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09-7822
Divorce Complaint 01UGINAL Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 • Fax: 717-975-0697 • Email: dianeradcliff @comcast.net Attorney for Plaintiff, Jeanene L. Olenick IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK, Plaintiff V. DAVID M. OLENICK, Defendant NO. bQ -'7saa t'iv i (- er-K : CIVIL ACTION - LAW : DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, 1st Floor, 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. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDER YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone No. (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK, Plaintiff NO. V. DAVID M. OLENICK, DIVORCE COMPLAINT AND NOW, comes the Plaintiff, Jeanene L. Olenick, by her Attorney, Diane G. Radcliff, Esquire and files this Divorce Complaint, whereof the following is a statement: COUNT I DIVORCE 1. The Plaintiff is Jeanene L. Olenick, an adult individual who has resided at 1109 Kent Drive, Mechanicsburg, Cumberland County, Pennsylvania 17050 since 2001. 2. The Defendant is David M. Olenick, an adult individual who has resided at 1109 Kent Drive, Mechanicsburg, Cumberland County, Pennsylvania 17050 since 2001. 3. Plaintiff and 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 December 10, 1994 in Lancaster, Lancaster, County, Pennsylvania. 5. There are two (2) children of this marriage under the age of eighteen (18), namely, to wit: Joshua D. Olenick, born 12/10/2000; and Christian M. Olenick, born 2/28/2003. 6. There have been no prior actions of divorce or annulment between the parties. 7. 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. 8. Neither Plaintiff nor Defendant is a member of the Armed Services of the United : CIVIL ACTION - LAW : DIVORCE Defendant -2- States or any of its Allies. 9. Plaintiff avers that the grounds on which the action is based is the marriage is irretrievably broken. 10. 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 11. Paragraphs 1 through 10 are incorporated by reference hereto as fully as though the same were set forth at length. 12. Plaintiff and Defendant have acquired property, both real and personal, and incurred debts during their marriage during the period from December 10, 1994, the date of their marriage, until the date of their separation, all of which are "marital property" or "marital debts". 13. 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". 14. 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 15. Paragraphs 1 through 14 are incorporated by reference hereto as fully as though the same were set forth at length. 16. Plaintiff lacks sufficient property to provide for her reasonable means and is unable to support herself through appropriate employment. -3- 17. 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 18. Paragraphs 1 through 17 are incorporated by reference hereto as fully as though the same were set forth at length. 19. Plaintiff has employed legal counsel in this case, but is unable to pay the necessary and reasonable attorney's fees for said counsel. 20. 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. 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 further award such additional counsel fees, costs and expenses as are deemed necessary and appropriate. Respectfully submitted, DCLIFF, ESQUIRE IME G.' 3 Road Camp Hill, PA 17011 Phone: (717) 737-0100 Fax: (717) 975-0697 Supreme Court ID # 32112 Attorney for Plaintiff -4- VERIFICATION JEANENE L. OLENICK verifies that the statements made in this Complaint are true and correct. JEANENE L. OLENICK understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. C? JE NE L. OLEN Date:U U', T_s 1 r" ( 1 7)V 7u09 r 0V 12 Ail 13: 3 t 44I6.50 Po AT" M *4(04q a333q#(, Prepared by: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 • Fax: 717-975-0697 • Email: dianeradcliff @comcast.net Attorney for Plaintiff, Jeanne 1. Olenick IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK, . (? - 7 ?? c }?, ; 1crM Plaintiff NO. V. DAVID M. OLENICK, : CIVIL ACTION - LAW : DIVORCE Defendant PETITION FOR SPECIAL RELIEF/INJUNCTION TO THE HONORABLE, THE JUDGES OF THE SAID COURT: AND NOW, comes the Petitioner, Jeanene L. Olenick, by her attorney, Diane G. Radcliff, Esquire, and files the above referenced Petition, and represents that: 1. This is a divorce case. This Petition involves a request for an injunction to prohibit the removal, transfer, conveyance, disposition, alienation or encumbering of marital property 2. The following attorneys have entered their appearances in this case: (a) Diane G. Radcliff, Esquire for Plaintiff; (b) None for Defendant . 3. A copy of this Petition is being served upon the Respondent concurrently with the service of the Divorce Complaint being filed immediately prior to this Petition. Given the nature of the request, consent to relief requested the Petition was not sought. 4. The following are the judges previously assigned to this case: None 5. Your Petitioner is Jeanene L. Olenick, (hereinafter referred to as "Wife"), and is the Plaintiff in the above captioned divorce action. 6. Your Respondent is David M. Olenick, (hereinafter referred to as "Husband" ), and is -2- the Defendant in the above captioned divorce action. 7. The within action was commenced by the filing of a Divorce Complaint immediately prior to the filing of this Petition. 8. In that Divorce Complaint, the following claims were raised: a. Divorce under Sections 3301(c) and 3301(d); b. Equitable Distribution of Marital Property and Debts; C. Alimony Pendente Lite; d. Alimony; e. Counsel Fees and Costs. 9. The parties are husband and wife. They were married on December 10, 1994. 10. The parties still reside in the same household. 11. During the course of their marriage the parties acquired certain marital assets which it is believe consist of the assets listed on the Table attached to this Petition as Exhibit "A" and made a part hereof. 12. After November 10, 2009 when Wife told Husband of her intention to divorce him, it is believed that Husband may have begun to transfer the parties' financial holdings into his sole name. 13. Wife believes and fears that Husband will removal, transfer, convey, dispose, alienate or encumber the assets listed on Exhibit "A" , all of which are marital and under his sole control, so as to prevent Wife from valuing said assets and/or from obtaining the fair and equitable division thereof, unless an injunction is entered prohibiting removal, transfer, conveyance, disposition, alienation or encumbering of property thereof. WHEREFORE, based on the foregoing, Wife respectfully requests this Honorable Court to enter an Order containing the following terms: 1. Enjoining and prohibiting the parties from the removing, transferring, conveyancing, disposing, alienating or encumbering of the parties' marital assets including the following: - 3 - No Description of Marital Property 1 1109 Kent Dr, Mechanicsburg, PA 2 Americhoice Home Equity Loan ny t V Y~Y,? 4 t title -Wife's use) 2002 Ford Windstar (J fr? .t? i. L ;; r }s,c. `R?:..ti w{k_7<^?'? 3''•£?fZ,>ytirt ' ?Gr 1`'. ''; tv, .i.= ,r i .'1: 6 2006 Honda Accord (H's use) 8 Member's 1s' CDS #72766 77, 777, X. .:; 7777,: f.•: ; ??ht : 1 C _ r, , * 7 ° 10 Member's 1s' CDs #148310 12 PA State Bank CDS . ;.T 437 is '. `r a K ;. ! 14 Sovereign Bank CDs 16 Pentagon Federal Credit Union CDS 18 Member's 1St Accounts, excluding checking accounts { 77 20 PA St Bank Accounts, excluding checking accounts 22 Pentagon FCU accounts, excluding checking accounts 2 4 Reassurance Life Policy B08668 ' } I/ 26 Husband's CSRS Retirement Plan 28 Husband's TSP 30 Wife's Pentagon Federal Credit Union IRA i o 1, 11 _ t ?y' ;t ? ? I F 32 Wife's OCE Retirement ?3 r z k 34 Disney Points 36 Household Goods and Furnishings -4- 2. Requiring Husband to transfer back into the joint names of the parties any of the parties' marital assets that were jointly held on November 1, 2009 and transferred into his sole name after that date. 3. Requiring the parties to return to the marital home any items of household goods and furnishings that were in the marital home on November 1, 2009 and removed to a different location after that date. 4. Specifically, enjoining and prohibiting the parties from terminating or cancelling and from making any withdrawals from or loans against and of the following life insurance policies, and requiring the parties to maintain the following life insurance policies and to pay the premium required therefor: A. Reassurance Life Policy B08668; B. The group life insurance policy on Husband's life obtained through his civil service employment with the Federal Government. 3. Specifically, enjoining and prohibiting the parties from terminating or cancelling and from making any withdrawals from or loans against any of the following retirement plans or accounts: a. Husband's CSRS retirement plan; b. Husband's TSP retirement plan though his civil service employment; C. Wife's Pentagon Federal Credit Union IRA; d. Wife's OCE retirement plan. 4. Requiring the parties to designate the other party as the beneficiary of any death benefits for the the following life insurance policies and retirement plans and accounts: a. Reassurance Life Policy B08668; b. The group life insurance policy on Husband's life obtained through his civil service employment with the Federal Government; C. Husband's CSRS retirement plan; - 5 - d. Husband's TSP retirement plan though his civil service employment; e Wife's Pentagon Federal Credit Union IRA; f. Wife's OCE retirement plan. 5. Requiring Husband to pay for all reasonable attorneys fees and costs incurred by Wife in bringing this Petition; 6. For such other and further relief as the Court may deem appropriate. Respectfully submitted, DIANE CLIFF, ESQUIRE 8 Trindle oad A 17011 Phone: (717) 737-0100 Supreme Court ID # 32112 Attorney for Petitioner, Jeanne L. Olenick -6- VERIFICATION I verify that the statements made in the foregoing document 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. ?ti x AJ JE ENE L. OLE Date: November 11, 2009 -7- CERTIFICATE OF SERVICE I hereby certify that I am this day serving 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: Service by Certified Mail, Restricted Delivery, Addressed as Follows: David M. Olenick 1109 Kent Drive Mechanicsburg, PA 17050 (Defendant, pro se) A copy of the Certified Mail mailing receipt, is as follows: Camp Hill, PA 17011 Email: dianeradcliff@comcast.net Phone: (717) 737-0100 Fax: (717) 975-0697 Counsel for Jeanne L. Olenick Dated: Z C) -8- EXHIBIT "A" Jeanene Olenick vs David Olenick DOM: 12/10/94 DOS: 11/11/09 est (Length of marria e: 15 years) Description of Property or Liability Estimated Net Calculation Value Est. Marital Distribution Value 1 109 Kent Dr. Mechanicsburg, PA Amenchoice Home Equity Loan 309.000.00 (14,706.0-3) 3 Net Equity 285,293.97 285,293.97 4 - 2002 Ford Windstar (Jt title ?'v'ilc s usc) :TBD I BD 6 2006 Honda Accord (I I's use) TBD 4BD 8 9 Member's I" CDS «7'_766 213,000.00 219.000.00 10 I 1 Member's 1" CDs #14_8310 1 10,300.00 1 10300.00 12 1 > PA State Bank CDS 55,000.00 55.000.00 14 - 15 Sovereign Bank CI)s 152,000,01} 151000.00 16 17 Pentagon Federal Credit l;nion CDS TBD T13 D 18 - 19 Member's I'` Acct #72769 14,000.€10 10.000.00 20 21 Member's 1" #148310 300.00 300.00 22 - 23 PA St Bank 410503365 Savings 20,000.00 20,000.00 24 - 25 Reassurance Life Police 808668 TBD TBD 26 - 27 H's (''SRS Pcnsion E ,t On]v -`TBD FBI) 28 29 CSRS Survivors Anniiity ' TBD T'BD 30 31 H's TSP 160,000.00 160,000.00 32 33 W's Pentagon Federal Credit Union IRA 28,000,0t? 28,000.00 34 35 OCF Retirement 14000.00 14,000.00 36 - H's Comp Time, Vac ition and Sick Leave TBD TBD 38 '9 Disnev Points TBD 40 41 ESPN Washington Mutual #1859 (16,200,00) (16,200.00) 42 3 Juniper #0938 (11),000.00) (1 9,()00.00) 44 TOTALS 45 Total of Assets and ]Liabilities 1,018,693.97 F(LIFT).., Cr THE f'. I , 0-1',?Y 20 23 N - aY 12 1.1 !f'' 39 r Ty r OYICINAL IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK, Plaintiff v. DAVID M. OLENICK, Defendant N0. Cif- '7$ZZ CIVIL ACTION -LAW DIVORCE RULE AND TEMPORARY INJUNCTION AND NOW, this ~~`"day of , 2009, upon consideration of the within Petition, IT IS HEREBY ORDERED that: A Rule is entered upon the Defendant to show cause why the relief requested in the within petition should not be granted. Rule Returnable at a hearing scheduled for the ~a'"day of "IilOU~i~r , 20 U~ at !3v o'clock ~.m. in Courtroom .S of the Cumberland County Courthouse, Carlisle, Pennsylvania. The parties shall appear at that date and time and give testimony and argument on the issues raised in the within Petition. AND IT IS FURTHER ORDERED that pending the hearing and further order of Court ,but without prejudice to either party, the parties are enjoined and prohibited from the removing, transferring, canceling, conveyancing, disposing, alienating, encumbering ,taking out any loans against, or otherwise taking any action that would diminish the value of any of the marital assets set forth on Exhibit "A" attached to the within Petition, excluding only checking accounts. BY THE COURT: UDGE DISTRIBUTION T0: ~ A torney for Plaintiff: Diane G. Radcliff, Esquire, 3448 Trindle Rd., Cam Hill PA 17011 P Defendant, pro se: David M. Olenick, 1109 Kent Drive, Mechanicsburg, PA 17050 ~GaaEs rn~~~ I ll~lLl ~l 1 '~ `." ~~. F-~ _ _ :~ -;_ _.~ .: ! ~ 4 i. ` t J" ~ J I ~ .... ~~ ~~ i r Timothy M. Barrouk, Esquire Attorney ID No. 204537 4807 Jonestown Road, Suite 148 Harrisburg, PA 17109 (717) 657-3900 Fax: (717) 657-2060 tmb@themcshanefirm.com JEANENE L. OLENICK, Plaintiff vs. DAVID M. OLENICK Defendant :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA :CIVIL ACTION No. 09-7822 :CIVIL ACTION -LAW :DIVORCE PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Enter my appearance on behalf of the Defendant, David M. Olenick, in the above-captioned matter. Papers may be served at the address set forth below. Respectfully submitted, THE MCSHANE FIRM, LLC ~, ~ ~- Timothy M. Barrouk, Esquire Attorney ID No.: 204537 4807 Jonestown Road, Suite 148 Harrisburg, PA 17109 Telephone: (717) 657-3900 Fax: (717) 657-2060 Attorney for Defendant CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Praecipe for Entry of Appearance was hand-delivered November 30, 2009, to: Diane G. Radcliff, Esquire 3448 Trindle Rd. Camp Hill, PA 17011 Counsel for Plaintiff Date T miT othy M. Barrouk, Esquire ti ~ _ l~. Lu ~ pp _,~1 J'J iii"! i' I l7 r,, tY~t ~^ /, ~ -+ } 4pp~, Li.tt~~.- •-~~~:, _. _`. r, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK, Plaintiff v. DAVID M. OLENICK, Defendant Handing a copy to Defendant at /~~ `'1 ~ r'w~ ~ ~C. P V' ~z ~-l-..g"++~' g~'z) f ~~ I, the undersigned, being duly sworn/affirmed according to law, deposes and says: 1. I am over 18 years of age and am not related to either party to this action. 2. I served a true and correct copy of the Complaint in Divorce, Petition for Special Relief/Injunctionand Rule and Temporary Injunction ,properly endorsed with a Notice to Plead, upon the Defendant, David M. Olenick, on //' a~ 3 ~ `t by the manner checked below: N1 a. [ ] b. Handing a copy to NO. 09-7822 CIVIL ACTION -LAW DIVORCE AFFIDAVIT OF SERVICE an adult member of the family with whom the Defendant resides at Defendant's residence located at or if that person is not a member of Defendant's family, then said [ ] c. person is the adult person in charge of Defendant's said residence; Handing a copy to , at ,said person being the Defendant's agent or to the person for the time being in charge of Defendant's office or ususal place of business located at I~^ (Signa e), ~ ~,~,,9,~,p ~/l,,fY 7 Z~/(~ (Printed name) Sworn to and subscribed before me a Notary Public in and for Cumberland County, Pennsylvania this~~ day of}•~e,inn ~.20(~9 N~•T'ARY PUBLIC -_ ... bfan~'`i '>~t„~f, s~lot,~ryNitbi=~~ Fr,Rmr+ w;!! Bnro. Cumberland C:~s;~ :, Ma~~itfr; ~ennaylvanla A~®orilrAtloA of Notariea My commission expires: .r'11' ~ t i ~ _ .. ZUu~ ~~~~~ 3~ ~' s ~~ G J :~ l ~ w JEANENE L. OLENICK, PLAINTIFF V. DAVID M. OLENICK, DEFENDANT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7822 CIVIL IN RE: PETITION FOR SPECIAL RELIEF ORDER OF COURT AND NOW, this 27~' day of July, 2010, upon consideration of the Plaintiffs Petition for Special Relief, IT IS HEREBY ORDERED AND DIRECTED that: 1. A Rule is issued upon the Defendant to show cause why the relief requested should not be granted; 2. The Defendant will file an answer on or before August 16, 2010; 3. The Prothonotary is directed to forward said Answer to this Court. 4. A hearing on this matter will be held on Friday, September 17, 2010, at 9:00 a.m. in Courtroom No. 2 of the Cumberland County Courthouse, Carlisle, Pennsylvania. By the Court, / Diane G. Radcliff, Esquire Attorney for Plaintiff .~ Timothy M. Barrouck, Esquire Attorney for Defendant bas CvP~'es r-1~.~ ~, ?'~zz~w ~r~ M. L. Ebert, r., J, r> ~ _ C `a ,. -cb ~ .-n r_.. ~ ~ i i~F r_ a~ x ~ ~,- ~ .> ',~ `_ , Timothy M. Barrouk, Esquire ID# 203250 The McShane Firm, LLC 4807 Jonestown Road Suite 148 Harrisburg, PA 17109 Telephone- (717)657-3900 Fax- (717)657-2060 tznbQthemcshanefirm.com Attorney for Defendant JEANENE L. OLENICK IN COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA Plaintiff V. No: 09 Civil Term DAVID M. OLENICK CIVIL ACTION- LAW Defemdant DEnNDA"tS ANSWER TQ, I FF'S PETITION FOR SPECIAL IIELIEF AND NOW this 16THDay of August, 2010, comes the Defendant, David M. Olenick, by and through his undersigned Attorney, The McShane Firm, LLC'and Timothy M. Barrouk , Esquire and avers in support of their Answer as Follows: 1. Admitted 2. Admitted 3. Admitted 4. Admitted 5. Admitted 6. Admitted 7. Paragraph seven (7) is a conclusion of law to which no responsive pleading is required. 8. Admitted 9. Admitted 10. Admitted 11. Admitted 12. Admitted 13. Admitted 14. Denied in Part and Admitted in part. It is denied that Husband earns at least $107,854 dollars per year. Rather husband anticipates making less than this figure for this year. It is admitted that he works at DDC New Cumberland. 15. Admitted 16. Paragraph sixteen (16) is a conclusion of law to which no responsive pleading is required. 17. Denied in part and admitted in part. It is admitted that the Party's are the owner of the property. However, it is denied that the value of the property is $365,025. Specific proof of this amount is demanded at trial. 18. Admitted 19. Admitted 20. Paragraph twenty (20) is a conclusion of law to which no responsive pleading is required. To the extent it is deemed factual in nature it is expressly denied that exclusive possession of the home should be granted to the Wife. A. Denied. Husband is a positive influence in his children's life and his presence is beneficial to there well being. B. Denied. Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. C. Admitted D. Admitted E. Denied. Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. F. Denied. Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. Further pursuant to Paragraph Thiry-Seven (37) of Wife's complaint, she is unable to determine whether or not to ask. for distribution of the marital home. G. Denied in Part and Admitted in Part. Husband has not indicated one way or the other whether he wishes to retain the marital home. H. Denied. Husband fully intends on engaging in settlement negotiations. However, at the time of this filing there was incomplete information to enter into meaningful negotiations. 20. Admitted. Husband stipulates to the relief requested in the second Paragraph twenty (20) related to the dog. 21. Paragraph twenty-one (21) is a conclusion of law to which no responsive pleading is required. 22. Admitted. 23. Admitted. 24. The averments contained in Paragraph twenty-four (24) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. A. The averments contained in Paragraph twenty-four (24)(A) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 1. The averments contained in Paragraph twenty-four A 1 (24)(A)(1) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 2. The averments contained in Paragraph twenty-four A 2 (24)(A)(2) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 3. The averments contained in Paragraph twenty-four A 3 (24) (A)(3) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. B. The averments contained in Paragraph twenty-four B (24)(B) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. C. The averments contained in Paragraph twenty-four C'(24)(C) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. D. The averments contained in Paragraph twenty-four D (24)(D) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded 25. The averments contained in Paragraph twenty-five (25) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations!, contained in this averment. Specific proof demanded. A. The averments contained in Paragraph twenty-five A (25) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 1. The averments contained in Paragraph twenty-five A 1 (25)(A)(1) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 2. The averments contained in Paragraph twenty-five A 2 (25)(A)(2) are conclusions of law to which no 'responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 3. The averments contained in Paragraph twenty-five A 3 (25)(A)(3) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. B. The averments contained in Paragraph twenty-five B (25)(B) are conclusions of law to which no responsive pleading is required. Further, Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 26. Denied in Part and Admitted in Part. It is admitted that the CDs are due to mature on August 2, 2010. It is denied that this fact requires immediate Court intervention as there is already an Order in place barring the parties from access to the CD's. 27. Paragraph twenty-seven (27) is a conclusion of law to which no responsive pleading is required. 28. Admitted 29. Admitted 30. Admitted 31. Denied. Husband did obtain a post office box. However, Husband never directed the refund check to mailed to the Post Office Box. 32. Denied. Husband has given Wife her share of the tax refund. 33. Paragraph thirty-three (33) is a conclusion of law to which no'tesponsive pleading is required. 34. Denied. Wife has use of joint credit cards and does not provide husband documentation in the form of receipts for expenditures. 35. Admitted. 36. Denied. Husband agrees to provide wife with an accounting of their Household expeditures. 37. Husband is without sufficient information to admit or deny the allegations contained in this averment. Specific proof demanded. 38. Paragraph thirty-eight (38) is a conclusion of law to which no responsive pleading is required. 39. Paragraph thirty-nine (39) is a conclusion of law to which no responsive pleading is required. To the extent that it is deemed factual in nature it is specifically denied as there is no statutory or common law authority for an award of council fees. 40. Paragraph forty (40) is a conclusion of law to which no responsive pleading is required. WHEREFORE, Defendant requests that this Honorable Court issue an Order denying the relief requested by the Plaintiff. NEW MATTER 41. Husband has been providing wife with reasonable financial resources since the time of separation. 42. Wife has refused to provide husband with receipts from credit card expenditures. 43. Wife has engaged in behavior designed to frustrate and cause emotional distress to husband, including but not limited to dumping out beverages that husband has purchased. 44. Prior to their separation, the Party's agreed that the CD's where to be for the benefit of the Children's education and not their own personal benefit. 45. Although Wife is physically and mentally capable of working, she has not attempted to gain full time employment. WHEREFORE, Defendant requests that this Honorable Court issue an1Order denying the relief requested by the Plaintiff. Respectfully Submitted, Date. Timothy M. Barrouk, Esquire Attorney LD.# 204537 4807 Jonestown Road Suite 242 Harrisburg, Pennsylvania 17109 #717-657-3900 Attorney for Defendant JEANENE L. OLENICK IN COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA Plaintiff ?QO V. No: 09 ivil Term DAVID M. OLENICK CIVIL ACTION- LAW Defemdant TO THE HONORABLE JUDGES OF SAID COURT: CERTIFICATE OF SERVICE I, Timothy M. Barrouk, Esquire, hereby certify that the following service has been completed in compliance with the Rules of Civil Procedure: First Class Mail Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Respectfully submitted, The McShane Firm, LLC T Timothy M. Barrouk, Esquire Attorney ID # 204537 Attorney for the Petitioner 4807 Jonestown Road Suite 242 Harrisburg, PA 17109-1739 Telephone: 717-657-3900 Facsimile: 717-657-2060 JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V DAVID M. OLENTCK, 09-7822 CIVIL TERM Defendant IN RE: PETITION FOR SPECIAL RELIEF ORDER OF COURT AND NOW, this 17th day of September, 2010, after hearing on wife's Petition for Special Relief, IT IS HEREBY ORDERED AND DIRECTED: 1. Wife will be granted exclusive possession of the marital home. Husband and his dog will vacate the home on or before October 22, 2010. 2. The value of the ten CD's from PNC Bank, the amount of which has been deposited into wife's exclusive account, will be divided equally. Wife shall provide husband through counsel with one-half of this sum on or before the close of business on September 21, 2010. 3. The husband shall provide the wife with the names and monthly amounts of the utilities and taxes which he has been paying with regard to maintenance of the marital home. Husband will pay attorney's fees in the amount of $1000.00. By the Court, M. L. Ebert, Jr., Diane G. Radcliff Es u' q ire For the Plaintiff Timothy Barrouck, Esquire For the Defendant mt f ~ P ~ frS n'tat t l4GC,, ~/aa~ro ~~ c~ r., p ""~ w t:.? ~~ .~ :v~v ~~ na -~ ~ rv ~<,, ~ ~" ~~ ~ 0 ~, c cr a r~,a ~ o~ L~ -~~ -rt ~ ra ~ ~ -°~ o -~ on --i -'Y D -~ ~~~ , ~? ~'~~[~ ~~~~~1~~4~T1~~~ Ol: ~',:~ ~ €~ Zal~ ~~~ -~ ~~1 3~ 09 ~r!~'i~~~~ ~'~,i'~[~ COI~~~T', C~.. { 1! PACSES CASE NO. 388111982 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK, Plaintiff N0. 09-7822 v. DAVID M. OLENICK, Defendant CIVIL ACTION -LAW DIVORCE ORDER OF COURT AND NOW, this 5th day of octob~r , 20~_, upon consideration of the attached Petition for Alimony Pendente Lite, it is hereby directed that the parties appear before DAVID C. HATCx ,the Domestic Relations Conference Officer on n~vEr~EU 3, 201o at x:30 o'clock a .m. at the Domestic Relations Office located at 13 North Hanover Street, Carlisle, Pennsylvania for a conference, after which the Conference Officer may recommend that an order for Alimony Pendente and interim counsel fees and costs be entered. Your are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed. (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 191-.11(c) (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you If you fail to appear for the conference or bring the required documents, the court may issue a warrant for your arrest. BY OR FOR THE COURT Date of Order• 1A~..c1.5~1n ALB RT H. MASLAND, JUDGE t YOUR HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. 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 MAY GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone No. (717j 249-31 b6 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. FOR THE COURT: COURT ADMINISTRATOR - 2 - _ f- ILED-G-{ I- PCE- 1, 0 T1 1"E_ 3 I f.:? 1'"4 1 1 Lori K. Serratelli, Esquire Pa. Supreme Court ID No. 27426 Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road Suite 201 Harrisburg, Pennsylvania 17110 Telephone (717) 540-9170 Fax (717) 540-5481 lserratelli@ssbc-law.com Attorney For Defendant fi0 ( HOV 22 Pry 3: 0 bt Cow JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-7822 CIVIL TERM DAVID M. OLENICK, CIVIL ACTION - LAW Defendant IN DIVORCE PRAECIPE Please withdraw the appearance of Timothy Barrouk, Esquire, as attorney for the Defendant in the above-captioned matter. Dated: to //I/ W f Timothy Barrouk, Esquire 4807 Jonestown Road, Suite 148 Harrisburg, PA 17109-1744 Please enter the appearance of Lori K. Serratelli, Esquire, as attorney for the Defendant in the above-captioned matter. Dated: ,// / V J LorVK."Serratelli, Esquire SERRATELLI, SCHIFFMAN & BROWN, PC 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 (717) 540-9170 (717) 540-5481 Fax lserratelli@ssbc-law.com JEANENE L. OLENICK, Plaintiff/Petitioner VS. DAVID M. OLENICK, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 09-7822 CIVIL TERM IN DIVORCE PACSES CASE: 388111982 ORDER OF COURT AND NOW to wit, this 13th day of December, 2010, it is hereby Ordered that the Petition for Alimony Pendente Lite is dismissed, without prejudice, pursuant to an order for Spousal Support being entered under PACSES #338111964 and docketed at 00861 S 2010. This Order shall become final twenty (20) days after the mailing of the notices of the entry of the Order to the parties unless either party files a written. demand with the Office of the Prothonotary for a hearing de novo before the Court. BY THE COURT: Albert H. Masland, J. DRO: R.J. Shadday a'3 r-0 r) xc: Petitioner x rn r°*t Respondent r- n rn Diane G. Radcliff, Esq. -C x'' Coq Timothy Barrouck, Esq. ?C t7 C-) Mir 'x- CEormQE-00 g Service Type: M Z?orlt?210 W e t' w i.+F-FIC:E [;0THONOTAIR', ui1Pt l?21 PM 2:25 CUMBERLAND COUNTY PENNSYLVANIA Constance P. Brunt, Esquire Supreme Court ID #29933 Beaufort Professional Center 1820 linglestown Road Harrisburg, PA 17110 (717) 232-7200 FAX (717) 232-0255 cpbrun#@CPBruntlaw.com JEANENE L. OLENICK, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW DAVID M. OLENICK, NO. 09-7822 Defendant IN DIVORCE/CUSTODY PRAECIPE TO WITHDRAW APPEARANCE TO: David D. Buell, Prothonotary Please withdraw the appearance of Diane G. Radcliff, Esquire, as counsel for Plaintiff, Jeanene L. Olenick, in the above-captioned action. DATE: -?) i, I DI NE G. RA CLIFF, ESQUIRE Sup ourt ID #32112 3448 Trindle Road Camp Hill, PA 17011 (717) 737-0100 (717) 975-0697 dianeradcliff@comcast.net PRAECIPE TO ENTER APPEARANCE TO: David D. Buell, Prothonotary Please enter the appearance of Constance P. Brunt, Esquire, as counsel for Plaintiff, Jeanene L. Olenick, in the above-captioned action. 12, DATE: g 17 I I CONSTANCE P. BRUNT, ESQUIRE Supreme Court ID # 29933 Beaufort Professional Center 1820 Linglestown Road Harrisburg, PA 17110-3339 (717) 232-7200 FAX (717) 232-0255 cpbrunt@cpbruntlaw.com CERTIFICATE OF SERVICE I, CONSTANCE P. BRUNT, ESQUIRE, do hereby certify that on the (t day of ?M (IAk,h , 2011, 1 served a true and correct copy of the foregoing Praecipe by depositing same in the United States Mail, first-class postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire 2080 Linglestown Road, Suite 201 Harrisburg, PA 171 10 Attorney for Defendant Z19Z4 CONSTANCE P. BRUNT, ESQUIRE Supreme Court ID # 29933 Beaufort Professional Center 1820 Linglestown Road Harrisburg, PA 17110-3339 (717) 232-7200 FAX (717) 232-0255 cpbrunt@cpbruntlaw.com Attorney for Plaintiff ED-0417F ICE ?";7 i.i,I.r _t ROTHUNOTARY 2012 AUG -1 AM 11: 41 Johnson, Duffle, Stewart & Weidner By: Melissa Peel Greevy, Esquire I.D. No. 77950 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 mpg@jdsw.com CUMBERLAND COUNTY PENNSYLVANIA Attorneys for Plaintiff JEANENE L. OLENICK, Plaintiff V. DAVID M. OLENICK, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7822 CIVIL ACTION - LAW IN DIVORCE PLAINTIFF'S INVENTORY Plaintiff files the following inventory of all property owned or possessed by either party the time the action was commenced and all property transferred within the preceding three years. Plaintiff verifies that the statements made in this Inventory are true and correc . Defendant understands that false statements herein are made subject to penalties of 18 Pa. C. . §4904 relating to unsworn falsification to authorities. Date: J ENE L. OLEO I , Plaintiff Submitted by, HNSON, UFFIE, STEWART & WEIDNER Melissa Peel Greevy, Esquire - 1 - ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and item the assets on the following pages. (X) 1. Real property (X) 2. Motor vehicles (X) 3. Stocks, bonds, securities and options (X) 4. Certificates of deposit (X) 5. Checking accounts, cash (X) 6. Savings accounts, money market and savings certificates () 7. Contents of safe deposit boxes () 8. Trusts (} 9. Life insurance policies (indicate face value, cash surrender value and cu beneficiaries) () 10. Annuities () 11. Gifts () 12. Inheritances () 13. Patents, copyrights, inventions, royalties () 14. Personal property outside the home () 15 Businesses (list all owners, including percentage of ownership, and office/dir positions held by a party with a company) (X) 16. Employment termination benefits-severance pay, worker's compens claim/award, accumulated leave, bonuses () 17. Profit sharing plans (X) 18. Pension plans, thrift savings plans (indicate employee contribution and date vests), 401(k) (X) 19. Retirement plans, Individual Retirement Accounts () 20. Disability payments () 21. Litigation claims (matured and unmatured) () 22. MilitaryN.A. benefits () 23. Education benefits () 24. Debts due, including loans, mortgages held () 25. Household furnishings and personalty (include as a total category and a itemized list if distribution of such assets is in dispute) () 26. Insurance benefits -2- MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced. Defendant reserves the right to supplement this list prior to time of trial. ITEM DESCRIPTION OF PROPERTY NAMES OF ALL OWNERS COMMENTS NO. 1 1109 Kent Drive, Mechanicsburg H & W 2 Husband's post-separation H & W withdrawals from home equity loan 3 PNC (formerly PA State Bank) H & W Checkin acct. no -3365 4 PNC (formerly PA State Bank) H & W Savings acct. no. - 2513 5 Metro Bank Checking acct. no. W -9969 6 Metro Bank Savings acct. no. W -0705 7 Members 1st Checking acct. no. H & W -2769-11 8 Members 1st Savings acct. no. H & W -2769-00 9 Members 1st Money Management H & W acct. no. - 2769-05 10 Husband's bonus aid for 2009 H 11 Members 1 st CD no. - 2769-56 H & W 12 Wells Fargo CD no. - 6578 H & W 13 Pentagon FCU CD no. - 2560 H & W 14 Pentagon FCU CD no. - 2561 H & W 15 Pentagon FCU CD no. - 3563 H & W 16 Pentagon FCU CD no. - 9568 H & W Already cashed an % was distributed t 17 PNC CD's nos. - 4690 through - H & W each party as 4699 (10 total) advance by Order o f 9/17/10 18 Americhoice CD no. - 8237-0061 H & W 19 Americhoice CD no. - 8237-0062 H & W 20 All Bank CD no. - 3726 H & W 21 GE stock 370.249 shares H 22 IBM stock 1 share H Husband's accumulated 23 compensatory time, vacation leave H and sick leave -3- ITEM NO. DESCRIPTION OF PROPERTY NAMES OF ALL OWNERS COMMENTS 24 2002 Ford Windstar w 26 2006 Honda Accord H & W 26 Federal Thrift Savings Plan H 27 Pentagon FCU IRA # - 7221 W 28 Civil Service Retirement System pension H -4- HUSBAND'S NOW MARITAL PROPERTY F Plaintiff lists all property in which Defendant has a legal or equitable interest which is claimed to be excluded from marital property. ITEM DESCRIPTION OF PROPERTY BASIS FOR EXCLUSION NO. Non-marital portion of Civil Service Retirement Acquired prior to and System pension subsequent to marriage WIFE'S NOW MARITAL PROPERTY Plaintiff lists all property in which she has a legal or equitable interest which is claimed be excluded from marital property. ITEM DESCRIPTION OF PROPERTY BASIS FOR EXCLUSION NO. 1 Members 1 st Checking acct. no. - 6089-06 Acquired post separation 2 Canon Vanguard Savings Plan Acquired post separation -5- _0 0) a? r« N W (v :-r 01 O a n N N N N (D a. 7?D .0 N N .rN N 01 N JOINT LIABILITIES OF PARTIES Plaintiff lists all marital debts outstanding as of the date this action was commenced. DESCRIPTION OF NAMES OF ALL NAMES OF ALL ITEM NO. PROPERTY CREDITORS DEBTORS 1109 Kent Drive, Americhoice (home equity loan acct. no. - H & W Mechanicsburg 237 -7- Johnson, Duffie, Stewart 8 Weidner By: Constance P. Brunt, Esquire I.D. No. 29933 Melissa P. Greevy, Esquire . D. No.77950 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 JEANENE L. OLENICK, Plaintiff vs. Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVA~ NO. 09-7822 DAVID M. OLENICK, CIVIL ACTION -LAW Defendant IN DIVORCE PLAINTIFF'S INCOME AND EXPENSE STATEMENT Current Income Estimate Based on July 15, 2012 Pay Stub SEMI-MONTHLY MONTH YEAR NOT Grosslncome 1,875.0 3,750.0 45,0010. Basesa a Commission varies 976.65 - Penns Ivania Ste#e Tax 90.12 180.2 2,162. Local IncomeTax 46. 93.9 1,127. Federal Income Tax 405.0 810.1 9,721.2. Fed OASDI/EE 123.41 246.8 2,961 Fed MED/EE 42.6 85.2 1,022.4 401 k) 141.8 283.6 3,403.2 FSA Healthcare 10.42 20. 250.0 FSA In ndent Care 83. 166.6 2,000.1 Total Deductions 943.7 1,887.4 22,648. Net Income 1,907.95 3,815.90 S ousel and Child Su ort 966.50 1,933.00 ci .:, ry~i? ~~:~ 20 F~ 2: OU Ct1~-8~:RL~NQ COUNTY ~'E~NSY~VANIA :507957 EXPENS~8: WEEK II~NTH YEAR NOTE Home: Mort Home quit~r Loan-Americhoice 38.31 166.00 1,992.00 Maintenance 23.08 100.00 1,200.00 Furniture and A Hance Other E ses: Ulfiilit~ea: Electric 23.08 100.00 1,200.00 Gas 19.23 83.33 1,000.00 Tela hone/Cablellntemet 39.23 170.00 2,040.00 Cell Pfione 46.15 200.00 2,400.00 Lon Distance Water/S~+ver 11.54 50.00 600.00 Trash 11.54 50.00 600.00 Secur' Alarm Em nt: Public Trans anon Lunch Unreimbursed Travel 3.85 16.67 200..00 Taxes: Real Estate 69.23 300.00 3,600.00 Personal Pro rt Income: federal & FICA State Local 16.35 70.83 850.00 Anticipated Taxes on Alimony R nested Durance: Homec~mer's 22.40 97.08 1,165.00 Renter's Automobile 11.54 50.00 600.00 Life Accident Health Medical 15.00 65.00 780.00 Dental 4.62 20.00 240.00 O tical Disabil' Umbrella 507957 Lon Term Care Other Personal Liabilit 1~utomol~le: Pa manta 7.69 33.33 400.00 estima e Maintenance 19.23 83.33 1,000.00 Ina ion/Em~sons 1.54 6.67 80.00 m~-imum a timate Fuel 70.00 303.33 3,640.00 non-work r fated Re airs Licensin 0.77 3.33 40.00 Parkin Tolls Car P ntenbs: For boats, airplanes, motorcycles recreational vehicles Stor a Fees Bus/Trolle Taxi Parkin Medical: Doctor 1.92 8.33 100.00 Child Qoctor 1.92 8.33 100.00 Dentist 5.77 25.00 300.00 orthodontist Prea ions 3.85 16.67 200.00 Hos 'tal Child Medicine 1.92 8.33 100.00 Chirp ractic Trainer Thera ist/Counselor O tical 1.92 8.33 100.00 Child O tical 6.73 29.17 350.00 Education: Private School Parochial School Col a Savi s Plan Rel' ions Books 1.92 8.33 100.00 School Su lies 1.92 8.33 100.00 Field Trips/Education Activities 3 85 16.67 200.00 Tutorin Com uter Software Instrument Rentals 507957 Child lessons and su lies 5.77 25.00 300.00 s orts Food, Household, Sundries: Grote Store 150.00 650.00 7,800.00 Restaurants 17.31 75.00 900.00 Schaal Lunches 15.38 66.67 800.00 Lunches Out Household Su lies 2.88 12.50 150.00 Dru Stcne/Toilet~ies 3.85 16.67 200.00 Hous+ehcrid H~ : Cleanin Snow Rernoval Lawn Care 11.54 50.00 600.00 estima e Windows Pets Ca t Cleanin BarberlBea Shop: Haircuts etc. 23.08 100.00 1,200.00 Manicures 8.37 36.25 435.00 Cosmetics Child Groomn 7.69 33.33 400.00 Clos~in Child Clothes/Uniforms 19.23 83.33 1,OOO.OQ Clothin 28.85 125.00 1,500.00 Enbsr~tainntpent: Jeanene Entertainment 9.62 41.67 500.00 Child Entertainment 11.54 50.00 600.00 Movies Dinin Out Miscellaneous Athletic clubs S ortin Events Birthda artier Pa rsJg©ok a azines CD's DVD's Miscellaneous Ex enses Cone a Ex Haas Gifts: Holida Weddin Bab Showers Miscellaneous 48.08 208.33 2,500.00 :507957 Cha~ta#~is Coriit~butions: Church/Tithe 73.08 316.67 3,800.00 Individual Chanties 5.77 25.00 300.00 Yaca7t: 38.46 166.67 2,000.00 Child Vacation and Cam 15.38 66.67 800.00 Travel Lode in Meals Fees Ex Haas Auto Rental L al Haas: Per Issue 156.68 678.96 8,147.50 1/1/12-8/ ($25,000 in date /12 ption to Ex rts Accountants Oth®~ E sos; Da care 134.62 583.33 7,000.40 Child Allowance 10.00 43.33 520.00 Dues/Clubs D Cleanin 3.85 16.67 200.00 Pet Ex Haas Vetenrtanan S orts/Hobbies/Lessons 50.00 216.67 2,600.00 includes outs Christmas Fund Coll a Fund Savings-retirement, miscellaneous 5192 225.00 2,700.00 TOTAL EXREhtSES: 1 389.03 6,019.13 72,229.50 507957 VERIFICATION I, JEANENE L. OLENICK, verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are made subject to the penalties of 18 Pa. C.S.A §4904, relating to unsworn falsification to authorities. Date: ~' ~ ~, " Oce Imagistics Inc. 100 Oakvlew Dr. Trumbull, CT 06611 RRR%77Jidfrd 'ay Group: PBS-Ore Imagistics Semi Monthly Business UNC OCEI 'ay Begin Date: 07/0112012 Advice #: 0000000000 651 'a End Date: 07/15/2012 Advice Daze: 07/13/2012 Jearrene L. Oleoick Employee ID: 086295 TAX DATA: Federal PA State 1109 Kent Drive, Department: 0130200112-Baltimore Public Sector Marital Status: Single n!a Mechanicsburg, PA 17050 Location: Baltimore, MD Allowances: 3 0 Job Title: Senior Account Executive Addl. Pct.: Pa Rate: 51,875.00 Semimontid Addl. Amt.: - -------- Cwrent ---------- ---------- YTD ----- on Rate Horns Hours Descri on Curterrt YTD Regular Earnings 1,875.00 1,080.00 23,509.60 Fed Withholdng 405.05 268.89 Auto Allowance 220.00 2,860.00 Fed MED/EE 42.60 528.86 Commission Earnings - Suppl 976.65 6,907.53 Fed OASDUEE 123.41 1 531.68 50% Comm Ellg for 401K 488.33 0.00 PA Withholdng 90.12 1 118.57 Commissions 0.00 3,044.12 PA Wlthholdng 46.96 148.72 Holiday Earnings 0.00 40.00 865.40 Marketing Cash -Visa Card 0.00 1,000.00 Awards/Gifts/I'RP 0.00 20.00 Total: 3 071.65 1 120.00 36186.65 Total: 7 14 7 596.92 BEFORE-TAX DPDIiCTZONS AFi'ER-TAX DEIILTCT101115 EMPLOYER PAID BB816F1TS Descrl Curreg YTD n Current YTD Current YTD Medical Deduction 32.50 422.50 Medical Deducton 161.46 2 358.98 Dental Deduction 10.00 130.00 Employee Life 0.01 0.13 401 (k) 141.80 1,761.05 Employee Life* 3.05 37.95 FSA Healthcare 10.42 135.44 401(k) 82.72 1 027.30 FSA Dependent Care 83.34 1,083.32 Current: Advice #000000000044651 MESSAGE: Oce Imi~stkx Inc. 100 Oakview Dr. Trtlmbttll, CT 06611 Date 07/13/2012 Advke No. 44851 Deposit Amount: 52.085.45 , To The Account(s) Of JEANENE L. OLENICK 1109 Kent Drive, Mechanicsburg, PA 17050 Location: Baltimore, MD DIRECT DEF'OSiTDISTRIBUTIOid Account T Account Number sit Checking ----9969 2, 5.45 Tom: 2 5.45 NON-NEGOTIABLE ~IQ, 044VIeaa, ~ •..-. r..... ... .......... ~ASFI Usa at www.irs,gov/eflle Employee eference Copy Wage ar~d lax ~0 ~ ~ ~ Statement Co for em areooNt.. OMa No. Y545~0006 ` d Control numl»r Dept Corn, Employer uee only a888019BG1 WRV otaoxo 3429 c Employer's name, addraaa, and ZIP code OCE IMAQISTICS INC„ 100 OAKVIEW DR. TRUMBULL, CT 06611 e!i Employes'a name, addrcea, and ZIP cods JEANENE L OLENICK 1109 KENT DRNE, MECHANICSBURCi, PA 17050 num r fi 6 ~ a Empbyr-- - ° • -•~ O 1 11 8 1 Wayea, tips, otlrer comp. Federal brooms tax wltrrnshi 52723.43 6087.92 S Socialsecurltywayaa 4 Soclr,IsaccritytaxwMhMid 52725.43 2214.38 Medlesro wcyss aml tips 6 Mediocre tax withheld 5 723.43 784.4 !7 Soold seourifytips a .Altooatsd ps :•.: • , :..:•..;','••;; ~;.' +.:••{ ~; :.::..:: ^:~ 10 Dspendsrd Dare benaias 11 NonquallNad plans I 74 Oth ~~ 11 sr I ~~ 1a rn pargslWc 16 8tcb Employer's stcte ID rro. 8 Stele wyw, Mps, eta PA etaee.s72 827 .43 17 Shtc Moons toc 1 B Local ways, tips, ale. 1618.65 Looel irroome tax 20 LoeelNy name LM ! R ARl_L aaRIW Rte,/-UR RIwR1lMV YVRRre R1r1/"w1-~.. 1 Thi; Stssf,airy t: included wi.th:yaur W-2 ~~o hill? describe portions. in tllore detail. The reverse side includes information that vlitl also be helpful. Your Gross-Pay was adjusted as follows to produce your W-2 Statt3reent. coepensation Box 1 of 'W-2 GROSS PAY , MedlcaT'' -719.40 W-2 WAGES Wages Wages Box 3 of W-2 Box 5 of W-~'. ~-T3~4Tw~3 -719.40 -719!M40 JEANENE L OLEI 1109 KENT DRIHI MECHANlCSBURC O 2W t ADP, INC. __.________________~_.____~___ r Feld mM Delac ---r----------------- f~~ I ~n1 Department of the Treasury-Internal Revenue Service (98) -0onotwriteorsta 7 ~ IRS U O ~ 2~~ ~ le in this space V U .S. individual Income Tax Return se 4 OMB No. 1545-1x) , nry . -.m somas Jan. 1-Dee. 31, 2011, or other tax year beginning , 201 S, ending , zo See se crate instr ICtions. °-~->s ~,~ne and initial Last name Your social security n mbar . ~anene L Olenick s <~-a. return, spouse's first name and initial Last name Spouse's social racuri number -~ r e address (cumber and street). fl you have a P.O. box, see instructions. ApL no. ~ Make sure the SS (s) above 110 9 Kent Driv@ and on Ima sc a xrtea. _ Prli<Identlal EI on Campaign _ _ _-..,~ or post office, state, and ZIP code. If you have a foreign adtlress, also oompbte spaces beknv (see instructions). Cheek here K u, or your spouse :~chanicsbur PA 17050 If filingjoiMly,w fund. Checking a3 to go tothi= Dox below will _ ----_ ~ country name Foreign provinee~wunty Foreign postal Clxle not change you tax or refund. You Spouw : Head of household (with gwtifying person)- (See instructions.) H 4 1 f i ng Status I• 1 the qur+tifying pKSOn is a child but not your dependern, enter this Single 2 one had rcrcome) chHds rams here. - (even'rf onl int i d ici M 3 y ng jo y arr e Married filing separetely. Enter spouse's SSN above 5 ~ Oualily:ng vridow(er) wdh dependent child Check only one - and full name here b6X. 6a . Yourself. If someone can claim you as a dependent, do not check t•px 6a ... . ... . ..... . BCXea C .... . .. ~ on 6e Ckal 6b 1 Exemptions b Souse ......................... ................................................... ... No.ofc ildren ~ ° it on 6c r o: 2 c Dependents: (2) Dependent's (3) Dependent's 1. • lived cgs 17~ Ith you social security number relationship to you tax txedlt • did n see inetr. you due t Ilve xlth divorce (1 First-name Last name i e ~` e8 If more than four Joshua Oleziek I Son t a j ons) dependents, see Christian Olenick. L Son Depend is on Be instructions an _ . :~_ _ nM ante ed above check here - ' Add nu Tines ab bars on 3 e - d one claimed ................................................................... Total number of exam .... ....... w 2 h F ~ 52 72 3 7 , .. _ . . . . . . . . . . . . . orm(s) - wages, salaries, ups, etc. Attac 12 395 Income Attach Schedule B ff required 8a Taxable interest 8a Attach Form(s) , , . b Tax-exetn~it irrteresf Dos=pot include on line 8a , , L ~8b I , W-2 here. Also B if required g lttactl Schedrle dividends Ordina 9a a , .. . . ry attach Forms b Qualified dividends ~ 9b ........ .. ~ w , W-2G and 10 , . , . credits or offsets ofstate and focal come taxes Taxable refunt3s ~ . "'10 1099-R if tax ithh ld 11 , . _:, , . received Alimon 11 7 , 220 . was w e y 12 Attach Schedule C or C-EZ Business income or (loss) 12 - If you did not 13 ............................................. . chadc Here - ~ ~ It not required Attach Schedule D K required am or (loss) ital Ca ' 13 get a W-2, , . . g p e instructions 14 Attach Form 4797 Other gains or (losses) : i4 . se . . 15a tRA distributions 15a ....................... ................... ....,.......... b l taxable amourt 15b 15a Pensions and annuities 15a b Taxable amount 15b Enclose but do 17 partnerships, S corporations, trusts, etc. Att;:-ch Schedule E royalties Rental real estate 17 , , , not attach, any 1 B Attach Schedule F Farm income or (loss) 18 payment. Also, 19 . ............................................................. Unemployment compensation - ~ 19 please use ................................ ... .r.................. .......... Form 1040-V 20a Social security benofits 120a I , b ',~axable amount 20b . 21 List type and amount Other income 21 22 . Combine the 3rnounts in the far ' ht column for lines 7 throe 21. This :: our total.income - - 22 ~ 72 338 - ;.,, ~ • 23 Educator expenses .-•~ Adjusted 24 Certain business expenses of reservists, performing artists, and ' Gross fee-basis government officals. Attach Form 210G or 2106-EZ "~4 " ' I 25 Health savings account deduction. Attach Form 8889 ?5 nCOm@ 26 Moving expenses. Attach Form 3903 ~ -`5 27 Deductible part of self-employment tax. Attach Schedule Sc ~7 28 ..... Self-employed SEP, SIMPLE, and qual~ed plans _ 8 29 Self-employed health-insurance deduction '•9 30 ..... ` Penaltt! on early withdrawal of savings ~:0 .. , _ • . _ ... b Recpient's SSN - 31a Alimony paid "~a . • 32 IRA deduction :cg . ....................................................... 33 Student loan interest deduction ~3 34 .............................. ........ Tuition and fees. Attach Form 8917 ~~4 ... ............:.................. 35 Domestic production activities deduction. Attach Form 8903 5 36 Add lines 23 through 35 - 3S 37 Subtract line 36 from line 22. This is your adjusted gtross income .... . ............................ - 37 72 338 For Disclosure, Privaq Act, and Paperwork kedut~ion Act Notice, sea separate instructions. orm 1040 (tot t ) DAA r ~_~'-z, Jt=anene L Olenick ' Pena 2 .i~id 38 .Amount from line37(adjustedgrossincome),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, 38 72 33$ ~ 39a Check You were born before January 2, 1947, Btind. Total boxes ~ 8 if: ~ 61ind.-~. checked.-. Spousewasbom,beforeJanuary2,1947, 39a b If your spouse itemizes on.a separate return or you were a due{-status a5en, check here - 39b I' Standard €}eduction 40 Itemized deductions (from Schedule A) or your standard deduction see left margin) ;. 40 9 32 5 for- 41 ... _ Subtract Tine 40 from line 38 ............................................:{ :................ ... ............ 41 , 63 013 • P~P~ who 42 F~remptions. Multiply $3,700 by the number on line 6d ~ 42 11 100 chedtany box on line 43 ................................... Taxable Income. SubUad line 42 from hne 41.. if line 42 a more than the 41, amen -o- :~ . .. ..... ....... 43 51 913 39a or39b or who can be 44 ..... .. ................. Tax (see instr.). Check if any from: a ~ 8814 s) b ~ 49 2 c LJ e~lac ...........a? ................ ......... ............ 44 7 7 4 9 claimed es a dependent 45 . Alternative minimum tax (see instructions). Attach Form 6251 ....... .~ .. . 45 , see InS1NdlOrla 46 . . ............. Add lines 43 and45.•....,••.•........•,, ................ ................................ s . ............ ........ - 46 7,749 . An otters: 47 Foreign tax credit. Attach Fonn 1116 if required ~ .A7 single or 48 Credit for child and dependent care expenses. Attach Form 2441 4S 1 2 00 Married n~,g selurately 49 Education credits from Form 8863, line 23 d9 . ss,eoo 50 ............................ Retirement savings contributions credit. Attach Form 8880 SO Married filing fo~y,r 51 .. .... . Child tax cred,•f (see instructions) `.51 2 0 0 0 Qualifying widow(er) 52 .... ................. . Residential. energy credits. Attach Form 5695 ... 52 s11 soo 53 ... Other credits from Form: a ~ 3800 b ~ 8801 c ~ 33 Head of household, 54 Add lines 47 through 53. These are.your total credits ~: 54 3 200 se,soo 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- .. , , . , . , , , , , , , , , , , , , , , , 55 4 5 4 9 Oth 56 Self-employment tax. Attach Schedule SE 56 er T 57. Unreported social security and Medicare tax from Form: a 4137 b 8919 57 axes 58 Additional tax on IRAs, other qualfied retirement plans, etc. Rttach Form`,329 if requited .. . .. 58 59a .. ... • . ...... .... Household employment taxes from Schedule H _ . . ..... . . .. .. .. .. ... 89a b . . . . , . , .. : First-time homebuyer credit repayment. Attach Form 5405 if required .................. ........... 59b 60 Other taxes. Enter code(s) from instructions 60 61 Add lines 55 through.60. This is your total tax. .. _ . _ ........ .. - 61 4 549 62 Federal income tax withheld from Forms W-2 and 1099 E2 6 0 68 ;, Pa menu 63 2011 estimated`tax payrnents~nd amount applied from 2010.detum ~ ;3 B you have a 54a Earned income credit (EIC) ~.. ~,„ .. °94.a 5•.^. ~ ~~~ '" b Nontaxable combat pay el~ectjo '~ E 64ti • setwduk etc. 65 Additional childdax credit. Attach Fo 8812 R5 - ~ `° 66 American'o~iportunity°credit fro rm 8853, line 14 : "~66 67 . . • . • • First-time homebuyer credit from Form 5405, line 10 ~:7 - 68 Amount paid with request for extension to file . . ........ . ............. °"s8 " " 69 Excess social security and tier 1 RRTA iax withheld a8 70 Credit for federal tax on fuels. Attach Form 4136 -70 71 Credits from Form: a ~ 2439 b ~ 8839 e ~ 8801 d ~ 8885 71 72 Add lines 62, 63, 64a, and 65 through 71. These are your total paymsrtt: _ .:... _ ..... ..... ...... .............. ....... - ;2 6 068 Refund 73 If Tine 72 is more than line 61, subtract line 61 from line 72. This is the amriunt you overpaid • ..... 73 1 519 74a Amount of line 73 y ou want refunded to you.:lf Form 8888 is attached, ,:heck here.. , , , .. _ - ~ 74a 1 519 Dired deposit? - b Routing number ~ _ ~ - ~ Checking ~ Savings Sae - d ~ Account number instructions. ' 75 Amount of line 73 you want applied to your 2012 estimated tax - ~ !5 Amount 76 Amount you owe. Subtract line 72 from line E1. For details on how to p=;'; see instructions . , , .. . - 76 YOU Owe 7T Estimated tax penalty (see instructions) , , . , , , , , , • , , ( ~ .............. t 7 Third Party Do you want to allow another person to discuss this return wah the IF2S (see jnstr•~~tions)? Yes. Complete belpw. . ~ No Designee Pars .~,al idenlificc;ion number (PIN) - .2 212 Designee's name - Daniel W Bort:3man CPA Phonenc. - 717-77g 8129 S+, n Under psnakies of perjury, 1 declare that I have examined this return and aceomoarryirg sdtedubs and ataramenta, andto tl,s best of my knnwkdge snd baf at, 9 Here they are true, corned, and complete. Dedaretion or preperer (othor than taxpayer) ie based on all irNarmetian of which praperer has arty knowbdge. Y i our s gna ture Date Your occupation f Da e yfirn ph number Joint return? . 3a14a8 ~ . ' Keep e copy for our Spouse's s ignature. If a joint return, both must sign. Date Spouse's oxupatrn H.the IRS aoM Ptcadbrt Pr N, ou an Identity y records. enter it hero (ase lrtslr.) Print/T ype preparers name . -,L Preparers signature Date Check if PTr Paid Daniel w sor~man CPA ~ seH-employed PO 139448 Preparer Firm's name - Boretnan & Babb , CPA's ' ~ FiRn'a e1N - 25 1847161 , USe Ortly Fam's address - 710 Bridge S ~ F Phone no. . , NeFv _ Clunberland PA 17C':70-1934 717-774- 129 F ~ ~4~ (2011) DAA _. r-,®.- _ A of Bfe Treasury Ssrvia atnwm on Form 7C ene L "`i~+tiical ,` and f~ental Expenses. Taxes You Paid Itemized Deductions _ - Attach to, Form 1040. - See Instructions for Schedule A (Form 1040). ' 89 • 40 ~ Your social security Olenick Caution. Do not indude expenses reimbursed or paid by others. . 1 Medical and dental expenses (see instructions) ~ ~1 • ~ . 2 Enter amount from Fonn 1040, line 38 2 7 2 3 3 8 3 Multiply line 2 by 7.5% (.075) ......................... _.3 5 425 '' .............. 4 Subtract kne 3 from line 1. If line 3 is more than line 1, enter -0- .. . . . . ........ . . . ... . • . _ , , ...... , ..... 4 5 State and local (check only one box): . a X Income taxes, or -~5 1 619 b General sales taxes .. 6 Real estate taxes (see instructions) ............................. . .... 6 3 65 6 11 No. 7 Personal property taxes 7 8 Other taxes. List type and amount - 8 9 Add lines 5 through 8 ~ g 5 2 7 5 Interest 10 Home mortgage interest and points reported to you on Form 1098 ~ 10 You Paid 11 Home mortgage interest not reported to you on Form 1098. tf paid to the person from whom you txx~ght the home, see instructions and show that _ Note. person's name, identifying no., and address - Your mortgage interest deduction may ....................................................................... be limited (see .... ....... ......... . instructions). 12 Points not reported to you on Form 1098. See instructions for spedal rules ..................................................:...... 12 13 fvlortga , ' • urance<premiums (see instructions) _ _~~ 13 ' 14 Inves "~ ent interest. Attach Form 4952 if required (See instnions.) ....... .. .. _ .. 14 tS .4~sis+.N~ets aD shs,~y a:;ta _ .... . ...::.... ~ .L; Gifts to 18 Gifts by chef. If.~ou~made any gift of 5250 or;more, Charity see instructions ~ is 4 05.0 45 you shade a 17 Other than by cash or check. If any gift of $250 or more, see gift and got a instructions. You must attach Form 8283 if over $500 ".7 - - benefd for it, 18 Carryover from prior year ~ ~ ~ ~ ~ ~ ..... ...................................... . ' 8 ~ . see instructions. 19 Add lines 18 through l8 .,,,, ......................... 19 I 4,050 Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . ........ . ... . . . . . . .. . . . . . ........... . 20 Job Expenses 21 Unreimbursed employee expenses-mob travel, union dues, and Csrtain job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) - Miscellaneous ..... . ..................................... ; .............................:...................... ........ . 21 Deductions ... . .... 22 Tax preparation fees :.2 23 Other expenses-investment, safe deposit box, etc. List type and amount - ................ ..................................... l3 K. 24 Add lines 21 through 23 _ 24 25 EnteramountfromForm1040,1ine38 25 ~ 72 338 ~- 26 Muftipty line 25 by 2% (.02) ~S 1 4 4 7 27 Subtract line 26 from line 24. If line'26 is more than line 24 enter -0- : :. ........ . ... . . . . .. . . . . . .. 27 Other 28 Other-from list in instructions. List type and amount - Miscelisneous ........ _ .................... ............ . Deductions ..........................................:...:.......................... .: : .............. >, ............ 28 Total 29 Add the amounts in the far right column for lines 4 through 28. Also, ente*'fhis amount Itemized on Form 1040, line 40 29 9 325 DeductlOns 30 If you elect to itemize deductions even though they are less than your sta~ti~ard deduction, dteck here ....... .. .... .. ...................: ........ . . - ri -_, ~.. :a , ,. For Paperwork Reduction Act Notice, see Form 1040 instructions. •- ~ Schedule A (F 1040) 2011 DAA ~- '~ ~ OM No.1545-0D74 Interest and Ordinary Dividends 011 ~~~ 1t}40) ! _,~,~ y t~ij - Attach to Form 1040A or 1040. - S+tie instructions on back. I ~~ °"No O$ =::pn Your soelal sscuri number :>e L Olenick ~ 1 List name of payer. If any interest is from aseller-financed mortgage and the:.. buyer used the property as a personal residence, see instructions on back ara~l:list `' f this interest first. Also, show that buyer's social security number and addressl A11X.. Bank .............................. . .......................................................... Americhoice Federal Credit Union instruct ra ; Wells Fargo Bank ~. - back and ~ ~ Members First Federal Credit Union instructions I r pentagon FCU •,, corm ........... ......................................... ...........~ ............................:. 1 Form 1040, ......................................................,......... -. ............................................. ._.. line 8a.) ..............~.................................................... Note.lf you ..............................................................~ .., received a Fur i ................:............................................................................... ~ ~ .............. 1099-INT, Fcn .......... ................ .............................................................:....... .............. 1099-OID, ar substitute • r statementfrc,r ........ .................................................................................... .............. a brokeragefir r, ...................... ...................................................................... .............. list the firm's name as the 2 ............................................................................................... Add the amounts on line 1 ~'• ' .............. 2 payer and en~~E 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. the total intere.~ : shown onth~t •. Attach Form 8815 ::: 3 form. 4 ...................... .............. ..................................... Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form- .............. 1040,1ine 8a .................................................................... .......... ........... - 4 Note. If line 4 is over $1,500, ou must corn lete Part III. - _._ Part I I 5 List name of p$!}fetr~- ~ ~: Ordinary,; ........ _ _. _ _. _. ........ ~ .. Dividenh~s ,.,~ ~ (See instructia s ........... - _ .. _ - _ on back and the ' instn~cfionsfor .......:......:...:....................:..........................:............................. ............: Form 1040A,ar ..... ...................................................................................... .............. Form 1040, ...................................... ........................................................ .............. line 9a.) ............................................................................................... .............. 5 . ................. Note.lfyou .......................................................................................... . received a Fonu, ............................................................................................................. 1099-DIV or substitute ........................................................................ statementfrom .................................... a brokerage fimr,, ............................................................................................................ list the firm's ............................................................................................................. name as the payer and ente° ............................................................................................................ . the ordinary 6 Add the amounts on Tine 5. Enter the total here and on Form 1040A, or Form dividends shown 1040, line 9a - on that form. Note. If Gne 8 is over 51.500. you must comolete Part III. 828 116 288 I I 3 , 658 12.3 You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Yes No Part III 7a At any time during 2011, did you have a financial interest in or signature authority over a financial account {such as a bank account, securities account, or brokerage account) located in a foreign Foreign country? See instructions . :....... . . . .. . ....... _ _ . .. _ . _ , .. X ACCOUntS If "Yes,' are you required to file Form TD F 90-22.1 to report that financial interest or signature _. and Trusts authority? See Form TD F 90-22.1 and its instructions for filing requirements and exceptions io (See those requirements ' .......................................................................................................... instructions on b If you are required to file Form TD F 90-22.1, enter the name of the foreign Country where the back.) financial account is located ........................ - '~ B During 2011, did you receive a distribution from, or were you the grantor of, cr transferor to, a fo n trust? If "Yes " ou ma have to file Form 3520. See instructions on back ...................:........................ X For Paperwork Reduction Act Notice, see your tax return instructions. Schedrile B (Form 104 or 1040) 2011 DAA Child and Dependent Care Expenses oMe o.,s45-oo~4 1040A - Attach to Form 1040, Form 1oa0A, onForm:1oa0NR. 10aoNR O 11 3-E'sreawry - 2441 marl seerKe (as} - See separate instructions. s nee No. 2 ~ -: arr return Your social security numbs ane L Olenick Persons or Organizations Who Provided the Care-You must complete this part. /tf ....~, i,a..e .....mss 4L.,~.. i.u,. ,.,..w .......:,Jw.w w,.,. LL.,.:....F.. .,.t:,..... ~ 1 (a) Care provider's (b) Addross (c) Ident'rfyinp number (d) Dorn paid name (number, street, apt. rro., dty, stets, and ZtP code) (SSN or EIN) (see nstnrctions) 230 S Sporting; Hil1.==Road .Hampden Township ~chanicsburg, PA 13050~~~~~ 23-6050136 2,172 410 Fallowfield Road West Shore YMCA C Hill, PA~~17011 23-1665437 5,.238 Did you receive No Complete only Part II below. dependent care benefits? Yes Complete Part III on the back ne Caution. If the care was provided in your home, you may owe employment taxes. If you do, you cannot file Form 1040A. For details, see the instructions for Form 1040, line 59a, or Form 1040NR, line 58a. Fartai: Credit for Child and Dependent Care Exoensea 2 Information about our lull in non s . If ou have more than two uali i rsons, see the instructions. (a) (}ualiryinp person's name (b) l2ualHyinq person's socal (c) QualHi ~~ and sxpanssa you In 20,1 for the First Lesi security number rson lie in colurrei e Joshua Olenick 3 700 Christian Olenick 3 710 3 Add the amounts in column (e~of~ihe 2. Dia nit enter more than $3,000 for one qualifyinp~ person or $6,000 for two or more persons: f you ca~pd(~ted Part Nt enter the amount ' - ~ ',~ .' from line 31 ............... ~ ............ : . : -:::. :_ c ........ -13 6 000 4 Enter our earned income See instrictiiins ~ y 4 52 723 5 If married filing jointy, enter yoar'spouse's'eamed in die (if your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4 - 5 52 72 3 6 Enter the smallest of line 3, 4, or 5 . . ............ _ ........................................................................ 6 6 0 0 0 7 Enter the amount from Form 1040, line 38; Form , 1040A, line 22; or Forrn 1040NR, line 37 7 72 338 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7 If line 7 is: If line 7 is: But not Decimal But not Decimal _ Over over amount is Over over amount is $0-15,000 .35 $29,000-31,000 .27 15 000-17 000 34 31 000-33 000 26 , , . , , . 17,000-19,000 .33 33,000-35,000 .25 8 19,000-21,000 .32 .. 35,000-37,000 .24 21,000-23-,000 .31 37,000-39,000 .23 23,000-25,000 .30 39,000-41,000 .22 25,000-27,000 .29 41,000-43,000 .21 27,000-29,000 .28 43,000-No limit .20 9 Multiply line 6 by the decimal amount on line 8. If you paid 2010 expenses in 2011, see the instructions g 70 Tax liability limit. Enter the amount from the Credit Limlt Worksheet in the instructions 1 p 7 7 4 9 - ........................................................ .... 11 Credit for child and dependent cars expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 48~Foim 1040A, line 29; or Form 1040NR, line 46 ............................................ 11 For Paperwork Reduction Act Notice, see your tax return instructions 1,2 20 1,200 2441(20„) DAA 1040 ( General Sales Tax Deduction Worksheet I_~ :.~- ~ as shown on return Jeanene L Olenick Taxpayer Identificatlion Number State of Locality of Penns lvania General Sales Tax from IRS Tables 1. Enter the amount of adjusted gross income (AGI) from Form 1040, Line 37 1. 72 338 2. Add the nontaxable amounts from Form 1040, lines 8b, 15a, 16a, 20a (Exch,de rollovers and tex-tree Sec. joss exeherges) 2. 3. Add the follbwing nontaxable items: nontaxable combat pay, public assistance, veteran's benefits, and workers' compensation. Also indude any amounts which increase spendable income, such as the refundable portion of refundable tax credits received in 2011 3. ... ......... .. . : . .. ... ... .... . ... . . . ... : . . ... . ... .. .. .... . .......... .. . .. . . . .... ... . . ................... 4. Add lines 1 throw h 3, this is income for eneral sales tax table u oses 4. 9 9 P rP ................ . 72 338 . 5. Enter the. amount from the sales tax table in the Schedule A instructions. 5. ................................................. 7 01 Part-year residents, complete lines 6 - 8; Full-year residents skip lines 6 - 8 arnf >+v'ftzr'tYtie a~mrnml Smm time 5 tm 4m8 8 8. Enter the number of days of residence in state 6. .............................................. 7. Total days in year 7. 365 ........................................................................... 8. Divide line 6 by line 7 (rounded to at least 3 decimal places) 8. 9. Multiply line 5 by line 8, this is the dedudible general says tax using the 1RS table. 9. 7 O1 Local Sales Tax Using IRS '"ables 10. Enter the amount from the sales tax table in the Schedule A instructions. 10. 11. If you are a resident of Alaska, Arizona, Arkansas, California (Los Angeles County only), Colorado, Georgia, Illinois Louisiana, Missouri, New York State, North Carolina, South Carolina, Tennessee, Utah, cr Vrginia, enter the amount from the appliealile•Optiol`tal Ldcal Sates Tax Table in the.Schedule A in5ti~°ctions. 11. 12. Enter the local general sales tax rate{exdude stateside local sales tax rate) '. 12. a 13. Enter the state general sales ta~rate,(indudeTstatewide total sales taz rate) 13. 14. Divide line 12 by line 13 (rounded to at`least 3 dearral places) 14. ............................. 15. If you entered an amount on line 11, multiply line 11 by line 12. This is the local sales tax using the optional local sales tax tables. Part-year residents, complete tines 16 - 18; Full-year residents skip lines 16 - 18 and enter the amount from li;ie 15 on line 19 If you did not enter an amount on line 11, multipy line 10 by line 14. This is the local sales tax 15. using the optional state and certain local sales tax tables. Part-year residents, complete lines 16 - 18; Full-year residents skip lines 16 - 18 and enter the amount from line 15 on line 19 16. Enter the number of days of residence in locality 16. ~ ~~~~~. ~ ~~~~~.~~~~~~~~~~.. ~~~~~~~~~~ 17. Total days in year 17. 365 ........................................................................... 18. Divide line 16 by line 17 (rounded to at least 3 dedmal places) 1 B. 19. Multiply line 15 by tine 18. This is the dedudible general local sales tax using the IRS tables. 19. ............................ General Salas Tax Summatiy 20. Enter the sum of line 9 from all General Sales Tax Deduction Worksheets 20. 7 O1 21. Enter the sum of line 19 from all General Sales Tax Deduction Worksheets 21. 22. Add fines 20 and 21, this is the total General Sales taxes using the tables 22. 701 23. Enter the actual state and local general sates taxes paid 23. 24. Enter the greater of line 22 or fine 23 24. 7 O 1 25. Enter the state and local taxes paid on specified items (major purchases) 25. 26. Add fines 24 and 25, this is the deductible General Sales tax 26. 7 O l 27. Enter total state and local income taxes paid 27. 1 619 Enter the greater of line 26 or 27 an Schedule A, line 5. If line 26 is greater, ma: k Sd~edule A, line 5b. If line 27 is greater, mark Schedule A, li a Sa. ~" f~r1, 1040 Chiid Tax Credit Worksheets 01`1 ., 1lCane Jeatnene L Olenick Taxoaver Identifica ion Number Chiid Tax Credit Worksheet -Form 1040, Line 51, Form 1040A, Line 33 or Form 1040NR, Line 48 1. Number of qualifying children: 2 x 51,000. Enter the result ............................................................. .... 1. 2 000 2. Enter the amount from Form 104D, line 38, Forth 1040A, line 22, or Form 1040NR, line 37. ........................................ 2. ... 72 338 3. Enter the total of any exdusion of income from Puerto Rico, and amounts from Form 2555, lines 45 and 50 or Form 2555-F1, line 18 3. .,:: 4. Add lines 2 and 3. a. 72 338 5. Enter. 5110,000 if martied filing jointly; E75,000 if single, head of household, or qualifying widow(er); $55,000 'rf married filing separately. 5. 7 5 0 0 6. Is the amount on tine 4 here than the amount on fine 51 '.t' X No. Leave line 8 blank. Enter -0. on line 7. Yes. Subtract line 5 from line 4. N the result is not a multiple of $1,000, incxease it to the next multple of 51,000. ..... 6, T. Multiply the amount on Tine B by 5°h (.05). Enter the result. ..................................................................... T ... 8. Subtract line 7 from line 1. If zero or less, stop here; you cannot take this credit. ................................................. s. ... 