED PROPERTY OR DEBT AGREED/ AFTER LIENS DISTRIBUTION DISTRIBUTION DISPUTE TO HUSBAND TO WIFE ACCT-2 Joint PSECU savings 1.31.04 512.67 512.67 512.67 #4097 ACCT-2 Joint PSECU 1,31.04 2.51 2.51 2.51 checking #4097 Comments * 1.3 1.04 statement balances of $512.67 (savings) and $2.51 (checking) f ACCT-3 Wife's EDS Credit 1.31.04 7,808.51 7,808.51 7,808.51 Union Savings #02- 011 Comments * 1.31.04 statement balance @ $ 7,808.51 d LIFE INSURANCE POLICIES INS-1 Husband's Eric Life 11.18.03 2,520.67 2,520.67 2,520.67 Insurance Policy Update #1553 Comments * It. 18.03 @ $2,520.67 ok Husband to supply account statement indicating value as of 1/29/04. RETIREMENT PLANS RET-1 Husband's Select 12.31.03 78,113.57 78,113.57 78,1]3.57 Medica1401K Update RET-1 * 12.31.03 g $78,113,57 d Comments * Husband to supply plan statement as of 1/29/04 all statement issued after that date to the current date. RET-2 Wife's Pershing 12.30.04 8,965.00 8,965.00 8,965.00 Rollover IRA #0557 RET-2 * 1.31.04 @ $7,868.00 d Comments * 12.30.04 @ $8,965.18 -t No post-separation contributions Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS:1/29/04 Prepared: February 1, 2005 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF PROPERTY OR DEBT DATE/ AGREED/ DISPUTE GROSS VALUE NET VALUE AFTER LIENS PROPOSED DISTRIBUTION TO HUSBAND PROPOSED DISTRIBUTION TO WIFE RET-3 Wife's EDS Personal Pension Plan 11.30.04 7,749.15 7,749.15 7,749.15 Comments * 1.31.04 @ $7,391.17 * 11.3 0.04 @ $7,749.15,( -i No post-separation contributions HOUSEHOLD GOODS, P'VANISHINGS, TOOLS, PERSONAL EFFECTS ETC. PP-1 Husband's Personalty as is division as is division as is division Comments -?Personalty already divided as per parties' agreement. PP-2 Wife's Personalty as is division as is division as is division Comments -i Personalty already divided as per parties' agreement. OTHER PROPERTY OP-1 Husband's Bonus 1 1.04 or 2.04 7,839.00 7,839.00 7,839.00 Comments * 1.04 or 2.04 @ $7,839 4- -1'Paid after separation but accrued pre-separation. Husband retained. LOANS, CA D1T CARDS AND OTHER DEBTS DEBTA MBNA #1176 2.5.04 (234.45) (234.45) (234.45) Comments * 2.5.04 it, $234.45 .I 7777 TOTALS Total of Assets and Liabilities 236,428.69 200,581.03 35,847.66 P04NTAGE OF DIVISION Totals from Above 236,428.69 200,581.03 35,847.66 Percentage of Total 0.85 0.15 DIANE G. RADCLIFF, ES 3448 Trindle Road, Camp Hilt, PA 17011 Phone: 717-737-0100 Fax: 717-975-0697 E-mail: dianeradcliff@comcast.net December 8, 2004 Jeffrey Evans 279 Alpat Drive Diltsburg, PA 17019 Re: Angela L. Evans vs. Jeffrey A. Evans Cumberland County Divorce No. 04-1892 Dear Mr. Evans: After speaking with several realtors I have concluded that the marital residence is worth more than the $145,000.00 value we previously assigned and is more likely worth in the vicinity of $165,000.00. Therefore, we would tike to have the home appraised so that a more accurate value can be assigned. We would like to use Mark Heckman for this purpose. Please advise me if you are agreeable to the appraisal of the home. If so 1 will have Mr. Heckman contact you directly to set up a date and time for the appraisal. I await your response on or before December 20, 2004. Very truly yours, DIANE G. RADCLIFF, ESQUIRE DGR/rzs cc: Angela Evans File 48-03 TRANSMITTED BY MAIL From: "Jeffrey Evans" <jetal963@yahoo.com> To: <dianeradeliff@comcast.net> Subject: Appraisal Date: Monday, December 13, 2004 1:30 PM Diane: How have you concluded the property is worth this amount above what it was appraised for a little over a year ago and how have these "several" Realtors come to this conclusion? Please be advised that anyone entering my property without my permission will be arrested. I will be the one to determine when, who and if an apprasial is done not yourself. Jeffrey A Evans Do you Yahoo!? Yahoo! Mail - Find what you need with new enhanced search. Learn more. DIANE G. RADCLIFF, ESQUIRE 3448 Trindle Road, Camp Hill, PA 17011 Phone: 717-737-0100 Fax: 717-975-0697 E-mail: dianeradctiff@comcast.net January 13, 2005 Jeffrey Evans 279 Alpat Drive Dillsburg, PA 17019 Re: Angela L. Evans vs. Jeffrey A. Evans Cumberland County Divorce Dear Mr. Evans: Enclosed is a copy of my preliminary analysis of this case. In order for me to put this document in final form and move this case forward to settlement discussions or a Divorce Master's hearing, I need the following information from you: 1. Your last pay stub for 2004 and all pay stubs issued in 2005. 2. A copy of the real estate appraisal you recently secured; 3. A statement of the value of your Erie Life Insurance Policy as of 1/29/04 or the nearest available date thereto; 4. Statements for your Select medical 401K plan from 1/29/04 or the nearest available date thereto through 12/31/04; 5. Statements for your GPU 401 K Plan from 1/29/04 or the nearest available date thereto through 12/31/04. If that Plan was rolled over into another plan before separation, then proof of that roll over needs to be provided. I trust that this information will be provided on a voluntary basis within thirty (30) days of the date of this letter. To assure compliance therewith, I am herewith providing you with an original and two copies of the Plaintiff's Request for Production of Documents pursuant to which you are mandated to provide this requested documentation on or Page 2 Jeffrey Evans January 13, 2005 before February 13, 2005. Very truly yours, DIANE G. RADCLIFF, ESQUIRE DGR/dr Enclosure(s): Analysis Request for Production of Documents (Original + 2 copies) cc: Angela Evans File 48-03 TRANSMITTED BY MAIL ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA JEFFREY A. EVANS, V. Defendant NO. 04-1892 CIVIL ACTION - LAW IN DIVORCE PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS DIRECTED TO DEFENDANT, JEFFREY A. EVANS TO: JEFFREY A. EVANS 279 Alpat Drive Diltsburg, PA 17019 You are requested, in accordance with Pa. R.C.P. No. 4009, within thirty (30) days of service of this Request for Production of Documents to make available to Plaintiff's attorney, Diane G. Radcliff, Esquire, at 3448 Trindle Road, Camp Hill, Pennsylvania, or otherwise make arrangements mutually satisfactory to the undersigned, for inspection and/or copying of the within requested documents. DIANE G. RADCLIFF, ESQUIRE 3448 Trindle Road Camp Hill, PA 17011 Supreme Court ID # 32112 Attorney for Plaintiff Date: January 13, 2005 DEFINITIONS AND INSTRUCTIONS 1. "Document" or "Documentation" means any written, printed, typed or other graphic matter of any kind or nature, including but not limited to, agreements, contracts, assignments, letters, telegrams, inter-office communications, memoranda, reports, records, transcripts, instructions, specifications, notes, notebooks, diaries, minutes, minutes of meetings, plans, photocopies, charts, graphs, descriptions, photographs, motions pictures, videotapes, mechanical or electronic sound recordings or transcripts thereof, computer records, disks tapes or other media and any other retrievable data, whether an original or a copy made by any means, including any non-identical copy (whether different from the original because of any alterations, notes, comments, or otherwise), together with any supplements or attachments thereto or enclosures therewith. 2. "Date" means the exact day, month and year if ascertainable, or if not, the best approximation including relationship to events. 3. "Person" means an individual, corporation, proprietorship, partnership, association or other entity. 4. "Plaintiff" shall mean the Plaintiff(s) to this litigation. 5. "Defendant" shall mean the Defendant(s) to this litigation. 6. "Relate to" (or a form thereof) shall mean constituting, reflecting, representing, supporting, contradicting, referring to, describing, analyzing, noting, embodying, containing, mentioning, studying, recording, discussing, evaluating or relevant thereto. As indicated, the term necessarily includes information which is in opposition to as well as in support of the position or positions you have taken in this action. 7. "Reflect" (or a form thereof) shall mean to embody, contain, record, note, refer to, relate, describe, be relevant to, state and/or mention. 8. Whenever the expression "and/or" is used in these Requests, the documents called for should be set out both in the conjunctive and disjunctive, and wherever the documents are set out in the disjunctive, it should be given separately for each and every element sought. 9. Whenever a Request is framed in the singular, it shall also be taken in the plural or visa- versa. 10. The use of any tense of a verb shall be considered to also include within its meaning all other tenses of the verb so used. 11. With respect to any document or communication for which you claim a privilege, state the privilege involved, the factual and legal basis of the privilege, the identity of the document or communication, including the general subject matter, but not its substance, by stating (a) the date; (b) author or addressor; (c) addressee any recipients of all copies or of the communication; (d) the type of document (e.g. notes, letter, memorandum, telegram, photograph, brochure, chart) or some other means of identifying it; and (e) its present location or custodian. 12. No Request is to be without a response. If the answer to a Request or a subparagraph of a Request is "none" or "unknown" such statement should be written in the responses. If the request is inapplicable, "N/A " must be written in the answer. If a document is omitted because of the claim of privilege, the basis of the privilege is to be stated. 13. These Requests are continuing, and any documents secured subsequent to the filing of your answers which would have been included in the answers had it been known or available, are to be supplied by supplemental answers and/or documents. 14. If you object to the production of any document on the grounds that the attorney-client, attorney work-product or any other privilege which is applicable thereto, you shall, with respect to that document: a. State its date; b. Identify its author; C. Identify each person who prepared or participated in the preparation of the document; d. Identify each person who received it; e. Identify each person from whom the document was received; f. State the present location of the document and all copies thereof; g. Identify each person who has ever had possession, custody or control of it or a copy thereof; and h. Provide sufficient information concerning the document and the circumstances thereof to explain the claim of privilege and to permit the adjudication of the propriety of that claim. DOCUMENTS REQUESTED 1. Your last pay stub for 2004 and all pay stubs issued in 2005. 2. A copy of the appraisal you recently secured; 3. A statement of the value of your Erie Life Insurance Policy as of 1/29/04 or the nearest available date thereto; 4. Statements for your Select medical 401K plan from 1/29/04 or the nearest available date thereto through 12/31/04; 5. Statements for your GPU 401K Plan from 1/29/04 or the nearest available date thereto through 12/31/04. If that Plan was rolled over into another plan before separation, then proof of that roll over needs to be provided. 6. Any and all appraisals of any marital asset. 7. Any exhibits which you intend to produce at the trial or hearing in this case. CERTIFICATE OF SERVICE I, DIANE G. RADCLIFF, ESQUIRE, hereby certify that I served an original and two copies of the foregoing Request for Production for Documents upon the Defendant's on January 13, 2005, by mailing same by first class mail, postage prepaid, addressed as follows: Jeffrey Evans 279 Alpat Drive DiRsburg, PA 17019 DIANE G. RADCLIFF, ESQUIRE 3448 Trindle Road Camp Hill,, PA 1701 1 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Plaintiff Diane: I cannot meet your February 13, 2005 deadline for the information requested due to my work schedule and not being in town. I need till the end of February to meet the request and will be providing you with a property settlement proposal via email, which is the only communication outlet I will have at my disposal for the next three to four weeks. The GPU 401K plan was rolled over to my Select Medical 401K when I began my employment. I have no documentation to prove this but Angela knows this as fact so this should not even be an issue. All others will be sent within my requested timeline. Sincerely Jeffrey A Evans (January 26, 2005 email to Jeff Evans) Jeff I am in receipt of your recent email. Please verify that you will send me a copy of the marital home appraisal by the end of February. Please also inform me now of the value found by the appraiser, If you provide that information, (will agree to extend the required discovery time period to February 28th. Thank you. Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Phone: 717.737.0100 Fax: 717.975.0697 Email: dianeradclifflil)comcast.net r? C) - . T1 ? , .-1 .? ?' ".1 .. ?1Z ?"? t -?) { ' _ ` ? ? r "? 1 ? A MAR a 4 2005 A ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 04-1892 JEFFREY A. EVANS, CIVIL ACTION - LAW Defendant IN DIVORCE RULE RE: PLAINTIFF'S MOTION TO COMPEL DISCOVERY AND/OR FOR SANCTIONS AND NOW, this 15 • day of /7-7oc-6 , 2005, upon consideration of the within Motion, a Rule is entered upon the Defendant to show cause why the relief requested in the within motion should not be granted. Rule returnable .20 days after service hereof. BY THE COURT: Distribution to: UATrORNEY FOR PLAINTIFF : Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011 -,KFENDANT PRO SE: Jeffrey Evans, 279 Alpat Drive, Dillsburg, PA 17019 ?? 1 O 43 `?- D ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA JEFFREY A. EVANS, Defendant NO. 04-1892 CIVIL ACTION - LAW IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Angela L. Evans, Plaintiff, moves the Court to appoint a Master with respect to the following claims: [x] Divorce [x] Distribution of Property [ ] Annulment [ ] Support [x] Alimony [x] Counsel Fees [x] Alimony Pendente Lite [x] Costs and Expenses In support of the Motion the Plaintiff states: 1. Discovery is complete with respect to the claims for which the appointment of the Master is requested. 2. The non-moving parry [X] has [ ] has not appeared in the action [X ] personally 3. The statutory ground for the divorce is/are: Section 3301 (c) No-Fault; Section 3301(d) No-Fault; Section 3301(a)(2) Adultery; and Section 3301(a) (6) Indignities. 4. Check the applicable paragraphs: [ ] The action is not contested. [ ] An agreement has been reached with respect to the following claims: [X] The action is contested with respect to the following claims: All Claims 5. The action does not involve-complex issues of law or fact. 6. The hearing is expected to take one (1) day. 7. Addis nal information, if any, Date: AND NOW, 2004, E. Robert Elicker, II, Esquire is appointed Master with respect to the following claims: [x] Divorce [x] Distribution of Property [ ] Annulment [ ] Support [x] Alimony [x] Counsel Fees [x] Alimony Pendente Lite [x] Costs and Expenses BY THE COURT: JUDGE MOVING PARTY Angela L. Evans, Plaintiff Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 NON MOVING PARTY Jeffrey A. Evans, pro se 279 Alpat Drive Dillsburg, PA 17019 Std (J cy? cD IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. 04-1892 V. CIVIL ACTION - LAW IN DIVORCE JEFFREY A. EVANS, Defendant AFFIDAVIT OF CONSENT A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 29, 2004. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree in 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. Section 4904 relating to unsworn falsification to authorities. Dated:_ 61. &0- - ANGELA 6 L. EVANK, PLAL Tim c> ?> ? -?? ?= ? .a --- ? ? ? ? 5,-?: { ' ?, ,F; , ' ? s yc ? ??: ?`= ? `='' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. 04-1892 V. CIVIL ACTION -LAW JEFFREY A. EVANS, DIVORCE Defendant INVENTORY OF ANGELA L. EVANS Plaintiff files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Plaintiff verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Omq: L ANGELA L. EVANS, PLAINTIFF Dated: ?S DIVT D IFF, ESQUI ind d 170 1 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court D #32112 16 .4-, ASSETS AND LIABILITIES OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets and debts on the following pages: (X) 1. Real Property and Real Estate Mortgages (X) 2. Motor Vehicles and Vehicle Liens O 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 (X) 9. Life Insurance Policies O 10. Annuities O 11. Gifts O 12. Inheritances O 13. Patents, Copyrights, Inventions, Royalties O 14. Personal Property Outside the Home O 15. Business O 16. Employment Termination Benefits-Severance Pay, Worker's Compensation O 17. Profit Sharing Plans (X) 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 unmatured) O 22. Military/V.A. Benefits O 23. Education Benefits O 24. Debts Due, including loans, mortgages held (X) 25. Household Furnishings and Personalty (X) 26. Other Assets (X) 27. Loans, Credit Cards and Other Debts Page 2 INFORMATIONAL NOTES AND CODES N r" denotes that the entry (value) is verified by a document. 2. " *" denotes documents/information to be supplied by the designated party. 3. "X" denotes an item about which a decision is required. 4. "NM" denotes non-marital property not subject to equitable distribution. 5. The values used in the various Tables herein may, in some cases, be based on estimated values. Those estimated values are subject to adjustment upon appraisal or otherwise. 6. Any adjustment figures used in the various tables herein are for illustration purposes only and are not to be deemed a representation on the part of the Plaintiff a to whether an adjustment should be made or the amount of the adjustment, if any is appropriate. " denotes that the entry (value) is verified by a document. Page 3 SECTION I. BACKGROUND INFORMATION The following Table #1 sets forth the background information relevant to this case: TABLE #1-A PARTIES DESCRIPTION HUSBAND' WIFE Name Jeffrey Allen Evans Angela Lyn Evans Maiden Name N/A Poticher Address 279 Alpat Drive Dillsburg, PA 17019 162 Chestnut Grove Road Dillsburg, PA 17019 Home Phone -- 717-432-4612 Cell Phone No. 717-574-6183 717-979-4359 Work Phone No. 717-944-6630 717-691-4578 E-mail -- -- Date of Birth 7/4/63 11/13/65 Age 41 39 Place of Birth Elkins, West Virginia Harrisburg, PA Race White White Health Status Good Good Educational Background High School Diploma High School Diploma Names and Relationship of Persons Living with Party Unknown Courtney Lyn Evans, daughter Ryan Jeffrey Evans, son Date Party Moved to Current Residence 7/04 6/04 Date PA Residency Began Current Military Service N/A N/A Employer's Name and Address Select Medical 4716 Old Gettysburg Rd Mechanicsburg, PA Mechanicsburg School District Occupation (Job Position) Pilot Aide Date Employment Commenced October 2002 August 2004 Est. Annual Income $2,090.34/bw $4,528.33/mo $54,340/yr $417.69/bw $905/mo $10,860/yr Page 4 TABLE #1-B MARRIAGE INFORMATION DESCRIPTION INFORMATION Date of Marriage 2/15/85 Place of Marriage Grantham, PA, Cumberland County Date of Separation 1/29/04 (Physical) Brief Statement of Marital Problems Husband's adultery 1998 and 2004; Husband moved out of house 1/29/04. Grounds for Divorce No Fault Prior Divorce Actions Between Parties None Number of this Marriage for Wife 1 Number of this Marriage for Husband 1 TABLE #1-C CHILDREN OF THIS MARRIAGE NAME AGE DATE OF BIRTH' SCHOOL GRADE CUSTODIAN OR EMANCIPATION Courtney Lyn Evans 11 2/15/94 5'h Plaintiff Ryan Jeffrey Evans 6 7/22198 kindergarten Plaintiff TABLE #1-D SUPPORT FOR THIS MARRIAGE DESCRIPTION INFORMATION Name of Party Paying Support Jeffrey Evans Beneficiaries of Support Angela, Courtney and Ryan Evans Amount ofSupport $1,626/month Allocation $1,136 for children; $490 for spousal Agreement or Order Order Date of Agreement or Order 12/17/04 Docket Number of Support Order 361 Support 2004; PACSES: 556106365 Comments To decrease in fall due to deletion of day care expenses Page 5 TABLE #1-E PRIOR MARRIAGES PARTY NUMBER OF DATE OF MANNER OF TERMINATION MARRIAGE TERMINATION N/A N/A N/A N/A TABLE #1-F CHILDREN OF OTHER RELATIONSHIPS/MARRIAGES PARTY NAME OF CHILD DATE IOF AGE CUSTODIAN OR BIRTH EMANCIPATION N/A N/A N/A N/A N/A TABLE #1-G SUPPORT/ALIMONY FOR PRIOR MARRIAGES/RELATIONSHIP DESCRIPTION INFORMATION INFORMATION Name of Parry Paying Support N/A N/A Beneficiaries of Support N/A N/A Allocation N/A N/A Agreement or Order N/A N/A Date of Agreement or Order N/A N/A. Docket Number of Support Order N/A N/A Comments: N/A N/A Page 6 TABLE #1-H PROCEEDINGS INFORMATION: COMPLAINT Complaint Filing Date 4/29/04 Date of Service 5/4/04 Manner of Service Certified Mail Restricted Delivery Type of Divorce Requested 3301(c) No Fault; 3301(d) No Fault Economic Claims Raised Equitable Distribution; APL; Alimony; Counsel Fees and Costs ANSWER, COUNTERCLAIM AND/OR OTHER PLEADING RAISING ECONOMIC CLAIMS Type of Pleading Pleading Filing Date Type of Divorce Requested Economic Claims Raised INCOME AND EXPENSE STATEMENTS Plaintiffs I&E Statement Filing Date 1/24/05 Defendant's I&E Statement Filing Date INVENTORIES Plaintiffs Inventory Filing Date TBD Defendant's Inventory Filing Date 3301 C DOCUMENTS Plaintiffs 3301(c) Affidavit Date TBD Plaintiffs 3301(c) Affidavit Filing Date TBD Defendant's 3301(c) Affidavit Date Defendant's 3301(c) Affidavit Filing Date Plaintiffs 3301(c) Waiver of Notice Date Plaintiffs 3301(c) Waiver Filing Date Defendant's 3301(c) Waiver of Notice Date Defendant's 3301(c) Waiver Filing Date Page 7 TABLE #1-H PROCEEDINGS INFORMATION: 3301 D DOCUMENTS Date of In House Separation N/A Date of Physical Separation 1/29/04 In House 2 Year Separation Date N/A Physical2 Year Separation Date 1/29/06 Plaintiff's 3301(d) Affidavit Date Plaintiff's 3301(d) Affidavit Date Filing Date 3301 (D) Affidavit Service Date Manner of Service of 3301(d) Affidavit Date of Plaintiffs Notice oflutent to Request Entry of Divorce Decree and Praecipe to Transmit Record Plaintiffs Notice to Request Entry of Divorce Decree and Praecipe to Transmit Record Service Date Manner o Service of Plaintiffs Notice to Request Entry of Divorce Decree and 3301(d) Counter- Affidavit BIFURCATIO N Has the case been bifurcated? No Date of decree granting bifurcation N/A If bifurcation granted by consent or after hearing N/A PREVIOUSLY RESOLVED' ISSUES Issue #1 Resolution Child and Spousal Support Order entered in related support case. Issue #2 Resolution Page 8 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physical): 1/29/04 Date Prepared: 4/22/04 SECTION II. MARITAL ASSETS AND DEBTS The following Table #2 sets forth the listing of the marital assets and debts of the parties: TABLE #2 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE VALUE PROPOSED PROPOSED H91, W% H ADJUST W ADJUST PROPERTY OR DEBT AGREED TO HUSBAND TO WIFE VERIFIED .: R': hHi : r ?? ;' i o 6 E ? 11 ( yy?,, ? kP?' :AI ?, °I#}r. , 5 ,y C F i s . ° f 7! FE? F 19 1 Ii .v EEC slI i }v v 5 t ! z' °{ ... .. 0H n.' . _,, ., ..::.., . I i , !'!.._v,.Ifl ,.-. ...,. ' _ R-1 279 Alpat Drive 12.22.04 200,000 200,000 0.40 0.60 0 120,000 Dillsburg, PA I R-1 Members 1" mtg 1.1.05 (74,183) (74,183) 0.40 0.60 0 (44,510) Update R-1 Est. Sales Cost TBD TBD 0.40 0.60 0 0 Comments: k vl ° 7 v C i I n Ivry Ipt Iv ?I'kj e i? i 7 ° ° ?,? vti !{? ° ! i, _.I {. ° P v ?° ? ?? l X; ng ,....; ,? i? vk. m , ? V-1 Husband's 1998 4.14.04 11,525 11,525 0.40 0.60 0 6,915 Chevrolet K1500 d pickup Comments: V-2 Wife's 2000 4.14.04 11,325 11,325 0.40 0.60 4,530 0 Chevrolet Blazer d Comments: V-3 1996 Chrysler 4. 14.04 Sold & Sold & Sold & 0.40 0.60 0 0 Concord d equal equal equal division division division Comments: V-4 Husband's Seville 3.25.05 1,900 1,900 0.40 0.60 0 1,140 21' Cuddly Cabin boat Comments: As per Attorney Shade's 3.25.05 letter Husband sold for $3,800.00; Husband's one-half interest was $1,900.00 Wife believes it was sold for $5000 and Husband's half interest is @$2500 V-5 Husband's 1995 3.25.05 200 200 0.40 0.60 0 120 Palmer Trailer Comments: Asper Attorney Shade's 3.25.05 letter@ $200.00 V-6 Husband's 1998 4.14.05 2,830 2,830 0.40 0.60 0 1,698 Yamaha Wolverine d ATV Comments: Page 9 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physical): 1/29/04 Date Prepared: 4/22/04 TABLE #2 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE VALUE PROPOSED PROPOSED H % W% H ADJUST W ADJUST PROPERTY OR DEBT AGREED TO HUSBAND TO WIFE VERIFIED V-7 Husband's 2000 3.25.05 1,000 1,000 0.40 0.60 0 600 Polaris Trail Boss AT Comments: As per Attorney Shade's 3.25.05 letter sold by husband for $1,000 * 4.14.04 NADA ARV @ $1,975.00 d V-8 Husband's 1998 4.14.04 1,330 1,330 0.40 0.60 0 798 Yamaha Badger d ATV Comments: As per Attorney Shade's 3.25.05 letter Husband alleges this is the parties' daughter's ATV and should not be part of ED. * 4.14.04 NADA ARV @ $1,330.00 vr V-9 Husband's (Ryan) 3.25.05 700 700 0.40 0.60 0 420 2000 Eton Youth Four Wheeler Comments: As per Attorney Shade's 3.25.05 letter, Husband states this was sold for $700 and a used dirt bike purchased for Ryan. .' I Ut 1? I .' i `!IE 6tli t i I l?( ? t ? I? A-1 Joint Members 1s' 1.31.04 Closed; Closed; Closed; 0.40 0.60 0 0 Savings #2634 divided divided divided equally equally equally A-1 Joint Members 151 1.31.04 Closed; Closed; Closed; 0.40 0.60 0 0 Checking #2634 divided divided divided equally equally equally Comments: A-2 Joint PSECU 1.31.04 513 513 0.40 0 308 savings #4097 A-2 Joint PSECU 1.31.04 3 3 0.40 HO.6 0 2 checking #4097 d Comments: A-3 Wife's EDS Credit 1.31.04 7,809 7,809 0.40 0.60 3,123 0 Union savings d #02011 Comments: Page 10 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physical): 1/29/04 Date Prepared: 4/22/04 TABLE#2 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE VALUE PROPOSED PROPOSED H % W°/a H ADJUST W ADJUST PROPERTY OR DEBT AGREED TO HUSBAND TO WIFE VERIFIED .'! 3 i t 3 i 7f i{ Ii 17 -j 1 iilltt .t i i i! i iR I' m ! n i : ? ., lm all .... , i . v.. , :i.,....a ... E;a.., ..... ... :........ ' It Mu .... ... . .v: .... : e. .. , . .n Ins-1 Husband's Erie 1.7.05 2,666 2,666 0.40 0.60 0 1,600 Life Policy #1553 d Comments: ;:; .. 3 6 f { i i3 Ei ?i i>>> 3 E 39i 1i ?9 fr ?! EO I t h {{I r tl E?,?r? { i ' 3 { ry, ? v `1 I ( ? :: . . .. :: ! ,.,, d f r•..... ! z• :,... ,. .:.:,.,,.... ! ., d,,.al, t . i vrl. ,.% !' ?, f...,,,IIt { ...I .,:i..-. . ..:: ....1.., e,i'' I .,.,..... °i i _ d!!'...,.{i{.. it R-1 Husband's Select 1.31.04 79,371 79,371 0.40 0.60 0 47,622 Medical 401 K R-1 Est Taxes @ TBD TBD 0.40 0.60 0 0 Comments: R-2 Wife's Pershing 12.30.04 8,965 8,965 0.40 0.60 3,586 0 Rollover IRA d #0557 R-2 Est Taxes @ //% TBD TBD 0.40 0.60 0 0 Comments: R-3 Wife's EDS 1.31.04 7,391 7,391 0.40 0.60 2,956 0 Personal Pension d Plan R-3 Est Taxes @ //% TBD TBD 0.40 0.60 0 0 Comments: No post-separation contributions. 4?,'ItY ..its{`{E! N!U??.i { 3 11 { E M t .51 ml .i 3, t,. HG-1 Husband's AS IS AS IS 0.40 0.60 0 0 Personalty Comments: Personalty already divided as per parties' agreement. HG-2 Wife's Personalty AS IS AS IS 0.40 0.60 0 0 Comments: Personalty already divided as per parties' agreement. tlii E? i? i {) -. 3 fi tx i? 9?{ t' ail I t i i i I i>>i F E) jE! I t?El? j !(?`y.{ ,i,}}t t { { ti I I '. i t ? l ? ( ,...._i,{ ii' E, hi l '? OA-1 1 1.04 or 7,839 7,839 0.40 0.60 0 4,703 Husband's Bonus 2.04 Comments: Paid after separation, but accrued pre-separation. Husband retained. Page 11 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physicat): 1/29/04 Date Prepared: 4/22/04 TABLE #2 MARITAL ASSETS AND DEBTS N0. DESCRIPTION OF DATE VALUE PROPOSED PROPOSED H % W% H ADJUST WAD JUST PROPERTY OR DEBT AGREED TO HUSBAND TO WIFE D-1 MBNA #1176 2.04 (234) (234) 0.40 0.60 0 (141) Comments: TOTALS Total of Assets and Liabilities 270,948 235,458 35,490 IJkl N?IN IIA?EIVS Adjustment payment due party from above .04 14,196 14,196 141,275 141,275 Less adjustment payment due other party from above (141,275) (14,196) NET LINE ITEM ADJUSTMENTS (127,079) 127,079 PERCENTAGE OF DIVISION WITHOUT LINE ITEM ADJ USTMEN TS Totals from Above 270,948 235,458 35,490 Percentage of Total 86.90% 13.10% r? yl y ADJUSTMENT FOR OVERAL L 50150 DIVISIO N Totals from above 270,948 235,458 35,490 Amount Due in 50/50 Division 135,474 135,474 Adjustment Figure for 50/50 (99,984) 99,984 ADJUSTMENT FOR OVERAL L 45/55 DIVISIO N Totals from above 270,948 235,458 35,490 Amount Due in 45/55 Division 121,927 149,021 Adjustment Figure for 45/55 (113,532) 113,532 ADJUSTMENT FOR OVERAL L 40160 DIVISIO N Totals from above 270,948 235,458 35,490 Amount Due in 40/60 Division 108,379 162,569 Adjustment Figure for 40/60 '" t t t i t i' SDIINIAR Q Adj 1ustment payment for 50/50 (127,079) t 0E , . _L' A (99,984) 127,079 ai i'.LJtJS'Gh4EIQT'Sr 99,984 n t ( .:.t{{tl?l „ FI ?,I ?{{ t Adjustment payment for 45/55 (113,532) 113,532 Adjustment payment for 60/40 (127,079) 127,079 Page 12 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physical): 1/29/04 Date Prepared: 4/22/04 TABLE #2 MARITAL ASSETS AND DEBTS NO. I DESCRIPTION OF DATE VALUE PROPOSED PROPOSED H % W% H ADJUST W ADJUST PROPERTY OR DEBT AGREED TO HUSBAND TO WIFE R-1 Husband's Select Medical 401K 1.31.04 d 79,371 79,371 R-2 Wife's Pershing Rollover IRA 12.30.04 -1 8,965 8,965 R-3 Wife's EDS Personal Pension 1.31.04 d 7,391 7,391 100 Totals Retirement Plans "ADJt)ST Totals from above 95,727 NIENT FQR 5 95,727 79,371 0/50 D1r$IQN,t 79,371 16,356 ?Fi ftET(IV( 16,356 T.PIA 00 Amount Due in 50/50 Division 47,863 47,863 Adjustment Figure for 50/50 AQJt#STINT F©t (31,507) 5911ff 1,C1t 31,507 ? Totals from above 95,727 79,371 16,356 Amount Due in 45/55 Division 43,077 52,650 Adjustment Figure for 45/55 ApJl1STMENT F?R:40 (36,294) 611 Q)fSlQtb 36,294 F M2T#ItFMEN T P .. Totals from above 95,727 79,371 16,356 Amount Due in 40/60 Division 38,291 57,436 Z 11Z10 Adjustment Figure for 40/60 7 77 Slll?lfp(tY QF QJUSTMLN (41,080) SOI C?115) 41,080 M O # PTC tk1t F Adjustment payment for 50/50 (31,507) 31,507 YZZA Adjustment payment for 45/55 (36,294) 36,294 Adjustment payment for 60/40 (41,080) 41,080 Page 13 Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physical): 1/29/04 Date Prepared: 4/22/04 TABLE #2 MARITAL ASSETS AND DEBTS NO. DESCRIPTION OF DATE VALUE PROPOSED PROPOSED H % W% H ADJUST PROPERTY OR DEBT AGREED TO HUSBAND TO WIFE VERIFIED SUMMARY OF ADJSTM6TS.SEPARA7lIV RT?t?MNT PLANS 1;OM:O HEFt ASSETS W ADJUST SUMMARY FOR 50/50 DIVISION Overall Adjustment for all Assets 50/50 (99,984) 99,984 Retirement Plan Adjustment 50/50 (31,507) 31,507 Non Retirement Plan Adjustment (68,477) 68,477 SUMMARY FOR 45/55 DIVISION Overall Adjustment for all Assets 45/55 (113,532) 113,532 Retirement Plan Adjustment 45/55 (36,294) 36,294 Non Retirement Plan Adjustment 45/55 (77,238) 77,238 SUMMARY FOR 40/60 DIVISION Overall Adjustment for all Assets 40/60 (127,079) 127,079 Retirement Plan Adjustment 40160 (41,080) 41,080 .100 Non Retirement Plan Adjustment 40/60 (85,999) 85,999 Page 14 SECTION III. LISTING OF HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY The following Tables #3-A and # 3-B set forth the household goods and contents and other personal property of the parties: ' NOTE: The parties' personal property was previously divided as per agreement of the parties and, therefore, Tables #3-A and #3-B have not been completed. TABLE #3-A HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY IN HUSBAND'S POSSESSION NO. DESCRIPTION OWNER POSSESSOR DATE VALUE BASIS FOR OF EXCLUSION IF VALUE NON- MARITAL 1 N/A H & W Husband Comments: TOTAL HUSBAND'S POSSESSION TABLE #3-B HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY IN WIFE'S POSSESSION NO. DESCRIPTION OWNER POSSESSOR DATE VALUE BASIS FOR OF EXCLUSION IF NON- VALUE MARITAL I N/A H & W Wife Comments: TOTAL WIFE'S POSSESSION Exclusions from marital property include property acquired before marriage, property acquired after separation, or property acquired during marriage by way of gift or inheritance from third party not a spouse. For gifts and inheritance also specify the source person. Page 15 SECTION IV. NON-MARITAL ASSETS AND DEBTS The following Table #4 sets forth the non-marital assets and debts of the parties: z,' NOTE: There is no known non-marital property and, therefore, Table #4 has not been completed. TABLE #4 NON-MARITAL PROPERTY AND DEBTS NO. DESCRIPTION OWNER POSSESSOR DATE VALUE BASIS FOR OF EXCLUSION IF VALUE NON- MARITAL N/A Comments: Note: Exclusions from marital property include property acquired before marriage, property acquired after separation, or property acquired during marriage by way of gift or inheritance from third party not a spouse. For gifts and inheritance also specify the source person. 'The value of each item has been estimated by Plaintiff unless otherwise noted. Page 16 SECTION V. PROPERTY TRANSFERRED The following Table #5 is Plaintiffs listing of all property which was transferred within 3 years of the date of the commencement of this action: NOTE: No property is known to have been transferred within three years of the date the action was commenced and, therefore, Table #5 has not been completed. TABLE #5 PROPERTY TRANSFERRED NO. DESCRIPTION OF PROPERTY TRANSFER CONSIDERATION TRANSFEROR TRANSFEREE DATE N/A Page 17 V4 CERTIFICATE OF SERVICE I, Diane G. Radcliff, Esquire, hereby certify that on April 25, 2005 , I served a copy of the within Inventory, by mailing same by first class mail, postage prepaid, addressed as follows: Wayne F. Shade Esquire 53 West Pomfret Street Carlisle, PA 17013 Page 18 Supreme Court ID # 32112 Phone: (717) 737-0100 Fax: (717) 975-0697 Attorney for Plaintiff C„7 h7 ?? {+ (-.J r "l _ .Tn' _ IT. T N i C.J "il r"I l ' 3 ; W ?-? . ANGELA L. EVANS, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW V. NO. 04-1892 CIVIL TERM JEFFREY A. EVANS, Defendant : IN DIVORCE PRAECIPE TO: Curtis R. Long, Prothonotary Please enter my appearance on behalf of Defendant in the above-captioned matter. Date: May 3, 2005 _? Wayn F. Shade, Esquire Supreme Court No. 15712 53 West Pomfret Street Carlisle, Pennsylvania 17013 Telephone: 717-243-0220 Attorney for Defendant WArnEF Attorney a 53 West Point Carlisle, Pen, 17015 Law at Street ? cv - - o b v -k cn S k j K. a ?. 6 ORIGIN IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS Plaintiff NO. 04-1892 V. CIVIL ACTION -LAW JEFFREY A. EVANS, DIVORCE Defendant PLAINTIFF'S PRE-TRIAL STATEMENT Plaintiff, Angela L. Evans, by her attorney, Diane G. Radcliff, Esquire files this Pre-Trial Statement. TABLE OF CONTENTS SECTION DESCRIPTION PAGE - Informational Notes, Codes and Rules 2 1. Background Information 4 H. Listing of Marital Assets and Debts 9 III. Listing of Personal Property 15 IV. Listing of Non-Marital Assets and Debts 16 V. Pensions 17 VI. Incomes and Expenses 18 VII. Counsel Fees and Costs 22 VIII. Expert Witnesses 23 IX. Other Witnesses 24 X. Proposed Resolution 25 XI. Listing of Proposed Exhibits 26 XII Proposed Exhibits Supplement Respectfully Submitted, DATED: June 30, 2005 '448 Trin le Road Cam Hi PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Plaintiff INFORMATIONAL NOTES AND CODES, RULES & SANCTIONS NOTES AND CODES "P' denotes that the entry (value) is verified by a document. 2. 'W' denotes documents/information to be supplied by the designated party. 3. "W denotes an item about which a decision is required. 4. "NM" denotes non-marital property not subject to equitable distribution. 5. The values used in the various Tables herein may, in some cases, be based on estimated values. Those estimated values are subject to adjustment upon appraisal or otherwise. 6. Any adjustment figures used in the various tables herein are for illustration purposes only and are not to be deemed a representation on the part of the Plaintiff as to whether an adjustment should be made or the amount of the adjustment, if any is appropriate. APPLICABLE RULES R-1 Rule 1920.33 b 1 i : The Pre-Trial Statement shall include a list of the assets which may be in chart orm, specifying the marital assets, their value, the date of valuation, whether any portion is non-marital; and any liens and encumbrances thereon. R-2 Rule 1920.33(b)(9): The Pre-Trial Statement is to include, where there is a dispute, the description and value o an y items of tangible personal property, the method of valuing each item, and the evidence, including documentation, to be offeredd in support of the valuation. R-3 Rule 1920.33(b)(101: The Pre-Trial Statement shall include a list of the marital debts including the amonnnnnn eac?i debt as of the date of separation, the date on which the debt was initially incurred, the initial amount of the debt and its ppurpose, the amounts and dates of payments made since separation, the evidence that will be offered in support of the claim. R-4 Rule 1920-33(b)(7): The Pre-Trial Statement shall include the value of the pension or retirement benefits, the marital portion thereof, and the facts and documentation upon which the party relies to support the valuation. R-5 Rule 1920.33(b)(5)(6): The Pre-Trial Statement shall include the party's gross income from all sources, each payroll deduction, and the party's net income, including the party's most recent federal and state income tax returns and pay stubs. If the party intends to offer testimony as to his or her expenses, the party must supply a current expense statement in the form required by the practice and procedure governing an action in support. R-6 Rule 1920.33(b)(8): If there is a claim for counsel fees, the Pre-Trial Statement shall include the amount o j He rendered. fees to be charged; the basis for the charge; and a detailed itemization of the services . R-7 Rule 1920.33(b)(2): The Pre-Trial Statement shall include the name and address of each expert the party inten s to c at trial as a witness. The report of each expert shall be attached to the Pre-Trial Statement. The expert report shall describe witness's qualifications and experience and state the substance of the facts and opinions to which the expert?is expected to testify and a summary of the grounds of each opinion. R-8 Rule 1920.33(b)(3): The Pre-Trial Statement shall include the name, address and a short summary testimony o each person, other than a party, whom the party intends to call at trial as a witness. -2- R-9 Rule 1920.33(b)(11): The Pre-Trial Statement shall include a proposed resolution ofthe economic issues. R-10 Rule 1920.33(b)(4 : The Pre-Trial Statement shall include a list of all exhibits a party expects to otter into evidence , each containing an identifyin mark. All Exhibits that do not exceed three (3) pages shall be attached. All exhibits over three 5) pages shall be described. SANCTIONS S-1. Rule 1920.33 c : If a party fails to file either an inventory as required by subdivision (a) or a Pre- Trial Statement -as required by subdivision (b), the Court may make an appropriate Order under Rule 4019(c) governing sanctions. S-2. Rule 1920.33 d i : A party who fails to comply with the requirement of subdivision of this Rue e i mg o a Pre-Trial Statement with the information set forth m subparagraph (b3) shall, except upon good cause shown, be barred from offering; any testimony or introducing any evidence in support o gor opposition to the claims for the matters not covered therein. S-3 Rule 1920.33 d ii : A party shall, except upon good cause shown, be barred from offering any testimony or introducing any evidence that is inconsistent with or which goes beyond the fair scope of the information set forth in the Pre-Trial Statement. -3- SECTION L BACKGROUND INFORMATION The following Table #1 sets forth the background information relevant to this case: TABLE #1-A PARTIES DESCRIPTION HUSBAND WIFE Name Jeffrey Allen Evans Angela Lyn Evans Maiden Name N/A Poticher Address 279 Alpat Drive Dillsburg, PA 17019 162 Chestnut Grove Road Dillsburg, PA 17019 Home Phone ?? 