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HomeMy WebLinkAbout10-0293FILED-C' TICE OF ?f ;F F9,0 ? un?JOTAQI' p 2010 JAN 1 i PM 12: C 9 SMIGEL, ANDERSON & SACKS, LLP Ann J. Levin, Esquire ID #70259 Susan E. Good, Esquire ID #93295 4431 North Front Street, 3" Flr. Harrisburg, PA 17110-1778 (717) 234-2401 alevinFgsasllp.com seood(asasllp.com Attorneys for Plaintiff SUELLYN KOSTUKOVICH, PLAINTIFF V. JOHN S. KOSTUKOVICH, DEFENDANT CU - 4 ? .iv: d.Y l??ri •?1 ?Ji) ? l.. ??r(?:?i± * x{`10 . SO pID ATr4 CjCW 4'180 V4 A'VP018 ? ?L IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : DOCKET NO. 1o- ag3 Civi 1 ?-Fe r h CIVIL ACTION - 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 for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, Pennsylvania, 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 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 lease 72 hours prior to any hearing of business before the Court. SMIGEL, ANDERSON & SACKS, LLP Ann V. Levin, Esquire ID #70259 Susan E. Good, Esquire ID #93295 4431 North Front Street, 3rd Flt. Harrisburg, PA 17110-1778 (717) 234-2401 alevinnsasllp com s ood saslln com Attorneys for Plaintiff SUELLYN KOSTUKOVICH, PLAINTIFF IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. : DOCKET NO. 16 - c. 9 3 JOHN S. KOSTUKOVICH, DEFENDANT CIVIL ACTION -DIVORCE COMPLAINT UNDER SECTION 3301(c) OR 3301(d) OF THE DIVORCE CODE TO THE HONORABLE, THE JUDGES OF SAID COURT: AND NOW, comes Plaintiff, Suellyn Kostukovich, by and through her attorneys, SMIGEL, ANDERSON & SACKS, LLP, and represents as follows: COUNTI DIVORCE UNDER SECTION 3301(c) OR 3301(d) OF THE DIVORCE CODE 1. Plaintiff is Suellyn Kostukovich, who currently resides at 11 Montego Court, Dillsburg, Cumberland County, Pennsylvania 17019 and has resided there since 1997. 2. Defendant is John S. Kostukovich, who currently resides at 1064 Turnberry Court, Mechanicsburg, Cumberland County 17050 and has resided there since on or about August 2009. 3. Both Plaintiff and Defendant have been bona fide residents in the Commonwealth for at least six (6) months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on July 26, 1986, at Harrisburg, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 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. Plaintiff avers that there is one child of the parties under the age of 18, namely: Tiana Kostukovich, date of birth September 11, 1992. WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter a Decree in Divorce pursuant to Section 3301(c) or (d) of the Divorce Code. COUNT II EQUITABLE DISTRIBUTION 13. Plaintiff repeats and realleges the averments of paragraphs 1 through 12 which are incorporated by reference herein. 14. Plaintiff and Defendant possess various items of both real and personal marital property which is subject to equitable distribution by this Court. WHEREFORE, Plaintiff respectfully requests that this Honorable Court equitably distribute the marital property after an inventory and appraisement has been filed by the parties. COUNT III ALIMONY UNDER SECTION 3701 OF THE DIVORCE CODE 15. Plaintiff repeats and realleges the averments of paragraphs 1 through 14 which are incorporated by reference herein. 16. Plaintiff requires support to adequately maintain her in accordance with the standard of living established during the marriage. WHEREFORE, Plaintiff respectfully requests that this Honorable Court award her reasonable alimony pursuant to Section 3701 of the Divorce Code. COUNT IV ALIMONY PENDENTE LITE, COUNSEL FEES, COSTS AND EXPENSES UNDER SECTION 3702 17. Plaintiff repeats and realleges the averments of paragraphs 1 through 16 which are incorporated by reference herein. 18. Plaintiff has no adequate means of support for herself during the course of this litigation. 19. Plaintiff does not have sufficient funds to pay counsel fees, costs or expenses incidental to this action. 20. Plaintiff has no health insurance other than that presently available to her through Defendant's employment. WHEREFORE, Plaintiff respectfully requests that this Honorable Court award her alimony pendente lite, counsel fees, costs and expenses. SMIGEL, ANDERSON & SACKS, LLP Date: - / D By: V J Ann V. Levin, Esquire I.D. 470259 Susan E. Good, Esquire I.D.#: 93295 4431 North Front Street, 3`d Flr. Harrisburg, PA 17110-1778 (717) 234-2401 Attorneys for Plaintiff VERIFICATION I, Suellyn Kostukovich, verify that the statements contained in the foregoing pleading are true and correct to the best of my knowledge, information and belief. I understand that false statements therein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: l 7 -'L i C ?i' " 4 " ??- ?Suellyn Kos kovich F LED-0- tCE }F " ;". F-t?-?=,r,,nbTARY ,,: , 2010 JAN 12 Ali 11: 01 SMIGEL, ANDERSON & SACKS, LLP Ann V. Levin, Esquire ID 1170259 Susan E. Good, Esquire ID #93295 4431 North Front Street, 3' Mr. Harrisburg, PA 17110-1778 (717) 234-2401 alevin a.sasllp.corn saoodc csasllp.com Attorneys for Plaintiff SUELLYN KOSTUKOVICH, PLAINTIFF V. JOHN S. KOSTUKOVICH, DEFENDANT GUMPE', d A141 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : DOCKET NO. /')w - : CIVIL ACTION -DIVORCE PLAINTIFF'S DEMAND FOR HEARING) ON COUNT IV, CLAIM FOR ALIMONY PENDENTE LITE AND NOW, comes Plaintiff, Suellyn Kostukovich, pursuant to Rule 1920.3 1 (a)(3), and hereby demands a hearing on her claim set forth in Count IV of Plaintiff s Complaint Under Section 3301(c) or 3301(d) of the Divorce Code, a copy of which is attached hereto. Respectfully Submitted, SMIGEL, ANDERSON & SACKS Date: By Ann V. (vin, Esquire I.D.#: 70259 Susan E. Good, Esquire I.D.#: 93295 4431 North Front Street, 3rd Fir. Harrisburg;, PA 17110 (717) 234-2401 Attorneys for Plaintiff SUELLYN KOSTUKOVICH, THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 10-293 CIVIL TERM JOHN S. KOSTUKOVICH, IN DIVORCE Defendant/Respondent: PACSES NO: 193111400 ORDER OF COURT AND NOW, this 12th day of January, 2010, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before Kelly M. Bare on February 1, 2010 at 1:30 P.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU 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 1910.110 (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. 0 C If you fail to appear for the conference or bring the required documents, the Court may is warrant for your arrest. i, Copies mailed to: Petitioner BY THE COURT, Respondent ` Ann V. Levin, Esq. John J. Connelly, Jr., Esq. Date of Order: January 12, 2010 Edward E. Guido, r-113 o c, 'n ?`.. T W co J rti Judge YOU 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 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 SUELLYN KOSTUKOVICH, Plaintiff/Petitioner VS. JOHN S. KOSTUKOVICH, THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 10-293 CIVIL TERM IN DIVORCE Defendant/Respondent : PACSES NO: 193111400 ORDER OF COURT - RESCHEDULE A CONFERENCE n r r==;; 0 m 1V c? w 'J .n r??rn rn ry J? -c AND NOW, this 14`h day of January 2010, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shadday on February 18, 2010 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. This date replaces the prior conference date of February 1, 2010. YOU 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 1910.110 (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you (6) IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Date of Order: JanuM 14, 2010 Copies mailed to: Petitioner Respondent Ann V. Levin, Esq. John J. Connelly, Jr., Esq. Edward Judge YOU 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 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 SMIGEL, ANDERSON & SACKS, LLP Ann V. Levin, Esquire ID #70259 Susan F. Good, Esquire ID #93295 4431 North Front Street, 3rd Flr. Harrisburg, PA 17110-1778 (717) 234-2401 alevin asasllp.com sgood@sasllp.com Attorneys for Plaintiff SUELLYN KOSTUKOVICH, PLAINTIFF V. JOHN S. KOSTUKOVICH, DEFENDANT IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOC.?iLET NO. 10-293 : CIVIL ACTION -DIVORCE ACCEPTANCE OF SERVICE I, John J. Connelly, Jr., Esquire, counsel for Defendant, John S. Kostukovich, accept service of the Complaint Under Section 3301(c) or 3301(d) of the Divorce Code and Demand for Hearing on Count IV, Claim for Alimony Pendente Lite on behalf of Defendant and certify that I am authorized to do so. JAMES, SMITH, DIETTERICK & CONNELLY Dais - t ? } b- ----- - By: Hershey, FA 17033 (717) 533-3280 Attorney for Defendant C= t r '3'J SUELLYN KOSTUKOVICH, Plaintiff/Petitioner VS. JOHN S. KOSTUKOVICH, THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 10-293 CIVIL TERM IN DIVORCE Defendant/Respondent : PACSES NO: 193111400 ORDER OF COURT - RESCHEDULE A CONFERENCE n !V O M UJ CTS rv CTI -J 'T AND NOW, this 16" day of February 2010, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on March 24, 2010 at 9:00 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. This date replaces the prior conference date of February 18, 2010. YOU 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 1910.110 (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you (6) IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Date of Order: January 14, 2010 Copies mailed to: Petitioner Respondent Ann V. Levin, Esq. John J. Connelly, Jr., Esq. Edward E. Guido, Judge YOU 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 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 SUELLYN KOSTUKOVICH, Plaintiff/Petitioner VS. JOHN S. KOSTUKOVICH, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -DIVORCE NO. 10-293 CIVIL TERM IN DIVORCE PACSES CASE: 193111400 ORDER OF COURT AND NOW to wit, this 25th day of March, 2010, it is hereby Ordered pursuant to an agreement of the parties, the scheduled March 24, 2010 conference is continued generally for thirty (30) days and may be relisted by the call of either party, if needed. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary's Office for a hearing de novo before the Court. BY THE COURT: a•- Edward E Guido, J• DRO: R.J. Shadday xc: Petitioner Respondent John J. Connelly, Jr., Esq. Ann V. Levin, Esq. ~t£ ~Z Nd SZ ~~N 0101 Form 0E-001 Service Type: M ~~~Ji~~~ ~,~, ~ Worker: 21005 ~ ~~.. .. 3 JUN 2 g 2010 ~ SUELLYN KOSTUKOVICH, PLAINTIFF v. JOHN S. KOSTUKOVICH, DEFENDANT IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO. 2010-293 CIVIL ACTION -DIVORCE ORDER ...... AND NOW, this ~_ day of ~„/ ~,,~. ~/ ~ , 2010, upon consideration of the attached Answer and Defendant's Petition for Special Relief, it is hereby ORDERED and DECREED that . in e ital Plaintiff s Counterclaim to Defendant's Petition for Special Relief will be heard during the scheduled hearing on July 2, 2010 at 11:00 a.m. before the Honorable Edward E. Guido, to be held at the Cumberland County Courthouse, courtroom V. Levin, Esquire as counsel for Plaintiff, 4431 N. Front St., Harrisburg, PA 17110 J. Connelly, Jr., Esquire as counsel for Defendant, P.O. Box 650, Hershey, PA 17033 ~'Q ~(~/ a ~l ao j~v J. c-a ~ ^.. r ~; Q , ~ -~ .a.~,. a = ~ -~. ~;, ~- .. ::"t =''~ f John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant/Petitioner SUELLYN G. KOSTUKOVICH, PlaintifFlRespondent ~. JOHN S. KOSTUKOVICH, Defendant/Petitioner r r 2010 J~~ir -6 °i'i ~~ ~~7 CiL;djt`.