2 000 9. Enter the amount from Form 1040, line 46, Form 1040A, line 28, or Form 1 oaONR, line 44. ........................................ 9. ... 7 7 4 9 10. Add the amounts from Form 1040 lines 47, 48, 49, 50, or Form 1040A lines 29, 31, and 32, or Form 1040 NR, lines 45, 46, and 47, plus any amounts from Form 5695, in 14, Form 8634, In 23, Fonn 8910, In 22, Forth 8936, In 15, and Schedule R, In 22. Enter the total. 10. 1 2 0 d 11. Are you claiming any of the following credits? ~ Mortgage interest credit, Form 8396 ~ Residential energy effident property credft, Form 5695, Part II ~ Distrid of Columbia first-time homebuyer it Form 8859 $ No. Enter the amount from Ifne 10. , Yes. Enter the amount from Child Tax Credit -Line 11 Worksheet below. } .............::.:.......................... 11. ... 1 20~ 12. Subtract line 11 from line 9. 12. 6 Je 4 9 13. Child tax credit. Enter the smaller of line 8 or line 12 here and an Form 1040, line 51, Form 1040A, line 33 or Form 1040NR, line 48. 13. 2 0 0 Child Tax Credit -Line 11 Worksheet Use this worksheet only if you check': Yes" on'Ifne 1~f of the Child Tax Credit Worksheet above- •° 1. Enter the amount from line 8 of the Ch~IdTax~Credit Worksheet above. ~ ,, 2. Enter the taxable earned income from the Child Tax Credd Taitable~Earned Income Worksh t _ ee 2, 3. is the amount on line 2 more man 53.0001 , _: v No. Leave line 3 blank, enter -0. on line 4, and go toline 5. Yes. Subtract S3,OD0 from the amount on line 2. Enter the result 1 ~ : J ............. ........ ......... ........ . , 3. .. 4. Multiply the amount on line 3 by 15% (.15) and enter the result. ................................... .............................. .. 4 .. 5. Is the amount on line 1 of the Child Tax Worksheet above 53,000 or more? No. If line 4 above is: ~ Zero, enter the amount from line 1 above on line 12 of this worksheet Do not complete the rest of this worksheet. Instead enter , the amount from Child Tax Credit Worksheet line 10 on line 11, and complete lines 12 and 13. ~ More than zero, leave lines B through 9 blank, enter 0 on line 10, go to line 11 below. Yes. If line 4 above is equal to or more than line 1 above, leave lines B through 9 blank, enter -0- on line 10, and go to line 11 below. Otherwise go to tine 6: 6. Enter the total soda) security and Medicare taxes withheld from your pay (and your spouse's if filing a joint return). These taxes should be shown in boxes 4 and 6 of your Form(s) W-2. If you worked for a railroad, see below, g, .................. 7. Enter the total of the amounts from Forth 1040, line 27 and lime 57 (Form 1040NR, lines 27 and 55), plus any taxes identified with .. code "UT' on the dotted line next to Foml 1040, line 60 (Forth 1040NR, line 59). ...... 7. ..................................... 8. Add lines 6 and 7. ................................................................... .. ......................... ....... ..... 9. Add the amounts from Fonn 1040, lines 64a and 69 or Form 1040A, fine 38a and excess social security tax included on line 41 or .. Forth 1040NR, line 85. Enter total. ......................................._. .............. 9. ............................ 10. Subtract Tine 9 from line 8. If the result is zero or less, enter -p-. ~ ............................. 10 ........................:.............. 11. Enter the larger of line 4 or line 10. , .............................................. ... .... s . 1 1. ....... . .............................. . 12. Is the amount on line 11 of this worksheet more than the amount on line 1? . ~ No. Subtract tine 11 from line 1. Enter the result ~ Yes. Enter -0-. } ...........................:.................................. .............. . 12. . ........................... Next, complete Forms 8396, Fonn 5695 (Part il), or Form 8859 where applicable. . 13. Enter the total of the amounts from Form 6396, line 9, Form 5695, line 31 and Form 8859, line 9. 13. .............................. ..... 14. Enter the amount from line 10 of the Child Tax Credit Worksheet above. ........... . 14. ................................................ 15. Add lines 13 and 14. Enter this amount on line 11 of the Child Tax Credit Worksheet above. ................ . 15. ......................... Railroad employees. Include in the total on tine 6 above any of the following taxes. . ~ Tier 1 tax withheld from your pay. This tax should be shown in box 14 of your form(s) W-2 and identified as 'Tier 1 tax". ~ If you were an em b ee re resent ti 50% ' p y p a ve, of the total Tier 1 tax and Tier 1 Med xare tau you psid for 2011. r a ~ `~ ui o D a a € o LL O LL Q O ~~ d a E Z c O .~ M. c d U a C,' E N Z C C G Q `= N O N ~ M ~ c c c c c c ~ ~ l'7 ~ O aG ap Os Os GO GD GO oD GFO W GD t'~ C Il LL ll lL LOL tL E = o a tr O O O N to = ._ .~ Y :~ C ' ~ O N d ~ ~ m c_ :_ E ~ co rn yy ~ ~. v C C C U r ._ r ~ X ~O~pa O O U € € E o~ '~ U U li LL li W to Z ._ ...., Y t~ (,,7 t~ N !~ r-1 R ~ C1 ~ m w: '7~ ~ VO ~ ~ d C C C C C E ~ ~ Or O ~ O d ~ O ~ ~ € E € o w ~~xpp y v r U U U U X E 19 ~ .x~., m c ~ w- ~ v c ~ ~~p E 7 ~ •~ ~O C1 _ ~i' ~ o t -a m p tY Q LL U W~ Q A .C ci 9 ai r.: 1' ~_ ~+ R ~ a a ~ GLf °' m a ~ C 11 ~4 .,, to 0 ~ a oD oD m o LL O a I _ ~~~~ I , ~ td ~ 41 ~€;. O ~ C ~ N € LL O a ~ ~ ~ V' ~ ~ ~ ~ ~ ~ ~ ~ N E ~ O LL ~A W~U r N G+f of 10 t0 N m C 3 ~ o ~ : ~ E ~ > N r ~ ~ :v ~ :~ m :~ = :to E • U C O ~.'T' .O C ~.~. ~ ~ ~ ~ y y~y _ O C a O. C O d ~ ~ c m a~ ~ c r' E .. W C m C X 'c9 •~ W E v U D ~ ~ ~. ~. o c ~_ ° .°. C O = :A .N.. !6 ~ ~ ~ L Fes- O ~ ¢ U U r N M t1 tG! GD U d N °~ o°Do O LL ° t . . ,. r M"M-~' lA 10 N~ CJ C 3 .~ o ~ : ~ E ~ > ' :A `- > A :~ N ~ O m . ~ ~ m E ~ ~ o E o '~ o U ~ ~N y- G v C a o_ c o m ~ a~ 0 m W O M E m W C N C X d W :~ w ~ W U, p ~ C C w r~ ..0.. 6 ~ dl N "~' ~ • f :°.t ~ E E ~ Fes- O ~ Q U U r tV IM t* Ip GD r N M ~ It1 i0 N C c :~ ~o E > H r : > ~ .. N ~ O to U C : ~ C w C o c w o ~ ~ ` ~ C v C d ~ ~' ~ E ~ ~ o ~' E `° _ d ~ f6 C tD C x l~0 ~ 'O O O c "' ~ .~ `~ C l~6 3 N tll t6 N ~ O m ~ Fes- O ~ Q U U r N t"f ~ Id1 G7 :i . ~. :m . C 'I :E ~o :w C E t6 W t C tG ~ :, :o m ~ v E c ~ o v o ego € ~° O U h. LL v N E y c E C ~ 3 p `~ O ~ , l0 ~ Q C w r ~ m CV ~ W W N ~ aD eri ;. O .~ m nNi v E c c ~ _ _ ~` f~D ~ C GO ~4 aFCO r ~ O O V f V- lL N E E ~ , U ~ C C C ~ N O O ~ C ~ N p ~ w ~ w OD m d d W W W t LL r N {'~ ~ m m L W C r C V c ~a u~ a~ c v Q U ~. O N d C ~ M d O d GOD ~ Cpr C - ~ LL ~ C O c ~O 0 Z ~ r a~ w` ~~ :c a ~ : M U tp C : O E ~ ~ c Lt. d E ° o r w N w C ~ ~ `o E to ~ ~ E H .wd. c O m c Z w W ~ GD Federal Statements Form 1040, Line 11 -Alimony Received Taxpayer Spouse Description Amount Amount David M Olenick $ 7,220 $ Total $ 7,220 $ 0 I, Federal ~tafieme~~s Schedule A, Line 5 -State and.1..~~cal Taxes Amount =' Mate Withholding on W-2s '~~ Total Income Taxes* General Sales Tax Total Sales Taxes *Income taxes are being deducted $ 1.,619 1., 619 701 701 Schedule A. Line 16 -Charitable Contributions by Cash or Check Description Amount West Shore Evangelical Free $ 3,880 Scott Key Center 20 WJTL 15 0 ''' Total $ 4; 050 '~'~ -y Salaries & Wages Report 201:1 :-. II Taxpayer Identificatibn Number ~e L Olenick ~~"~ ~ Employer Federal Wages Federal Withheld Soc See Wages G;::E Imagistics Inc 52,723 6,068 52,723 _ ... ... __. H _- -_-_~ I _ __ ,J I~ -_.. . L_ - --~ tVl Taxpayer Spouse Totals :•c, rc.~ o,vca ~~c, rc3 ;loc Sec Withheld Medicaro Wages Medicare Withheld Soc Sec Tips Allocated Tips Dep Caro Ben Other, Box 14 A 2,214 52,723 764 B C u - . , F G H '.. J K L M ~I T~~E;;~.aver Slpr~l ise Tc~lr s 2,214 52,723 764 ~~ " ~ ~ ages a ame o oca oca ages oca i e A P_A 52,723 1,619 Hampden T 103 52,723 B _ C _ D _ E _ F _ G H J _ K _ L _ M Ta~u~ ~r Ayer Sp~:~Gi se 723 Tcyiaa~, 52 , 723 1, 619 52 , Federal Return Summary ~~ 01~1 `~' '; ~ , Taxpayer Identificat i n Number , r e L Olenick _ ""~ := 10 4 0 Filing Status HH Dependents 2 Income Tax Computation ar~: : w rges 52 , 723 Regular tax 7 749 aL ~ iie Est income 12 , 3 95 Aftemative minimum tax " a~ a ;rnpt interest Total tax before credits 7 7 4 9 ~ idt; - ircc me Child and dependent care credit 1 2 00 :lua i' d dividends Education credits ;ah ~ #.9f=/local refunds Other credits .... ......... .. ...... 2 000 n rbor , ~, , ~ wed .................. .. 7 , 2 2 0 Total credits .......... ...... ... 3 2 0 0 :: ,;;inE;: income/-loss Tax after.credits 4 549 :: a~aital : iiin/•loss Self-employment tax :: tier r ~,'-lass (Form 4797) Additional tax on IRAs, etc. ' i,aablr ~A distributions Other taxes '" i,cabl, pension distributions Total tax ... . ... . . ... ... . 4 549 =~'.>nta.l, yalty, partnership, etc. income/-loss .... .. ...... . ... .. ... . . Payments "9'm I" 7rnE:/-TOSS : ............ ................ _+~~ern,Fr anent compensation .. Federal ir.: ome tax withheld 6 068 ty ................. 1" ixablr ocial securi benefds .. p y ................... Estimates a ments ................ ::'ther it erne .. p y ............................ Other a ments/credits 1'~atal irr:ome 72 338..; Tot~attpayments 6 068 Adjustments. RefundlAmaunt'`~ue alovin ~ ~ c reuses g ' E _ .:~ _ v. d ~ Amount ove a+ rP : 1 519 .... . , .. ' " _ I .... . .... ~If-em ., o' ment tax ad ustment .. i y f Ove ant applied : . ................ d i_P, SiI.+ PLE, and qualfied plan deduction . .......... .... ............. Form 221L~ penalty a~:ylf-em::~'oyed health insurance deduction Amount.d~e/-refund 1 519 ,a imony t aid .......................... Failure to tae penalty lf~:A decl~.,:tion Failure to. pay penalty Sl:udent loan interest deduction Late filing interest ~~~ther acrJustments Net amount duel-refund ... ... 1 519 `f,~tal acl.,stments ............................... Adjustr;d gross income . 72 , 338 2012 Estimates Deductions 1st quarter ..................................... 2nd quarter ..............:. Medical ,:a~~d Dental expenses 3rd quarter .. Taxes p~:id $ , 275 :.................................... 4th quarter Interest I:a;~id Total Charitab.~e~ contributions ......................... 4 , . 050 Tax Rates 01:her iterized deductions Total allavvable itemized deductions 9 , 325 Marginal tax rate 25.0 ............. or, Stanclaird deduction . Effective tax rate 9 Eremptinn amount 11 , 100 Rate of Long-term capital gain °~ Taxable income 51, 913 CERTIFICATE OF SERVICE AND NOW this ~ "~ da of Au u 2 1 y g st, 0 2, the undersigned does hereby certify that she did this date serve a copy of the foregoing Plaintiff's Income and Expense Statement upon the Defendant's counsel by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER Melissa Peel Greevy, Esquire :510730 R. h` E( SAND COUNT° Johnson, Duffle, Stewart & Weidner Melissa P. Greevy, Esquire I.D. No. 77950 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 mpg@jdsw.com JEANENE L. OLENICK, Plaintiff V. DAVID M. OLENICK, Defendant Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09 -7822 CIVIL TERM : CIVIL ACTION - LAW IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Jeanene L. Olenick, Plaintiff, moves the court to appoint a master with respect to the following claims: [X] Divorce [ ] Annulment [X] Alimony [X] Alimony Pendente Lite [X] Distribution of Property [ ] Support [X] Counsel Fees [X] Costs and Expenses and in support of the Motion states: 1. Discovery is complete as to the claims for which the appointment of a master is requested. 2. The Defendant has appeared in the action by his attorney, Lori K. Serratelli, Esquire. 3. The statutory grounds for divorce are no fault divorce pursuant to 23 Pa. C.S. 3301(d). 4. The action is contested with respect to the following claims: all claims set forth above. 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take one day. 7. Additional information, if any, releva o the otion: None. Date: :518686 Melissa P. Greevy, Esquire I.D. No. 77950 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 Attorneys for Plaintiff ORDER APPOINTING MASTER AND NOW, this day of 2012, Esquire, is appointed Master with respect to the following claims: BY THE COURT: J. MOVING PARTY Jeanene L. Olenick, Plaintiff MELISSA P. GREEVY, ESQUIRE Johnson, Duffie, Stewart & Weidner 301 Market Street Lemoyne, PA 17043-0109 717-761-4540 mpg@jdsw.com NON-MOVING PARTY David M. Olenick, Defendant LORI K. SERRATELLI, ESQUIRE Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 (717) 540-9170 Iserratelli@ssbc-law.com CERTIFICATE OF SERVICE AND NOW, this 00dUay of October, 2012, the undersigned does hereby certify that she did this date serve a copy of the foregoing Motion for Appointment of Master upon the Defendant's counsel by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 Attorney for Defendant , DUFFIE, STEWART & WEIDNER Melissa P. Greevy, r 1 - ? L 6 k{ ??'? ?jy y P1 R r ?CC bit {J: +~ 6 SYLVANJA Johnson, Duffie, Stewart & Weidner Melissa P. Greevy, Esquire I.D. No. 77950 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 mpg@jdsw.com Attorneys for Plaintiff JEANENE L. OLENICK, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7822 V. DAVID M. OLENICK, Defendant : CIVIL ACTION - LAW IN DIVORCE TO: MELISSA P. GREEVY, ESQUIRE, Attorney for Jeanene L. Olenick, Plaintiff LORI K. SERRATELLI, ESQUIRE, Attorney for David M. Olenick, Defendant DATE: CERTIFICATION I certify that discovery is complete as to the claims for which the Master has been appointed. OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. (b) Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. 0 IJ i Z" DATE ,k,q 6a,/-j COUNSEL FOR PLAINTIFF ( ) COUNSEL FOR DEFENDANT (( ) NOTE: PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE AT THE MASTER'S DISCRETION. AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY COUNSEL, INDICATING THAT DISCOVERY IS NOT COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL STATEMENTS WILL BE ISSUED AT THE MASTER'S DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL STATEMENTS WILL BE ISSUED IMMEDIATELY. THE CERTIFICATION DOCUMENT SHOULD BE RETURNED TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF THE DATE SHOWN ON THE DOCUMENT. MOVING PARTY Jeanene L. Olenick, Plaintiff MELISSA P. GREEVY, ESQUIRE Johnson, Duffie, Stewart & Weidner 301 Market Street Lemoyne, PA 17043-0109 (717)761-4540 mpg@jdsw.com NON-MOVING PARTY David M. Olenick, Defendant LORI K. SERRATELLI, ESQUIRE Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 (717) 540-9170 lserratelli@ssbc-law.com CERTIFICATE OF SERVICE AND NOW, this v day of 2012, the undersigned does hereby certify that she did this date serve a copy of the foregoing Certification that discovery is complete upon Defendant's counsel by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire t Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 Attorney for Defendant E, STEWART & WEIDNER P. Greevy, Esquire 517639 2. The Defendant has appeared in the action by his attorney, Lori K. Serratelli, Esquire. 3. The statutory grounds for divorce are no fault divorce pursuant to 23 Pa. C.S. 3301(d). 4. The action is contested with respect to the following claims: all claims set forth above. 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take one day. 7. Additional information, if any, releva o the otion: None. l Date: 010// :518686 Melissa P. Greevy, Esquire I. D. No. 77950 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 Attorneys for Plaintiff ORDER APPOINTING MASTER ?Q AND NOW, this /a -4 day of 2012, Esquire, is appointed Master with respect to the following claims: MOVING PARTY Jeanene L. Olenick, Plaintiff MELISSA P. GREEVY, ESQUIRE Johnson, Duffle, Stewart & Weidner 301 Market Street Lemoyne, PA 17043-0109 717-761-4540 mpg@jdsw.com &p,'-es /mc, l wle- BY THE COUR 10 J. NON-MOVING PARTY David M. Olenick, Defendant LORI K. SERRATELLI, ESQUIRE Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 (717) 540-9170 Iserratelli@ssbc-law.com `L- Tye} -i rz? t?.J N ? ?w CERTIFICATE OF SERVICE AND NOW, this D day of October, 2012, the undersigned does hereby certify that she did this date serve a copy of the foregoing Motion for Appointment of Master upon the Defendant's counsel by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 Attorney for Defendant DUFFIE, STEWART & WEIDNER Melissa P. Greevy, Esq JEANENE L. OLENICK, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 09 - 7822 CIVIL DAVID M. OLENICK, Defendant IN DIVORCE TO: Melissa P. Greevy Lori K. Serratelli , Attorney for Plaintiff , Attorney for Defendant DATE: Tuesday, October 23, 2012 tiw t=- ?-> < _j _ CERTIFICATION 7 ? CD ~r-.W 5 C [ ] I certify that discovery is complete as to the cl,*&irjtS for which the Master has been appointed. Y' ? OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. (b) Provide approximate date when discovery will be complete and indicate what action is being taken to complete discovery. ?0L?/12, DATE COUNS FOR PLAINTIFF ( ) COUNSEL FOR DEFENDANT ( ) NOTE: PRETRIAL DIRECTIVES WILL NOT BE ISSUED FOR THE FILING OF PRETRIAL STATEMENTS UNTIL COUNSEL HAVE CERTIFIED THAT DISCOVERY IS COMPLETE, OR OTHERWISE AT THE MASTER'S DISCRETION. AFTER RECEIVING THIS DOCUMENT FROM BOTH COUNSEL OR A PARTY TO THE ACTION, IF NOT REPRESENTED BY COUNSEL, INDICATING THAT DISCOVERY IS NOT COMPLETE, THE DIRECTIVE FOR FILING OF PRETRIAL STATEMENTS WILL BE ISSUED AT THE MASTER'S DISCRETION. HOWEVER, IF BOTH COUNSEL, OR A PARTY NOT REPRESENTED, CERTIFY THAT DISCOVERY IS COMPLETE, A DIRECTIVE TO FILE PRETRIAL STATEMENTS WILL BE ISSUED IMMEDIATELY. THE CERTIFICATION DOCUMENT SHOULD BE RETURNED TO THE MASTER'S OFFICE WITHIN TWO (2) WEEKS OF THE DATE SHOWN ON THE DOCUMENT. Lori K. Serratelli, Esquire ID No. 27426 Serratelli, Schiffman & Brown, PC 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 (7l 7) 540-9170 (7l7) 540-5481 fax lserratelli~ssbc-law.com Attorney for Defendant JEANENE L,. OLENICK, Plaintiff v. DAVID M. OLENICK, Defendant { 4 i ~ ~, I~f~;~, t~12 a~'T ~9 ~M It' ~ 7 CUMBEfiLA~rU Cc~U~'TY PEhfNSY~VANIQ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7822 CIVIL ACTION -LAW IN DIVORCE, DEF:ENDANT'SINVENTORY Defendant files the following inventory of all property owned or possessed by either party at the time the action was commenced and all property transferred within t:he preceding three f 3 j years. Defendant verifies that the statements made in this Inventory are true and correct, Defendant: understands that false statements herein are subject to penalties of 18 Pa.C.S. X4904 relating to unsworn falsification to authorities. Date:---~ ~ ~ ~ ,~~ 1 ~ ; ~r-''~~~n / ~- Davi M. Olenick, Defendant Submitted by, SERRATELLI, SCHIFPMAN & BROWN, PC /(~i .4 L~+1ri K.`Serratelli, Esquire ASSETS OF PARTIES ( ) Plaintiff (°) Defendant marks on the list be:Low those items applicab le to the case at bar and itemizes the assets on the following page s. ( ,. ) 1 . Real Pro~~erty (}~) 2. Motor Vehicles (;') 3. Stocks, bonds, securities and options (,,} 4. Certificates of deposit (`) 5. Checking accounts, cash ('~.) 5. Savings accounts, money market savings certificates ( ) 7. Contents of safe deposit boxes ( ) 8. Trusts ( ) 9. Life Insurance policies (indicate face value, cash ( ) 10. ( ) 11. ( ) 12. ( ) 13 . ( ) 14. ( ) 15. ("b~) 16. ( 17. (`~ ) 18. (~ } ( ) ( ) ( ) ( } ( ) 19. 20. 21. 22. 23. 24. surrender value and current beneficiaries) Annuities Gifts Inheritances Patents, copyrights, inventions, royalties Personal :property outside the home Businesses (list all owners, including percentage of ownership, and officer/director positions held by a party with company) Employment termination benefits -- severance pay, workman's compensation claim/award Profit sharing plans Pension plans (indicate employee contribution and date plan vests) Retiremeni~ plans, Individual Retirement. Accounts Disability payments Litigation claims (matured and unmat.ured) Military/~T.A. benefits Education benefits Debts due, including loans, mortgages held ( ) 25. Household furnishings and personalty (:include as a total category and attach itemized list if distribution of such assets is in dispute) ( ) 26. Other MARITAL PROPERTY Defendant lists all martial property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action commenced. Defendant reserves the right to supplement this list prior to time of trial. ITEM NO. DESCRIPTION OF PROPERTY NAMES OF ALL OWNERS COMMENTS _ __ __ ___ 1. _ PNC (formerly PA State Bank) Checking account # 3365 _ H & W _ _ __ __ ___________ 2. PNC (formerly PA State Bank) Checking account # 2513 H & W __ ___ ____ ~ 3. Metro Bank Checkin account # - 9969 _ W ___ _ _ _ __ __ 4. Metro Bank Checking account # - 0705 W ________ S. Members 1St Checkin Account # 2769-11 H & W ______ ____ __ 6. Members 1St Savin s Account # 2769-00 H & W - _ ---------------- 7. , `' Members 1St Money Mgt Account # 2679- OS H & W _______ ______ 8. Bonus Paid for 2009 _ H _ __ ____ ! ^ 9. Members 1St CD # 2769-56 H & W __ _ _ ___ __ i 10. Wells Far o CD # 6578 H & W _ __ 11. Penta on FSC CD # 2560 H & W 12. Penta Ton FSC CD # 2561 H & W 13. Pentagon FSC CD # 3563 ~ H & W _ _ ~ 14. Penta on FSC CD # 9568 H & W ____ _ ___ __ __ __ _ _ 15. PNC CD's #s 4690 thru 4699(1(? in total) H & W _ __ - 16. AmeriChoice FCU CD # 8237-0061 H & W ----------- 17 AmeriChoice FCU CD # 8237-0062 _ H & W 18. 19. All r Bank CD # 3726 _ GE Stock (370.249 shares) H & W_ H _ _____ ___ __ 20. IBM Stock (1 share) H ________ 21 2002 Ford Windstar H & W __ _ _ ~ 22. 2006 Honda Accord H _ 23. Federal Thrift Saving Plan H 124. 2S. _ Husband's Accumulated Compensatory Leave, Vacation leave and sick leave i PNC CD's ((4690 thru 4699 (10 t.otal)) _ _ H H & W _ __ __ ___ _ _ Cashed -'iz distributed to each arty by Order of 9/17/2010 26. Wife's OCE Accumulated Compensatory Leave. vacation leave and sick leave lans W 27. Wife's Pentagon FCU IRA # 7221 W 28. 29. Wife's Social Security Retirement Wife's OCE Retirement Plan W ---_______ W ~ _ _ _ _ ___ _ 31. 11.09 Kent Drive, Mechanicsburg, PA ( H & W HUSBAND' SNON-MARTIAL PROPERTY Defendant lists all property in which he has a legal or equitable interest which .is claimed to be excluded from the marital property Item No. DESCRIPTION OF PROPERTY BASIS FOR EXCLUSION 1. 1135 Sandpiper Ct, Mechanicsburg, PA Acquired post separation ___J 2. __ __ Savings and Inventments Ac uiq red prior to marriage _ 3. Integrity Bank Checking # 201041804 Ac uired ost separation 4. Non-martial portion of Civil Service Retirement System and 'Thrift Savin s Plan Acquired prior to and subsequent to marri~e ___ ___ _ __~__ P KOPERTY TRANSFERRED Defendant lists all martial property with was transferred with the past three years. Item Description of Date of Consideration Reason To Whom TValue No_ _ Pro erty Transfer Transferred 1. None ------ -- - ---- -- - ---- --- - j--- JOINT LIABILITIES OF PARTIES Defendant lists alI martial debts outstanding as of the date this action was commenced. Item No ___ Descri tion Of Property Names of All Creditors Names of All Debtors 1.~~ 1 I09 Ken Drive, Mechanicsburg AmeriChoice (HEL Acct. No. 237) H & VJ CERTIFICATE OF SERVICE ~L~ I, Lori K. Serratelli, Esquire, do hereby certify that on this ~~c day of October 2012, I served a copy of the foregoing document by first-class mail, postage prepaid, in the Post Office at Harrisburg, Pennsylvania, to the following person(s): Melissa P. Greevy, Esquire Johnson, Duffle, Stewart & Weidner, PC 301 Market Street PO Box 109 Lemoyne, PA 17043-C-109 ~~ r ,~ ~ Lori K. S rratelli, Esquire SE~RATELLI, SCHIFFMAN & BROWN, PC 2080 Linglestown Road Suite 201 Harrisburg, PA 17110 (717)540-9170 Attorney for Defendant INCOME AND EXPENSE STATEMENT OF DAVID M. OLENICK Employer DDC, New Cumberland Address--- 2001 Mission Drive, New Cumberland, PA Type of Work Management Analyst G-13 Payroll Number 97380500 Pay Period (weekly, bi-weekly, etc.) Bi-weekly Gross Pay Per Pay Period 4436.80 (See Exhibit A ITEMIZED PAYROLL DEDUCTIONS: Federal Withholding 930.75 FICA 62.42 Local Wage Tax 6g,gg Stage Income Tax 162.17 Mandatory Retirement 310.58 LST Tax 2.00 Healt7 Insurance 131.73 Other ;specify) Child Support 714.46 Spousal Support 177.69 Net Pay Pe~~ Period 1876.12 ~ c~ `~~-: 2rn n -- ~_~; r-- ~y ~ tV ~ ~ '' ~ ~~ ~ ~ •~.~ 4~1 ,~'"" ~'! _~ ~ 'ti~ 1 OTHER INCOME: WEEK MONTH Interest $ $ .35 Dividends $ $ Pension Distribution $ $ Annuity $ $ Social Security $ $ Rents $ $ Royalties $ $ Gifts $ $ Unemploymen~ Comp. $ $ Workers Comp. $ $ Employer Fringe Benefits $ $ __ Other (spec:ify) YEAR $ $ $ $ ---- TOTAL NET ANNUAL INCOME ....., .................$ 48,783.32 2 EXPENSES Week: Monthly Yearly HOME Mortgage/Rent $ $ 1079.13 $ 12,_949,56 Maintenance $ $ $ UTILITIES: Electric $ $ 65.00 $ 780.00 Gas $ $ 55.00 $ 660.00! Cell. $ $ 20.00 $ 240.Ou Cable!Phone $ $ 130.24 $ 1, 562__._ 88 Internet Water $ $ 32.50 $ 390..00 Sewer; Trash $ $ 50.00 $ 600.00 EMPLOYMENT Lunch $ $ 100.00 $ :1,200.00 TAXES: Real Estate $ $ 182.68 $ 2,:192.22 Income $ $ $ ---_----____- INSURANCE: Automobile $ $ 54.?5 $ 656.98 Life $ $ 31.89 $ 382.68 SUBTOTALS $ $ 1801.19 $ 21.,614.32 3 r , AUTOMOBILE: Payments $ $ 240.51 $ 2,886.:12 Fuel $ $ 240.00 $ 2,880.00 Maintenance $ $ 20.00 $ 240..00 Licensing $ $ 3.33 $ 90.00 MEDICAL: Doctor $ $ 33.50 (Avg.)$ 402.OG Dentist $ $ 8.33 $ 100.00 Orthodontist $ $ $ H o s p i t a l $ $ $ ____ ________ Medicine $ $ 10.00 $ 120.GO Special Needs $ $ $ J_,________ EDUCATION: School $ $ 4.00 $ 48.00 PERSONAL: Clothing $ $ 100.00 $ 1,200_00 FOOd $ $ 350.00 $ 4,200.00 Barber/Hairdresser $ $ 18.00 $ 216.00 CREDIT PAYMENTS: Credit Card. (Visa) $ $ 110.00 $ 1,320.00 Credit Card (Kohls) $ $ 20.00 $ 200.OC; {Ba_~. ) Credit Card (Discov er)$ $ 350.00 $ 4,200.Ou Memberships (Pool) $ $ 5.00 $ 60.~~G SUBTOTALS $ $ 1,512.67 $ 18,11.2.12 4 LOANS: Home Equity Loan _ $ $ 200.00 $ 2,400.00 Parent's Loan $ $ 100.00 $ 1,200.00 --- - $ $ $ MISCELLANEOUS: Household Help $ $ $ Children* $ $ $ See Exh.i.bit B Papers/Books/Magaz $ $ 12.50 $ 1.50.00 Entertainment $ $ 100.00 $ 1.200.00 Vacation $ $ 150.00 $ 1800.OU Gifts $ $ 125.00 $ 1500.00 Legal Fees $ $ $ F164.43** Charitab.e Contrib $ $ 25.00 $ 300.00 Other (specify) Townhouse Mgt Fee $ $ 59.50 $ 714.00 SUBTOTALS $ $ 772.00 $ 9,264.00 w/o leg fees 15,428.43 w/leg fees *Although t:he amount: spent for th e children has not been included i n the totals it is provided as an attachment for informational purp oses. **Total legal fees and costs to date are $18,493.30 over a t:riree year period for an average of $6 164.43 per year. TOTAL ANNUAL EX PENSES: $ 48,990.44 _w/o legal fees $ 55,154.87 w/lega l fee s 5 PROPERTY OWNED: Checking Accounts Savings Accounts Credit Union Stocks/Bonds Real Estate Other TOTAL ....................... $ DESCRIPTION VALUE H W J See Inventory and Appraisement (H) = Husband (W) = Wife (J) = Join° 6 COVERAGE INSURANCE HOSPITAL Blue Cross Other MEDICAL Blue Shield Other Health/Accident Disability Income Dental Other COMPANY POLICY # H [v Thru Emp=Coyer 816464374 x_ x __ x Thru Emp]_oyer 816464374 x_ __~___ x (H) = Husband (W) = Wife (C) = Chila. 7 SUPPLEMENTAL INCOME STATEMENT (a) This form is to be filled out by a person (check c>nej: 1. who operates a business or practices a profession, oY 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} she most recent Profit and Loss Statement. (c) Name of Business: Address _ Telephone No. (d) Nature of Business (check one): 1. partnership 2. joir_t venture 3. profession 4, closed corporation 5. other (e) Name of accountant, controller or other person in r_h:~:~~ge or financial records: (f) Annual income from business: 1) How often is income re~~eived? 2) Gross income per pay period? 3) Net .income per pay period? 4) Specified deductions, if any: 8 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I under statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unswor~ authorities. Date: _ ~1 ~ ~i :~~ : / ~ ~~~ c~.,.k' /~6 ~' v~.c~, David M. Olenick CERTIFICATE OF SERVICE ~~. ~,~, I, Lori K. Serratelli, Esquire, do hereby certify that on this <~~ day of October , 2012, I served a copy of the foregoing document by first-class mail, postage prepaid, in the Post Office at Harrisburg, Pennsylvania, to the following person(s): Melissa P. Greevy, Esquire Johnson, Duffie, Stewart & Weidner, PC 301 Market Street PO Box 109 Lemoyne, PA 17043-0109 --~ .. Lore. S~rratelli, Esquire SERRATELLI, SCHIFFMAN & BROWN, PC 2080 Linglestown Road Suite 201 Harrisburg, PA 17110 (717)540-9170 Attorney for Defendant my;~a.y Yage I of Z k rAYr Smart Leave and Earnings Statement x F Y h x F Save II Print ; I Printer Friendly Version {_ HTML Version , View Mole 08/25/2012 ~ 1 t3o I DEPARTMENT OF DEFENSE ~ 1. Pav Period End 08/25/12 Cl`VII.iAN LEAVE AND EARNINGS STATEMENT 2. Pav Date VISIT TIC DF~~S WEB SITE AT: W W W.DFAS.MIL 08/31/12 Nwne 3 4. Pav ~. 6. Basic/OT 7. Basic Pav + Locality Adj = Adjusted Basic . OLEMCK VI PianlGrade/Sten Hourly/Daily/Rate Rate Pav DA D M GS 13 10 55.46 Y 55.46 93,175.00 22,567.00 115,742.00 8 Soc Sec No 9 L lit % 10 FLSA C ~ 11 5CD L ] 2. Mai Leave Camp Over 13. Leave Year End . . oca y . ateeon . eave *** '*-1643 24.22 E 08/23/76 240 01/12/13 14. Financial. Institution -Net Pav 15. Financial lnstitution -Allotment #1 16. Financial lnstitutian -Allotment #2 INTEGRITY BANK I7. Marital Exem tionsAdd'1 Marital T 18 F ti Add'1 T i 19. Cumulative Retirement o Tar Status - . ax .xema ans ax ng Authority St t a us 20. Military Deposit FED S 0 0 420861 S 0 0 FAIRVIEW'I'WPNR CSRS: PA S 0 30 421080 S 0 0 HAMPDENTWP 92, i 19.71 Zi. Current Year to Date GROSS PAY 4.436.80 90,849.22 TAXABLE WAGES 4.305.07 88,487.'L8 NONTAXABLE WAGES 13 L73 2,36194 TAX DEFERRED WAGES O.i}0 27 - DEDUCTIONS 2.560.69 49,778.11 AEIC NET PAY 1.876.11 41,071. (1 CURRENT EARNINGS TYPE HOURS/DAYS AMOUNT TYPE HOURS/DAYS AMOUNT TYPE HOURS/DAYS AMOUNT REGULAR PAY 80.00 4,436.80 DEDUCTIONS TYPE CODE CURRENT TEAR TO DATE TYPE CODE CURRENT YEAR TO DATE ALIMONY, GRN 177.69 3,198.42 CHLD SUP,GRN 714.46 12,860.28 FEHB 112 131.73 2,361.94 MEDICARE 62_x3 1,283.07 RETIRE, CSRS 1 310.58 5,590.44 TAX, FEDERAL 430.75 19,775.59 TAX, LST 420861 2.00 36.00 TAX, LOCAL 421080 68`88 1,415.81 TAX, LOCAL 420749 0.00 0.00 TAX,LC~ C>CC 420861 0.00 0.00 TAX, STATT' PA i 62.17 3,256.56 LEAVE TYPE PRIOR YR ACCRUED ACCRUED USED USED DONATEDf CURRENT USE-LOSE/ BALANCE PAY PD YTD PAY PD YTD RETURNED BALANCE TERM DATE ANNUAL. 240.00 8.Q0 136.00 9.00 79.50 0.00 296.50 136.50 SICK 3,017.50 4..00 68.00 7.00 47.00 0.00 3,038.50 COMPENSATORY 3.00 0..00 109.50 0.00 0.00 0.00 109.50 TRAVEL COMP 0.00 0..00 87.50 0.00 87.50 0.00 0.00 HOLIDAY 0.00 0.00 0.00 0.00 40.00 0.00 0.00 ADMIN 0.00 0..00 0.00 0.00 8.00 0.00 0.00 BENEFITS PAID BY GOVEKNMENT FOR YOU TYPE CURRENT YEAR TO DATE TYPE CURRENT YEAR TO DATE FEHB 395.21 7,086.18 MEDICARE 62.4:1 1 283.07 RETII2E, CSRS 310.58 5,590.44 , REMAKKS YOUR PAYROLL OFFICE ID NUMBER IS 97380500 - DEPARTMENT OF DEFENSE. CELEBRATE CONSTITUTION DAY/CITIZENSHIP DAY (SEP 17), PLEASE VISIT HTTP://CONSTI TUTIONDAY.CPMS.OSD.MIL PRETAX FEHP EXCLUSION $ 131.73 3.00 COMPENSATORY TIME HOURS PAID YTD. . _ ..., ,..._...,,. ~ ,.,va.. ~....,, u..-vnivui i lulu ~unJr,~, r 1 v r t1C YKl V Al.; Y At, 1 Vh f Yl4 AJ AMENDED _. _. _ ___ _. _. K ti _ _ • We recommend that you select the Printer Friendly Version of your LES if you desire to print your LES. It requires Adobe Acrobat Reader. Often, Acrobat Reader is already added to web browsers. If you don't have Adobe Reader and applicable security policies allow you to install d, it can be downloaded at http://www.adobe.corn/products/acrobat/readermain.hlml. If you prefer the html version, click the Print button. You may have to make adjustments to your margins in your browser Page ~~ Monthly Expenditures Below is a list of the current monthly expenditures that I make in support of my sons when they are with me for the two weekends a month. Food: Each weekend that the boys are with me I spend on average of $50 additionally for food for I try to buy some homemade soups, streaks, and fish, along with eating our for lunch. So 2 weekends per month, food bill is around $100 more. Clothing for the boys, in buying shirts, shorts, pants, etc., along with sneakers; this comes to around $150 in total for them on average. For example, Josh needed a new pair of sneakers that when we went to DICKS Sporting Goods last week, we picked up a pair that he wanted and they cost $74.99 alone. Toys -they like to build LEGOS and occasionally they want a new WII game ar DS game for their handhelds. So each weekend I have been spending on average $50 for each child on Star War LEGOS to build. So this comes to be $200 a month (2 boys x $50 - 100 x 2 weekends a month = $2.00). When I don't spend the money on LEGOS, then it's buying a WII and/or DS game. So the total for the above is around: $450 per month (100 +150+200). Not sure where this goes for expenses on the list for the MASTER. Other: I recently purchased school pictures and for both boys this came to be around $60. Not sure where this goes for expenses on the list for the MASTER and others like this that pop up during the year. ~~ E Department of the Treasury-Internal Revenues Service (99} ~0 ti• ~.a~. B~d~~'diUaO ~i~~®~~. ~¢~~ ~~'.~~~~ r OMB No. 15 45-0074 IRS Use On ty-Do not write or staple in this space. For the year Jan. 1-Dec. 31, 2011, or other tax year beginning , 2011, ending , 20 See separate instructions. Your first name and initial Las': name ~ - Your social security number ~° lr -~ If a joint return, spouse's first name and initial Las': name i~~ Spouse's social security number Home address (number and street) If you have a P.O. box, see instructions. Apt. no' Make sure the SSN(s) above _~ _~ ~~F~ ~ V ;~ `v~y ~ ~,°.; ~ ,°~° I and on line 6c are. correct. City, town or post offi ce, state, and ZIP code. If you have a foreign address, al s o complete spaces Below (see instructions).. Presidential Election Campaign [ ~ t P r ~ N,~; s=_~`f €'T ,~4~ (~.,,~ r~~ t` ~ ~. C.`„~ `<~ ~ p ~ ~ ~ ~"5 .~~ r-,. Check here if you, or your spouse ff filing Foreign country name Foreign province/county Foreign postal code lointty, want $3 to go to this fund. Checking a box below wid not change your tax a refund ~ You ^ Spouse ~I(Ifl~ ~$a$t.OS 1 ^ Single 4 ^ Head of household (with qualifying person). (See instructions.) If 2 ^ Married filing jointly (even if only'one had income) the qualifying person is a child but not your dependent, enter this Check only one 3 ®Married filing separately. Enter spouse's SSN above child's name Here. box. and full name here. ®~ ~' ~ -- ~~j ~ 5 Quali In widow er with de endent-child .. ~ ~ . ~ ~ ^ fy~ 9 ( ) P ~3teP1r6j3$I®69S If more than four dependents, see instructions and check here ® ^ 6a ~ Yourself. If someone can claim you as a dependent, do not check box 6a . b n Soouse c Dependents: (1) First name Last name (2) Dependent's social security number (3) Dependent's relationship to you (4) / if child under age '17 Qualifying for child tax credit (see instructions) - ^ ---- ^ ---_- ----- at I oral number of exemptions claimed . ~~C®~~ 7 - Wages, salaries, tips, etc. Attach Form(s) W-2 .e -'T 7 8a r t. Taxable interest. Attach Schedule B if required ~.9 F-= 1~~`': ~X ! ~ ~ ~x.~' ~'' ,.rte -rF ~ ~ ga b f Tax-exempt interest. Do not include on line 8a ~ 8b ~ _ Attach Forms} W-2 here Also 9a ~- --- -- Ordinary dividends. Attach Schedule B if required ,`~ -I ? 9a . attach Forms b Qualified dividends 19b I 1 W-2G and 10 _ Taxable refunds, credits, or offsets of state and local income taxes ! 10 1099-R if tax i hh ld 11 Alimony received _ _ !~11 i was w t e . 12 Business income or (loss). Attach Schedule C or C-EZ -- 92 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ~ ^ ~ 13 If you did not get a W-2, 14 Other gains or (losses). Attach Form 4797. '--- ; 14 _ see iristructions. 