717-432-4612 Cell Phone No. 717-574-6183 717-979-4359 Work Phone No. 717-944-6630 717-691-4578 E-mail -- -- Date of Birth 7/4/63 11/13/65 Age 41 39 Place of Birth Elkins, West Virginia Harrisburg, PA Race White White Health Status Good Good Educational Background High School Diploma High School Diploma Names and Relationship of Persons Living with Party None Courtney Evans, daughter Ryan Evans, son Date Moved to Current Residence 7/04 6/04 Date PA Residency Began Unknown All Life Current Military Service N/A N/A Employer's Name and Address Select Medical 4716 Old Gettysburg Rd Mechanicsburg, PA Mechanicsburg School District Occupation (Job Position) Pilot School Aide Date Employment Commenced October 2002 August 2004 Est. Annuallncome $2,090.341bw $4,528.33/mo $54,340/yr As per 12/04 Support Order $417.69/bw $905/mo $10,860/yr As per 12/04 Support Order -4- TABLE #1-B MARRIAGE INFORMATION DESCRIPTION INFORMATION Date of Marriage 2/15/85 Place of Marriage Grantham, PA, Cumberland County Date of Separation 1/29/04 (Physical) Brief Statement of Marital Problems Husband's adultery 1998 and 2004; Husband moved out of house 1/29/04. Grounds for Divorce No Fault Prior Divorce Actions Between Parties None Number of this Marriage for Wife 1 Number of this Marriage for Husband 1 TABLE #1-C CHILDREN OF THIS MARRIAGE NAME AGE DATE OF BIRTH SCHOOL GRADE CUSTODIAN OR EMANCIPATION Courtney Lyn Evans 11 2/15194 6"' Plaintiff Ryan Jeffrey Evans 6 7/22198 1s` Plaintiff TABLE #1-D SUPPORT FOR THIS MARRIAGE DESCRIPTION INFORMATION Name of Party Paying Support Jeffrey Evans Beneficiaries of Support Angela, Courtney and Ryan Evans Amount of Support $1,626/month Allocation $1,136 for children; $490 for spousal Agreement or Order Order Date of Agreement or Order 12/17/04 Docket Number of Support Order 361 Support 2004; PACSES: 556106365 Comments -5- TABLE #1-G SUPPORT/ALIMONY FOR PRIOR MARRIAGES/RELATIONSHIP I#RIPTION 60k 01 1RBOI 10 Name of Party Paying Support N/A N/A Beneficiaries of Support N/A N/A Allocation N/A N/A Agreement or Order N/A N/A Date of Agreement or Order N/A N/A Docket Number of Support Order N/A N/A Comments: N/A N/A -6- TABLE #1-H PROCEEDINGS INFORMATION: COMPLAINT Complaint Filing Date 4/29/04 Date of Service 5/4/04 Manner of Service Certified Mail Restricted Delivery Type of Divorce Requested 3301(c) No Fault; 3301(d) No Fault 3301(a)(2) Adultery; 3301(a)(6) Indignities Economic Claims Raised T Equitable Distribution; APL; Alimony; Counsel Fees and Costs ANSWER COUNTERCLAIM AND/OR OTHER PLEADNG RAISING ECONOMIC CLAIMS Type of Pleading Pleading Filing Date Type of Divorce Requested Economic Claims Raised INCOME AND EXPENSE STATEMENTS Plaintiffs I&E Statement Filing Date 1/24/05 Defendant's I&E Statement Filing Date Not filed INVENTORIES Plaintiffs Inventory Filing Date 4/26/05 Defendant's Inventory Filing Date Not Filed 3301 C DOCUMENTS Plaintiffs 3301(c) Affidavit Date 4/22/05 Plaintiffs 3301(c) Affidavit Filing Date 4/26/05 Defendant's 3301(c) Affidavit Date Defendant's 3301(c) Affidavit Filing Date Plaintiffs 3301(c) Waiver of Notice Date Plaintiffs 3301(c) Waiver Filing Date Defendant's 3301(c) Waiver of Notice Date Defendant's 3301(c) Waiver Filing Date -7- TABLE #1- PROCEEDINGS INFO H RMATION: Date of In House Separation N/A Date of Physical Separation 1/29/04 In House 2 Year Separation Date N/A Physical 2 Year Separation Date 1/29/06 Plaintiff's 3301(d) Affidavit Date Plaintiffs 3301(d) Affil davit Date Filing Date 3301 (D) Affidavit Service Date Manner of Service of 3301(d) Affidavit Date of Plaintiffs Notice of Intent to Request Entry of Divorce Decree and Praecipe to Transmit Record Plaintiffs Notice to Request Entry of Divorce Decree and Praecipe to Transmit Record Service Date Manner o Service of Plaintiffs Notice to Request Entry of Divorce Decree and 3301(d) Counter- Affidavit IiI??'1?RC??I`I£ J?t Has the case been bifurcated? No Date of decree granting bifurcation N/A If bifurcation granted by consent or after hearing PRE/J17S3" 70 N/A b i Issue #1 Resolution Child and Spousal Support Order entered in related support case. Issue #2 Resolution -8- Angela L. Evans vs. Jeffrey A. Evans DOM: 2/15/85 DOS (Physical): 1/29/04 Date Prepared: SECTION IL MARITAL ASSETS AND DEBTS The following Table #2 sets forth the listing of the marital assets and debts of the parties: TABt.E #2 MARITAL ASSETS AND DEBTS No. Description DIAN Gross Net value Proposed Proposed H% W% H Adjust W Adjusi RE-1 279 Alpat Drive 12.22.04 209,000 209,000 209,000 q.34 060 ( 0 125,40( Dillsburg, PA 17019 RE-1 Members 1" Mtg 1.15.054 (74,183) (74,183) (74,183) 44t . 060 0 (44,510' Update RE-1 Costs of Sale N/A N/A N/A N/A 0.40 0.60 0 0 RE-1 Net Equity 134,817 Comments: ,k 12.22,04 appraised value .$200,0004 r1 li *1,1;05,:m r% *Wh i r n h th 0 l t l ebalartce( o d.$g 18 , ' e e prev Dt ous s elewee o be s 0 a l e l pn0e ffers st tist priee of $209F000 MEN= V-1 H's 1998 Chevrolet 4.14.044 11,525 11,525 11,525 040 11.60 ! 0 6,915 K1500 pickup Comments: V-2 W's 2000 4.14.044 11,325 11,325 11,325 0,40 060 4,530 0 Chevrolet Blazer Comments. V•3 1996 Chrysler 4.14.044 Sold Sold Sold Sold 0.50 0.50 0 0 Concord equal equal equal equal divlsion divlsion divlsion divlsion Comments; V-4 H's Seville 21' 3.25.05 2,500 2,500 2,500 10.40 0.60 0 1,500 Cuddly Cabin boat Comments; As per Attorney Shade's 125.05 letter, Husbaand sold for $3,800; Husband's one-half interest was $1 900, Wife' , believes it was sold for $5:000 and husband's pm -half interest s $2,,5100. V-5 H's 1995 Palmer 3.25.05 200 200 200 OA 0.60 0 120 trailer Comments: As per Attorney Shad e's 3.25,05 tatter @1200' V-6 H's 1998 Yamaha 4.14.054 2,830 2,830 2,830 440 D60 0 1,698 Wolverine ATV ' - Comments: Husband's value is $1,500 -9- TABLE #2 MARITALAMETS AND: DEBTS No. Description DIAN Gross Net Value Proposed Proposed H % W% H Adjust W Adjus Value Husband Wife V-7 H's 2000 Polaris 3.25.05 1,000 1,000 1,00 b.40 Ho 0 600 Trail Boss ATV Comments: * 4.14.04 NADA ARV @ $1,9761 As per Attorney Shade's 3.25:05 letter, sold bey husband for $1,000 V-8 H's 1998 Yamaha 4.14 041 1,330 1,330 1,33, I t 0.A0 0.80 0 798 Badger ATV Comments: *4.14.04 NADAARV @ $t,33V As per Attorney Shade's 312&05'1e6r,1404andallem thi isttte paltiOAAUghfer'sANan& hould not be psrtbf:ED. V-9 H's (R an) 2000 3.25.05 700 700 700,40 060 0 420 Eton Youth 4-WLR I rnmmonfe- At nor A"mov ChaEro'a 2 9F nF: ia+tcM hueh;?nrt afa4e5a?cntrl fnr My'P.l1i sn nrN l,nenel s ,.ea.l AW W],. i,r D,- A-1 Joint Members Vt Savings #2634 1.31.04 Closed; Equal Closed; Equal Closed; Equal Closed; Equal 60 560 0 0 A-1 Joint Members Vt Checking #2634 1.31.04 Closed; Equal Closed; Equal Closed; Equal Closed, Equal 0,56 b.66 0 0 Comments: A-2 Joint PSECU savings #4097 1.31.041 513 513 513 0.40 060 0 308 A-2 Joint PSECU checking #4097 1.31.041 3 3 3 0.40 0.60 0 2 A-2 Net Equity 516 Comments: A-3 Wife's EDS CD Savings #02011 1.31.041 7,809 7,809 7,809 0.46 0460 3,124 0 Comments, Ins-1 H's Erie Life Policy 1.7.051 2,666 2,666 2,666 #1553 Comments: 0 1,600 R-1 H's Select Medical 1.31.041 79,371 79,371 79,371 I A.4o 1 060 ,I 0 I 47,623 401K Update - Comments: 3.31.04 $80,3441 Update marital valueto date of dlstrtbutiott R-2 W's Pershing R-0 1.30.041 8,151 8,151 8,151 0140 0.60 3,260 0, IRA #0557 Update Comments: 12.30.04 @ $8965.181 Update marital vatus to date of distribution; -10- TABLE #2 MARITALASSETSA WDEBTS No. I Description DIAN Gross Net Value Proposed Proposed H % W^/, H Adjust W Adjus Value Husband Wife R-3 W's EDS personal 1.31.041 7,391 7,391 7,391 0.40 0.60 2,956 0 pension plan Update - Comments: No post separation contributions. 11,31041 $7749,1 I lnelafo rrmari#al varnefn elafn nE!HlaiHil.rr4En : D-1 MBNA#1176 2.5.041 (234) (234) (234) 0.411 040 0 (140) >L Comments: { ., t ii{P ' ' CIE )I? "iE V ?ti{!ii { i?V K! HIM!" i!!I 34:5 E ii .. ,. s' v: I! I I VII `i .. IEVi ;E I ! (: 2 Total of Assets and Liabilities 279,736 245,0110 34,676 13,870 147,036 4 Adjustment payment due party from above (Line 2) 13,870 147,036 5 Less adjustment payment due other party from above (Line 2) (147,036) (13,870) 6 NET LINE ITEM ADJUSTMENTS (Subtract Lines 4-5) (133,166) 133,166 0 -o! MIA EU 11 T, 141 8 Totals from Above (Line 2) 279,736 245,060 34,676 9 Percentage of Total 87.60% 12.40% I'? `I' Iii EI!{ i .. rt { , i E„ 44t t _ i r i tE iL{.t{ j i Ylitit, t :..: .. ........ { .., ,,,:,:,P MA,. .. kt i3(a: 6: i i :.,=V* V L:...e a,.. 11 Totals from above (Line 2) 279,736 245,060 34,676 OOF 00 00, 12 Amount Due in 50/50 Division (Line 11 x %) 139,868 139,868 00'Z 00' 13 Adjustment Figure for 50/50 (Subtract Lines12-11) (105,192) 105,192 V, OVX/ Oft , 8 ?.... . , n:,i::,, 15 Totals from above (Line 2) 279,736 245,060 34,676 16 Amount Due in 45/55 Division (Line 15 x %) 125,881 153,855 17 Adjustment Figure for 45155 (Subtract Lines 16.15) (119.1791 119.179 - 11 - I THOLE #2 MARITAL ASSETS AND DIcBTS No. Description DIAN Gross Net Value Proposed Proposed H % W% H Adjust W Adjusl 19 Totals from above (Line 2) 279,736 245,060 34,676 20 Amount Due in 40/60 Division (Line 19 x %) 111,894 167,842 21 Adjustment Figure for 40160 (Subtract Lines20.19) (133,166) 133,166 23 Overall Adjustment for 50/50 (Line 13) (105,192) 105,192 24 Overall Adjustment for 40155 (Line 17) (119,1'19) 119,179 25 Overall Adjustment for 40160 (Line 21) (133,166) 133,166 / 28 H's Select Medical 401 K 79,371 79,371 29 W's Pershing Rollover IRA 8,865 8,865 30 W's EDS Personal Pension 7,391 7,391 31 Totals Retire Plans (Sum Lines 28-30) 95,627 79,371 16,256 33 Total Retirement Plans (Line 31) 95,627 79,371 16,256 34 Ret. Plan Distribution for 50/50 Division (Line 33 x %) 47,814 47,814 35 Ret. Plan Adjustment for 50150 (Subtract Lines 34-33) (31,556) 31,558 , 37 Total Retirement Plans (Line 31) 95,627 79,371 16,256 ZZA IZI 38 Ret. Plan Distribution for 45/55 Division (Line 37 x %) 43,032 52,595 39 Ret. Plan Adjustment for 45155 (Subtract Lines 38-37) (36,339) 36,339 ii'. 41 Total Retirement Plans (Line 31) 95,627 79,371 16,256 42 Ret. Plan Distribution for 40/60 (Line 41 x %) 38,251 57,376 43 Ret. Plan Adjustment for 40160 (Subtract Lines 42-41) (41,120) 41,120 45 Retirement Plan Adjustment for 50150 (Line 35) (31,558) 31,558 46 Retirement Plan Adjustment for 45/55 (Line 39) (36,339) 36,339 47 Retirement Plan Adjustment for 40/60 (Line 43) (41,1:0) 41,120 , -12- I TABLE #2 MARITAL ASSBTS AND DEBTS No. Description DIAN Gross Net Value Proposed Proposed H% W% H Adjust W Adjusl 49 1 SUMMARY FOR 50/50 DIVISION 50 Overall Adjustment for all Assets 50/50 (Line 23) (105,192) 105,192 51 Retirement Plan Adjustment 50150 (Line 45) (31,558) 31,558 ?e V 52 Non Ret. Plan Adjustment 50/50 (Subtract Lines 50.51) (73,635i) 73,635 53 SUMMARY FOR 45/551 DIVISION 54 Overall Adjustment for all Assets 45/55 (Line 24) (119,17.9) 119,179 55 Retirement Plan Adjustment 45155 (Line 46) (36,339) 36,339 OF OF 56 Non Ret.Plan Adjustment 45/55 (Subtract Lines 54.55) (82,840) 82,840 57 SUMMARY FOR 40/60 DIVISION 58 Overall Adjustment for all Assets 40/60 (Line 25) (133,166) 133,166 59 Retirement Plan Adjustment 40160 (Line 47) (41,120) 41,120 60 Non Ret.Plan Adjustment 40160 (Subtract Lines 58-59) (92,045) 92,045 -13- SECTION III. LISTING OF HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY The following Tables #3-A and # 3-B set forth the household goods and contents and other personal property of the partie NOTE: The parties' personal propertywas previously divided as per agreement of the parties and, therefore, Tables #; and #3-B have not been completed. TABLE #3-A HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY IN HUSBAND'S POSSESSION NO. DESCRIPTION OWNER POSSESSOR DATE VALUE BASIS FOR OF EXCLUSION IF VALUE NON- MARITAL I N/A H & W Husband Comments: TOTAL HUSBAND'S POSSESSION TABLE #3-B HOUSEHOLD GOODS AND CONTENTS AND OTHER PERSONAL PROPERTY IN WIFE'S POSSESSION NO. DESCRIPTION OWNER POSSESSOR DATE VALUE BASIS FOR OF EXCLUSION IF NON- VALUE MARITAL 1 N/A H & W Wife Comments: TOTAL WIFE'S POSSESSION 'Exclusions from marital property include property acquired before marriage, property acquired after separation, or property acquired during marriage by way of gift or inheritance from third party not a spouse. For gifts and inheritance also specify the source person. -14- SECTION IV. NON-MARITAL ASSETS .AND DEBTS The following Table #4 sets forth the non-marital assets and debts of the parties: z,' NOTE: There is no known non-marital property and, therefore, Table #4 has not been completed. TABLE #4 NON-MARITAL PROPERTY AND DEBTS NO. DESCRIPTION OWNER POSSESSOR DATE VALUE BASIS FOR OF EXCLUSION IF VALUE NON- MARITAL N/A Comments: 2Note: Exclusions from marital property include property acquired before marriage, property acquired after separation, or property acquired during marriage by way of gift or inheritance from third party not a spouse. For gifts and inheritance also specify the source person. 'The value of each item has been estimated by Plaintiff unless otherwise noted. -15- SECTION V., PENSIONS AND RETIREMENT BENEFITS The following Table #5 sets forth the listing of the pensions and retirement plans of the parties: TABLE #5 RETIREMENT PLANS NO DESG UIPTION DA7? 'iOP A? 1I 1?1 PG ?Cx if ACTS f# t M#WTtA?(iF - . - iMI 111 Itr tMOI I3LtTENTktF VAL. .. .. 1 Husband's Select 1.31.04 79,370.68 TBD 1.31.04 Statement Medical 401K -- Comments: 2 Wife's Pershing 1.30.04 8,150.94 TBD 1.30.04 Statement Rollover IRA -- Comments: 3 Wife's EDS 1.31.04 7,391.17 TBD 8.12 Internet Statement Personal Pension Plan Comments: -16- SECTION VI. INCOME AND EXPENSES Note: The following information was taken from Wife's Income and Expense Statement filed on 1/24/05. It is subject to update and revision at or prior to the hearing in this case. The following Table #6-A sets forth Wife's income: TABLE' #6-A INCOME OF WIFE At M!{I?jI ?, p? 3 ?{{ 1 1 {i F `5 ii' 11, 31 .W-, 9' ?j ? i ,i t ??', 4??, DESCRIPTION WIFE Gross Pay per Pay Period 905.10 MANDATORY DEDUCTIONS FICA (44.10) Medicare (10.35) Federal Tax (55.35) State Tax (21.90) Local Tax (8,85) Union Dues Mandatory Retirement (53.40) SUBTOTAL 711.15 -17- The following Table #6-B sets forth Wife's monthly expenses: TABLE #6-11 MONTHLY EXPENSES OF WIFE n++FFxA;xua HOME EXPENSES: A,g,;. Rent $650.00 First Mortgage Second Mortgage/Home Equity Loan Maintenance and Repairs Electric $92.00 Gas $10.00 Oil $55.00 Telephone $58.00 Water Sewer Trash $12.00 EMPLOYMENT Public Transportation Lunches $45.00 Other Employment Expenses TAXES: Real Estate Taxes Personal Property Taxes Income Taxes Not Withheld Per Capita/Occupation Taxes $1.00 INSURANCE: Homeowners Insurance $12.00 Automobile Insurance $57.00 Life Insurance $3.00 Accident Insurance Health Insurance -18- TABLE #6-B MONTHLY EXPENSES OF WIFE "'..''777777777 7771 AUTOMOBILE EXPENSES: Payments Fuel $120.00 Maintenance and Repair $25.00 License and Registration $4.00 MEDICAL EXPENSES NOT REIMBURSED BY INSURANCE: Doctor $20.00 Optical $10.00 Dental $5.00 Orthodontic Hospital Medicine $15.00 Special Needs/Therapy Etc. EDUCATIONAL EXPENSES: Private School Parochial School College/Vocational Religious Training or Education Books/Fees and Supplies Other Educational Expenses - school lunches/field trips/etc $15.00 PERSONAL EXPENSES: Clothing $100.00 Food $440.00 Barber and Hair Dresser $35.00 Memberships $15.00 Other Personal Expenses CREDIT CARDS AND LOANS: -19- TABLE #6-B MONTHLY EXPENSES OF WIFE MISCELLANEOUS EXPENSES: Household Help Child Care $300.00 Newspapers/Magazines/Books Entertainment $100.00 Pay TV $26.00 Vacations $250.00 Gifts $120.00 Legal Fees $225.00 Charitable Contributions Other Child Support (not this action) Other Spousal Support or Alimony (not this action) Courtney - dance $40.00 Courtney - flute $25.00 Courtney - soccer $15.00 Ryan - soccer & baseball $15.00 Cat - vet $5.00 TOTAL EXPENSES I $2,920.00 -20- SECTION VII. COUNSEL FEES The following Table #7 sets forth the listing of the counsel fees and expenses incurred by Wife if a claim has been made for counsel fees and costs: TABLE #7 COUNSEL FEES AND COSTS DFOCRIVI" SAND Dates Services Were Rendered 2/19/04 to Present (6/20/05) Hourly Rate $200.00 Costs At Cost Total Amount of Fees and Costs Claimed to 9745 6/20/05 Anticipated Fees and Costs $5000 Itemization of Services Rendered See itemized billing statement attached in Exhibit Section -21- SECTION VIII:. EXPERT WITNESSES The following Table #8 sets forth the listing of the experts who the party intends to call to testify in this case: TABLE #8 EXPERT WITNESSES NAME Stl'RT U J ftlklftl]EiA1iiCk}'8t StiA Experts who prepared any To be determined Report is attached if and If not currently available, report referenced in the to extent such report is Report to be supplied as Proposed Exhibits in Section referenced in Exhibit soon as available XI and X11. ** Section. "Additional experts who may be called to testify are not known at this time. Plaintiff reserves the right to call additional expert witnesses upon proper notification to the other party once those expert witnesses are identified and retained. -22- SECTION IX. OTHER WITNESSES The following Table #9 sets forth the listing of the anticipated witnesses other than experts who will be called to testify in this case: TABLE #9 LAY WITNESSES NAME SUBJECT OF TESTIMONY Angela L. Evans History of the marriage; Identification and valuation of marital assets and debts; Other relevant testimony relating to the factors set forth in the divorce code Realtors The Realtors who were involved in the possible sale of the parties' home will testify as to the fact that there were two offers about to be made at the listing price of $209,000 when husband removed the home from the market. "Additional witnesses who may be called to testify are not known at this time. Plaintiff reserves the right to call additional witnesses upon proper notification to the other party once those witnesses are identified and agree to testify. -23- SECTION XI. PROPOSED RESOLUTION The following is Plaintiffs proposed resolution of the issues presented in this case: A. DIVORCE: A No-fault Divorce Decree should be entered under either section 3301c or 3301d. B. EQUITABLE DISTRIBUTION: The parties' marital assets and debts should be divided and distributed 60% to Wife and 40% to Husband and in accordance with the schedule set forth in Section II of this Pre-Trial Statement. C. ALIMONY PENDENTE LITE: Wife's claim for Alimony Pendente Lite should be denied. Wife has been receiving spousal support during the period that APL is claimed. D. ALIMONY: Wife's claim for alimony should be granted. Wife should be awarded alimony in the amount equal to the spousal support order (currently $490.00 per month) for an indefinite period of time, modifiable based on a change in circumstances. E. COUNSEL FEES AND COSTS: Wife's claim for counsel fees and costs should be granted. Wife should be awarded counsel fees and costs in the amount of $9,000.00. Wife has done all of the financial leg work in this case. Husband has failed to cooperate thereby increasing Wife's counsel fees. -24- SECTION XII. PROPOSED EXHIBITS The following Table #11 sets forth Plaintiffs listing the proposed exhibits to be submitted at the hearing in this case. Exhibits are attached or to be supplied as indicated below.' TABLE #11 y^ LISTING OF EXHD31TS NOf IWUO A '. 1 n My[?D 1 Wife's Income and Expense Statement X X 2 Wife's Pay Stubs X X 3 Wife's 2004 Federal and State Income Tax Returns X 4 December 17, 2004 Support Order(s) and, if applicable, and subsequent support order. X X 5 Wife's Attorneys Fees Bill(s) X X 6 Proof of Insurance Costs upon Divorce X 7 Real Estate Appraisal X 8 Mortgage Balance Statement X 9 NADA Statements for the 1998 Chevy C 1500 X 10 NADA Statements for the 2000 Chevy Blazer X 11 NADA Statements for the 1998 Yamaha Wolverine X 12 NADA Statements for the 2000 Polaris ATV X 13 NADA Statements for the 1998 Yamaha Badger X 14 Joint PSECU #4097 statement X 15 Wife's EDS CD Savings #02011 statement X 16 H's Erie Life Policy #1553 statement X 17 H's Select Medical 401K statements X X 18 W's Pershing R-O IRA #0557 statements X X 19 W's EDS personal pension plan statements X X 20 H's 2003 Bonus check X 21 MBNA #1176 statement X 'Plaintiff reserves the right to submit additional exhibits upon proper notification to the other party. -25- CERTIFICATE OF SERVICE I, Diane G. Radcliff, Esquire, hereby certify that on June 30, 2005, I served a copy of the within Pre-Trial Statement, by mailing same by first class mail, postage prepaid, addressed as follows: Wayne F. Shade, Esquire 53 West Pomfret Carlisle, PA 17013 G. F, ESQUIRE Ymdl? Road Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: (717) 737-0100 Fax: ('717) 975-0697 Attorney for Plaintiff I, Robin Z. Shahan, hereby certify that on June 30, 2005_, I served a copy of the within Pre-Trial Statement, upon the Divorce Master by hand delivering a copy of this same to his office located at the following address: E. Robert Elicker, II Office of Divorce Master 9 North Hanover Street Carlisle, PA 17013 Z Ro n Z. Shah ecretary DIA lE G. RA LIFF, ESQUIRE 3448 Trindle Road Camp Hill PA 17011 Attorney {or Plaintiff -26- ANGELA L. EVANS, JEFFREY A. EVANS, Plaintiff V. Defendant IN THE COURT OF COMMON PLEAS i CUMBERLAND COUNTY, PENNSYLV/ NO. 04-1892 CIVIL ACTION - LAW IN DIVORCE INCOME AND EXPENSE STATEMENT OF ANGELA L. EVANS I verify that the facts set forth in the following Income and Expenses Form, includin attachments thereto, are true and correct to the best of my knowledge, information and be I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. relating to unsworn falsification to authorities. DATE: / /L7 . !> 1 t *-_tf / ?iLtECtn.?J ANGE L. EVANS, Plaintiff 1 G L ? Ti N v?? n a PLAINTIFF'S EXHIBIT a N 1 Q PART I. INCOME A. EMPLOYMENT INFORMATION: Employer: Mechanicsburg School District Position: I Aid Pay Period: Biweekly for 180 days per year. Figures below are annualized. B. INCOME: DESCRIPTION PAY DAY YEAR (180 days) MONTI Gross Income based on $60.34 per day for 180 days $60.34 $10,861.20 $90 FICA ($2.94) ($529.20) ($44 Medicare ($0.69) ($124.20) ($10 Federal Tax ($3.69) ($664.20) ($55 State Tax ($1.46) ($262.80) ($21 Local Tax ($0.59) ($106.20) ($8 Union Dues $0.00 $( Mandatory Retirement ($3.56) ($640.80) ($53 NET INCOME $47.41 $8,533.80 $711 -2- E. OTHER INCOME: DESCRIPTION WEEKLY MONTHLY YEAR Interest $0.00 $0.00 Dividends $0.00 $0.00 $ Pensions $0.00 $0.00 $ Annuities $0.00 $0.00 $ Social Security $0.00 $0.00 $ Rents $0.00 $0.00 $ Royalties $0.00 $0.00 $ Expense Account $0.00 $0.00 $ Gifts $0.00 $0.00 $ Unemployment Compensation $0.00 $0.00 $ Workman's Compensation $0.00 $0.00 $1 Income Tax Refunds $0.00 $0.00 $1 Support or Alimony Not this Case $0.00 $0.00 $( Commissions $0.00 $0.00 $( Tips $0.00 $0.00 $l $0.00 $0.00 $( TOTAL OTHER INCOME $0.00 $0.00 $C 2- PART II. ESTIMATED EXPENSES DESCRIPTION MONTHLY AMOUNT COMMENTS HOME EXPENSES: Rent $650.00 - First Mortgage Second Mortgage/Home Equity Loan Maintenance and Repairs Electric $92.00 Gas/maintenance/mowers $10.00 Oit/furnace $55.00 Telephone (home & cell) $58.00 Water Sewer Trash $12.00 EMPLOYMENT Public Transportation Lunches $45.00 Other Employment Expenses TAXES: Real Estate Taxes Personal Property Taxes Income Taxes Not Withheld Per Capita/ Occupation Taxes $1.00 -4- DESCRIPTION MONTHLY AMOUNT COMMENTS INSURANCE: Homeowners /Renters Insurance $12.00 Automobile Insurance $57.00 Life Insurance $3.00 Accident Insurance Health Insurance Otherlnsurance AUTOMOBILE EXPENSES: Payments Fuel $120.00 Maintenance and Repair $25.00 License and Registration $4.00 MEDICAL EXPENSES NOT REIMBURSED BY INSURANCE: Doctor $20.00 Optical $10.00 Dental $5.00 Orthodontic None currently; however, Courtney will be needing braces in the next year. Hospital Medicine $15.00 Special Needs/Therapy Etc. - 5 - DESCRIPTION MONTHLY AMOUNT COMMENTS EDUCATIONAL EXPENSES: Private School Parochial School College/Vocational Religious Training or Education Books/Fees and Supplies Other Educational Expenses $15.00 School lunches, field trip project/report/supplies PERSONAL EXPENSES: Clothing $100.00 Food $430.00 Barber and Hair Dresser $35.00 Memberships Other Personal Expenses $15.00 CREDIT CARDS AND LOANS: MISCELLANEOUS EXPENSES: Household Help Child Care $300.00 Newspapers /Magazines/ Books Entertainment $100.00 Pay TV $26.00 6- DESCRIPTION MONTHLY AMOUNT COMMENTS Vacations $250.00 This is for summer when will not receive work pay Gifts $120.00 Kids' birthday parties an( -christmas gifts- Legal Fees $225.00 $15 per day for 180 days I year= $2,700.00/yr or $225.00/mo Charitable Contributions Other Child Support (not this action) Other Spousal Support or Alimony (not this action) Courtney - dance $40.00 Dance 8 recital costume; dance shoes, tap 8 jazz Courtney - flute $25.00 Courtney - soccer $15.00 Ryan - soccer & baseball $15.00 Cleats, balls, clothing Cat - vet $5.00 TOTAL EXPENSES $2,910.00 -7- PART 111. PROPERTY OWNED PROPERTY OWNED OWNERSHIP TYPE DESCRIPTION VALUE H W Checking Varies TBD X Savings Credit Union Stocks/bonds Real Estate Marital Home See Inventory Other Retirement Plans Et Other See Inventory x X TOTAL 0.00 PART IV. INSURANCE INSURANCE INFORMATION COVERAGE TYPE COMPANY POLICY NO. H W Hospital (through wife) Capital Blue Cross YWP18350651400 Medical (through wife) Capital Blue Cross YWP18350651400 .? Hospital (through Husband) Blue Shield SBR102728440001 Medical (through Husband) Blue Shield SBR102728440001 d Health Accident Disability Income Dental (through Wife) Delta Dental 1225 f Dental (through Husband) Delta USA 2217-0001 178584097 Vision Highmark BlueShield ZAX110606226001 Other-Specify Prescription - Capital Blue Cross ME183506514 f *H=Husband; W=Wife; J=Joint; C=Child 8- PART V. SUPPLEMENTAL INCOME STATEMENT [ d ] CHECK HERE IF NOT APPLICABLE (a) This form is to be filled out by a person: (1) Who operates a business or practices a profession, or (2) Who is a member of a partnership or joint venture, or (3) Who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership; venture, business, profession, corporation or similar entity (check block to indicate the doct is attached): (1) The most recent Federal Income Tax Return. [ ] attached (2) The most recent Profit and Loss Statement. [ ] attached (c) Name of Business: Business Address: Business Telephone: (d) Nature of Business (check one) [ ] 1. Sole Proprietorship [] 2. Partnership [ ] 3. Joint Venture [ ] 4. Professional [ ] 5. Corporation [ ] 6. Other (e) Name of accountant, controller or other person in charge of financial records: (f) Bu! 1. 2. 3. 4. 5. iness Income: Annual income from business: How often is income received Gross income per pay period: Net income per pay period: Specify deductions, if any: --'CHANICSBURG AREA SD - 500 SOUTt, .,ROAD STREET - MECHANICSBGRG, Employee Name Check Date C EVANS, ANGELA L 12/10/2004 Reg Hrs OT Hrs Days Other Marital Exempts Tot Salary Tot Hourly To to 49.00 0.00 0.00 0.00 Single 0 0.00 422.38 Gross Pay Federal Tax Soc Sec Tax: Medicare Tax State Tax Unem Pay 422.38 29.76 26.19 6.12 12.97 YTD 3,685.05 309.35 228.47 53.43 113.12 Net Pay Local Tax Retirement Advanced EIC OPT Deduc Pay 310.00 5.28 31.68 0 .00 0. 00 YTD 46.06 276.39 0 .00 0. 00 -Deposit_In£ormation._:.I. MEMBERS 1ST FEDERAL CREDIT UNI -Savings- - 310,00 Voluntary Deductions I Wage Detail Reg. 49.00 ur tcrr Kate •rype 0.00 8.62 HOUR Ywsence Balances as of 11/26/2004 FISS PSSS SISS 1. 875 D 2. 875 D 6. 000 D MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA. 17055 22 Direct Deposit Receipt D0004071 Pay Date 12/10/2009 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 r.c CHANICSBURG AREA SD - 500 SOUTH .,ROAD STREET - MECHANICSBURG, I Employee' Name Check Date -7D EVANS, ANGELA L 12/24/2004 Reg Hrs OT.. Hrs -Days rOther Marital" Exempts Tot Salary Tot Hourly Tota] 63.00 0.00 0.00 0.00 Sinale 0 0-on Sa'4 nF -Gross Pay Federal- Tax 'Soc Sec Tax ' Medicare Tax State 'Tax Unemr Pay YTD 543.06 4,228.11 46 355 .50 .85 33.67 262.14 7.87 61.30 16. 129. 67 79 `:. Net Pay Local Tax- :Retirement Advanced EIC OPT -' Deduc Pay YTD 390.34 6 52 .79 .85 40.73 317.12 0.00 0.00 0. 0. 00 00 Direot-'De osit=Zri£arm P a-tori=- [IEMBER3-i°T-E'EBERAL-- ER£B F4?N?-9avirrgs -X90-.?M--- Happy Holidays!!!! Voluntary Deductions .1 - 11 1 Wage Detail ` ? ? x . - Reg. OT Fctr Rate Type 63.00 0.00 8.62 HOUR MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 Direct Deposit Receipt D0004517 SPay ,Date ,v.a.. 12/24/2009 22 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 .,a CHANICSBURG AREA SD - 500 SOUTH aROAD STREET - MECHANICSBURG, F Employee Name Check Date D( EVANS, ANGELA L 01/07/2005 Reg Hrs OT Hrs Days Other Marital Exempts Tot Salary Tot Hourly Total 56.00 0.00 0.00 0.00 Single 0 0.00 482.72 Gross Pay Federal 'Tax Scc"Sec Tax Medicare Tax State Tax Unemp pay YTD 482.72 37.93 482.72 37.93 Net Pay Local Tax 29.93 29.93 Retirement 7. 7. Advanced 00 00 EIC 14.62 14.82 OPT Deduct pay YTD 350.38 6.03 6.03 36.20 36.20 0. 0. 00 00 0.00 0.00 _MEMBERS-I'ST'FEDERAL CREDIT-"UNI"-- Savings - ` '350.28 I Voluntarv Deductions Wage Detail Reg. OT £ctr Rate Type 56.D0 0.00 8. 62 HOUR Absence `Balances as of .12/24/2004 r `SG, FISS PSSS SISS 1.875D 2.500 D 6.000 D MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 Direct Deposit Receipt D0004960 Pay Date 01/07/2005 22 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 DELTA DENTAU Ddla mental n[ Pway.lvania Subscriber I.D. Card Group Number 1225 Employ,,Nance An. e a L. Evans Eniploy,e S.S# _. (This card '01 inCorniauuu only - 11 is nul a guuranlc, of Ibb peil!'I ILS.I nm RIP 7y - www.c xpress-scripismom Rx EIN 003858 -_. RxPCN A4 .. _- ?. RxGrp 8C2A - Issuer ID ME783506514 1 Name ANGELA EVANS i Blue Shield" n , [P .'01 ANGELA EVANS : mu SBR102728440001 -- L g 1 ?? gl cam OV 430 ER $50 v, t ;zt - I Blue Shield Plan 37 8 , .91 --mrd m Capital B1ueCross pREAUTHORIZATION swIl ;?; Capital B1ueCross PPn e PPO MECHANICSBURG AREA SCHOOL DISTRICT ANGELA L EVANS YWP18350651400 05001380000 361 pe P 113 Plen Idel,Nflcellon Number CUSTOMER SERVICE 1-866-802-4711 OV420 ER450 P, DELTAU )f ..J GROUP NO. SUBSCRI 2217-0001 JEFF EVANS 14 n Blue Shield" PPO , raed IGH"K. c, BLUE SHIELD v. Y"/tiMlb?Iw6? Gr ti?SMYY?. t. HANICSBURG AREA SD - 500 SOUTH OAD STREET - MECHANICSBURG, Pi EVANS, ANGELA L 49.00 0.00 Pay 422.38 YTD 6,667.57 Pay 310.20 YTD 0.00 Single 0 0.00 422.38 29.56 26.19 6.12 12 .97 552.38 413.39 96.65 204 .68 5.28 31.66 0.00 0 .00 83.34 500.08 0.00 10 .00 MEMBERS 1ST FEDERAL CREDIT UNI Savings 310.20 Reg. OT Fctr Rate Type 49.00 0.00 8.62 HOUR FISS f PSSS SISS 1.875 D 0. 625 D 2.750 D MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 22 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 Direct Deposit Receipt D0010488 06/24/2005 PLAINTIFF' w EXHIBIT J r J MECHANICSBURG AREA SD - 500 SOUTH .,rfOAD STREET - MECHANICSBURG, PJ 'a ? a?gl1'e' QPlame. _ Cf?a?ka?? DO EVANS, ANGELAL 01/07/2005 Reg #F7jjr0 jubM a r,e Tai a? it ? Tou: d _4 k 1o a' 56.00 0.00 0.00 0.00 Single 0 0.00 482.72 Pay 482.72 37.93 29.93 7.00 14.82 YTD 482.72 37.93 29.93 7.00 14.82 Nek - ca e,..: ?emene Vane . .r . _P , e uct Pay 350.38 6.03 36.20 0.00 0.00 YTD 6.03 36.20 0.00 0.00 a as, on MEMBERS 1ST FEDERAL CREDIT UNI Savings 350.38 Reg. OT Fctr Rate Type 56.00 0.00 8.62 HOUR FISS PSSS SISS 1. 875 D 2. 500 D 6. 000 D MECHANICSBURG AREA SO 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 Direct Deposit Receipt D0004960 01/07/2005 22 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 M, 1NICSBURG AREA SD - 500 SOUTH B D STREET - MECHANICSBURG, PA D00( EVANS, ANGELA L 12/24/2004 63.00 0.00 0.00 0.00 Single 0 0.00 543.06 54 Pay 543.06 46.50 33.67 7.87 16.67 0 YTD 4,228.11 355.85 262.14 61.30 129.79 3 Pay NO 1 390.34 01191131101 6.79 =1=1 Iffill 40.73 iffim 0.00 0.00 0 MEMBERS 1ST FEDERAL CREDIT UNI Savings 390.34 **** Happy Holidays!!!! **** Reg. OT Fctr Rate Type 63.00 0.00 8.62 HOUR MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 22 Direct Deposit Receipt D0004517 12/29/2009 ANGELA L EVANS -----------162-C'HSTNUT-GROVE--R0AD DILLSBURG PA 17019 M: ANICSBURG AREA SD - 500 SOUTH P 'D STREET - MECHANICS UB RG, PA WIN D00( EVANS, ANGELA L 12/10/2004 49.00 0.00 0.00 0.00 Single 0 0.00 422.38 42 Pay 422.38 29.76 26.19 6.12 12.97 0 YTD 3,685.05 309.35 228.47 53.43 113.12 3 Pay Mills 1111111111 310 00 5.28 31.68 0.00 - 0.00 dbwmm I 0 . ova IQ n no n.nn 0 MEMBERS 1ST FEDERAL CREDIT UNI Savings 310.00 Reg. OT. Fctr Rate Type 49.00 0.00 8.62 HOUR FISS I PSSS SISS 1.875D 2.875D 6.000 - Ii /aIto /o MECHANICSBURG AREA SD 500 SOUTH BROAD STREET MECHANICSBURG, PA 17055 22 Direct Deposit Receipt D0004071 12/10/2004 ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 183506514 Department of the Treasury .. iternal Revenue Service Form 1040 U.S. Individual Income Tax Re IRS Label (See A B Your first name and initial ANGELA Last name EVANS Your social security number 6514 instructions on page 16.) E If ajoint return, sp. first name & initial Last name Spouse's social security number L Use the IRS label. H Home address (number and street). If you have a P.O. box, see page 16. Apt. nc. ! Important! S Otherwise, E 162 CHESTNUT GROVE ROAD You must enter please print E City, town or post office. slate, and ZIP code. If you have a foreign address, see page 16. your SSN(s) above. or type. DILLSBURG PA 17019 Presidential Election Campaign Note. Checking "Yes" will not change your lax or reduce your refund. You Spouse 1 _ - /SPP nRnP 1R t r)n vnu nr vnnr snnimp if filinn n inint return want S3 to nn to this Rind2 I II 1?I F ] F ? Yes Ih No Yes 1 No 1 Single iu 4uvl bu your 4 LAJ the qualifying person n is is a child bu not ot your ependent, enter Filing Status H 2 Married fling jointly (even if only one had income) this child's name here. ? COURTNEY E VANS Check only 3 Married fling separately. Enter spouse's SSN above 5 [] Qualifying widow(er) with dependent child. (See page 17.) One box. and full name here. 6a X Yourself. If someone can claim you as a dependent, do not check box 6a Boxes checked Y ...... ........ ..... on 6a and 6b Exemptions b Spouse No. of children Dependents: ' O 3 Dependent's on who; (4) CL if lived with child ow qual (2) Dependent s relationship to . for child you - (see 0 did not live with tax or 1 First name Last name social security number you .. . 18 you due to divorce or separation (seepage 18) _ If more than four Dependents on 6 t dependents, see c no en, tered above - page 18. Atltl numbers 7 Wages, salaries, tips, etc. Attach Form(s) W-2 7 3,911 Income 8a ........ .. Taxable interest. Attach Schedule B if required . . . . . ........ ... ...... ......... ..... ....................... . . .. . ......... Be 6! Attach Form(s) b Tax-exempt interest. Do not include on line 8a LBb W-2 here. Also 9a Ordinary dividends. Attach Schedule B if required 9a attach Forms b ..... . Qualified dividends (see page 20) ..... .. ............ I 9b ...... W-2G and _ 1099-R If tax 10 Taxable refunds, credits, or offsets of state and local income taxes (see cage 20) 10 was withheld. 11 Alimony received , , , , ...... 11 3 4 8 ............... . . . . . ............ .................... 12 Business income or (loss). Attach Schedule C or C-EZ ,,,,,,,, _,.,. 12 If you did not et a W-2 13 ,,,,,,,,, Capital gain or (loss). Attach Schedule D if required. If not required, check herd . . ... . . . .. LJ . 13 g , see page 19. 14 Other gains or (losses). Attach Form 4797 ... 14 ..... . . . ....... 15a IRA distributions 15, b -Taxable amount (see page 22) 15b 16a Pensions and annuities 16a b -Taxable amount (see page 22) 161p Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, e tc. Attach Schedule E 17 not attach, any 18 Farm income or (loss). Attach Schedule F 18 payment. Also, lease use 19 ...................... Unemployment compensation ..... ....... ..... 19 p .... ..................... ................... ....,.... Form 1040-V. 20a Social security benefits 120a b Taxable amount (see page 24) 20b 21 Other income. List type and amt. (see page 24) 21 22 Add the amounts in the far right column for lines 7lhrou h 21. This is our total income .. ? 22 7,45S 23 Educator expenses (see page 26) ............................ .. 23 Adjusted 24 Certain business expenses of reservists, performing artists, and 24 G fee-basis government officials. Attach Form 2106 or 2106-EZ ........... . ross 25 IRA deduction (see page 26) ,, ,,,,,,,,,, , 25 Income 26 Student loan interest deduction (see page 28) .................. 