~~ ~=L~`~l IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW IN DIVORCE PRAECIPE TO WITHDRAW DEFENDANT'S PETITION FOR SPECIAL RELIEF TO THE PROTHONOTARY: Please withdraw the Petition for Special Relief, filed by DefendantlPetitioner, John S. Kostukovich, on June 10, 2010, in the above-captioned action. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: ~- ~ By: Jo :Conn ly, Jr. . #15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner John S. Kostukovich SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent v. JOHN S. KOSTUKOVICH, Defendant/Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Praecipe to Withdraw Petition for Special Relief on the following on the date and in the manner indicated below: VIA U S MAIL, FIRST CLASS, PRE-PAID Ann V. Levin, Esquire Smigel, Anderson & Sacks, LLP 4431 North Front Street Harrisburg, PA 17110 JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: a By: o J o elly, Jr. rn . #1S61S P.O. BOX 6S0 Hershey, PA 17033-0650 (717) 533-3280 .~ SM[GEL, ANDERSON & SACKS, LLP Ann V. Levin, Esquire ID #70259 Susan E. Good, Esquire ID #93295 4431 North Front Street, 3rd Flr. Harrisburg, PA 17110-1778 (717) 234-2401 alevin~sasllp.com seoodn~sasllp.com Attorneys for Plaintiff SUELLYN KOSTUKOVICH, PLAINTIFF v. JOHN S. KOSTUKOVICH, DEFENDANT Fl1.~`~ ~ Et ~: ,,,.; , h 20E0 ,1~J~ -~ °~~ IZ~ w i IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO. 2010-293 CIVIL ACTION -DIVORCE PRAECIPE TO WITHDRAW COUNTERCLAIM TO THE PROTHONOTARY: Please withdraw Plaintiff's Counterclaim for return of furniture to the marital residence, which was filed in the above captioned matter on June 25, 2010 as part of Plaintiff s Answer to Defendant's Petition for Special Relief. Respectfully Submitted, Date: - ~ ~ ~ SMIGEL, ANDERSON & SACKS, LLP By: l.J Ann .Levin, Esquire I.D.#: 70259 Susan E. Good, Esquire I.D.#: 93295 4431 North Front Street, 3rd Flr. Harrisburg, PA 17110 (717) 234-2401 Attorneys for Plaintiff r ~, SUELLYN KOSTUKOVICH, PLAINTIFF v. JOHN S. KOSTUKOVICH, DEFENDANT IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO.2010-293 CIVIL ACTION -DIVORCE CERTIFICATE OF SERVICE I, Ann V. Levin, Esquire, counsel for Plaintiff/Respondent in the above-captioned matter, do hereby certify that I served a true and correct copy of the foregoing Praecipe to Withdraw Counterclaim on The Honorable Edward E. Guido via facsimile and on counsel for Defendant via facsimile and U.S. Mail, First Class, postage paid on the 2°d day of July, addressed as follows: John J. Connelly, Jr., Esquire James, Smith, Dietterick & Connelly P.O. Box 650 Hershey, PA 17033 The Honorable Edward E. Guido Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 SMIGEL, ANDERSON & SAC S, LLP By: V Ann V. Levin, Esquire I.D.#: 70259 Susan E. Good, Esquire I.D.#: 93295 4431 North Front Street, 3`d Flr. Harrisburg, PA 17110 (717) 234-2401 Attorneys for Plaintiff ?1E IrNOTARY <? 2j P 1? 12 CUMf L"z,?'4 s::# OJUNN SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON P IPYLV" Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOST'UKOVICH, : CIVIL ACTION - LAW Defendant : IN DIVORCE IN('.OME STATEMENT OF JOHN S. KOSTUKOVICH I, John S. Kostukovich, verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Date: .?i?v Jo . Kostukovich, Defendant INCOME Employer: John S. Kostukovich, CPA Address: 3900 Trindle Road, Camp Hill, Pennsylvania Type of Work: Certified Public Accountant Payroll Number: Pay Period (weekly, biweekly, etc.): monthly Gross Pay per Pay Period: $14,583.00 Itemized Payroll Deductions: Federal Withholding $3,384.00 FICA $1,494.00 Local Wage Tax $233.00 State Income Tax $448.00 Mandatory Retirement Union Dues Health Insurance Other (specify) INCOME Employer: John S. Kostukovich, CPA Address: 3900 Trindle Road, Camp Hill, Pennsylvania Type of Work: Certified Public Accountant Payroll Number: Pay Period (weekly, biweekly, etc.): monthly Gross Pay per Pay Period: $14,583.00 Itemized Payroll Deductions: Federal Withholding $3,384.00 FICA $1,494.00 Local Wage Tax $233.00 State Income Tax $448.00 Mandatory Retirement Union Dues Health Insurance Other (specify) Net Pay per Pay Period: $9,024.00 OTHER INCOME: Interest Dividends Pension Distributions Annuity Social Security Rents Royalties Unemployment Comp. Workers Comp. Employer Fringe Benefits Other WEEK MONTH YEAR (Fill in appropriate column) $ $ $ 3900 Trindle Road (commercial real estate) $0.00 TOTAL $0.00 $ $ TOTAL INCOME $0.00 $ $ PROPERTY OWNED Ownership Description Value H W J Checking accounts $ Savings accounts S Credit Union $ Stocks/bonds Real estate $ Other Total $ INSURANCE Hospital Blue Cross Other Medical Blue Shield Other Health/Accident Disability Income Dental Other Coverage Company Policy No. H W J SUPPLEMENTAL INCOME STATEMENT (a) This form is to be filled out by a person (check one): (1) who operates a business or practices a profession, or (See attached Exhibit "A") (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. 3900 Trindle Road, LLC (see attached Exhibit "B") (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, professional, corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement. (c) Name of business John S. Kostukovich, CPA Address and 3900 Trindle Road, Camp Hill, Pennsylvania Telephone Number: (717) 730-0820 (d) Nature of business (check one): (1) partnership (2) joint venture (3) profession (4) closed corporation (5) other (e) Name of accountant, controller or other person in charge of financial records: John S. Kostukovich (f) Annual income from business: $175,000.00 (1) (2) (3) (4) How often is income received? As clients pay Gross income per pay period: $14,583.00 Net income per pay period: $9,024.00 Specified deductions, if any: Monthly Monthly Monthly Total Children Parent EXPENSES Home Mortgage or Rent $1,235.00 Maintenance Lawn Care 2nd Mortgage UTILITIES Electric $75.00 Gas $80.00 Oil Telephone Cell Phone Water $35.00 Sewer Cable TV $35.00 Internet $45.00 Trash/Recycling TAXES Real Estate Personal Property Monthly Total INSURANCE Homeowners/Renters $25.00 Automobile $140.00 Life $163.00 Accident/Disability $147.00 Excess Coverage Long-Term Care AUTOMOBILE Lease or Loan Payments $1,057.00 Fuel $150.00 Repairs $110.00 Memberships $5.00 MEDICAL Medical Insurance $858.00 Doctor $50.00 Dentist $40.00 Hospital Medication Counseling/Therapy $85.00 Orthodontist Special Needs (glasses, etc.) $30.00 Monthly Monthly Children Parent Monthly Monthly Monthly Total Children Parent EDUCATION Tuition Tutoring Lessons Other PERSONAL Debt Service Clothing $225.00 Groceries $460.00 Haircare $15.00 Memberships $30.00 Dry Cleaning $115.00 MISCELLANEOUS Child Care Household Help Summer Camp Papers/Books/Magazines $15.00 Entertainment $400.00 Pet Expenses Vacations $750.00 Gifts $190.00 Legal Fees/Prof. Fees $1,000.00 Charitable contributions $80.00 Children's Parties Children's Allowances $550.00 Other Child. Support $1,300.00 Alimony pendente lite payments $2,200.00 TOTAL MONTHLY EXPENSES $11,695.00 John S. Kostukovich, CPA INCOME STATEMENT 7 Months Ended 7 Months Ended July 31, 2010 July 31, 2009 Sales Billings $ 336,458.30 S 383.874.82 Less: Returns & Allowances -_- `200) (37330) Total Sales 366,23&30 383,501.52 Gross Profit 366,238.30 383,501.52 Operating Expenses Advertising 2,455.70 '52,00 Auto Expense 3.806.85 3,562.34 Bank Service Charges 401.63 132.36 Client gifts 0.00 496.49 Continuing Education 0,00 2.954.00 Contracted Labor 3,168.65 0.017 Contributions 685.00 188.00 Cues & Subscriptions 351.98 57 65 Electric 3,020.39 2.377-15 Equipment Rental 552.72 1,884.22 Insurance 6,063.42 6.931.42 Empl bene 1,801.32 1100 Health Insurance 0.00 2,62'. 08 InterQst Expense 200.41 115,08 Licenses, Fees, Permits 143.80 278.00 Miscellaneous 120.38 Office & Postage Expense 8,266.87 Copier costs 2,421.40 1 96 Pension Plan 623.66 959 09 Professional Fees 73.50 0,00 Repairs and Maintenance 6,012.40 3,57075 Rent ' 5,800.00 i6,800,00 Salaries: General 106.461.33 94,769.57 Software 1,353.21 20,189-08 Supplies 1,304.82 4,42 3.30 Taxes: Payroll 9,017.15 7,010.16 Taxes: FUTA 0.00 243.83 Taxes: SUTA 0.00 5358.29 Taxes: Other 977.52 72.,_92 Telephone 3,196.84 4.255.18 Trash Removal 336.60 772,85 Travel & Entertainment 347,44 1,684 87 Entertainment 1,713.68 4,121;.85 Utilities 1,714.41 431.48 Water -- - 0.00 475.62 Total Operating Expenses 193,393.04 2071,8_>1_-g See Accountants' Compilation Report 1 John S. Kostukovich, CPA INCOME STATEMENT Operating Income (Loss) Other Income (Expense) Net Income (Loss) Before Taxes Net Income (Loss) 7 Months Ended 7 Months Ended July 31, 20190 July 31, 2009 172, 845.26 181.580.33 '72,845.26 _ 181.08133 S 172,845.26 S -R1 t ^:u See Accountants' Compilation Report 2 3900TRINDLE 02/16/2010 9:59 AM 1065 U.S. Return of Partnership Income OMB No. 1545-0099 Form Department of the Treasury For calendar year 2009, or tax year beginning ending 2009 Internal Revenue Service ? See separate instructions. A Principal business activity Use the Name of partnership _ D Employer identification number IRS Real Estate label. 3900 Trindle Road LLC 20-4527894 B Principal product or service Other- Number, street, and room or suite no. If a P.O. box, see the instructions. E Date business started Rental wise, 3900 Trindle Road 03/23/2006 C Business code number print City or town, state, and ZIP code F Total assets (see the instructions) 531120 °r?'pe Camp Hill PA 17011 $ G Check applicable boxes: (1) Initial return (2) ? Final return (3) ? Name change (4) 11 Address change (5) Amended return (6) Technical termination - also check (1) or (2) H Check accounting method: (1) X Cash (2) ? Accrual (3) F1 Other (specify) ? ................................. I Number of Schedules K-1. Attach one for each person who was a partner at any time during the tax year ? ??2``?? .........................u J Check if Schedules C and M-3 are attached .......................................... ...................................................... Caution. Include only trade or business income and expenses on lines 1a through 22 below. See the instructions for more information. 1a Gross receipts or sales ....................................... . 1a . ........... b Less returns and allowances ............................................... 1b 1C 2 Cost of goods sold ;Schedule A, line 8) .................................................................... 2 E 3 Gross profit. Subtract line 2 from line lc ........................................ ......................... 3 v . 4 Ordinary income (loss) from other partnerships, estates, and trusts (attach statement) .................................... 4 5 Net farm profit (loss) (attach Schedule F (Form 1040)) 5 6 Net gain (loss) from Form 4797, Part Il, line 17 (attach Form 4797) .......................................... 6 7 Other income (loss) (attach statement) ......................................... .. ........................ 7 8 Total income (loss). Combine lines 3 -through 7 8 9 Salaries and wages (other than to partners) (less employment credits) ....................................... 9 cg _ 10 Guaranteed payments to partners ............................................. ......................... 