15a IRA distributions 15a b Taxable amount ; 15b 16a Pensions and annuities 16a b Taxable amount ~ b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E -17 Enclose, but do not attach, any 18 Farm income or (loss): Attach Schedule F . ~-- 18 payment. Also, 19 Unemploymen# compensation °., 1g please-use 20a Social security benefits 20a L. ~ I ~ b Taxable amount ?~ 20b Form 1040-V. 21 Other income: List type and amount ~ 22 Combine the amounts in the far right columri for- lines 7 through 21 This is your total income ® 22 _ 14CI~US~eC~ 23 Educator expenses 23 ~il'O$S 24 Certain business expenses of reseMsts, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 24 InCOITt~ _ 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Form :3903 26 27 Deductible-part of self-employment tax. Attach Schedule SE 27 __ 28 Self-employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurance deduction 29 _ ___ 30 Penalty on early withdrawal of savings . 30 _ 31a Alimony paid b Recipient's SSN f> f ~'~~t~ ~~ ~ !:,~~ 31a ~~ ~ i~'~ ~~~~ 32 IRA deduction.. 32 __ -- - 33 Student loan interest-deduction . 33 __ 34 Tuition and fees. Attach. Form 8917. 34 _ 3s Domestic production activities deduction. Attach dorm 0903 3~ _ 3E _ Add lines 23 through 35 ~ 3g 37 Subtract line 36 from line 22. This is your adjusted gross income i> 37 For Disclosure, Privacy Act, and Paperwork Reductiars Act Notice, see separate instructions. Cat. Nc: ~ ? 3203 Boxes checked on 6a and 6b No. of children on 6c who: lived with you did not live with you due to divorce or separation (see instructions) Dependents on 6c not entered above Add numbers on lines above 4~ f~~~~, i - Form ~~~® 12011) Form 1040 (2011) Page from line 37 {adjusted gross income) ~_- ~~~ and 38 Amount 38 ;~ ; " ~ a~ ~ , ':: t Cres~i$s 39a Check ( ^ You were born before January 2, 1947, ^ Blind. 1 Total boxes if: l ^ Spouse was born before January 2, 1947, ^ Blind. J checked ~ 39a standard-~__ b If your spouse. itemizes on a separate return or you were adual-status alien, check here ~ 39b^ Deduction 40 Btemiaed deductions from Schedule A or our standard deduction see left mar In for- - ( ) Y ( 9 ) 40 ` ~~,; r f-° ~' People who 41 Subtract line 40 from line 38 41 ,` ~ 6 ~ ~ ~ `, `- check any box on line 42 Exem dons. Multi I $3,700 b the number on line 6d . p ~ p Y Y ~ 42 '~. ~s' ~• ~ '' ~ `~ 39a or 39b or who can be 43 Taxable income. Subtract sine 4P from line 41. If line 42 is more than line 41, enter -0- 43 ,r ~ ~' ~`' ~ ~ ._ r/'.: claimed as a 44 Tax (see instructions). Check if ariy from: a ^ Form(s) 8814 b ^ Form 4972 c ^ 962 election 44 ', r f,,,F,eg' dependent, see 45 Aiternative minimum tax (see instructions). Attach Form 6251 . 45 instructions. 46 Add lines 44 and 45 G> 46 _ c~'.= ~, ~~4.m; All others: le or Sin 47 Foreign tax credit. Attach Form 1116 if required . 47 - -- _ g Married filing 48 Credit for child and dependent care. expenses. Attach Form 2441 48 i separately, $5,800 49 Education credits from Form 8863., line 23 49 - -- Married filing 50 Retirement savings contributions credit. Attach Form 8880 50 ___ QualY ~n 51 Ghild tax credit (see instructions) , 51 _ __ widow er}, $11 600 52 Residential energy credits: Attach f=orm 5695 52 _ __ , Head of 53 Other credits from Form: a ^ 3800 b ^ 8801 c ^ 53 _.__ household, $8 500 54 Add lines 47 through 53. These are your total credits _ 54 ' , 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- _V p 55 ,:,~ ' t ~.,,, ~~ ~"- _ . _ +~t~~~ 56 Self-employment tax. Attach Schedule SE _56 ~ 57 Unreported social security and Medicare tax from Form: a ^ 4137 b ^ 8919 ~ 57 ~~~~ 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 58 59a Hcusehold employment taxes from :ichedule li 59a b First-time homebuyer credit repayment. Attach Form 5405 if required 59b 60 Uther taxes. Enter code(s) from instructions --------------------------------------------------------------- 60 61 Add lines 55 through 60. This is your total tax ~ ~ 61 -`t,,~ ,~ ~,~~;° ~ ;_ ~ayn,ein~~ 62 Federal income tax withheld from Forms W-2 and 1099 62 ` ~ ~ :v ~ ~-`t- 63 2011 estimated tax payments and amount applied from 2010 return 63 _-a If you have a 64a Earned income credit (EIC} lif i 64a. I ~ y qua ng child, attach b Nontaxable combat-pay election ~ b -- ' Schedule EIC. 65 Additional child tax credit. Attach Form 8812 65 66 American opportunity credit from Form 8863, line 14 66 __ 67 First-time homebuyer credit from f=orm 54O5,~line 10 . 67 __ 68 Amount paid with request for extension to file 68 _ 69 Excess social security and tier 1 RRTA tax withheld 69 p 70 Credit for federal tax on fuels: Attach Form 4136 70 _ 71 Credits from Form: a ^ 2439 b ^ 8839 c [] 8801 d ^ 8885 71 72 Add lines 62, 63; 64a, .and 65 through 71. These are yourtptal p ayme nts }~ 72 -~'~",, s;~ f ~, <; r'ieftind 73 if line 72 is ..rare than line 61, subtract line 6T from line 72. Tnis is the amount you verpai '`• _ 73 ~ ~~c`.~ o ; 74a Amount of line 73 you vivant ~ d d to~cou. If Form 8888 is attached, check here ®^ _74a .,~ ~~, ~'~; ~_ ;~ Direct deposit? ~ b Routing number ®c Type:- ^ Checking ^ Savings ~ See i~ d Account number ~ ( ~ ~ ~ ~ ~ I ~ a instrpctions. 1 75 ,4mount of line 73 you want applied to your 2012 estimated tax ®~ 75 AmOUnt 76 Amount you owe. Subtract line 72 from line 6i. For details on how to pay, see instructions ~ f 76 i.-_. r i r_snmarea tax penalty (see tnstructlons) i 77 I Third Party ~o You want to allow another person to discuss this return with the IRS (see instructions)? ~1 Yes. Complete below: ^ No ®esignee Designee's Phone Persdnal identification name ~ no_ ® number (PIN) ~ ~~~~ ~t'~9l Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements; and to the best of my knowledge and belief, ~„~~~.~ they are true, correct; and complete. Declaration of preparer (other than taxpayery is based on all. information of which preparer has any knowledge. Joint return? See ~ ~f. y~ -~ ~ $ (!: I Datc I ruur occupauor~ 1 ~~aytme phone number instructions. ~ "`~ .,;;-S: ~- err" ~[~'~i'. i`l. ~~ ~~ _ f fu ~ ?-~.,._, j It ..~ f w. f E. r -~ ~ ~. ~~ , - Keep a copy for '-'-~ gpouse's signature. If a joint return, both must sign. Date Sp use's occupation If the IRS sent you an Identity Protection your records. PIN; enter it here see inst. _ _ Frint~-yne preparer's name Preparers, signature Date PTIN ~a9CA Check ^ if PrepareP --- - _ _`_~_elt_employed ~Se ®nly _Flrrn's Warne ~ Firm's EIN D`_ _ - Firms address ~ Phone no. Form ~ ®~® (2011) ~C~E;®I.~lsi° ~~ ( {~~~Z~~ ~dP~CtI®~~ OMB No. 1545-0074 ~F®rt~ 1 Q4f){ ~ ^ Department o" ;he Treasury } F> Attach to Form 1040. ®See Instructions for Schedule q (Farm 1040E Attachment Internal Revenue service (99) I Se uence No. 07 Nameis) sho•.vn ~n Form 1040 ` ®~®`~ Your social security number _ -~ f'F~' :~ FRG%L- ~ }~(A ~~ 'v{t ~ ~~ -~~ ~ / / kftedica€ Caution. Do not include expenses reimbursed or paid by others. and "r Medical and dental expenses (see instructions) 1 i Mental 2 Enter amount from Form 1040, line 38 ~_ - - - -- - ----~-~ Expenses 3 Multiply line 2 by 7.5% (.075) 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- 4 Taxes 1(ou 5 State and local (check only one box): Paid a ~ Income taxes, or } 5 ~. ~ . t~- --- ~-~ ^~; I b ^ General sales taxes J - 6 Real estate taxes see instructions i ~ ~ ~, ~ 7 Personal property taxes 7 ~ ~~ 8 Other taxes. List type and amount ~ ,.~ ------------------------------------------------------------------------------------ 8 S Add lines 5 through 8 . y I ~-~ 'l ~ ~, ~,~ Interest 10 Home mortgage interest and points reported to you on Form 1098 10 "~ "~, ~ ` ~ ~• i You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid _ ___ ote to the person from whom you bought the home, see instructions i I Y . our mortgage and show that person's name, identifying no., and address ld ' interest ---------------------------------- .~ deduction may __ 1 „.,. - r be limited see ( 12 P ints not reported to you on Form 1098. See instructions for ', µ ~", i instructions . 13 p s eclat rules . Mortgage insurance premiums (see instructions) . 12 13 ____ _ __ '~~ ' 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 ___ ___ _ - 15 Add lines 10 through 14 15I ~~ F~ ~ ci , Gifts to 16 Gifts by cash or check. If you made any gift of $250 or more ~" Charity , see instructions . 16 ;~ ;; ~ ~~ If you made a 17 _ Other than by cash or cheek. If any gift of $250 or more, see ___ , gift and got a instructions. You must attach Form 8283 if over $500. 17 ~ ~7 ~ ~ i~` benefit for it, 18 Carryover from prior year 18 f '~~ see instructions. 19 Add lines 16 throw h 18 , 19 ~ ~~ _ U ; Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . 20 it Job Expenses 21 Unreimbursed employee expenses-job travel, union dues j ~~ `~ ^ and Certain Miscellaneous , job education, etc. Attach 1=orm 2106 or 2106-EZ if required. ', ` (See instructions.) ® 21 .~; i Deductions 22 ______ --------~----------------------------------------------~ 22 Tax preparation fees ____ 23 _____ Other expenses-investment, safe deposit box, etc. List type R. _ ~:+~. and amount - ~ , ~~ 4 25 23 _ ---------------------------------------------------------------------------------- - Add lines 21 through 23 24 - Enter amount from Form 1040, line 38 25 _ ~ ~ ~.r,: ~, :; ~: -~ ~, 26 Multiply line 25 by 2% (.02) . 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- 27 Other 28 Other-from list in instructions. List type and amount ® j Iscellaneous Deductions ------------------------------ -. _. - --_ - Total 23 28 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount ~ Itemized Deductions 30 on Form 1040, line 40 _ _ If you elect to itemize deductions even though they are less than your standard 2g I _ ~ ~ ~ ~` ~ c(~ x~ ~ ~x-s~ ~ c deduction, check here _ p> ~~ ~^ ~~-.~~' °: 7*,~ ~~ '~ yr rapervvor~ rceaucnon HcE rvonce, see Form 1040 instructions. Cat. No. 17145C Schedule A (Form 1040} 2011 c=art ~r~C~~or-oao{ ~r~- ~ ,~ m; treasury Snterrai ~ r.~em~eServ~ce(99)! r art Y <. h„a4n ~n ~>turn ~nf:er~s~ and O~d~~aary ®i~6dends ®Attach to Form 1040A or 1044. ~ See instructions orr baci; (~~~~ ~ 1 List name of payer. If any interest is from aseller-financed mortgage and the buyer used the property as a personal residence, see instructions on back and list ~'n~C;l'E'.a`,. this interest first Also ~~how that bu er's social securit n b d dd ~- OMB No. 1545-0074 ~~ Attachment Sequence No. ~$ Yoour social security nu/tuber Amount . , •> y y um er an a ress , - s ~ _ - .-~ ~-.> (See instruCtions ----------~=L-~Y~~~1~~_~~_ / -- ~ ~v ~~ ~ - d..t,.5 c; ~ ------- ------------- --1--- ----- -~-~--=--=~---------- - --_- !~ on back and the ~ ~---------------------- --- - -=~----~;_~------------ ----------~~ -------...----- instructions for ` ( //'('~ t,`c P, 8 y~ ---~-~-~-=-~- ~---- ~---~----------_ ------ `~`'~ -5~ .- form 104C', J~' - ~ ------- ~~---~-`5-~---- ~ --rte- --- ~-:~ ------- --- - ----- 1 ~ 3d line 8a± Note. If you -------~ ~j~'~Ft~,7-t' '`---mac ~----- ~---------?-1--'`)~--- ~ ~----th---~--=---~------------- ----- ~ ~ received aForm -------------------------------~---------------------------------------------------------------~------------- 1099-INT, Form .-~ '^ '~" - -~=~-'thy---~-c-h~-`''- t-~~ --- ~C- ~ --'----------~~--~ f'---z -`b-~~----'~-- =~=------. - ----- ~~ ~ 1099-OiD, cr substitute ------------------------------------------------------------------- statementfrom -------------------------------._ a brokerage firm, _________ _ _ _ ------------------------------------------------- -------------------------------------------- list the firm's - --------------------------------------------------------------------------------------- name as t ,e 2 Add .the amounts on line 1 2 ~ ~ C -~ payer and enter - - ~ ` the total interest 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. shown on that Attach Form 8815. 3 form. 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form 1040, line 8a _-_-_-_ - d q, ~~ ,~ ~,~ ~ ~ Note. If line 4 is over $1,500, you must complete Part III. Amount Part !! 5 List name of payer - Ordina -------------------------~-1~---'~-----~~- -~-~='V-~---- =---~'=-------------- -, ~S s~ Dividends --____-- ----- - - --_-_ ~~ 1 ,.~ ' o (See instructions ------------------------------------------------------------------------------------ on back and the instructions for Form 1 040A, or ---------------------------------------------------------------- - Form 1040, ------------------------------------------------------------------------------------------------------__-___ 5 line 9a.) Note.lf you ------------------------------------------------------------------------------------------------------ - - _-. received a Form 1 099-DIV or ---------------------------------------------------------------------------------- substitute --------------------------------------------------------- statement from ------------------------------------------------------------ a brokerage firm, ------------------------------------------ ._ . list the firm's ---------------------------------------------------------------------------------- name as the --____-___________________ payer and enter - ---------------=------------------------------------------------------------------------- the ordinary g Add the amounts on line 5. Enter the total here and on Form 1040A, or Form dividends shown on that form. 1040, line 9a p. ' 6 ~ ~; ~ ~ ~. Note. If line 6 is over $1,500, you must complete Part III. i You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Yes No Part ~~0 7a At any time during 2011, did you have a financial interest in or signature authority over a financial '~'~-'~ "` Foreign account (such as a bank account, securities account, or brokerage account) located in a foreign country? See instructions i~ICCOUntS If "Yes," are you required to file Form TD F 90-22.1 to report that financial interest or signature ''"- I,'}_}_._ and Trus#s authority? See Form TD F 90-22.1 and its instructions for filing requirements and exceptions to .'~~- , ~} ~ ~~ (See those requirements - - ~ instructions or' b If you are required to file Form TD F 90-22.1, enter the name of the foreign country where the = ~ ~`~-.~ . financial account is located ~-_ _ I 1 back.) - ---- - -y ---------_~--.-_..----_ -------------------------- ', 8 Durincd ?011, did gnu r,.r.Pive a distrihution from, or wPrP ar_t the raptor nf, or transferor to, a ~~' "'",'` foreign trust? If "Yes," you may have to file Form 3520. See instructions on bark . I I / For Papen~ork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Farm i040A or 1040) 2011 Schedule B (Form 1040A or 1040) 2011 . ~~e~~~°~8 i~~~rr~acfi®~~ Section references are. to the Internal Ravenue Code unless otherwise noted. If additional information with respect to Schedule B (Form 1040A or 1040) develops later in the filing season, the IRS wit' make that informaton available at www.irs.gov/form1040 Use Schedule B if any of the following applies. You had over 31,tS00 of taxable interest or ordinary dividends. You received interest from aseller-financed mortgage and the buyer used the property as a personal residence. You have accrued interest from a bond. You are reporting original issue discount (DID) in an amount Tess than the amount shown on Form 1099-OID. You are reducing your interest income on a bond by the amount of amortizable bond premium. You are claiming the exclusion of interest from series EE or I U.S. savings bonds issued after 1989. You received interest or ordinary dividends as a nominee. You had a financial interest in, or signature authority over, a financial account in a foreign country or you received a distribution from, or were a grantor of, or transferor to, a foreign trust. Part III of the schedule has questions about foreign accounts and trusts. Specific 9rlsfructi®ns You can list more than one payer on each entry space for lines 1 and 5, but ~~ be sure tv clearly show the amount paid next to the payer's name. Add the separate amounts paid by the payers listed on an entry space and enter the iota/ in the. "Amount' column. If you still need more space, attach separate statements that are the same size as the printed schedule. Use the same format as lines 1 and 5, but show your totals on Schedule 8. Be sure to put your name and social security number (SSN) on the statements and attach them at the end of your return. Part I. Interest Line 1. Report vn line 1 all of your taxable interest. Taxable interest should be shown on your Forms 1099-INT, Forms 1099-OID, or substitute statements. Include interest from series EE, H, HH, and I U.S. savings bonds. List each payer's name and show the amount. Do not report on this line any tax-exempt interest from box 8 or box 9 of Form 1099-INT. Instead, report the amount from box 8 on line 8b of Form 1040A or 1040. If an amount is shown in box 9 of Forrn 1099-INT, you generally must report it on line 12 of Form 6251. See the Instructions for Form 6251 for more details. Seller-financed mortgages. If you sold your home or other property and the buyer used the orooerty as a oersonal residence. list first any interest the buyer paid you on a mortgage or other form of seller financing. Be sure to show the buyer's name, address, and SSN. You must also let the buyer know your SSN. If you do not show the buyer's name, address, and SSN, or let the buyer know your SSN you may have to pay a $50 penalty. Nominees. If you received a Form 1099-INT that includes interest you received as a nominee (that is, in your name, but the interest actually belongs to someone else), report the total on line 1. Do this even if you later distributed some or all of this income to others. Under your last entry on line 1, put a subtotal of all interest listed on line 1. Below this subtotal, enter "Nominee Distribution" and show the total interest you received as a ncminee. Subtract this amount from the subtotal and enter t-~e result on line 2. <= ~ _~ r'T?, !f you received interest as a nominee, I-.~' ;, _ you must give the actua! owner a Form ' ~~I~L=" ~ 1099-WTunlessthe owner is your ~~ spouse. You must also file a Form 1096 ~ and a Form 1099-INT with the IRS. For more details, see the General Instructions for Certain Information Returns and the Instructions for Forms 1093-INT and 1099-OID. Accrued interest. When you buy bonds between interest payment dates and pay accrued interest to the seller, this interest is taxable to the seller. If you received a Form 1099 for interest as a purchaser of a bond with accrued interest, follow the rules earlier under Nominees to see how to report the accrued interest. But identify the amount to be subtracted as "Accrued Interest." Original issue discount (O1D). If you are reporting OID in an amount less than the amount shown on Forrn 1099-OID, follow the rules earlier under Nominees to see how to report the OID. But identify the amount to be subtracted as "OID Adjustment." Amortizable bond premium. If you are reducing your interest income on a bond by the amount of amortizable bonii premium, follow the rules earlier under Nominees to sf:e how to report the interest. But identify the amount to b~=_ subtracted as "ABP Adjustment." Linea 3. If, during 2011, you cashed series EE or I U.S savings bonds issued after 1989 and you paid qualified higher education expenses for yourself, your spouse, or your dependents, you may be able to exclude part or all of the interest on those bonds. See Forrn 88 i 5 for cietaiis. Part II. ®rdinary ®ividends You may have to file Form 5471 if, in ~~,~ 2011, you were an officer or director of a foreign corporation. You may also have to file Form 5471 if, in 2011, you owned 10% or more of the tots! (a) value of a foreign corporation's stock, or (b) combined voting power of all classes of a foreign cvrti,orativn's stook wi'h vvtiry rights. For details, see Form 5471 and its instructions. Linea 5. Report on line 5 all of your ordinary dividends. This amount should be shown in box 1a of your Forms 1099-DIV or substitute statements. List each payer's name and show the amount. Nominees. If you received a Form 1099-DIV that includes ordinary dividends you received as a nominee (that is, in your name, but the ordinary dividends actually belong to someone else), report the total on line 5. Do this even if you later distributed some or all of this income to others. Under your last entry on line 5, put a subtotal of all ordinary dividends listed on line 5. Below this subtotal, enter "Nominee Distribution" and show the total ordinary dividends you received as a nominee. Subtract this amount from the subtotal and enter the result on line 6. If you received dividends as a nominee, you must give the actual owner a Form ~B~ 1099-DIV unless the owner is your spouse. You must also file a Form 1096 and a Form 1099-DIV with the IRS. For more details, see the General Instructions for Certain Information Returns and the Instructions for Form 109E)-DIV. Fart III. f=oreign a4ccounts anti Trusts Regardless of whefheryou are required to file Form TD F 90-22.1 (FEAR), you ~~~~ maybe required to file Form 8938, Statement of Specified Foreign Financial Assets, with your income tax return. Failure to file Form 893$ may resuif in penalties and extension of the statute of limitations. See www.irs.gov/form8938 for mere information. Line 7a-Question 1. Check the "Yes" box if at any time during 2011 you had a financial interest in or signature authority over a financial account located in a foreign country. See the definitions that follow. Check the "Yea" box even if you are not required to file Form TD F 90-22.1. Page Financial account. A financial account includes, but is not limited to, a securities, brokerage, savings, demand, checking, deposit, time deposit, or other account maintained with a financial institution (or other person performing the services of a financial institution). A financial account also includes a commodity futures or options account, an insurance policy with a cash value (such as a whole life insurance policy), an annuity policy with a cash value, and shares in a mutual fund or similar pooled fund (that is, a fund that is available to the general public with a regular net asset value determination and regular redemptions). Financial account located in a foreign country. A financial account is located in a foreign country if the account is physically located outside of the United States. For example, an account maintained with a branch of a United States bank chat is physically located outside of the United States is a foreign financial account. An account maintained with a branch of a foreign bank that is physically located in the United States is not a foreign financial account. Signature authority. Signature authority is the authority of an individual (alone or in conjunction with another individual) to control the disposition of assets held in <i foreign financial account by direct communication (whether in writing or otherwise) to the bank or other financial institution that maintains the financia! account. See the Instructions for Form TD F 90-22.1 (Report of Foreign Bank and Financial Accounts) for exceptions, and definitions of "financial interest," "United States," and other relevant terms. Dv not consider the exceptions relating to signature authority in answering Question 1 on Ime 7a Note. You can yet Form TD F 90-22.1 from the IRS website at wwrv.irs.gov/pub/irs-pdf/f90221.pdf. Line 7a-Question 2. See Form TD F 90-22.1 and its instructions to determine whether you must file the form. Check the "Yes" box if you are required to file the form; cher,.k the "Nt>° hnx if ypir are not renliir@d to file the forrr, If you checked the "Yes" box to Question 2 on line 7a, file Form TD F 90-22.1 with the Department of Treasury at the address shown in the instructions for that form. Do not attach Form TD F 90-22.1 to your tax return. To be considered timely,, Form TD F 90-22.1 must be received by June 30, 2012. It you are required fo file Form TD F 90-22. 1 but do not properly do so, you ® may have to pay a civil penalty up to ~ $10,000. A person who willfully fails to report an account or provide account identifying information may be subject to a civil penalty equal fo the greater of$100,000 or 50 percent of the balance in the account at the time of the violation. Willful violations may also be subject to criminal penalties. Line 7b. li you are required to file Form TD F 90-22.1, enter *he name of the foreign country or countries in the space provided on line 7b. Attach a separate statement if you need more space. Line 8. If you received a distribution from a foreign trust, you must provide additional information. For this purpose, a loan of cash or marketable securities generally is oonsidered to be a distribution. See FlJl lit J., <.U I~.1~ ~]elalij, If you were the grantor of, or transferor to, a foreign trust that existed during 2011, you may have to file Form 3520. Do not attach Form 3520 to Form 1040. Instead, file it at the address shown in its instructions. If you were treated as the owner of a foreign trust under I:hE: grantor trust rules, you are also responsible for ensuring that the foreign trust files Form 3520-A. Form 3520-A is due on March 15, 2012, for a calendar year trust. See the instructions for Form 3520-A for more details. 1~ AF~orm Y~ ~2 Wage and Tax tatement 2011 )epartment of the Treasu ry- Intemal Revenue Service a Employee's social security number OMB No. 1545-0008 Tnisir~orma6on'sbeingturn'shedtotfxlMen~allievenuc 3znk:e ti you are required tofilea 1 7 3 - ~~ ~ - 1 E 4 3 tic return, a neglgence penalty or other sanction nay be imposed on you rf th s ir~corrv~ i. tattdrk a nd you tail to report it. b~er identification number d Control number 1 Wages, tips, other compensation ~ F=eder~t ircnme tax withheld 31-1 _~ 7 X192 CSD0086354 123421.86 ~!`~l~l .26 c Employer= name, address and ZIP code 3 Social security wages 4-Social ,ecurity tax withheld DEFEPdSI; F 1 NANCE & ACTG SERV ROOM 1~0 5 Medicare wages and tips _~ _ 6 Medicue tax withheld 1240 1s 9TH STREET (ZKA) 123421.86 :_"89.62 CLEVP~AND OH 44199 7 Social security tips - 8 Allocated lips e Employee's name, address, and ZIP code g :..~ ~T= 1G Dependent :are benefits 12 See instructions for box 12 14 See instructions for box 14 V 3172.16 x: 52.00 DAVID M OLENICK. 1135 SANDPIPER CT MECHANLCSBURG, PA 17050-8334 - 13 ^ Statutory ~ _.-- Retirement ('-~ Third-party employee plan t_J sick pay 15 State Employers state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc 19 Loral income tax 20 Locality Warne PA 1f3944869 123421.8'0 4569.05 FAIRVIEW 123421.86 19?9."'? HAMPDEN 0000119864 Copy C For EMPLOYEE'S RECORDS (See Notice to Employee on back of Copy B) rr~~ ~ R ~ R .1 .1.'_1_1_1 _.Jr- f>e .' ,' . _ PA-40 2011 cos-11) Pennsylvania Income Tax Return PA Department of Revenue, Harrisburg, PA 171 Zfl OFFICIAL USE ONLY PLEASE PRINT IN BLACK INK. ENTER ONE LETTER OFt NUNIBEFt ItJ EACH BOX. FILL IN OVALS COMPLETELY. YoL -Social Security Number Spouse's Social S.cu-ity t`IuT ber ~'if `ding jointly) }}.r{+ f ii // ~( A as: ame ~ ~ Suftix w ~ Yot, -First Name N11 ~ _4 ~. C I ~ ,~.' OVERSEAS ~ i / ~ ~ Spcuse's First Nam IV1 .,,_ _ _ e a a ~ I See Foreign ' _ Admess InsmJCtims in FA-0U ~looklet 1 Spouse's Last Nam ~ ~ ly t ~~ r ~r:nt from Last Name above ~ Ct. ~ . ~. - -I- ~ Suff~ ~~ ::~ , First Line of Address ,.d Second Lin< ~ Address ~ a . ,..- - E ...a, ,. _ -. ~w<~~ City or Post Office State ZIP Code Daytime Telephone Number ~f ~ - ~'u School Code - 1 J ~v O Extension. See the instructions. O Amended Return. See the instructions. Residency Status. Fill in only one oval. R Pennsylvania Resident O N Nonresident O F Part-Year Resident from __ /_, /201't to _ /_ !2011 Filing Status. Fill in only one oval. O S :iinyle O J Married, Filing Jointly ~ M Married, Filing Separately O F Final Rehirr.. Indicate reason: O C Deceased. Date of death _ /_ /2011 ® IdentlBcation Label Change. F'II in this oval if the label is not completely correct. Discard the incorrect label. Fill in this oval if you did not file a 201 G PA lax return O Farmers. Fill in this oval if at least two-thirds of your gross income is from farming.. Name of school district where you lived on 12/31 /2011: ~<1~6 ~~ d (J6~~a , Your occupation Spouse's occupation Nl~-'~ ~t.~1~" 1a. Gross Compensation. Do not include exempt income, such as combat zone pay and ;+i qualifying retirement benefits. See the instructions . .................... ........ 1a, 1b. Unreimbursed Employee Business Expenses. ....... ........ 1b.~ 1c. Net Compensation. Subtract Line 1b from Line 1a .............................. . 2. Interest Income. Complete PA Schedule A if required. ~ . ~~. ~"'~~~~~J ~ 3. Dividend and Capital Gains Distributions Income. Campfete PA Schedule B if requiretd~ . lilt 4. Net Income or Loss from the Operation of a Business, Profession or Farm. .. joss O 5. Net Gain or Loss from the Saie, Exchange or DispcJSition of Property. ..... , .. joss O 1 c. 2. 3. 4. 5. 6. Net Income or Loss from Rents, Royalties, Patents or Copyrights............ L~ 6. 7. Estate or Trust Income. Complete and submit PA Schedule J . .................... 7. ~` -F'',. ~M1 ~ v, `G~ S Y ~ _. t s . ~ `r 1 s:•~a 8. Gambling and Lottery Winnings. Complete and submit PA Schedule T . ............. 8. a ~~ - .a 9. Total PA Taxable Income. Add only the positive income amounts from Lines 1 c, 2, 3, '~'~`~'`-"~"~ `• '1 ~ ` "~' 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6 ............... 9. ~ I ~ -il -, ~~f s ~ ~ ~_ 10. Other Deductions. Enter the appropriate code for the type of deduction. See the instructions for additional information . ........................ 10. _ _--_-----T.. --....-~........ •~ 11. Adjusted PA Taxable Income. Subtract Line 10 from Line 9 . ..................... 11. ri _ .; r' ~=~ ~-+ ~. r ; ~ :. Side 1 EC OFFICIAL USE ONLY FC t ~ ~. Z~Joolzoalz ~_ ~ 7,I,Q01,1,~Q7,~ - ~-,is~'~''. ~~~ ~ (08-111 7i~~~'['rr ~ e ~~~ ~~` , 31 : ;~c ~ifi J ~ n ~e- (shown first) - % ~ _ ~.. "~ ~;'.-'"' Names; - ---------------- ~~ - 12. PA Tax Li- .It i L' Li' E 11 b 3.07 ercent (0.0307).. - .. ........ Y• " P Y P 12. ~ M1 ~i ~~ ~ ~ ' _. 13. Total PA Te 'ithi e t S ::' e instructions . ............... . . ........ 13. k ~f C~ ~ 14. Credit from u ~ l'r PE. rc xne Tax return . ............. ..... .... 14. ~~ u ~ ~ 15. 2011 Estim ~~ i fn .tit' mer t Ps:~menfs. Fill in oval if including i=crm RE=V-4',1913. O 15. ~ i a , ; ~ °' ~- 1 ~ 1 16. 2011 Exter i P~ynr~nt .......................... .............. 16. ~ „ a ~ d ~ 17. ~ Nonresider' ! x V.ithheld~rorn your PASchedufe(s) NRK-1. (Nonresidents only) ... 17. H i ,; L18. T~tai Estin cat ~ ~d Payrnen' s and Credits. Add L-fines 14, 15, 16 and 17 . ............ 18. ~ '' t ' Tax Forgivene ;s Ireclit, sub nit PA Schedule SP Dependents, Part B, Line 2, ~~ 19a. Filing Sta .. ~ C=~ U imarried or O Married O Ciec:eased 19b. PA Schedule SP ... # S aparated ti. ,,,~, :_ . ,.~.. ... ...... r 20. . r ~ Total Eligibilit !r ome from Pa t C, Line 11, PA Schedule SP. ~ i ~ ;~ 9 - --.~.~ _,__ . -~ -~. -~. -~- z a 4 O D -~-- 5. ~-~- 21. Tax Forgiv~anr~ss (,redit f'om Part D, Line 16, PA Schedule SP . ................. 21. '~ . , 22. Resident G ecl t. Submit your PA Schedule(s) G-R with your .„ __, T R PA Schedula~ ;) G..S, G-L and/or RK-1 .................................... 22. •~ ~. 23. Total Other Cu:dits. Submit your PA Schedule UC ................... ........ 23. ~ ~ 24. TOTAL PA4'Mf3NTS and CREDITS. Add Lines '13, 18, 21, 22 and 23 ............... 24. ~ ~j ~ 25. USE TAX. f`alti amount. St>e the instructions . ................................. 25. 26. TAX DUE. If the total of Line 12 and Line 25 is rnore than Line 24 , 26 enter the difference here . ................................................. 27. Penalties and interest. See the instructions for additional Information. F II in Quell if including Form REV-1630/REV-1630A ...... O 27. 28. TOTAL PAYMENT DUE. See the instructions ................................. . 28. C _________ ~ D ___ 29. OVERPAYMENT. If Line 2.1 is more than the total of Line 12, Line 25 ;and Lines 27 enter the difference here . ....................................... ........ 29. ~ a fl The total o't L.ines 30 through 36 must equal Line 29. ___c~ _ 30. Refund--Amount of Line :?9 you want as a check mailed to you.........~EFUND 30. 31. credit - An~lotmt of Line 29 you want as a credii: to your 2012 estimated account. .... 31. '' ~ 32 4 . mount of Line 29 yot, want to donate to the Wiid Resource Conservation Fund.... 32 ( 33. 4mount of Line 29 you want to donate to the Military Family Relief y ~ Assistance Program . ................................................ 33. , ~ 34. 4mount of Line 29 you want to donate to the Gavernor Robert P. Caney Memorial ~ ~'A`' ~ Drgan and Tissue Donation Awareness Trust Fund . .......................... 34. ~ 35. 4mount of Line 29 you want to donate to the Juvenile (Type 1) Diabetes Cure F Research Fund ....... ................................................ 35. ~ 36. 4mount of Line 29 you want to donate to the PA Breast Cancer Coaliltion's Refunds t ~ ~ gar Breast and Cervical Cancer Research Fund . ............................ 36. " ,~ ? E . urtgor. unuer pamm~as or paqury, t twe) aectare via[ r (wr.) have exammad this return, Inckuding all accompanying achadulas and atataments, and to the best of my our ~atief, they ere true, correct, and complete. - ---- Your Signature Date E:-File Opt Out (~ Preparer's PTIN t F... l n r- _ ,_ ~ S'~ee the instructions. "` .m - ' ' -~ - -~~-1~-~'-1L~`~.:~~-i..t-fit `~ ~ ~ _~_ ._ Spou n's Signature, if i ,ng iointly Pre arer's erne and Telephone Number Firn ire PLEASE DO NOT CALL ABOUT YOUR REFUND UNTIL EIGHT WEEKS .4FTER YOU FILE. Side 2 11,00220019 11,0022007,9 PA SCHEDULE A/ ~, • . .' . interest fncomelDividend Income PA-40 Schedule A!B ~®~ (()8.11) OFFICIAL USE ONLY If you need more space, you may photocopy. Names own first on Yie PA-40 (if filing jointly) Social Security Number (sh/ow/n first) CAUTI+:)N: Federal <3nd PA rules for taxable interest and dividend income are different. Read the instructions. If your otal taxable interest and dividend income (taxpayer, spouse and/or joint) are both $2,500 or less, you must report the income; but do not need to submit any schedule. If either your total interest or dividend income (taxpayer spouse and/or joint) is more than $2,500, you must submit a PA Schedule A and/or B. A taxpayer and spouse must compic~te separate schedules to report their income or if any amounts are reported on Lines 3 througt 7 of Schedule A or Lines 3 and 4 of Schedule B. However, if all the income is earned on a joint basis, one schedule may be completed. Complf:te the oval to indicate whether the income included on the schedule is from the taxpayer, spouse or joint. When reporting interest and/or dividend) income from jointly owned accounts not reported on a joint Schedule A and/or B, the taxpayer and spouse must show their share of the interest and/or dividend income on their separate Schedules Aand/or B. PA SCHEDULE A ®PA~T®XabOe Interest 9neome (See the instructions.) on_en n +na_,n Taxaaver ® Spouse O Joint O --~- ~y o .u G'e~, ZS+e"/t?`~C C>` i/\~ / . f ~l/ ~ P __.____-t~_ tr _ •J 7 - ~ 2. Total Interest Income. Add all amounts listed (including amounts on additional schedules). 2. _ -ls~~L^ ~ ti 3. Distributions from Life Insurance, Annuity or Endowment Contracts included in federal taxable income. 3. 4. Distributions from Charitable Gift Annuities included in federal taxable income. 4. 5. Distributions from IRC Section 529 Qualified Tuition Programs for non educational purposes. 5. 6. Distributions from HeelthlMedical Savings Accounts included in federal taxable income. 6. 7. Interest income from PA S corporations and partnership(s), from your PA Schedule(s) RK-1. 7. 8. Total PA-Taxable Interest Income. Add Lines 2, 3, 4, 5, 6 and 7. Enter on Line 2 of your PA-40. 