26 .. 27 Tuition and fees deduction (see page 29) 27 28 Health savings account deduction. Attach Form 8889 28 29 Moving expenses. Attach Form 3903 29 30 One-half of self-employment tax. Attach Schedule BE 30 31 Self-employed health insurance deduction (see page 30) 31 32 Self-employed SEP, SIMPLE, and qualified plans 32 33 Penalty on early withdrawal of savings 33 34a Alimony paid b Recipient's SSN? :34a 35 Add lines 23 through 34a PLAINTIFF'S 36 Subtract line 35 from line 22. This Is your adjusted gross Income w EXHIBIT m 7 45! For Disclosure, Privac DAA y Act, and Paperwork Reduction Act Notice, see page 75. S m 1040 (zoc N J 183506514 Form 1040 (2004) ANGELA EVANS I ` W Tax and 37 Amount from line 36 (adjusted gross income) , 37 Credits 38a Check You were born before January 2, 1940, Blind. B _ Total boxes Blind. J if: B Spouse was born before January 2, 1940, checked ? 38a b If your spouse itemizes on a separate return or you were a dual-status alien, see page 31 ? 38b Standard and check here ,........ Deduction 39 Itemized deductions (from Schedule A) or your standard deduction (see left margin) .. .... .... 39 for- 40 Subtract line 39 from line 37 ' 40 People who 41 the t n Pa e'er of exemptions bl l dh If line 37 is $107,025 or less, multiply $3 100 41 checked any o g . . . . . . .. ........... ine 6d. If line 37 is over $107,025, see tfte wo worksheeet on page 33 . . . . . . . . . . the worksheet ....... box on line 38a or 38b or 42 Taxable income. Subtract line 41 from line 40. If line 41 is more than line. 40, enter -0- - .. . . . . . 42 who can be 43 Tax (see page 33). Check if any tax is from: a [] Farm(s) 8814 .. claimed as a dependent, . .................. .. .. b ? Form 4972 ....... 43 see page 31. 44 . ., .. .... . ......... ...... ..... .. ......... Alternative minimum tax (see page 35). Attach Form 6251 All others: ? 45 Single or 45 Add lines 43 and 44 ................................... ...... .. . ........ .. ... 77-77 Married filing 46 Foreign tax credit. Attach Form 1116 if required 46 separately, $4,850 47 Credit for child and dependent care expenses. Attach Form 2441 .. 47 Married filing 48 Credit for the elderly or the disabled. Attach Schedule R 48 ' jointly or Qualifying 49 Education credits. Attach Form 8863 49 widow(er), widow( 50 Retirement savings contributions credit. Attach Form 6880 50 51 Child tax credit (see page 37) 51 Head of household 52 Adoption credit. Attach Form 8839 ... .... ........ 52 , $7,150 53 Credits from: a ? Form 8396 b Form 8859 53 54 Other credits. Check applicable box(es): a Form 3800 '? ' b [] Form 8801 c E] Specify 54 . 55 Add lines 46 through 54. These are your total credits 55 56 .................... Subtract line 55 from line 45. If line 55 is more than line 45, enter-0- ? .... 56 57 Self-employment tax. Attach Schedule SE 57 Other 58 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137, 58 Taxes 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59 60 Advance earned income credit payments from Form(s) W-2 60 61 Household employment taxes. Attach Schedule H .. ... 61 62 Add lines 56 - 61. This is our total tax ............ ................ .... ? 62 63 Federal income tax withheld from Forms W-2 and 1099 63 356 Pa ments 64 2004 estimated tax payments and amount applied from 2003 return 64 If you have a 65a Earned Income credit (EIC) 65a 1 570 qualifying b Nontaxable combat pay election ? child, attach 66 Excess social security and tier 1 RRTA tax withheld (see page 54).. 66 Schedule EIC. 67 Additional child lax credit. Attach Form 8812 ...................... 67 >'. 68 Amount paid with request for extension to file (see page 54) : 68 ' 69 Oolhner pymt. is F] Farm 2439 b 11 Form 4136 c 11 Form 8885 fr. 69 70 Add Ins. 63, 64, 65a, 8 66 - 69. These are your total payments , , .. ... ? 70 Refund 71 If line 70 is more than line 62, subtract line 62 from line 70. This is the amount you overpaid ... 71 Direct deposit? 72a Amount of line 71 you want refunded to you. ? 72E See page 54 ? b Routing number ? c Type: Checking Savings and fill in 72b, ? d Account number 72c, and 72d. 73 Amount of line 71 you want applied to your 2005 estimated tax ? 1 73 Amount 74 Amount you owe. Subtract line 70 from line 62. For details on how to pay, see page 55 . ? 74 Yni t nwa 75 Estimated tax penalty (see pace 55) 1 75 1 .. 1.92E Third Party Do you want to allow another person to discuss this return with the IRS (see page 56)? U Yes. Complete the following LX] No ? Designee Desi Personal Identification number (PIN) ? Phone no. ? Under enallies of perlury , I tledare that have examined this return and accompanying schedules and statements, and to the best of my knowledge and Sign belief, y are true, correct, and complet Declaration of prepare, (other than taxpayer) i:. based on all information of which preparer has any knowledge Here Yo sigi`ature Date Your occupation Daytime phone number Joint return? t See page 17. ss// f 5?/'6u HOMEMAFMR Keep 8 -copy Spouse's sig eture. If a joint return , both must sign. Date Spouse's occupation Paid Prep star's Da[e Check if Preparer's SSN or PTIN Preparer'ssigr;ture 4/27/05 self-employed P00224291 Use Only Firm sname(or Howard's Accounting EIN 23-227013. yours if self-employed), 8 west. Big Spring Ave. Phone no. address, and ZIP code NewPille PA 17241 717-776-5864 DAA Form 1040 (2004 6514 459 1636065110. 0 A 0X Department of the Treasury-Internal Revenue Servi• Form II Y AA I Atflended U.S. Individual Income Tax rceturn OMB No, 1545-0091 This return is for calendar year ? 2004 . or fiscal vear ended lll? P Your first name and initial Last name Your social security number I ANGELA EVANS 6514 e o a r If a joint return, spouse's first name and initial Last name Spouse's social security number s e t y p Home address (no, and street) or P.O. box if mail is not delivered to your home Apt. no. Phone number e 162 CHESTNUT GROVE ROAD 717-432-4612 a City, town or post office, stale, and ZIP code. If you have a foreign address, see page 2 of the instructions. For Paperwork Reduction Act t DILLSBURG PA 17019 Notice, see page 6. A If the name or address shown above is different from that shown on the original return, check here . . . . . .... . . ............ ...... ... .... P. LJ e Has the original return been changed or audited by the IRS or have you been notified that it will be? .... ......................... ... ? Yes ? No C Filing status. Be sure to complete this line. Note. You cannot change from joint to separate rewrns after the due date. On original return 8 Single e Married fling jointly 8 Married fling separately 8 Head of household B Qualifying widow(er) On this return Ili Single Married filing jointly Married fling separately X Head of householtl' Qualifying widow(er) " If the aualifvino person is a child but not your deoendent, see oaoe 2. Use Part 11 on the back to explain any changes A. Original amount or B. Net change- amount of increase C. Correct as previously adjusted or (decrease)- amount Income and Deductions (see pages 2-6) (see page 3) explain in Part II 1 Adjusted gross income (see page 3) 1 7 460 -1 9 7,45 2 Itemized deductions or standard deduction (see page 3) 2 42,850- 2 300 7 15C 3 Subtract line 2 from line 1 3 2 610 -2 301 309 4 Exemptions. If changing, fill in Parts I and II on the back 4 3 100 3 10C 5 Taxable income. Subtract line 4 from line 3 5 0 T 6 Tax (see pg. 4). Method used in col. C Tables 6 0 L 7 Credits (see page 4) 7 ............................... a 8 Subtract line 7 from line 6. Enter the result but not less to than zero - 8 0 C I 9 Other taxes (see page 4) 9 t 10 Total tax. Add lines 6 and 9 10 0 11 Federal income tax withheld and excess social security and tier 1 RRTA lax withheld. If changing, see page 4 11 356 35E P 12 Estimated tax payments, including amount applied from prior a year's return 12 y m 13 Earned income credit(EIC) 13 1 570 1 57C a 14 ............................... Additional child tax credit from Form 8812 14 n t 15 .................. Credits from Form 2439, Form 4136, or Form 6885 15 s 16 Amount paid with request for extension of time to file (see page 5) 16 17 Amount of tax paid with original return plus additional tax paid after it was filed .. ... 17 18 . Total payments. Add lines 11 through 17 in column C , , ... 18 1 92 E Refund or Amount You Owe 19 Overpayment, if any, as shown on original return or as previously adjusted by the IRS 19 35f 20 Subtract line 19 from line 18 (see page 5) .... 20 1 57C 21 Amount you owe. If line 10, column C, is more than line 20, enter the difference and seepage 5 21 22 If line 10, column C, is less than line 20, enter the difference 22 1 57C 23 Amount of line 22 you want refunded to you .............. 23 1 57C 24 Amou ............................................... nt of line 22 you want applied to our estimated tax 24 ..... Sign Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules Here and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than Joint retu See page rn? 2 taxpayer) is based on all inform ofwch the preparer has any knowledge. . Keep a copy for , r ?s ?a 1 our records. your si n tune Date S Ouse's si nature. If a'oint return, both must sign, Data Date Preparer's SSN or PTIN Paid Preparer's ' Check if P ' s ignature 4/27/05 self-em to ad P00224291 reparer s 1 U O l Firm'sname(or Howar s Accounting FIN 23-227013: se n y yours if self-employed), 8 west Big Spring Ave. Phone no. address, and ZIP code Newville PA 17241 717-776-5864 DAA Form 1040X (Rev. 11-200 183506514 ANGELA EVANS Form 1040X (Rev. 11-2004) 6514 Page 2 . Exemptions. See Form 1040 or 1040A instructions. A .Art 1 A. Original ..., . number of C. Correct If you are not changing your exemptions, do not complete this part. exemptions B. Net change number of If claiming more exemptions, complete lines 25-31. reported or as exemptions If claiming fewer exemptions, complete lines 25-30. previously adjusted 25 Yourself and spouse 25 1 1 ,,,.,,,,.,, Caution. If someone can claim you as a dependent, you cannot claim an exemption for yourself. I-X ........... ,,. 26 Your dependent children who lived with you 26 27 Your dependent children who did not live with you due to divorce or separation 27 .... ............................ 28 Other dependents 28 ........................................... 29 Total number of exemptions. Add lines 25 through 213 29 1 1 30 Multiply the number of exemptions claimed on line 29 by the amount listed below for the tax year you are amending. Enter the result here and on line 4 But see the Instructions for Tax Exemption line 4 on page 3 If the year amount amount on line 1 is over: 2004 $3,100 $107,025 2003 3,050 104,625 2002 3,000 103,000 2001 2,900 99,725 _ 30 3 100 3,100 31 Dependents (children and other) not claimed on original (or adjusted) return: NNrlo.3 of hilldren ' ' (d) Check if qualifying 0 lived with s social (b) Dependent (c) Dependent s child for child tax you ......... (a) First name Last name security number relationship to you credit see page 5 did not live with you due to divorce or separation (see page 5) ...... Dependents on 31 not entered above Part,l,., Explanation of Changes to Income, Deductions, and Credits Enterthe line number from the front of the form for each Item you are changing and give the reason for each change. Attach only the supporting forms and schedules for the Items changed. If you do not attach the required Information, your Form 1040X may be returned. Be sure to include your name and social security number on any attachments. If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form P.6 tltl,. Presidential Election Campaign Fund. Checking below will not increase our tax or reduce our refund. If you did not previously want $3 to go to the fund but now want to, check here ........ , . , . I. Form 9 U4UA (Rev. 11-200 DAA 183506514 SCHEDULE EIC E. .led Income Credit ,,40A OMB No. 1545-0074 (Form 1040A or 1040) Qualifying Child Information 1040 EIC 2004 Department of the Treasury Complete and attach to Form 1040A or 1040 Attachment Internal Revenue Service only if you have a qualifying child. Sequence No. 43 Name(s) shown on return Your social security number ANGELA EVANS 514 Before you begin; Seethe instructions for Form 1040A, lines 41 a and 41b, or Form 1040, lines 65a and 65b, to make sure that (a) you can take the EIC and (b) you have a qualifyinq child. • If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See back of schedule for details. i • It will take us longer to process your return and issue your refund if you do not fill in all lines that apply CAUT1.014; for each qualifying child. • Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child's social security card is not correct, call the Social Security Administration at 1-800-772-1213. Qualifying Child Information Child 1 Child 2 1 Child's name First name Last name First name Last name If you have more than two qualifying children, you only have to list two to et the maximum credit. COURTNEY EVANS RYAN EVANS 2 Child's SSN The child must have an SSN as defined on page 42 of the Form 1040A instructions or page 44 of the Form 1040 instructions unless the child was born an died in 2004. If your child was born and died in 2004 and did not have an SSN, enter "Died" on this line and attach a cop of the child's birth certificate. 4 8 97 Anno? 4 77 3 Child's year of birth 1993 1998 vear vear If born after 1985, skip lines 4a If born after 1985, skip lines 4a and 41b; go to line 5 . and 4b; go to line 5. 4 If the child was born before 1986- a Was the child under age 24 at the end ? Yes. ? No. Yes. No. of 2004 and a student? Go to line S. Continue Go to line 5. Continue b Was the child permanently and totally ? Yes. ? No. ? Yes. 11 No. disabled during any part of 2004? Continue The child is not a Continue The child is not a qualifying child, qualifying child. 5 Child's relationship to you (for example, son, daughter, grandchild, niece, nephew, foster child, etc. Daug hter Son 6 Number of months child lived with you in the United States during 2004 • If the child lived with you for more than half of 2004 but less than 7 months, enter "71" • If the child was born or died in 2004 and your 12 months 12 months home was the child's home for the entire time he or Do not enter more than 12 months. Do not enter more than 12 months. she was alive during 2004, enter "12." You may also be able to take the additional child tax credit if your child (a) was underage 17 at the end of 2004, (b) is '. TIP claimed as your dependent on line 6c of Form 1040A or Form 1040, and (c) is a U.S. citizen or resident alien. For more details, see the instructions for line 42 of Form 1040A or line 67 of Form 1040. For Paperwork Reduction Act Notice, see Form 1040A Schedule Etc (Form 1040A or 1040) 20( or 1040 instructions. DAA A 1 Schedule EIC Worksheet 1 EVANS Worksheet 1. Investment Income Dividends t Enter any amount from Form 1040, line Be ....................................................................... 1. 2. Enter any amount from Form 1040, line 8b plus any amount on Form 8814, line tb .. ... ............................ 2. 3. Enter any amount from Form 1040, line 9a ....................................................................... 3. 4. Enter the amount from Form 1040, line 21, that is from Form 8814 if you are fling that form to report your child's interest and dividend income on your return. 4. Capital Gain Net Income 5. Enter the amount from Form 1040, line 13. If the amount on that line is a loss, enter zero . ...................................................................... 5. 6. Enter any gain from Form 4797, Sales of Business Property, line 7. If the amount on that line is a loss, enter zero. (But, if you completed lines 8 and 9 of Form 4797, enter the amount from line 9 instead.) ..................... 6. 7. Subtract line 6 of this worksheet from line 5 of this worksheet. (If the result is less than zero, enter zero.) ............................. _ ..................................................... Rovalties and Rental Income from Personal Prope 8. Enter any royalty income from Schedule E, line 4, plus any income from the rental of personal property shown on Form 1040, line 21. ............................. 8. 9. Enter any expenses from Schedule E, line 21, related to royalty income, plus any expenses from the rental of personal property deducted on Form 1040, line 35...... ... 9. 10. Subtract the amount on line 9 of this worksheet from the amount on line 8. (If the result is less than zero, enter zero.) ......................................................................... Passive Activities 11. Enter the total net income from passive activities ................... ...................... .................. 11 12. Add the amounts on lines 1, 2, 3, 4, 7, 10 and 11. Enter the total. This is your Investment Income ....................................................................... 12 Worksheet 2. Earned Income 1. Enter the amount from line 7 (Form 1040 or Form 1040A) or line 1 (Form 1040EZ)........ 2. If you received a taxable scholarship or fellowship grant that was not reported to you on a form W-2 but was included in the total on line 7 (Form 1040 or Form 1040A) or line 1 (Form 1040EZ), enter the amount. 2 3. Clergy. If you are a member of the clergy who files Schedule SE and the amount on line 2 of that schedule includes an amount that was also reported on line 7 (Form 1040), enter that amount ............................................... 3. 4. Church employees. If you received wages as a church employee (as defined on page 20), enter any amount you included on both line 5a of Schedule SE and line 7 (Form 1040) ............................................................ 4. 5. If you received a pension or annuity from a nonqualifed deferred compensation plan or a section 457 plan and it was included in the total on line 7 (Form 1040 or Form 1040A) or line 1 (Form 1040EZ), enter the amount. (This amount may be reported in box 11 of your Form W-2. If you received such an amount but box 11 is blank, contact your employer for the amount of the pension or annuity.) 5. 65 1 3,911 6. Add the amounts on lines 2, 3, 4 and 5 of this worksheet. 6. Taxpayer Identification Number 14 7. 7. Subtract line 6 of this worksheet from line 1. This is your Earned Income. 7 3 , 911 ,40 Schedule EIC Worksheet;2 Taxpayer Identification Number EVANS Earned Income Credit Worksheet B Self-Employed, Clergy and People with Church Employee Income Filing Schedule SE a. Enter the amount from Schedule SE, Section A, line 3, or Section B, line 3, whichever applies. 1a. b. Enter any amount from Schedule SE, Section B, line 4b and line 5a 1 b. c. Add lines 1a and 1b. .......................................................... 1c. d. Enter the amount from Schedule SE, Section A, line 6, or Section B, line 13, whichever applies. .. . .......... 1d. e. Subtract line 1d from line 1c. Is. 2. Self-Employed NOT Filing Schedule SE Do not include on these lines any statutory employee income or any amount exempt from self-employment tax as the result of the fling and approval of Form 4029 or Form 4361 . a. Enter any net farm profit or (loss) from schedule F, line 36, and from farm partnerships, Schedule K-1 (Form 1065), box 14, code A ., ................ 2a. b. Enter any net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-6), box 9. ....... ................. 2b. c. Add lines 2a and 2b. 2c. 3. Statutory Employees Filing Schedule C or C-EZ Enter the amount from Schedule C, line 1, or Schedule C-EZ, line 1, that you are filing as a statutory employee ............................................. ................................ 3. 4. All filers Using EIC Worksheet B a. Enter your earned income from Worksheet 2, line 7. 4a. 3 , 91 b. Combine lines 1 e, 2c, 3 and 4a. This is your total earned income. _ . _ 4b. 3 , 911 Is the amount on line 4b less than: • $11,490 ($12,490 for married fling jointly) if you do not have a qualifying child, • $30,338 ($31,338 for married fling jointly) if you have one qualifying child, or • $34,458 ($35,458 for married fling jointly) if you have 2 or more qualifying children? YES. Continue on to line 5. NO. Stop, you cannot take the credit. 5. Look up the the amount on line 4b above in the EIC Table in the Instructions to find the credit. Use the correct column for your filing status. Enter the credit here. ..................... _ .......................................................................... 6. Enter your adjusted gross income (line 37 of Form 1040; line 22 of Form 1040A; or line 4 of Form 1040-EZ) ............................ Note: If the amounts on lines 4b and 6 are the same, skip line 7 and enter the amount from line 5 on line 8 7. If you have • No qualifying children, is the amount on line bless than $6,400 ($7,400 if married fling jointly)? • 1 or more qualifying children, is the amount on line 6 less than $14,050 ($15,050 if married filing jointly)? YES. Leave line 7 blank; enter the amount from line 5 on line 8. NO. Lookup the amount on line 6 in the EIC table in the instructions. s. 1 , 570 6. 7 , 459 Use the correct column for your filing status. Enter the credit here. 7. ............................ . 8. Look at the amounts on lines 5 and 7. Then, enter the smaller amount on line 8. This is your earned income credit. 8. 1 , 570 alaries & Wages Report .................................... .................................... .................................... .................................... X004 Tax tification Number :LA EVANS 6514 ,e Employer Federall Wages Federal Withheld Soc Sec Wages MECHANICSBURG AREA SCHOOL DISTRICT 3,911 356 4,228 B _ C _ D _ E _ F _ G _ H _ I J _ _ K _ L _ M Taxpayer Spouse Totals 31911 356 4,228 Soc Sec Withheld Medicare Wages Medicare Withheld Allocated Tips Advanced EIC Dep Care Ben Other, Box 14 A 262 4,228 61 _ B _ C _ D _ E _ F G _ H _ _ I J _ K _ L _ M _ Taxpayer _ Spouse Totals 262 4,228 61 A PA B _ C _ D E _ F _ G _ H _ I _ J _ K _ L _ M Taxpayer Spouse Totals 4,228 130 4 ,228 53 130 4, 228 53 ,002) 1 Paid Preparer's Earned Income Credit Checklist No. for OMB No. 1545-162 definitions of the following terms, see Pub. 596 for the year for which you are completing this form. *investment income •Qualifying Child •Earned Income , autlon. Taxpayers who file Form 2555 or Form 2555-EZ cannot take the earned income credit (EIC). Taxpayers who were nonresident aliens for any part of the year cannot take the EIC unless their fling status is married filing jointly. Partt All Taxpayers 651! 1 Taxpayer's name ? ANGELA EVANS . Year after ........................ ........ ................................. ..................... 2001, for which you are completing this form ? 2004 2 Is the taxpayer's filing status married filing jointly, head of household, qualifying widow(er), or single? ® Yes No 3 Does the taxpayer, and the taxpayer's spouse if filing jointly, have a social security number (SSN) that allows him or her to work or is valid for EIC purposes (see the instructions before answering)? ® Yes No Next, if you checked "No" on line 2 or line 3, stop; the taxpayer cannot take the EIC. Otherwise, continue. 4 Is the taxpayer's investment Income more than the limit that applies to the year on line 1" See Pub. 596 for the limit ................................................................................. ................. Could the taxpayer, or the taxpayer's spouse if filing jointly, be a qualifying child of another person in the year on line 1? Next, if you checked "Yes" on line 4 or line 5, stop; the taxpayer cannot take the EIC. Otherwise, go Yes ® No Yes ® No Part it Taxpayers With a Qualifying Child Child 1 Child 2 Caution. If there are two children, complete lines 6-11 for one child before i i going to the next column. 6 Is the child- 0 The taxpayers son, daughter, adopted child, or stepchild, or • A descendant of the taxpayer's son, daughter, adopted child, or stepchild, or • The taxpayer's brother, sister, stepbrother, or stepsister, or • A descendant of the taxpayer's brother, sister, stepbrother, or stepsister, or • The taxpayer's foster child? Yes ........................................................... ...... 7 If the child is married, is the taxpayer claiming the child as a dependent? (If the child is not married, check "Yes.") Yes 8 Did the child live with the taxpayer in the United States for over half of the year? .................................................... Yes .................................... 9 Was the child (at the end of the year on line I)- Underage age 19, or • Under age 24 and a full-time student, or • Any age and permanently and totally disabled? 04 Yes ............................................... Next, if you checked "Yes" on lines 6 through 9, the child is the taxpayer's qualifying child; go to line 10a. If you checked "No" on line 6, 7, 8, or 9, the child is not the taxpayer's qualifying child. If the taxpayer does not have a qualifying child, go to Part III on the back to see if the taxpayer can take the EIC for taxpayers who do not have a qualifying child. 10a Could any other person check "Yes" on lines 6 through 9 for the child? Yes I Next, if you checked "No" on line 10a, go to line 11. Otherwise, continue. to Enter the child's relationship to the other person(s) ................................................ c Is the other person(s) taking the EIC based on the child? Yes f .......................................... d If the tie-breaker rules applied, would the child be treated as the taxpayer's qualifying child (see the instructions before answering)? Yes f 11 Does the qualifying child have a valid SSN (see the instructions before answering)? ........................... Yes f Did you check "Yes" on line 11? ® Yes. The taxpayer can take the EIC if the taxpayer's earned Income and adjusted gross income are each less than the limit that applies to the taxpayer's filing status for the year on line 1. See Pub. 596 for the limit. Complete Schedule EIC and attach it to the taxpayers return. If there are two qualifying children with SSNs, list them on Schedule EIC in the same order as they are listed here. If the taxpayer's EIC was reduced or disallowed for a year after 1996, see Pub. 596 to find out if Form 8862 must also be filed Yes I I No No F] No. The taxpayer cannot take the EIC not even the credit for taxpayers who do not have a qualifying child. For Paperwork Reduction Act Notice, see back. Form 8867 (Rev. 11-200 DAA -AIPLOYEE'S RECORDS 2004 OMS No. .1ce to Employee an back of Copy B. ) 1545-0008 .of number i Wages, tips, other comp. 2 Federal income lax withheld 00067 3910.99 355, 85 3 Socal security wages A Social security tax withheld If Employer ID number 4228.11 2112 .14 j 5 Medicare wages and tips 6 Medicare tax withheltl --1 23-6005359 4228.11 !51.30 C Employer's name, atltlress, and ZIP code MECHANICSBURG AREA Sr.) 500 SOUTH BROAD STREET MECHANICSBURG PA 17055 of Employee's social security number e Empicyce's na , address, and ZIP code ANGELA L EVANS 162 CHSTNUT GROVE ROAD DILLSBURG PA 17019 7 Social security tips 6 Allocated tips 9 Advance EIC payment 16 Dependent care benefits 11 Nonqualified plans 12. Cade See inst. for box 12 13 Swtutoryemployee 140ther PSERS 317.12 121b Code 3 80 Retirementplan UJC . 12c Code X Third-party sick pay 12C Code PA 23-6005359 4228.11 129.79 15 State Employer s state I.D. # 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 cal income tax 20 Locality name 4228.11 52.85 CARROLL TWP Form W?2 Wage and Tax Statement 41.1626(361 Dept. of the Treasury - IRS This information is being furnished to the IRS. If you are required to file a tax return, a negfigance penalty or other sanction may be imposed on you if this income is taxable and you fail to report it. ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION JEFFREY A. EVANS, PACSES NO. 556106365 Defendant DOCKET NO. 361 SUPPORT 2004 INTERIM ORDER OF (COURT AND NOW, this 171h day of December, 2004, upon consideration of the Support Master's Report and Recommendation, a copy of which is attached hereto as Exhibit "A", it is ordered and decreed as follows: A. The Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit for transmission to the Plaintiff the sum of $1,626.00 per month allocated as follows: $1,136.00 per month for the support of his children, Courtney L. Evans and Ryan J. Evans, and $490.00 per month as spousal support. B. The Defendant shall continue to provide health insurance coverage for the benefit of his wife and children as provided through his employer at a reasonable cost. C. The Defendant shall pay 78% of the unreirnbursed medical expenses incurred by his children as that term is defined in Pa. R.C.P. 1910.16-6(c). D. The Defendant shall be entitled to claim said child as dependency exemptions for federal income tax purposes commencing with tax year 2004. E. The Plaintiff shall execute and deliver to the Defendant any and' all documentation required by the Internal Revenue Service toeffectuate said exemptions. 'v F. The Defendant shall pay directly to the Plaintiff as spousal support within seven days of receipt thereof 30% of any net bonus hereafter received. G. The effective date of this order is August 25, 2004. The parties are hereby advised that they may file written exceptions to the Support Master's Report and Recommendation within ten (10) days of this order. Exceptions shall conform with the requirements of Rule 1910.12(f), Pa. R.C.P. If written exceptions are filed by any party, the other party may file exceptions within ten (10) days of the date of service of the original exceptions. If no < PLAINTIFF'S w EXHIBIT ? y J Q exceptions are filed within ten (10) days of this interim order, this order shall then constitute a final order. By the Court, Y Kevin A. Hess, J. Cc: Angela L. Evans Jeffrey A. Evans Diane G. Radcliff, Esquire For the Plaintiff DRO ANGELA L. EVANS, Plaintiff V. JEFFREY A. EVANS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC (RELATIONS SECTION PACSES NO. 556106365 DOCKET NO. 361 SUPPORT 2004 SUPPORT MASTER'S REPORT AND RECOMMENDATION Following a hearing held before the undersigned Support Master on December 16, 2004 the following report and recommendation are made: FINDINGS OF FACT 1. The Plaintiff is Angela L. Evans, who resides at 162 Chestnut Grove Road, Dillsburg, Pennsylvania. 2. The Defendant is Jeffery A. Evans, who resides at 279 Alpat Drive, Dillsburg, Pennsylvania. 3. The parties are married and are the parents of two minor children, Courtney L. Evans, born February 15, 1994, and Ryan J. Evans, born July 22, 1998. 4. Following a hearing before this Master on July 30, 2004 an order was entered on August 2, 2004 setting the Defendant's obligation for spousal support at $743.00 per month and his obligation for child support at $1,034:0.0 pgr, month.' J 5. On October 11, 2004 the Defendant filed at petition for modification of said order. ' 6. Since August 2, 2004 there have been no material and substantial cha+iges in the Defendant's financial circumstances. 7. On August 2, 2004 the Plaintiff was not gainfully employed. On August 25, 2004 the Plaintiff began employment for the Mechanicsburg Area School District as a teacher's aide. 9. The Plaintiff is paid $60.34 per day for 180 school days per year. ' The Support Master's Report and Recommendation dated August 2, 2004 is incorporated herein and made a part hereof. 1+ 1TIl TT 11 T.1 10. The Plaintiff has a mandatory retirement contribution of 7.5% of her gross pay. 11.The Plaintiff pays $15.00 per day in childcare expenses on the days she works. 12. The Plaintiff will file her federal income tai; return as head of household. 13. The Defendant pays $156.00 bi-weekly for health insurance coverage on the family. 14. The Defendant will file his federal income tax return as married/separate and will claim both children as dependency exemptions. DISCUSSION A party seeking to modify his support obligation has the burden of demonstrating that a material and substantial change of circumstances has occurred since the entry of the order to justify a modification. Samii v. Samii, 847 A.2d. 691 (Pa. Super. 2004). The prior order was entered in August 2, 2004, only four and a half months ago. The Defendant testified that there have been no material changes in his income since the prior hearing. However, the Plaintiff, who was staying at home to care for the children when the prior order was entered, obtained employment as a teacher's aide on August 25, 2004. Because she now has actual earnings a modification of the order is justified. The Plaintiff will work 180 days during the school year for an annual income of $10,861.00, or an average monthly income when annualized of $905.00. Filing her federal income tax return as head of household and claiming neither child as a dependency exemption, she will have net monthly income for support purposes of $1,081.OO.z The Defendant testified that there have been no material and substantial changes in his earnings since the prior order. His net monthly income in August was calculated to be $3,511.00. However, in reaching that figure his health insurance expenses were deducted from his gross income to arrive at a net income pursuant to Pa. R.C.P. 1910.16-6(b)(4) because the Plaintiff had no income. With the Plaintiff now employed that rule is no longer applicable. Therefore, his bi-weekly insurance deduction of $156.00 will be added back to his income resulting in a net monthly income for support purposes of $3,849.00.3 ' The earned income credit results in a higher net income than gross income. See Exhibit "A." 3 See Exhibit "A" for the tax deductions from gross income. With combined net monthly income of $4,929.00 the basic support requirement for two children is $1,325.00.4 The Defendant's proportionate share of that amount is $1,035.00. After adjustments for the Plaintiff's childcare costs5 and the Defendant's health insurance expenses, the Defendant's child support obligation under the guidelines is $1,136.00 per month.6 With net monthly income for the Plaintiff of $1,081.00 and for the Defendant of $3,849.00, and with a child support obligation of $1,136.00, the Defendant's spousal support obligation is calculated to be $490.00 per month.' His total monthly support obligation is $1,626.00. The effective date of the modification will be August 25, 2004, the date on which the Plaintiff's employment began.8 RECOMMENDATION A. The Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit for transmission to the Plaintiff the sum of $1,626.00 per month allocated as follows: $1,136.00 per month for the support of his children, Courtney L. Evans and Ryan J. Evans, and $490.00 per month as spousal support. B. The Defendant shall continue to provide health insurance coverage for the benefit of his wife and children as provided through his employer at a reasonable cost. C. The Defendant shall pay 78% of the unreimbursed medical expenses incurred by his children as that term is defined in F'a. R.C.P. 1910.16-6(c). D. The Defendant shall be entitled to claim said child as dependency exemptions for federal income tax purposes commencing with tax year 2004. E. The Plaintiff shall execute and deliver to the Defendant any and all documentation required by the Internal Revenue Service to effectuate said exemptions. F. The Defendant shall pay directly to the Plaintiff as spousal support within seven days of receipt thereof 30% of any net bonus hereafter received. ° See Pa. R.C.P. 1910.16-3. The childcare costs at $15.00 per day for 180 days per year are annualized, and an average monthly expense of $225.00 was allocated between the parties. c See Exhibit "B" for the guideline calculation. See Exhibit "C" for the calculation. a Although the Defendant's petition was not filed until October 1. 1, 2004, a recommendation is made that the effective date of the modification be retroactive to the start of the Plaintiffs employment. Because the Plaintiff was imputed with no earning capacity in the prior order, the recommendation to modify the order effective with the Plaintiff s receipt of actual earnings is believed to be fair and! equitable. G. The effective date of this order is August 25, 2004. Date Michael R. Rundle Support. Master Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION C-IOURS AMOUNT BALANCE 01/31/2004 Balance forward 0.00 02/19/2004 Client Consultation 1 195.00 195.00 02/20/2004 PMT #3295. 0.00 04/21/2004 4.21.04 prepare divorce complaint 1 200.00 200.00 04/21/2004 4.21.04 letter to client 0.1 20.00 220.00 04/22/2004 4.22.04 open file and set up binder 0.3 60.00 280.00 04/29/2004 4.29.04 file divorce complaint with Cumberland 0.2 40.00 320.00 Prothy 04/30/2004 4.30.04 letter to Jeffrey Evans 0.3 60.00 380.00 04/30/2004 PMT #3637. PAYMENT FROM TRUST 0.00 ACCOUNT 05/05/2004 5.5.04 meeting with client and review custody 0.3 60.00 60.00 complaint 05/06/2004 5.6.04 letter to Attorney Sumple-Sullivan 0.2 40.00 100.00 05/07/2004 5.7.04 prepare preliminary draft Inventory 2 400.00 500.00 05/07/2004 5.7.04 prepare Praecipe to Enter Appearance in 0.1 20.00 520.00 Custody Case 05/07/2004 5.7.04 letter to prothy 0.1 20.00 540.00 05/10/2004 5.10.04 prepare Praecipe to Enter Appearance 0.1 20.00 560.00 05/10/2004 5.10.04 letter to prothy for filing of Praecipe for 0.1 20.00 580.00 Entry of Appearance in custody case 05/10/2004 5.10.04 RR note and sister's email from client 0.1 20.00 600.00 05/10/2004 5.10.04 letter to client 0.4 80.00 680.00 05/10/2004 5.10.04 letter to Atty Sumple-Sullivan 0.2 40.00 720.00 05/12/2004 5.12.04 RR letter and Custody Proposal from Atty 0.3 60.00 780.00 Sumple-Sullivan CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAY:; PAST OVER 90 DAYS AMOUNT DUE DUE DUE DUE PAST DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. PLAINTIFF'S EXHIBIT Page 1 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION I-IOURS AMOUNT BALANCE 05/12/2004 5.12.04 RR 5.11.04 letter and proposed custody 0.4 80.00 860.00 order from Arty Sumple Sullivan 05/12/2004 5.12.04 letter to client 0.4 80.00 940.00 05/13/2004 5.13.04 letter to Atty Sumple-Sullivan re support 0.1 20.00 960.00 conf. 05/13/2004 5.13.04 letter to Domestic Relations 0.1 20.00 980.00 05/17/2004 5.17.04 RR faxed letter from client 0.2 40.00 1,020.00 05/17/2004 5.17.04 letter to Atty Sumple Sullivan 0.2 40.00 1,060.00 05/17/2004 5.17.04 prepare custody Stipulation and Order 0.5 100.00 1,160.00 05/19/2004 5.19.04 2 TCs with client 0.2 40.00 1,200.00 05/19/2004 5.19.04 RR 5.19.04 letter from Atty Sumple 0.2 40.00 1,240.00 Sullivan 05/20/2004 5.20.04 letter to Any Sumple Sullivan 0.8 160.00 1,400.00 05/20/2004 5.20.04 RR letter from Atty Sumple Sullivan 0.1 20.00 1,420.00 05/20/2004 5.20.04 TC client re 5.21.04 conf. 0.1 20.00 1,440.00 05/20/2004 5.20.04 prepare Conciliation Memorandum 0.3 60.00 1,500.00 05/21/2004 5.21.04 attend Custody Conciliation Conference 2.5 500.00 2,000.00 05/21/2004 5.21.04 prepare revisions to court order 0.2 40.00 2,040.00 05/21/2004 5.21.04 letter to Atty Sumple-Sullivan 0.1 20.00 2,060.00 05/24/2004 5.24.04 2 TCs with client 0.2 40.00 2,100.00 05/25/2004 5.25.04 letter to Atty Sumple Sullivan re sale of 0.1 20.00 2,120.00 home 05/25/2004 5.25.04 letter to Atty Sumple-Sullivan re computer 0.2 0.00 2,120.00 05/26/2004 5.26.04 RR 5.26.04 letter from Atty Sumple 0.2 40.00 2,160.00 Sullivan 05/26/2004 5.26.04 letter to client re support cord. 0.2 40.00 2,200.