10 E 11 Repairs and maintenance ................................................. .......................... 11 y 12 Bad debts .. ............................................................ . 12 S ' _ 13 Rent ........................................................................ 13 z N 14 Taxes and licenses ............................................ 14 15 Interest ........................... .... ........................... 15 L 16a Depreciation (if required, attach Form 4562) 16a 12,052 N b Less depreciation reported on Schedule A and elsewhere on return ............ 16b 12,052 16c 0 U) 17 Depletion (Do not deduct oil and gas depletion.) 17 .......................................................... O 18 Retirement plans, etc. ......................................... ............................... 18 . 19 Employee benefit programs ................................. 19 20 Other deductions (attach statement) ...................................................................... 20 0 21 Total deductions. Add the amounts shown in the far right column for lines 9 through 20 ..... . .. .. . ......... 21 0 22 Ordinary business income (loss). Subtract line 21 from line 8 ............ . . ... . . .. . .. . ............. . 22 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than general partner or limited liability company member manager) Sign is based on all information of which preparer has any knowledge. M Here ay the IRS discuss this return with the preparer shown below (see ' instructions)? ? Yes E] No ' Signature of general partner or limited liability company member manager Date Paid Preparers signature john S Kostukovich Date 02/16/10 Check if self-employed ? Preparers SSN or PTIN P00098505 Preparer's Firm's name (or yours John S. Kostukovich CPA EIN ? Use Only if self-employed), 3900 Trindle Rd Phone address, and ZIP code Camp Hill, PA 17011-6912 no. 717-730-011120 For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form 1065 (2009) DAA 3900TRINDLE 02/16/2010 9:59 AM Form 1065 (2009) 3900 Trindle Road, LLC 20-4527894 Page 2 Schedule A Cost of Goods Sold see the instructions 1 Inventory at beginning of year .. . ..................................................... 1 2 Purchases less cost of items withdrawn for personal use 2 3 Cost of labor ............................................................................................... 3 . 4 Additional section 263A costs (attach statement) ............................................................ 4 5 Other costs (attach statement) ................................ 5 6 Total. Add lines 1 through 5 .................................................................... 6 7 Inventory at end of year ................................................................ 7 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 8 9a Check all methods used for valuing closing inventory: (i) Cost as described in Regulations section 1.471-3 (ii) Lower of cost or market as described in Regulations section 1.471-4 (iii) Other (specify method used and attach explanation) ? ................................ . . .._................ b Check this box if there was a writedown of "subnormal" goods as described in Regulations section 1.471-2(c) ..... ? ................... c Check this box if the LIFO iiventory method was adopted this tax year for any goods (if checked, attach Form 970) ? d Do the rules of section 263A (for property produced or acquired for resale) apply to the partnership? 8 Yes No e Was there any change in determining quantifies, cost, or valuations between opening and closing inventory? Yes No If "Yes," attach explanation. Schedule 8 Other Information 1 What type of entity is filing this return? Check the ap plicable box: Yes No a H Domestic general partnership b Domestic limited partnership c Domestic limited liability company d Domestic limited liability partnership e Foreign partnership f Other ? ...................... ............................................. 2 At any time during the tax year, was any partner in the partnership a disregarded entity, a partnership (including an entity treated as a partnership), a trust, an S corporation, an estate (other than an estate of a deceased partner), or a nominee or similar person? ................................................... ........ X ..................................... 3 At the end of the tax year: a Did any foreign or domestic corporation, partnership (including any entity treated as a partnership), trust, or tax- exempt organization own, directly or indirectly, an interest of 50% or more in the profit, loss, or capital of the partnership? For rules of constructive ownership, see instructions. If "Yes," attach Schedule B-1, Information on Partners Owning 50% or More of the Partnership ................................... ............................................. X b Did any individual or estate own, directly or indirectly, art interest of 50% or more in the profit, loss, or capital of the partnership? For rubes of constructive ownership, see instructions. If "Yes," attach Schedule B-1, Information on Partners Owning 501% or More of the Partnership .............................. .. . .... X 4 At the end of the tax year, did the partnership: a Own directly 20% or more, or own, directly or indirectly, 50% or more of the total voting power of all classes of stock entitled to vote of any foreign or domestic corporation? For rules of constructive ownership, see instructions. If "Yes," complete (i) through (iv) below .. . .. . .... . . . ..................... . . . .. . ........ ............................... X (i) Name of Corporation (ii) Employer Identification Number (if any) (iii) Country of Incorporation (iv) Percentage Owned in Voting Stock b Own directly an interest of 20% or more, or own, directly or indirectly, an interest of 50% or more in the profit, loss, or capital in any foreign or domestic partnership (including an entity treated as a partnership) or in the beneficial interest of a trust? For rules of constructive ownership, see instructions. If "Yes," complete (i) through (v) below .............. X (i) Name of Entity (ii) Employer Identification Number if an (iii) Type of Entity (iv) Country of Organization (v) Maximum Percentage Owned in Profit, Loss, or Capital Form 1065 (2009) DAA 3900TRINDLE 02116/2010 9:59 AM Form 1065 (2009) 3900 Trindle Road, LLC 20-4527894 Page 3 Yes No 5 Did the partnership file Form 8893, Election of Partnership Level Tax Treatment, or an election statement under section 6231(a)(1)(B)(ii) for partnership-level tax treatment, that is in effect for this tax year? See Form 8893 for more details ....................................... X 6 Does the partnership satisfy all four of the following conditions? a The partnership's total receipts for the tax year were less than $250,000. b The partnership's total assets at the end of the tax year were less than $1 million. c Schedules K-1 are filed with the return and furnished to the partners on or before the due date (including extensions) for the partnership return. d The partnership is not filing and is not required to file Schedule M-3 X If "Yes," the partnership is not required to complete Schedules L, M-1, and M-2; Item F on page 1 of Form 1065; or Item L on Schedule K-1. 7 Is this partnership a publicly traded partnership as defined in section 469(k)(2)? . _ ...... .................. ........... . . . . . . . . . . . . . X 8 During the tax year, did the partnership have any debt that was cancelled, was forgiven, or had the terms modified so as to reduce the principal amount of the debt? 9 Has this partnership filed, or is it required to file, Form 8918, Material Advisor Disclosure Statement, to provide information on any reportable transaction? ......................................................... ................ ............... 10 At any time during calendar year 2009, did the partnership have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. If "Yes," enter the name of the foreign country. ? .. .............................. . .. . .. ..... . . . . ... ....... X 11 At any time during the tax year, did the partnership receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? If "Yes," the partnership may have to file Form 3520, Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts. See instructions ......... ..................... .............. X 12a is the partnership making, or had it previously made (and not revoked), a section 754 election? ......................... ......... . . See instructions for details regarding a section 754 election. . . . b Did the partnership make for this tax year an optional basis adjustment under section 743(b) or 734(b)? If "Yes," attach a statement showing the computation and allocation of the basis adjustment. See instructions .................... .............. X c Is the partnership required to adjust the basis of partnership assets under section 743(b) or 734(b) because of a substantial built-in loss (as defined under section 743(d)) or substantial basis reduction (as defined under section 734(d))? If 'Yes," attach a statement showing the computation and allocation of the basis adjustment. See instructions . .... . ... . ....... . .. ......... X 13 Check this box if, during the current or prior tax year, the partnership distributed any property received in a like-kind exchange or contributed such property to another entity (other than entities wholly-owned by the partnership throughout the tax ear . . .......... . .... ............................................................... ? ..... 14 At any time during the tax year, did the partnership distribute to any partner a tenancy-in-common or other undivided interest in partnership property? .... , ... , .. . 15 If the partnership is required to file Form 8858, Information Return of U.S. Persons With Respect To Foreign Disregarded Entities, enter the number of Forms 8858 attached. See instructions ? ............ ........... 16 Does the partnership have any foreign partners? If "Yes," enter the number of Forms 8805, Foreign Partner's Information Statement of Section 1446 Withholding Tax, filed for this partnership. ? . ................................ X 17 Enter the number of Forms 8865, Return of U.S. Persons With Respect to Certain Foreign Partnerships, attached to this return. ? .................... Designation of Tax Matters Partner (see instructions) Enter below the general partner designated as the tax matters partner (TMP) for the tax year of this return: Name of ' designated Identifying TMP number of TMP If the TMP is an ' entity, name Phone number of TMP representative of TMP Address of Form 1065 (2009) DAA 3900TRINDLE 0211612010 9'.59 AM Form 1065 (2009) 3900 Trindle Road LLC 20-4527894 Page 4 T..?..1 n r4 Sched ule K Partners' utstriputlve snare items - - - - -- line 22) e 1 a l ) ( i i 1 ........... , g oss p ncome ( ness 1 Ordinary bus .............. ch Form 8825) l tt i 2 957 ................... ............... oss) (a a ncome ( 2 Net rental real estate 3a Other gross rental income (loss) b Expenses from other rental activities (attach statement) 3b .......................... Subtract line 3b from line 3a l i 3c .. .... oss). ncome ( c Other net rental t 4 N s 4 Guaranteed paymen p i 5 ncome 5 Interest J dividends di r C d 6a -- .. r na y s: a 6 Dividen E b Qualified dividends 6b O l i 7 v 7 Roya t es ................... .......................... ............................. .......... . ain (loss) (attach Schedule D (Form 1065)) ital t N h t g erm cap - et s or 8 ss) (attach Schedule D (Form 1065)) in l l it 9a ( ga o a 9a Net long-term cap b Collectibles (28°,10) gain (loss) 9b ........................................... c Unrecaptured section 1250 gain (attach statement) c .......................... ain (loss) (attach Form 4797) tion 1231 e 10 N t 1 g e s c 11 Other income (loss) (see instructions) Type ? 