6. (,.,Z, ~~ IMPORTANT: Capital Gains distributions are dividend income for PA purposes. PA SCHEDULE B - PA~Taxable D'evidend and Capital Gains Distributions Income (See the instructions.) PA-40 B (08-11) Taxpayer ~ Spouse ® Joint O 1. ---- - - 1 ---- --- -- 2. Total Dividend Income. Add all amounts listed (including amounts on additional schedules). 2. - - ~ c5y~-. -- -~-'----- 1 3. Capital Gains Distributions -See instructions 3. 4. Dividend income from PA S corporation(s) and partnerships, from your PA Schedule(s) RK-1. 4. 5. Total PA-Taxable Dividend Income. Add Lines 2, 3 and 4. =nter on Line 3 of your PA-40. 5. ~ , ~~ ~ ,~ ~ALO~~LOO7A9 Lzo~A~~ oa~~ _ COPIES OF STATE `~ ~~1''~~~~r ~~;",'~,~`~ a ~_1~n~.~ f' ~~ ~~J~ ~t~,J 'SCHEDULES AP1DlOR ALL I''-~~) d~: -i s ~~~!l~ j w-a~s a~ 1oss~s ~ l._~ 1iicP' i.61 _ ~~r~ ~ = si~._1,:n.:t; . ro `fAX YEAR ~? l :t`. :.(~ :J° 3 1 .~ ~ f Lf - HlS RETCSlS N C)PI OR BEFORE APRIL 15th EVEN IF NO SAX IS DUE OR iF ALr_. ?'A?: HAS BEEN VYfi kiHELtJ f ( L!. ~'E~t< F E~ C ~ ~ ~- E: Ln ~7 ® MUNICIPALITY ~~ ~ trl ~,~ ~~ A husband and wife may both five on this form, however ~,_, 4 tax ca{culations must be reported in separate columns. ~ t l ;i tt ~ i yj ~ ~. A~~ C:f~ Jointfi{ing (combining of income or expenses) is not _~:.~ t° ~ ~ f _ j permitted. 7) t C~ C~. ~,.~~ i\.l C. 340ti? CJ"_3"- F tJ f~` i~ l "~ IE YC3t! MOVED C7+JRMn[G TF#!. TA,X YEAR CaMPLET~THE ~©LLOWING MQVI NG fNF©RMATIQN~ Moved in 1(1 ... ~_.,._v. Addrnss Moved m 1 Ad ress Moved Out _ Moved Out Moved in ®e ~~~~ ~ Moved in --~----~- Moved Out 12/31 - ~--- --_-_---- Moved Out 12131 ~ 1'a~:payer A,SS # j ~.3 ~ - 6 YUU~MUS~" \ ~ 3 T1P A - NAME ~ T/P B -NAME y eoMP~ErE ~ 1'~ai~payer B SS ~ 1. Gross Earning< €rom Ernplcr~ment: E;~close av-2s 1 ~~ j ~ ~ j e~~ 2. Allowable Non-Res 1lbursed employee Business Expenses i=nc!ose PA Sch vE 2 3. Other Earned income Enclose 11199-NtISC ! 4099-R Exc4udiny CC)t7ES 3, :1 S ? i 1088-C DO NO'T It~lCI_UDE INTEREST, CiiVtDENDS cr CAPITAL GAINS 3 ~ __ 4. Taxab{e Earnings ine ^ rr,inus Line 7 plus Line 3. CAt1 NC~T BE < SO 4 ~ ~(~ ~ E. 5. Net Profit Attach PA .,ch C;, F', I<K-1' andlor NRK-1 °REPCIRT S Corp Profit on reverse side only 5 ,___~ _ __ 6. Net Loss Attach PA Bch C:, F, RK-1 and/or NRK-1 'REPORT S C:crp [_^ss on reverse side only 6 ,~ 7, 5uhtotal Subra~t Line 6 from Line 5 iF LESS "THAN 7_ERO, ENTER ZERO 7 8. Total Earned fnrome Line a plug, Line 7 DO NOT ROl1ND PAST Ti-i{S POfN"i 8 ~ ~ai, ~-~ 9. Tax Liability tine 8 multiplied by tax rate ~'~ 6~ (See instructions) 9 ~ ~ ~ - `7,S` 10. Earned Income Tax U'Jithheld 10 Cr-? ""J .j 11. Quarterly Estimattec' Payments~Credit Fram Previous 'tax Year 11 12. MISC Credit See wor~sheei un back of form for calculating Philadelphia/Out of State Credit 12 ~ 13. Total of 10, 11, & '12 13 - __ ~ ~ ~ '~." . ~eS~ 14. REFUND/CREDIT Subtract Lire 9 from Line 13 NOTi: NO Retunds under ~t.Ot'i 1G ~--Fj 15. CREDIT TO NEXT YEAR/CREDIT TO SPOUSE Next Year (~ Spouse ^ 15 -_-- - ~. TAX Dt1E !f Line ~ is creaser than Line 13-Subtract Line 13 from Line 9 16 16 . NOTE: Amounts Less than $1.00 need not be paid. __ 17. Penalty after Apri! 15th SEE tNSTNUC TlONS 17 18. Interest after Aprii 1;>th SEE iNSTRt7CTIc~NS 18 ~ 19. TOTAL ANtOUNT DIiE Line 16 plus Line 17 plus Line 18 19 ~ f ~~' MAKE CHECKS P1\'t'AELi~ TC CUPIIBERLAND COUNTY --AX I3UREAU..4 FEE OF $20A0 WILL BE GHARGE33 *OR RETURNED CHECKS. I declare t:nrer penalties of perjury that I have examined this return and to the best of my knowl edge an d belief, it is a true, accurate and cnmpletereturn. Si nature-Tax a r F\_ Date Occu ation E-it9ail _~ Mime Te{e~hone Si nafiure-Tarpayer B __ Date Occu ation E-{VRaii `/_ ~)aytime Tole hone L~` r- ------- ---~ --- ~f, :~~ 0 ' C' ~' ~ 7 ~ ~~ tyr ~ ,.~ ;~, ~'A p ,._f Johnson, Duffle, Stewart 8~ Weidner By: Melissa Peel Greevy, Esquire I.D. No. 77950 Attorneys for Plaintiff 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff NO. 09-7822 v. DAVID M. OLENICK, Defendant CIVIL ACTION -LAW IN DIVORCE PLAINTIFF'S PRETRIAL STATEMENT PURSUANT TO PA. R.C.P. 1920.33 I. BACKGROUND A. Marriage -December 10, 1994 (Lancaster, PA) 1. Separation -November 11, 2009 B. Children -Two minor children, Joshua D. Olenick (age 11) and Christian M. Olenick (age 9) who are in PLAINTIFF's primary physical custody C. PLAINTIFF is age 42, having been born in 1970. PLAINTIFF is in good physical health. -~- DEFENDANT is age 58, having been born in 1954. DEFENDANT is believed to be in good physical health. D. Complaint and Pleadings: 1. A Complaint in Divorce was filed by PLAINTIFF on November 12, 2009, under §3301 (c) or §3301(d) of the Divorce Code. DEFENDANT was served by personal service on November 23, 2009 (See Affidavit of Service filed November 30, 2009). 2. On November 30, 2009, PLAINTIFF filed an Affidavit Under §3301(d) of the Divorce Code, which was served by mail on DEFENDANT's counsel of record. No Counteraffidavit was filed by DEFENDANT. 3. Contested claims -Equitable Distribution of marital property, alimony, alimony pendente lite, counsel fees, costs and expenses. 4. Divorce - It is anticipated that both parties will file Affidavits of Consent and Waivers of Notice, permitting the entry of a Decree under §3301 (c) of the Divorce Code. In the event that DEFENDANT refuses to execute and fi-e an Affidavit of Consent, PLAINTIFF will proceed with a divorce under §3301 (d) of the Divorce Code. II. MARITAL ASSETS A. See attached spreadsheet for detailed listing. B. Notes regarding real estate: 1. The marital residence. Following hearing on her Petition for Special Relief, PLAINTIFF was awarded exclusive possession of the marital residence at 1109 Kent Drive, Mechanicsburg, Cumberland County, Pennsylvania, by Order entered on September 17, 2010, with DEFENDANT ordered to vacate by October 22, 2010. PLAINTIFF has continued to reside there, together with the parties' two minor sons. PLAINTIFF has paid all of the expenses of maintaining that property since DEFENDANT vacated. -2- III. NON-MARITAL ASSETS A. See attached spreadsheets for detailed listing. IV. MARITAL DEBTS A. See attached spreadsheets for detailed listing. V. WITNESSES A. Expert Witnesses. 1. PLAINTIFF anticipates that the parties will stipulate to the value of most of the marital assets. PLAINTIFF reserves the right to supplement her witness list prior to the time of trial upon prior notice to the hearing master and opposing counsel. B. Fact Witnesses. 1. PLAINTIFF will testify about her income and earning capacity, her living expenses, the identity and value of marital and non-marital property, her contributions to the marriage, DEFENDANT'S marital misconduct, and any other matter relevant to the issues involved in this matter. 2. PLAINTIFF reserves the right to call additional witnesses for rebuttal if necessary, based upon the testimony offered at trial. PLAINTIFF reserves the right to supplement this witness list prior to trial upon proper notice to the hearing master and opposing counsel. -3- VI. A. EXHIBITS PLAINTIFF intends to introduce the following exhibits at trial: 1. PLAINTIFF's 2011 tax return (attached to Income and Expense Statement filed). 2. PLAINTIFF's 2011 W-2 form (attached to Income and Expense Statement filed). 3. PLAINTIFF's most recent paystub immediately prior to trial (7/13/12 paystub is attached to Income and Expense Statement filed). 4. PLAINTIFF's Social Security Statement dated October 3, 2012. 5. Current statement for Americhoice home equity loan acct. no. - 237 (Statement dated 9/30/12 attached. To be updated prior to trial). 6. Transaction history for 11/09 through 12/09 for Americhoice home equity loan acct. no. - 237. 7. Copies of checks for DEFENDANT's post-separation withdrawals against Americhoice home equity loan acct. no. - 237. 8. Statements dated 10/15/09 and 12/18/09 for Metro Bank checking acct. no. - 9969. 9. Statement dated 12/18/09 for Metro Bank savings acct. no. - 0705. 10. Transaction history from 11/13/09 through 12/31/09 for Members 1st Checking acct. no. - 2769-11. 11. Transaction history from 10/26/09 through 12/31/09 for Members 1st Savings acct. no. - 2769-00. 12. Transaction history from 7/1/09 through 11/30/09 for Members 1st Money Management acct. no. - 2769-05. 13. Transaction history 7/31/09 through 12/31/09 for Members 1st CD no. - 2769-56. 14. Current statement for Members 1st CD no. - 2769-56 (Statement dated 4/3/12 attached. To be updated prior to trial.) 15. Current statement for Wells Fargo CD no. - 6578 (Statement dated 9/30/12 attached. To be updated prior to trial.) -4- 16. Current statement for Pentagon FCU CD's nos. - 2560, - 2561, - 3563, and - 9568 (Statement dated 10/10/12 attached. To be updated prior to trial.) 17. Statement dated 1/8/10 for PNC CD's nos. - 4690 through - 4699 (10 total). 18. Receipts dated 8/4/10 for redemption of PNC CD's nos. - 4690 through - 4699 (10 total). 19. Order of Court entered 9/17/10. 20. Current statement for Americhoice CD's # 8237-0062 and # 8237-0063 (Statement dated 9/30/12 attached. To be updated prior to trial.) 21. Current statement for Ally Bank CD no. - 3726 (Statement dated 9/10/12 attached. To be updated prior to trial.) 22. Statement dated 10/28/11 for GE Stock Direct Plan (to be updated by DEFENDANT prior to trial). 23. Current Quote for GE stock (Quote dated October 11, 2012 attached. To be updated prior to trial.) 24. 2011 Form 1099-DIV for IBM stock. 25. Current Quote for IBM stock (Quote dated October 11, 2012 attached. To be updated prior to trial.) 26. DEFENDANT's paystub dated 11/27/09. 27. Exhibit with calculation of value of DEFENDANT's accrued leave at 11/27/09. 28. Kelley Blue Book value dated 1 /6/10 for 2002 Ford Windstar. 29. Kelley Blue Book value dated 3/5/10 for 2006 Honda Accord. 30. Statement dated 6/30/12 for DEFENDANT's Federal Thrift Savings Plan account (to be updated by DEFENDANT prior to trial). 31. Current statement for PLAINTIFF's Pentagon Federal Credit Union IRA Acct. no. - 7221 (Statement dated 10/10/12 attached. To be updated prior to trial.) 32. CSRS Benefit Estimate dated 8/20/12(to be updated by DEFENDANT prior to trial). 33. Report dated 4/25/12 for PLAINTIFF's Oce Cash Accumulation Plan for retirement date of 6/1/12. 34. DEFENDANT's Social Security Benefit Estimate and Earnings Record dated August 20, 2012. -5- 35. Counsel fees exhibit (to be completed prior to trial to include all trial preparation services). B. PLAINTIFF reserves the right to supplement and/or update this list of exhibits as more recent information is available or to submit additional exhibits for rebuttal if necessary, based upon the testimony offered at trial. VII. PLAINTIFF'S INCOME AND EXPENSES A. PLAINTIFF has been employed by Oce Imagistics, Inc., since January, 2011. She receives a base salary of $45,000 per year and earns commissions based on the sales of imaging equipment. Because she travels extensively for her job, she also receives a car allowance of $220 per month. Her total income for 2011 was $53,443. B. PLAINTIFF'S expenses are reflected on the Income & Expense Statement she filed on or about August 18, 2012. VIII. DEFENDANT'S INCOME AND EXPENSES A. DEFENDANT is employed by the U.S. Department of Defense. As of August 31, 2012, he was salaried at $115,742 annually, but he earned $123,422 in gross annual wages in 2011. B. PLAINTIFF is unaware of DEFENDANT'S expenses. IX. PENSION AND RETIREMENT BENEFITS A. PLAINTIFF has an Individual Retirement Account # - 7221 with Pentagon Federal Credit Union valued at $37,038 as of October 10, 2012. She also has a pension with the Oce Cash Accumulation Plan that she acquired through her initial employment with the company from June 30, 1997 through January 3, 2003, when she left employment to become afull-time homemaker and mother. That pension has a lump sum value of $22,079 as of June 1, 2012. Since returning to employment in January 201 Z, she also has been participating in the Canon -6- Employee Savings and Retirement Plan. Her account was valued at $976 as of March 31, 2012. B. DEFENDANT has participated in the Civil Service Retirement System through his 36 years of employment with the federal government. He has been eligible to retire with payment of full retirement benefits since he reached age 55 in 2009. As of 8/31/12, he was eligible to receive an accrued benefit was $6,837.80 per month or $82,053.60 per year, payable for life. DEFENDANT also participates in the federal Thrift Savings Plan and had accumulated $229,405 as of 6/30/12. X. COUNSEL FEES AND COSTS A. PLAINTIFF paid the filing fees for the Complaint in Divorce and her economic claims. B. To date, PLAINTIFF has incurred counsel fees and miscellaneous costs billed by counsel through October 31, 2012 of $14,540. She also has incurred unbilled fees and costs for the month of November, 2012, and will continue incurring such fees and costs for preparation for and appearance at the Divorce Master's hearing in this matter, for submission of a Post-Trial Memorandum, and for any other action required until the divorce action is concluded and all assets have been distributed. Such fees are currently charged at the rate of $275 per hour, but are subject to change upon notice. XI. PERSONAL PROPERTY A. The parties have previously divided marital household personal property. XII. PROPOSED RESOLUTION A. PLAINTIFF proposes the following resolution: -7- 1. With the exception of the DEFENDANT's Civil Service Retirement System pension, the marital assets of the parties should be distributed as set forth on the attached spreadsheet. 2. The marital portion of DEFENDANT's Civil Service Retirement System pension should be distributed on a deferred basis by means of a Court Order Acceptable For Processing ("COAP") to be prepared by Jonathan Cramer of Conrad Siegel Actuaries. PLAINTIFF should receive 60% of the marital portion of the DEFENDANT's "Gross Annuity" at his retirement, as defined in the applicable federal regulations, including any Cost of Living Adjustments to which DEFENDANT is entitled and any refund of employee contributions. Such payments shall be made directly to PLAINTIFF by the Office of Personnel Management. In the event of PLAINTIFF's death, her equitable distribution share should be payable to her estate. Further, the COAP should award the maximum former spouse survivor annuity to PLAINTIFF, payable in the event that DEFENDANT predeceases her. 3. DEFENDANT should be ordered to pay alimony to PLAINTIFF in the amount of $500 per month for an indefinite period of years. 4. Each party should be responsible for payment of his/her own counsel fees. JOHNSO FFI , STEWART 8~ WEIDNER Date: ~~ ~1 Y Melissa Peel Greevy, Esquire -8- CERTIFICATE OF SERVICE AND NOW, this 1~~ day of November, 2012, the undersigned does hereby certify that she did this date serve a true and correct copy of the foregoing Plaintiffs Pretrial Statement Pursuant To Pa.R.C.P. 1920.33 upon Defendant's counsel of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. 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P y www.socialsecuri~:gov d P.re ared es eclall fox J'esnene lCl:.Oleniclt f~ISTRP` October 3, 2012 ` See inside forpovr personal lnfarmadun ~""'~d What's inside... Your Estimated Benerts .............».......................:..:,....».,............2 Your Earning~Record._ ..............................................................3 Some Fads.About SocSa] 5ecttrtty ........:.................»...................4 If Yoa 1Veed lVtore Information ...:................................................4 What Social Security Means To Y©u This Socla! Security Statement can help you plan for your financial future. It provides estimaf~s of your Social Security benefits under current law and updates your latest reported earnings. Please read this Statement carefully. If you see a mistake, please i~t us kziow~ That's important because your benefits will be based on our record of your lifetime earnings. We reconunend 3+ou keep a copy of your Staterrienf with your financial records. Social Security is for people of a>a ages,:.. We're more than a retirement prr~gram. Social. Security also can provide benefits if you become disabled and help support your famiiy:aftei yott die. Work is build a secure future... Social Security is the largest source of income for most elderly Americans today, but Social Security was never intended to be your only source of income when you retire. You also will need other:savings, investments;pensians orretiremerit accounts. ta. make sure you have"enoug~. money'to live :comfortably when you.:retire. Saving and investing wisely<aTe importantnot only far you and your family, lui far the. entire country. If you want to learn more abouthow-and why to save; you should visit .rnymoneygov,. a federal government website dedicated to teaching all Americans the basics of financial management. About Social Security's future... Social Security is a compact between generations. Since 1935, America kas kept the promise of security for its workers and their faz_itiii~s. Now, however, the Social Security system. is facing serious fzizaneial problems, and.action is needed soon to.make sure the system will be sound when today's younger workers are ready for retirement. Without changes, im 2033 the Social Security Trust Fund will be able to pay only about 7S cents for each dollar of scheduled benefits.` We need to resolve these issues soon to.make sure Social Security continues to provide a foundation of -protection for ilZture.;generatiiaris. Social Security. on .tire lY'et... You.ean read publicatioAS, including When To Start RecelvingRetirement.$ene~ts, zlse our Retirement Estimator to obtain immediate and.personalized estimates of future benefits; and when you're ready to apply for benefits, use our improved online application-It's so easyl lvlichael ]. Astrue Commissioner * These estirriatcs are based on the intermediate assumptions from tbe.Social Security Trustees' Annual Report to the Congress. Your Estimated Benefts '12eliremeat You have earned enough credits to qualify forlienefits. At:your current earnings rate, if you continue working until.:. your full retirement age'(67 years your payment d,~od3d be about ................:.....::.......................:... S 1;934 a month age 70, your payment would be about .................................. ...................................................... $ 2,40$ a month age 62, your payment would be about ............................................................................................... ~ I;24Z o month *I)isability To gat benefits if you become disabled right now, you need.20 credits of work, and 20 of these credits }tad to be earned in the last 10 years. Your record shows you do not trove enough c;edits in the right time period. ~, *Family If you get retirement or disability benefits, your spouse and children also may qualify for.benefits. *Survlvors You have earned enough credits for your family to receive:5urvivorshenefits. Ifyou die this year, , certain members of your family may qualify for the following benefits; Your child... .........................................................~..................._...... .... ................................. $ 1;310 a month Your spouse who_ is caring. for your child ...............:.:..........:.....:.:....:.......:......................................... $ 1,310 a month Your spouse, if benefits start:af full retirement agc :::.......:............;...............................,................... $ 1,746 a month Total family tienafits eannot..be. more than ............. ................ ............ .. ......................... $ 3,097 a month Your spouse or minor chiid=nlay .ba eligible for a.speciai onetime death:benefit of $255. 117edicare You have:enough credits to qualify for Medicare at.hge.65: Even.ifyau .do not-retire at age 6S;.be sure to contact Social Security three months before your 65th birthday to enroll in Medicare. * Your esdmeted benefit are based oa current law. Congress ties made changesta the taw in the past and can do so at any Hare. The law governing heaetit amounts may change because, by 2033, the payroA taxes collected will be enough fo pay only about 75 percent of scheduled benefits. We based your benefit estimates on these facts: Your date of birth (please verify your name on page i and this date of birth) .................................. 1970 Your estimated taxable earnings per year after. 2012 ...........................:............................,..,................ $52,723 ;Your Social Security number (only tkr; last four. digits are shown to help prevent. identity tkeft) ......... 70IX-XX-9630 Haw Yuur Benefits Are Estiimat~d To qualify for benefits, yon earn "eiedits'"through yotuwork - up to foureach year. T}iis: year, for example,, you earn one credif for- each $1,130 of wages. or self-employment income. When you've earned $4,52t), you ve: earned your four credits forthe year: Most people need 40 credits, earned over their woddng7ifciime, to receive retirement benefits. For disabilityand sui-aivors benefits, young people-need fewer credits to be eligible. We checked your records to see whether you have earned enough credits to qualify for benefits. If you haven't earned enough, yet to qualify for a~ type of benefit, we can't give you a benefit estimate now. if you continue to work, we'1] give you an estimate when you da qualify. What we-assumed -- If you.have enough-work credits, we estimated gout benefit amounts using your average earnings over your worlcing.lifetime. For 2072 and later.(up to retirement ege); we assumed you!ll continue. io work and make.abouR the sonic; as you did in 2010 dr'20I k. Wa nlso;incIuded credits we assrmted you earned last year sad ties year. Generally, the older you are and the closer you are to retirement, the more accurate the retirement estimates wilt be because they are based on a longer wodc history with fewer uncertainties such as earnings fluctuations and future law changes. We encoutago you to use our online Retirement Estimator to obtain immediate and personalized benefit estimates. We can`t provide your actual benefit. amount until you apply for benefits, And that amount may diII'er frost the estimates shove because: (1) Your earnings may~increase.or decrea5e.in the future.. (2) After. }±ou Matt receiving benefits, they.will he.adjusted-foe cost-of-living increases. (3) Your:estimated benefits are bash an current. law: Tke law gavernin~.benetitamounts mAy-change. (4) Your bent;ftt amount may be affected by `military service, railroad employmcut or pensions earned through work on which you Bid not pay'Social Security tax. Visit www.sr~clalseetultygavta learn more. R'indfall Elimination Provision (WEP) - In the future, if you ~-, receive a pension from employment in which you. do not pay Social Security taxes, such as some federal, state or local government work, some nonprofit organizations or foreign employment, and you also qualify far your own Social Security retirement or disability benefit; your Social Security benefit may be reduced, but not eliminated, by WEP. The aaiount.af the reduction, if any,. depends on: your.earnings and nuttrber of years in jobs in which you paid Social Security'taxes;;~nd. tie year yon arc: age 62 ar become i)isabled.l<ormore irifbrmation; please see Wmrifall Elimination Provision (PiililicatianNo- 05=3.0045} at www:soclalsecurltygov/ hVEP, Government.Pcnsion Offset (CSPO) -.1f you receive a pension based on federal, state or local government work in which you did not paySocial Security taxes and you qualify, now ar in the future, for Social Security benefits as a current or former spouse, widow or widower, you. are Likely to be affected liy GPO. If GPO applies, your Social Security benefit will be reduced by an amount equal to two-tkirds of yoiu;gavernmcnt pension, and could be reduced to .zero. )rveo if yourben~fit is~rednced to zero,you will be eligible for Medicare at age 65. on your spouso's record. To learn more, please see GovernmenF Persian t7ffset.(Publication: No. OS-10007) at wlyw_socia(seurrltygov/GPO: 2 [C} Your Earnings ]E2ecord YaurTaxed YourTaacd Years You Social Security Medicare Warlacd Earnings EnminBs 1985 848 848 1986 990 990 .1987 2,414 ?,414 1988 3,306 3,506 1989 4;548 4,548 1990 12,256 12,ZSG 1991 74,558 19;558 1992 1G,1?0 16,{20 3993 20;560 '20,560 1944 21;10] '21;501 1495 D 0 1996 754 754 1997 19,086 19,088 1998 53,:58 53,SR 1999 65,066 GS,a66 20011 73.759 73.769 2001 59,9{4 59,9!4 2002 fi9,8I3 69~$I3 2003 G,l'}3 6,113 2004 0 0 2oc5 n t n 1 Zoos o 0 2oa7 0 0 Zoos o 0 2ao9 a o 2010 i44 i44 ?all 52,723 52,723 You_ and your family may be eligible for valuable benefits: 1Nherr you die, youramily msybe eligible fo receive' survivors benefits. Social Secarity may help you if you become disabled- even at a young age. A young person who has worked and paid Social Security faxes in as few es two years can be eIigt~le for disability benefits. Social Serenity ctedits..you earn movo- with you from job to job throughout your career. Total Social Security and Medicare taxes paid over your working career through the lest veal reported on .the chart above: Estimated taxes paid for Sbcinl Security.: Estimated taxes paid for Ivledicare: You paid; $29,781 You paid: 57,210 Your emphiyei's paidi $30,835 Your employers pain: $7,210 Note: 1n.ZQi1, you"pafd A:2 perafnt afyueu'~alary; up'to 5306,SW~.in.Soclal Security Lazes nod 1,Q5 percent in 1Fledirarc taxes on yoar entire salary. Yuur employer paid:b.l'perccat is Socisl 8eceu~ity taxes and 1.45 percent is 141edii'sro taxes for you. lCyou were selC- emplDyed, you peeid the cotnbined'employee and employer. amount .of 10.4 percent9o Soclat 5cc~rrtty razes and 2.4 percent.in Medicare taxes on your act earnings. Help Us Keep Your Earnings Record Accurate You, your employer and Soclai Security share responsibility for the accuracy of your comings record. Since you began working, we recorded your reported earnings underyour name and Social Security number. We Have updated your record eaeh.time your employer (or you, if you're self-employeri) reported.yottr comings. Remember, it`s your earnings, not Cite amount of taxes you;paid or the number of credits you'Ve.earned, that dettrmine yburbenefit amount. When we figure that airtoerirt; we.base it oi;i youi average .earnings Aver your lifetime, If our records are wr+7ng, you may. not receive alI the benefits to which you're entitled. Review t{ils chart carefully using your own records to make sure our information is correct and. that we've recorded each year you worked. You'rtr the only person who can look of the earnings chart and know whether it is cornplele sad correct. Some or all of your comings from last year may not be shown on your Statement It .could be that we sti)1 were processing last year's earnings reports when your Staterrrentwas prepared. Note; If you worked for mare than Doe employer during any year, or if you had botlt:ca;nings and self-emplgyment income, we combined your oan7ings for the year. Tltore's,a Iimit:ao the amount of earnings on which you pay Socfai Security taxcv each year. The limit increases yearly, Earnings above the Limit will not appear. on your earnings chart as 5oaisl 5eeurity comings, (For Ivledicare faxes, the maxirnpm eardings amount began rising in 1991, Since 1994, ail of your earriliigs arc taxed.for Medicare.) , Call as.right.;away ai 1-800-772-1213 (7 a.m.-7 p.m. your .local dine) .if any earnings fur years tief'ai•e;last year are showQ incorrectly. Please. have your W-2 or tax return far those years availatiie. (If you live outside the U.S., follow the. directions at'the bottom of page 4.) 3 ,~ ~~~~~ ? 175 HumGlc &ec Hollpa Eioad MccMaaicsbmg, PA 17p55 FEDERAL C R E C t T U N 1 4 N w,°v, amvrldi°icc ° auilding Re/atiorrships For Life Address service Rcgnested oasas llllallhl~11111111111)~I~II~l~llln,lllllllU~~IiIIIhlIIHII!1! JEANENE L OLENECtC '~ 11'49 KENT OR_ iNEC}1ANIG5BURG PA f7Q50-76'!4 Statement of Accounts~t'~- Sep 01, 2012 thru Sep 30, .20'12 Accoun# Number. xxxxx~oc237 Acc~t~nt Balances at a Gkance Savings: 6.85 Certificates: 311,176.28 Loans: 16,269.07 New Relationship Reward l:evei is:`~General Etiedive January 1, 2019, AmeriChoice will no longer participate in the Credit Union Service Center Nehvork as many lower cost altematlves exist to handle . these transactions. Forthe smell percentage of members who use this service, watch for additional information in the upcoming months. Looking to save iha~usands on your cun'ent mortgage'T Look no further than AmeriClzoice[ Now is the tirrie`tc`refinance your mortgage with incredibly low - rates) Log onto wwW:arrleridioice.org to team rnoiel. Page 1 of 2 REGULAR SHARE - 0001 t)ate Transaction Description Additions 5ubf~actions Balance x79-01 9alance Forward 6.85 09-30 Ending Balance 6.85 Dividends Paid Year to Date 0-p0 6 MONTH CERTIFICATE -0062 Date Transaction. Description 09=30 Etiiling Balance '6 MONTH CERTIFICATE wW mature on 12730/2012 Dividends: Patti Yeas fo TJat+M 38.:34 ?9,152.99 19,162.99 6 MONTH CERTIFICATE -.0063 Date Transaction Descriptien Additions Subtractions Balance 09-01 Balance Forward 12;023 29 09-30 Ending Balance 12,023.29 6 MONTH CERTIFICATE will mature on 12130012 Dividends Paid Year to Date 24.08 HELOC PAYBAGK=VARIABLE RATE - D050 Elf Trans Date Dots - Tyr ,~actinn Des ri 'oiS oun# 09-01 Balance Farwarti 09-04 Payments by Check -165.68 09-30 Ending Balance Annual Percentage Rafe 4.000% Daily Rate .010958% The rate shown above Is variable and is subject to change A payment of 331.36 is due on September 30, 2012 Next Scheduled Due Date: October 31, 2012 Past Due Amount:1S5.68 interest Paid Year to Date 496.93 interest Paid in 2011 652.84 CttOR5 interest Raid YTD: 4J6.9~ Interest. Late Prinetnal Chase Eee Bala ce 16,308:59 -48,32 116.16' . 16,259:07 16;259.OT Plionet. (7I ~) t'i97-374 Toll. Free.: ($00) .24:0,4364 Fax Number: (7I7) 697-3713 AmeriChoice FEDERAL CREpIT I/NION Building Relationships For Life Account ?Number. ~ooaoooc237 Sep t]1, 2012 thru Sep 30, 202 Page 2 of 2 YTD SUMMARIES TOTAL DNIDENDS PAID REGULAR SHARE 6 MONTH CERTIFICATE 6 MONTH CERTIFICATE Total Dividends. Paid Year to Date Total Interest Paid Ysar to Date O:OQ. 38.34 24.t?g: TOTAL LQAN 1[UTERE$'T PAtD HELOG PAYBACK-Vi4RIABtE 496.93 RATE 62.42 496.93 as ° °' v o ' ~v ~ ~ ~ N ~ N ~ tir~n-~ ~ N .; N N titirti ~ttiCOM _ (... , ~ ~, . . ~~~ N N N O O O r r r O O O O O O L' L' L. 0) OS ~U .n .Q a ~ ~ 7 7 3 zzz ~~~ 000 ~ N N N N '~Y ~A~MT (O ~ O CO In to r r r r r N O r O O L' 01 A 7 Z 0 (V r 6 6 0 0 0 O ~ O 0 0 0 0 O ~'~~~ c ~ X 0 0 0 O ~ N ~ N 0 0 0 O C l ~ 1p 0000 O U iri 'ooopop 0 U ~ NNtn N ~ r M 00 f6 m s} 000 r o ccooorn Q o r;oao~t o, Z, o 'NOOO~ ~o y~ O r N N~ ~ ~ N i~4 r M p ~ CO ~ o~U C Q. 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'~J r~ M c, S~'~ ....~.. ~.. _--~t _ u r> C.~. o ~ o 0 0 0 ~ ~ ~ ~ ~ ~ cr sr •~' ~ ~• ~ O N n ~ !~ M 00 6i <D M ~ h O M N r i 6 M cD i C 0 O Q ~ O ~ ( 0 f 0 l 0 C O O O O O O O O O O O O O C O O O O O O d, O O O O O O C .C 00070)N~~O~~ u (j O O O~ O M` O~ O~ ~ rO~00~OO~ to O V ~hMfDt'9h-MC6MCOMC0 ~ N ~ O Ot ~ 3 l6 O O O m O O O O O O E O O Q~ o N O W o V~ or ~ Q O O O O O O C ~`-tQIIT h0f~0OCOOOCOO 0 0 0 o a o~ ~ O O O O O O i!? ~ E(y 1n to lf> m as v as v a> E a~ d.~ d~ aE aL d ~ d R ar ~ a> ~a m m a> ca m o wawn~o~o~ca~-r~ ~ a c~ cd cn}. cam. cd c ~ ~aQvQ~aQvQvQv 0 0 •- o a •- o o •- t`4 0 •>o >_~•>o >o >o > }- o Q o A o Q o A o A o ~ CT m W to O O °' o °o °a °o °o °o is ~ r o ~ o ~ ~ ~ IM M (M M M C_M • r r ~ O O O ~ ~ ~ ~ ~ ~ O O O O O O A O O O O O O ~ ~ ~ ~ ~ ~ CA O O C~ O N CO O O O O O O Q ~ N ~ r O r O r r ~ a M fM M M M a ~ o rn ao ~ r o a o r N /.. . ~ 1\ Q. ~uac-e anu Loari LiSI st M ~FE Page 1 of 1 ~~ EMBERS 1s1 D6RAL CR$DJT t3fWON Share Loan List For Account: .769 DAViD M OLENICK Accounf T e; General Titanium Yp Membership Member Type Birthdate SSN Home Number DAVID M OLENiCK Primary '1954 JEANENE LYNN OLENiCK Joint - _ '1970 JEANENE LYNN OLENlCK Joinf S ~ 1970 1135 SANDPIPER CT MECHANICSBURG, PA 17050- 0685 e Share Description Available Rate Maturity Dat - Balance S 0000 REGULAR SAVINGS $ 0.13 $ 5.13 S 0011 CHECKING $ 0.70 $ 0.70 S 0056 60 MONTH CERT 4.94% 06/30/2012 $189,110.46 $188,610.4$ DEPOSIT TOTAL $ 188,616.29 I.QAN TOTAL $ 0.00 file://C:1ProgramDataUack Henry and AssociateslEpisys For WindowslHTML1HTMLView... 4/312012 PMA account 1801 ^ September 1, 2012 -September 30, 2012 ^ Page 1 of 5 ® Wells Fargo° PMA Package Questions? Please contact us: -Wells Fargo Rremier Banking Tea m"' ". Available 24 hours a day, 7 days a week Phone: 1-8U0-742-4932, TTY: 1-8D0-60~=:4833 Spanish: i-877-727-2932 Chinese 1-800-88-2288 Online: well~rgq~gr;1• ~:.; ~~. Write: Wells Fargo Bank, N.A. 003361 1 AV 0.350 978941. P.O. BOX 699$ Ilhillmt~ilnl~ylll~h~dlllllul~l~~u~lyhlllnn~lh~~rl~~ Portland, OR 47228-6995 ' '} JEANENE i_ OCENICK 201 SE t2R1b21' 30 2 1105 KENT DR P , . MECHANICSBURG PA 17050-7fi10 Total assets: $ 7 39,493.38; n Last month: $138,919.05 ~ Change in $: $574.33 Change in 9~6: 0.41 %ar, z 0 Total liabilities: $0.00 a - Last month: $0.00 z Change in $: $0.00. z Change in °!oI 0.009'0 z z Z Qualif in Balance: Y 9 $13.9,493.38. z Deposit Balance: $1.39,493.38 z Contents raye z z Overview ..................._.. ....:.....2 0 PMA° Premier Checking Account ..... ...........3 °o ru Certificates of Deposit ............ ...........4 ~ .. o ~, o w N N w O w !D v V Qs PMA account . '•801 ^ September 1, 207 2 -September 30, 2012 ^ Page 2 of 5 Cwerview of your PM~1 account Assets Percent Balance last Batancethis Increase/ Percept Accaun[ fAccourrtN~m6ed oftotaf month ($) month ($J decrease {$) dtange PMA' Premier Checking Accounts i N/A O.OD 0.00 6.00 0.00% Certificate of Deposit i „; l00% 138,914.05 139,493.38 574.33 0.41 % Tatal assets $138,919.05 $139,49313$ $57433 0.41% Total asset aI[ocation (by accounttype) CeRMmLM O~DCPOSIC 10095 Interest, dividends and: other income The information-below shouldnot be used for tax pfanningpurposes. Account Thismonth This year Certificate of Deposit I3a~aozov3azt~al 574.33 5,158.56 Total interest dividends and other Income $57433 $5,15856 The "Overview of your PMA Account" secticvl of your statement is provided for informational and convenience purposes. The Overview shows activity and information from {1) deposit,credit and trust accounts with Wells Fargo Bank, N.A., and (2) brokerage accounts with Wells Fargo Advisors, LLC, or INelis Fargo Advisors Financial Network, LLC (members SIPC); brokerage accounts are carried and cleared through First Clearing, LLC; (3) Welts Fargo Funds Management, LLC provides investment advisory and administrative services for Wells Fargo.Advantage Funds; other affiliates provide subadvisory and other services forthe Funds; and {4) insurance products offered through non-bank insurance agency affiliates of Wells Fargo & Company and underwritten by unaffiliated insurance companies. PMA account X801 i September 1, 2012 -September 30, 2012 ^ Page 3 of 5 PMA® Premier Checking Account ActlVlty SUMinary Account number:R Balance on 9!1 0-00 JEANENE L OLENICH ~+. Deposits/Additions „~;~~~ D.DO Wells Fargo Bank, iV.A., Pennsylvania (MemberFOln WithdrawalslSuhtraaion~~ - 0.00 Questions about your account: 1-800-742-4932 Balance on 9/30 $0.00 Worksheetto balance your account and General Statement Policies can be found towards the end of this statement Interest you've. earned ~ Interest paid on 9130 $0.00 ~ Average collected balance this month $D.t70 c Annuai percentage yield earned 0.00°.L x Z Interest paid this year $0.00. o m z z z z z z z z z z z z z z z z 0 0 N O O w A N - O N O N O W _~ V V QI PMA account " 301 ^ September 1, 2012 -September 30, 20i 2 ^ Page 4 of 5 d Certificates of Deposit 4 ... ~ Certificate of Deposit AClOUOt SIiIB1111ary Account number:f ~ ;578 Origina[ value $114,200.00 DAVID M OLENICKAND/OR Current value $134,443.38 JEANENE L OLENlCK Original issue date 10/6/08 Wells Fargo Bank,N.A.,Pennsylyania(MemberFDlq Currentissuedate 10/6/08 Questions aboutyouraccount: 1-800-742-4933 Maturity date 10/6/13 Term b0 months Interest you've earned Interest.rate 5.02% Annual percentage yield 5:15% Interest accrued bucnot paid $19.18 interest paid this year $5,158.5fi Activity detail InterestPaid 574.33 Current balance ; 739,493.38 PMA account 801 t September 1, 20i 2 -September 30, 2012 ^ Page 5 of 5 Worksheet to balance your checking account i 1. Go through your check register and mark each check tthis includes 2. Using the chart below, fist any outstanding, converted or substitute cancelled, converted and subsdtute checla that may appear on your checks, as well. as any ATM withdrawals, payments or any othei, statement), withdrawal. ATM transaction, payment, depositor other aedit ' withdrawals pncluding any from previous months) which are lilted in your listed in the Transaction history" section ofyour statement Be sure your register but are not shown on your statement register shows any interest or dividends paid ihto your account and any service charges, automatic payments or transfers withdrawn from your 3. Balance your account byfiifing inthe spaces below. ' account during this statement period. ~ ENTER ® The "ending balance" shown on your statement ~v ADD 0 Any deposits listed in your register or transfers into your account which are not shown on your statement . ~ CALCULATE SUBTOTAL (Add parts ®and® ) ~ SUBTRACT Total of outstanding checks and withdrawals from the chart at right try CALCULATE. ENDING BALANCE (Part®+Part©-Part©} This amount should be the sameas the current ba{ance shown in your check register. 