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 2 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION HOURS AMOUNT BALANCE 05/26/2004 5.26.04 letter to client re lap top computer 0.1 20.00 2,220.00 05/27/2004 5.27.04 TC with client 0.1 20.00 2,240.00 05/27/2004 5.27.04 letter to Atty Sumple Sullivan re custody 0.2 40.00 2,280.00 slip. 05/31/2004 PMT #3645. Payment from Trust Account 0.00 06/01/2004 6.1.04 letter to Conciliator Vaughn 0.2 40.00 40.00 06/08/2004 6.8.04 letter to Atty Sumple-Sullivan 0.3 0.00 40.00 06/10/2004 6.10.04 RR job history from client 0.2 40.00 80.00 06/21/2004 6.21.04 attend Support Conf. 2 400.00 480.00 06/22/2004 6.22.04 TC with client 0.3 60.00 540.00 06/22/2004 6.22.04 letter to Atty Sumple-Sullivan 0.2 40.00 580.00 06/23/2004 6.23.04 letter to client with support calculations 0.3 60.00 640.00 06/24/2004 6.24.04 RR 6.23.04 letter from Atty 0.2 40.00 680.00 Sumple-Sullivan 06/24/2004 6.24.04 letter to client 0.2 40.00 720.00 06/24/2004 6.24.04 prepare support appeal and Hearing De 0.2 40.00 760.00 Novo Request 06/24/2004 6.24.04 letter to Domestic Relations 0.1 20.00 780.00 06/25/2004 6.25.04 letter to Atty Sumple-Sullivan 0.1 20.00 800.00 06/29/2004 6.29.04 letter to Any Sumple-Sullivan 0.1 20.00 820.00 06/29/2004 6.29.04 TC with Domestic Relations re hearing 0.1 20.00 840.00 scheduling 06/30/2004 6.30.04 RR Notice of Support Appeal Hearing 0.1 20.00 860.00 06/30/2004 6.30.04 letter to client 0.1 20.00 880.00 06/30/2004 PMT #3657. PAYMENT FROM TRUST 860.50 ACCOUNT CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAY: PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 3 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION HOURS AMOUNT BALANCE 07/02/2004 7.2.04 RR 7.2.04 letter from client 0.2 40.00 900.50 07/06/2004 7.6.04 TC with Client 0.2 40.00 940.50 07/06/2004 7.6.04 letter to Atty Sumple-Sullivan 0.1 20.00 960.50 07/07/2004 PMT #538. 4Io0!Sw 100.00 07/14/2004 7.14.04 letter to client 0.2 40.00 140.00 07/14/2004 7.14.04 letter to Atty Sumple-Sullivan 0.1 20.00 160.00 07/19/2004 7.19.04 TC with client 0.2 40.00 200.00 07/20/2004 7.20.04 TC with Atty Sumple-Sullivan 0.2 40.00 240.00 07/20/2004 7.20.04 letter to client 0.2 40.00 280.00 07/21/2004 7.21.04 RR letter and day care and employment 0.2 40.00 320.00 information from client 07/23/2004 7.23.04 RR 7.22.04 letter from Any Sumple 0.3 60.00 380.00 Sullivan 07/27/2004 7.27.04 client consult 1 200.00 580.00 07/27/2004 7.27.04 letter to Atty Sumple-Sullivan 0.2 40.00 620.00 07/30/2004 7.30.04 prepare Praecipe for Kids First Workshop 0.1 20.00 640.00 07/30/2004 7.30.04 letter to Prothy 0.1 20.00 660.00 07/30/2004 7.30.04 letter to Arty Sumple Sullivan 0.1 20.00 680.00 07130/2004 7.30.04 attend support appeal hearing 1.75 350.00 1,030.00 08/03/2004 8.3.04 RR Support Order 0.2 40.00 1,070.00 08/04/2004 8.4.04 letter to client 0.3 60.00 1,130.00 08/04/2004 8.4.04 RR Support Order from Court 0.2 40.00 1,170.00 08/04/2004 8.4.04 letter to Attorney Sumple-Sullivan 0.2 40.00 1,210.00 08/10/2004 8.10.04 letter to client 0.1 20.00 1,230.00 08/10/2004 S. 10.04 telephone conference with Attorney 0.2 40.00 1,270.00 Sumple-Sullivan CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 FAT, PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 4 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 71 DATE DESCRIPTION HOURS AMOUNT BALANCE 08/11/2004 8.11.04 RR 8.11.041tr from Atty SumpleSullivan 0.3 60.00 1,330.00 08/11/2004 8.11.04 letter to client 0.2 40.00 1,370.00 08/11/2004 8.11.04 letter to Attorney Sumple-Sullivan 0.3 60.00 1,430.00 08/11/2004 8.11.04 RR letter from Attorney Sumple Sullivan 0.2 40.00 1,470.00 08/12/2004 PMT #551. 440.00 08/23/2004 8.23.04 TC with client 0.1 20.00 460.00 08/27/2004 8.27.04 prepare support calcs. 0.3 60.00 520.00 08/27/2004 8.27.04 letter to client 0.2 40.00 560.00 08/27/2004 8.27.04 letter to Domestic Relations 0.2 40.00 600.00 09/01/2004 9.1.04 letter to Arty Sumple Sullivan 0.1 20.00 620.00 09/01/2004 9.1.04 RR 8.31.04 letter from Atty Sumple Sullivan 0.1 20.00 640.00 09/08/2004 9.8.04 RR message memo from client 0.1 20.00 660.00 09/08/2004 9.8.04 letter to Arty Sumple-Sullivan 0.3 60.00 720.00 09/09/2004 PMT #573. 120.00 09/17/2004 9.17.04 RR 9.10.04 letter from Mr. Evans 0.1 20.00 140.00 09/17/2004 9.17.04 letter to client 0.1 20.00 160.00 10/12/2004 PMT #591. Gj* 0.00 10/14/2004 10. 14.04 receipt and review letter and Praecipes 0.1 20.00 20.00 from Attorney Sumple Sullivan 10/14/2004 10, 14.04 letter to client 0.1 20.00 40.00 10/18/2004 10.22.04 telephone conference with client 0.1 20.00 60.00 10/18/2004 10.22.04 letter to Mr. Evans 0.2 40.00 100.00 10/28/2004 10.28.04 receipt and review e-mail from Jeffery 0.2 40.00 140.00 Evans 11/01/2004 11.1.04 TC with client 0.1 20.00 160.00 11/02/2004 11.2.04 prepare revised Support Calculations 0.4 80.00 240.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON LJNP.AID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 5 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION HOURS AMOUNT BALANCE 11/02/2004 11.2.04 letter to jeffrey Evans 0.3 60.00 300.00 11/07/2004 PMT #605. 4daWok 160.00 11/08/2004 11.8.04 TC with client 0.1 20.00 180.00 11/08/2004 11.8.04 letter to Jeffrey Evans 0.1 20.00 200.00 11/15/2004 11. 15.04 RR letter from client 0.2 40.00 240.00 11/17/2004 11. 17.04 attend support cont. 1.75 350.00 590.00 11/19/2004 11. 19.04 RR support order 0.2 40.00 630.00 11/19/2004 11.19.04 letter to client 0.1 20.00 650.00 11/22/2004 11.22.04 letter to client 0.5 100.00 750.00 11/22/2004 11.22.04 prepare Inventory 1 200.00 950.00 11/29/2004 11.29.047 RR Order Scheduleing Support Appeal 0.2 40.00 990.00 Hearing 11/29/2004 11.29.04 letter to client 0.1 20.00 1,010.00 12/06/2004 PMT #617. 104k 0.00 12/06/2004 12.6.04 client consult 0.4 80.00 80.00 12/07/2004 12.7.04 TC with Realtor 0.2 40.00 120.00 12/08/2004 12.8.04 TC with Realtor 0.2 40.00 160.00 12/08/2004 12.8.04 letter to Jeff Evans 0.2 40.00 200.00 12/13/2004 12.13.04 RR email from Jeff Evans 0.1 20.00 220.00 12/14/2004 12.14.04 letter to client 0.1 20.00 240.00 12/16/2004 12.16.04 attend support appeal hearing 1.75 350.00 590.00 12/21/2004 12.21.04 RR Support Order 0.2 40.00 630.00 12/21/2004 12.21.04 letter to client 0.1 20.00 650.00 12/23/2004 12.23.04 letter to client 0.1 20.00 670.00 01/10/2005 PMT #627. ONWA& 0.00 01/13/2005 1. 13.05 RR letter and documents from client 0.3 60.00 60.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 6 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION HOURS AMOUNT BALANCE 01/13/2005 1. 13.05 letter to Jeff Evans 0.2 40.00 100.00 01/13/2005 1. 13.05 Prepare Request for Productions of 0.4 80.00 180.00 Documents 01/24/2005 1.21.05 TC with client 0.2 40.00 220.00 01/24/2005 1.24.05 file Income and Expense Statement 0.2 40.00 260.00 01/25/2005 1.25.05 letter to Mr. Evans 0.2 40.00 300.00 01/25/2005 1.25.05 RR email from Mr. Evans 0.1 20.00 320.00 01/26/2005 1.26.05 email to Jeffrey Evans 0.1 20.00 340.00 01/26/2005 1.26.05 letter to client 0.1 20.00 360.00 01/27/2005 1.27.05 letter to client 0.1 20.00 380.00 02/01/2005 2.1.05 letter to Jeff Evans 0.2 40.00 420.00 02115/2005 PMT #648. ON" 40.00 03/02/2005 3.2.05 preparation of Motion for Sanctions 1 200.00 240.00 03/08/2005 PMT #668. oote& 200.00 03/11/2005 3.11.05 file Discovery Sanctions Petition with 0.2 40.00 240.00 Court 03/11/2005 3.11.05 letter to Jeff Evans 0.1 20.00 260.00 03/15/2005 3.15.05 RR message from Jeff Evans re arty 0.1 20.00 280.00 representation and discovery request 03/16/2005 3.16.05 RR Court Order re Discovery 0.1 20.00 300.00 03/16/2005 3.16.05 letter to Jeff Evan 0.2 40.00 340.00 03/22/2005 3.22.05 letter to Arty Shade 0.2 40.00 380.00 03/28/2005 3.28.05 RR letter and financial documents from 0.3 60.00 440.00 Arty Shade 03/28/2005 3.28.05 TC with client 0.2 40.00 480.00 03/28/2005 3.28.05 letter to Atty Shade 0.2 40.00 520.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS AMOUNT DUE DUE DUE DUE PAST DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 7 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION HOURS AMOUNT BALANCE 03/2812005 3.28.05 letter to client 0.2 40.00 560.00 03/29/2005 3.29.05 RR email from Jeff Evans to client 0.2 40.00 600.00 04/08/2005 PMT #689. 0.00 04/14/2005 4.12.05 prepare revised Analysis 0.4 80.00 80.00 04/15/2005 4.15.05 letter to client 0.3 60.00 140.00 04/15/2005 4.15.05 letter to Arty Shade 0.1 20.00 160.00 04/21/2005 4.21.05 TC with client 0.2 40.00 200.00 04/22/2005 4.22.05 prepare Inventory for filing 0.3 60.00 260.00 04/25/2005 4.25.05 TC with client 0.2 40.00 300.00 04/25/2005 4.25.05 RR copy of letter from client to spouse 0.2 40.00 340.00 04/25/2005 4.25.05 letter to Prothy 0.1 20.00 360.00 04/25/2005 4.25.05 letter to Atty Shade 0.2 40.00 400.00 04/25/2005 4.25.05 letter to Atty Shade re bonus payment 0.2 40.00 440.00 04/26/2005 4.26.05 letter to Arty Shade 0.2 40.00 480.00 05/02/2005 5.2.05 letter to Sally Kreitzer 0.2 40.00 520.00 05/04/2005 5.4.05 RR letter and docs from Arty Shade 0.2 40.00 560.00 05/04/2005 5.4.05 letter to client 0.2 40.00 600.00 05/04/2005 5.4.05 letter to Todd Moul 0.1 20.00 620.00 05/09/2005 5.9.05 TC with client 0.2 40.00 660.00 05/10/2005 PMT #706. 0001 180.00 05/10/2005 5.10.05 letter to Atty Shade 0.3 60.00 240.00 05/12/2005 5.12.05 RR Discovery Certification Notice from 0.1 20.00 260.00 Divorce Master 05/12/2005 5.12.05 letter to Divorce Master 0.1 20.00 280.00 05/23/2005 5.23.05 TC with client 0.1 20.00 300.00 06/01/2005 6.1.05 TC with client 0.1 20.00 320.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NET 30 DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 8 Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 TO: Angela L. Evans 162 Chestnut Grove Road Dillsburg, PA 17019 INVOICE DATE 6/22/2005 AMOUNT DUE $600.00 DATE DESCRIPTION HOURS AMOUNT BALANCE 06/01/2005 6.1.05 letfer to Atty Shade 0.1 20.00 340.00 06/02/2005 PMT #723. *QQLN 40.00 06/02/2005 6.2.05 letter to Atty Shade 0.1 20.00 60.00 06/06/2005 6.6.05 letter to Atty Shade 0.1 20.00 80.00 06/09/2005 6.9.05 letter to Atty Shade 0.1 20.00 100.00 06/14/2005 6.14.05 RR 6.13.05 letter and does from Atty 0.3 60.00 160.00 Shade 06/14/2005 6.14.05 prepare alternative analysis 0.3 60.00 220.00 06/14/2005 6.14.05 letter to Atty Shade 0.1 20.00 240.00 06/14/2005 6.14.05 letter to client 0.4 80.00 320.00 06/16/2005 6.16.05 TC with client 0.2 40.00 360.00 06/17/2005 6.17.05 letter to Atty Shade 0.3 60.00 420.00 06/20/2005 6.20.05 RR Pre-Trial Directive Letter from Divorce 0.2 40.00 460.00 Master 06/20/2005 6.20.05 letter to client 0.2 40.00 500.00 06/20/2005 6.20.05 letter to Atty Shade 0.1 20.00 520.00 06/20/2005 6.20.05 letter to Arty Shade 0.2 40.00 560.00 06/20/2005 6.20.05 letter to client 0.1 20.00 580.00 06/20/2005 6.20.05 letter to Atty Shade re marital misconduct 0.1 20.00 600.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS DUE DUE DUE PAST DUE AMOUNT DUE 0.00 600.00 0.00 0.00 0.00 $600.00 TERMS: NE 13U DAYS: 1.5% PER MONTH SERVICE CHARGE ON UNPAID BALANCE AFTER 30 DAYS. (18% APR). VISA AND MASTERCARD ARE ACCEPTED. Page 9 S. W. BARRETT REAL ESTATE & APPRAISAL SERVICES APPRAISAL OF L. >' LOCATED AT: 279 Al Pat Drive Dllleburg, PA 17019 FOR: Jett Evans 279 Al Pat Drive Dilluburg, PA 17019 BORROWER: EVANS,Jett AS OF: December 22, 2004 BY: Cassandra J. Crockett 124129 S. W. BARRETT REAL. ESTATE & APPRAISAL SERVICES 01/06/2005 Jeff Evans 279 Al Pat Drive Dlllsburg, PA 17919 File Number: 04.0545 Mr. Evans; In accordance with your request, I have personally Inspected and appraised the real property at: 279 Al Pat Drive Dlllsburg, PA 17019 The purpose of this appraisal is to estimate the market value of the subject property, as Improved. The property rights appraised are the fee simple Interest in the site and Improvements. In my opinion, the estimated market value of the property as of December22, 2004 Is: $200,000 Two Hundred Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications. Respectfully submitted, Cassandra J. Crockett Certified Residential Appraiser yT 124-126 NORTH AND FAX 717-243-8627 Eli] Lo.elbn Urban X Suburban Rural Bull up Over 75% 25-75% Under 25% Gmwlh rate Rapid X Stable Slew PredorNn.rm singElr /amlly h...Ing ocwpnno, `IN?C GE X Ovmw 100 Low New Prinentlanduse% One lardy 65% 24 fork 0% Land use change Not Body E) L6 8 In process Pmperlyvalues Increasing Stable Declining Tenant 400+ Hi h 100 LABNaudy 0% To: Residential/ Derrvndfwpply Shortage Inbd d h earypy X VasadLew) PradcrrJnenl Commemed 5% Commercial Markelln time Ulder'Jma. SEroo. Overa.6. WN-ft 200 20 Vacant 30% Note: Race and the racial composition of the neighborhood are not appraised factors. Neighborhood boundaries and charecterislics: Sublee Is bounded on the north by Cumberland County line: on the east by 1-83• on the south h Adams County line- and on the It h Whisk. Sprlnas Road/mountains. • Factors that affect the marketability of the properties N the nelghborhood (pvoximlly to employment and amenities, employment stability, appeal to market, tc.): Subject Property Is located In an expanding area of single y family homes and farms between Grantham and Dllleburc. " Shopping and other amenities are within a short driving distance. School system Is Northern York District and students are bused. SMSA 42-8280. Markel conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing lima -- such as data on competBNs properl]ea for sale In the neighborhood, description of the prevalence of vales and financing concessions, etc,): Property values are current) stable with an averse marketing time of 80-100 days. Economic trends and lending rates have remained favorable. Sales concessions occur Infra gent" f. There are new homes under construction in surrounding developments, as well as resales available In the neighborhood. Project Information for PUDS(ifapplicable) -- Is the developerlbuilder In control of the Home Owners' Assoclallon(HOA)7 YES NO Appoxkmtetotalmrrbwofunhsintheaubjectproject N/A _ ApproxLmle total number of unite for sale In the subject project NIA Describe common elements and recreational facBSlee: N/A Dimensions Two Tracts: .50 Acre M/L 8.21 Acre MIL face legal descrl tion/tax me Topography Sloping to level Site area .71 Acre M/L Cumx Lot Yee LFJ No She Typical for area Speak zoning desaSlcat]on and description RS Residential Suburban Zoning compliance ?X Legal LepdnonmNmriq(Grardbehesduu) linci Noroning Shape Irregular Oni.ge Appears adequate Hhed d beat use ..d Prs.NUss Olhwue.e M view Residential/Countryside Utilities Public Door E. N.. Improvements Type Public Private Landscaping Typical Detlrklly Strobl Asphalt ? Driveway Sudan Asphalt Gas GrNguNw None Apparent easements NoneA B rent Water Weil Sidewalk None FEMA Special Flood Hazard Ana Yee N Sanitary sewer Se tie SUeN IpMS None FEMAZone C Map Del, 312/81 Storm saww ABe None FEMA Ma No. 422216 Comments (apparent adverse easements, anooachments, special assessments, elide areas, illegal wlegal nonconforming zoning, use, el.J: We11/Septlc common for area and have no adverse affect on marketability. There are no adverse easements, encroachments or other adverse conditions. GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION No. of Unl. One Foundation Stone Slab None Area Sq.Ft. 400 Rod No. of Stories Two Edericr W.B. Vinyl C dSpo Partial %Fnshed 0% C.Ing Type(DeL/Alt.) Detached Roof Surface Shn MRUbbr Ba.mnt Partial Calling Unfinished walls X Doolpn(Style) 2Story Dorm a Domain.. Aluminum Sump Pump Yes Walls Stone Floor ExielinglPmpooed Exlstln yWndmTyp. DoubleHun Dampness None Obs. Flow Dirt/Conc None [ Age(Yro) 100 Yrs+/_ sin rasa.m Thermal Battlement None Obs. out" fintry, Yes* Esedb.A a rs. 10-12 Manufactured House No [revelation None Obs. .onto orch ROOMS F mw Livin Dinh ICSden Den Family Rm Rea Rm. Bedrooms BBaths Laundry Othx uses .Fl Bwm t Level I Area 1 Area 1 1 .5 Area 1 21 • Lwel2 3 1 8f • Fnbhed yea above de owta'ns: 5 Roam: 3 Bedmo s 1.5 Bathe' 2.068 S u we Fast of Grove. Linn An • INTERIOR Matedess/Co dSicn HEATING ]OTCHEN EQUIP. ATTIC AMENITIES CAR STORAGE: Flom Carpet/Vinyl Type Ht Puns Refrigerator None Fkeplace(s)t None ? • Wags Drywall/Panel Fuel Electric RmgelOven Stork X Patio Concrete Gauge sofu TrMFlnbh Wood CwidiionOood Disposal Drop 'stair Deck Affachsd Bath Flow Vinyl Tile COOLING Dishwasher S.Sle Porch Three X _ Detached 2 Bath Wchscat D all/Fbr Is Grrhd Yes FaMfood Float For. Privacy BuIHn Dow. 6 Panel Moulded Other None Ltkmwwe Heated Pod _ Carport Av /Good Condition Owdi'vnGlood r Wool, . Finished _ Orlvawa 4/Pvd E Additional features (special energy efficient Sena, etc.)c See Attached Addendum Id Condition of the impr.amenls, depredation (physical, functional, and extemel), repairs needed, quality of construction remodeling/add8]ons, etc.: Improve Ad, .. envkommrlal conditlcna (such as, but not limited lo, hazardous wastes, lox]. subalan.s, do.) present In the improvements, on the site, or in the immediate vicinity of the subject properly: No adverse environmental conditions are apparent/clisciosed. FlYIM Wervn la atl SUMMARY APPRAISAL REPORT El Bormxer. EVANS Jeff Flle No.: 04-0845 Prepwhf Address: 279 AI Pet Dike Cate No.: Ctv Clllehum State: PA Lo: 17019 Lender. Jeff Eme Additional Features Much of home has been ramodekdlup4ated, new goorings, fixtures, appliances, nave kitchen. baths; original EBB still In place at supplemental beat source; oil space Mater In thing room; original wood callings exposed on 2nd floor, cedar closet under stairs; detached game storage shad [1g x 101 In average condition; wooden privacy fencing; alone terracing walls. Addendum Pepe 1 di VTtwt''7 SUMMARY APPRAISAL REPORT UNIFORM RESIDENTIAL APPRAISAL REPORT File No. 04-0845 uatlonSection ESTIMATED SITE VALUE .......... .................' E 45000 Commenle on Cost Approach (such as, source of cost estimate, ESTIMATED REPRODUCTION COST-NEWOF IMPROVEMENTS: eXevalus, squsrefoot calculation and for HUD, VA and FmHA. the Pssibg 2.068 Sq. Ft. Q E 88.00 2 E 136.485 sellmated remaining economic 19, or the Property): Bart. 400 Sq. R. QE 12.00 + 4,800 Cost new from Marshall Swift Valuation Service Well/Sep/Porches/HrU /Fncti/Shed . 20.000 Handbook and local cost analysis. Land value from GangeSapcrt 800 So, R. Q S 18.00 - 14 400 Market Data Comparlson. Depreciation based on no U rMa cwu,.tw flnu sew . S 175.888 observed condition and Market Data Analysis. Functional s Ph atd L Euene l Ed. Rweuhp EmA Lib: -10 Estimated Remaining Econ omic Life is 40-45 years. I y I es E25 000 D dati . E 25.000 epre on reciated Value dbrprwemeee De . 150.688 e E . . . . .... p ravemants b'VWe of SIN ln Y .......... . _ .E 5500 o INDICATED VALUE ........ p BY COS APPROACH _ . I......... . ....... • • e 201 200 FIEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE COMPARABLE NO. E 279 At Pat Drive Street 454 South Fileys Road 202 129 South York Road Address Dlllsbur Olllabu Dlliabur Dlllsbu pnobra I. Su W 3.4 M1 SW 2.2 MI SSE 2.1 MI pESE Sales Price E N/A 204500 E 250 000 T!'''P 153.0 PricaGw LM. Am 0.00 0 E 87.32 85.73 0 E 124.39 0 Data snd1or Inspection Verification Sources Deed/CHR MLS/Courthouse Records MLS/Courthouse Records MLS/Courthouse Records VAUEADI11d1MENA OESCRIFTION DESCRIPTION • f DESCRIPTION .. r DESCRIPTION • t Stlw or Financing None, Conv None, Conv None, Conv Conwebne DOM 75 DOM TO DOM 234 Date of Salartbr 8/04 8/03 3/04 Location Suburban Suburban Suburban Suburban LONOwr.sknis Fee Simple Fee Simple Fee Simple Fee Simple Ste .7 Acre+/- .15 Acre+/- 2 000 6.8 Act"+/. -24,000 1.2 Acres+/. -210 View Ress(dlCint sat ResidlCorm Ressid/C d ReasldhD sat ' Deakin and Appeal 2 Sto /Av 2.5 Sto /AV 2 Sto /Av 2 Sto /Av QuellYdOonsruchan A /V n l Good/Brick J.500 Av /Alum/Brick Av In I 100/10 Yrs+/. 100/10 Yrs+/. 33/10 Yrs --3500 100/15 Yrs+/- ConeHlon AV /Good AV 9/Good Av /Good Averse 10.01 AbwoGrade rw`eeaa' sere ma•ea,m` bwe rsa'aaw' ass, ro'ams' euv Room Count 2 5: 31 1.50 7- 3. 2.50 -21000 91 41 2.50' -2,000 1.50' Grave Lhln Area 2,088 S Ft. 2,342 S .Ft. .5500 2 918 S F4 .17 000 1,230 S .Fl. ( 18 Bt Sawmmt S Frvshed Partial Bert/ Full Bsmt/ -2,000 Partial BamV Partial Bsmi/ Roam Below Grade Dirt Floor Concrete Concreta -1000 Concrete -101 Functional LAM Avers a Avers a AVera a Avers e Hea1M u HP/CA OFHAICA EBB/None 2.000 OHW/None 2,0( Em,y ESidsd Aem • Typical T ical T Icel Typical G 2 Car Gara a OSP 6 000 2 Car Gara a OSP 6.01 Pace, Palo, Door. PoreheslPetlo/ PorcheslFP 1,000 Porch/Patio/ 0 Porches/FP/ e eta Hrth.Fn /Shed FP/Shad Sheds FenosPod Mc Nona 10 Pool/Fnc 3 000 None None ' ' 3181 9000 + is 45,600 X • 'E Nat Ad. dal + X1. 'S 10 1 Adjuated Saw Prue 1 1 184 8' dC ends 195 500 204 500 Comments on Sales Comparison (Inducting the subject prapertyh compelib h Io the nelphbahocd, etc ): All compes are similar In urtillty' and location to the sub ect ro Party. arc verMed closed sales and ar the best curtently available Limited sales of older homes In sub ect'c value fence have recent) occurred requiring an arg ended search Surplus land adiusted 0 $4 OOOlacre. Fourth_ comparable added from the direct neI hborhood as edditl real data Rance o1 value Ia $184 000 to $232000. ITEM SUBJECT COMPARABLE N0.1 COMPARABLE NO.2 COMPARABLE NO.3 Gale, Pita and Data 6/11/03 Saau kr prloreaba None $180,000 None None wlhb da eel CHR CHR Courthouse Records Courthouse Records 0 Analyst, deny current agreement of sale, option, bristling dlhe wbjed property and analysis deny rrursdw doubjed and coop ableawlhn one yeardflw eatedappaew INDICATED VALUE BY SALESCOMPARISON APPROACH ........ 200.0 Caru%1 mafAppnm1: Fkad 'brat,' U wbjsdtothrapabAMeretbm, n. op.,.,fthis apprah bto.tlbrete the none value dthe real propuly that Is the wbjed dtht, report, based on thesews coniiRmend It, catFdm...nlN e andlinhing conditions, and marketvabe de&kiwthdenelaWintheatladed FmkoolwFam43SFmkMNFarm10048(RwbW 6/93 } I(WE)F-SNMATETHEMARIIET VALUE, AS PENNED, OFTHE REALPROPERTYTHAT ISTHESUBJECTOFTHISREPJRT,ASOF 12/22/2004 (WHICH IS THE DATE OF INSPECTION ANDTHE EFFECTNEDATEOFTHISREPORT)TO BEE 0000 APPRAISER: 5U APPRAI' 10 B- FREM Y Signalur /i111n.?,1C. 5? `?? / ?Dd ©Did ,,..... c....,ed...t_ Crnekstf Name Steven W. Barrett. SRPA. SRA Inspect Property 60 F. SUMMARY APPRAISAL REPORT P.w+p ina.?nwawm...d.xe. SKETCH/AREA TABLE ADDENDUM Casa No He No 040845 16P p+y e IPA J 6.P a d BY °a PwN Y LL ZP 12.P Beataom ?e pY KIKMn,ts v 12.t ? Be10 n, 68 . Bedroom bia pwot LIWnp ROOM ]l9 PorN 24.0' R Comments: scale: 1 + ? IVIf 13 , ARFA'.BR?AKDQWN '.: 9rea1{tlown` : 5?' 6totals First Floor 5.0 x 5.0 40.00 24.0 z 34.0 616.00 11.0 x 29.0 348.00 second Floor 14.0 z 36.0 864.00 4 Areas Total (rounded) 2068 FRONT VIEW OF SUBJECTPROPERTY Appraised Date: Deeem ber 22, 2004 REAR VIEW OF SUBJECT PROPERTY STREET SCENE SUBJECT PROPERTY PI )ADDENDUM tiFf± f'?i: a \ y 365 Map Redaction: RES, 1999 MAP - PC COMPARABLE SALE #i 202 Gettysburg Street Dlllsburg Sale Date: 8104 Sale Price: $ 204,500 COMPARABLE SALE #2 454 South Fileys Road Dlllsburg Sale Date: 5103 Sale Price: $ 250,000 COMPARABLE SALE #3 129 South York Road Dlllsburg Sale Date: 3104 Sale Price: $ 153,000 COMPARABLE PROPERTY TO ADDENDUM 11 COMPARABLESALE94 309 AI Pat Drlve Dlllsburg Sale Dale: 5103 Sale Price: $ 280,000 COMPARABLE SALE #5 Sale Date: Sala Price: $ COMPARABLE SALE #6 Sale Date: Sale Price: $ COMPARABLE PROPERTY, 'OADDENOUM F L17CATION MAP VSa e I S J$f SJ o q A` / g ? 'n R / I JJ 9' 9 / c ? P ? ?9 e 15 N s ?JP N l } I E E N I / I W RR RO 15 / / nN1sx no 1 0 - C W m e G 981AH CO LEGS / RELL I ? i ?EECAB 6 d9' a / T ale n Nn $ A ?? :^ S ? ? e! S 6 SNJ f R' ! w o / R c 00 PB °P 4 a1D0 3 was i 1 R.LO s R N N " ?Nq Ip? ( , ? LOCUST LN ? ° Q9 y f O' o 1E 0 WILL RD ? d' $ 0 1 0J t J ? P PD I ! B ao a.a: \ 15 n 1 ? b N °? a Z e 6 4 16 CRR' d f? m 0(0 c Y N ORK ' A 0 w R LN ? PB a -° O TANNERY RD '90 N PD ?q x dNA WPO 904-2W4 TELE N N?, rN Scaler 6.43 miles Prepared by. Steen W. E9rte0RE. Appr. S<. (7771245-0846 ID Addm a Dm PNn RM BB SW Salt Pta?AY B 279 AL PAT D9 B/A N/A 6 3 1.5 2068 0.00 W 1 202 9EFMO909G ST 0/04 204500 7 3 2.5 2342 3.4 = BE 2 454 4 F =IS eD 8/03 250000 9 4 2.5 2916 2.2 ali 099 3 129 9 Y(= 9D 3/04 153000 5 3 1.5 1230 . 2.1 = ESE 4 309 AL BAT Wk 5/03 200000 9 4 3.5 2674 0.22 ba ON *"`"""•QUALIFICATIONS00em The following checked Items are SPECIFIC SPECIAL CONDITIONS that were identified by this appraiser during the inspection of the subject property, the cemparables sales, and their neighborhoods and locations. Unless otherwise noted, the conditions that apply to the subject property or the comparable sales used DO NOT AFFECT THE MARKET VALUE OR THE FUTURE MARKETABILITY OF THE SUBJECT PROPERTY BEING APPRAISED. This Is not a home Inspection service. This Is an appraisal to estimate market value. _1. The subject Is located In a rural area and Is leas than 25% built-up. CommerciaUlndustrlal uses are located within the subject's neighborhood. These uses are typical of similar neighborhoods. _x_3. Vacant and undeveloped land uses are located within the subjects neighborhood. These uses are typical for the area. _4. The predominant value In the neighborhood Is less than that of the market value of the subject property. This Is due to the very wide range of value of properties In the area and superior quality of the subject property. _5. The subject property Is located in a F.E.M.A. Identified Flood Zone. Flood Insurance coverage is required and suggested. _8. Dampness is noted in the basement of the subject Standing or running water was not present on basement floor. This condition is considered typical In dwellings of this style. _x_7. The subject property Is serviced by private well and/or septic systems which is common for the area x_B. The subject Is older than five(S) years. All mechanical systems Including the heating, electrical and plumbing systems appear upon a visual exterior Inspection to be in working order. No warranties are Implied In this statement ... 9. Repair Items were noted in the comments section of the report These comments on repair hems are for descriptive purposes only and are not required repairs. The Items listed are cosmetic In nature. _x_10. The basement floor Is a dirt floor. This condition Is common and typical for the area. and does not pose a health or safety hazard. _11. The subject property does contain functional obsolescence as noted In the report This condition Is considered typical and common for the area and this stile dwelling. _72. The land value exceeds 30% of total value due to the high demand for vacant land In this neighborhood. This condition Is considered common and typical for the neighborhood. _13. The land value exceeds 30% of total value. This is due to the large size of the site. This condition Is considered to be typical and common. _14. Individual adjustments were required that exceed 15%. These adjustments were required due to lack of more similar comparables on that Individual rating. All comparables used are the best available. _16. Total adjustments exceed 25%. This Is due to the lack of comparable sales that were mom similar in the subjects market area. All comparables used are the best available. _A_18. One or more comparable sales are older than eix(8) months. Although them are comparable properties in the subjects area, none have sold recently; therefore, sales In excess of slx(6) months have to be used. All corn parables used are the beet avallable. _x_17. One or more comparables used were in excess of one (1) mile from the subject property. Although there are comparable properties In the immediate area, none have sold recently. Therefore, it was necessary to use comparable sales outside of She Immediate area All comparables used are located In similar neighborhoods and within the same marketing area. All comparables used am the best wailable. _18. The electrical system was not connected during Inspection. _1g. The water service was not connected during Inspection. _20. The heating system was shut down during Inspection. _21. Rcofing_Plumbing_Electrical_Heatinig_certificatlon(s) Islam suggested. _22 Inground swimming pool__, out bulldings__am included not Included according to lender's guidelines. _23. According to lender's guidelines a maximum al acres wem considered for this valuation. Remaining acreage was given no value. ""'aaa` QUALIFICATIONS _24. The subject property is located on a private road. _25. Wood Infestation Inspection Is suggested. _x_28. Last recorded deed transfer. Dste_10104/80__, Consideration: $5,500 [land]. _27. Proposed construction/renovation In nocordanceto plans and specifications to be completed Ina workman-like manner. _28. Seller Is Paying part or all of closing mats. _x_28. All comparable sales sre verified closed sales. _;;._30. There are no special conditions or other requirements that would affect market value or future marketability in the Appraisal Report CHECKED ITEMS ARE SPECIFIC SPECIAL CONDITIONS THAT WERE IDENTIFIED BY THIS APPRAISER DURING INSPECTION. 11 1e QUALIFICATIONS Confidentiality and Security Policy We consider privacy to be fundamental to our relationship with clients. We are committed to maintaining the confidentiality, Integrity and security of clients' personal Information. Internal policies have been developed to protect this confidentiality, while allowing client needs to be served. We restrict access to personal Information to authorbmd Individuals who need to know this Information to comply with federal standards to protect your nonpublic personal Information. We do not disclose this Information about you or any former consumers or customers to anyone, except as permitted by law. The law permits us to share this Information with our affiliates. The law, also permits ns to share this Information with companies that perform marketing. When we share nonpublic Information referred to above, the Information is made available for limited purposes and under controlled circumstances. We require third parties to comply with our standards for security and congentiality. We do not permit use of consumer/customer Information for any other purpose nor do we permit third parties to rent, sell, trade or otherwise release or disclose Information to any other party. Education As of the date of this report, l andlor Steven W. Barrelt, SRPA, SRA, have completed the requirements under the continuing education program of the Appraisal Institute. 11 .. u. b?3??'LRStp? e ?._ f" - Fie No. 04-0845 DEFINITION OF MARKET VALUE: The most probable price which a property should bring In a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price Is not affected by undue stimulus. Implicit In this definition Is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well Informed or well advised, and each acting In what he considers his own best Interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash In U.S. dollars or In terms of financial arrangements comparable thereto, and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions' granted by anyone associated with the sale. 'Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily Identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party Institutional lender that is not already Involved in the property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the markers reaction to the financing a concessions based on the Appraiser's judgment. STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION rl ?? CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report Is subject to the following conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appralsed or the title to it. The appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title. The property is appraised on the basis of it being under responsible ownership. 2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the Improvements and the sketch is included only to easier the reader of the report In visualizing the property and understanding the appraiser's determination of Its size. 3. The appraiser has examined the available good maps that. are provided by the Federal Emergency Management Agency (or other data sources) and has noted In the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because the appraiser Is not a sways, he or she makes no guarantees, express a Implied, regarding this determination. 4. Tha appraiser will not give testimony or appear In court because he or she made an appraisal of the property In question, unless specific arrangements to do so have been made beforehand. 5. The appraiser has estimated the value of the land In the coat approach at Its highest and best use and the Improvements at their contributory value, These separate valuations of the lend and Improvements must not be used in conjunction with any other appraisal and, are Invalid they are so used. 6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the presence of hazardous wastes, toxic substances, etc. ) observed during the Inspection of the subject property or that he or she became aware of duing the normal research involved In performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapperent conditions of the property or adverse environmental conditions (Including the presence of hazardous wastes, toxic substances, etc. ) that would make the property more or lees valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or Implied, regarding the condition of the property. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser Is not an expert In the field of environmental' hazards, the appraisal report must not be considered as an environmental assessment of the property. 7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such Items that were furnished by other parties. 8. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Pracdco. 9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, a alterations on the assumption that completion of the Improvements will be performed in a workmanlike manner. lib. The appraiser must provide his or her prior written consent before the lender/client specified In the appraisal report can distribute the appraisal report (Including conclusions about the property value, the appraiser's Identity and professional designations, and references to any professional appraisal organizations or the firm with which the appraiser Is associated ) to anyone other than the borrower; the mortgagee or Its successors and assigns; the mortgage Insurer; consultants; professional appraisal organizations; any state or federally approved financial institution; or any department, agency, or Instrumentality of the United States or any state or the District of Columbia; except that the lender/client may distribute the property descriptlon section of the report only to data collection or reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, or other media. Fmddle RA- Frvm Ale 9A1 P.- 1 of 9 Fannin u.. ic- f nndR a_03 11 APPRAISERSCERTWICATION: The Appraiser certifies and agrees that: File No. 04-0845 1. 1 have researched the subject market area and have salad ad a minimum of three recent sales at properties most similar and proximate to the subject property for consideration In the sales comparison analysis and have made a dollar adjustment when appropriate to reflect the market reaction to those Items of significant variation. If a significant Rem In a comparable property Is superior to , or more favorable than, the subject property, I have made a negative adjustment to reduce the adjusted salsa price of the comparable and, if a significant hem in a comparable property is Inferior to, or less favorable than the subject property, I have made a positive adjustment to Increase the adjusted sales price of the comparable. 2. 1 have taken Into consideration the factors that have an Impact on value In my development of the estimate of market value in the appraisal report. I have not knowingly withheld any significant Information from the appraisal report and I believe, to the best of my knowledge, that all statements and Information In the appraisal report are true and corned, 3. 1 stated In the appraisal report only my own personal, unbiased, and professional analysis, opinions, and concluslons, which are subject only to the contingent and limiting conditions spedfled in this form. 4. 1 have no present or prospective Interest in the property that is the subject to this report, and I have no present or prospective personal Interest or bias with respect to the participants In the trarmaction. I did not base, either partially or completely, my analysis and/or the estimate of market value in the appraisal report on the race, color, religion, sex, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties In the vicinity of the subject property. S. I have no present or contemplated future Interest in the subject property, and nelther my current or future employment nor my compensation for performing this appraisal is contingent on the appraised value of the property. 6. 