11 179 decuction (attach Form 4562) ti 12 Se 1 on ............................................................. c c tributions 13 C 13a on a ........................................................................................ rest ex ense t int t b I 13b p men e nves ...................................................................... c Section 59(e)(2) expenditures: e ? (2) Amount 00- 1 T 13c(2) ( ) yp d Other deductions see instructions Type ? ............................................................ 13d s (loss) from self-employment nin N 14 t 14a c a g ear a e or fishing income Gross farmin 14b 15 . Z w E g b ...................................................................... c Gross nonfarm income . ................................................ ............................ 14c credit section 420)(5)) ome housin -in 15 L 15a g ow c a b Low-income housing credit (other) 5b rA .................................................................... c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468) 15c d Other rental real estate credits (see instructions) Type ? 15d V e Other rental credits (see instructions) Type ? 15e f Other credits see instructions) Type ? .. 15f 16a Name of country or U.S. possession ? ................................................................ b Gross income from all sources C ............................................. ............... ........ c Gross income sourced at partner level 16c O w ................................................................. Foreign gross income sourced at partnership level N d Passive category ? e General category ? f Other ? 16f O Deductions allocated and apportioned at partner level R g Interest expense ? In Other ? 16h ................. c Deductions allocate3 and apportioned at partnership level to foreign source income i Passive category ? j General category ? k Other ? 16k L O .................... ............ 1 Total foreign taxes (check one): 0- Paid Accrued 161 LL m Reduction in taxes available for credit (attach statement) 16m ................................................ n Other foreign tax information (attach statement) ........................................................ K 17a Post-1986 depreciation adjustment 17a 165 H W .................................................................. b Adjusted gain or loss 17b y ............................................................................... r E 4) c Depletion (other than oil and gas) 17c ........................................... ........................ d Oil, gas, and geothermal properties-gross income: 17d p H E ...................................................... . C and geothermal properties-deductions gas e Oil 17e Q Q ?- , , ......................................................... f Other AMT items (attach statement) ......... 17f 18a Tax-exempt interest income C b Other tax-exempt income 18b .................... ....................................................... c Nondeductible expenses 18c ............................................................................. 19a Distributions of cash and marketable securities 19a C . .......................... b Distributions of other property 19b - ......................... ... ............................................. 20a Investment income 20a w .................................................................................. b Investment experses 20b O ............................................... ... c Other items and amounts (attach statement) .................. .......... ........................ ....... Form 1065 (2009) DAA 3900TRINDLE 02/16/2010 9:59 AM Form 1065 (2009) 3900 Trindle Road LLC 20-4527894 Page 5 Analysis of Net Income (Loss) 1 Net income (loss). Combine Schedule K, lines 1 through 11. From the result, subtract the sum of Schedule K, lines 12 through 13d and 161 1 957 2 Analysis by partner type: a General partners b Limited partners (il Corporate ....... ..... ...... (ii) Individual (active) ................ (iii) Individual (passive) (iv) Partnership (v) Exempt organization (vi) Nominee/Other 957 Schedule L Balance Sheets per Books Beginning of tax year End of tax year Assets (a) (b) (c) (d) 1 Cash 2a Trade notes and accounts receivable b Less allowance for bad debts .............. 3 Inventories 4 U.S. government obligations 5 Tax-exempt securities .................... 6 Other current assets (attach statement) 7 Mortgage and real estate loans ............ 8 Other investments (attach statement) ............ . 9a Buildings and other dep eciable assets b Less accumulated depreciation 10a Depletable assets ........................ b Less accumulated depletion 11 Land (net of any amortization) 12a Intangible assets (amortizable only) _ b Less accumulated amortization ............ 13 Other assets (attach statement) ... ..... ... . 14 Total assets Liabilities and Capital 15 Accounts payable 16 Mortgages, notes, bonds payable in less than 1 year 17 Other current liabilities (attach statement) 18 All nonrecourse loans 19 Mortgages, notes, bonds payable in 1 year or more 20 Other liabilities (attach statement) ... .......... . 21 Partners' capital accounts 22 Total liabilities and capital . . Schedule M-1 Reconciliation of Income (Loss) per Books With Income (Loss) per Return Note. Schedule M-3 may be required instead of Schedule M-1 (see instructions). 1 Net income (loss) per books 6 Income recorded on books this year not included 2 Income included on Schedue K, lines 1, 2, 3c, on Schedule K, lines 1 through 11 (itemize): 5, 6a, 7, 8, 9a, 10, and 11, not recorded on a Tax-exempt interest $ books this year ....... ......... ...... (itemize) : ......... .......... ...... . ............................................. ..................................... 3 Guaranteed payments (other than ............................................. 7 Deductions included on Schedule K, lines health insurance) 1 through 13d, and 161, not charged ..................... 4 Exppenses recorded on books this year not included on Schedule K lines 1 through against book income this year (itemize): , 13d, and 161 (itemize): a Depreciation $ .............................. a Depreciation $ b Travel and . . $ entertainment ....................... .............................. . .... .................. . ............. 8 Add lines 6 and 7 ............ .. . 9 Income (loss) (Analysis of Net Income .... ......... . 5 Add lines 1 through 4 ................. (Loss), line 1). Subtract line 8 from line 5 ...... Schedule M-2 Analysis of Partners' Capital Accoun ts 1 Balance at beginning of year 6 Distributions: a Cash 2 Capital contributed: a Cash b Property b Property 7 Other decreases (itemize) : .... 3 Net income (loss) per books ........... .................... ......... 4 Other increases .............. " ...................... . ...... (itemize): . . . . . . . . . . ........................... ......... ..... 8 Add lines 6 and 7 5 Add lines 1 through 4 ........ ..... .. 9 Balance at end of year. Subtract line 8 from line 5 DAA Form 1065 (2009) 3900TRINDLE 02/16/2010 9:59 AM Farm 8825 Rental Real Estate Income and Expenses of a (Rev. December 2006) Partnership or an S Corporation OMB No. 1545-1186 Department of the Treasury ? See instructions on back. Internal Revenue Service ? Attach to Form 1065, Form 1065-B, or Form 1120S. Name Employer identification number 3900 Trindle Road, LLC 20-4527894 1 Show the kind and location of each property. See page 2 to list additional properties. Commercial Rental A 3900 Trindle Road,...Camp Hill r...PA ........ . ................................. B ............................................................................................................................................ C ............................................................................................................................................ D . ........................................................................................................................................... Rental Real Estate Income A B C D 2 Gross rents 2 52,980t 3 Rental Real Estate Expenses Advertising ........................ 3 4 Auto and travel ..................... 5 Cleaning and maintenance 5 6 Commissions ...................... 6 7 Insurance 7 8 Legal and other professional fees 8 9 Interest ............................ 9 10 Repairs ........................... 10 11 Taxes ............................. 11 12 Utilities ............................ 12 13 Wages and salaries ................ 13 14 Depreciation (see instructions) 14 15 Other (list) ? ...................... See Statement 1 . .................................. 5 30,47 52 1 16 Total expenses for each property. Add lines 3 through 15 16 52 , 023 17 Total gross rents. Add gross rents from line 2, columns A through H ............................................. 18 Total expenses. Add total expenses from line 16, columns A through H .......................................... 19 Net gain (loss) from Form 4797, Part ll, line 17, from the disposition of property from rental real estate activities ............................................................................................. 20a Net income (loss) from rental real estate activities from partnerships, estates, and trusts in which this partnership or S corporation is a partner or beneficiary (from Schedule K-1) .................................. b Identify below the partnerships, estates, or trusts from which net income (loss) is shown on line 20a. Attach a schedule if more space is needed: (1) Name (2) Employer identification number ............................................... .. . ................. ........ ....................................... ..................... .. . ................ ................................... ......... _. 21 Net rental real estate income (loss). Combine lines 17 through 20a. Enter the result here and on: • Form 1065 or 1120S: Schedule K, line 2, or • Form 1065-B: Part I, line 4 17 52,980 18 52,023 19 20a 21 957 For Paperwork Reduction Act Notice, see back of form. Form 8825 (12-2006) DAA 900TRINDLE 02/16/2010 9:59 AM SCHEDULE B-1 (Form 1065) (December 2009) Department of the Treasury nt--i RAwp..