5 _$ General statement pot! ^ To dispute orreport inaccuracies in information we fiavs tarnished to a Consumer fleporting Agency about your accounts. You have the right to dispute the accuracy of information that Wells Fargo_ Bank,. N.A. has famished to a consumer reporting agency by writing to us at Wells Fargo Servicing, P.O. Bax 14415, Des Moines, IA 50306-3415. Please describe the specii'ic information that is inaccurate.orin dispute and the basis for the dispute along with supporting documentation. 1f you believe the information furnished is the result of identity theft, please provide us:with an identity then report icies for 1Nells Fargo Bank ~ Checking account information. After balanclngyour checking account, please report any differences to us as soon as possible but no later than within 30 days. Special provisions, including a reporting period of up to 60 days, apply if the difference involves an electronic funds transfer. These provisionsate explained befaw. ~ Incase of errors or questions about your elecvonic transfers,. telephone usat.the number printed on the front of this statement orwrite us at Wells Fargo Bank, P.O. Box 6945, Portland, DR 97328-6495 assoon as you mrt, if you think your statement or receipt is wrong or if you need more informatlon abput.a transfer on the statement or receipt. We must hear Pram you no later than 60 days afterwt: sent you the FIRST statement on which the error or problem appeared. 1. Tell us your name and account number (if any). 2. Describe [he error or the transfer you are unsure about, and explainas clearly as yov can why you believe iris an error ar why you. need more Information. 3. Tell us the dollar amountoF the suspected error. We will investigate your.Somplaint and will correct any error promptly. It we take more than 10 business days to do this; we wilt tredit your account for the amount you think~is in error, so that you vrill have the use of the money during the .time it takes us to complete our investigation. ~ Deposit and credit products offered by Wells Fargo Bank, NA., Member FDIC 0 a v c s D Z w m_ z z z z z z z z z z z z z z 0 0 A 41 N 0 N V O W V m ®20.12 Wells Fargo Bank N.A. All rights reserved. NMLSR lD 399801 ~: PenFed Online Page ,1 of 1 Pentagon Federal Credit Union Currerit:Date and`Time (Eastern] W~rees<tay;.OCtotier 10, 2092 915:18:58.ANi Glick here to printfhis page Return to Previous Page Checking, Savings and Money Market Accounts Account Name Account Number Available Balance Current Balance .Regular Share "*'9012 OiSplay $0.D5 $5.05 Regular Share "`8013 Display -$4:97° ~D.03 Money Market certificates Account Narne Account Open Date Maturity Dividend APY Current Number Oate Rate Rate Balance 5 YR Money Market Certificate *"'2561 Dispiay D113D/2009 01/30/2014 4.40% 4,50°7° $29,341.D5 5 YR Maney Market Gertificate **"3563 RiSplay 02/13/2009 02(13121714 4.3D% -4.39% $29,186.31 5 YR Money Market Certificate "*256D Dispiay 03/26/2009 03/26/2094 3.92% 4.04% $11,465.29 71'R. Money Market Certificate ,,,,,~ 9568 Display 1}71292009 {}7137201.6 3.92% 4.00°k $119;911.59 !RA Share-and Certificates Account Name Account Maturity open Date Dividend APY Current Number Date Rate Rate Balance IRA Share Traditional **'6405 Display 02/26/20D9 N!A N/A N(A $O.DO 5 YR IRA Certificate Traditional '"`7221 Display 02/2820D9 02128/2014 4.3D% 4.39% $37,037.9D hops:!/~nline7,penfed.org/PenFedpnline/MainlvMeniiTex#.aspx 1 D/ 10/2D 12 Page: 1 Document Name: untitled U/ N c $ tti CII5 1 IDS CDA/REA CUSTOMER INQUIRY al/a8/la 1 6.aa.22 BANK 40 40 MS ACTION'SUCCE5SFUL ACCT> 839 PROD> CDA BRANCH 99999 COST CENTER 9999999 `'STONER NUMBER 839 SUBPRDCT DC -CDA CUSTOMER ~"'ME DAVID M OLENICK ~ SUBOWNER O1 REGULAR NAME DAVID M OLENICK RELATIONSHIP JOI & JEANENE L OLENICK - TIN ADDR 1109 KENT DR _ WTHLD CD PC CERTIFIED TIN MECHANICSBURG PA 17 050-7&10 DATE WTHLD CERT 08/0 8/2008 BIRTH DATE 1954 LAST MAINT DATE - ~ REA PLAN - PACKAGE CD ADDED COUNTRX - REMOVED - SEL SUB ACCOUNT RST ISSIRENEW MATURES PKG 'APY CURRENT BALANCE STAT MT o"90 08/04/2005 08/04/2010 5.OQ 6,078.50 99 MT :691 08/04/2005 08/04/2010 5.00 6,078.50 99 MT .i92 08/04/2005 08/04/2010 5.00 ~ 6,078.50 99 MT 693 0$/04/2005 08/04/2010 5.00 6,078.50 99 MT 694 08/04/2005 08/04/2010 5-.00 &,078.50 99 PF: 1-HELP 2-MSGS 3-PLVL 4-RRS 6-CIF 7-SB 8-SF 9-C134 10-CI10 11-CI11 12-CI50 Date: 1/8!2010 Time: 4:00:27 PM ~ n ~ Z Pages 1 Document Name: untitled BANK. 40 40 ACCT> "`~~'STOMER NUMBER ~. -MME DAVID M OLENICK ~- NAME DAVID M OLENICK & JEANENE L OLENiCK ADDR 1109 KENT DR MECHANICS$URG . COUNTRY SEL SUB MT MT-__ MT MT MT RELATIONSHIP JOI TIN WTHLD CD PC CERTIFIED TIN PA 17050-7610 DATE WTHLD CERT 08/08/2008 BIRTH DATE 1954 LAST ZvIAINT DATE REA PLAN PACKAGE CD ADDED REMOVED ACCOUNT RST ISS/RENEW MATURES PKG APY CURRENT BALANCE STAT :695 08/04/2005 08!04/2010 5.00 .6,078.50 99 :696 08/04/2005 08/04/2010 5.00 6,078.50 99 697 OSI04/2005 08/04/2010. 5.00 6,07$.50 99 698 08/04/2005 08/04/2010 5.00 6,078.50 99 699 08/04/2005 08/04/2010 5.00 - 6,078.50 9~ PF`: 1-HELP 2-MSGS 3-PLVL 4-RRS 6-CIF' 7-SB 8-SF 9-CT34 10-CI10 11-CI11 12-CI50 \~ ~...... CI15 1 IDS CDA/REA CUSTOMER INQUIRY 41/08/10 1.6.00.29 MS ACTION SUCCESSFUL $39 PROD> CDA BRANCH 99999 COST CENTER 9999999 $39 SUBPRDCT DC CDA CUSTOMER SUBOWNER O1 REGULAR Date: 1!8/2010 Time: 4:00:33 PM ~._.., v a X Q U a o~ .~ ~~ O r ~ M w O "a' - ~ Vt X Y Op ~--- ~~W ~p ~~ ~4 ~O~O O ~ X r ~ ~J{-+J Q ~~' ~ O C tai] G=.1 ~ ~ ~ ~ ¢ 7 7 H ~ ~ ~ ~ ~ ~ ~ U L d 117 O O_ ~ /"~ O ~ N ,_.. st ~ ~~~ `"' ~G X LiJ r g r UQ~ N ~ a 2 j O d ~-- U ..C .... ~ J L~ tl7tQC:Sd d°'U L~ NO.aia ~^ ~ N O H H d9 'n ~ (~6 U Z W -- d LtJ E L7J ~ V~7 H N U zF- ~+ ~ '~'' W ~ W cn z ~° L ,F, ~ o~ z z ~ ~ ~ ~ J ~ ~ U N tf) ~ d 4 a o0 0 ~ ~ -n ~ ,- O + o O a N =-- v ° v- ~ °f .°7, ~ m m ~ rn ° 6 9 L'S ~ a O ¢ Z p L q 3 '~ ° ~ a c i+~ a at' N ~ a a ~ m a o ~ U Q LT ~ ~ ~ ~ ~ ~ ~ ~ ~ 8 00 r ia '~ i ~ w Z ~ ~~ - - A 9 L 3 O ~ L.L ~ ~ y G 1~0 Q ~ ~ -F- ~ uq-. O 0 3 M 62 ~ O ~ '~- O1 U d u~ @ i7 ~ H -. m m c + m v~ m a Q L '~'"' U L m r O ~ O A N N N c • ~ ~ ~ L O . , i q O 1^- CD ~ O C7 o 4 [Q ~ O .~ y ~ 7 a ~ N ~ ~ ~ _ ~ m a _ i N 7 ,. A L c ~ N ~ ~ b' m O y s o ~ p j ~ + + N q ~ C ~ H a~f i~-~ q ~ ~, ~ ~ .~ a .~ Z ~ !-- t!7 n v .p a ~ d 1 t_L ~ L N o` m mS ~ C L - o ++ m p~ O r ~ Z O N ~ U C7 N o++ ~ ~ U N E Q c0 ~ v~ o a Q i ~ U~ ~ v -+ + .-. w O O ?~ `` R) O ;~ `y m a c fn Cn d7 ~ CQ d ~-- a -+' ° JEANENE L. OLENICK, Plaintiff V DAVID M. OLENICK, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 09-7822 CIVIL TERM IN RE: PETITION FOR SPECIAL RELIEF ORDER OF COURT AND NOW, this 17th day of September, 2010, after hearing on wife's Petition for Special Relief, IT IS HEREBY ORDERED AND DIRECTED: 1. Wife will be granted exclusive possession of the marital home. Husband and his dog will vacate the home on or before October 22, 2010. 2. The value of the ten CD's from PNC Bank, the amount of which has been deposited into wife's exclusive account,. will be divided equally. Wife shall provide husband through counsel with one-half of this sum on or before the close of business on September 21, 2010. 3. The husband shall provide the wife with the names and monthly amounts of the utilities and taxes .which he has~been paying with regard to maintenance of the marital home. Husband will pay attorney's fees in the amount of $1000.00. By the Court, ~. M. L. Ebert, Jr., - Diane G. Radcliff, Esquire For the Plaintiff /othy Barrouck, Esquire For the Defendant I- :mtf ~i IFS /)'1°7t~ 9~~.~ r v n C N O _T.} O -° w z `~ ~ z ~~ ~ N~ N N ~O C'-~ ~O C ~ i~' ~ ='T'1 °=' 0 z D~ 2 o -~~t~ - --I -~ N o, ~ ~ t~hQ1C~ ? 175 9pm61c &a H°llow Rnnd ~ a.,-~, ~, PA 17055 F E D E RAL C R E D l i UNION www.emeddmirE.orv, Building Relationships For Life Address Scr~ice Requested oo5as Cjlllllh~~illlhllll~f,ulll~Ifhll~i~fill~ry+~lllllhlliliil~l! .IEANEtdE L OLENICIC i " 1 1'09 KENT OR MECHANIGSBURG PA 17050-7610 Stattem~ent of AccQUnts~'~- Sep 01, 2012 thin Sep 30, .2012 Accourl# Number ~ooooooc237 Account Balances at a Glance Savings: 5.85 Certificates: 311,176.28 Loans: 16,259.07 New Relationsfrp Reward LeveE is:`~Gensral Page 1 of 2 Effective January 1, 2019, AmeriChaice will no longer participate in the Credit Union Service Center Network als many lower cost~altematlves exist to handle these transactions. Forthe smatt. percentage a# members who use this sertice, • watch for additional information In the upcoming months. Looitirsg to save itlousands an•yourcurrent moRgege7 Look no further than AmeriCtioicel flaw is the titYie`tq~refinance your mortgage with incredibly law ~. , rates) Log on to wwvi:amerid~ioice.org to learn maiei REGULAR SHARE -x001 Date Transaction Description Additions 5ubtractians _ Balance 09-0! BafaACe Forward 6.85 09-30 Ending 8aiance fi.85 Dividends Paid Year to Date 0.00 6 MONTH CERTIFICATE --0062 - Date Transaction Description 09-0? Balance Forward 09-30 EndingBafance '6 IVfONTH CERTfFICAI'E wTj[ mature or1-1ti30110'I2 Dividends. Paid Yeai to Data 38.:34 Additions 5ubtractiarts Balance 79,152.99 79,752.99 6 MONTH CERTIFICATE -0063 Gate Transaction Description Add[tions Subtractions Balance 09-07 Balance Forward 12,023.29 09-30 Ending Balance 12,023.29 6 MONTH CERTIFICATE will mature on 1213~l2012 Dividends Paid Year to Date 24.08 HELDC PAYBAGK=VARIABLE RA`l~'E - 0050 interest Paid YFD: 496.93 Eff Trans Interest. Late Date n~s~ction Description Amount Da4s - Tr4 Principal Charge Fee Balance 09-D1 „ 8aiance Farivarpt i 6,308:59 09-04 Payments by Che>rlc -~65.6t3 -,49,32 1'1(1.16`- 16;259:0 09-30 F.rte6ng Balance -. i 6;259.07 Annual Percentage Rate 4.000% Daily Rate .01 E7958% The rate-shown above Is variable and is subject to change A payment of 331.36 is due on September 30, 2D42 Next Scheduled Due Date: Oatober3l, 2012 Past Due Amount: 165.68 interest Paid Year to Date 496.93 interest Paid In 2011 652.64 Plione~ (.717) X97-3474 • ~ToT1~Free.: ($00).240-4364 Fax Nuraiber. (717) 697-3713 AmeriCt~c~ice FEDERAL CREDIT UNION Building Relationships For Life Accourrt Number. ~oocx~ooc237 ~~ Sep 01, 2412 thru Sep 30, 2012 i Page 2 of 2 YTD SUMMARIES TOTAL DlV.1DEt~t1]S PAED REGULAR SHADE 6 MONTH CERTIFICATE 6 MONTH CERTIFICATE Total Dividends. Paid Year to Date Total Interest Paid Year to Date TOTAL LOAM 3NTERES'T PA[D 0:00. HELOC PAl'~AGK-VARIABLE 496.93 RATE 38.34 24.06: 62.42 498.93 a q Ally P.O. f3o:c 254 Crlnbery T~vp, PA 16066 01 7 058/1 828d6f1135TMT1FOS(lOTli705610002/000U01/O66Z21 000 01 000000 JEANGNE L OI:E1JtCfC DAVID M OLEt~1CiC 1109 !CENT DR IvIECHANICSt3URG PA 17650-7610 3x~ Account Type t;l1STOMER STATEMENT AccounYN'umber BegFnning Balance Ending Balance --- No I~enalty .CQ xxxxxxxx3726 Total Account Balances Statement Period 08!11!2012 - 09!1012012 Page 1 Customer Care E formation Toll Free 877-247-A~LY {2559) www.ally.com :~ 353,631.64 $53,531.64 $63,531.64 $53,531.64 if you arily have a Certificate of Deposit(CD} account with us, you will receive s quarterly. eta#ement. if you have a savings or checking account with us, then we wi11 make yaur statement available for all of your accounts, including CDs, monthly by mail or electronically. If you have a CD with .electronic transfers, you will receive a monthly statement for any month an electronic transfer occurs. The Ally Bank No Penally 11-Month CD: Get a great CD rate with no early withdrawal penalty. You can withdraw all your money, including interest earned, without any penalties, anytime after the first six days following the date you fund your account. To learn more, visit us.at allybanK,com The Statement :Period Shown. above is the statement .beginning date for the. oldest open account 9nd the, statement ending date of-ail of the accounts shavi+n on this statemenf, The. "Days in the Stafemerri Period" orr the following Pages is the actual number of days In':lha statement period fog the account shown on that' page. Ally Bank Member FDIC COMBiNE© CUSTOMER STATEMENT STMTCM6100 1 if2011 COMSINED CUSTOMER STATEMENT ~ N1 Statement Period 08111!2012 - 09/1072012 Page 2 Customer Care Information i Toll Free 877-247-RELY (2559) No Penalty CD Summary For: Jeanene L Olenick Davtd M OleniCk www.ally.COm Account Number: xxxxxxxx3726 Open Date: 01/15/2009 ' Product: No Penally 1 1-Month CD Maturity Date: 11./16/2012 F Summary ....._. Be innln Balance 9 9 $53,531.64 Days In Statement Period ' 31 Deposits and Other Credits $0.00 Annual Percentage Veld Earned 1.21% Interest Paid T1iis Period $O.OD .Average Daily Balance This Period 553 531.64 Withdrawals and Other Debits -$0.00 lnisrest Paid Year to Date. , $O.DO Endfn Balance 9 $53 531 64 Ihterest Accrued This Period $54.6'1 , . Interest Accrued Year.fo Date $447.45 Activity • ~~ " Date __ Description ^ ~~ _._ ~ Credits Debits Balance 08/11(2012_Beginnfng.Balance ~ ~ ~ ~ ~_..__~__._ - ~~ ~~ ~. $53,531.64 09710!2012 Ending Balance $53,531.64 Ally Bank Member FDIC STMTCMBi 00 11/ZUT 1 111^IL h'IR:w~ :\~S'J'\ITIfIISllnl:4]I14~ Ww: WNMIYI 4N'!., IMINII`INIIXlIIII Send Correspondence to; Ally Bank P.O. Box 951 Horsham, PA '19044 Send Deposit to; Ally Bank P.O. Box.136Z5 PFiiladelphia,,.PA 19.101-3625 To receive prompt credit of your deposit, please.mai) toaeDeposit a address I}sted above. Checks which are not made.payable to.Aliy Bank should be properly endorsed. Deposits received:at any other address '+ may be subject to delays. Do.not send correspondence vrith your deposit(s). Regulatory Requirement: In Case of Errors or Questions about Your Electronic Transfers: COMBINED CUSTOMER STATEMENT Statement Period OBl11/2012 - 0911.012012 Page 3 • Telephone us at: Ally Bank Customer Care, 1-877-247-ALLY (2558) Or • Write us at: Ally Bank Customer Care, P.O. BaX.2554, Cranberry Twp, PA 16066 Customer Care InfArmatiort Toil Frae $77-247<ALLY (2559) www.ally. com For recurring transactions and other inquiries, please call the phone number above. Contact us as, soon as you can, tt you think .yciur statement or receipt.is wrong or if you need more information about a transfer listed on the statement or receipt: We must hear from you no later than 80 days aftet W~ s"end you or make available to you the FIRST statement on which the problem or error appeared. Tell us the following information: ' • Your name and account number • The dollar amount of the suspected error • Describe khe error or the transfer you are unsure about, and explain as clearly as you can why you believe there is an error or why you need more information If you tell us orally, we may require you send us your complaint or questions In writing within ten (1t)) Business Days. We will determine whether an error occurred within ten (10) Business Days after we hear from you and will correct any error promptly. !f we need more time, however, we' may take up to forty-five (45) days to Investigate your complaint or question. If we decide to do this, we will credit.your.accountw~thin ten (10). Business Days for the amount you think is in anor, so.that you will have the use ofi the money during the 6me It takes us to complete our investigation. tf we.ask you to put, gout complaint-pr question in writing and we do not receive it within 10 lusiness Days, we may not crecGt:your account For errors involving-new accounts; point~f-sale, or foreign=initiated transactions, we may take up to ninety (90) days to investigate your complaint or.questiori: For view accounts, :we may take up to iwerity {20j eusirtess Days.to credityour account for the amount you think is in error. We will tell you the results within three {3) Business Days efter completing our investigation. If we decide there was no error, we' will send you a written explanation. You may ask for copies of the documents that we used in our investigation. •l7~:: CHECKS OUTSTANDING Check Nurntier Amount Total Ally Bank Member FDSC ~__ TO BARANCE YOUR ACCOUNT 1. Enter Ending balance from this statement: 2. Add deposits recorded in yow che~kbor5k but:not shown on this statement. Enter the interest earned deposit into your checkbook. ~ l 3. Total (1 and 2 above) ~ - _ __._,__ _,_ .. i 4. Enter "Ghecks Outstanding" Total. Balance: (3 less 4. should equal your checkbook balance) S'i'MTCMB100 11801'1 i i 1 P.O,Box 358035 Psttsburgh, PA 15252-8035 00T2d32 01 AT 0.365 +*AUTO S4 0 8315 17050-833035.001 B4t4~I -1 - httil=Iul=iiillltirrdriilututt==li=i==iluikili{rilh~ll! DAViD M OLENICK 1135 SANDPIPER CT MECNANISCBERG PA 17050-8334 Year-To-Date Accaunf Summary 4021 01 0072432 0285818 Page t o! 5hareHolder Of,' GENERAL ELECTRfC COMPAiV GE STOCtC DIRECT PLAN STATEi41ENT PRINT DATE: CUSIP: 10!281201' X41 t SYMBOL: GE ACCOUNT KEY: INVESTOR ID: OLENiCK--DAViM000( FOR QUESTIONS CONCERNING YOUR ACCOt7NT PLEASE CALL 1-800-786-2593 Save this Statement for Tax Purpose: AS OF: itY2br201i CASH DIVIDENDS NET AMOUNT TOTAL MARKET VALUE (S} ___ CLOSING PRICE (;) INVESTMENTS (;) TOTAL {S) 3AX WITHHELD;;) AMOUNT TO INVEST (i} INVESTEG (S} 6,053,57 16.3500 210.49 210.49 210.49 TRADING FEES PAID 8Y (S) SERVICE FEES PAID BY {i) SALE OF PLAN SHARES (;) CERFIFlCATED SHARES HELD SHARES HELD BY TOTAL COMPANY HAREHOLDE COMPANY HAREHOLDER GROSS PRQCEEDS -TAX WITHHELD SHARES HELD BY YOU 8Y PU1N OTHER PLAN(S) SHARES ..~ 370.2490 370.2490 Current Activity inforrnafion RECORD DATE TRANSACTION DMDEND 3tIARE9 ACQUIRED CASH TOTAL PAYABLE DATE ~ DESCRIPTION RATE OR WITHDRAWN INVESTMENT (S) GROSS (i) _09119/2011 _ 1012512D11 COMMON DMDEND 0.1500000 3.3823 55,1 PARTICIPATING RECORD DATE bISTRIBUTION TRX rRADPlO FEES PAID aY (S) 9ERVtCE FEES PAID aY jil TOTAL CERTIFICATED SHARES SHARES HELD -~ ,SHARES HELD 8Y TOTAL WITHHELD {;) ewa~v+r syv~wcom wwun stune+wine~e HET (S) HELP BY YOU BY PLAN OTHER PLAN(S) SHARES 55.03 366.8667 366.861 Year=To-Date Transaofion Detail DATE FRANSACTION CASH NET TRAOINO SERVICE AMOUNT PRICE PER SHARES ACQUIRED SHARES HELD DESCRIPTION INVESTMENT iS} D1STR18UT[ON (S) FEES (i) FEES {S7 INVESTED {S) SHARE (;) OR WITHDRAWN 8Y PLAN BALANCE FORWARD 358.85• 01!25!1 i COMMON DMDEND 50.25 60.25 20.0400000 2.5075 361.46 04125111 COM61iON DMDEND 50.61 50.61 20.0200000 2.5280 363.89 D7125/11 COMMON DMDEND 54.6D 54.50 18.9950D00 2.8744 366.86 10125111 COMMON ON)OEND 55.03 55.03 1&2700000 3.3823 370.24 raNFaAt. ELECTRIC COMPANY Accuunr ,.~,: ~~c1<n..C--DAVIM0000 DRUID M OLENtCK 1135 SANDPIPER CT I+AECHANISCBERG PA't7050-8334 A8 ov~rrer(s} rrwst sips and date above (on~facf f~um~er 7575 Partial Withdrawal (Continue Plan Participation) Additional Gash investments Issue a ce[tificate for This ~ Write the amount endossd: namberot shares: ~ ~ ff _ Make ch®ck payable to: i. -_ Seri this number of shares: ~ C 13NY MfELLON/GENERAL ELECTRIC __.___.___.____.___ YOt)MAYINCREASEYOURSi-WRESWITH OPTIONAL CASH INVESTMENTS OF $10 Full Withdrawal {TernTinate Pian Participation) UP TO $10,0(X] PER INVESTMENT l Issue a certificate for all twit shares ~ J and a check for tractional shares. Deposit of Cerfif'tcates r-~ J Seit all plan shares, -- Deposit the endosed number of shares: GE: Summary for General Electric Company Common- Yahoo! Finance Page 1 of 2 New User? Register Sign In Help Preview Mail wl YI Toolbar Mail My Y! Yahoo! + Search Search Wetr .- NOME INVESTING NEWS PERSONAL FINANCE MY PORTFOL705 EXCLUSIVES Get QUO!!!r-; `. Finance Search Thu, Oct 17 , 2012, 6:O6PM ED' ~~ LLS. Markets closed DOw 10.14% Nasdaq 30.08% streaming More On GE ~~. G'E 'M ~~ RQSpOI1Se ouoTES oi~crlnNACCOtnJC, ~.~,~,~o' denied by Summary rwmr~°ruann.rue _ 117.,+..1.(_..., r.7 Order Book General EI@CtrjC COmpaOy (GE)- NYSE __ Adtl to Portfolio Like 'a0 Options CA 22.5 1 t d.08~~.36%~ 4:05PM EDT I After HOUrs 22.58 10,07 (0.31 k) 5:32PM EDT --- ~- Historical Prices CHARTS Prev Close: 22.43 Day's Range: Ganatal Ele ctrle Company Common 22.48 • 22.71 Interactive ... ...._. -...___.. ... ___ -._.. ._._ -___.. ^GE ,-.r ~ ~ :anpm cC i Open: 22.59 52wk Range: --. _ _ 14.68 •23.18 _ __ _ z2.e Basic Chart ... ___.. ... .. ...._.... _. _ Bid: 22.55 x s0o Volume: - 24,115,257 zz.7 Basic Tech. Analysis ...- __. _....._.. __ ._ __ ... - NEWS 8 INFO Ask. 22.60 x 90o Avg Vol (3m): 43,050,700 zz.6 ~~"~'~ Headlines 1 Tar et Est: 24.69 y g Market Cap: 237.688 ~ zzs Financial Blogs Beta: 1.43 _ _ PIE (tVn). _ _ - -~,~n- 19.52 - - - - ---- --- zz.q company Events Next Earnings 19-Oct-12 ~ EPS (ttm): loam 1 15 12pm 2pm dpm ---- Prc+ious clr~ Date: -__ - __ _ . _ _.` Message Boards "~~"~----- -_"-"" '-~--"-"-~~`--~- DIV & Yield: 0.68 (3.00%) 1d 5d tm 3m 6m 1y 2y 5y Market Pulse Peo le vieWln GE also viewed: P 9 max COMPANY pFi_ MRK DD KFT PG JAIJ customize chart Profile _. __-.. _..__ -______. _...__-. ___. __ Tae ~+' ': Select your broker - Key Statistics -- SEC Filings compare B®tlal>es delayed, except where indicated otherwise. Currency in USD. Competitors Industry FleadilneS Filter Headlines Components Google, Apple top list of most sought-after companies for ANALYST COVERAGE emplOyeeS at bizjoumals.com (Thu 5:39PM EDT) Analyst Opinion ° GE: Ftring Oh AImOSt All Cylinders at Seeking Alpha (Thu 5:3zPM Analyst Estimates ED`7 Research Reports ' Comcast's Laggard NBC Network Toms Leader in New N star analysts Year at Bloomberg (Thu 4:49PM EDT) OWNERSHIP 'Boeing Wins $5 Billion Order for Alaska Air's 737 Fleet at 8loomberq (Thu 4:19PM EDTi Major Holders Cabela's, GE, Sturm Ruger In Zombie Stock Portfolio at Comparison Insider Transactions Investor's Business Daily (Thu 4:01 PM EDT) Symhol ^/ Cng Mkt Cap Insider Roster ($$] Siemens's New Plan to Focus on Cost Cuttin Sim Ij in 9 P fY 9 --- -- - -~_--- _ --- ~-------- FINANCIALS , BltSineSS at The wa115treet Journal (Thu 3'58PM EDT) GE -----~ --"- t0.36°/ -..._ 237.688 _.._ ___-___. Income statement • A hale entrepreneunal advice from Jack Welch a<bizjournals.dom GEC L _ _ __ _ 147.33% _ 186.686 _ ______ Balance sheet (Thu 2:54PM EDTI BHEL.NS 12.65% NIA JefF Probst Unplugged: Exclusive Behind the Scenes Look at - -- -- - Cash Fiow His New Daytjme Talk Show at Forbes (Thu z:osPM EDT) SMIN.L --_ ._ ___ _ 10.94% - . _ 4.228 _____-- •This Hedge Fund Manager Lost Big on These 2 Stocks, Did IMI.L _ 10.60 % 2.948 _ _._. . YOU? at Motley Fool (Thu 1:46PM EDT) » More Competitors a More Headlines for GE Sector Industrial Goods Add GE Headlines to My Yahoo! Industry Divers~ed Machinery Key Statistics Financial Biogs Forward P/E (1 yr): 13.01 ITW Medical Expands Product-Line Zacks (Tue, oct 9> PIS (ttm>: 1.63 http://finance.yahoo.com/q?s=ge&q1=1 10/11/2012 ,~~ _ ____ r rr~ r~r r ~ a ~~~ ~~~~~ ~ ^r ~~w ~~ ~ rq IMPORTANT TAX RETURN DOCUMENT ENCLOSED t~ ....'~....:..AUTO" 3-DiGiT 170 00005810022012 0 2 2 01, 2 ~. ~ illlirltllllr~rllh111rllelifllil'Ilhilui~llli~aliillerlliilill ~ Recipient ~ DAVID M OLENICK ~ 1135 SANDPIPER CT lip MECHANICSBURG PA 37050-8334 =g +~ompu~ershare Computershare PO Box 43078 Providence, RE 02840-3076 Within USA, US tenitories& Canada 888 IBM 6700 Outside USA, US territories 6 Canada 781 575 2727 ibm@computershare.com www.bm.carNinvestor (Go to StockiaMer Services and then Regtsbred Siocklwider Access} Holder Account Ffumber INS II~Ib~R~N~MIR~~9~ __ OOICSOOOS.DOML?4p13QS_I'QS.38M.1 F2345_41957/0220 tZ/02201?1 v<yCq~.y^,L•'aC}!;". eu±v+C+S4..'~sca.~.-;.tom. cZ~~ka.'ys52241v3".~J6!R•'~vaf-~'V7-+,.•.y~~S!:.~ - - ~"fln~-swan.,. .~ R.FT3RlaibnTaIL~EOB.-a:T.~~+#~~.'::5~:3 International Business Machines Corpvratitan - Combined Dividend Payment / 2011 Tax Fvrm 1499-DIV Corrected {ff checked) Account Numbor 718 Form 1099 -DIV -Dividends and nistributions 2Q'i'i Copy 8 -For Recipient Recipient's tD No. ending to "F "•1843 Payer's Federal ID No. 13.0871985 Thta la hnpottmlt tae hdomla0ort and b beMg hrnlshed to the tnteaml Revenue Service. IFyou are required to Ak a n3tum, a netjllgenco OMB Na. penalty or other aanetlon may ba Imposed onyou If tllls income b taxable and the IRS determines tltat 8 has not been reported, Deperpneot of Ure Treaswy • Inemal Revenue Servke Recipient bAViD M OLENiCK 1135 SANDPIPER CT MECHANICSBURG PA 17050.8334 L1TatalOrdinary fb t~uallfledu NondMdend 4 FFAERALINCOhSE a ForelgRTax r ForeigpCoaBry a Cashllquidatiooj Dividends ($) Dividends {$) f DistribuGans ($) TAX WAtIHEID (S) Paid t$} ar U.S. Passessbn DLstri. ($)i Payer's Deiafls 2.so 2.90 0.00 o.oa o.oa IaM CIO COMPUTfRSHARE P.O. BOX 43010 PROVIDENCE RI 02940.3010 Form 1089-DIV (Keep for your records) Dividend Confiirmatian Payment Date ~ Class Description ~ Participaiing ~ Dividend I Gross I Deduction I Deduction ( Net Shares/Units Rate Div'sdend {$) I Amount ($) Type f D{vldend {$) 10 Dec 2011 COMMON 1 $0.75 0.75 0.00 NIA 0.75 Year•TaDate Paid 2.90 0.00 290 i:6 i r{:7 _,:; `:_ ; f: OORX6A•PP-lF2} 46UTX I B M '"~"'" IBM: Summary for International Business Machines- Yahoo! Finance Page 1 of 2 New UseR Register Sign In Help Upgrade to Safer IE9 Mail My Y! Yahoo! [~ Search _. - -- - _.~ .l _ ~ ~MN1ti0Y11F I f I HOME l INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES ~i Finance Search Thu, Oct 11, 212, 6.14PM EDT - U.S. Markets closed Dow 10.14% Nasdaq 10.08% Streaming More On IBM ~ ; ~ Response ,~ ouoTES ' ®,,yl, o i denied by _ _ _ __ _ _ .xf~+,.~,~,,.,,.a Summary Order BOOk IntBfOatlOnal BUSIr1B88 McGhln@8 Corporation (IBM)- NYSE Add to PoRfollo '. Like ~51 -_. Options C Jc 205. / 6 i ~.U6(~.03%~ 4:01PM EDT i After Hours :206.12 t0.36 (0.17%) 4:57PM EDT -Nasdaq Real Time Price Historical Prices CHARTS Prev Close: 205.82 Day's Range: Intaritattonal 6ualtwas IMehlt»s 205.63 - 207.27 ~ Interactive ~teM ~ 207.5 Open: 206.57 52wk Range: 176.17 -211.79 Basle Chart Bid: 205.75 x 300 Volume: 2,909,999 zoo Basic Tach. Analysis Ask: 208.10 x 200 Avg Vol (3m): 3,635,170 zos.5 NEWS & INFO 1 y Target Est: 216.91 Market Cap: 235.148 - zos.o Headlines Financial Blogs Beta: 0.61 P/E (ttm): 14.95 '~`~ zo5.5 1Pam 12pm 2pm 4pm Company Events Next Earnings EPS ttm : 16-Oct-12 t~ ( ) 13.77 P v'°"` cis Date: - Message Boards Div & Yield: 3.40 (1.60%) 1d 5d 1m 3m 5m 1y 2y 5y __ _ __ _ __ max Market Pulse COMPANY people viewing IBM also viewed: P customize chart Q MMM CPB INTC MSFT KO H Profile _ _ _ _ '~ rraa• 14ow ~ Select your brokei Key Statistics --- - '-- " sEC Filings compare B®uaASS delayed, except where indicated otherwise. Currency in USD. Competitors Industry H@adlin@S Filter Headlines Components • Final Glance: Computer Companies AP (Thu 6:07PM EDT) ANALYST COVERAGE • Forbes Earnings Preview: International Business Machines at Analyst opinion ForfJes (Thu 4:28PM EDTI Analyst Estimates • Tech Earnings Outlook Cautious Headed Into Q3 Reports at Research Reports Investor's Business Daily (Thu 4:09PM EDT) Star Analysts 'IBM Third Quarter Earnings Sneak Peek ac wall st. cheat sheet (Thu 3:31 PM EDTI OWNERSHIP • Firms Drop Billions to Enter Fast-Growing "Algorithm Hiring" Major Holders Market at Motley Fool (Thu 3 14PM EDT) Insider Transactions • BUy Cisco NOW Before Th15 Happens at Seeking Alpha (Thu 2:28PM Insider Roster EDT) FINANCIALS • MIC(OSOtt I11CreaSBS DlVidend By 15% at Investopedia (Thu 1:33PM Income Statement EDT) • U.S- Loses PC Lead To China's Lenovo; HP Fails at Investor's Balance Sheet Bus4ness Daily (Thu 1:32PM EDTI Cash Flow • Midday Glance: Computer companies AP (Tr,u 131PM EDT) » More Headlines for IBM Add IBM Headlines to My Yahoo! Financial Blogs • H-P No Longer World's Top PC Maker Packs (Thu 322PM EDT) • iBM'S BraZll EXpansion Continues Zacks (Thu 10:29AM EDT) » More Financial Blogs for IBM http://finance.yahao.com/q?s=IBM&q1=0 Comparison Symbol % Chg Mkt Cap IBM 10.03% 235.14B HPQ t0.49% 28.028 TDC 10.39% 12.316 SGI 10.38% 255.05M » More Competitors Sector Technology Industry Diversified Computer Systems Key Statistics Forward PIE (1 yr): 12.31 P/S (ttm). 2.22 Ex-Dividend Date: 08-Aug-12 » More Key Statistics 10/11/2012 • I)EI'ARTIVIENT OF llL+'1+'L`'1V5L+' .. iii i zi os CIYILI~.I~~ ~~ : ~. ~!. ~T;~' ~1.I~TI~- EARNINGS STATEMENT i MY GATE ylSf$ ft.; _r`~!:: '5~,+_~ - t~7~rE~E1.;^g~..2ij 11/27/09 _-.._ • 1jNAME ']. ~ ~ _~ P/.Y - • LOCALTY AD.1 • ~.[ ^__~- ":_ 4 PAV PVJ7i3RAo-1ST::' 1:.''.-LSD. ': •" :: .c • ADA7ST® BASID PAY OLENICK DAVID M - YA 02 00 ~ o?.S.u 81.23 ~ 81801,00 21208,00 113007.00 i 50"'. `~'~NO L WOAt7EY % 11 P15A CAT[OOAY it. SCD LEAVE S1 MAX LEAVE DAERY OYQ 11 IEAYE YFM ETA .... j-1643 23:10 E U8/23/76 240. O1/02!10 Il FINANCIAL INETfM10N - NET PAV IC FWANGIAL INSTTES1f10N - ALLOTMENT 11 10. FiNANCW.'WSnTIlTION - ALLOTM@R n MEMBERS 1ST FCU 17. TAX STATi/S E70MPTIONS AOryL 1LTAX MTT ~Al EXEMPnCf$ ADD'L TAXVA AI1TNdI1TY i~. CUMULATIVE EEtNIFllAiT E0. MLITMY DEPOSIT FED S 2 420861 'S - FAIRVIEW TS ,NR CSRS: PA S ~30 421080 S HAMPBEN TS PA 69779.97 ss- CURRENT YEAR TO DATE n GROSS PAY 5040.81 135848.5b TAXABLE WAGES 4128.90 123770.96' - NDNTAXABLE WAGES 99.91 2389.59 TAX DEFERRED WAGES 812.00 19488.00 - dEDUCTI0N5 2348,44 81613.79 • AEIC • NST PAY 2691,37 74034.76 - URRENT -EARNINGS C TYPE kOURi/DAYS AMOUNT _ TYFE HOURS/DAYS AMOUNT TYPE HOURS/DAYS AMOUNT REGULAR PAY 80,00 4332,00 OVERTIME 3.00 243.89 AGED CT PD 8.00 485,12 DEDUCTIONS _ , TYPE CODE CURRENT YEAR TO DATE TYPE .CODE OURREN7 YEAR TO DATE FEHB Ii2 99.,91 2389,b9 MEDICARE 71,64.. - 1932.26. RETIRE, CSRS 1 303.24 7283;93 SPECIAL PAY 255.07 TAX, FEDERAL 789,91 23293.76 TAX, LST 420881. 2.00 - 48.00 j TAX, LOCAL 421080 79.05 2132,09 TAX; LOCAL 420749 TAX,LOC OCC 420861 TAX, STATE PA 181,89 4811.10 TSP..SAVINGS ,- 597.OD 14328.00 TSP CUC 215.00 , 5160.OQ { LEAVE ~ I TYPE PRIOR- YR ACCRUED, ACCRUEp USED USED DONATED/ CURRENT [SSE-LOSE/ ~ BALANCE PAY FD YTD PAY PD YTD RETURRED BALANO€ ~ 7ERM DAT£'I ANNUAL 240.00 S,DO 184.00 107.00 317,00 101.00 SICK 2804.00 4:00 92,00 2896.00 COMPENSATORY 92.00 11.00 38..00 GF COMP TIME 352.00 ~ 352.00 TRAVEL COMP 112,00 68.00 7.00 170.00 8.OD HOLIDAY S.DO 56.00 ADMIN 4.DD' BENEFITS PAID •BY GOVERNMENT FOR YOU TYPE CUAP.ERT YEAR TO ,DATE TYPE CURRENT YEAR TO DATE' FEHB 299,7b 7168•25 MEDICARE 71.64 1932,25 RETIRE, CSi~S 503.24 7283.93 REMARKS • YOUR PAYROLL OFFICE ID NUMBER IS 97380500 - DEPARTMENT OF DEFENSE. FEDERAL EMPLOYEES' HEALTH BENEFITS ( FEHB) OPEN SEASON FROM THE SECOND MONDAY OF NOVEMBER THROUGH'THE SECOND MONDAY OF DECEMBER. ;SAVE MONEY ON HEALTH CARE & DAY CARE EXPENSES! •ENROl1 IN FSAFEDS (FEDERAL FLEXIBLE SPENDING ACCOUNT PROGRAM} DURING OPE ( N SEASON NOV 9 - DEC 14, 2009. -WATCH OUR VIDEOS & ENROLL AT WWW.FSAFEDS.COM. CURRENT PARTICIPANTS MUST RE-ENROLL TO CONTINUE SAVING MONEY! ! PLEASE SUPPORT YOUR COMB INED FEDERAL CAMPAIGN GOING ON NOW S PRETAX FEHB EXCLUSION n• 99,81 ~ 65.00 COMPENSATORY TIME HOURS PAID YTD, 27.00 HOURS COMPENSATORY TIME WILL BE PAIB PAY PERIOD ENDING 12/18/09, LIFE INSURANCE AGE CATEGORY CHANGED, -~-----~ - ~-....-----• ~f--'--.- .~-.~.7tiLS-HEP433'f -CONtAIN$_INF.ORMATION-57161EC,TI.70.,3tiE. PR3YACY. ACi G7~.,~~74 AS_F!MP.,j~D..E~ .:.,._,..._. } ~'+ n r ................. :__........_....~ .....«.. ........ ._,._.m:. ......... ....u,~w... ......«.-«. .-..:. ... .....a .. DFAS FORM 1 I - 1E7 1 JEANENE L. OLENICK V. DAVID M. OLENICK NO.09-7822 CIVIL TERM VALUE OF HUSBAND'S ACCRUED LEAVE AT DATE OF SEPARATION Annual Leave 317 Sick Leave 2,896 Compensatory Time. - _ 38 GF Compensatory Time 352 Travel Compensatory Time 8 TOTAL ACCRUED HOURS Hourly rate at 11/25/09 3,611 54.15 TOTAL VALUE OF ACCRUED TIME $ 195,535.65 2002 Ford Winds#ar -Trade In Value, blue book value -Kelley Blue Book ~~~~ye~e~oot ~-., TiiETRUSTED RESOURCE _ ~ ---- - ---.... k6bt•M _ .......---...__.._ .. advertisement v; ~, 8 ~a~ shQppirl~ foals its ~ iPhol~eTM a~f~ .~ Free app by Nationwide Insurance i • . - . ' . ''" 2002 Ford Windstar SEL Minivan BLUE. BROK.; TRAGE•1H YALUE tom- Condition Excellent Goad •`` ~ Fair (Selected} Value $3,950 $3,675 $3,200 -- (Vehicle Highlights C l Mileage: 52,882 ;Engine: V6 3.8 Liter ~Transmission: Automatic Drlvetrain: .FWD ~Sefected Equipment Standard I7 Passenger Tilt Wheel Leather (Air Conditioning Cruise Control Quad Seating Rear Alr AM/FM Stereo Roof Rack ~POwer Steering Single Compact Disc Privacy Glass !Power Windows Dual Front Alr Bags Ailoy Wheels Power Ooor Locks ABS (4-Wheel) System Dual Power Seats Biue Book Trade-In Value Kelley Blue Book Trade-In Value is the amount consumers can expect to receive from a dealer for atrade-in vehicle, assuming an accurate appraisal of the vehicle's condition, mileage and features. This value will likely be less than the Private Party Value because the reselling dealer incurs the cost of safety inspections, reconditioning and other costs of doing business. Vehicle Condition Ratings Excellent ~~i~ $3,950 • Looks new, is in excellent mechanical condition and needs no reconditioning. • Never had any paint or body -vork and Is free of rust. • Clean title history and wilt pass a smog and safety Inspection. • Engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. • Complete and verinable service records. Page 1 of 2 Send to Printer t Without CAl~ FAX hrip;//www.kbb.com/KBBitTsedCars/PricingReport,aspx?Ac#ion-&Yearld=2002&Mileage,.. 1 /6/2010 Close Window __......_.._.._....... 2002 Ford Windstar -Trade In Value, blue book value -Kelley Blue Book Page 2 of 2 Less than 5% of ail used vehicles fall Into this category. ' Good ~~ ~e~`sE_i~' < $3,675 • Free of any major defects. • Clean title history, the paints, body, and interior have only minor (If any) blemishes, and there are no major mechanical problems. • little or no rust on this vehicle. • Tires match and have substantial tread wear left. • A 'good" vehicle w111 need some reconditioning to ire sold at retail. Most consumer owned vehicles fall Into this category. Fair (selected) ~Q~" $3,2U0 • Some mechanical or cosmetic defects and needs serv(cing but is sill! In reasonable running condition. • Clean title history, the paint, body andJor interior need wark performed by a professional. • Tires may need to be replaced. • There may be some repairable rust damage. Poor N/A • Severe mechanical and/or cosmetk defects and is in poor running condition. • ttay have problems that cannot be readlly.fixed such ~s a damaged frame or crusted-through body. • Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley Btue Book does not attempt to report a value on a "poor" vehicle becau~ the value of these vehicles varies greatly. A vehcle in poor condition may require an independent appraisal to determine its value. " Pennsylvania I/b/2010 { •i http:!