1 was not required to report a predetermined value or direction In value that favors the cause of the client or any related party, the amount of the value estimate, the attainment of a specific: result, or the occurrence of a subsequent event In order to receive my compensation andior employment for performing the appraisal. 1 did not base the appraisal report on a requested minimum valuation, a specific valuation, a the need to approve a specific mortgage pan. 7. 1 performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place as of the effective date of this appraisal, with the exception of the departure provlelon of those Standards, which does not apply. I acknowledge that an estimate of a reasonable time for exposure in the open market Is a condition in the definition of market value and the estimate I developed is consistent with the marketing time noted In the neighborhood section of this report, unless I hove otherwise stated In the reconcfisfion sadion. 8. 1 have personally Inspected the Interior and exterior areas of the subject property and the exterior of all properties listed as comparables in the appraisal report. 1 further certify that 1 have noted any apparent or known adverse conditions in the subject Improvements, on the subject site, or on any site within the Immediate vicinity of the subject property of which I am aware and have made adjustments for these adverse conditions In my analysts of the property value to the extent that I had market evidence to support them. I have also commented about the effect of the adverse conditions on the marketability of the subjed property. 9. 1 personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report. If I rolled on significant professional assistance from any Individual or individuals In the performance of the appraisal or the preparation of the appraisal report, I have named such Indlvidual(s) and disclosed the specific tasks performed by them in the reconciliation section of this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any Item in the report; therefore, 5 an unauthorized change Is made to the appraisal report, l will take no responsibility for R. SUPERVISORY APPRAISER'S. CERTIFICATION: If a supervisory appraiser signed the appraisal report, he or she certifies and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree with the statements and conclusions of the appraiser, agree to be bound by the appraiser's cerd8catione numbered 4 through 7 above, and am taking lull responsibility for the appralsal and the appraisal report. ADDRESS OF PROPERTY APPRAISED: 270 At Pat Drive DillsburgPA 17019 _ APPRAISER: Signature: 1 Name: Cassandra J. Crockett _ Data Signed: 0110512005 State Certification t. RL-001348-L or State License V. _ Stater PA Expiration Date of Certification a License: June 30. 2005 SUPERVISORY APPRAISER (only M reajulred) Signatve: ? ? _ Name: Steven W Barrett SRPA SRA Date Signed: 0110612005 State Cadifzstion P. OA-000288-L or State License #: RB-028921-A Expiration Date of Certification a Llcanse: June 30, 2005 ? Did ® Di Not Inspect Property Certified Residential Appraiser Certifled General Appraiser FledAe aAve P,m 630 e-an Memoers ISL reucrai i.reuiL Uiuvrt vnnne - MY AWcuuMS - vices rWwunt lieuuis rage i w i s You may sort your account register by date, ID, or amount by clicking o n the appropriate column heading. Account: HOME EQUITY/03 Current Balance 01/01/2005 $74,182.94. Available Balance _ 01/01/2005 $0.00. Year to Date Interest 01/01/2005 $0.00 Payoff Amount 01/01/2005 $74,649.46 `Interest Rate 4.990 Prior Year Interest $3,552.80 Next Payment Date 01/01/2005 Next Payment Amount $433.20 There are no transactions for the date range selected. C http nFFxaaocu vuiuw - vvt a v wuv - rage t or t AD ¦ ?? F?.; The Recognized Authority Since 1933 Home I Subscribe to Trade Guides I Site Map I FP ifli rLC ane I ?? I? t Fiea v?riick ?f?c,ng8inlarr`ak6n New Car Dealer Quote I Vet an Auto Loan I Free VIN Check I Free insurance Quote I Free Warranty Quote I Check Your crn You are here: Categorv > Make > Year > Model > Vehicle Options > Vehicle Value Report> Get Another Price Gtheri You v Sevnn.. ?.. I tSed Car 'C^"So.-Mr Pr's°..s Might hY Need... 1998 Chevrolet C1500 Pickup-112 Ton- April 14, 2004 For this vehicle V8 Print Report Flestside Ext. Cab 6112' • Email a friend 72,000 miles • Find this Car K as the 1st position of the model # denotes 4WD Other services • New Car Dealer Quote Average Trade-in Average 13etaol • Car Loans - 31.991% Base Price $8,500 $10,625 APR • Insurance quote • Vehicle History • Extended,Warranty Mileage Adjustment • FREE VIN check *'-S • Get LoJack at a 72,000 miles add: $225 $225 dealer, near you, • Auto Transport Options and Equipment • DIMMforms Power Seat add: $100 $125 • Check your credit . Parts & Accessories Third Door (Std. Sportside) add: $200 $225 • Car Care Center 4 Wheel Drive add: $1,900 $2,125 For a new car Compact Disc Player add: $50 $75 • Price a new car • Compare side-by-side Aluminum/Alloy Wheels add: $100 $125 • New Car Reviews ncentives & Rebates • i Silverado Trim add: $400 450 . _ _. • Dealer Price Quote Add Trailer Towing/Camper add: $50 $75 . Leasing Library Pkg. Certification and Extended Warranties In other words Total Price $11 525 r $14 050 , Find out what you can afford with our "Lease or Average Retail Price represents a clean vehic a in go condition and is assumed to Purchase" calculator have a Clean Title History. Looking to purchase a new car? Get a free quote from a i Go to New f"Flississ dealer near you. Obtain used car financing rates as low as 4,40 % APR. Selling your comparison and r P vehicle? Print a checklist and the required DMV Title & Registration forms to complete your sale. Sell your car through AutoTrader.com, and get the most money for your Lu vehicle. 4 You have u _ http;llwww2.nadauWdes.comNaluesNalueCate2oryReport.asp?U serID=530819E26D 169... 1VAtJA Appraisal Guides - Oet a Value - You are here: Category > Make > Year > Model > Vehicle Options > Vehicle Value Report > Get Another Price d You ion ... Used Car Consumer Prices 1 !Migght ht Ne Ne Otheri etl Page 1 of 2 ADA,gulde5i The Recognized Authority Since 1933 Home I Subscribe to Trade Guides I Site Map I Ff Fr'ee'vchick Pricing 8 InbnnaLan r r ; :'• ' "}r?'. ",': New Car Dealer Quote I Get an Auto Loan I Free VIN Check I Free Insurance Quote I Free Warranty, 4Quote I Check Your Cre 2000 Chevrolet Blazer-1/2 Ton-V6 April 14, 2004 For this vehicle Tailgate 4D LS (4WD) • Print Report 47,000 miles • Email a friend • Find this Car A verage Trade- In Average l2etail Base Price $9,800 $12,050 Other services • New Car Dealer Quote • Car Loans-- 3.99% Mileage Adjustment APR • Insurance quote 47,000 miles add: $350 $350 • Vehicle History • Extended Warranty • FREE VIN check Options and Equipment dealer near you. Power Seat add: $125 $150 • Auto Transport Bose Stereo System add: $150 $175 • DMV forms Leather Seats add: $300 $350 • Check your credit • Parts & Accessories LT Trim add: $500 $575 • Car Care Center Add Trailer Towing/Camper add: $100 $125 Pkg. Average Retail Price represents a dean vetion and is assumed to hicle in condi have a Clean Title History. Looking to purchase a new cart Get a free quote from a dealer near you. Obtain used car financing rates as low as 4.400/o APR. Selling your vehicle? Print a checklist and the required DMV Title & Registration forms to complete your sale. Sell your car through AutciTrader,com, and get the most money for your vehicle. Certification and Extended.Warranties $ Other Vehicle Information Total Price 11,325 $13,775 Model Number: T13 Weight: 4049 M1?7, Value Explanations The free consumer values on NADAguides.com are based on the Consumer edition of For a new car • Price a new car • Compare side-by-side • New Car Reviews • Incentives & Rebates • Dealer Price Quote_ • Leasing Library In other words Go to trF 1t C http://www2.nadaguides.comNaluesfValueCategoryRoport.asp?UserID=530819E26D 169... 4/14/2004 Find out what you can afford with our "Lease or Purchase" calculator NADA Appraisal Guides - Get a Value - Motorcycles Page 1 of 2 ?1RD 'des The Recognized Authority Since 1933 Home I Subscribe to Trade Guides I Site Map I FP dak IN Free Vehicle Pricing & Information > > Get a Bike Loan I Free Insurance Quote I Check Your Credit I Give Us Your Feedback Apply today, ride away on: Bike Loans E+ TRADE Friday 11.09:14 ipl Noww Motorcycle, Snowmobile Consumer Pricing 1981 to 2003 YAMAHA 1998 4 Wheel ATV Model: YFM350FXK WOLVERINE Piston Displacement (CCs): 348 Stroke: 4 Cylinders: 1 Speeds: 5 Dry Weight: 485 Low Retail: a $2150 Average Retail: $2,830 Print Rep!or Research A New Car 443t Anokher Prlc!e What's Your Credit Score' Need a new Pickup Truck or SUV to haul your Motorcycle or ATV? Before you buy Check your Credit and get a Free Finance Quote. ??? Obtain a Free Insurance Quote for your Motorcycle. f ------ - --------- ----- ------- Click below on the first letter of the Manufacturer's Name. 16I8 IC19IEIFI93 IHII111KILIMINI9 IPIRIaITIVIVIWIYI r 650 [ Motorcycle/ATVs I Side Cars I Motorcycle Trailers Snowmobile I Personal Watercraft ] You have received 1 of the 10 free daily values for Motorcycles Low Retail Value - low retail unit may have extensive wear and tear. Body parts may have dents and blemishes. The buyer can expect to invest in cosmetic and/or mechanical work. This vehicle should be in safe running order. Low retail vehicles usually are not found on dealer lots. Average Retail Value - An average retail unit should be clean without obvious defects. All rubber and cables should be in good condition. The paint should match and have a good finish. All lights and switches should work properly. The mileage should be within or slightly comumsn soar higher than the average range. This unit should also pass any emission inspection. PLAINTIFFS S EXHIBIT n http://www2. nadaguides.conl/Values/V alueReport.asp?Userll)=550919E2C424F&DID=3 ... 4/14/2004 isrttJJAtipprntsat uwues - vet a value - motorcycles Yage 1 Ot 2 - , The NADAguides Recognized Authority Since 1933 Home I Subscribe -to Trade Guides I Site Map i FP - Free Vehicle Pricing & iniorinabon Get a Bike Loan I Free Insurance Quote I Check Your Credit I Give Us Your Feedback POLARIS 2000 4 Wheel ATV Model: TRAIL BOSS 325 Piston Displacement (CCs): 325 Stroke: 4 Cylinders: 1 Speeds: V Dry Weight: 504 Low Retail: $1,505 Average Retail: $1,975 Print Report rResearch A New Car $G®t AA, mother Puce I-) DUE TO LIMITED DATA WE ARE UNABLE TO DETERMINE A USED VALUE AT THIS TIME Need a new Pickup Truck or SLIV to haul your Motorcycle or ATV? Before you buy Check your Credit and get a Free Finance Quote. Obtain a Free Insurance Quote for your Motorcycle. Click below on the first letter of the Manufacturer's Name. [AIBICIDIEIFIG IH11IJIK ILIMINIOIPIRISITIL) IVIWIYl [ Motorcycle/ATVs I Side Cars I Motorcycle Trailers I Snowmobile I Personal Watercraft ] You have received 2 of the 10 free daily values for Motorcycles Low Retail Value - low retail unit may have extensive wear and tear. Body parts may have dents and blemishes. The buyer can expect to invest in cosmetic and/or mechanical work. This vehicle should be in safe running order. Low retail vehicles usually are not found on dealer lots. Average Retail Value - An average retail unit should be clean without obvious defects. All rubber and cables should be in good condition. The paint should match and have a good finish. All lights and switches should work properly. The mileage should be within or slightly higher than the average range. This unit should also pass any emission inspection. Bike Loans Ei TRADE Apply todal n"ide away an Bike Loans E4 TRADE 14;L http://www2.nadaguides.comNaluesNalueReport.asp?UserID=530819E26D NADA Appraisal Guides - Get a Value - Motorcycles Pagel of 2 -- The R NADAg ecognized Authority Since 1833 Home I Subscribe to Trade Guides I Site Map I FP ?uia?s NAtiA Free vehicle Prahrig B lntarmahan i r • 'i "" ' AK- Get a Bike Loan I Free Insurance Quote I Check Your Credit I Give Us Your Feedback America's 01 Motorcycle Insurance Company I Motorcycle, Snowmobile Consumer Pricing '1981 to 2003 I YAMAHA ......_...- ... 1998 4 Wheel ATV Model: YFM80K BADGER Piston Displacement (CCs): 79 Stroke: 4 Cylinders: 1 Speeds: 3 Dry Weight: 243 Low Retail: $1,0 Average Retail- 1,330 1 a 7 ,? GPI' A. not/ter Price Print Report 4GOResearch A New Car Need a new Pickup_Truck or SUV to haul your Motorcycle or ATViI Before you buy Check.your_C_redit and get a Free Finance Quote. Obtain a Free Insurance-Quote for your Motorcycle. Click below on the first letter of the Manufacturer's Name. [AIBICIQIEIFIG I H I I I J I K I L IMIN101PIRISITIUIVIWIY1 ( Motorcycle/ATVs I Side Cars I Motorcycle Trailers I Snowmobile I Personal Watercraft ] You have received 1 of the 10 free daily values for Motorcycles Low Retail Value - low retail unit may have extensive wear and tear. Body parts may have dents and blemishes. The buyer can expect to invest in cosmetic and/or mechanical work. This vehicle should be in safe running order. Low retail vehicles usually are not found on dealer lots. Average Retail Value-An average retail unit should be clean without obvious defects. All rubber and cables should be in good condition. The paint should match and have a good finish. All lights and switches should work properly. The mileage should be within or slightly higher than the average range. This unit should also pass any emission inspection. Bike Loans E*TRADE----_ Apply tod'°3 nude away an Friday 1 D:13:32 --- 48 hours -- Bike Loans Ei TRADE 13 http://www2.nadaguides.comNaluesNalueReport.asp?UserID=530819E26D I STATEMENT OF AC'COL. 1 CREDIT UNION PLACE HARRISBURG, PA 17110 PSECO the finxndul link,. JEFFREY A EVANS ANGELA L EVANS IV1%z 6-Q;1 279 ALPAT DR 01/01/04 DILLSBURG PA 17019-9503799 01/31/ 19 F STING" ??' GTNE?E Mxi. - B B! P TF 1' FJy ?eBGREU ? AN??' !9 R ?°? ?NS,SCTRfN : ATE. Tl r !. .v t. v CEBRW ?GE .GEP ? G ?? EW n 01/01 ID 01 REGULAR SHARE Beginning Balance 512.: 01/31 Payment: Dividend 0.750% 0.33 512.( Annual Percentage Yield Earned 0.76% from 01/01/04 through 01/31/04 Based on Average Daily Balance of 512.34 01/31 Ending Balance Dividend YTD: Year to Date Dividend YTD: In 2003 01/01 ID 04 CHECKING Beginning Balance 01/31 Ending Balance Dividend YTD: Year to Date Dividend YTD: In 2003 Y? - Total Dividend YTD: Year to Date Total Dividend YTD: in 2003 Total YTD Finance Charge: Year to Date 0 67,102 512.( 0.33 ?• 0.25 2.` 0.00 1.64 0.33 1.89 0.00 riease oirecr inquiries ro: EDS Credit U-- -*on P. O. Box 250169 Plano, TX 75025-0169 AUTOLINE MONEYLINa 1-800-235-8088 1-800-682 Member Service 1-800-337-3328 Main Office Web Site 214-291-1776 www.edsefcu.org Your Account Number 60202 011 PAGE 1 OF 1 air? * I,DGG2003 00007849 1 AT 0292 09231S L??IIL I IMIII II, a IIInl661InuJIILu1LLr61n1 1701SEVA ANGELA EVANS NS 279 ALPAT DR 007849 DILLSDURG PA 17019 Date ENTAGE YIELD EARNED 01-01.04 THRU 01-31-04 ;020504;AD & D INS 5000 LOUISE DRIVE EDS CREDIT UNION HAS CHOSEN USERS INC. FOR ITS CORE PROCESSING SYSTEM. THE CONVERSION TAKES PLACE ON JULY 1, 2004. LOOK FOR UPDATES IN YOUR STATEMENTS AND ONLINE AT WWW.EDSEFCU.ORG. Payment Finance Late Change to Amount Charge Fees Balance .80 ANNUAL PE FEBOS EFT CUNA MUTUAL FEB09 EFT WITHDRAWAL PA MECHANICSBURG FES29 TOTAL DIVIDEND OF 8.40- 160. Do- Balance 7,800. 7,640. NEW SHARE BALANCE 7,640. $4.88 TO BE CREDITED ON 03101104 PLAINTIFF'S - t5 EXHIBIT ----- ******** 2004 YEAR-TO-DATE FINANCIAL SUMMARY DIVIINT DIVIINT MORTGAGE MORTGAGE MORTGAGE OTHE PAID WITHHOLDING POINTS LATE CHO FINANCE CHG FIN :? Your Statement of Accounts 02-01-04 THRU 02-29-04 ,T ERIE FAMILY LIFE INSURANCE COMPANY Member Be Insurance Group Home Office • 100 Erie Insurance Place • Erie, Perenyhwk 18530 • (814) 8762000 Toll Free 1.800.458-0811 - Fax (814) 8762099 • www.aiekmwwm.com • January 7, 2005 Jeffrey A. Evans 279 Alpat Dr. Dillsburg, PA 17019-9503 Re: Policy # 821-553 Insured: Jeffrey A. Evans Dear Mr. Evans: In accordance with your request, your Universal Life policy has been terminated effective January 5, 2005. The enclosed check(s) - represents all proceeds due you: $ 2,666.26 Cash Surrender Value $ 0.00 LESS Outstanding Loan Balance and Interest Due $ 2,666.26 Net Cash Surrender Value $ 0.00 Refund of Premium $ 2,666.26 TOTAL Amount Enclosed In the future when you review your life insurance needs, we hope you will contact Erie Family Life for assistance in your financial !-)y security planning. If you have any questions, please contact one of our Universal Life Service Representatives at our toll-free number: 1-800-458-0811, extension 4538. Sincerely, Mary Reed, Team Leader Universal Life Services MR:CM2 Life Policy Administration Dept. Enclosures: Check(s) cc: Anthony Insurance, Inc', AA7810 *UL08215530* 17 11 EVANS, JEFFREY A 32020 -SELECT MEDICAL CORP ' <as ui!a v:eauar4: ??- Select Medical Corporationp 4. 401(k) Plan JEFFREY A EVANS 604 AIRPORT DRIVE MIDDLETOWN, PA 17057- Select Medical 401k Statement $ Customer Service: (800) 890-,IM5 Fidelity Investments Insillutional Services Ca 82 Devonshire Street Boston, INA 02109 Your Account Summary Statement Period: 01101/2004 to 01131/2004 Beginning Saloom 878,113.57 Employee Contributions $341.20 Employer Contributions $120.60 Fees -$2.50 Change in Market Value $697.81 Ending Balance $78,370.88 Additional Information Vested Baler. $77,90721 Dividends & Interest $130.92 . ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... . .............................................. 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Your Personal Rate of Return YOIs Period Your Personal Rate of Return Is calculated with a time-weighted formula, widely used by flnandal analysts to calculate Investment earnings. It reflects the results of your Investment selections as well as any activity in the plan account(s) shown. There are other Personal Rate of Return formulas used that may yield different results. Remember that past performance Is no guarantee of future results. Your Asset Allocation Statement Period: 01/01)2(104 to 01/31/2004 Why Is This Important? e-Learning: Lmm about asset allocation. :......................... .................................. ......... ,,,'' ¦ 51.86% Stock Investments: $41,162.44 0 48.14% Bond Investments: $38,208.24 Page 1 of 3 1 https://workplaceservices 100.fidelity.com/netl)enefits/savings2lsodlsoddetail?sodPreview=... EVANS, JEF11F EY A 32U2U - SEL1rUT M> DIUAL Uo" Your account is allocated among the asset classes specified above as of 01/31/2004. Percentages and totals may not be exact due to rounding. i; 0 13 Market Value of Your Account Statement Period: 01/01/2004 to 01/31/2004 Displayed In this section is the value of your account for the statement period, in both shares and dollars. Shams stares Pate Pace Market Veloe Market Value Investment as of to of W of as of a. of u of 12/312003 011312004 121312003 011312004 121312003 01/31/2004 Stock Investments :40,214.65 $41,152.44 FID OA4dand Growth 1,473.064 1,479.599 $27.30 $27.62 $40,214.65 541,182.44 Bond Investments $37,996.92 $39,208.24 FIG MOD IM Part 37,8aa.920 38,208.240 $1.00 $1.00 $37,898.92 $36,208.24 Account Totals $79,113.37 $79,370.60 Remember that a dividend payment to fund shareholders reduces the share price of the fund, s0 a decrease in the share price for the statement period does not necessarily reflect lower fund performance. Your Contribution Elections As of 03/13/2005 This section displays the funds in which your future contributions will be invested. Your Current Investment Elections as of 031132005 All Eligible Sources Investment Option Current Stock Investments FID DIVIDEND GROWTH 50% Bond Investments FID MGD INC PORT 50% Total 100% Your Contribution Summary Statement Period: 0110112004 to 01/31/2004 Contributions Employee contribution Employer Match Reliever Period to date $241.20 $120.60 $0.00 Vested Percent 100% 0% 100% Total Account Balance $3,090.15 $1,463.47 $74,817.06 Total Vested Balance $3,090.15 $0.00 $74,817.06 Your Account Activity Statement Period: 01/0112004 to 01/3112004 Use this section as a summary of transactions that occurred in your account during the statement period. rage 2 or s https://workplaceservices 100.fidelity.com/netbenefits/savings2/sod/soddetail?sodPreview=... 3/13/2005 hVA1VJ, Jl;rPKEY A SLULU - Nh.LA;1 NitVIUALUU-Kr - Activity rte. __ FID Dividend Growth FID MOO Inc Port Total Beginning Balance $40,214.65 $37,898.92 $78,113.57 Employee Contributions $120.60 $120.60 $241.20 Employer Contributions $60.30 $60.30 $120.60 Fees $0.00 -$2.50 -$2.50 Change In Market Value $766.89 $130.92 $897.81 Ending Balance $41,162.44 $36,208.24 $79,370.68 Dividends & Interest $0.00 $130.92 $130.92 Your Account Inforniation As of 03/11/2005 Use this section to ensure Fidelity's records of your Information is up4odate. View Payroll Deductions General Information Participant Status Active " PRINTING INSTRUCTIONS" Click below to print your statement. To print performance, dick anywhere in Performance and click the print button on your browser. Print Statement Alternate Printing Instructions Click anywhere on this online statement screen, then click the print button on your browser. To print performance, click anywhere in performance and click the print button on your browser. Questions? Call (800) 890-4015. Nftu4wrsfsts'h0 PlY. r 646 by ® Copyright 1996-2005 FMR Corp. All rights reserved. a "" o ' Your Security m- . a av ra AA-1 DC=125 HW-4 IA=3 AT-3 SZ=1 11 rage.) or i https://workplaceservices 100.fidelity. com/nethenefits/savings2/sod/soddetail?sodPreview=... 3/13/2005 111111 V I I I I?? I ?? l t I I u u¦ Ip'°' Illlllui??? M a N ? o M .. ?z a y IN 2t wi r° o °viVm 0 °m do N Q i 0 .A S Co wti 3 'y A 7 ? y s r 3 d; 0 a ° W - O o C6 r f'1 ., W raj ? 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'c m ?? jE c m i _ m rn c o 3: a (a N a' C o N m mN n 0 m c ` E o N m c c i U 2'm' v? m m ¢ .0a rtir N N b N N 0 d m ?'O VI 6 O d F .0 N C O N C V f- 0 0 a c I °n ?'L O O m0 dry' Oi to o M1 O m m v, m w 0 x LL UJ? LL ? ul x ?oLL w V Z yQ ? ¢ Z t n 6 O ?+ V Z? d L] Z W O W Q LL Z ]Nrym[ ?_ Q ¢ a Z 2 a ti 2 o u c ? O ? d ? p O 9 C ? ? A O O w N M N o 0 r: ? D m ai C N N ?s+ ? ? O O C C rn rn' ? a r_ r -- C 0 v? Q O d r O N L r O S m O! O = N r C; rn ? 0 m V ou'. J p Z O N O °m ?twJOm ? Z `?'1U Z? 4`?a ??DOw?ZZt d m p d- u ?j r7-?=ld ?.. e2 O N u Z _ 9 C O d a m A o N L O ? p o u v e S 6 Q ~ ,y y N C rw ? `U ?J N V U?1 ' e y N ? te ? u ° y? Y! C ? O N _ ? N N 'g ? ? Y }? g 6 o W Q U op ? ? 2 O Y N[ W ? O J d 4 a Z `L > CC EE C) U N 2 O r ? T O O Q 6 O Y Z OU or `c = O Y Z Y Y 4 Q U Z C, ?? og CC ? Q O z) J [ccO QLo Zz 74 J "?? 0 U3 0 0 T W a 0 0 ZrZ(5 X U 4 4 Z W W ??? QfC ? O C Qi L iS U of a3 m? 6 dggy° s? r v Your investment ana Account z?ummartes - reusiou tu;wtutt otutntuuy rirLt_t -page from your browser, and then cI?_this browser window to return to your original task. Company: EDS Name: ANGELA L EVANS Investment and Account Summaries Account Summary Personal Pension Account Opening Balance on 01-01-2004 Interest Closing Balance on 01-31-2004 Balances for any given month are typically updated near the end of the following month. Vesting as of 08-12-2004 You are 100% vested in the plan. Copyright ® 1997-2004 Hewitt Management Company LLC Personal Pension Account Account Balance $7,356.29 $7,391.17 PLAINTIFF'S EXHIBIT Date: 08-12-2004 Time: 9:45 a.m. ../TbiaTrnsPage?nodeld=DbCshbAcctSumPage&u=109232186101 Your investment ano Accoum .lumtnartCS - retl,tuti rtu:uwu otuintiniy , -5' Prin this oaoe from your browser, and then close this browser window to return to your original task. Company: EDS Date: 08-12-2004 Name: ANGELA L EVANS Time: 9:41 a.m. Investment and Account Summaries Account Summary Personal Pension Account Personal Pension Account Account Balance Opening Balance on 02-01-2004 $7,391.17 Closing Balance on 02-28-2004 $7,391.17 Balances for any given month are typically updated near the end of the following month. Vesting as of 08-12-2004 You are 100% vested in the plan. Copyright ®1997-2004 Hewitt Management Cornpany LLC ...ITbiaTrnsPage?nodeId=DbCshbAcctSumPage&u=1092321607536&llId=default&Device=P09112/2004 r our rnvesunent ana Account aummanes - renslon Aecounr ?Pumrnary Print this page from your browser, and then close this browser window to return to your original task. Compan Name: ANGELA L EVANS Investment and Account Summaries Account Summary Personal Pension Account Opening Balance on 11-01-2004 Interest Closing Balance on 11-30-2004 Balances for any given month are typically updated near the end of the following month. Vesting as of 01-01-2005 You are 100% vested in the plan. Date: 01-01-2005 Time: 4:00 p.m. CST Personal Pension Account Account Balance $7,712.58 $36.57 $7,749.15 Copyright C 1997-2005 Hewitt Management Company LLC rage 1 of i https://1b22.resources.hewitt.comlellybrdgp8/tbiappt400l TbiaTrnsPage?nodeId=DbCshbAc... 1/1/2005 Your Investment and Account summaries - rension rtu:utun )ujLuinuy l Mbv . -. bA-0 Print this oaag from your browser, and then close t17is browser window to return to your original task. Company: EDS Name: ANGELA L EVANS Investment and Account Summaries Account Summary Personal Pension Account Opening Balance on 12-01-2003 Interest Closing Balance on 12-31-2003 Balances for any given month are typically updated near the end of the following month. Vesting as of 08-12-2004 You are 100% vested in the plan. Copyright ® 1997-2004 Hewitt Management Company LLC Date: 08-12-2004 Time: 9:43 a.m. Personal Pension Account Account Balance $7,324.64 $31.65 $7,356.29 .../TbiaTmsPage?nodeld=DbCshbAcetSumPage&u=1092321760297&lHd=default&Device=P08/12/2004 W"S 012601 ANGELA L. EVANS 279 ALPAT DRIVE DILLSBURG PA 17019 EDS Retiren._at Plan Statement Statement Date 02-07-2004 Your Account Summary from January 1, 2003 to December 31, 2003 Opening Balance on January 1, 2003 $6,985.36 Interest Credits $370.93 Basic Credits $0.00 Excess Wage Credits $0.00 Conversion Credits $0,00 Mid-Career Adjustment Credits $0.00 Closing Balance on December 31, 2003 $7,356.29 56 9 of-, You are vested in your Personal Pension Account. Birth Date November 13, 1965 Hire Date January 6, 1986 Interest credits this yea- were credited to your opening balance compounded monthly at a rate of 5.31%. C delivered by He"I t 123330049 03169-012601 October 01, - December 31, 1997 f For information call: Vanguard Participant Services In the USA (800) 523-1188 Pagel of E EDS DEFERRED COMPENSATION PLAN Plan No.: 091333 Soc. Sec. No.: 183-50-6514 ANGELA L EVANS Balance $ 7,182.06 279 ALPAT DR DILLSBURG PA 17019-9503 YOUR. ACCOUNT ACTIVITY This quarter Year-to-date Opening balance $ 6,709.03 $ 5,370.21 Contributions EE PRETAX BASIC $ 257.52 $ 1,030.08 Earnings Dividends/capital gains $ 272.26 $ 466.34 Unrealized gain/loss -56.75 315.43 Closing balance $ 7,182.06 $ 7,182.06 Any information labeled as Year-to-Date represents activity since January I of the current calendar year. Earnings are defined as the net change in your account value due to the reinvestment of dividends and/or interest, as well as the change in the fund prices. A detailed explanation can be found on the reverse side of this statement. YOUR PLAN ALLOCATION BY CATEGORY Current asset mix Contribution allocation Short-term 49% 60.0% This information will help you evaluate JU reserves Chow your plan savings are invested. Your O Bonds 16% 14.0% overall asset mix should be based on your Stocks 30% 26.0% investing time frame and your risk ® Company Stock 5% tolerance. See "A 401(k) Plan for Your Future" included in your EDS Employee Handbook or request a copy from Moore at (972) 605-9736. 17329 X 1111116111111111111111111111111II III II 111/111111 Fill VIII fell HIM IHI fill III October 01, 1997 - December 31, 1997 Page 2 of 6 For information call: Vanguard Participant Services ® In the USA (800) 523-1188 ANGELA L EVANS HOW YOUR CONTRIBUTIONS ARE INVESTED AS OF 01/23/1998 EE PRETAX BASIC Income Fund 60.0% Vanguard/Wellington Fund 40.0% CONTRIBUTION PERCENTAGE AS OF 1281/1997 _ Your deferral percentage is 5.00% of your salary If you would like to change the amount you are contributing, please update your percentage on the Corporate Administrative System (CAS). YOUR FUND IS PERIOD Opening balance Net change Cbsing balance Vanguard Money Market Reserves- Prime Portfolio $ 6.08 $ 0.09 $ 6.17 Income Fund 3,253.39 205.88 3,459.27 Vanguard/WellingtonFund 3,154.35 196.08 3,350.44 EDS Stock Fund 295.20 70.98 366.18 Total $ 6,709.03 $ 473.03 $ 7,182.06 Vanguard Money Market Reserves- Prime Portfolio Opening balance $ 6.08 Dividends/capital gains 0.09 Closing balance $ 6,17 Closing share price $ 1.0000 Closing shares 6.170 Income Fund Opening balance $ 3,253.39 Contributions 154.50 Dividends./capital gains 51.38 Closing balance $ 3,459.27 Closing share price $ 1.0000 Closing shares 3,459.270 17329 X 1n111u1n1111Hill 111111111111nfill Hill n111111uu Hill lnnHill III) Vanguard/Wellington Fund October 01, 1997 - December 31, 1997 For information call: Vanguard Participant Services In the USA (800) 523-1188 ANGELA L EVANS EDS Stock Fund Page 3 of 6 Opening balance $ 3,154.36 Opening balance Contributions 103.02 Dividends/capital gains Dividends/capital gains 219.56 Unrealized Clain/loss Unrealized gain/loss .126.50 Closing balance Closing balance $ 3,350.44 Closing unit price Closing share price $ 29.4500 Closing units Closing shares 113.767 Company stock price _ Approximate stock shares MARKET NEWS $ 295.20 1.23 69.75 $ 366.18 $18.7200 19.561 $ 43.9375 8.33 Strong economic growth and low inflation helped the U,S. stock market achieve another exceptional year, with the S&P 500 Index gaining 33.496 in 1997. However, financial turmoil in Asia took center stage in the fourth quarter, with Japan's economy faltering and many of the region's emerging markets hurt by slumping real estate prices and nearly insolvent banking sectors. Fear that Asia's troubles might spread worldwide led to sharp losses in U.S. markets in October, but the S&P 500 recovered to gain 2.996 for the quarter - its 12th consecutive quarterly gain. Smaller-capitalization stocks lagged the overall market, with the Russell 2000 Index falling 3.3% over the last three months of 1997, but gaining 22.496 for the year. Lower inflation and a "flight to quality" resulting from Asia's problems benefited domestic fixed-income investors as long-term interest rates fell. The Lehman Aggregate Bond Index rose 2.9% in the fourth quarter and 9.7% for the year. Although the Federal Reserve boosted short-term interest rates slightly during 1997, the yield on the bellwether 30-year U.S. Treasury Bond fell to 5.92%, a decline of 0.48% in the fourth quarter and 0.72% since the end of 1996. Investments outside the United States suffered, reflecting Asia's woes and a stronger U.S. dollar. For U.S. investors, MSCI's Europe, Australasia, Far East Index fell 7.7% in the fourth quarter and gained a modest 2.1% for all of 1997 (in dollar terms). The European markets in the Index performed relatively well, up 24.2% for 1997, but were offset by returns from Asia - especially Japan, whose; market plummeted 23.5%. c ,y a. 17329 X 1111111 PI 1111111 Hill 1111111111111111111111111111111111111111111 Hill III II iii I IIE October 01, 1997 - December 31, 1997 Page 4 of 6 For information call: Vanguard Participant Services ® In the USA, (800) 523-1188 ANGELA L EVANS PERFORMANCE SUMMARY AS OF 12/31/1997 VOICE'" fund Date fund Year-to Slnce fund number started 3 months -date 1 year 5 years 10 years started Short-Tenn Reserves • Vanguard Money Market Reserves- Prime Portfolio Lipper Money Market Funds Average • Income Fund Bonds Vanguard Bond Index Fund- Total Bond Market Portfolio Lehman Aggregate Bond Index Balanced (Stocks and Bonds) • Vanguard/WellingtonFund Wegington Composite Index Domestic Equity (Stocks) Vanguard Growth and Income Portfolio S&P 500 Index VanguardU.S. Growth Portfolio Upper Growth Vanguard Explorer Fund Small Co. Growth Fund Stock Index 0030 0637 06/04/1975 12/31/1984 1.36% 1.23 1.55 5.44% 4.90 6.19 5.44% 4.90 6.19 4.72% 4.26 6.60 5.86% 5.37 7.85 7.69' --- 8.82 0084 12/11/1986 2.83 9.44 9.44 7.42 8.88 8.09 2.94 9.65 9.65 7.48 9.18 --- 0021 0710111929 2.88 23.23 23.23 16.54 14.69 8.43 3l32 26.27 26.27 16.37 15.52 --- 0093 12/10/1966 1.73 35.59 35.69 20.74 18.33 16.52 2.87 33.36 33.36 2027 18.05 --- 0080 01/06/1959 4.02 25.93 25.93 17.61 18.18 13.65 -1,15 25.30 25,30 16.16 15.41 -- 0024 12111/1967 -5.59 14.57 14.57 13.93 15.30 9.55 -5.00 20.56 20.56 16,06 15.58 --- Irdemstlonel Equity (Stocks) Vanguard International Growth Portfolio 0081 09130/1981 -9.47 4.12 4.12 14.87 9.23 15.82 MSCI EAFE Index -7.77 2.06 2.06 11.71 6.56 --- Client Specific , • EDSStockFund 1117 12/3111984 24.04 2.88 2.88 7.12 17.91 17.24 S&P 500 Index £:.87 33.36 33.36 20.27 18.05 --- • Indicates the funds in which you have balances. --- Not available for this time period. See "Date fund started". Performance figures for periods of more than one year are expressed as average annual total returns. Performance figures include the reinvestment of dividends and, capital gains distributions. Return since inception is listed under "Since fund started". The inception date is under "Date fund started". Standard & Poor's 500,' "S&P 500®,' "Standard & Poor's@," "S&P®," and "500" are trademarks of The McGraw-Hill Companies Inc. , 17329 X I11111111111 INN IIIII IIIII 11111111111111111111 III81IIit IIIII1111111111III11AI October 01, 1997 December 31, 1997 Page 5 of 6 For information call: Vanguard Participant Services In the USA (800) 523-1188 ANGELA L EVANS PERFORMANCE SUMMARY AS OF 12131/1997 (CONT'D. The total return data provided represent past performance, and the investment return and principal value of an investment will fluctuate so that an investor's shares, when redeemed, may be worth more or less than their original cost. . An investment in a money market fund is neither insured nor guaranteed by the U.S. government, and there is no assurance that the fund will be able to maintain a stable net asset value of $1 per share. Vanguard funds are neither insured nor guaranteed by the U.S. government. The Performance Summary above shows how the funds in your Plan have performed over time. Please keep in mind that the performance of these funds as compared with your balance, may differ depending on how and when your money was invested. The Performance Summary includes industry benchmarks (in italics) that match the objectives of your funds. The benchmarks give a broad overview of the markets. These measures are specific to their associated funds and should not be used to compare funds with different investment objectives. A MESSAGE FROM YOUR EMPLOYER 1998 Internal Revenue Service Limits The 1998 IRS limits for 401(k)contributions are as follows: ` Elective Deferral Limit--$10,000 " Compensation Limit--$160,000 In the event you reach one of these limits, your contributions will automatically be stopped until the beginning of the following plan year. Did You Know...? The EDS Deferred Compensation plan is qualified under the Internal Revenue Code (IRC). The IRC requires the plan to pass certain tests. The plan may be required to make refunds of excess 1996 deferrals or contributions to certain participants. Participants should delay filing income tax returns pending the outcome of these tests. Two of these tests are: ` Section 415(c) Test. Each participants total deferral dollars in a calendar year may not exceed the lesser of $30,000 or 2555 of compensation. Compensation does not include pre-tax premiums or spending accounts under the EDS Flexible Benefits Plan or pre-tax deferrals, such as deferred compensation. " A Non-Discrimination or "Fairness" Test must be passed to ensure the plan does not provide greater benefits to certain groups of participants. Termination Distribution, Withdrawal and Loan Applications 17329 X IIIIIII IIIIIIII lilt pill IIIIIIII Nil lilt 1111111111111111111111111111111111111111111) IIIII111 Aft RS-erect Employmmt Services, Inc. 4716 Old Gettysburg Road Mechanicsburg, PA 17055 PNC',BANK 60-12731313 CENT-'L PA DIRECT DEPOSIT ADVICE Members 1st Savings Account XXXXXX3000 729.61 Mr. Jeffrey A. Evans 604 Airport Drive Middletown PA 17057 NON-NEGOTIABLE *** PLEASE TAKE NOTE OF YOUR NEW EMPLOYEE NUMBER **` C EMPLOYEE NAME SOCNL SECURITY NO. EMPLOYEE NUMBER ORGANIZATION Mr. Jeffrey A. Evans 178-58-4097 134441 Select Medical Mechanicsburg PERIOD START PERIOD END PAYMENT DATE CHECK NUMBER BASE SALARY EID HOURS PTO HOURS 26-JUN-2004 09-JUL-2004 16-JUL-2004 4529.08 81 216 FEDERAL FILING STATUS FEDERAL ALLOWANCES STATE FILING STATUS STATE ALLOWANCES Married 0 Not Used PA 0 DESCRIPTION HOURS AMOUNT YEAR TO DATE DESCRIPTION AMOUNT YEAR TO DATE R ary 80.00 2090.34 31974 79 FIT 197.68 4952.61 Bonus 0.D0 7 9.0 MEDICARE 28.05 537.02 mou ed In 0.18 SS 119.94 2296.23 (PA) SIT 59.38 1136.90 (PA) SUI 1.88 35.20 Paid Time Off 0.00 EID Time Off 0.00 (Lower Allen To 19.34 370.28 PTO Accrual 5.54 EID Accrual 1.85 (Lower Allen To 0.00 10.00 PTO Balance 216.00 EID Balance 81.23 (NORTHERN Y) SD 0.00 39.12 Child Support G 639.00 1278.00 Dental Plan 12.98 194.70 Dependent Life 0.49 7.35 Medical Plan 143.06 1885.71 Savings 401 k PI 125.42 1876.48 Spousal Life 2.54 37.18 Supplemental Li 10.97 160.30 PL AINTIFF'S Gross Pay 209052 39116.33 EXHIBIT Pre-Tax Deductions 281.46 7 3956.69 937 36 DIRECT D EP < ao Tax Deductions 426.27 7. Other DarlurlinnR 653.00 1482.83 U e r4'R", • cep class IOW. ep GA strong. 