-P. Sarvira Information on Partners Owning 50% or More of the Partnership ? Attach to Form 1065. See instructions on back. OMB No. 1545-0099 Name of partnership Employer identification number (EIN) 3900 Trindle Road, LLC _ 20-4527894 Part I Entities Owning 50% or More of the Partnership (Form 1065, Schedule B, Question 3a) Complete columns (i) through (v) below for any foreign or domestic corporation, partnership (including any entity treated as a partnership), trust, or tax-exempt organization that owns, directly or indirectly, an interest of 50% or more in the profit, loss, or capital of the partnership (see instructions). (i) Name of Entity (ii) Employer Identification Number (if any) (iii) Type of Entity (iv) Country of Organization v) Maximum ( Percentage Owned in Profit, Loss, or Capital Part II Individuals or Estates Owning 50% or More of the Partnership (Form 1065, Schedule B, Question 3b) Complete columns (i) through (iv) below for any individual or estate that owns, directly or indirectly, an interest of 50% or more in the profit, loss, or capital of the partnership (see instructions). (i) Name of Individual or Estate (ii) Identifying Number (if any) (iii) Country of Citizenship (see instructions) (iv) Maximum Percentage Owned in Profit, Loss, or Capital John Kostukovich 191-40-7548 United States 50.000000 Suellyn Kostukovich 207-56-5895 United States 50.000000 For Paperwork Reduction Act Notice, see the Instructions for Form 1065. Schedule B-1 (Form 1065) (12-2009) DAA 900TRINDLE 02/1612010 9:59 AM Partner# 1 A A A A ? Final K-1 ? Amended K-1 651109 OMB No. 1545-0099 Schedule K-1 ZUUU Part III Partner's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department of the Treasury For calendar year 2009, or tax 1 Ordinary business income (loss) 15 Credits Internal Revenue Service year beginning ending 2 Net rental real estate income (loss) Partner's Share of Income, Deductions, * 479 Credits, etc. ? See back of form and separate instructions. 3 Other net rental income (loss) 16 Foreign transactions Part 1 Information About the Partnershi 4 Guaranteed payments A Partnership's employer identification number 20-4527894 5 Interest income B Partnership's name, address, cty, state, and ZIP code 3900 Trindle Road, LLC 6a Ordinary dividends 3900 Trindle Road 6b Qualified dividends Camp Hill PA 17011 7 Royalties C IRS Center where partnership filed return Cincinnati OH 45999-0011 8 Net short-term capital gain (loss) D ? Check if this is a publicly traded partnership (PTP) 9a Net long-term capital gain (loss) 17 Alternative minimum tax (AMT) items Part II Information About the Partner A 83 E Partner's identifying number 9b Collectibles (28%) gain (loss) 191-40-7548 F Partners name, address, city, state, and ZIP code 9c Unrecaptured section 1250 gain John Kostukovich 10 Net section 1231 gain (loss) 18 Tax-exempt income and nondeductible expenses 11 Montego Court 11 Other income (loss) Dillsbur PA 17019 G © General partner or LLC ? Limited partner or other LLC member-manager member H © Domestic partner ? Foreign partner 19 Distributions I What type of entity is this partner? Individual 12 Section 179 deduction J Partners share of profit loss and capital (see instructions): , , Beginning Ending 13 Other deductions Profit 50.000000 % 50.000000 pro 20 Other information Loss 50.000000 ro 50.000000% Capital 50.000000 ro 50.000000% K Partners share of liabilities at year end: Nonrecourse $ ............. .............. 14 Self-employment earnings (loss) Qualified nonrecourse financing $ ............. Recourse $ L Partner's capital account analysis: *See attached stateme t f dditi l i f i n or a ona n ormat on. Beginning capital account $ ... .............. Capital contributed during the year $ ........... Current year increase (decrease:) $ . ... . ....... Withdrawals & distributions $ ( ) -E Ending capital account $ a) N ? Tax basis ? GAAP ? Section 704(b) book U) Other (explain) `o M Did the partner contribute property with a built-in gain or loss? ? Yes © No If "Yes", attach statement (see instructions) For Paperwork Reduction Act Notice, see Instructions for Form 1065. Schedule K-1 (Form 1065) 2009 DAA 900TRINDLE 02/16/2010 9:59 AM Partner# 2 ^9%9%r% ? Final K-1 ? Amended K-1 651109 OMB No. 1545-0099 Schedule K-1 LVV? Part III Partner's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department of the Treasury For calendar year 2009, or tax 1 Ordinary business income (loss) 15 Credits Internal Revenue Service year beginning ending 2 Net rental real estate income (loss) Partner's Share of Income, Deductions, * 478 Credits, etc. ? See back of form and separate instructions. 3 Other net rental income (loss) 16 Foreign transactions Part I Information About the Partnership 4 Guaranteed payments A Partnership's employer identification number 20-4527894 5 Interest income B Partnership's name, address, cry, state, and ZIP code 3900 Trindle Road, LLC 6a Ordinary dividends 3900 Trindle Road 6b Qualified dividends Camp Hill PA 17011 7 Royalties C IRS Center where partnership filed return Cincinnati OH 45999-0011 8 Net short-term capital gain (loss) D ? Check if this is a bli l t d d hi PT pu c y ra e partners p ( P) 9a Net long-term capital gain (loss) 17 Alternative minimum tax (AMT) items Part II Information About the Partner A 82 E Partner's identifying number 9b Collectibles (28%) gain (loss) 207-56-5895 F Partner's name, address, city, state, and ZIP code 9c Unrecaptured section 1250 gain Suellyn Kostukovieh 10 Net section '231 gain (loss) 18 Tax-exempt income and nondeductible expenses 11 Montego Court 11 Other income (loss) Dillsbur PA 17019 G ? General partner or LLC ® Limited partner or other LLC member-manager member H © Domestic partner ? Foreign partner 19 Distributions I What type of entity is this partner Individual 12 Section 179 deduction J Partner's share of profit, loss, and capital (see instructions): Beginning Ending 13 Other deductions Profit 50.000000 % 50.000000 pia 20 Other information Loss 50.000000 % 50.000000% Capital 50.000000 % 50.000000% K Partner's share of liabilities at yE!ar end: Nonrecourse $ 14 Self-employment earnings (loss) Qualified nonrecourse financing $ ............. Recourse $ L Partner's capital account analysis: Be innin it l *See attached statement for additional information. g g cap a account $ Capital contributed during the year $ ........... Current year increase (decreases $ ............ Withdrawals & distributions $ ( ) c Ending capital account $ O .. ....... ... . . m U) Tax basis ? GAAP ? Section 704(b) book U) Other (explain) 0 u- M Did the partner contribute property with a built-in gain or loss? ? Yes © No If "Yes", attach statement (:see instructions) For Paperwork Reduction Act Notice, see Instructions for Form 1065. DAA Schedule K-1 (Form 1065) 2009 3900TRINDLE 0211612010 9:59 AM Form 1065 Rent and Royalty 5cneclu e 2009 State PA For calendar year 2009, or tax year beginning and endin Name Employer Identification Number 3900 Trindle Road, LLC 20-4527894 Property Description Type of Property Commercial Rental Rental Real Estate 3900 Trindle Road, Camp Hill, PA Other Rental Property Royalty Property Is the net income (loss) from this property included in the computation of self employment income? Yes No Is the net income (loss) from this property included in the computation of Section 179 business income? Yes H No Income and Expenses Income Gross rents Gross royalties ................................................................ Other income Income from sale of property reported on Form 4797, Line 17 ..................... Total gross income ............................................................ Expense Advertising ................................................................... Auto and travel Cleaning and maintenance ..................................................... Commissions ................................................... Insurance ..................................................................... Legal and professional ................. Interest . . Repairs ...... Taxes ....................... .............................................. . Utilities ...................... ................................................ Wages and salaries .......... ................................................ Depreciation Other expenses Total expenses Less % personal use Net deductible expenses ................. Net income or loss from this property 52,980 52,980 30,478 3,800 5,528 12,052 165 52,023 52,023 957 3900TRINDLE 3900 Trindle Road, LLC 2/16/2010 9:58 AM 20-4527894 Federal Statements FYE: 12/31/2009 Statement 1 - Commercial Rental - Form 8825. Line 15 - Other Description Amount Amortization $ 165 Total $ 165 FILED-OFFICE 25 PM 1: 12 SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMONdjIW ;, - ij i ouw Plaintiff : CUMBERLAND COUNTY, PENN55iIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW Defendant : IN DIVORCE INVENTORY OF JOHN S. KOSTUKOVICH Defendant files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years. Defendant verifies that the statements made in this inventory are true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Date: AOS. Kostukovich ASSETS OF PARTIES Defendant marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. If an item has been appraised, a copy of the appraisal report is attached. (x) 1. Real property (x) 2. Motor vehicles () 3. Stocks, bonds, securities and options O 4. Certificates of Deposit ( x) 5. Checking accounts, cash (x) 6. Savings accounts, money market O 7. Contents of safe deposit boxes () 8. Trusts (x) 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries) () 10. Annuities O 11. Gifts O 12. Inheritances O 13. Patents, copyrights, inventions, royalties (x) 14. Personal property outside the home ( x) 15. Businesses (list all owners, including percentage of ownership, and officer/director positions held by a party with a company) O 16. Employment termination benefits - severance pay, workman's compensation claim/award O 17. Profit sharing plans O 18. Pension plans (indicate employee contribution and date plan vests) (x) 19. Retirement plans, Individual Retirement Accounts O 20. Disability payments O 21. Litigation claims (matured and unmatured) O 22. MilitaryN.A. benefits O 23. Education benefits O 24. Debts due, including loans, mortgages held (x) 25. Household furnishings and personalty (include as a total category and attach itemized list if distribution of such assets is in dispute) O 26. Other MARITAL PROPERTY Defendant lists all marital property in which either or both spouses have a legal or equitable interest individually or with any person as of the date this action was commenced. ITEM NUMBER DESCRIPTION NAMES OF ALL OF PROPERTY OWNERS Marital residence 1 11 Montego Court Husband and Wife Dillsburg, Pennsylvania Commercial building 1 3900 Trindle Road Husband and Wife Cam Hill, PA 17011 2 2006 Ford Expedition Husband 2 2006 Mercedes SLK 350 Husband and Wife 2009 Mazda 3 2 (vehicle damaged/ insurance Husband and Wife proceeds) 5 First National Bank Husband and Wife Account #xx64 9 Genworth Financial Nationwide Life Insurance 14 2005 VX 100 Jet Ski Husband 14 1997 GP 1200 Jet Ski Husband 14 1995 Triton 2 bay Husband Jet Ski Trailer ITEM NUMBER DESCRIPTION NAMES OF ALL OF PROPERTY OWNERS 15 John S. Kostukovich, CPA Husband office contents 19 ESI Illuminations Husband SIMPLE Account Personal Property: 25 2008 Sony 42" television and Husband Golf clubs Personal Property: 25 Coffee table, end tables and Husband and Wife steeper sofa Personal Property: 25 Household furnishings Husband and Wife NON-MARITAL PROPERTY Defendant lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property. ITEM NUMBER DESCRIPTION REASON FOR OF PROPERTY EXCLUSION 5 Metro Bank Business Business account opened post- Checking Account #537xx5 separation 5 Metro Bank Checking Business account opened post- Account #083xx8 separation 5 First National Bank Business Business account opened post- Checking. Account #95xx4 separation 5 First National Bank (3900 Business account opened post- Business Account #95xx3) separation 6 Metro Bank Business Savings Business account opened post- Account #537xx4 separation 6 Metro Bank Savings Account Business account opened post- separation 6 First National Bank Business Business account opened post- Savings Account #97xx2 separation Personal property: 25 Kitchen items, couch, (2) TV Purchased post-separation stands and bedroom furniture PROPERTY TRANSFERRED ITEM NUMBER DESCRIPTION DATE OF TRANSFER CONSIDERATION TRANSFEREE 2 2009 Mazda 3 February 2010 $0.00 Wife LIABILITIES ITEM NUMBER DESCRIPTION CREDITORS DEBTORS Mortgage 1 encumbering 11 First National Bank Husband and Wife Montego Court, Dillsburg, Pennsylvania Mortgage 1 encumbering 3900 First National Bank Husband and Wife Trindle Road Camp Hill, Pennsylvania 2 2006 Ford Expedition Ford Credit Husband and Wife vehicle loan 2 2006 Mercedes SLK VA Heritage Bank Husband and Wife 350 vehicle loan w Y AUG 2 6 2010 SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION - LAW IN DIVORCE I t r 'J z?. '? 