/www.kbb.comlKBBlUsedCarsfPricingReport.aspx?Action=&Yearld=2002&Miteage... 1 /6/2010 2(706 Honda Civic - Trade In Value, blue book value -Kelley Blue Book Page 1 of~ ~TNE7RiJ5TlD R1rSt]URCE _ i.... ~' Home New Cars Gertifled Pre-Owned Used Cars Research Reviews & News Dealers & Inventory Cias<_ Used Car Values ~ Search used Cars for Sale j Gertifled Pre-Owned ! Compare Vehicles ! Perfect Car Finder_ ( Most Researched Vehicles ~ C Welcome Back ! Slgn In ~ Create Account ~ My KBB ZIP Code: 17050 Recently Viewed You Might Als 9 s ~: :~ ~n .I3 ~. ,s'; rr;: ~..; j-l~r ~ > t~s ~, Cars > Sedans > Ho dry > C- ivtc > 2006 > DX Sedan 4D 2006 Honda Givic DX Sedan 4D Trade-In Vatue Private~Party Value Suggested Retail Value CPO Value Photo Gallery Compare Vehicles N~V1i 1. , 'Blue Book Review Consumer Ratings Find Your Next Car Specifications 1#ur A urn enR On Blue Book ClassifledsTM Honda _~i Cvic 7S Miles Near ZIP 17050 To View Ads, Click s_~S'~ Shopping Taols BLUE B~~K~•~'RADi:-I~ V,4lUE }-~ More Photos Condition <UJHrtISrHIS7 Vatue Excellent -$9,200 Good $8,625 Fair $7,700 ;~ ~~~ ~ ~ Price New Cars Lacai Listings: (~ Search Honda CJvic Q Search Certified Pre-Owned Honda Civic (~ Search ail Classlileds near 17050 Average Consumer Rating (1074 Reviews) Read Reviews Free CARFAX Reeord Check Simitar New VehlCles f Auto Loan from 4.24°!o APR 2010 Handa,Civic 2010 Chevrolet Cobalt Compare Insurance Rates with Progressive -Photos P11Q~2~ Payment Calculator Revtew Pricing i Find a Dealer { -- --- - Pr cing F1Nd F11E RlfHT CkR More Results Compare Used vs. Nlew j 1 $5,000 to $10,000 _~ I ~ i J httn_//www.khh.e~m/khh/[ ISedC:ar.~'ricinuRenn7f.asnx?Weh~ateanrvTd=~RRrYP.arfcl=7.(}(1FiRr.T1i Save Vehlcie P ~ Finance & Insurani Get a New Car Loan from 4.24% APR Get a Fre-Owned Loan fror 4,79% APR Get Your Credit Score Now Get a Free Insurance Quat~ advertisement - tl1 P.a f7P.=~ R ~~~i~n~ n 2406 Honda Civic -Trade In Val~Ie, blue book value - Kelley Bluff Boak Both New and Used // Sedan t~ 7o View List, Glick VIEW ANOTHER YEHICi-E Select Year.., Select Make... Select Model.. Or Search by Category . Or Change ZIP Code Vehicle Highlights Mileage: 38,350 Engine: 4-Cyl. 1.8L VTEC -Transmission: Automatic Drivetrain: FWD Selected Equipment - Change Equipment Standard ~ • Power Steering Tiit WheeE Front Side Air Bags Power Windows Dual: Front Air Bags ABS {4-Wheel) Optional Air Conditioning Cerise Control Single Compact Disc Power Door Locks AM/FM Stereo J Blue• Book Trade-inl Value ICeiley 81ue Book Trade-Iri Value is the amount consumers can expect to receive from a dealer for atrade-fn vehicle, assuming an accurate appraisal of the vehicle's condition, mileage and features. 7h€s value will likely be less than the Private Party Value because the reselling dealer incurs the cost of safety Inspections, reconditioning and other costs of doing business. Vehicle•Condition Ratings Check Vehicle Title History Excellenfi • $9, 200 s [.ooks new, is in excellent mechanical condltton and needs no reconditioning. - o Never had any paint or body work and is free of rust. • Clean title history and will pass a smog and safety inspection. • • Engine compartment is clean, with no fluid leaks and Is. free of any wear or xisible defects. • Complete and verifiable service records. . Less than 5% o€ all used vehicles fall Into this category. Good ~ ~ $8,625 • Free of any major defects. • Clean title history, the paints, body, and interior have only minor {if any) blemishes, and there are no major mechanical problems. • Little or no rust on this vehicle. • Tires match and have substantial tread wear Left. • Page 2 of 4 htfn•//www khh ~.nm/irhh/T•feP.ri(`arelPririno•Rpr,nrt- ace,rVWPhC'afPnnrvT~-~RRrVParTrt-7(1f1f,R.lvfitpacza=~R~ ~/S/~llifl 2406 Honda Civic -Trade In Value, blue book value -Kelley Blue Book " ':' v A °good° vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles Pali Into this category. I__~__., Pair o Some mechanicaE or cosmetic defects and •needs servicing but Is stilt in reasonable running condition. a Clean title history, the paint, body and/or interior need work . performed by a professional. a fires may need to be replaced. r There may be some repairable rust damage. Poor ~~`.~ N/A o Severe mechanical and/or cosmetic defects and is in poor running condition. e May have problems that cannot be readily tlxedsuct3 as a:damaged frame or arusted-through body. s Branded title (salvage, flood, etc.) or unsubstantiated mileage. i<eliey Blue Book does not attempt to report a value on a °poor" vehicle because the value of these vehicles varies greatly, q vehicle in poor condition may require an Independent appraisal to determine its vatue. * Pennsylvania 3/5/2010 Accurate Condition Appraisal Change Cardition Accurately apprais€ng the condition of a vehlcte is an important aspect to determining its Blue Book value. Taking our 16 question condition quiz wilE ensure you know the correct condition rating. t * Price iVew Cars © 2010 Kelley Blue Book Co., Inc. Al! rights resented. 3/5/2010-3/11/201D Edition. The spechSc information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehkle valuations are op/nlons and may vary from vehfcle to vehicle, AcfuaJ valuatJOns wil! vary based upon market conditions, speclflcations, vehicle condition or other particular cirrumstantes pertinent Ln thts particular vehicle or the transaction or the parties to the transaction. This report Is intended for the fndNldual use of the person generating this report only and shall not he sold or transmftted to another party. Kelley Blue Book assumes no responsib/lfty for errors or om/ssfdns. (v.1003i) Page 3 of 4 hffr,•//~~vtxrcar irl~h r•.nmlkhh/rlcPr~C`arc/PrirtiroRPnrnt acri~r`]WPh(•'atPanrvTrl!-'2RRrVaarTrl='~nf1F.RrArtslr anP-~R~ ~i~/~n~ n 2006 Honda Civic -Trade In Value, blue book value -Kelley Blue Book Page ~ of 4 On K86.com Home New Cars Used Cars Research & Explore News & Reviews Dealers & Inventory Classifieds Loans & Insurance KBB®Green KI Featuring Chicago Auto Show New Cars For Sale Used Cars For Sale New Car Prices 5 Great Car Deals Car Reviews Car Videos Auto Show; About K88 About Us Contact Us Careers FAQ Media Advertislrtg Unking Privaty Slte Map Copyright & Trademarks. Terms of Service E p 1945-2x10 Kelley Btue Book Co., Inc. Business Inquiries hffin_//www.khh_cam/khh/iTcedC'.arclP~•icinuRennrt_a~nx?Vi~ehC`atesr~;vTc1=3R~4r:YearTci=2llOfi~4r.Mileage=3R~___ '~1512(}1(1 °~°~~ v~ ! h 8326538356iN DD 074018 973805fl0 07112 O OO S S Z $ 07 AV 0.347 '•A1JC0 T2 0 5107 47050$33435 P05533 IN42 I~llrllltrriruynpl~lrr,lllui~~lirl~Itirllllrl4~jrllhrlrlln DAVfD M. OLENfCK 1135 SAtdDPIPER CT MECNANICSBURG, PA 17050-8334 Here's how the ~~altae ofi your SSW accolwlnt has changed. Value on April 1, 2012 $228,481.44 Contributions and Additions $0.00 Withdrawals and Deductions $0.00 Invesirnent Gain (or Lossj $923.96 Value on June 30, 2012 $229,405.40 Your account balance distribution L-2050 D% r'' t zo4o a°i° L 2030 0% L 2020 0% ® L Income 0% G Fund 100°~ F Fund 0°~ C Fund 0°~ S Fund 0°k x~ I Fund 0°/° Your investment allocation for future contributions L 2050 0°k L 204D 0°f° ` L 203D 0% L 2020 0% L rncome 0% ® G Fund 400°/a F Fund 0°/0 C Fund 0% S Fund 0% ,- I Fund 0°/ Account Number: ;254 Date of Birth: 1954 Retirement Coverage: CSRS Employment Status: Acfire Beneficiary Designation: No !~ Message for You Your quarterly participant statement has a new look. In addition to the regular features of your statement, you can now see how your account balance is broken down by traditions[ (pre-tax) and Roth (after-taxi amounts, view your personal rate of return for:the 12 months preceding the end of the quart- er, and review your share and share price history for each of your invest- mentfunds. However, in an effort to cut costs for all participants and become more environmentsrly responsible, Transaction Detail by Fund is now a feature of your online statement only. You can log into My Account on the TSP website to view your furl partici- pant statement at any time. Yotar Personal Rate of Return Last 1Z Months x.81°fo Questions? www.tsp.gav ThriftLine: 1-TSP-YO[3-FRST 1-877-968-3778 Outside U.S. arid Canada: 404-Z33-4400 TDD: 1 TSP-THRIFT5 1-877-847-4385 To correct personal or contribution information, contact your agency. 0005528-0000004-0006093 N N y. e- O ~ N G ~ O d I N O N O O L3' N r O Lt O lC) [~ t4 ,~.+ O V (J Q ~3? W U' w ..J d o~ ~ Z C] c U © Q O O ~. ~ N C' t Z ~ N G a ~ ~ N W ~ ~ 15. r Ef3 00 0 N ~ i ~ ~ t4 ~ ~ 3 ~ Z C C ~ N ~ ~ ~ '~ ai ~ r O O V; ~t ~ ~ __ ~ ~ ~ 'CS IV O N wm ~ O O N O W ~~.I ~ ~ ONi C~~ ~~ oo°a° ~ ` °~ °~ ~~ ~ N ~~ c~ F V1 ~ O O 3 O s°o ~°r ~ t '~f ~ ~ ~a ~ ~ n ~~ y O O ~ ° c °c+~ U3 ~~° F,,., ~ N T3 ~ U Q ~ ~v <C ~ v v y.. cR N~ ~ ~`~ ~~ W rtt ~~y ~ ~ ~ v ~ ~ 3 ~ ~ W Fes-- ~ ~ p C O ~ r ~rj ~ ~ ~ ~ •~ pp" ai h ~ N 6q ~ O O O O O ~ ~ Ow ~ O ~~ W ~ rn ~ ~ ~ ~ N O ~+ p ~ a> v a~ ~ N ~ ~ ll .! ~ ~ iu ' ~ ~ ~o ~ ~ ~ C=1 ~ a ~ o ~ ~ rti" ~ ~ N ~ U ~ J ~ ~ Of3 J c c ~ o v~ R ~ ,~ ~ ,~ C Y Z ~ ! l (9 W ~ c e, ~ y go ~ ~ ~.,.'r~''~*, ~h 0 rn d .o 3 a L O C O U ~i c 3 U U Q L_ C L N °> >. C m a~ a a~ a G t6 T G O m N a c v c m v U a c w ~T w c 0 ryU C b 7~. 0 _~ 19 m O 0005528.OOppppl_pppbpg3 ~/ PenFed Online Page ,1 of 1 i Pentagon l=edera! Credit Union < Cun`erit~l~ate•and`Tinte (Easterixj Weslnesday;.6Ji;tofier 1b,'20'!2'16:'E13:58.AM I Cliok here fo print •this page Return to Previous Page I. Checking, Savings and Money Market Accounts Account Name Account Number Available Batanae Current Balance Regular Share "*'9012 Display $O.D5 $5.05 Regular Share *•'8013 Display -$4:97° 60.03 Money lVtarlce# Certficates• Account Narne Account Maturity Open Date Dividend APY Current , Number Date Rate Rate Balance 5 YR Money Market Certificate *"2561 Dispiay D113D/2009 01/30!2014 4.4090 4.50°7° $29,341.05 5 YR Money Market Certificate "*''3563 Dis la P y 02/13/20D9 02113!20'14 4.3D°~ 4.39% $29,186.31 5 YR Money Market Certificate "'2560 Display 03/26/2009 03!26!2014 3.92°~ 4.00% $11,465,29 7 YR. Money, Market Certificate ,~,, 9568 Displajr f37129/Z009 {171L~tZD1.& 3.92°!° ° 4.OQ /° $'119;911.59 1RA Share-and Certificates Account Name Account Maturity Open Date Dividend APY Current Number Date Rate Rate Balance fRA Share Traditional "`#'6405 Display 02/26/2009 N!A PUA N/A $Q.00 5 YR IRA Certificate Traditional `"'7221 Display OZl28l2DD9 02/28/2014 4.30°Io 4.39% $37,037.90 hags://online7,penfed_t~rglPenFeclpnline/Mainlvle~Te~c#.aspx 1 dl.l 012012 CSRS Benefit Es#imate Report DAVID OLENICK Repor# Date: 08(20/2012 Optional Ret(rement Annuity Unreduced tNonthly Annuity .. , .:.:.... _....$6,837.80 Reductions Early Retirement Age $0.00 Unpaid CSRS Deposit $0.00 Survivor Benefit .. , $OAO Unpaid CSRS Redeposit _ $0.00 All:emative Annuiiy _ $0.00 Total Reductions $OAO GROSS MONTHLY ANNUITY , ..: _. $6,837.00 Deductions Health Insurance Premium $285.42 Life Insurance Premium $0.00 Deritaf Insurance Premium $0.00 Vision Insurance Premium $0.00 1=ederal Tax Withhoiding , ...... .:: _ ::. $1,334A0 Total Deductions $1,619.42 ,. NET MONTHLY ANNUITY $5;212:58 Monthly Social Securiiy Offset N!A Monthly Survivor Annuity Elected . .:.:.. _ . , $0.00 Service Credits Total Service Includes Yrs .Mos Davs Yrs Mos Davs CSRS Service Credits $ti ` a} 5. LEO/FF/ATC Seniice - 0 0 ~ 0 Nonereditabfe Service 0 0 0 Total Mlfitary Service 0 0 0 _.. _ Sick Leave . ~ ':.1 `. 5 15. Unpaid Mllltary Service b 0 :. 0 Total Service Credit 37 5 20 Congressional Service 0 0 0 Estimate Basis Date of Birtb _ `` ` /1954 Retirement System `. `. CSRS Regular Age at Retiremeni 57 Years 10 Monihs Date of Retirement 08/31/2012 Retirement SCD 08/2ti/1976 Date of Se aration p ' N!A LEOIFF/ATC SCD N!A High-3 Average Salary $115,433 Spouse's Date of Birth N!A Sick Leave Hour§ '3041.5 Spouse's Age N/A Survivor Benefit Base Elected NIA FEGLI Eiection BO Unpaid Pre 10l01H982 CSRS Deposif $0.00 FEi-IB Plan Code 112 Unpaid Pre 03/01/1991 CSRS Redeposit $0.00 Dental insurance Plan Type None CSRS lump-Sum Credit N!A Vsion Insurance Plan Type None Tax Status Single with 0 Exemptions Footnotes are on 2nd Page. Page 1 or4 CSRS Benefit Estimate Report DAVID OLENICK Report Date: 08!2012012 BENEFIT AMOUNTS SHOWN IN THIS REPORT ARE ESTIMATES AND NOT INTENDED TO REPRESENT ACTUAL AMOUNTS. THE OFFICE OF PERSONNEL MANAGEMENT HAS SOLE AUTHORITY AND RESPONSIBILITY FOR ADJUDICATING RETIREMENT CLAIMS. Upon retiremen€, your retirement application and supporting documeniafion is submitted to OPM. Upon receipt of your retirement claim, OPM will place you in an interim pay status. Your interim payments will continue until OPM has completed full adjudication of your retirement claim. A CSRS service factor of 0.710833, which represents your total service credit for re€irement computation purposes, was used in the formula #o compute your estimated monthly annuity. Based on employee's fnal basic pay of $115,742 and 297.50 hours of unused annual leave, the gross lump-sum annual leave payment would be $16,527.08 Page 2 of 4 Report Date: 08!2012012 CSRS Benefit Estimate Report DAVID OLENICK Ext~(anation of Annuity Computation Unreduced Monthly Annuity: Monthly annuity amount before any reductions, The amounf is based on employee's high-3 average salary and total service credit at date of retirement and the applicable CSRS benefit formula. Annuity Reductions: Early Retirement Age: A reduction of 2.0 percent for each year employee is under age 55 at date of retirement Applies only to early and discontinued service retirement cases. Unpaid CSRS DeposiE A reduction equal to 10 percent of the amount of unpaid deposits reiating to any creditable service prior to 10/01/1982 during which employee made no retirement contributions. Survivor Benefit: A reduction for the cast of a survivor benefit election. The cost is approximately equal to 10 percent of Ehe base specified for use in compufing the benefit. Unpaid CSRS Redeposit A reduction applicable to cases in which employee received a refund of CSRS retirement contrEbufions for a period of service which ended before 03!01!1991 and has elected not to make a redeposit. The reduction is based on the amount of the unpaid redeposit and the employee's age at time of retirement. The actuarial reduction is not applicable in disability cases - a redeposit must be made for the refunded service in order for the service fa be included in the computation of the disability annuity. Alternative Annuity: An actuarial reduction that is applied when an employee elects the "Alternative Form of Annuity" (AFA). The amounf of fhe reduction is based on the surn of the employee's total retirement contributions, the total of all unpaid civilian service deposits and CSRS past 02/28/1991 redeposits, and the employee's age at time of retirement. The AFA election is not applicable in disabBity cases. Gross Monthly Annuity: Monthly annuity payable after employee's "Unreduced Monthly Annuity" is reduced by the sum of applicable reductions. Annutty Deductions: Heal#h Insurance Premium: Monthly cost of health plan coverage elected. (See Health Insurance Election, below, far details.} Life Insurance Premium: Monthly cost of life insurance coverage elected. (See Life Insurance Election, below, for details.} Dental Insurance Premium: Monthly cost of dental insurance coverage elected. (See Dental Insurance Election, below, for details.} Vision Insurance Premium: Monthiy cost of vision insurance coverage elected. (see Vision Insurance Election, below, for details.) Federal Tax Withholding: Federal tax wllhhoiding based on amount of the Gross Monthiy Annuity payable, number of exemptions claimed, and the 8iing status (married or single} elected. The tax withheld is based on 2012 rates and each exemption reduces the taxable annuity by $316.67. NET MONTHLY ANNUITY: Monthiy annuity payable after employee's "Gross Monthiy Annuity" is reduced by the sum of applicable deductions. Monthly Social Security Offset: The Gross Monthly Annuity will be reduced (offset} when employee first becomes eligible for Social (CSRS Offset only) Security (usually at age 62), even if employee does not apply for Social Security. A surviving spouse's CSRS annuity may also be reduced if Social Security benefits are payable.. Monthly Survivor Annuity Monthly survivor annuity payable based on 55 percent of the base speci#ied for use in computing the Elected: annuity. (See Survivor Annuity Alternatives, below; for details.) Service Credits CSRS Service Credits Total service (civilian and military) creditable under CSRS for purposes of determining eligibility for retirement- Noncreditable Service: Service that is not creditable and is not used in computing the amount of an annuity. Examples of such service are unpaid post-09130!1982 deposit service and unpaid post-02/28/1981 redeposit service, or in the case of disability retirement any unpaid redeposit service. Sick Leave: Service credits based on employee's total hours of unused sick leave at date of retirement. Unused sick leave hours are converted to service credit years, months, and days, as applicable. Total Service Credits: Service credits used in compufing employee's annuity. Total Service Includes: (Types of service included in employee's Total Service Credit, as applicable.) LEOIFFlATC Service: Service as a Federal law enforcement officer, firefighter, or air traffic controller. Total Military Service: Creditable active duty military service used in computing employee's annuity. Unpaid Military Service: Military service used in compufing employee's annuity for which a deposit has not been made. if employee is eligible for Social Security benefits at age 62, the annuity may be recomputed excluding this service. Congressional Service: Service performed as a Congressional empfayee_ Page 3 of 4 Report Date: 08/20/2092 CSRS Benefit Estimate Report DAVID OLENICK Estimate Basis (The data shown in this section of the Benefit Estimate Report was considered in computing estimated benefits.) Date of Retirement: Date employee separated from Federal service. The annuity commencement date depends on the type of retirement. In Disabiilty and Discontinued Service Retirement cases; the annuity begins the day following the date of retirement. In Optional and Earfy Retirement cases, if the date of retirement is before the 4th day of the month, Ehe annuity begins fhe day following the date of retirement. Otherwise, the annuity begins the f st day of the month following the month of retirement. Date of Separation: This date is applicable only in a Defer-ed Retirement. case and is the date employee separated froth Federal service. In such cases, the Dafe of Retirement refers to the date the deferred annuity will commence. High•3 Average Salary: Employee's highest average salary during any 3 years of consecutive service. The computation is based on annual rates of pay and the period of time each rata was in effect. CSRS Lump-Sum Credlf Employee's total unrefunded CSRS retirement contribukions as of Date of Retirement- The total includes all civilian service deposits, refund redeposits, and military service deposits made by employee. The amount is used to compute the nontaxable portion of the annuity and the reduction applied when an Alternafive Annuity is elected. lax Status: Shows, if applicable, the basis used to compute Federal Tax Withholding deductions. Survivor Annuity Alternatives Alternative Base Bass Amount Survivor Annuity MEonthly Cast ~' .;00% ' ' i ;'. $0..130 `::0.00 '' -$0.00...- : . 80% $0.00 $0.00 $0.00 ' ` 80°l0 $0,.00 .. ` $0 00 . - ' $0.00 . 70% $0.00 $0.00 $0.00 50% $OAO $0.00 $0.00 40°k $0.00. $0 00 `.$0.00 ..' , 30% $0.00 $0.00 $0.00 20% `: $0.00. $0.00 .: ` $0.00 . $0.00 $0.00 $0.00 The table above shows the monthly amount and cost of a survivor annuity based on the selection of alternative portions of a retirement annuity far use in computing the amount of the survivor annuity. Health Insurance Plan Name Tvpe Monthlv Premium Blue Cross and 13tue Shield Service Benefit Plan -'Nationwide Basic Family ' $265.42 (Based on 2012 FEHB rates.} Life Insurance The table below shows the amount of insurance coverage employee elected io continue in retirement and the monthly premium costs, based on 2012 FEGLI rates (rates effective January 2005). Reductions begin at age ti5 or dale of retirement if later. Coverage Based On Final Basic Pay Of $O.OtT Ntonfhly Premiums Basic N1A TYpQ At Retirement At Aae 65 At Age 70 At Aae 75 At Ane 80 Option A -Standard N1A Basic Option B - Additional [0 multiples] NIA 75% Reduction NIA N!A NIA N!A N1A Total Coverage NIA 50% Reduction NIA N!A N/A N!A NIA Option C -Family [0 multiples] Ne Reduction N1A NIA N/A N/A NIA Spouse N!A Option A N1A N/A N/A N/A N/A Child NIA [0 mui.] NIA N1A NIA N!A NIA [O mul.j NIA N/A N1A N!A NIA Note: Dental & Vision Insurance Plan Name Tvoe Monthlv Premium N!A Denta{ None NIA N1A Vision None NIA (Based on 2012 FEDVIP rakes.) Pagedor4 Oce Employees' Cash Accumulation Plan ~~~ Pension Estimate Statement Statement Date: 04-25-2012 7EANENE L OLENICK 1109 KENT DRNE MECHANICSBURG, PA 17050 Here's the pension estimate you requested. The amounts shown are estimated benefits based on the Plan's terms and applicable law currently in effect and your personal information on file. Actual benefits payable to you may vary from the amounts' shown on this estimate and will be based on the Plan's terms and applicable law in effect when benefits become payable. The Plan Sponsor reserves the right to correct any errors. If it is determined at any time that the information provided on this statement is inaccurate or conflicts with the terms of the Plan, the.Plan's terms will prevail and the amount of your benefit will be corrected accordingly. Your Personal. Information Birth Date 1970 Original Hire Date June 30, 1997 Marital Status Marred Beneficiary Date of Birth 1954 Spouse Date of Birth 1954 Your Assumptions Last Day of Employment January 3, 2003 Benefit Commencement Date June 1, 2012 Age at Date You Begin Receiving Benefits (in years) 42.0000 Interest Rate 5.00% Annual Pay Increase Percentage 0.00% CAP Starting Balance on January 1, 2003 $13,701.70 Payment Option Information Following is a list of estimated payment options that are available to you based on the assumptions you requested on Apri120, 2012. Please refer to the Pension Option Descriptions for additional options that may be available. The Single Life Annuity is the automatic payment form if youre single, unless you elect a different payment option. The 50% Joint and Survivor Annuity is the automatic payment form if you`re married, unless you elect a different payment option and your spouse consents. Your :Estimated Payment Options Pension Estimate Statement, Page 2 Payable to Your Payable Beneficiary Upon Estimated Monthly Payments as of Jnne 1, 2012 to You Your Death Lump Snm $22,078.62 $0.00 ,This option is a one-time payment. Single Life Annuity $103.10 $0.00 50% Joint and Survivor Annuity $101.90 $50.95 75% Joint and Survivor Annuity. $101.32 $75.94 100% Joint and. Survivor Annuity $100.73 $100.73 10-Year Certain and Life $102.83 $102.83 If you die after receiving 10 years of payments, no benef t would be payable to your beneficiary. If You're Planning to Start Your Payment Soon Please notify the Oce Retirement Information Center 45 to 90 days before the date you want your pension payments to start. Missing this deadline may delay your payments. For More Information Tf you need additional information, call the Oce Retirement Information Center toll-free at 1-866-505-3375 Oce Retirement Information Center Representatives are available between 8 a.m. and 4 p.m., Central Time, Monday through Friday. Oce Employees' Cash Accumulation Plan ~C~ Pension Option Descriptions Statement Date: 04-25-2012 JEANENE L OLENICK Here are your payment options under the Oce Employees' Cash Accumulation Plan: Single Life Annuity This option provides a monthly payment until your death. Your monthly payments under this option are larger than those under the 50% Joint and Survivor Annuity. However, all pension payments stop when you die regardless of your marital status. If you`re married and elect this option, your spouse must consent to your election. "This is the automatic payment form if you're single, unless you elect a different payment option. Joint and Survivor Annuity _ This option provides a monthly payment until your death. 50%, 75%, or 100°10 of the amount you receive will be paid aftef your death to your designated beneficiary as long. as he or she lives. Under this option, the amount you. would receive during your lifetime is less than the amount you would receive under the Single-Life Annuity. The amount of the reduction depends on the age of both you and your beneficiary and on the percentage to be continued after your death. If you're married and elect this option (other than the 50% option with your spouse as your beneficiary), your spouse must consent to your election. The 50% Joint and Survivor Annuity is the automatic payment form if you're married, unless you elect a different payment option and your spouse consents. 1 Q-Year Certain and Life This option provides a monthly payment until your death. If you die before you receive payments for 10 years, your beneficiary (or estate, if no beneficiary is designated) will receive the remaining payments. If you and all of your beneficiaries die before 10 years of payments are made, the estate of the last survivor will receive a single lump sum payment based on the value of the remaining payments. If you die after you receive 10 years of payments, no further benefits will be paid to any beneficiary. If you're married and elect this option, your spouse must consent to your election. Lump Sum Option This option provides a single payment of the value of your entire benefit. If you're married and elect this option, your spouse must consent to your election. ~~ s.~~U ~USA``~'~ d~ ~lillil ~c.~ j~'ISTRQ~ Prevent identity theft-protect your Social Security number Your Social Security Statement xnt~v.socinJsecuritygov Prepared especially for David M. Oleniclc August 20, 2012 See inside for your persoxnl information ~'~~ What's inside... Your Estfmated Benefits ...............................................................2 Your Earnings Record .................................................................. 3 Some Facts Ahont Social Security ............................................... 4 If You Need More Information ....................................................4 What Social Security Means To You This Social Security Statement can help you plan for your fmancial future. It provides estimates of your Social Security benefits under cuz~•ent law and updates your latest reported earnings. Please read this Stateme»t carefully. If you see a mistake, please let us know. That's important because your benefits will be based on our record of your lifetime earnings. We recommend you keep a copy of your Statement with your financial zecozds. Social Security is for people of all ages... We're more than a retirement program. Social Secutiry also can provide benefits if you become disabled and help support your family after you die. Work to build a secure future... Social Security is the largest source of income for most elderly Americans today, but Social Security was never intended to be your only source of income when you retire. You also will need other savings, investments, pensions or retirement accounts to make sure you have enough money to live comfortably when you retire. Saving and investing wisely are important not only for you and your family, but for the entire country. If you want to learn more about haw and why to save, you should visit fvww mymoneygov, a federal gavernrrzent website dedicated to teaching all Americans the basics of financial management. About Social Security's future... Social Security is a compact between generations. Since 1935, America has kept the promise of security for its workers and their families. Now, however, the Social Security system is facing serious financial problems, and action is needed soon to make sure the. system will be sound when today's younger workers are ready for retirement. Without changes, in 2033 the Social Security Trust Fund will be able to pay only about 75 cents foz• each dollar of scheduled benefits.* We need to zesolve these issues soon to make sure Social Security continues to provide a foundation of protection fax fiiture generations. Social-Security on the Net... You can read publications, :including When To Start Receiving Retire~~aent Benefits; use our Retirement Estimator to obtain immediate and personalized estimates of future benefits; and when you're ready to apply for benefits, use our improved online appIicatian--It's so easy! Michael J. Ashue Commissioner * These estimates are based on the intermediate assumptions from the Social Security Trustees' Annual Report to the Congress. Your Estimated Benefits *Retirement To get retirement benefits, you need 40 credits of tivork. Your record shows you have at least 14 credits at this time, including assumed credits for last year and this year if you continue to work. *DfsahiHty To get benefits if you become disabled right now, you need 36 credits of work. Your record shows you lu~ve at least l4 credits at this rime. *Family If you get retirement or disability benefits, your spouse and children also may qualify for benefits. *Survivors For your family to get survivors benefits if you die this year, you must have 36 credits of work. Your record shows you have at least 14 credits at this time. Medicare You have enough credits to qualify for Medicare at age 65. Even if you do not retire at age 65, be sure to contact Social Security three months before your 65th birthday to enroll in Medicare. * Yoar estimated benefits are based on carrent law. Congress has made changes to the Iaw in ttre past and can do so at any time. The Iaw governing benefit amounts may change because, by 2033, flee payroll taxes collected will be enough to pay only about 75 percent of scheduled benefits. We based your benefit estmates on flrese facts: Yorrr• date of birth (please verify your name on page I and this date of birth) .................................. 1954 Your estimated. taxable earnings per year after 2012 ............................................................................ NONE Your Social Security number (only the last four digits are shown to help prevent identity theft) ......... XXX-XX-1643 How Your Benefits Are Estimated To qualify for benefits, you earn "credits" through your work - up to four each year. This year, for example, you earn one credit for each $1,130 of wages or self-employment income. When you've earned $4,520, you've earned your four credits for the year. Most people need 40 credits, earned over thew working lifetime, to receive retirement benefits. For disability and survivors benefits, young people need fewer credits to be eligible, We checked your records to see whether you have earned enough credits to qualify for benefits.lf you haven't earned ennugit yet to qualify for any type of benefit, we can't give you a benefit estimate now. If you continue to work, we'll give you an estimate when you do qualify. What we assumed -If you have enough work credits, we estimated your benefit amounts using your average earnings over your working lifetime. For 20I2 and later (up to retirement age), we assumed you'll continue to work and make about th same as you did irr 2010 or 2011. We also included credits we as~surned you earned iastyear and this year. Generally, the older you are and the closer you are to retirement, the more accurate the retirement estimates will be because they are based on a longer work history with fewer uncertainties such as earnings fluchratiorrs and future law changes. We encourage you to use our online Retirement Estimator to obtain immediate and personalized benefit estimates. We can't provide your actual benefit amount until you apply for benefits. And that amount may differ from the estimates shave because: (1) Your earnings may increase or decreaserrr the future. (2) After you start receiving benefits, they will be adjusted for cost-of-living increases. (3) Your estimated benefits are based on ciurent law. The law governing benefit amounts may change. (4) Your benefit amount may be affected by military service, railroad employment or pensions earned through work on which you did not gay Social Security tax. Visit rvrvw.soeialsecnrttygov to learn more. Windfall Elimination Provision (VVEP) - If you receive a pension from employment in which you did not pay Social Security taxes and you also qualify for your own Social Security retirement or disability benefit, your Social Security benefit may be reduced, but not eliminated, by WEP. The amount of the reduction, if any, depends on your earnings and number of years in jobs in which you paid Social Security taxes, and the year you are age 62 or become disabled. To estimate WEP's effect on your Social Security benefit, visit rvrvrv soctaisecrrrttygot/WEP-CHART. In 2012, tine maximum monthly reduction is $384. For more inforrnation,'please see 13'indfall Eli»:rnation Provision (Publication No. OS-10045) at wwwsocialsecur7lygov/WEP. Government Pension Offset (GPO) -1f you receive a pension based on federal, state or locai government work in which you did not pay Social Security taxes and you qualify, now or in the future, for Social Security benefits as a cur~~nt or former spouse, widow or widower, you are likely to be affected by GPO. If GPO applies, your Social Security benefit will be reduced by an amount equal to two-thirds of your government pension, and could be reduced to zero. Even if your benefit is reduced to zero, you will be eligible for Medicare at age 65 on your spouse's record. To learn more, please see Government Pension Offset (Publication No. OS-10007) at ivrvrusoctalsecuritygov/GPO. t Clvlx Your Earnings Record Your Taxed You: Taxed Yeazs You Social Security Medicare Worked Eamiogs Earnings 1473 1,359 1,359 1974 3,857 3,857 1975 0 0 i97b 0 0 1977 432 432 1978 525 525 1479 0 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1942 1993 1994 1995 1996 1997 1998 1999 2000 0 2,509 1,512 0 26,616 28,371 31,518 32,494 36,5]4 36,656 40,584 43,252 43,140 47,868 54,513 56,888 57,257 63,985 56,096 65,289 77,021 191,108 Your Taxed Your Taxed Years You Social Security Mcdica~c Worked Pamings Comings 2001 0 95,141 2002 0 88,817 2003 0 130,722 2004 0 117,351 2005 0 104,607 200b 0 111,775 2007 0 109,411 2098 0 151,546 2009 0 144,547 2010 2011 Total Social Security and Medicare taxes paid over your working career Through the last year reported on the chart above: 128,049 123,421 Estimated taxes paid for Social Security; Estimated taxes paid for Medicare; You paid; $547 You paid: $31,602 Your employers paid: $547 Your elnpioyers paid: $31,602 Note: In 2011, you paid 4.2 percent of your salary, up to $106,800, in Social Secnrity taxes and 1.45 percent in Medicare taxes on your entire salary. Your empiayer paid 6.2 percent in Social Security taxes and 1.45 percent in Medicare faxes for you. !f you were self- employed, you paid the combined employee and employer amount of 10.4 percentln Sociat Security taxes and 2.9 percent in Medicare taxes on your net earnings. Help Us Keep Your Earnings Record Accurate You, your employer and Social Security share responsibility for the accuracy of your earnings record. Since you began working, we recorded your reported earnings under your name and Social Security number. We have updated your record each time your employer (ar you, if you're self-employed) reported your earnings. Remember, it's your earnings, not the amount of taxes you paid or the number of credits you've earned, that determine your benefit amount. When we figure that amount, we base it on your average earnings over your lifetime. If our records are wrong, you may not receive all the benefits to which you're entitled. Review this chart careflllly using your own records to make sure our information is correct and that we've recorded each year you worked. You're the only persou who can look at the earnings chart and know whether it is complete and correct. Some or all of your earnings from last year Inay not be shown on your Staten:ent. It could be that we still were processing last year's earnings reports when your Siateme~rt vas prepared. Note: if you worked for more than one employer during any year, ar if you had both earnings and self-employment income, ive combined yolk earnings for the year. There's a limit an the amount of earnings on which you pay S9c[a[ Seeu>;~lty taxes each year. The limit increases yearly. Earnings above the limit will slot appear on your earnings chart as Social Security earnings. (For Medicare taxes, the maximum earnings amount began rising in 1991. Since 1994, all of yotu earnings are taxed for Medicare.) Call us right away at 1-8110-772-1213 (7 a.m: 7 p.m. your local time) if any earnings for years before Last year are shown incorrectly. Please have your W-2 or tax return for those years available. (If you live outside the U.S., follow the directions at the bottom of page 4.) Some Facts About Social Security About Social Security and Medicare... Sociat Security pays retirement, disability, family and survivors benefits. Medicare, a separate program run by the Centers far Medicare & Medicaid Services, helps pay for inpatient hospital caze,,nursing care, doctors' fees, drugs, and other medjcal sernces and supplies to people age 65 and older, as well as to people who have been receiving Social Security disability benefits for two years or more. Medicare does not pay for long-term care, so you may want to consider options for private insurance. Your Social Security covered earnings qualify you for both programs. For more information about Medicare, visit rvwrv medicaregov or call 1-800-633-4227 (TTY 1-877,486-2048 ifyou are deaf or hard of bearing). Retirement - If you were boru before 1938, your full retirement age is 6S. Because of a 1983 change in the law, the full retirement age will increase gradually to 67 for people born in 1960 and later. Some people retire before their full retirement age. You can retire as early as 62 and take benefits at a reduced rate. If you work after your full retirement age, you can receive higher benefits because of additional earnings and credits for delayed retirement. Disability - If you become disabled before full retirement age, you can receive disability benefits after six months if you have: --enough credits from earnings (depending on your age, you must have earned six to 20 of your credits in the three to 10 years before you became disabled); and - a physical or mental impairment that`s expected to prevent you from doing "substantial" work for a year or more or result in death. If you are filing for disability benefits, please let us know ifyou are on active military duty or are a recently discharged veteran, so that we can handle your claim more quickly. Tamlly - If you're eligible for disability or retirement. benefits, your current or divorced spouse, Horror childreu or adult children disabled before age 22 also may receive benefits. Each may qualify for up to about 50 percent of your benefit amount. Survivors -When you die, certain members of your family inay be eligible for benefits: your spouse age b0 or older (SO or older if disabled, or any age if caring for your children younger than age 16); and ----your children if unmarried and younger than age 18, still in school and younger thaw ].9 years old, or adult childreu disabled before age 22. If you are divorced, your ex-spouse could be eligible fora' widow's or widower's benefit on yotu record when you die. Extra Help with Medicare - If you know someone who is on Medicare and has limited income and resources, extra help is available for prescription drug costs. The extra help can help pay the monthly premiums, annual deductibles and prescuphon co-payments. To Iearn more or to apply, visit wwwsocialsecuritygnv or call 1-800-772-1213 (TTY 1-800-325-0778). Receive benefits and still work... You can work and still get retirement ar survivors benefits. If you're younger than your full retirement age, there are limits on how much you can earn without affecting your benefit amount. When you apply for benefits, we'll tell you what the limits are and whether work would affect your monthly benefits. When you reach full retirement age, the earnings limits no longer apply. Before you decide to retire.., Carefully consider the advantages and disadvantages of early retirement. If you c}loose to receive benefits before you reach full retirement age, your monthly benefits will be reduced. To help you decide the best time to retire, we offer a free publication, IYhen To Start Recelvi~tg Retirement Benefits (Publication No. OS-10147}, that identifies the many factors you should consider befog applying. Mast people can receive an estimate of their benefit based on their actual Social Secuitity earnings record by using our online Retirement Estimator. You also can calculate future retirement benefits by using the Social Security Benefit Calculators at tvivivsocialsecuritygov. Other helpful free publications include: - RetirementBenefrts(No.05-10035) - Understanding The Benefits (No. OS-10024} - Your Retirement Berrefrt: How It Is Figured (No. OS-10070) _.. . - Windfall Elimination Provision (No. OS-10045) - Gove~•nnrenf Pension Q,(j'set (No. OS-10007} - Identity The1i' And Xour Social Sec:u•it~~ Number (IVo. OS-10064} We also have other leaflets and fact sheets with information about specific topics such as military service, self-employment or foreign employment. You can request Social Security publications at our website, wwwsocialsecuritygov, or by calling us at 1-800-772-1213.Our website has a list of frequently asked questions that may answer questions you have. We have easy-to-use online applications for benefits that can save you a telephone tali or a trip to a field office. You may -also qualify for government benefits outside of Social Security. For more information on these benefits, visit fvww.govhenefits,gov. If you need more ilnfarmation -Contact any Social Security office, or call us toll-free at 1-800-772-1213. (If you are deaf or hard of hearing, you may call our TTY number,1-800-325-0778.) If you have questions about your personal information, you must provide your complete Social Security Number. If you are in the United States, you also inay write to the Social Security Administration, Office of Earnings Operations, P.O. Box 33026, Baltimore, MD 21290-3026. If you are outside the United States, please write to the Office of International Operations, P.O. Box 17769, Baltimore, MD 21235-7769, USA. You can request a Statement at any time. Form SSA-7UU5-OL(OS112) ~t JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 09-7822 CIVIL TERM ;r70 Z�Z Fri V,r-- -- C-; CIVIL ACTION - LAW cx� r DAVID M. OLENICK, Defendant IN DIVORCE c� nC-, 77 STIPULATION TO VACATE ORDER AND NOW COMES, Plaintiff, Jeanene L. Olenick, by and through her attorney, Melissa P. Greevy, Esquire, and Defendant, David M. Olenick, by and through his attorney, Lori K. Serratelli, Esquire, who file this Stipulation to Vacate Order and aver as follows: WHEREAS, on November 12, 2009, Plaintiff filed a Complaint in Divorce. WHEREAS, on November 12, 2009, Plaintiff filed a Petition for Special Relief/Injunction to prohibit the parties from removing,transferring, conveyancing, disposing, alienating or encumbering of the parties' marital assets listed in said Petition. WHEREAS, on December 3, 2009, an Order of Court was issued prohibiting the parties from removing,transferring, conveyancing, disposing, alienating or encumbering of the parties' marital assets listed in the above-referenced Petition. WHEREAS, on June 6, 2013,the parties reached a full property settlement agreement of their assets. NOW,THEREFORE,the parties hereto stipulate and agree as follows: 1. The Order of December 3, 2009 shall be vacated by the Court; and 2. Counsel for Defendant shall advise all of the parties' banks and investment accounts that said Order is vacated. 3. The parties agree to the entry of a Court Order in accordance with the terms and provisions of this Stipulation by a court of competent jurisdiction. IN WITNESS WHEREOF, the parties and their counsel have set their hands and seals this day of 2013. WITNESSES: Melissa P. Greevy, Esquire J ene L. Oler Attorney for Plaintiff Ptrntiff L K. erratelli, Esquire David M. Olenick Attorney for Defendant Defendant x. Johnson, Duffle, Stewart&Weidner r-UtiBERLAND COUtITY By: Melissa P. Greevy, Esquire %a PENNSYLV"'A I.D. No. 77950 Attorneys for Plaintiff 301 Market Street P. 0. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 mpg@jdsw.com JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff NO. 09-7822 V. CIVIL ACTION—LAW DAVID M. OLENICK, IN DIVORCE Defendant AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under, Section 3301(c) of the Divorce Code was filed on November 12, 2009, 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and service the Complaint. 3. 1 consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the Decree. WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1 1 consent to the entry of a final Decree of Divorce without notice. 2. 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 above are true and correct.. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. C /L DATE: J NENE L. O E I K, PLAINTIFF JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 09-7822 CIVIL TERM CIVIL ACTION-LAW DAVID M. OLENICK, C= Defendant IN DIVORCE :zm C= co 7_4 S"i AFFIDAVIT OF CONSENT UNDER 3301(C) OF THE DIVORCE CODE =C:) 'C (1) A Complaint in Divorce under Section 3301(c)of the Divorce Code was filed on November 12,2009. (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 of divorce without formal notice of the intention to request entry of a divorce 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. Sec. 4904 relating to unworn falsification to authorities. DATED David M. Olenick JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 09-7822 CIVIL TERM CIVIL ACTION - LAW DAVID M. OLENICK, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER WOW) AND 0301(D) OF THE DIVORCE CODE I I consent to the entry of a final decree of 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 affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Sec. 4904 relating to unworn falsification to authorities. DATED David M. Olenick PICO ryli= ZZ -0 00 C-5 Z:--n C:) JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 09 - 7822 Civil DAVID M. OLENICK, Defendant IN DIVORCE ORDER OF COURT AND NOW, this day of 2013, an agreement having been reached between the parties resolving all claims raised in the proceedings, the agreement, at the request of counsel (see counsels ' letters of June 18, 2013, and June 19, 2013, attached hereto) , not to be made part of the record, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court, along with the affidavits of consent and waivers of notice of intention to request entry of divorce decree signed by the parties, requesting a final decree in divorce. BY THE COURT, Ke A. Hess, P.J. cc: A/elissa P. Greevy ZZ C- -a- Attorney for Plaintiff C= rTl--- 7)r-n (hr- Lori K. Serratelli Attorney for Defendant 1-.c trait to jl /! -r , _:� Z JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 09-7822 CIVIL TERM CIVIL ACTION - LAW ; DAVID M. OLENICK, -az w rat cw c._ s , Defendant IN DIVORCE r- ��,, ORDER D `D AND NOW, this 10 day of , 2013, upon consideration of the parties' Stipulation to Vacate Order, it is hereby ORDERED as follows: 1. The Order of December 3, 2009 is hereby vacated; and 2. Counsel for Defendant shall advise all of the parties' banks and investment accounts that said Order is vacated. BY THE COURT: M. L. Ebert,Judge Distribution: strib u,- Melissa P. Greevy, Esquire, 301 Market Street, PO Box 109, Lemoyne, PA 17043-0109 Lori K. Serratelli, Esquire, 2080 Linglestown Road, Suite 201, Harrisburg, PA 17110 ��l L H111 ('i F F1 2013 JUN 2 4 PH 1: 17 CUMBERLAND COUNTY PENNSYLVANA Johnson, Duffie, Stewart&Weidner By: Melissa P. Greevy, Esquire - I.D. No. 77950 Attorneys for Plaintiff 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 mpg @jdsw.com JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff NO. 09-7822 V. CIVIL ACTION — LAW DAVID M. OLENICK, IN DIVORCE Defendant PRAECIPE TO THE PROTHONOTARY: Please mark as withdrawn and discontinued the Plaintiff's claims for. equitable distribution, alimony, alimony pendente lite, and counsel fees, costs and expenses, as set forth under Counts II through IV of the Divorce Complaint, filed herein on November 12, 2009. Date: I Melissa P. Greevy, Esquire CERTIFICATE OF SERVICE ' Sf 1, Melissa P. Greevy, Esquire, do hereby certify that on the day of June, 2013, 1 served a true and correct copy of the foregoing Praecipe upon the counsel of record by depositing same in the United States Mail, first-class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART &WEIDNER Melissa P. Greevy, Esquire :564124 20'3 AN 24 pliq a 17 I'E iNS YLVM41 Johnson, Duffie, Stewart&Weidner By: Melissa P. Greevy, Esquire I.D. No. 77950 Attorneys for Plaintiff 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 mpg @jdsw.com JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff NO. 09-7822 V. CIVIL ACTION — LAW DAVID M. OLENICK, IN DIVORCE Defendant PRAECIPE TO TRANSMIT RECORD To the Prothonotary:. Transmit the record, together with the following information, to the court for entry of divorce decree: 1. Ground for divorce: irretrievable breakdown under§ 3301(c) of the Divorce Code. 2. Date and manner of service of Complaint: November 23, 2009 via personal service delivery. Affidavit of Service was filed with the Prothonotary on November 30, 2009. 3. Date of execution of the Affidavit of Consent required by § 3301(c) of the Divorce Code: by Plaintiff: June 17, 2013; by Defendant: June 14, 2013. 4. Related claims pending: None. 5. Date Plaintiff's Waiver of Notice in § 3301(c) Divorce was filed with the Prothonotary: June 18, 2013. Date Defendant's Waiver of Notice in § 3301(c) Divorce was filed with the Prothonotary: June 18, 2013. JOHNSON, DUFFIE, STEWART &WEIDNER Dat G� elissa P. Greevy :562462 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JEANENE L. OLENICK V. DAVID M. OLENICK NO. 09-7822 DIVORCE DECREE AND NOW, 1uh� �.� o.�C g�l� 2013 it is ordered and decreed that JEANENE L. OLENICK plaintiff, and DAVID M. OLENICK defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") None. By the Court, Attest: J. Prothonotary No-kae,4- Copt s mai Isd 4o attq -�erraktl i ��a7I .3 r ti rn co Johnson, Duffie, Stewart &Weidner ter_ By: Melissa P. Greevy, Esquire r--y� ' I.D. No. 77950 Attorneys for Plaintiff ..;..‘"73 -0 301 Market Street P. O. Box 109 3> Lemoyne, Pennsylvania 17043-0109 `" (717) 761-4540 mpg @jdsw.com JEANENE L. OLENICK, : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff : NO. 09-7822 v. : CIVIL ACTION — LAW DAVID M. OLENICK, : IN DIVORCE Defendant MOTION FOR ENTRY OF ORDER UPON STIPULATION AND NOW, comes Plaintiff, Jeanene L. Olenick, by and through her attorneys, Johnson, Duffie, Stewart & Weidner, and moves your Honorable Court to enter an Order upon Stipulation for the entry of a "Qualified Domestic Relations Order". The Honorable M.L. Ebert, Jr. signed the Decree in Divorce in this matter. The undersigned represents that Defendant's counsel concurs with the entry of this Order by the terms of the parties' signed Stipulation attached hereto. Respectfully submitted, Date: / 0/qt/3 JOHNSON, DUFFIE, STEWART &WEIDNER cpyttehrc..... ? Melissa P. Greevy Johnson, Duffie, Stewart &Weidner r, By: Melissa P. Greevy, Esquire No. 77950 Attorneys for Plaintiff -<1- c 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 <-- :? (717) 761-4540 = mpg @jdsw.com JEANENE L. OLENICK, : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff : NO. 09-7822 v. : CIVIL ACTION — LAW DAVID M. OLENICK, : IN DIVORCE Defendant MOTION FOR ENTRY OF ORDER UPON STIPULATION AND NOW, comes Plaintiff, Jeanene L. Olenick, by and through her attorneys, Johnson, Duffie, Stewart & Weidner, and moves your Honorable Court to enter an Order upon Stipulation for the entry of a "Qualified Domestic Relations Order". The Honorable M.L. Ebert, Jr. signed the Decree in Divorce in this matter. The undersigned represents that Defendant's counsel concurs with the entry of this Order by the terms of the parties' signed Stipulation attached hereto. Respectfully submitted, Date: 4I JOHNSON, DUFFIE, STEWART &WEIDNER • ,j1f t _ _I Melissa P. Greevy Jeanene L. Olenick : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. David M. Olenick : NO. 09-7822 Defendant DOMESTIC RELATIONS ORDER 1. This Domestic Relations Order ("DRO") creates and recognizes the existence of the Alternate Payee's right to receive a portion of the benefits payable with respect to the Participant. It is intended to constitute a Qualifying Retirement Benefits Court Order by the Federal Retirement Thrift Investment Board ("Board"). 2. This DRO is entered pursuant to authority granted under the applicable domestic relations laws of the State of Pennsylvania. 3. This DRO relates to the provision of marital property rights to the Alternate Payee. 4. This DRO applies to the Thrift Savings Plan ("Plan") and any successor thereto. David M. Olenick ("Participant") is a Participant in the Plan. Jeanene L. Olenick ("Alternate Payee"), the former spouse, is the Alternate Payee for the purposes of this DRO. 5. The Participant's name, mailing address, Social Security number and date of birth are: David M. Olenick 1135 Sandpiper Court Mechanicsburg, PA 17050 Social Security No.: See Addendum TSP Account No.: See Addendum Date of Birth: See Addendum 6. The Alternate Payee's name, mailing address, Social Security number and date of birth are: Jeanene L. Olenick 1109 Kent Drive Mechanicsburg, PA 17050 Social Security No.: See Addendum Date of Birth: See Addendum It is the responsibility of the Alternate Payee to keep a current mailing address on file with the Plan at all times. 7. This Order assigns to Alternate Payee an amount equal to $67,883.00 of the Participant's total account balance accumulated under the Plan as of the date of distribution. The Alternate Payee's award shall not be adjusted for earnings, gains or losses. In no event shall the Alternate Payee receive more than the Participant's vested account balance on the date of distribution. 8. The Alternate Payee shall be paid benefits as soon as administratively feasible following the date this Order is approved as a Qualifying Retirement Benefits Court Order by the Board. 9. Benefits are to be payable to the Alternate Payee in the form of a lump sum cash payment (in the form of a tax-deferred rollover to an IRA or eligible retirement plan, if so elected by the Alternate Payee on forms supplied by the Thrift Savings Plan Administrator). 10. All payments made pursuant to this Order shall be conditioned on the certification by the Alternate Payee and the Participant to the Board of such information as the Board may reasonably require from such parties. 11. This DRO does not require the Plan to provide any type or form of benefit the Plan does not otherwise provide. 12. This DRO does not require the Plan to provide increased benefits. 13. This DRO does not require the Plan to pay any benefits which another order previously determined to be a Qualifying Retirement Benefits Court Order requires the Plan to pay to another alternate payee. 14. In the event that the Plan inadvertently pays to 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 he has received such benefit payments and shall forthwith pay such amounts so received directly to the Alternate Payee within ten (10) days of receipt. In the event the Plan inadvertently pays to the Alternate Payee any benefits that are assigned to the Participant pursuant to the terms of this Order, the Alternate Payee shall immediately reimburse the Participant to the extent that she has received such benefit payments and shall forthwith pay such amount so received directly to the Participant within ten (10) days of receipt. 15. After payment of the amount required by this DRO, the Alternate Payee shall have no further claim against the Participant's interest in the Plan. 16. The Alternate Payee assumes sole responsibility for the tax consequences of any payments made to her under this DRO. 17. In the event the Participant predeceases the Alternate Payee before she receives her distribution, his death shall have no effect on her assigned portion of the benefits, as stipulated herein. If applicable, the Alternate Payee shall be treated as the beneficiary of the Participant to the extent of her assigned interest hereunder. 18. If the Participant takes any action that prevents, decreases or limits the collection by Alternate Payee of the sums to be paid hereunder, he shall make payments to Alternate Payee directly in an amount sufficient to neutralize, as to Alternate Payee, the effects of the actions taken by Participant. 19. The Court of Common Pleas of Cumberland County, Pennsylvania shall retain jurisdiction to amend this Order, but only for the purpose of establishing it or maintaining it as a Domestic Relations Order, provided, however, that no such amendment shall require the Plan to provide any form of benefit or any option not otherwise provided by the Plan, and further provide that no such amendment or right of the Court to so amend will invalidate this Order. 1%% c EXECUTED this I\ day of 0 r 7,6 BY THE COURT Judge CONSENT TO ORDER: J• • °t ( / .1 0 / r� y; 3 L9 '(intiff/Alte t Payee Dat Defendant/ Participant Date ',%, c 48,7 (3/41.3 c Attorney for Plaintiff/ Date Att?‘ for Defendant/ Date Alternate Payee Participant mom} _- ao p I.ex rk.Z.Lik .S > : 14:1;iO3 C._i o r CERTIFICATE OF SERVICE AND NOW, this Cam'"day of October, 2013, the undersigned does hereby certify that she did this date serve a copy of the foregoing Motion for Entry of Order Upon Stipulation upon Defendant's counsel of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER Melissa P. Greevy, Esqu. e :584945 Jeanene L. Olenick : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. David M. Olenick : NO. 09-7822 Defendant DOMESTIC RELATIONS ORDER 1. This Domestic Relations Order ("DRO") creates and recognizes the existence of the Alternate Payee's right to receive a portion of the benefits payable with respect to the Employee. It is intended to constitute a Court Order Acceptable for Processing ("COAP") under final regulations issued by the United States Office of Personnel Management ("OPM"). This DRO applies to the Civil Service Retirement System ("CSRS") and any successor thereto. The court has considered the requirements and standard terminology in Part 838 of Title 5, Code of Federal Regulations. The terminology used in the provisions of this Order that concern benefits under the Civil Service Retirement System are governed by the standard conventions established in that part. 2. This DRO is entered pursuant to authority granted under the applicable domestic relations laws of the State of Pennsylvania and in accordance with Part 838 of Title 5, Code of Federal Regulations. 3. This DRO relates to the provision of marital property rights to the Alternate Payee. 4. David M. Olenick ("Employee") is a Member of CSRS. Jeanene L. Olenick ("Alternate Payee"), the former spouse, is the Alternate Payee for the purposes of this DRO. 5. The Employee's name, mailing address, Social Security number and date of birth are: David M. Olenick 1135 Sandpiper Court Mechanicsburg, PA 17050 Social Security No.: See Addendum Date of Birth: See Addendum 6. The Alternate Payee's name, mailing address, Social Security number and date of birth are: Jeanene L. Olenick 1109 Kent Drive Mechanicsburg, PA 17050 Social Security No.: See Addendum Date of Birth: See Addendum It is the responsibility of the Alternate Payee to keep a current mailing address on file with the OPM at all times. 7. The Employee is or will be eligible for retirement benefits under the CSRS based on his employment with the United State Government. The Alternate Payee is entitled to a portion of the Employee's monthly annuity under the CSRS as set forth below. 8. This DRO assigns to Alternate Payee 38.55%of the marital portion of the Employee's self- only monthly annuity payable by the CSRS, calculated as of the date of Employee's benefit commencement date. If the employee waives military retired pay to credit military service under the CSRS, the increased CSRS annuity shall be used for purposes of this Section 8. The Alternate Payee's monthly benefit shall then be reduced by the cost of the former spouse survivor annuity awarded to the Alternate Payee pursuant to Section 12. The marital portion of the Employee's monthly annuity shall be determined by multiplying the Employee's monthly annuity by a fraction (less than or equal to 1.0), the numerator of which is 179.16 months (14.93 years) of creditable civilian and military service earned by the Employee during the marriage. The denominator shall equal the total number of months of creditable civilian and military service earned by the Employee as of the date of cessation of benefit accruals excluding any months of creditable service added to the Employee's service record by virtue of his unused sick leave. When Cost-of-Living Adjustments ("COLA") are applied to Employee's retirement benefits, the same COLA shall apply to the Alternate Payee's share. The OPM is hereby directed to pay Alternate Payee's share directly to Alternate Payee. 9. Payments to Alternate Payee shall commence on the date payments commence to the Employee. Employee agrees to arrange or to execute all forms necessary for the OPM to commence payments to the Alternate Payee in accordance with the terms of the DRO. 10. Payments shall continue to Alternate Payee for the remainder of the Employee's lifetime. If the Alternate Payee dies before the Employee, the Alternate Payee's share of the Employee's annuity shall be paid to Employee and Alternate Payee's surviving children, or if all such surviving children are 2 ineligible to receive payments from OPM, then the Alternate Payee's share of the Employee's annuity shall be paid to the Alternate Payee's estate. 11. If Employee leaves Federal service before retirement and applies for a refund of employee contributions under the CSRS, the OPM is directed not to pay the Employee a refund of such employee contributions. 12. Under Section 8341(h)(1) of Title 5, United States Code, the Alternate Payee is awarded a former spouse pre-retirement survivor annuity. If the Employee dies before his benefits commence, the amount of the survivor annuity payable to the Alternate Payee shall be 55.0% of the Alternate Payee's share of the Employee's self-only monthly annuity earned at the time of death, where the Alternate Payee's share is calculated pursuant to Section 8 of this Order. Under Section 8341(h)(1) of Title 5, United States Code, the Alternate Payee is awarded a former spouse post-retirement survivor annuity. If the Employee dies after his benefits commence, the amount of the survivor annuity payable to the Alternate Payee shall be calculated by applying the 55% survivor annuity percentage to a base amount of 38.55% of the marital portion of the Employee's self- only annuity, where marital portion is as defined in Section 8. Such base amount and survivor annuity shall be increased with COLAs from the Employee's date of retirement or death as applicable. The costs associated with providing this former spouse survivor annuity coverage shall be deducted from the Alternate Payee's portion of the monthly annuity. Employee agrees to take all necessary steps to elect Alternate Payee as designated beneficiary for the purposes of establishing and sustaining such former spouse survivor annuity for Alternate Payee. 13. In no event shall the Alternate Payee have greater benefits or rights other than those which are available to the Employee. The Alternate Payee is not entitled to any benefit not otherwise provided by the CSRS. The Alternate Payee is only entitled to the specific benefits offered by the CSRS as provided in this Order. All other rights, privileges and options offered by the CSRS not granted to Alternate Payee are preserved for the Employee. 14. The OPM shall issue individual tax forms to the Employee and Alternate Payee for amounts paid to each such person. 15. In the event that OPM inadvertently pays to the Employee any benefits that are assigned to the Alternate Payee pursuant to the terms of this DRO, the Employee shall immediately reimburse the 3 Alternate Payee to the extent that he has received such benefit payments, and shall forthwith pay such amounts so received directly to the Alternate Payee within ten (10) days of receipt. In the event OPM inadvertently pays to the Alternate Payee any benefits that are not assigned to her pursuant to the terms of this DRO, the Alternate Payee shall immediately reimburse the Employee to the extent she has received such benefit payments and shall forthwith pay such amounts so received directly to the Employee within ten (10) days of receipt. 16. In the event the Employee makes a one-time irrevocable election to transfer into the Federal Employees Retirement System ("FERS") before his retirement, then Alternate Payee shall be entitled to a portion of the Employee's Basic Annuity and/or a Refund of employee contributions under FERS calculated in a manner similar to that which is enumerated in Sections 8 through 11 above for the annuity and refund, respectively, and payable directly from FERS. Additionally, Alternate Payee shall be entitled to a former spouse survivor annuity payable under FERS and determined in a similar manner to the survivor benefits set forth under Section 12 above. Further, such former spouse survivor annuity shall be payable directly from FERS. 17. If Employee takes any action that prevents, decreases, or limits the collection by Alternate Payee of the sums to be paid hereunder, he shall make payments to Alternate Payee directly in an amount sufficient to neutralize, as to Alternate Payee, the effects of the actions taken by Employee. 18. The OPM shall notify the Alternate Payee and her legal representative when the Employee makes an application for any benefit payments or withdrawals from the CSRS. 4 19. The Court of Common Pleas of Cumberland County, Pennsylvania shall retain jurisdiction to amend this Order, but only for the purpose of establishing it or maintaining it as a Domestic Relations Order, provided, however, that no such amendment shall require the CSRS to provide any form of benefit or any option not otherwise provided by the CSRS, and further provide that no such amendment or right of the Court to so amend will invalidate this Order. "‘ Accepted and Ordered this day of © CA 0 tJ' , 10 t3 BY THE COURT 1 .4. l A" Judge CONSENT TO ORDER: we (/l9O� �� 1 3 t io/���3 C Dafe Plain ff/Altern ayee Date Defendant/ a ,,hf.cqZ-2.S2%8(67 9/131/3 \a___,L4is____Q_ I Attorney for Plaintiff/ Date At,„ n:y for Defendant/ Date I• -/o/eli .r Alternate Payee Employee rnc CD i,, -�rn C) , • --C . -- 1____ COF I CS i -• 'Lk• Mme ,_, ) - rr-. iiJ /y - A 41,k( k. azzall ,cfigli.2 CERTIFICATE OF SERVICE AND NOW, this 6"." day of October, 2013, the undersigned does hereby certify that she did this date serve a copy of the foregoing Motion for Entry of Order Upon Stipulation upon Defendant's counsel of record by causing same to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART &WEIDNER � ' , (c elissa P. Greevy, Es, uire :584945 J,ICi 7,12, 1 I4,1,,4 ,` 12 4111i: 41 CUMBERLAND PENNSA L V NI 4N f y JEANENE L. OLENICK, IN THE COURT OF COMMON PLEAS PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA vs. DAVID M. OLENICK, DEFENDANT DOCKET NO. 09-7822 CIVIL ACTION - LAW IN DIVORCE ENTRY OF APPEARANCE AS A SELF -REPRESENTED PARTY 1. I am the yPlaintiff ❑ Defendant in the above -captioned (MARK ONE) ❑ custody, N( divorce, ❑ support, 0 protection from abuse, El paternity case. 2. El This (MARK ONE) ❑ is ❑ is not a new case and I am representing myself in this case and have decided not to hire an attorney to represent me. OR (check only one box) ❑ This is NOT a new case and previously (Name of Attorney) represented me in this case. I have decided not to be represented by that attorney and direct the Prothonotary to remove that attorney as my counsel of record in this case. I have provided a copy of this form to that attorney listed above at the following address: OR (check only one box) I am entering my appearance as a self -represented party (sig My attorney acknowledges h`/he : '1 :y l as my attorney i (Attorney sig Batu s case. , Esq. 3. My address for the purpose of receiving all future pleadi •s and other legal notices is: 1109 Kent Drive, Mechanicsburg, PA 17050. I understand that this address w' = the only address to which notices and pleadings in this case will be sent, and that I am responsible to regularly check my mail at this address to ensure that I do not miss important deadlines or proceedings. This is my home address. ❑ This is not my home address. 4. My telephone number where I can be reached during normal business hours (8:00 a.m. — 4:30 p.m. Monday — Friday) is 717-329-0815. My email address is jolenick2(a�gmail.com ❑ My telephone number and email address are confidential pursuant to a Protection From Abuse Order. 5. I UNDERSTAND I MUST FILE A NEW FORM EVERY TIME MY ADDRESS OR TELEPHONE NUMBER CHANGES. 6. I have provided a copy of this form to all other attorneys or other self -represented parties at the following addresses•as listed below: (Use reverse side if you need more space) Name Lori K. Serratelli, Esquire Address 2080 Linglestown Rd., Suite 201, Harrisburg, PA 17110 Name Address 7. I fully understand that by deciding to represent myself, the Court will hold me to the same standards of knowledge regarding the statutory law, evidence law, Local and State Rules of Procedure and applicable case law as a Pennsylvania licensed attorney, and that I must be fully prepared to meet those responsibilities. I verify that the statements made in this Entry of Appearance as a Self -Represented Party are true and correct. I understand that if I make false statements herein, that I am subject to the criminal penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to auk orities which , ould result in a fine and/or prison term. Date /07 // (-7 ignature (Yo CERTIFICATE OF SERVICE AND NOW, this l day of , 2014, the undersigned does hereby certify that she did this date serve a true and correct copy of th foregoing Entry of Appearance as a Self -Represented Party upon counsel of record by causing sa to be deposited in the United States Mail, first class postage prepaid, at Lemoyne, Pennsylvania, addressed as follows: Lori K. Serratelli, Esquire Serratelli, Schiffman & Brown, P.C. 2080 Linglestown Road, Suite 201 Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER :596204