4 '. ,check Lsell66ulraj.lfilial ln,lelgill sustill mill nllal alb b: MBNA AMERICA P.O. BOX 15019 WILMINGTON, DE 19886-5019 Fa account Intamand can 1-8(10.789.8685 Pont change of addws a new telephone number balm PLATINUM PLUSO rr. ... ,r. •A••4 WWW.snbnaneb=,w corn 55490 9907 51701176 PAYMENT DUE DATE WW EI&ANDET07*r? 03/09/04 cooA.AF TOTALAINSWUMPAYMB/TDUE AIOIWTENCLCWEO CARDHOLDER SINCE $t5.00 1987 DETACH TOP PORTION AND RETURNW W PAWNT JEFFREY A EVANS 279 ALPAT DR DILLSBURG PA 17019-950379 cry aide 21P ( ) t ) 12 00023445000015000005490990751701176 Hams phares Work phana .41,111 14andr Crad9Lna pan a Cm*AalNWa a7r cycle O DO. Taar ARnharm Aa msMDw Pe nod DUe Deb 5490 9907 5170 1176 $23,500.00 $23,265.55 29 02/12/04 $15.00 03/09/04 Ong Egan Taa^ewla^a FEBRUARY 2004 STATEMENT p"'EOa d°eft0 therber TV" AYMENTS AND CREDITS 1/20 5112 MC BJ WHOLESALE #0015 WOX WILMINGTON DE 1/24 5566 MC PAYMENT - THANK YOU URCHASES D ADJUSTMENTS 1/16 15 6933 MC C BJ WHOLESALE #0015 WOX WILMINGTON DE 54.99 2/06 2808 MC C PAYPAL SHOPOEM 402 935 7733 CA 12.99 TAL FOR BILLING CYCLE FROM 01/15/2004 THROUGH 02/12/2004 $87.98 1IMPORTANT NEWS ENJOY THE CONVENIENCE AND FLEXIBILITY THE ENCLOSED CHECKS OFFER. t PLEASE SEE YOUR NEW PAYMENT DUE DATE ABOVE. IF YOUR TOTAL MINIMUM PAYMENT DUE I IS RECEIVED AFTER THE PAYMENT DUE DATE YOU MAY BE ASSESSED LATE FEES, YOU MAY I LOSE YOUR PROMOTIONAL RATES, AND THERE MAY BE ADDITIONAL RATE AND FEE IMPACTS I TO YOUR ACCOUNT. ALLOW AT LEAST FIVE DAYS MAIL TIME. 54.99 C 50.00 C $104.99 ( SUMMARY OF TRANSACTION$ rarA Mtruram PAYwaar our Printout aabnoa H Paymwu (+) Caah (+1 Pnnanaaaa and 1+1 Pedo4b nth (+1 Tnmrd w Fea (.) Nsw Bawd 0 ( arMOreAb Adm"eat A* Mwb WMANCl CIMREB FlIANCE 171ABOEe 7dtl .0 Peat Dua A®wd-_....___. $ Qarout Primot..„ .............. $15.0f $269.21 $104.99 $0.00 $67.96 $2.25 $0.00 $234.45 Tad u9rtanse Printout Due $15.01 FlMANCF CHARGE SCHEDULE OaneWwrding o Balance FOR YOUR SA7WAC710A; EVERY HOUR, EVERY DAY Ca" Padoma Rate M Subject to • Fa Custom 3Ntlakctlm and up to the n9nute anlnmdeA I"lamaud bale Percentage Russ cTaand on" balance, valsNe cted8, Payments retained, payments dust due r ? :ash Advances addreM Marmdbn, r4 braquwl dup9dle slelwnants,d - BALANCE TRANSFERS, CHECKS. 0.0000001A DLY* 0.00% T8 - Fu ATM, BANK ......... ........ 0.031232% DLY* 11.40% $0.001 r 0D-3 3178. LAEN'I1FFrS C. PURCHASES ............ .......0.031232X DLY* 11.40% $248.94 • Mel mints b: MBNA AMERI 198=65019. EXHIBIT ' • B" ttsweprwaner preferred b ' FrA rw Ra raun Pfau, Periodic Fiele May Vary . J u? ? ? . :?s ? ? J ...- - ? -r? ? y_ ? ? i ? G ? ?j ?j J ? O ANGELA L. EVANS, Plaintiff, V. JEFFREY A. EVANS, Defendant. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 04-1892 CIVIL ACTION - LAW DIVORCE PRAECIPE TO WITHDRAW APPEARANCE Please withdraw my appearance on behalf of JEFFREY A. EVANS in the above- captioned matter. Respectfully Submitted, Dated: O 0 f WayneF. Sb de, Esquire 53 West Pomfret Street Carlisle, PA 17013 717-243-0220 ID# /3'7A.1- Please enter my appearance on behalf of JEFFREY A. EVANS in the above-captioned matter. Respectfully Submitted, Dated: ?- _ dY G?tid Timothy J. C 1 s e WILEY, LENOX, COLGAN & MARZZACCO, P.C. 130 W. Church Street Dillsburg, PA 17019 (717) 432-9666 ID# 77944 ? : ( L rn ANGELA L. EVANS, Plaintiff, V. JEFFREY A. EVANS, Defendant. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 04-1892 CIVIL ACTION - LAW DIVORCE DEFENDANT'S PRE-TRIAL STATEMENT AND NOW, comes the Defendant, Jeffrey A. Evans, by and through his counsel, Timothy J. Colgan, Esquire of Wiley, Lenox, Colgan & Marzzacco, P.C. and submits the within Pre-Trial Statement: 1. Defendant Information Name: Jeffrey A. Evans Address: 279 Alpat Drive, Dillsburg, Pennsylvania 17019 Employer: Select Medical Corporation Occupation: Pilot II. Plaintiff Information Name: Angela L. Evans Address: 162 Chestnut Grove Road, Dillsburg, Pennsylvania Employer: Mechanicsburg School District Occupation: Teacher's Aide III. Marital Information Date of Marriage: February 16, 1985 Place of Marriage: Grantham, Pennsylvania Date of Separation: January 29, 2004 Minor Children: Courtney Lyn Evans, born on February 15, 1994 Ryan Jeffrey Evans, born on July 22, 1998 The Divorce Complaint was filed on April 29, 2004 under Sections 3301(c),(d) (a)(2) and (a)(6) of the Divorce Code. IV. Marital Assets Marital Residence at 299 Alpat Drive, Dillsburg, PA 17019 Appraised value as of December 22, 2004: $200,000.00. See Appraisal Report attached as Exhibit A. Mortgage balance as of date of separation: $79,649.41. Current balance as of July 1, 2005: $70,805.13 See Member's 1" Mortgage Statement attached as Exhibit B. 2. Select Medical Corporation 401(k): marital value as of date of separation was $79,047.42. See attached statement marked as Exhibit D. 1998 K-1500 Chevy Truck - Defendant will stipulate to NADA wholesale value as of date of separation. 4. 2000 Chevrolet Blazer (financed through mortgage) - Defendant will stipulate to NADA wholesale value as of date of separation. 5. Seville 21' Cabin Boat - Defendant will stipulate to NADA wholesale value (or other comparable valuation) as of date of separation. 6. 1995 Palmer Trailer - Defendant will stipulate to NADA wholesale value (or other comparable valuation) as of date of separation. 1998 Yamaha Wolverine - Defendant will stipulate to NADA wholesale value (or other comparable valuation) as of date of separation. 8. 1996 Chrysler Concord - Defendant submits that this vehicle was sold and divided to the mutual satisfaction of both parties. 9. 2000 Polaris Trail Boss - Defendant submits that this vehicle was sold and divided to the mutual satisfaction of both parties. 10. Wife's EDS Credit Union savings - estimated value of $20,000.00 subject to verification by statements for the six (6) months prior to date of separation. 11. Husband's Erie Life Insurance Policy - value of $2,666.00 as of date of termination on January 7, 2005. 12. Husband's 2003 Bonus - Gross value $7,389.00 2 14. Defendant submits that the PSECU Savings and Checking accounts were closed and divided to the mutual satisfaction of the parries. V. Non-Marital Assets Defendant submits that the 1998 Yamaha Badger ATV and the dirt bike replacing the 2000 Eton Youth 4-Wheeler are the children's and not to be considered as part of equitable distribution by agreement of the parties. 2. Defendant has made post-separation contributions to his Select Medical 401(k) that are to be considered non-marital. See attached statement which covers period of January 29, 2004 through July 1, 2005 marked as Exhibit D. Defendant will provide an updated statement for determination of value as of the date of distribution. Defendant is unaware of any non-marital assets attributable to Wife. VI. Expert Witnesses It is not clear at this time what experts, if any, will testify at the time of trial. Expert testimony could be necessary regarding the values of the marital residence and the retirement benefits of the parties. If expert testimony is required, appropriate notice will be provided to opposing counsel and the Master in advance of trial and copies of expert reports will be provided. VII. Defendant's Witnesses Husband will testify on his own behalf, 2. Wife, as on cross-examination; Husband reserves the right to call other witnesses to be determined in advance of trial with appropriate notice to opposing counsel. VIII. Exhibits A. S. W. Barrett Real Estate & Appraisal Services - Appraisal Report dated December 22, 2004 B. Member's First Mortgage Statements C. Defendant's Income and Expense Statement D. Select Medical 401(k) plan Statement IX. Income and Expenses A current Income and Expense Statement is attached hereto as Exhibit C. X. Pension / Retirement Defendant has a 401(k) plan with Select Medical, which is valued at $79,047.42 as of January 29, 2004. Husband had benefits through prior employment. However, the GPU and First Energy plans were rolled into the Select Medical 401(k). See Select Medical statement for the period dated January 29, 2004 through July 1, 2005 attached hereto as Exhibit D. 2. Plaintiff has an EDS pension in the amount of $7391.17 as of January 31, 2004 and Pershing IRA account in the amount of $8150.94 as of January 30, 2004. Defendant has made post-separation contributions to the Select Medical 401(k). See Select Medical statement for the period dated January 29, 2004 through July 1, 2005 attached hereto as Exhibit D. XI. Counsel Fees and Costs Defendant makes no claim for counsel fee and costs and proposes that each party pay their respective attorney's fees and costs. XII. Personal Property The personal property of the parties has been divided to their mutual satisfaction. XIII. Marital Debts Members 151 FCU Mortgage in the amount of 79,649.41 as of the date of separation. See Member's 151 Mortgage Statement attached as Exhibit B. MBNA America -balance in the amount of $234 as of February 5, 2004. XIV. Proposed Resolution Husband proposes that a No-Fault Divorce Decree be entered under section 3301(c) or 3301(d). 2. Husband proposes a 55/45 division of the total marital estate in favor of Wife. Wife shall receive her share through the assets in her possession or which have already been assigned, 55% of the net equity in the marital residence and the balance of her share via qualified rollover from Husband's 401(k). 3. Husband proposes that Wife's claim for alimony pendente lite be denied. 4. Husband agrees to pay Wife alimony, modifiable upon substantial change in circumstances, in the amount of $200 per month, which is terminable upon remarriage, cohabitation or death. 5. Husband proposes that Wife's claim for counsel fees and costs be denied. XV. Additional Considerations Note that counsel for Husband was retained and entered his appearance only days prior to the filing deadline for the Pre-Trial Statement. Counsel reserves the right to amend the information contained herein upon further review of previously filed documents, statements and/or file materials of prior counsel. Respectfully submitted, 7-2-o5- By; Timothy J squire WILEY, LENOX, COLGAN & MARZZACCO, P.C. 130 W. Church Street Dillsburg, PA 17019 (717) 432-9666 ID# 77944 Attorney for Defendant S:'iCLIENTSICOLGANIEVANS.JEFll920.33 S. W. BARRETT REAL ESTATE & APPRAISAL SERVICES 01/06/2005 Jeff Evans 279 Al Pat Drive Dillsburg, PA 17019 File Number: 04-0845 Mr. Evans; In accordance with your request, I have personally inspected and appraised the real property at: 279 Al Pat Drive Dillsburg, PA 17019 The purpose of this appraisal is to estimate the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the estimated market value of the property as of December 22, 2004 is: $200,000 Two Hundred Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications. Respectfully submitted, Cassandra J. Crockett = IBIT Certified Residential Appraiser EXH ° f # En umber From To Page 2634 01-01-04 101-31-0414 of 4 MEMO 0060032634 EVANS,JEFFREY A Loan 03: HOME EQUITY Transaction Summary 07/05/2005 ID __Eff Date Transaction Balance Chg Int/Pn... Fees New Balance Description/Pmt Prev Available L 03 07/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 07/01/2005 Transfer Pa... -288.21 145.79 0.00 70,805.13 Pmt: 434.00 0.00 L 03 06/16/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 06/16/2005 Transfer Pa... -287.62 146.38 0.00 71,093.34 Pmt: 434.00 0.00 L 03 06/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L03 06/01/2005 Transfer Pa... -277.26 156.74 0.00 71,380.96 Pmt: 434.00 0.00 L 03 05/16/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 05/16/2005 Transfer Pa... -286.46 147.54 0.00 71,658.22 Pmt: 434.00 0.00 L 03 05/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 05/0112005 Transfer Pa... -285.88 148.12 0.00 71,944.68 Pmt: 434.00 0.00 L 03 04/16/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 04/16/2005 Transfer Pa... -285.29 148.71 0.00 72,230.56 Pmt: 434.00 0.00 L 03 04/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 04/01/2005 Transfer Pa... -274.78 159.22 0.00 72,515.85 Pmt: 434.00 0.00 L 03 03/1612005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 03/16/2005 Transfer Pa... -284.15 149.85 0.00 72,790.63 Pmt: 434.00 0.00 L 03 03/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 03/01/2005 Transfer Pa... -303.59 130.41 0.00 73,074.78 Pmt: 434.00 0.00 L 03 02/16/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 02116/2005 Transfer Pa... -282.94 151.06 0.00 73,378.37 Pmt: 434.00 0.00 L 03 02/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 02/01/2005 Transfer Pa... -272.28 161.72 0.00 73,661.31 Pmt: 434.00 0.00 L 03 01/16/2005 From EVANS,JEFFREY A 0000241893 Share 11 L 03 01/16/2005 Transfer Pa... -249.35 184.65 0.00 73,933.59 Pmt: 434.00 0.00 L 03 01/01/2005 From EVANS,JEFFREY A 0000241893 Share 11 L03 01/01/2005 Transfer Pa... 0.00 434.00 0.00 74,182.94 Pmt: 434.00 0.00 L 03 11/16/2004 From EVANS,JEFFREY A 0000241893 Share 11 L 03 11116/2004 Transfer Pa... -281.30 152.70 0.00 74,182.94 Pmt: 434.00 0.00 L 03 11/01/2004 From EVANS,JEFFREY A 0000241893 Share 11 L 03 11/01/2004 Transfer Pa... -270.53 163.47 0.00 74,464.24 Pmt: 434.00 0.00 Page 1 IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS v. JEFFREY A. EVANS D.R.O. NO. DOCKET NO. 04-1892 OTHER REF NO. INCOME AND EXPENSE STATEMENT OF JEFFREY A. EVANS ADDRESS: 279 Alpat Drive Dillsburg, PA 17019 PHONE: (717) 798-4196 ATTORNEY: Timothy J. Colgan, Esquire 13D W. Church Street, Suite 100 Dillsburg, PA 17019 (7117) 432-9666 SECTION I : INCOME AND INSURANCE INFORMATION INSTRUCTIONS: THIS SECTION MOST BE FULLY COMPLETED. IF YOU ARE NOT PRESENTLY EMPLOYED, THE EMPLOYER INFORMATION SHOULD REFLECT EARNINGS INFORMATION FROM YOUR LAST JOB. INCOME: CURRENT OR LAST EMPLOYER, S aP PAYROLL ADDRESS- H-111, 0la t e, T4,- A ICu 1 Cry 3 -% ??? PO ou CC N- 1 Z POSITION HELD: 4(ATE OF PAYIFREQUENCY: $ HOW PAID: (CIRCLE ONE) WEEKLY IWEEKL MONTHLY / SEMI-MONTHLY / OTHER IF LAST JOB: DATE LEFT JOB REASON FOR LEAVING GROSS PAY PER PERIOD: $ I 'I • `I L, ITEMIZED PAYROLL DEDUCTIONS: $ FEDERAL WITHHOLDING $ © 9 SOCIAL SECURITY (& MEDICARE) $ • r1 LOCAL WAGE TAX $ o? D. I b STATE INCOME TAX $ MANDATORY RETIREMENT (REQUIRED MIMMUM % G - ) HEALTH INSURANCE $ N m` yl°cN s $ s p cl+?cG?$Ilrux -1.73•B-4 ` NET PAY PER PAY PERIOD $ ?, Jr"D • 4 B OTHER INCOME: WEEK MONTH YEAR PROPERTY OWNED: OWNERSHIP (FILL IN APPROPRIATE COLUMN) DESCRIPTION VALUE H W J INTEREST CHECKING ACCTS S _C) DIVIDENDS SAVINGS ACCTS. S PENSION CREDIT UNION $ v ANNUITY STOCK/BONDS SOCIAL SECURITY REAL ESTATE $ GL7 RENTS BUSINESS $ UNEMPLOYMENT COMP. WORKMENS COMP. a IRA TIP TOTAL ?CtIO ALIMONY (REC-D.) TOTAL $ _ INSURANCE (COVERING DEPENDENTS IN THIS CASE), COMPANY AND CLAIMS ADDRESS HOSPITAL BLUE CROSS MEDICAL SA UsK' Qi?]I1 N 11 ? Saf -BLUESHIELD t y q i Y OTHER i S-a3 j•-ScV? HEALTH/ACCIDENT DISABLITY DENTAL eI Ta nrnT?. OTHER COVERAGE GROUP # POLICY# H W C ??(1378/>a2go??a8?omi X ? X Rs -ea> Y K K •H=HUSBAND, W=WIFE, J=JOINT, CHILD SECTION II: SUPPLEMENT INCOME STATEMENT INSTRUCTIONS: IF YOU ARE SELF-EMPLOYED OR IF YOU ARE SALARIED BY A BUSINESS OF WHICH YOU ARE OWNER IN WHOLE OR IN PART, YOU MUST ALSO FILL OUT THIS SECTION. THIS FORM IS TO BE FILLED OUT BY A PERSON (CHECK ONE) (1) WHO OPERATES A BUSINESS OR PRACTICES A PROFESSION, OR (2) WHO IS A MEMBER OF A PARTNERSHIP OR JOINT VENTURE, OR (3) WHO IS A SHAREHOLDER IN AND IS SALARIED BY A CLOSED CORPORATION OR SIMILAR ENTITY B. ATTACH TO THIS STATEMENT A COPY OF THE FOLLOWING DOCUMENTS RELATING TO THE PARTNERSHIP, JOINT VENTURE, BUSINESS, PROFESSION, CORPORATION OR SIMILAR ENTITY (1) THE MOST RECENT FEDERAL INCOME TAX RETURN AND (2) THE MOST RECENT PROFIT AND LOSS STATEMENT. 1. NAME OF BUSINESS ADDRESS TELEPHONE NUMBER(S) 2. NATURE OF BUSINESS (CHECK ONE) (1) PARTNERSHIP (2) JOINT VENTURE (3) PROFESSION (4) CLOSED CORPORATION (5) OTHER 3. NAME OF ACCOUNTANT, CONTROLLER OR OTHER PERSON IN CHARGE OF FINANCIAL RECORDS: 4. ANNUAL INCOME FROM BUSINESS: (1) HOW OFTEN IS INCOME RECEIVED? (2) GROSS INCOME PER PAY PERIOD: (3) NET INCOME PER PERIOD? (4) SPECIFIED DEDUCTIONS, IF ANY: SECTION III: EXPENSES INSTRUCTIONS: 1. ONLY SHOW EXTRAORDINARY EXPENSES IN THIS SECTION, UNLESS 2. APPLIES TO YOU. 2. IF YOU ARE REQUESTING SPOUSAL SUPPORT/APL OR IF YOU ASSERT YOUR CASE CANNOT BE DETERMINED ACCORDING TO THE GUIDELINE GRIDS OR FORMULA, THIS SECTION' MUST BE FULLY COMPLETED. NUMBER OF PERSONS IN HOUSEHOLD AND AGES OF SAME _1? a, HOME MORTGAGE/RENT MAINTENANCE UTILITIES ELECTRIC GAS OIL TELEPHONE/DSL WATER/SEWER MONTHLY EXPENSES SELF CHILDREN SGS 160 MONTHLY EXPENSES SELF CHILDREN EMPLOYMENT PUBLIC TRANSIT (PARKING) OTHER AUTOMOBILE PAYMENTS FUEL REPAIRS/ MAINTENANCE MEDICAL DOCTOR DENTIST ORTHODONTIST HOSPITAL (a. S 5 SO L l._ -eE ao0 40 MEDICINE va5_ THERAPY I i?0 SPECIAL NEEDS (GLASSES, BRACES, ORTHOPEDIC DEVICES, ETC.) TOTAL MONTHLY EXPENSES EDUCATION PRIVATE SCHOOL PAROCHIAL SCHOOL COLLEGE RELIGIOUS PERSONAL CLOTHING $D FOOD BARBER/HAIRDRESSER aQ CREDIT PAYME7VTS CREDIT CARDS 1@5- CHARGE ACCOUNT MEMBERSHIPS LOANS CREDIT UNION MISCELLANEOUS HOUSEHOLD HELP CHILD CARE (cvp PAPERS/BOOKS/MAGS 'SO ENTERTAINMENT PAY TV VACATION rpm GIFTS LEGAL FEES CHARITABLE CONTRIB. OTHER CHILD SUPPORT ALIMONY PAYMENTS OTHER: ?3076.q w'Select Employment Services, Inc. 4716 Old Gettysburg Road Mechanicsburg, PA 17055 lembers 1st Savings Account Mr. Jeffrey A. Evans 604 Airport Drive Middletown PA 17057 DIRECT DEPOSIT ADVICE XXXXXX3000 650.48 NON-NEGOTIABLE ' PLEASE TAKE NOTE OF YOUR NEW EMPLOYEE NUMBER ' EMPLOYEE NAME SOCIAL SECURITY NO. EMPLOYEE NUMBER ORGANIZATION Mr. Jeffrey A. Evans 17858-4097 134441 Select Medical Mechanicsburg PERIOD STAHr PERIOD LTA PAYMENT DATE CFIECI(NUMBER BASF: SALARY EID HOURS PTO HOIRNS 11-1UN-2005 24,1UN-2005 01-JUL-2005 4710.25 127 216 FEDERAL RUNG STATUS STATE ALLOWANCES FEDERAL ALLOWANCES STATE RUNGS Married t U 0 Not Used F'A 0 DESCRIPTION HOURS AMOUNT YEAR TO DATE DESCRIPTION AMOUNT YEAR TO DATE Regular Salary 80.00 2173.96 28177.86 FIT 208.59 5239.98 SMC Bonus 0.00 8152.00 MEDICARE _ 29.23 526.25 Stock Option P 0.00 2000.00 SS 125.00 2250.18 GTL Imputed In 0.32 4.02 (PA) SIT 61.89 1114.09 (PA) SUI 1.96 34.50 (Lower Allen To 20.16 362.90 Paid Time Off 0.00 EID Time Off 0.00 (Lower Allen To 0.00 52.00 PTO Accrual 5.54 EID Accrual 1.85 Childs Support G 773.54 10056.02 PTO Balance 216.00 Ell Balance 127.39 Dental Plan 15.00 180.86 Dependent Life 0.49 6.37 Medical Plan 143.06 1859.78 Savings 401k PI 130.44 1690.70 Spousal Life 2.64 33.02 Supplemental Li 11.58 149.93 Gross Pay 2174.28 3833188 Pre-Tax sti°"S 44 8 579: o DIRECT DEPOSIT ADVICE TaxDeduon 6. 9 Other Deductions 788.15 10245.34 Net Pay 650.48 14773.28 - --- - -------------- --- --------------------------------- Cooled numbs ' E ployer kleiroficati- numbs , 1 Wages, tips, oll 1 Comp. 2 Federal irc lax wifteW 134441 f Farm W-2 Wage and Tax Statem ent 2004 25-1812245 56866.16 7324 .77 - - -- - 5npbyefs nano, adhess. end ZIP code _ _ - - - ---- ? F+nWq'eek social lewdly numbs -r 3 Spda1 saarirywages Sanal seosiry lax w66baW Select Employment Services, Inc. 3735.98 178-58-4097 60249.68 ---- --- - 4718 Old Gettysburg Pike ?? 5odal sewdry Gps 5 6bdrare wages and fps 6 MedCorelanw Wd Mechanicsburg, PA 17055 60249_68873.62 m i p pane v 10 Oependerd care bme6ls 6 Alloc&W rips 9 ndlallre 6nployao's name, add a and ZIP Code 11 No qualified plans - 12a-12d 13 coda - ? Jeffrey A. Evans iv 604 Ai t D i empbyee ?._, 4 .77 ; C 14 -- rpor r e Med125 3952:.89 ID 3381.52 P 011 Middletown, PA 17057 ( ; =d rly X _ synpaY -- 15 Stale Empbyefs stale 671Yl1bCr 16 slate wages. fps, etc. 17 Slap incase ba 16 local svaga, bps. ale. 19 local fnConne tax 20 PA 1976 912 60244.91 I 1849.46 60244.91 602.36 Lower Al 1976 9124 S PA 1. 15644.50 39.12 1 NORTHERN Copy 2 To Be Filed With Farployea16319e City, W Local lnsrwoa T. Relum OMB No. 15950006 DCoartmod alN Treamry-Inbmal Fee sue Senvice 9VANS, JEFFREY A 32020 - SELECT MEDICAL CORP Select Medical Corporation 401(k) Plan JEFFREY A EVANS 604 AIRPORT DRIVE MIDDLETOWN, PA 17057- Select Medical 401k Statement Q Customer Service: (800) 8904015 Fidelity Investments InstlhIIional Services Co. 82 Devonshire Street Boston. MA 02109 Your Account Summary Beginning Balance Employee Contributions Employer Contributions Fees Change in Market Value Ending Balance Additional Information Vested Balance Dividends & Interest Statement period: 01129[2004 to 07/01/2005 $79,047A2 $4,680.90 $2,340.45 -$15.00 $3,445.41 $89,499.19 $86,361.72 $2,988.03 Your Personal Rate of Return This Period 4.1% Your personal Rate of Return is calculated with a time-weighted formula, widely used by financial analysts to calculate investment earnings. It reflects the results of your Investment selections as well as any activity In the plan account(s) shown. There are other personal Rate of Retum formulas used that may yield different resutls. Remember that past performance is no guarantee of future results. Your Asset Allocation Statemerd period: 01/29/2004 to 07/0112005 Why Is This Important? `:. e-Leaming: Learn about asset allocation. Page 1 of 4 7/2/2005 EVANS, JEFFREY A 32020 - SELECT MEDICAL CORP ¦ 50.89% Stock Investments: $45,544.14 fit 49.11% Bond Investments: $43,955.04 Your account is allocated among the asset classes specified above as of 07/01/2005. Percentages and totals may not be exact due to rounding. Market Value of Your Account Statement Period: 01129/2004 to 07/01/2005 Displayed in this section is the value of your account for the statement period, in both shares and dollars. Shares Shares Price Price Ma,ketvalm Market value Investment as of as of as of as of as or as of 01/280004 07rolrW5 01rz82 07/01/2005 W284N?" 07/01/2005 Stock Investments $40,970.10 $15,544.14 FED DNWend GroxM 1,479.599 1.629.486 $27.69 $27.95 $110.970.10 145,544.14 Bond Investments $38,,077.32 $13,955.04 FED MGD Inc Port 38,077.320 43,955.040 $1.00 $1,00 $38,M.32 $43.955.04 Account Totals $79„047.42 $89,099.18 Remember that a dividend payment to fund shareholders reduces the share price of the fund, so a decrease in the share price for the statement period does rwt necessarily reflect lower fund performance. Your Contribution Elections As of 07/02/2905 This section displays the funds in which your future contributions will be invested. Your Current Investment Elections as of 0710212005 All Eligible Sources Investment Option Current Stock Investments FID DIVIDEND GROWTH 50% Bond Investments Page 2 of 4 hops://workplaceservicesl 00.fidelity.com/nothenefits/sayingsVsod/Soddeta!PsodPrevie... 7/2/2005 EYANS, JEFFREY A 32020 - SELECT MEDICAL CORP FID MGD INC PORT 50% Total 100% Your Contribution Summary Statement Period: 01/29/2004 to 07/01/2005 Contributions Employee Contribution Employer Match Rollover Period to date $4,680.90 $2,340.45 $0.00 Vested Percent 100% 20% 100% Total Account Balance $7,997.56 $3,921.83 $77,579.79 Total Vested Balance $7,997.56 $78437 $77,579.79 Your Account Activity Statement Perbil: 01/29/2004 to 07/01/2005 Use this section as a summary of transactions that occurred in your account during the statement period. Activity HD Dividend Growth FID MGD Inc Port Total Beginning Balance $$0,970.10 $38,077.32 $79,047.42 Employee Contributions $2,340.45 $2,340.45 $4,680.90 Employer Contributions $1,170.21 $1,170.24 $2,340.45 Fees $0.00 -$15.00 -$15.00 Charge in Market Value $3,063.38 $2,382X3 $3,445.41 Ending Balance $45,544.14 $43,955.80 $89,499.18 Dividends &Interest $606.00 $2,382.03 $2,988.03 Your Account Information As of 07/01/2005 Use this section to ensure Fdelitya records of your information is up-to-date. View. Payroll Deductions General Information Participant Status Active " PRINTING INSTRUCTIONS- Click below to print your statement. To print performance, click anywhere in perfommdnce and click the print button on your browser. Print Statement Alternate Printing Instructions Click anywhere on this online statement screen, then click the prim button on your browser. To print performance, click anywhere in performance and click the print button on your browser. Page 3 of 4 https://workplaceservicesl OO fidelity.tom/nethenefits/savings2/sod/soddeta!PsodPrevie... 7/2/2005 EVANS, JEFFREY A 32020 - SELECT MEDICAL CORP Page 4 of 4 Questions? Call (800) 890-4015. © Copyright 1996-2005 FMR Corp. Ne ,eots?" pimidedby All rights reserved. ONA/(CY Your Security a rsra DC=111 HW=4 1A=1 AT=2 SZ=3 https•.//woriplaceservices100.fidelity.com/nethenefits/savings2/arod/soddetail7sodPrevis... 7/2/2005 ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS Plaintiff, CUMBERLAND COUNTY, PENNSYLVANIA V. No. 04-1892 JEFFREY A. EVANS, CIVIL ACTION - LAW Defendant. DIVORCE CERTIFICATE OF SERVICE I, Timothy J. Colgan, Esquire hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States mail, first-class, postage prepaid, as follows: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 (Counsel for Plaintiff) E. Robert Flicker, II Office of the Divorce Master 9 North Hanover Street Carlisle, PA 17013 (Divorce Master) Date: 7- 7- o,5-- Respectfully submitted, By: Gr//l Timothy J. quire WILEY, LENOX, COLGAN & MARZZACCO, P.C. 130 W. Church Street Dillsburg, PA 17019 (717) 432-9666 ID# 77944 Attorney for Defendant r? r --p F _;. •t IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. 04-1892 V. CIVIL ACTION -LAW JEFFREY A. EVANS, DIVORCE Defendant AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on April 29, 2004. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. 1 consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. 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. Section 4904 relating to unsworn falsification to authorities. Dated: l0 -.20 00 0'?n" 0? &ko_? ANGELA L. EVANS, Plaintiff r,> c_ ? cg) rte; -71 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. 04-1892 V. CIVIL ACTION -LAW JEFFREY A. EVANS, DIVORCE Defendant 1. I consent to the entry of a final decree in divorce without notice. 2. 1 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. 1 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. 54904 relating to unsworn falsification to authorities. Dated: 16 -c;2 D -OCo or.? ,,? ANGELA L. EVANS, Plaintiff r?,, C?? t? e- ? - ? t ?J'Y I4*- 4?l„;y-4?? ? S. fi,J C =, ?}? "1 --° ?=? ?_j-. ?? ^'""' ANGELA L. EVANS, Plaintiff, V. JEFFREY A. EVANS, Defendant. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 04-1892 CIVIL ACTION - LAW DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in Divorce under § 3301(c) and (d) of the Divorce Code was filed on April 29, 2004. 2. The marriage of Plaintiff and Defendant is irretrievably broken. 3. The parties have lived separate and apart since January 29, 2004. 4. Ninety (90) days have elapsed from the date of filing and service of the Complaint. 5. 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 made herein are subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. to 4V Date Je re v s Defendant r av ^, ate. C ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS Plaintiff, CUMBERLAND COUNTY, PENNSYLVANIA V. No. 04-1892 JEFFREY A. EVANS, CIVIL ACTION - LAW Defendant. DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A 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 affidavit are true and correct. I understand that false statements made herein are subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date Jeffr A Defendant MI, N 4 Re: Angela L. Evans vs. Jeffrey A. Evans Cumberland County Divorce 04-1892 MARITAL SETTLEMENT AGREEMENT ?''?'? THIS MARITAL SETTLEMENT AGREEMENT, made this day of 2006, by and between JEFFREY A. EVANS, of Dillsburg, York County, Pennsylvania (hereinafter referred to as "Husband") and ANGELA L. EVANS, of Dillsburg, York County, Pennsylvania (hereinafter referred to as "Wife"): WITNESSETH: Q.?f,Cj02" +o( Xb-oL bvAVA 1 (0 1 19 9 11.-. 4 WHEREAS, the parties were married on 85, in Grant September Pennsylvania; WHEREAS, Husband and Wife are the natural parents of two (2) minor children: Courtney Lyn Evans, born on February 15, 1994 and Ryan Jeffrey Evans, born on July 22, 1998; WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the parties and it is the intention of Husband and Wife to live separate and apart, and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them in relation to the ownership and equitable distribution of real and personal property; settling of all matters between them relating to the past, present and future support, alimony and/or maintenance of Wife by Husband or of Husband by Wife; and in general, the settling of any and all claims and possible claims by either party against the estate of the other party. NOW, THEREFORE, in consideration of the premises and of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, Husband and Wife, each intending to be legally bound hereby covenant and agree as follows: 1. INTERFERENCE: Each party shall be free from interference, authority, and contact by the other, as fully as though he or she were single and unmarried, except as may be necessary to carry out the provisions of this Agreement. Neither party shall molest the other or attempt to endeavor to molest the other, nor compel the other to cohabitate with the other, or in any way harass or malign the other, nor in any way interfere with the peaceful existence, separate and apart from the other. 2. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS: This Agreement shall not affect or bar the right of HUSBAND or WIFE to a divorce on lawful grounds or to any S: IClients1COLGAMEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed to be a condonation on the part of either party hereto of any act or acts on the part of the other party which have occasioned the disputes or unhappy differences. 3. SUBSEQUENT DIVORCE: The parties hereby acknowledge that Wife filed a Complaint in Divorce in Cumberland County, Pennsylvania, claiming that the marriage is irretrievably broken under Section 3301(c) of the Pennsylvania Divorce Code and that the parties have lived separate and apart as required under Section 3301(d) of the Pennsylvania Divorce Code. The Divorce Complaint also included claims under Sections 3301(a) (2) and (a) (6). The parties hereby express their agreement that the marriage is irretrievably broken and they have lived separately and apart for more than two years, and express their intent to execute any and all Affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301(c) or 3301(d) of the Divorce Code. The parties hereby waive all rights to request court ordered counseling under the Divorce Code. It is further specifically understood and agreed by the parties that the provisions of this Agreement as to equitable distribution of property of the parties are accepted by each party as a full and final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. Should a decree, judgment or order of divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants shall not be affected in any way by such separation or divorce; nothing in any such decree, judgment, order or further modification or revision thereof shall alter, amend or vary any term of this Agreement. It is the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and conclusive upon the parties. 4. INCORPORATION OF DIVORCE DECREE: It is further agreed, covenanted and stipulated that this Agreement or the essential parts hereof, shall be incorporated in any decree hereinafter entered by any court of competent jurisdiction in any divorce proceedings that have been or may be instituted by the parties for the purpose of enforcing the contractual obligations of the parties. This agreement shall not be merged in any such decree but shall in all respects survive the same and be forever binding and conclusive upon the parties. 5. EFFECTIVE DATE: The effective date of this Agreement shall be the "date of execution" or "execution date," defined as the date upon which it is executed by the parties if they have each executed this Agreement on the same date. Otherwise, the "date of execution" or "execution date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 6. DISTRIBUTION DATES: The transfer of property, funds and/or documents provided for herein, shall only take place on the "distribution" date, which shall be defined as the effective date of this Agreement, unless otherwise provided for herein, including any spousal support and/or alimony payments. S. IClientslCOLGAMEVANSVEFIMSA Revised as of October S, 2006.doc Last edited 1011012006 9:04:24 AM 7. MUTUAL RELEASE: Except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provisions hereof, Husband and Wife each do hereby mutually remise, release, quit-claim and forever discharge the other and the estate of such other, for all time to come, and for all purposes whatsoever, of and from any and all rights, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situated, which he or she now has or at any time hereafter may have against the other, the estate of such other or any part hereof, whether arising out of any former acts, contracts, engagements or liabilities of such other or by way of dower or courtesy, or claims in the nature of dower or courtesy or widow's or widower's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will; or the right to treat a lifetime conveyance by the other as a testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any country or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, division of property, costs or expenses, whether arising as a result of the marital relations or otherwise. It is the intention of Husband and Wife to give each other by the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction. 8. REPRESENTATION BY COUNSEL: Husband has been represented by Timothy J. Colgan, Esquire, and Husband acknowledges that he has signed this Agreement freely and voluntarily after full consultation with his counsel. Wife has been represented by Diane G. Radcliff, Esquire, and Wife acknowledges that she has signed this Agreement freely and voluntarily after full consultation with her counsel. The parties acknowledge that this Agreement is not the result of any duress, undue influence, coercion, collusion and/or improper or illegal agreement. The parties further acknowledge that they have each made to the other a full and complete disclosure of their respective assets, estate, liabilities, and sources of income and that they waive any specific enumeration thereof for the purposes of this Agreement. 9. WARRANTY AS TO EXISTING OBLIGATIONS: Each party represents that they have not heretofore incurred nor contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable except as may be provided for in this Agreement. Each party agrees to indemnify and hold the other party harmless from and against any and all such debts, liabilities or obligations of every kind which may have heretofore been S. IChentslCOLGAMEVANS.JERMSA Revised as of October S, 2006.doc Last edited 1011012006 9:04:24 AM incurred by them, including those for necessities, except for the obligations arising out of this Agreement. 10. WARRANTY AS TO FUTURE OBLIGATIONS: Husband and Wife covenant, warrant, represent and agree that, with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnify and hold harmless the other party from and against any and all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement. 11. PERSONAL PROPERTY: The parties agree to divide specific items of personal property as follows: a. Coins: The parties agree that each will receive 50% of the coins that were given to them by their families. The parties agree to divide and distribute the coins within 30 days of the effective date of this Agreement, unless they have previously divided said coins to their mutual satisfaction in which event they each waive any further distribution thereof. b. Videos: The parties agree that Husband will provide copies of the family videos to Wife. As the videos are on 8mm and Husband needs to purchase equipment to convert and copy the videos, Husband shall provide copies of the family videos to Wife within six (6) months of the effective date of this Agreement. c. Other Personal Property: The parties have divided between them, to their mutual satisfaction, all other personal effects, household furniture and furnishings, and all other articles of personal property which have heretofore been used by them in common, and neither party will make any claim to any such items which are now in the possession or under the control of the other. d. Waiver: By these presents, each of the parties hereby specifically waives, releases, renounces and forever abandons whatever claims he or she may have with respect to any personal property which is in the possession of the other, and which shall become the sole and separate property of the other from the date of execution hereof. 12. DIVISION OF MARITAL RESIDENCE: The parties jointly own the marital residence situate at 279 Alpat Drive, Dillsburg, York County, Pennsylvania (the "Marital Home Real Estate") subject to a joint Mortgage obligation owed to Member's 1st FCU (the "Mortgage"). Husband shall retain sole and exclusive ownership and possession of said residence under and subject to the following set forth terms and conditions: a. Refinance/Assumption: Husband shall apply for refinancing/assumption of the Mortgage within fifteen (15) business days of the date of this Agreement and shall S. IClientsICOLGAN EVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM complete that refinance/assumption within sixty (60) days of the effective date of this Agreement so as to release Wife from further liability thereunder. The costs of refinancing/assumption shall be paid by Husband. b. Cash Payment: Husband shall make a one time cash payment to Wife in the amount of $67,695.00 contemporaneous with completion of settlement on the refinance/assumption. C. Deed/Conveyance: Husband's counsel shall prepare a Special Warranty deed transferring all of Wife's right, title and interest in the Marital Home Real Estate to Husband. The conveyance shall be subject to all liens and encumbrances, covenants and restrictions of record including, but not limited to, the lien of the Mortgage, any other mortgage, real estate taxes and any other municipal liens. Said deed shall be signed contemporaneous with the signing of this Agreement and shall be held in escrow by Wife's attorney pending completion of the refinance and payment to Wife of the $67,695 aforesaid at which time it will be released to Husband for recording. Wife thereafter waives all right, title and interest in the property. d. Marital Home Real Estate Expenses: Until such time as the Mortgage is refinanced/assumed and the Marital Home Real Estate conveyed to Husband, or sold to a third party in accordance with the provisions of this Paragraph, Husband shall be and remain solely responsible for any and all payments related to the Mortgage, real estate taxes, homeowner's insurance and maintenance of Marital Home Real Estate, any other municipal liens and any and all other expenses associated with the Marital Home Real Estate, whether incurred in the past, present or future, and shall indemnify and hold Wife harmless against any liability resulting from his failure to make payments thereon. e. Sale: In the event that Husband is unable to or fails to refinance or assume the Mortgage within the time allotted above, the parties shall list the Marital Home Real Estate for sale with a qualified real estate broker and shall market and sell the Marital Home Real Estate, the parties further agreeing to follow all reasonable advice as to listing and sales offered by their broker. Upon said sale the first $67,695.00 of the net proceeds from the sale of the Marital Home Real Estate shall be paid to Wife and the balance shall be paid to Husband. 