3t .ern ORDER APPOINTING MASTER AND NOW, this c2? day of 2010, E. Robert Elicker, Esquire is appointed Master with respect to the following claims: divorce, equitable distribution, alimony, alimony pendente lite, counsel fees, costs and expenses. By the Court: J. Distribution: rui V. Levin, Esquire, 4431 North Front Street, Harrisburg, PA 17110 . (717) 234-2401 (phone); (717) 234-3611 (fax); alevin(a;sasllp.com (e-mail) Attorney for Plaintiff deem J. Connelly, Jr., Esquire, P.O. Box 650, Hershey, PA 17033, (717) 533-3280 (phone), (717) 533-7771 (fax); jjc(aisdc.com (e-mail); Attorney for Defendant E. Robert Elicker, III, Esquire, Cumberland County Divorce Master, 9 North Hanover Street, T' 1 e d rct,uxx Carlisle, PA 17013; (717) 240-6535 (phone); (717) 240-7890 (fax) John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant/Petitioner SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner r)rz 3:'5 CI;PJ? t:. i ?joulYt ?E4 ?", a?YLVruN A IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE PETITION TO REDACT SOCIAL SECURITY NUMBERS AND NOW, comes the Petitioner, John S. Kostukovich, by and through his counsel, John J. Connelly, Jr., Esquire of James, Smith, Dietterick & Connelly, LLP and files this Petition to Redact Social Security Numbers as follows: 1. Petitioner is John S. Kostukovich, Defendant in the above-captioned action. 2. On August 25, 2010, Petitioner filed his Income and Expense Statement in this matter. 3. Set forth on Exhibit "B" of Petitioner's Income and Expense Statement is a corporate tax return for 3900 Trindle Road, LLC which includes the Social Security Numbers of Plaintiff and Defendant. 4. The Plaintiff's and Defendant's Social Security Numbers appear online at the Cumberland County website at pages 51 (Schedule B-1), page 52 (Partner #1, Schedule K-1) and page 53 (Partner #2, Schedule K-2),. A copy of the corrected pages are attached hereto as Exhibit "A» 5. Pursuant to Local Rule 500, as amended June 21, 2010, this matter is considered a "non-public" file and therefore should be removed from the Prothonotary's website for public access. WHEREFORE, the Petitioner requests the Court enter and Order directing the Prothonotary to redact the Plaintiffs and Defendant's Social Security Numbers referenced on the documents in paragraph 4 hereof. Additionally, the Petitioner respectfully requests that this Court enter an Order directing that the Prothonotary's office immediately remove all pleadings and documents filed in connection with the instant matter from the Prothonotary's website for internet access. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: f By. - ohn J. Connelly, Jr. / Attorney I.D. #15615 (i Christine Taylor Brann Attorney I.D. #82204 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner, John S. Kostukovich 2 3900TRJNDLE 02/16/2010 9 59 AM SCHEDULE B-1 Information on Partners Owning 50% or (Form 1065) (December 2009) More of the Partnership OMB No. 1545-0099 Department of the Treasury ? Attach to Form 1065. See instructions on back. Intemal Revenue Service _ Name of oa ne5hip Employer identification number (EIN) 3900 Trindle Road, LLC -720-4527894 Part I Entities Owning 50% or More of the Partnership (Form 1065, Schedule B, Question 3a) Complete columns ;i) through (v) below for any foreign or domestic corporation, partnership (including any entity treated as a partnership), trust, or tax-exempt organization that owns, directly or indirectly, an interest of 50% or more in the profit, loss, or capital of the partnership (.see instructions). i) Name of Entity (i?) Employer Iden6fcation Number (if any) iii) Type or Entity (iv) Country of Organization (v) Maximu m Percentage Owned in Profit, Loss, or Capital Part 11 Individuals or Estates Owning 50% or More of the Partnership (Form 1065, Schedule B, Question 3b) Complete columns (i) through (iv) below for any individual or estate that owns, directly or indirectly, an interest of 50% or more in the profit, loss, or capital of the partnership (see instructions). (i) Name of Individual or Estate John Kostukovich Suellyn Kostukovich (ii) Identifying Number (if any) (iii) Country of Citizenship (see instructions) United States - United States (iv) Maximum Percentage Owned in Profit, Loss, or Capital 50.000000 50.000000 - - , cc ura o -U Llvns rur rorm wrio. Schedule B-1 (Form 1065) (12-2009) DAA 3900TRINDLE 02/16/2010 9 59 AM Partner# 1 2U?9 Schedule K-1 (Form 1065) Department of the Treasury For calendar year 2009, or tax Irlernal Revenue Service year beginning ending _ Partner's Share of Income, Deductions, Credits, etc. ? See back of form and separate instructions. Part I Information About the Partnership A Partnership's employer identification number 20-4527894 B Partnership's name, address, city, state, and ZIP code 3900 Tri.ndle Road, LLC 3900 Tri.ndle Road Camp Hill PA 17011 C IRS Center where partnership tiled return Cincinnati, OH 45999-0011 D ? Check if this is a publicly traded partnership (PTP) Part II Information About the Partner E Partner's identifying number F Partner's name, address, city, stale, and ZIP code John Kostukovich 11 Montego Court DillsburgPA 17019 G ® General partner or LLC ? Limited partner or other LLC member-manager member H © Domestic partner ? Foreign partner What type of entity is this partner? Individual- J Partner's share of profit, loss, and capital (see instructions): Beginning Ending Profit 50.000000 % 50.000000 % Less 50.000000 % 50.000000% Capital 50.000000 % 50.000000% K Partner's share of liabihUes at year end: Nonrecourse $ Qualified nonrecourse finanrin_cl $ _ Recourse $ L Partner's capital account analysis: Beginning capital account $ ... .............. Capital contributed during the year $ Current year increase (decrease) $ Withdrawals & distributions $ Ending capital account $ ? Tax basis ? GAAP ? Section 704(b) book Other (explain) M Did the partner contribute p'OPEErty with a ouill-in gain or loss? ? Yes L No If "Yes", attach statement (see instructions) 651109 ? Final K-1 Amended K-1 OMB No. 1545-0099 Part III Partner's Share of Current Year Income, Deductions, Credits, and Other Items 1 Ordinary business income (loss) 15 c-edils 2 Net rental real estate income (loss) * 479 3 Other net rental income (toss) 4 Guaranteed payments 5 Interest income 6a Ordinary dividends 6b Qualified dividends 16 1 Foreign transactions 7 1 Royalties 8 Net short-term capital gain (less) 9a Net long-term capital gain (loss) 9b Collectibles (28%) gain (loss) 9c Unrecaptured section 1250 gain 17 I Altemalve minimum tax (AMT) items A 1 83 10 1 Net section 1231 gain (loss) 11 1 Other income (loss) 12 1 Section 179 deduction 13 1 Other deductions 14 1 Self-employment earnings (loss) 18 1 Tax-exempt income and nondeductible expenses 19 Distributions 20 1 Other information *See attached statement for additional O d 7 rn o` LL For Paperwork Reduction Act Notice, see Instructions for Form 1065. Schedule K-1 (Form 1065) 2009 DAA 3900TRINDLE 02/16i2C10 9:59 AM PAri-nP_r# 2 651109 ? Final K-1 ? Amended K-1 OMB No. 1545-0099 Schedule K-1 ZUUy Part Ili Partner's Share of Current Year Income, (Form 1065) Deductions, Credits, and Other Items Department of the Treasury For calendar year 2009, or tax 1 Ordinary nusiness income (loss) 15 C'EKittS Internal Revenue Service year beginning ending 2 Net rental real estate income (loss) Partner's Share of Income, Deductions, * 478 Credits, etc. ? See back of form and separate instructions. 3 Other net ental income (loss) 16 Foreign 'ransactions Part I Information About the Partnership 4 Guaranteed payments A Partnership's employer identification number _ 20-4527894 5 Interest income B Partnership's name, address, cty, state, and ZIP code 3900 Tr:indle Road, LLC 6a Ordinary dividends 3900 Trindle Road 6b Qualified dividends Camp Hi1.1 PA 17011 7 Royalties C IRS Center where partnership filed return Cincinnati, OH 45999-0011 8 Net short-term capital gain (loss) - D ? Check if this is a publicly traded partnership (PTP) 9a Net long-temp capital gain (loss) 17 Alternative minimum tax (AMT) items Part Il Information About the Partner A 82 E Partners identifying number 9b Collectibles (28%) gain (loss) F Partner's name, address, city, state, and ZIP code 9c Llnrecaptured section 1250 gain Suellyn Kostukovieh 10 Net section '231 gain (loss) 18 Tax-exempt income and nondeductible expenses 11 Montego Court 11 Other income (toss) Dillsburg PA 17019 G ? General partner or LLC ® Limited partner or other LLC member-manager. member H ® Domestic partner ? Foreign partner 19 Distributions I What type of entity is this partner? Individual 12 Section 179 deduction J Partner's share of profit, loss, and capital (see instructions): Beginning Ending 13 Other deductions profit 50.000000 % 50.000000% 20 Other information Loss 50.000000 % 50.000000% Capital 50.000000 % 50.000000 pro K Partner's share of liabilities at year end Nonrecourse $ 14 Self-employment earnings (loss) Qualified nonrecourse financing $ - Recourse $ L Partner's capital account analysis: *See attached statement for additional information. Beginning capital account $ Capital contributed during the year $ Current year increase (decreases $ Withdrawals & distributions $ ( ) - Ending capital accou-d $ O m Tax bans ? GAAP ? Section 704(b) book cn U) Other (explain) 0 LL M Did the partner contnoute prooery with a built-in gain or loss? ? Yes ? No if "Yes", attach statement (see instructions) For Paperwork Reduction Act Notice, see Instructions for Form 1065. Schedule K-1 (Form 1065) 2009 DAA SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. JOHN S. KOSTUKOVICH, NO. 2010 - 0293 CIVIL TERM Defendant ORDER OF COURT AND NOW, this 10TH day of SEPTEMBER, 2010, the PROTHONOTARY is directed to redact the Social Security Numbers of Plaintiff and Defendant as referenced on their website on pages 51 (Schedule B-1), page 52 (Partner #1, Schedule K-1) and page 53 (Partner 42, Schedule K-2). ?ANN LEVIN, ESQUIRE 2917 NORTH FRONT STREET HARRISBURG, PA 17110-1223 JOHN J. CONNELLY, JR., ESQUIRE P.O. BOX 650 HERSHEY, PA 17033 COURT ADMINISTRATOR - sld 0.o p E s < I 4l« 1 / ro -/11 Fr f Lam ,;-? P? (V--- B urt. Edward E. Guido. J. c --] 'C7l':: r•-] :A ;Z y? co `r John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent v. JOHN S. KOSTUKOVICH, Defendant/Petitioner ~+° ~-Gr""~= ~~ a~ TF~F ~;~ i"H~FQLl ~.~~r `c, 2~1! 0 OCT 15 P~ 1 ~ 5 I ~UP~~ER! A~~~ ~aU~T Pc~~t~SY~.V-~~-~i~. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW IN DIVORCE PETITION TO MODIFY SUPPORT AGREEMENT DATED MAY 24.2010 AND NOW, comes the Defendant, John S. Kostukovich, by and through his counsel, John J. Connelly, Jr., Esquire of James, Smith, Dietterick & Connelly, LLP and files this Petition to Modify Support Agreement as follows: 1. Petitioner is John S. Kostukovich, Defendant in the above-captioned action, (hereinafter referred to as "Husband"). 2. Respondent is Suellyn G. Kostukovich, Plaintiff in the above-captioned action, (hereinafter referred to as "Wife") 3. On May 24, 2010, the parties entered into a Support Agreement regarding child support for the parties' daughter, Tiana Lyn Kostukovich, born September 11, 1992, as well as spousaValimony pendente lite to Wife.. A copy of the Support Agreement dated May 24, 2010 is attached hereto as Exhibit "A" and hereinafter referred to as "Agreement". 4. The total amount of child support under said Agreement is One Thousand Three Hundred Dollars ($1,300.00) per month. 5. The total spousal support/alimony pendente lite payment attributable to Wife is Two Thousand Two Hundred Dollars ($2,200.00) per month broken down as follows: a. Nine Hundred Sixty-six Dollars ($966.00) per month mortgage payment; b. One Hundred Thirty Dollars ($130.00) per month homeowners' insurance; c. Seven Hundred Ninety Dollars ($790.00) per month county, township and school taxes; and d. Three Hundred Fourteen Dollars ($314.00) per month paid directly to Wife. 6. Under paragraph 14 of the Agreement, either party has a right to pursue a modification of the Agreement through the Court based on a change in circumstances. Husband believes and therefore avers that there has been a change in circumstances which warrants a modification of the Agreement through this Court since there is no support action pending and support is being paid through the Agreement. The changes in circumstances are set forth below. 7. Husband further believes and therefore avers that Wife is no longer eligible for either spousal support or alimony pendente lite. Wife's ineligibility for spousal support stems from her ongoing relationship with her boyfriend and cohabitation with him that occurs a minimum of four to five days a week at Wife's residence located at 11 Montego Court, Dillsburg, Pennsylvania on which Husband is making the payments as set forth in paragraph 5(a), (b) and (c) above. 8. Wife's ineligibility for alimony pendente lite stems from her refusal to move ahead a divorce action in this matter. 9. Husband filed a Motion for Appointment of Master and filed his Inventory and Income and Expense Statement consistent with the Motion. The Divorce Master issued a Certification of Discovery. Wife's response indicated that "Grounds for divorce have not been established as two years from date of separation have not passed and Plaintiff is not willing to sign a consent at this time". 2 10. The purpose of alimony pendente lite is to assist Wife in her litigation. Given her refusal to move the matter forward, she is no longer entitled to alimony pendente lite unless and until she is prepared to move ahead with the divorce action. 11. It is believed and therefore averred that the parties' minor child Tiana is not primarily residing with Wife at the marital residence. Tiana has represented to her father in the past that she intended to move out and on numerous occasions when he has checked on her whereabouts, he has been able to determine that she was not staying with her mother at the marital residence but at the residence of friends with whom she attends school. 12. Because of Tiana's graduation in June of 2011, it is believed and therefore averred that Tiana will not be primarily residing with her mother and therefore Wife is not entitled to child support. 13. Husband is ready, willing and able to provide Tiana with the financial support necessary to complete her senior year providing her with financial assistance directly and/or providing her a location where she can reside on a permanent basis pending her graduation. 14. It is believed and therefore averred that Tiana's failure to continue to reside with her mother at the marital residence is in part due to the fact that mother is residing with her boyfriend at that location a significant portion of the time. WHEREFORE, your Petitioner, John S. Kostukovich, is requesting that the Court terminate his responsibility to pay child support, spousal support or alimony pendente lite based on the current circumstances. 3 Respectfully submitted, JAMES, SNIITH, DIETTERICK & COTTNELLY, LLP Dated: f ~' ~ ~' ~ ~ By: - ~ ~ o J. onn ly, Jr. tto e~ LD. 15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner, John S. Kostukovich 4 VERIFICATION I, John S. Kostukovich, verify that the statements made in the foregoing pleading 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. Date: ~ U - ~ - / 0 /.,~~ S. Kostukovich i) A EXHIBIT "A" SUPPORT AGREEMENT THIS AGREEMENT dated the _ day of 2010, between JOHN S. KOSTUKOVICH, (hereinafter referred to as "Husband" ,and SUELLYN KOSTUKOVICH, (hereinafter referred to as "Wife"), each intending to be legally bound hereby, covenant and agree as follows: WHEREAS, Wife filed an action for child and spousal supportlalimony pendente lite on January 7, 2010 in the Court of Common Pleas Cumberland County, Pennsylvania indexed to PACSES Case No. 193111400; and WHEREAS, the parties are the parents of one minor child, Tiana Lyn Kostukovich, born September 11, 1992, who is currently residing primarily with Wife; and WHEREAS, it is the intent of the parties to reduce to writing their Agreement thereby eliminating the necessity of the matter being heard by the Court. NOW, THEREFQRE, in consideration of the mutual covenants contained herein, the parties agree as follows: 1. Husband agrees to pay to Wife as more particularly set forth and delineated herein the sum of Three Thousand Five Hundred Dollars ($3,500.00) per month in a combined child and spousal support/alimony pendente lite payment which shall include the direct payment of the mortgage, taxes and homeowners' insurance on the marital residence. 2. The amount of the child support for the parties' minor child, Tiana Lyn Kostukovich, shall be One Thousand Three Hundred Dollars ($1,300.00) per month. 3. The spousal support/alimony pendente lite payment attributable to Wife shall be in the amount of Two Thousand Two Hundred Dollars ($2,200.00) payable as follows: a. A direct payment of the parties' mortgage in the average amount of Nine Hundred Sixty-six Dollars ($966.00) per month, the homeowners' insurance prorated in the amount of One Hundred Thirty Dollars ($130.00) per month and the county, township and school taxes prorated in the amount of Seven Hundred Ninety Dollars ($790.00) per month for a total contribution of One Thousand Eight Hundred Eight-six Dollars ($1,886.00). The remainder of Three Hundred Fourteen Dollars ($314.00) per month will be paid directly to Wife. The entire amount payable to Wife or for her benefit (Two Thousand Two Hundred Dollars ($2,200.00) per month) shall be considered income to Wife and shall be deductible to Husband. 4. The payment of One Thousand Three Hundred Dollars ($1,300.00) per month to Wife for the minor child shall have no tax. consequence. 5. The total amount payable directly to Wife in the form of child and spousal support shall be One Thousand Six Hundred Fourteen Dollars ($1,614.00) with the remaining monies payable as set forth in paragraph 3 above directly to the mortgage company, homeowners' insurance company and real estate taxing authorities. 6. Said payments shall be due on the first (1~`) of each month and in no event no later than the fifth (5~') of each month. In the event Husband fails to make the payment on a timely basis, Wife has the right to enter this Agreement as an Order of Court in the Court of Common Pleas, Cumberland County, Pennsylvania. Any payments made by Husband under this Agreement, in the event of the filing of an action, shall be credited to him in any final Order. 2 7. Husband shall maintain the minor child on his medical insurance. Husband shall maintain Wife on his medical insurance until May 1, 2010 when Wife shall secure her own coverage through her employer. 8. Husband shall be responsible for eighty-five percent (85%) and Wife shall be responsible for fifteen percent (15%) of all medical bills not covered by insurance after the first Two Hundred Fifty Dollars ($250.00) is paid by Wife on both her uncovered medical expenses and those of the minor child. The medical bills payable shall be as defined and determined by the policies of the Cumberland County Domestic Relations Office and Rules of Court. Medical bills not covered by insurance may include services for psychiatric and/or psychological treatment in the event said services are agreed to by the parties. 9. The said Agreement is effective with the January 7, 2010 payment. 10. It is presumed that Husband has made the mortgage payment for the months of January, February and March 2010 with his next mortgage payment being due in Apri12010. It is also presumed that Husband has paid One Hundred Thirty Dollars ($130.00) per month for homeowners' insurance for those months as well as Seven Hundred Ninety Dollars ($790.00) for real estate taxes on a monthly basis. In addition, Husband has made direct payments to Wife in the amount of Four Thousand Dollars ($4,000.00) since January 7, 2010. For the months of January, February and March 2010, Husband would owe a total to Wife (without prorating the month of January) Ten Thousand Five Hundred Dollars ($10,500.00) ($3,500.00 x 3). Adding up all payments made by Husband as referenced above, he has paid a total of Nine Thousand Six Hundred Fifty-eight Dollars ($9,658.00) for the first three months of 20101eaving a balance due to Wife in 3 the amount of Eight Hundred Forty-two Dollars ($842.00) ($10,500.00 - $9,658.00) prior to his April 1, 2010 payment. 