13. BANK ACCOUNTS: Husband and Wife have owned various accounts during their marriage in both their individual and joint names. It is acknowledged that they have divided the jointly held accounts to their mutual satisfaction and they hereby agree that each shall become sole owner of their respective accounts and they each hereby waive any interest in, or claim to, any funds held by the other in any accounts. 14. MOTOR VEHICLES: Each party shall retain any and all vehicles, boats, trailers, and ATVs in his or her possession and shall become the sole and exclusive owner thereof. The non- S. IC1ients1COLGANIEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 10/1012006 9:04:24 AM possessing party shall cooperate in executing any and all documents in order to give effect to this paragraph and transfer sole title and ownership to the party in possession of the vehicles, boats, trailers, and ATVs. 15. AFTER-ACQUIRED PROPERTY: Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of property, be they real, personal or mixed, tangible or intangible, which are hereafter acquired by him or her, with full power in him or her to dispose of the same as fully and effectively, in all respects and for all purposes as though he or she were unmarried. 16. PENSIONS / RETIREMENT ACCOUNTS: Husband is the owner of a 401(k) through his employment with Select Medical. Husband shall retain sole and exclusive ownership of this account subject to a one time rollover payment via Qualified Domestic Relations Order ("QDRO") to Wife in the amount of $52,000.00, together with all earnings or losses thereon, on or after the effective date of this Agreement. Wife thereafter waives all right, title and interest in said account exclusive of, and excepting only, the amount to be paid to her aforesaid. A copy of the pre-approved QDRO is attached hereto as Exhibit A. The parties agree to cooperate in executing the QDRO and any additional documents required to give effect to this paragraph. Wife is the owner of a Defined Benefit Pension through her employment with EDS. Wife shall retain that pension in its entirety. Husband waives all right, title and interest in said account. The parties agree to execute any and all documents necessary to give effect to this paragraph. Wife is the owner of an IRA through Pershing. Wife shall retain that account in its entirety. Husband waives all right, title and interest in said account. The parties agree to execute any and all documents necessary to give effect to this paragraph. 17. LIFE INSURANCE: Each party agrees that Husband shall retain the Erie Life Insurance Policy in his name and Wife hereby waives any right, claim or interest she may have therein. Each party shall retain sole ownership of any other life insurance policy they may have acquired in their individual name and shall make any beneficiary designation they deem appropriate. 18. INCOME TAX: The parties have heretofore filed joint Federal and State income tax returns. Both parties agree that in the event any deficiency in Federal, State or local income tax is proposed, or any assessment of any such tax is made against either of them for any year in which a joint return was filed, each will indemnify and hold harmless the other from and against any loss or liability for any such tax deficiency or assessment and any interest, penalty and expense incurred in connection therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individual who is finally determined to be the cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns. S: IC1ienWCOLGAMEYA1VSJEMMSA Revised as of October S, 2006.doc Last edited 1011012006 9:04:24 AM 19. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS: The parties hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be within the scope and applicability of the Deficit Reduction Act of 1984 (hereinafter the "Act"), specifically, the provisions of said Act pertaining to the transfers of property between spouses and former spouses. The parties agree to sign and cause to be filed any elections or other documents required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement without recognition of gain on such transfer and subject to the carry-over basis provisions of said Act. 20. ALIMONY AND CHILD SUPPORT: The existing child/spousal support order entered in the case docketed to361 Support 2004; PACSES Number 556106365 shall remain in effect until the date of this Agreement. Nothing contained in this Agreement shall be construed to be a waiver of any rights and obligations under that existing order. Effective with the date of this Agreement, the current order for child support and spousal support shall be modified pursuant to the terms contained herein as follows: a. Child Support: Effective with the date of this Agreement, Husband shall pay child support to Wife in the amount of $950.00 per month. Husband shall also pay to Wife an additional sum or sums as Child Support equal to 15% of the net amount of any bonus he receives after the Effective date of this Agreement. The payment of the bonus share shall be made directly to Wife within seven (7) days of the date of receipt of the bonus payment. All other child support payments shall be paid through Cumberland County Domestic Relations Section This amount is agreed to by the parties without calculation 'oft e earns or earning capacities of the parties and shall be modifiable from time to time as permitted by the laws regarding child support in the Commonwealth of Pennsylvania or any other Court of competent jurisdiction. b. Termination of Spousal Support Order and Conversion to Alimony Order: As 0.10-0& of the date of this Agreement, the spousal support portion of the order entered in that case shall terminate and be converted to an order for alimony under the terms hereinafter set forth . Any credit or arrears on said spousal support order existing as of that date shall be a transferred from the spousal support order to the alimony order. c. Alimony: Husband shall pay to Wife indefinite alimony in the amount of $250.00 per month. Either party may seek a modification in the amount and/or duration of alimony payments due Wife from Husband based upon a substantial change in circumstances of the parties. In any event, alimony shall cease upon Wife's cohabitation with a member of the opposite sex who is not a member of her immediate family, Wife's remarriage or the death of either party. Alimony shall be determined after calculating the child support obligations of the parties so that the calculation of child support will be unaffected by the payment and/or receipt of alimony payments. The alimony shall be paid through Cumberland County Domestic Relations Section and Husband's wages shall be attached for such payment... S. IClientsiCOLGANIEVANSJEFWSA Revised as of October S, 2006.doc Last edited 10/1012006 9:04:24 AM d. Child's Estate/Life Insurance Rights: Husband shall maintain a Will or Trust which shall obligate Husband to provide for the parties' Children to inherit from his estate or receive life insurance proceeds upon his death as follows and under the following terms and conditions: 1. Estate Planning: Husband has executed a Last Will and Testament which names his children as his beneficiaries. Husband agrees that he shall maintain a Last Will and Testament that provides for each child in the same or substantially similar manner as presently directed by Husband's Last Will and Testament until such time as each minor child turns 18 years old or graduates high school, whichever shall last occur. Husband's Last Will and Testament referenced herein has been initialed and dated by each of the parties as of the date of this Agreement. 2. Employment Life Insurance Policy: Husband shall be required to maintain an employment life insurance policy naming the children as beneficiaries with a death benefit of not less than $150,000.00 for so long as: a) Such policy is available to his through his employment; b) The costs of such policy are substantially the same costs as the present cost. c) Husband's income is substantially equal to or greater than his current income. 21. EFFECT OF DIVORCE DECREE: The parties agree that, except as otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final Decree in Divorce may be entered with respect to the parties. 22. BREACH: If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this Agreement. 23. WAIVER OF CLAIMS: 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 shall now have or hereafter acquire, under the present and 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, dower, courtesy, statutory allowance, widow's allowance, right to take in intestacy, right to take against the Will of the other, and the right to act S: IClientslCOLGANIEVANSJEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM as administrator or executor of the other's estate, and 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 such interests, rights and claims. 24. ENTIRE AGREEMENT: This Agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 25. AGREEMENT BINDING ON HEIRS: This Agreement shall be binding on and shall inure to the benefits of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 26. ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time, at the request of the other, execute, acknowledge and deliver to the other any and all further instruments that may be reasonably required to give full force and effect to the provisions of this Agreement. 27. VOID CLAUSES: If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement and in all other respects this Agreement shall be valid and continue in full force, effect and operation. 28. INDEPENDENT SEPARATE COVENANTS: It is specifically understood and agreed by and between the parties hereto that each paragraph hereof shall be deemed to be separate and independent Agreement. 29. FINANCIAL DISCLOSURE: The parties confirm that they have relied on the completeness and substantial accuracy of the financial disclosure of the other as an inducement to the execution of this Agreement. The parties acknowledge that there has been no formal discovery conducted in their pending divorce action and that neither party has filed an inventory and appraisement as required by Section 3505(b) of the Pennsylvania Divorce Code. Notwithstanding the foregoing, the rights of either party to pursue a claim for equitable distribution, pursuant to the Pennsylvania Divorce Code, of any interest owned by the other party in an asset of any nature at any time prior to the date of execution of this Agreement that was not disclosed to the other party or his or her counsel prior to the date of the within Agreement is expressly reserved. In the event that either party, at any time hereafter, discovers such an undisclosed asset, the party shall have the right to petition the Court of Common Pleas of Cumberland County to make equitable distribution of said asset. The non-disclosing party shall be responsible for payment of counsel fees, costs or expenses incurred by the other party in seeking equitable distribution of said asset. Notwithstanding the foregoing this Agreement shall in all other respects remain in full force and effect. S: UientslCOLGAMEVANSJEEWSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM 30. MODIFICATION AND WAIVER: A modification or waiver of any of the provisions of this Agreement shall be effective only if made in writing and executed with the same formality as this Agreement. The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall not be construed as a waiver of any subsequent defaults of the same or similar nature. 31. DESCRIPTIVE HEADINGS: The descriptive headings used herein are for convenience only. They shall have no affected whatsoever in determining the rights or obligations of the parties. 32. APPLICABLE LAW: This Agreement shall be construed under the laws of the Commonwealth of Pennsylvania and more specifically under the Divorce Code of 1980 and any amendments thereto. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the date and year first above written. . 4 ss i Witn so (?? / &4-? ANGEL L. EVANS JEF A S: IC1ients1COLGANIEVANS.JEFIMSA Revised as of October S, 2006.doc Last edited 10/1012006 9:04:24 AM COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS. On this the V day of , 2006, before me the undersigned officer, personally appeared, Jeffrey A. Evans, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and notarial seal. COMMONWEALTH OF PENNSYLVANIA Notarial Seal I ftdl Jeanette L Roberts, Notary Public *NIOTARY PUBLIC Dilisburg Boro, York County My Commission Expires Aug. 22, 2010 My Commission Expires: Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND : SS. On this the day of Oa--k6?? , 2006, before me the undersigned officer, personally appeare , Angela L. Evans, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. N ARY PUBLIC fission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial SeoI Diane G. RadGiff; Notary Public i Camp Hill Boro, Cumberland County My Commission Expires Jan 008 _ fsiember, Pennsvl«am^ G4soci .,r`?r. ;)I J?r'es S. IClients1C0LGANIEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM ?.- ,? -? _?- _ 1 .._- .. t til ' _.j } - 'Y'.^'a ? ? l '? ANGELA L. EVANS, Plaintiff VS. JEFFREY A. EVANS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 04 - 1892 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this lP?` day of "I ? U1, ?Y?l (,? 2006, the economic claims raised in the proceedings having been resolved in accordance with a marital settlement agreement dated October 26, 2006, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, fem. Edgar B. Bayley, P.J.% cc: /iane G. Attorney 6'T?m othy Attorney Radcliff for Plaintiff 3. Colgan for Defendant /per ?Vy ?e tti r 1.„. qgq r j ?.1 Re: Aneela L. Evans vs. Jeff rev A. Evans Cumberland County Divorce 04-1892 MARITAL SETTLEMENT AGREEMENT C?' c7 O -n -ri 0''1 THIS MARITAL SETTLEMENT AGREEMENT, made this 2-& day of Co?bcqe , r j ?= 2006, by and between JEFFREY A. EVANS, of Dillsburg, York County, Pennsylvania ?, ?L} g (hereinafter referred to as "Husband") and ANGELA L. EVANS, of Dillsburg, York_ Count - Pennsylvania (hereinafter referred to as "Wife"): =' f-n C_) WITNESSETH: kb i b , iG t pry , in Grantham, Pennsylvania; WHEREAS, the parties were married on SeMemix=? WHEREAS, Husband and Wife are the natural parents of two (2) minor children: Courtney Lyn Evans, born on February 15, 1994 and Ryan Jeffrey Evans, born on July 22, 1998; WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the parties and it is the intention of Husband and Wife to live separate and apart, and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them in relation to the ownership and equitable distribution of real and personal property; settling of all matters between them relating to the past, present and future support, alimony and/or maintenance of Wife by Husband or of Husband by Wife; and in general, the settling of any and all claims and possible claims by either parry against the estate of the other party. NOW, THEREFORE, in consideration of the premises and of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, Husband and Wife, each intending to be legally bound hereby covenant and agree as follows: 1. INTERFERENCE: Each party shall be free from interference, authority, and contact by the other, as fully as though he or she were single and unmarried, except as may be necessary to carry out the provisions of this Agreement. Neither party shall molest the other or attempt to endeavor to molest the other, nor compel the other to cohabitate with the other, or in any way harass or malign the other, nor in any way interfere with the peaceful existence, separate and apart from the other. 2. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS: This Agreement shall not affect or bar the right of HUSBAND or WIFE to a divorce on lawful grounds or to any S: IClientslCOLGAMEVANSJEFIMSA Revised as of October S, 2006.doc Last edited 1011012006 9:04:24 AM defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed to be a condonation on the part of either party hereto of any act or acts on the part of the other party which have occasioned the disputes or unhappy differences. 3. SUBSEQUENT DIVORCE: The parties hereby acknowledge that Wife filed a Complaint in Divorce in Cumberland County, Pennsylvania, claiming that the marriage is irretrievably broken under Section 3301(c) of the Pennsylvania Divorce Code and that the parties have lived separate and apart as required under Section 3301(d) of the Pennsylvania Divorce Code. The Divorce Complaint also included claims under Sections 3301(a) (2) and (a) (6). The parties hereby express their agreement that the marriage is irretrievably broken and they have lived separately and apart for more than two years, and express their intent to execute any and all Affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301(c) or 3301(d) of the Divorce Code. The parties hereby waive all rights to request court ordered counseling under the Divorce Code. It is further specifically understood and agreed by the parties that the provisions of this Agreement as to equitable distribution of property of the parties are accepted by each party as a full and final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. Should a decree, judgment or order of divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants shall not be affected in any way by such separation or divorce; nothing in any such decree, judgment, order or further modification or revision thereof shall alter, amend or vary any term of this Agreement. It is the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and conclusive upon the parties. 4. INCORPORATION OF DIVORCE DECREE: It is further agreed, covenanted and stipulated that this Agreement or the essential parts hereof, shall be incorporated in any decree hereinafter entered by any court of competent jurisdiction in any divorce proceedings that have been or may be instituted by the parties for the purpose of enforcing the contractual obligations of the parties. This agreement shall not be merged in any such decree but shall in all respects survive the same and be forever binding and conclusive upon the parties. 5. EFFECTIVE DATE: The effective date of this Agreement shall be the "date of execution" or "execution date," defined as the date upon which it is executed by the parties if they have each executed this Agreement on the same date. Otherwise, the "date of execution" or "execution date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 6. DISTRIBUTION DATES: The transfer of property, funds and/or documents provided for herein, shall only take place on the "distribution" date, which shall be defined as the effective date of this Agreement, unless otherwise provided for herein, including any spousal support and/or alimony payments. S: IClientslCOLGANIEVANSJEIIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM 7. MUTUAL RELEASE: Except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provisions hereof, Husband and Wife each do hereby mutually remise, release, quit-claim and forever discharge the other and the estate of such other, for all time to come, and for all purposes whatsoever, of and from any and all rights, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situated, which he or she now has or at any time hereafter may have against the other, the estate of such other or any part hereof, whether arising out of any former acts, contracts, engagements or liabilities of such other or by way of dower or courtesy, or claims in the nature of dower or courtesy or widow's or widower's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will; or the right to treat a lifetime conveyance by the other as a testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any country or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, division of property, costs or expenses, whether arising as a result of the marital relations or otherwise. It is the intention of Husband and Wife to give each other by the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction. 8. REPRESENTATION BY COUNSEL: Husband has been represented by Timothy J. Colgan, Esquire, and Husband acknowledges that he has signed this Agreement freely and voluntarily after full consultation with his counsel. Wife has been represented by Diane G. Radcliff, Esquire, and Wife acknowledges that she has signed this Agreement freely and voluntarily after full consultation with her counsel. The parties acknowledge that this Agreement is not the result of any duress, undue influence, coercion, collusion and/or improper or illegal agreement. The parties further acknowledge that they have each made to the other a full and complete disclosure of their respective assets, estate, liabilities, and sources of income and that they waive any specific enumeration thereof for the purposes of this Agreement. 9. WARRANTY AS TO EXISTING OBLIGATIONS: Each party represents that they have not heretofore incurred nor contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable except as may be provided for in this Agreement. Each party agrees to indemnify and hold the other party harmless from and against any and all such debts, liabilities or obligations of every kind which may have heretofore been S.• IClientsICOLG.4MEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM incurred by them, including those for necessities, except for the obligations arising out of this Agreement. 10. WARRANTY AS TO FUTURE OBLIGATIONS: Husband and Wife covenant, warrant, represent and agree that, with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnify and hold harmless the other party from and against any and all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement. 11. PERSONAL PROPERTY: The parties agree to divide specific items of personal property as follows: a. Coins: The parties agree that each will receive 50% of the coins that were given to them by their families. The parties agree to divide and distribute the coins within 30 days of the effective date of this Agreement, unless they have previously divided said coins to their mutual satisfaction in which event they each waive any further distribution thereof, b. Videos: The parties agree that Husband will provide copies of the family videos to Wife. As the videos are on 8mm and Husband needs to purchase equipment to convert and copy the videos, Husband shall provide copies of the family videos to Wife within six (6) months of the effective date of this Agreement. c. Other Personal Property: The parties have divided between them, to their mutual satisfaction, all other personal effects, household furniture and furnishings, and all other articles of personal property which have heretofore been used by them in common, and neither party will make any claim to any such items which are now in the possession or under the control of the other. d. Waiver: By these presents, each of the parties hereby specifically waives, releases, renounces and forever abandons whatever claims he or she may have with respect to any personal property which is in the possession of the other, and which shall become the sole and separate property of the other from the date of execution hereof. 12. DIVISION OF MARITAL RESIDENCE: The parties jointly own the marital residence situate at 279 Alpat Drive, Dillsburg, York County, Pennsylvania (the "Marital Home Real Estate") subject to a joint Mortgage obligation owed to Member's 1St FCU (the "Mortgage"). Husband shall retain sole and exclusive ownership and possession of said residence under and subject to the following set forth terms and conditions: a. Refinance/Assumption: Husband shall apply for refinancing/assumption of the Mortgage within fifteen (15) business days of the date of this Agreement and shall S. IC1ients1COLGAMEVANS.JEFIMSA Revised as of October S, 2006.doc Last edited 1011012006 9:04:24 AM complete that refinance/assumption within sixty (60) days of the effective date of this Agreement so as to release Wife from further liability thereunder. The costs of refinancing/assumption shall be paid by Husband. b. Cash Payment: Husband shall make a one time cash payment to Wife in the amount of $67,695.00 contemporaneous with completion of settlement on the refinance/assumption. C. Deed/Conveyance: Husband's counsel shall prepare a Special Warranty deed transferring all of Wife's right, title and interest in the Marital Home Real Estate to Husband. The conveyance shall be subject to all liens and encumbrances, covenants and restrictions of record including, but not limited to, the lien of the Mortgage, any other mortgage, real estate taxes and any other municipal liens. Said deed shall be signed contemporaneous with the signing of this Agreement and shall be held in escrow by Wife's attorney pending completion of the refinance and payment to Wife of the $67,695 aforesaid at which time it will be released to Husband for recording. Wife thereafter waives all right, title and interest in the property. d. Marital Home Real Estate Expenses: Until such time as the Mortgage is refinanced/assumed and the Marital Home Real Estate conveyed to Husband, or sold to a third party in accordance with the provisions of this Paragraph, Husband shall be and remain solely responsible for any and all payments related to the Mortgage, real estate taxes, homeowner's insurance and maintenance of Marital Home Real Estate, any other municipal liens and any and all other expenses associated with the Marital Home Real Estate, whether incurred in the past, present or future, and shall indemnify and hold Wife harmless against any liability resulting from his failure to make payments thereon. e. Sale: In the event that Husband is unable to or fails to refinance or assume the Mortgage within the time allotted above, the parties shall list the Marital Home Real Estate for sale with a qualified real estate broker and shall market and sell the Marital Home Real Estate, the parties further agreeing to follow all reasonable advice as to listing and sales offered by their broker. Upon said sale the first $67,695.00 of the net proceeds from the sale of the Marital Home Real Estate shall be paid to Wife and the balance shall be paid to Husband. 13. BANK ACCOUNTS: Husband and Wife have owned various accounts during their marriage in both their individual and joint names. It is acknowledged that they have divided the jointly held accounts to their mutual satisfaction and they hereby agree that each shall become sole owner of their respective accounts and they each hereby waive any interest in, or claim to, any funds held by the other in any accounts. 14. MOTOR VEHICLES: Each party shall retain any and all vehicles, boats, trailers, and ATVs in his or her possession and shall become the sole and exclusive owner thereof. The non- S. IClientslCOLGANIEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM possessing party shall cooperate in executing any and all documents in order to give effect to this paragraph and transfer sole title and ownership to the party in possession of the vehicles, boats, trailers, and ATVs. 15. AFTER-ACQUIRED PROPERTY: Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of property, be they real, personal or mixed, tangible or intangible, which are hereafter acquired by him or her, with full power in him or her to dispose of the same as fully and effectively, in all respects and for all purposes as though he or she were unmarried. 16. PENSIONS / RETIREMENT ACCOUNTS: Husband is the owner of a 401(k) through his employment with Select Medical. Husband shall retain sole and exclusive ownership of this account subject to a one time rollover payment via Qualified Domestic Relations Order ("QDRO") to Wife in the amount of $52,000.00, together with all earnings or losses thereon, on or after the effective date of this Agreement. Wife thereafter waives all right, title and interest in said account exclusive of, and excepting only, the amount to be paid to her aforesaid. A copy of the pre-approved QDRO is attached hereto as Exhibit A. The parties agree to cooperate in executing the QDRO and any additional documents required to give effect to this paragraph. Wife is the owner of a Defined Benefit Pension through her employment with EDS. Wife shall retain that pension in its entirety. Husband waives all right, title and interest in said account. The parties agree to execute any and all documents necessary to give effect to this paragraph. Wife is the owner of an IRA through Pershing. Wife shall retain that account in its entirety. Husband waives all right, title and interest in said account. The parties agree to execute any and all documents necessary to give effect to this paragraph. 17. LIFE INSURANCE: Each party agrees that Husband shall retain the Erie Life Insurance Policy in his name and Wife hereby waives any right, claim or interest she may have therein. Each party shall retain sole ownership of any other life insurance policy they may have acquired in their individual name and shall make any beneficiary designation they deem appropriate. 18. INCOME TAX: The parties have heretofore filed joint Federal and State income tax returns. Both parties agree that in the event any deficiency in Federal, State or local income tax is proposed, or any assessment of any such tax is made against either of them for any year in which a joint return was filed, each will indemnify and hold harmless the other from and against any loss or liability for any such tax deficiency or assessment and any interest, penalty and expense incurred in connection therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individual who is finally determined to be the cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns. S: iClientsICOLGANIEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM 19. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS: The parties hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be within the scope and applicability of the Deficit Reduction Act of 1984 (hereinafter the "Act"), specifically, the provisions of said Act pertaining to the transfers of property between spouses and former spouses. The parties agree to sign and cause to be filed any elections or other documents required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement without recognition of gain on such transfer and subject to the carry-over basis provisions of said Act. 20. ALIMONY AND CHILD SUPPORT: The existing child/spousal support order entered in the case docketed to361 Support 2004; PACSES Number 556106365 shall remain in effect until the date of this Agreement. Nothing contained in this Agreement shall be construed to be a waiver of any rights and obligations under that existing order. Effective with the date of this Agreement, the current order for child support and spousal support shall be modified pursuant to the terms contained herein as follows: a. Child Support: Effective with the date of this Agreement, Husband shall pay child support to Wife in the amount of $950.00 per month. Husband shall also pay to Wife an additional sum or sums as Child Support equal to 15% of the net amount of any bonus he receives after the Effective date of this Agreement. The payment of the bonus share shall be made directly to Wife within seven (7) days of the date of receipt of the bonus r` "u51xiL.,\i IS payment. All other child support payments shall be paid through Cumberland County Domestic Relations Section, This amount is agreed to by the parties without calculation of the earnings or earning capacities of the parties and shall be modifiable from time to s time as permitted by the laws regarding child support in the Commonwealth of Pennsylvania or any other Court of competent jurisdiction. I 6k. _?. E /0-.20-06 b. Termination of Spousal Support Order and Conversion to Alimony Order: As of the date of this Agreement, the spousal support portion of the order entered in that case shall terminate and be converted to an order for alimony under the terms hereinafter set forth . Any credit or arrears on said spousal support order existing as of that date shall be transferred from the spousal support order to the alimony order. c. Alimony: Husband shall pay to Wife indefinite alimony in the amount of $250.00 per month. Either party may seek a modification in the amount and/or duration of alimony payments due Wife from Husband based upon a substantial change in circumstances of the parties. In any event, alimony shall cease upon Wife's cohabitation with a member of the opposite sex who is not a member of her immediate family, Wife's remarriage or the death of either party. Alimony shall be determined after calculating the child support obligations of the parties so that the calculation of child support will be unaffected by the payment and/or receipt of alimony payments. The alimony shall be paid through Cumberland County Domestic Relations Section and Husband's wages shall be attached for such payment... S. IC1ients1COLGANIEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04:24 AM d. Child's Estate/Life Insurance Rights: Husband shall maintain a Will or Trust which shall obligate Husband to provide for the parties' Children to inherit from his estate or receive life insurance proceeds upon his death as follows and under the following terms and conditions: 1. Estate Planning: Husband has executed a Last Will and Testament which names his children as his beneficiaries. Husband agrees that he shall maintain a Last Will and Testament that provides for each child in the same or substantially similar manner as presently directed by Husband's Last Will and Testament until such time as each minor child turns 18 years old or graduates high school, whichever shall last occur. Husband's Last Will and Testament referenced herein has been initialed and dated by each of the parties as of the date of this Agreement. 2. Employment Life Insurance Policy: Husband shall be required to maintain an employment life insurance policy naming the children as beneficiaries with a death benefit of not less than $150,000.00 for so long as: a) Such policy is available to his through his employment; b) The costs of such policy are substantially the same costs as the present cost. c) Husband's income is substantially equal to or greater than his current income. 21. EFFECT OF DIVORCE DECREE: The parties agree that, except as otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final Decree in Divorce may be entered with respect to the parties. 22. BREACH: If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election to sue for damages for such breach or seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this Agreement. 23. WAIVER OF CLAIMS: 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 shall now have or hereafter acquire, under the present and 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, dower, courtesy, statutory allowance, widow's allowance, right to take in intestacy, right to take against the Will of the other, and the right to act S: IClientslCOLGANIEYANS.JE,RMSA Revised as of October S, 2006.doc Last edited 10/1012006 9:04:24 AM as administrator or executor of the other's estate, and 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 such interests, rights and claims. 24. ENTIRE AGREEMENT: This Agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 25. AGREEMENT BINDING ON HEIRS: This Agreement shall be binding on and shall inure to the benefits of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 26. ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time, at the request of the other, execute, acknowledge and deliver to the other any and all further instruments that may be reasonably required to give full force and effect to the provisions of this Agreement. 27. VOID CLAUSES: If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement and in all other respects this Agreement shall be valid and continue in full force, effect and operation. 28. INDEPENDENT SEPARATE COVENANTS: It is specifically understood and agreed by and between the parties hereto that each paragraph hereof shall be deemed to be separate and independent Agreement. 29. FINANCIAL DISCLOSURE: The parties confirm that they have relied on the completeness and substantial accuracy of the financial disclosure of the other as an inducement to the execution of this Agreement. The parties acknowledge that there has been no formal discovery conducted in their pending divorce action and that neither party has filed an inventory and appraisement as required by Section 3505(b) of the Pennsylvania Divorce Code. Notwithstanding the foregoing, the rights of either party to pursue a claim for equitable distribution, pursuant to the Pennsylvania Divorce Code, of any interest owned by the other party in an asset of any nature at any time prior to the date of execution of this Agreement that was not disclosed to the other party or his or her counsel prior to the date of the within Agreement is expressly reserved. In the event that either party, at any time hereafter, discovers such an undisclosed asset, the party shall have the right to petition the Court of Common Pleas of Cumberland County to make equitable distribution of said asset. The non-disclosing party shall be responsible for payment of counsel fees, costs or expenses incurred by the other party in seeking equitable distribution of said asset. Notwithstanding the foregoing this Agreement shall in all other respects remain in full force and effect. S: IClientsICOLGANIEVANSJERMSA Revised as of October S, 2006.doc Last edited 1011012006 9:04:24 AM 30. MODIFICATION AND WAIVER: A modification or waiver of any of the provisions of this Agreement shall be effective only if made in writing and executed with the same formality as this Agreement. The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall not be construed as a waiver of any subsequent defaults of the same or similar nature. 31. DESCRIPTIVE HEADINGS: The descriptive headings used herein are for convenience only. They shall have no affected whatsoever in determining the rights or obligations of the parties. 32. APPLICABLE LAW: This Agreement shall be construed under the laws of the Commonwealth of Pennsylvania and more specifically under the Divorce Code of 1980 and any amendments thereto. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the date and year first above written. Wi nes- ayw-'& (/1 ANGELA L. EVANS .1-1 J111W I A, JEFF "" trVANS S:1C1ien1s1COLGANIEVANS.JEFIMSA Revised as of October S, 1006.doc Last edited 10/1011006 9:04:24 AM COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF YORK On this the day of CC 2006, before me the undersigned officer, personally appeared, Jeffrey A. Evans, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and notarial seal. f% f N COMMONWEALTH OF PENNSYLVANIA Notarial Seal Jeanette L. Roberts, Notary Public NOTARY PUBLIC v Dillsburg Boro, York County My Commission Expires Aug. 22, 2010 Ly Commission Expires: Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. On this the 2 ) day of , 2006, before me the undersigned officer, personally appeared, Angela L. Evans, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have-hereunto set my hand and notarial seal. { NOTARY PUBLIC ? My Commission Expires: COMMONWEAL.? "'1 """FYI_VANIA Noi,'-- -- Diane G. Raderii, Camp Hill Rom, Czr,Trxitanc ;.:. MY Colnrny= S:10ientslCOLGAMEVANS.JEFIMSA Revised as of October 5, 2006.doc Last edited 1011012006 9:04-24 AM ANGELA L. EVANS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 04-1892 JEFFREY A. EVANS, CIVIL ACTION - LAW Defendant DIVORCE PRAECIPE OF TRANSMIT RECORD TO THE PROTHONOTARY: Transmit the record, together with the following information, to the court for entry of a divorce decree: 1. GROUND FOR DIVORCE: Irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. DATE OF FILING AND MANNER OF SERVICE OF THE COMPLAINT: a. Date of Filing of Complaint: April 29, 2004 b. Manner of Service of Complaint: Certified Mail/Restricted Delivery C. Date of Service of Complaint: May 2, 2004 3. DATE OF EXECUTION OF THE AFFIDAVIT OF CONSENT REQUIRED BY SECTION 3301 (C) OF THE DIVORCE CODE: a. Plaintiff: October 20, 2006 b. Defendant: October 26, 2006 OR DATE OF EXECUTION OF THE PLAINTIFF'S AFFIDAVIT REQUIRED BY SECTION 3301(D) OF THE DIVORCE CODE AND DATE OF SERVICE OF THE PLAINTIFF'S 3301 (D) AFFIDAVIT UPON THE DEFENDANT: a. Date of Execution: N/A b. Date of Filing: N/A C. Date of Service: N/A 4. RELATED CLAIMS PENDING: No issues are pending. All issues have been resolved pursuant to the parties' Marital Agreement dated October 26, 2006, which Agreement is to be incorporated into but not merged with the Divorce Decree. 5. DATE AND MANNER OF SERVICE OF THE NOTICE OF INTENTION TO FILE PRAECIPE TO TRANSMIT RECORD, A COPY OF WHICH IS ATTACHED, IF THE DECREE IS TO BE ENTERED UNDER SECTION 3301(D)(1)(1) OF THE DIVORCE CODE: a. Date of Service: N/A b. Manner of Service: N/A OR DATE WAIVER OF NOTICE IN SECTION 3301(C) DIVORCE WAS FILED WITH THE PROTHONOTARY: a. Plaintiff's Waiver: November 2, 2006 b. Defendant's Waiver: November 2, 20 l C> n (1 / DIANE G. D LIFF, ESQUIRE 34 rindl p,R o a d C Aft, PA 17011 Supreme Court ID # 32112 Phone: (717) 737-0100 r-? " 3 v `_= _ '" `? ?. _-- ?_.; ....- _ ?} ?5.. --f,9 _ ,?.. ? ?j-l l J-1 ry? ti i'? . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff V. JEFFREY A. EVANS, Defendant NO. 04-1892 CIVIL ACTION - LAW DIVORCE STIPULATION FOR ENTRY OF DOMESTIC RELATIONS ORDER r ` w AND NOW, this + day of OCR bL , 2006, Plaintiff /Alternate Payee, Angela 1. Evans, and Defendant/ Participant, Jeffrey A. Evans, stipulate and agree that the foregoing Domestic Relations Order shall be entered by the Court. IN WITNESS WHEREOF, the parties have set their hands and seals the day and year above written. ATTORNEY FOR PARTICIPANT: 1?? Timothy a squire Date: ATTORNEY FOR ALTERNATE PAYEE: :Dia; c ff, Esquire Date: (C) /2x) D PARTICIPANT: J fre ans Date: -7 o. ALTERNATE PAYEE: "4?4 Off. uV-A? Ange a L. Evans Date: 10-20-0(0 -6- C ? T ^.; 3 C= i IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. No. 04-1 X392 (,TVTL TERM VERSUS JEFFREY A. EVANS, Defendant DECREE IN DIVORCE AND NOW, zi'"a ,2006 , IT IS ORDERED AND DECREED THAT ANGELA L EVANS , PLAINTIFF, AND JEFFREY A. EVANS DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; No issues are outstanding. All issues have been resolved and settled by the Parties' Marital Agreement dated October 26, 2006, filed of record and incorporated into, but not merged with, this Decree. BY THE COURT: ATT E J t PROTHONOTARY 1h, 70v ??? R - i?99fr1A1? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANGELA L. EVANS, . Plaintiff NO. 04-1892 V. CIVILIACTION - LAW JEFFREY A. EVANS, DIVORCE Defendant QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this 4- day of :tom.`. , 2006 , based on the findings set forth herein, IT IS HEREBY ORDERED, ADJUDGED AND DECREED as follows: 1. PARTIES: The parties hereto were husband and wife, and a divorce action is in this Court at the above number. The parties were married on February 16, 1985 and were divorced on November 22, 2006. This Court has personal jurisdiction over the parties. 2. PARTICIPANT INFORMATION: The name, last known address, Social Security Number and date of birth of the "Plan Participant" are: • Name: Jeffrey A. Evans; • Address: 279 Alpat Drive, Dillsburg, PA 17019; • SSN:178-58-4097; • Date of Birth: July 4, 1963. 3. ALTERNATE PAYEE INFORMATION: The name, last known address, Social Security Number and date of birth of the "Alternate Payee" are: • Name: Angela L. Evans; • Address: 162 Chestnut Grove Road, Dillsburg, PA 17019; • SSN: 183-50-6514; • Date of Birth: November. 13, 1965. n 1 9I; i Q ? Q lop The Alternate Payee shall have the duty to notify th Plan Administrator in writing of any changes in mailing address subsequent to the er try of this Order. 4. PLAN NAME. The name of the Plan to which this Order applies is the Select Medical Corporation 401(k) Plan (hereinafter referred to as "Plan"). Any changes in Plan Administrator, Plan Sponsor, or'', name of the Plan shall not affect Alternate Payee's rights as stipulated under this Order. 5. EFFECT OF THIS ORDER AS A QUALIFIED DOMESTI? RELATIONS ORDER. 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 under section 457(b) of the Internal Revenue Code (the "Code"). 6. PURSUANT TO STATE DOMESTIC RELATIONS LAW. This Order is entered pursuant to the authority granted in the applicable domestic relations laws of the Commonwealth of Pennsylvania. 7. PROVISIONS OF MARITAL PROPERTY RIGHTS. This Order relates to the provisions of marital property rights as a result of the Order of Divorce between the Participant and the Alternate Payee. 8. AMOUNT OF ALTERNATE PAYEE'S BENEFIT. This Order assigns to the Alternate Payee an amount equal to $52,000.00 of the Participant's total account balance accumulated under the Plan as of October 26, 2006, the date of the execution of the Parties' Marital Settlement Agreement, (or the closest valuation date thereto). The Alternate Payee's benefit herein awarded shall be credited with any interest and investment income (or losses) attributable thereon from the date of the execution of the Parties' Marital Settlement Agreement , (or the closest valuation date thereto), until the date of total distribution to the Alternate Payee. The Alternate Payee's portion of the benefits described above shall be allocated on a pro rata basis from all of the accounts and/or investment options maintained under the Plan on behalf of the Participant. Such benefits shat also be segregated and separately maintained in a nonforfeitable account(s) established on behalf of the Alternate Payee. This account(s) will initially be established in the same fund mix percentages as the Participant's account. As soon as administratively possible, and if permitted under the Plan, the Alternate Payee's portion of the benefits described above shall be paid to the into individual retirement account for the Alternate Payee which will be represented to be eligible to receive this transfer. 9. COMMENCEMENT DATE AND FORM OF PAYMEN TO ALTERNATE PAYEE. If the Alternate Payee so elects, the benefits shall be paid to the Alternate Payee as soon as 2 a administratively feasible following the date this Order is approved as a qualified domestic relations order by the Plan Administrator, for at the earliest date permitted under the terms of the Plan or Section 414(p) of the Code, of later. Benefits will be payable to the Alternate Payee in any form or permissible option otherwise available to participants under the terms of the Plan, except a joint or survivor payment. The Alternate Payee will be responsible for paying any applicable withdrawal charges imposed under any investment account(s) with respect to his or her share under the plan. 10. ALTERNATE PAYEE'S RIGHTS AND PRIVILEGES. On and after the date that this Order is deemed to be a qualified domestic relations order' but before the Alternate Payee receives a total distribution under the Plan, the Alternate Payee shall be entitled to all of the rights and election privileges that are afforded to Plan beneficiaries, including, but not limited to, the rules regarding the right to designate the Alternate Payee's estate as beneficiary for death benefit purposes, and the right to direct Plan investments, only to the extent permitted under the!, provisions of the Plan. 11. DEATH OF ALTERNATE PAYEE. In the event of the Alternate Payee's death prior to receiving the full amount of benefits assigned under this Order and under the benefit option chosen by the Alternate Payee, the remainder of any unpaid benefits under the terms of this Order shall be paid to the Alternate Pay e's estate. The Alternate Payee may not designate a beneficiary other than his or he estate. 12. DEATH OF PARTICIPANT. Should the Participant predecease the Alternate Payee, such Participant's death shall in no way affect the Alternate Payee's right to the portion of the benefits as stipulated herein. 13. SAVINGS CLAUSE. This Order is not intended, and Shall not be construed in such a manner as to require the Plan: a. to provide any type or form of benefit or any, option not otherwise provided under the Plan; b. to provide increased benefits to the Alternate Payee; C. to pay any benefits to the Alternate Payee w ich are required to be paid to another alternate payee under another order previously determined to be a qualified domestic relations order; or d. to make any payment or take any action which Is in Y consistent with any Federal or state law, rule, regulation or applicable judi ial decision. 14. CERTIFICATION OF NECESSARY INFORMATION All p?yments made pursuant to this 3 Order shall be conditioned on the certification y the Alternate Payee and the Participant to the Plan Administrator of such information as the Plan Administrator may reasonably require from such parties. 15. CONTINUED QUALIFIED STATUS OF ORDER. It is thej intention of the parties that this qualified domestic relations order continue to qualify as a qualified domestic relations order under section 414(p) of the Code, as it may be !,amended from time to time, and that the Plan Administrator shall reserve the right t& reconfirm the qualified status of the Order at the time benefits become payable hereunder. 16. TAX TREATMENT OF DISTRIBUTIONS MADE UNDER THIS ORDER. For purposes of sections 402(a)(1) and 72 of the Code, or any successor Code section, any Alternate Payee who is the spouse or former spouse of the P rticipant shall be treated as the distributee of any distribution or payments made t the Alternate Payee under the terms of this Order, and as such, will be required to pay the appropriate Federal income tax on such distribution. 17. PARTIES RESPONSIBLE IN EVENT OF ERROR. In the event that the Plan inadvertently pays the Participant any benefits that are assigned to'the Alternate Payee pursuant to the terms of this Order, the Participant shall immediately reimburse the Alternate Payee to the extent that the Participant has receivedl,,such benefit payments by paying such amounts direction to the Alternate Payee within ten (10) days of receipt. In the event that the Plan inadvertently pays the Alte Ilnate Payee any benefits that are to remain the sole property of the Participant pursua t to the terms of this Order, the Alternate Payee shall immediately reimburse the Participant to the extent that the Alternate Payee has received such benefit payments by paying such amounts directly to the Participant within ten (10) days of receipt. 18. EFFECT OF PLAN TERMINATION. I the event of a Plan termination, the Alternate Payee shall be entitled to receive his or her portion of the Participant's benefits as stipulated herein in accordance with the Plan's termi ation provisions for participants and beneficiaries. 19. CONTINUED JURISDICTION The Court retains juri! this Order to establish or maintain its status as a under Code section 414(p), as amended and the stipulated herein. The Court shall also retain jurisd as a necessary to enforce the assignment of benefits herein. 20. NOTICE OF PENDING RETIREMENT. In the event that Alternate Payee to wait until the Participant's :tion over this matter to amend ilified domestic relations order iginal intent of the parties as on to enter such further orders the Alternate Payee as set forth terms of the Plan require the at date of termination of 4 ? 1 r i r employment or retirement before becoming eligible o receive a distribution, then the Participant shall be required to notify the Alternate ayee, in writing, within ten (10) days following such termination of employment or retirement. This notice shall be sent via regular first-class mail. For this purpose, the Alternate Payee shall notify the Participant of any changes in mailing address. 21. FEE. If a processing fee is charged by the Plan Administrator, that processing fee shall be charged one-half against the Alternate Payee's !ccount and one-half against the Participant's account. In the event that the Alternate Payee is awarded 100% of the Participant's account balance as of the date this Order is processed pursuant to this Order, the entire processing fee shall be charged t the Alternate Payee's account. If there are not sufficient funds in either party's account to pay the party's respective share of the fee, the difference shall be charged to the account of the other party. BY THE COURT: Judge Distribution to: ATTORNEY FOR PARTICIPANT: I PARTICIPANt: Timothy J. Colgan, Esquire Jeffrey A. Evans 130 W. Church Street 279 Alpat Drive Diltsburg, PA 17019 Dillsburg, PA 17019 ATTORNEY FOR ALTERNATE PAYEE: ALTERNATE PAYEE: Diane G. Radcliff, Esquire Angela L. Evans 3448 Trindle Road 162 Chestnut (Grove Road Camp Hill, PA 17011 Diltsburg, PA 7019 5 IN THE COURT OF COMMON PLEAS OF CUMBERLAN COUNTY, PENNSYLVANIA ANGELA L. EVANS, Plaintiff NO. 4-1892 V. - CIVIL ACTION - LAW JEFFREY A. EVANS, DIVOT CE Defendant , AND NOW, this A- day of OCR b-l' , 2006, Pt Ilintiff/Alternate Payee, Angela 1. Evans, and Defendant/ Participant, Jeffrey A. Evans, stipul to and agree that the foregoing Domestic Relations Order shall be entered by the Court. IN WITNESS WHEREOF, the parties have set their hands a?d seals the da an year above written. y and ATTORNEY FOR PARTICIPANT: PARTICIP "?Z Timothy a sDate: 7-;,B-o& ATTORNEY FOR ALTERNATE PAYEE: Dia cl ff, Esquire Date: I C) I? Date: or1 `' ?? ALTERNATE AYEE: 01Y?4? GK Ange a L. Evans Date: /U -20-0 -6- r-I Q I'D V f n ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 04-1892 CIVIL State Commonwealth of Pennsylvania 556106365 OOriginal Order/Notice Co./City/Dist. of CUMBERLAND 361 S 2004 QAmended Order/Notice Date of Order/Notice 02/02/09 (Terminate Order/Notice Case Number (See Addendum for case summary) QOne-Time Lump Sum/Notice RE:EVANS, JEFFREY A. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 178-58-4097 Employee/Obligor's Social Security Number SELECT EMPLOYMENT SERVICES INC 8634101324 4714 GETTYSBURG RD Employee/Obligor's Case Identifier ME CHANI CSBURG PA 17055-4325 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 950.00 per month in current child support $ o . oo per month in past-due child support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current medical support $ 0.00 per month in past-due medical support $ 250.00 per month in current spousal support $ 0.0o per month in past-due spousal support $ 0.00 per month for genetic test costs $ o. oo per month in other (specify) $ one-time lump sum payment for a total of $ 1,200.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 276.92 per weekly pay period. $ 600.00 per semimonthly pay period (twice a month) $ 553.85 per biweekly pay period (every two weeks) $ 1, 200.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call 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. BY THE COURT: ys?+' DRO: R.J. Shadday Service Type M OMB No.: 0970-0154 A. Hess, Judge Form EN-028 Rev. 4 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS Ifjhecke?l you are required to provide aaopy of this form to your employee. If yo r employee works in a state that is di Brent rrom the state that issued this o er, a copy must be provided to your empYoyee even if the box is not checked 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employeelobligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 2518122450 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:EVANS, JEFFREY A. EMPLOYEE'S CASE IDENTIFIER: 8634101324 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT- NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeelobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. 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, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 4 Worker ID $zATT i ? ADDENDUM Summary of Cases on Attachment Defendant/Obligor: EVANs, JEFFREY A. PACKS Case Number 556106365 Plaintiff Name ANGELA L. EVANS Docket Attachment Amount 00361 S 2004 $ 950.00 Child(ren)'s Name(s): DOB COURTNEY Y N EVANS L . ., - . .. AN?3112ESC E?Et1?75 07????98 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Service Type M OMB No.: 0970.0154 PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Form EN-028 Rev. 4 Worker I D $ IATT +4 ?'' a . cs ^" t ? ?./1 Z r?j t ? t ! . s ;. _. .. ?w ? ? - •--` -3 ` ? ? In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: JEFFREY A. EVANS Member ID Number: 8634101324 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name ANGELA L. EVANS ANGELA L. EVANS PACSES Docket Case Number Number 556106365 00361 S 2004 602110632 04-1892 CIVIL TOTAL ATTACHMENT AMOUNT: h N ? Attachment AmountiF 950.00 250 00 T TF ? rTt-.- . :1I7 t" G7 '? rn C a) QQ ? p - 1 =-rt C7 -n C 3 c; $ = of $ 1,200.00 51 Now, by Order of this Court, the Department of Labor and Industry, Office of Unemployment Compensation Benefits (OUCB), is hereby directed to attach the lesser of $ 276.16 per week, or 50%, of the Unemployment Compensation benefits otherwise payable to the Defendant, JEFFREY A. EVANS Social Security Number XXX-XX-4097, Member ID Number 8634101324. OUCB is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from OUCB to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. § 1673 (b)(2) and 23 Pa. C.S.A. § 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the OUCB and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated AUGUST 21, 2011 is exhausted, expired or deferred. OUCB shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: AUG 3 0 2011 ????,,,,".•? Albert H. Masland JUDGE Form EN-530 Service Type M Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State: Commonwealth of Pennsylvania 556106365 Co./City/ ist. o : CUMBERLAND 361 S 2004 Date of Order/Notice: 09/08/11 Case Number (See A e?for case summary) Employer/Withholder's Federal EIN Number SELECT EMPLOYMENT SERVICES INC 4714 GETTYSBURG RD MECHANICSBURG PA 17055-4325 RE: EVANS, JEFFREY A. 04-1892 CIVIL O Original Order/Notice Q Amended Order/Notice Terminate Order/Notice O One-Time Lump Sum/Notice Employee/Obligor's Name (Last, First, MI) 178-58-4097 Employee/Obligor's Social Security Number 8634101324 Employee/Obligor s Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current child support $ 0.00 per month in past-due child support Arrears 12 weeks or greater? Q yes Q no $ 0.00 per month in current medical support ;,) C71 $ 0.00 per month in past-due medical support -oz $ 0.00 per month in current spousal support CO 7z ern r r-ra- $ 0.00 per month in past-due spousal support z? -v ter` $ 0.00 per month for genetic test costs cn? t MM $ 0.00 per month in other (specify) rte"'S?C') $ one-time lump sum payments "a X c? for a total of $ 0.00 per month to be forwarded to payee below. F' You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does notmatch the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per semimonthly pay period 0.00 (twice a month) $ per biweekly pay period (every two weeks) $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). 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. -,--a _ -..*V r..% BY THE COURT: Service Type M Albert H. Masland OMB No.: 0970-0154 Form EN-028 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS r-1 If checked you are required to provide a copy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligoes principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Orddr/Notlceto the Agency identified below. 2518122450 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER: O THE°EMPLOYEEIOBLIGOR NO LONGER WORKS FOR: O EMPLOYEE'S/OBLIGOR'S NAME: EVANS JEFFREY A. EMPLOYEE'S CASE IDENTIFIER: 8634101324 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: NEW EMPLOYER'S NAME/ADDRESS: FINAL PAYMENT AMOUNT: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* 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's/obligor's principal place of employment. 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, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks: If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact - WAGE ATTACHMENT UNIT by telephone at (717) 244-6225 or by FAX at (717),240-6248 or by internet www.childsupoort.state.pa.us OMB No.: 0970.0154 Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: EVANS, JEFFREY A. PACSES Case Number 556106365 PACSES Case Number 602110632 Plaintiff Name Plaintiff Name ANGELA L. EVANS ANGELA L. EVANS Docket Attachment Amount ck Attachment Amount 00361 S2004 $ 0.00 04-1892 CIVIL $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB COURTNEY LYN EVANS 02/15/94 RYAN JEFFREY EVANS' 07122/98 PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 Service Type M OMB No.: 0970-0154 Worker ID $IATT INCOME WITHHOLDING FOR SUPPORT =? j lR 1 U lo"?loc? O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) 31"1 's O AMENDEDIWO [11 clI I DLC13I O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT C4 - 15? 01 a C 1 U I J O TERMINATION OF IWO Date: 02108112 ? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One) NOTE: This IWO must be r arQ9, itsaface. Under certain circumstances you must reject this IWO and return it to the sender (see IWO instructions http 9/www cf hF Paov/ o6?rams/cse/newhire/emolover/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/Tribe/Territory Commonwealth of Pennsylvania Remittance Identiter pnciuae wipayment/: ooa%iu iavo City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for order/docket Informa/ton) Private Individual/Entity _ CSE Agency Case Identifier: (See Addendum for case summary) SELECT EMPLOYMENT SERVICES INC 4714 GETTYSBURG RD MECHANICSBURG PA 17055-4325 Employer/Income Withholder's FEIN 251812245 Child(ren)'s Name(s) (Last, First, Middle) Child(ren)'s Birth Date(s) 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-) i $ 0.00 per month in current child support ?=s rt $ 0.00 perm nth in past-due child support - Arrears 12 weeks or greater? O 341P (•?lo $ 0.00 permonth in current cash medical support ca 2 " t - r`'i ..3 r . ,? $ 0.00 per month in past-due cash medical support r 3 , 4C.) - $ 0.00 perm nth in current spousal support r-- :c $ 0.00 per month in past-due spousal support C- $ 0.00 per month in other (must specify) N C ' for a Total Amount to Withhold of $ 0.00 per month. 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 CUMBERLAND County, 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 CUMBERLAND County, Commonwealth of Pennsylvania (State/Tribe), obtain withholding limitations, time requirements, and any allowable employer fees at httg://www.acf.hhs.aov/programs/cse/newhire/employer/contacts/ contact map.htm for the employee/obligor's principal place of employment. RE: EVANS JEFFREY A. Employee/Obligor's Name (Last, First, Middle) 178-58-4097 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 http://www.acf.hhs.gov/proarams/cse/newhiire/ emp(gver/oublication/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. 2518122450 Document Tracking Identifier Service Type M OMB No.: 0970-0154 Form EN-028 01/12 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 law): 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.oov/programs/cse/newhirelemRoyer/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(bx7)). 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 - 0513112014. 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 01/12 Service Type M Page 2 of 3 Worker ID $IATT Employer's Name: SELECT EMPLOYMENT SERVICES INC Employer FEIN: 251812245 Employee/Obligor's Name: EVANS JEFFREY A. 8634101324 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 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: 2518122450 Q This person has never worked for this employer nor received periodic income. Q 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 Employerlincome 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 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. Service Type M OMB No.: 0970-0154 Page 3 of 3 Form EN-028 01/12 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: EVANS, JEFFREY A. PACKS Case Number 556106365 Plaintiff Name ANGELA L. EVANS 00361 S 2004 $ 0.00 Child(ren)'s Name(s): DOB COURTNEY LYN EVANS 02/15/94 RYAN JEFFREY EVANS 07/22/98 PACSES Case Number Plaintiff Name Docket Attachment A ount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment mount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number 602110632 Plaintiff Name ANGELA L. EVANS Docket Attachment Amount 04-1892 CIVIL $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name D2. e Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Addendum Form EN-028 01/12 Ca-ire Tvoe M OMB No.: 0970-0154 Worker ID $IATT Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Pill : ("D ANGELA L. EVANS, Plaintiff v. JEFFREY A. EVANS, Defendant RLAQ COUNT WVW OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 04-1892 CIVIL ACTION -LAW PETITION TO TERMINATE/MODIFY DOWNWARD ALIMONY 1) Petitioner is Defendant, Jeffrey A. Evans, an adult individual residing at P.O. Box 95, Elliottsburg, Perry County, Pennsylvania 17024. 2) Respondent is Angela L. Evans, an adult individual residing at 162 Chestnut Grove Road, Dillsburg, York County, Pennsylvania 17019. 3) The parties were married February 16, 1985 and divorced November 22, 2006. 4) Two (2) children were born of the marriage being Courtney L. Evans (Born: 2/15/94) and Ryan J. Evans (Born: 7/22/98). 5) The parties entered into a Marital Settlement Agreement on October 26, 2006 which resolved all outstanding issues of the divorce. 6) The Marital Settlement Agreement provided terms relating to alimony payable to Respondent. Paragraph 20 provided, inter alia: C. Alimony: Husband shall pay to Wife indefinite alimony in the amount of $250.00 per month. Either party may seek a modification in the amount and/or duration of alimony payments due Wife from Husband based upon a substantial change in circumstances of the parties. In any event, alimony shall cease upon Wife's cohabitation with a member of the opposite sex who is not a member of her immediate family, Wife's remarriage or the death of either party. Alimony shall be determined after calculating the child support obligations of the parties so that the calculation of child support will be unaffected by the payment and/or receipt of alimony payments. The alimony shall be paid through Cumberland County Domestic Relations Section and Husband's wages shall be attached for such payment. 7) Petitioner presently seeks to terminate or modify downward the alimony payment because his employment and financial circumstances have drastically changed since the time of divorce in 2006. 8) At the time of the parties' divorce in 2006, Petitioner was employed by Select Medical Corporation as a pilot, at which time his income was $64,470.00. 9) Petitioner is currently unemployed, after being separated from Select Medical Corporation on August 5, 2011. Petitioner received a six (6) month severance package which will terminate on January 29, 2012. Petitioner had been receiving unemployment compensation in the amount of $585/week. However, due to his attempts to earn income by doing per diem work, the Department of Labor is revising his eligibility for unemployment compensation. 10) Petitioner has attempted to be in the work force. Since August 2011, Petitioner has applied for at least 20-25 positions in aviation and other industries. However, he has been unsuccessful in obtaining employment. 11) Like all pilots, Petitioner is qualified to fly only the jets/aircraft that he is rated in as a pilot. Petitioner's qualification will end in June 2012, at which time he will be unqualified to fly jets/aircraft. He will be required to pay $25,000 in order to be re-qualified. Petitioner does not have the financial means to pay for re- qualification. 12) Because Petitioner's financial circumstances have negatively changed since the parties were divorced in 2006, Petitioner respectfully requests that the court terminate Respondent's alimony award. 13) To the contrary, it is believed that Respondent's financial situation has improved since the divorce. Respondent was not employed outside of the home at the time of divorce. 14) Presently, Respondent is working full time for the Mechanicsburg School District and has increased her earnings to approximately $28,000.00. 15) At the time of divorce, Respondent was the primary custodian of the children who are elementary school ages 8 and 12. Presently, the children are 18 (on 2/15/12) and 14 (on 7/22/12). 16) Although unemployed since August, 2011, Petitioner has timely paid all alimony (and child support) payments required pursuant to the Marital Settlement Agreement through his severance; however, due to that terminating, he does not have the funds to continue alimony payments. Petitioner had also filed for reduction of the child support. 17) Petitioner files this request and relies upon 23 Pa. C.S.A. §3701(e) which provides: (e) Modification and termination- An order entered pursuant to this section is subject to further order of the court upon changed circumstances of either party of a substantial and continuing nature whereupon the order may be modified, suspended, terminated or reinstituted or a new order made. Any further order shall apply only to payments accruing subsequent to the petition for the requested relief. Remarriage of the party receiving alimony shall terminate the award of alimony. 18) The Honorable Judge Kevin A. Hess was previously assigned to this matter. 19) Opposing counsel, Diane Radcliff, has not concurred with the filing of this Petition. WHEREFORE, Petitioner respectfully requests an order fully terminating his alimony payments. DATE: April 3, 2012 New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant Barbara Numpie-aunivan, ,squire 549 Bridge Street It . Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. JEFFREY A. EVANS, Defendant NO. 04-1892 CIVIL ACTION - LAW VERIFICATION I, Jeffrey A. Evans, hereby certify that the facts set forth in the foregoing Petition are true and correct to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities. Dated: a 2H /Z JE .EVANS Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 04-1892 JEFFREY A. EVANS, CIVIL ACTION -LAW Defendant CERTIFICATE OF SERVICE I, BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date, I served a true and correct copy of Petition to Modify Alimony in the above-captioned matter upon the following individual(s), by United States first-class mail, postage prepaid, addressed as follows: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 DATE: April 3, 2012 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. JEFFREY A. EVANS, Defendant : NO. 04-1892 CIVIL ACTION -LAW RULE M tca -c w 77 AND NOW, this day of a4A:L_L 2012 on consideration of Defendant's Petition to Terminate or Modify Downward Alimony, a RULE is issued on Plaintiff to show cause, if any, why the Court should not grant the relief requested. The Rule is returnable at hearing to be held on o , 2012 at /d .'63 A.M./hl?? in Courtroom of the Cumberland County Courthouse, Carlisle, PA. BY THE COURT: Distribution: ?B bara Sumple-Sullivan, Esquire, 549 Bridge Street, New Cumberland, PA 17070; (717) 774-1445 ?Diane G. Radcliff, Esquire, 3448 Trindle Road, Camp Hill, PA 17011; (717) 737-0100 1. 12 62S /'YL.'t6 -v/ a`?Z r-,." ANGELA L. EVANS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - LAW NO. 2004-1892 JEFFREY A. EVANS, Defendant IN RE: DEFENDANT'S MOTION TO MODIFY ALIMONY ORDER AND NOW, this Z 0' day of April, 2012, at the request of counsel for the plaintiff and with the concurrence of counsel for the defendant, hearing herein set for May 23, 2012, is continued to Thursday, May 31, 2012, at 10:00 a.m. in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. BY THE COURT, Kevin A. ess, P. J. Diane Radcliff, Esquire For the Plaintiff ? Barbara Sumple-Sullivan, Esquire For the Defendant :rlm Coo , /nat , r n w s+. -n MM - -urn cnr"- ? Ay © --mc r C a L-3 _ Y ' c-? M 3 C ' C = OM, ? w -I • Barbara Sumple-Sullivan, Esquire Supreme Court 432317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ANGELA L. EVANS, Plaintiff V. JEFFREY A. EVANS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSY?YANIA NO. 04-1892 M . CIVIL ACTION - LAW ?- c-1 t r.? ORDER ADOPTING STIPULATION OF PARTIES AND NOW, to wit, this 3l- day of 127 , 2012, upon consideration of the attached Stipulation and on motion of Diane G. Radcliff, Esquire, counsel for Plaintiff, and Barbara Sumple-Sullivan, Esquire, counsel for Defendant, it is hereby ordered, adjudged and decreed that the terms, conditions and provisions of the attached Stipulation are adopted as an Order of Court and Plaintiff's alimony is hereby suspended. BY THE COURT, J. Distribution:. Diane G. Radcliff, Esquire, 3448 Trindle Road,. Camp Hill, PA 17011 Barbara Sumple-Sullivan, Esquire, 549 Bridge Street, New Cumberland, PA 17070 hand deliver .0 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 04-1892 CIVIL ACTION - LAW STIPULATION FOR SUSPENSION OF ALIMONY This Agreement is made this 3/ day of , 2012 by and between Barbara Sump] e-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ANGELA L. EVANS, Plaintiff V. JEFFREY A. EVANS, Defendant Plaintiff, Angela L. Evans, and Defendant, Jeffrey A. Evans. WITNESSETH: WHEREAS, the parties were divorced in 2006 and incident to divorce, the parties entered into a Marital Settlement Agreement dated October 26, 2006; WHEREAS, the Marital Settlement Agreement at Paragraph 20(c) provided that: (c) Alimony: Husband shall pay to Wife indefinite alimony in the amount of $250.00 per month. Either party may seek a modification in the amount and/or duration of alimony payments due Wife from Husband based upon a substantial change in circumstances of the parties. In any event, alimony shall cease upon Wife's cohabitation with a member of the opposite sex who is not a member of her immediate family, Wife's remarriage or the death of either party. Alimony shall be determined after calculating the child support obligations of the parties so that the calculation of child support will be unaffected by the payment and/or receipt of alimony payments. The alimony shall be paid through Cumberland County Domestic Relations Section and Husband's wages shall be attached for such payment. 1 A f • 1 • . WHEREAS, as of August, 2011, Defendant lost his job as a pilot with Select Medical Corporation where he was employed at the time of entering into the Marital Settlement Agreement; WHEREAS, as of August, 2011, Plaintiff has been employed in a full time position with the Mechanicsburg School District; WHEREAS, the parties agree to suspension of the alimony payments at this time; NOW THEREFORE, the parties do set forth the terms of their agreement as follows: 1. The Whereas Clauses set forth above are incorporated herein as material terms of this Agreement. 2. Commencing February 1, 2012, the alimony payment due to Plaintiff as set forth at Paragraph 20(c) of the parties' Marital Settlement Agreement, shall be suspended. 3. Each parry reserves his or her right to future court review for modification or termination of Plaintiff s alimony award without prejudice arising from this Stipulation and suspension. The parties intending to be legally bound, do set their signatures: SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF: Esquire Barbara Sumple-Sullivan, Esquire Attorney for Defendant -CIO Angela. Evans ?f ? Jeff