11. So long as Husband is making the support payments as set forth herein, and Wife continues to reside in the marital residence, she will be entitled to deduct the real estate taxes and mortgage interest on any individual tax return filed by her. 12. In consideration of the fact that Husband has paid Wife's health insurance in the amount of Four Hundred Forty-four Dollars ($444.00) for the months of January, February and March 2010, and will be responsible for Wife's Apri12010 health insurance payment, -the arrearage due to Wife referenced herein shall be extinguished by the said payments. Therefore, as of April 1, 2010, no arrearages are owed to Wife. 13. The parties shall share expenses for extracurricular activities of the minor child eighty-five percent (85%) to Husband and fifteen percent (15%) to Wife. The minor child is enrolled in dance and has been for several years. The cost for dance is approximately Ninety Dollars ($90.00) per month. In the event the minor child would attend out of town shows which rec}uire overnight lodging and/or meals, these expenses shall be split between the parties as set forth herein only in the event both parties agree on the expenditure. 14. The provisions of this Agreement are subject to modification based on a change in circumstances.. Either party has a right to pursue a modification through Domestic Relations, Husband by petitioning the Court to modify this Agreement and Wife by filing a Petition with Domestic Relations for a modification. In the event Husband files a Petition with the Court, the matter will be referred by the Court to Domestic Relations for the entry of an Order. 4 IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. WITNESS.: ~~ ~ ~ Jo ' nn lly, Jr., Esq ire A s fob ohn S. Kos WITH S: U Ann .Levin, Esquire Attorneys for Suellyn G. Kostukovich S. Kostukovich uellyn G ostukovic SUELLYN G. KOSTUKOVICH, Plaintiff v. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, LLP, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Petition on the following on the date and in the manner indicated below: VIA U.S. MAIL, FIRST CLASS. PRE-PAID Ann V. Levin, Esquire Smigel, Anderson & Sacks, LLP 4431 North Front Street Harrisburg, PA 17110 Dated: ` ~ `1 ' ~ ~ BY~ JAMES, SMITH, DIETTERICK & CONNELLY, LLP Attorneys for Defendant Hershey, PA 17033-0650 (717) 533-3280 OCT 1 g 2010 SUELLYN '~ . KOSTUKOVICH, Pl ' tiff/Respondent v. I,~ JOHN S. itioner IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 ~ : -~ 3 0 CIVIL ACTION -LAW ~ IN DIVORCE u, r-- ~ ~ o ~o ~y ~ '~J RULE TO SHOW CAUSE °' ~ ~~ ~~ .. NOW, this ~ day of ~ ~'~~~ , 2010, upon consideration of the foregoing P~tition, it is hereby ORDERED that: 0 --~ ~~ ~rn ~~ o, --~ o ~ -~, O "'~`i ~ r~~ (1) I; A Rule is issued upon the Plaintiff, Suellyn G. Kostukovich, to show cause why the I~ Defendant, ~ohn S. Kostukovich, is not entitled to the relief requested; (2) !, ~ The Defendant shall file an Answer to Petition within0~ ~ days of this date; (3) III ~I A hearing shall be held on the 3d day of 201 ~ at ~~ a.m./~., '' Courtroom No. ~ , of the Cumberland County Courthouse, One Courthouse ~~~~ Square, C i~ isle, Pennsylvania, before the Honorable ~~ By the Court, '~'. II ~ jl J. /A}~n V. Lei ohn J. Cod ~ "Jt~£z' Iii w X01 ~i~. Esquire, 4431 North Front Street, Harrisburg, PA 17110 ly, Jr., Esquire, P.O. Box 650, Hershey, PA 17033 l~ I Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 f SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant i i:_THE'C0VRT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW ANSWER TO PETITION TO MODIFY SUPPORT AGREEMENT DATED MAY 24, 2010 1. Admitted 2. Admitted 3. Admitted 4. Admitted 5. Admitted 6. Denied. Paragraph 6 is denied. The Agreement is a writing which speaks for itself. Any characterization of the terms of the Agreement is denied. Further, Wife is' without personal information sufficient to form a belief as to the truth of the averment since she is personally unaware of the beliefs of Husband. 1 7. Denied. Wife is without personal information sufficient to form a belief as to the truth of the averment. It is further asserted that Paragraph 7 is denied as a conclusion of law to which no responsive pleading is due. It is further specifically denied that Wife is cohabitating. By way of further answer, it is asserted that Wife is the innocent and injured party and that Husband committed marital misconduct which has lead to the parties' separation and Husband's leaving the marital residence. Husband has a continued duty of support owed to Wife despite the fact that he is engaged to be married to a woman with which he had the extramarital relationship with prior to the parties' separation. 8. Denied. Paragraph 8 is denied as a conclusion of law to which no responsive pleading is due. 9. Admitted. By way of further answer, Wife's response to paragraph 7 is incorporated herein by reference. 10. Denied. Paragraph 10 is denied as a conclusion of law to which no responsive pleading is due. 2 11. Denied. Paragraph 11 is denied. It is averred that the child, Tiana, is residing with Wife in the marital residence. The remainder of the paragraph is denied by Wife since she lacks personal information sufficient to form a belief as to the truth of the averment. By way of further answer, it is asserted that if the child made such comments, they were made most likely upon circumstances where the child was angry at Wife since the child has suffered emotional distress as a result of Husband's separation and the pending divorce. 12. Denied. It is denied that Tiana is not residing with her mother. It is denied that her proposed graduation in June of 2011 has any rational relationship to her current circumstances. Tiana is in the primary custody of her mother and support is due and shall be continuing. 13. Denied. After reasonable investigation, Wife is without knowledge to form a reasonable belief as to the truth of this averment. By way of further answer, it is asserted that Tiana is estranged from Husband. It is also asserted that Husband has not been timely in even meeting his obligations under the current support agreement so that it is not reasonable to believe that he is ready, willing or able to provide Tiana with the financial support necessary to complete her senior year. 3 14. Denied. It is denied that Tiana does not continue to reside with Wife or that Wife is residing with her boyfriend. WHEREFORE, Wife is requesting that the Court grant child and spousal support. It is further requested that all counsel fees incurred by Wife in defense of this Petition be reimbursed to Respondent by Petitioner. tted, ]DATE: November 8, 2010 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court T.D. 32317 Attorney for Defendant 4 Barbara Sumple-Sullivan, Esquire; Supreme Court. #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 10-293 JOHN S. KOSTUKOVICH, CIVIL ACTION -LAW Defendant VERIFICATION I, Suellyn G. Kostukovich hereby certify that the facts set forth in the foregoing Answer are true and correct to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. §4904 relating to unworn falsification to authorities. Dated: SULELL' . KOSTUKOVICH Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 10-293 JOHN S. KOSTUKOVICH, CIVIL ACTION- LAW Defendant CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the foregoing Answer in the above-captioned matter upon the following individual(s) by first class mail, postage prepaid, addressed as follows: John J. Connelly, Jr., Esquire James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 DATED: November 8, 2010 Barbara Sumple-Sullivan, Esquire Attorney for Plaintiff 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. No. 32317 5 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW IN DIVORCE MOTION FOR CONTINUANCE 1. Petitioner is Plaintiff, Suellyn G. Kostukovich. 2. Respondent is Defendant, John S. Kostukovich. 3. A Hearing is scheduled in this matter for January 3, 2011 at 9:30 a.m. before the Honorable Judge Guido. 4. This date and time conflict with Petitioner's previously scheduled visit and celebration with her elderly Father. The visit is to celebrate her birthday as well as her Father's 87 h birthday. Petitioner is scheduled to travel to Florida for this visit. 5. Petitioner was planning not to return until January 4, 2011 in an effort to avoid the high travel costs for the holiday. L 'I 1 6. Based on this conflict, Petitioner is requesting a continuance and the rescheduling of the Hearing scheduled for January 3, 2011 at 9:30 a.m. 6. Counsel for Respondent does not concur with the request for rescheduling. 7. The Honorable Judge Guido has been assigned to this matter. WHEREFORE, Petitioner requests that the hearing be continued and rescheduled. Respectfully submitted, Dated: November 16, 2010 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Petitioner 2 549 Bridge Street New Cumberland, PA 17070 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, Plaintiff V. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 JOHN S. KOSTUKOVICH, Defendant CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the Motion for Continuance, in the above-captioned matter upon the following individual, by regular mail as follows: John J. Connelly, Jr., Esquire James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 DATE: November 16, 2010 3 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Attorney for Petitioner F; L E 3a 0 ;" t` C_' Barbara Sumple-Sullivan, Esquire ry Supreme Court #32317 17 AM 11 549 Bridge Street ? r10 0 ' New Cumberland, PA 17070 , _ . , ,, 717 774-1445 i l B i t-,1 , , as 1U i''a i SUELLYN G. KOSTUKOVICH, RT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, CIVIL ACTION -LAW Defendant PRAECIPE TO WITHDRAW APPEARANCE Please withdraw my appearance on behalf of Suellyn G. Kostukovich in the above-captioned matter. Respectfully submitted, 41 Dated: zj'2 Ann . Levin, Esquire Smigel, Anderson & Sacks, LLP 4431 North Front Street Harrisburg, PA 17110 (717) 234-2401 PRAECIPE TO ENTER APPEARANCE Please enter my appearance on behalf of Suellyn G. Kostukovich in the above-captioned matter. Dated: /! - /y - lo Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 NOV 18 2010 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, CIVIL ACTION -LAW Defendant IN DIVORCE ORDER AND NOW this day of 2010, upon consideration of Plaintiff's Motion for Continuance, the Hearing in the above-captioned matter scheduled for January 3, 2011 at 9:30 a.m. is hereby continued and rescheduled for the ti day of 2011 at 4"30 A.M./*M,before the Honorable Judge Guido. BY THE '/ &rbarcZ &Aotpje :Su1hoo, , ESQ ? 504,1 ?op;es h?.(ed 111aarlo J. c? ?n m ?, o --+ Pl r n "G r- -am N C7?i ? -rt T1- CC XC) = Cj C ° c:> -1"n 3 a t John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner OF THE PROTHONOTAR Y 2010 NOV 23 AM I f : 5 7 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE PETITION FOR SPECIAL RELIEF AND NOW, comes the Defendant, John S. Kostukovich, by and through his counsel, John J. Connelly, Jr., Esquire of James, Smith, Dietterick & Connelly, LLP and files this Petition for Special Relief as follows: 1. Petitioner is John S. Kostukovich, Defendant in the above-captioned action, (hereinafter referred to as "Husband"), who is an adult individual currently residing at 805 North Walnut Street, Mechanicsburg, Cumberland County, Pennsylvania 17055. 2. Respondent is Suellyn G. Kostukovich, Plaintiff in the above-captioned action, (hereinafter referred to as "Wife"), who is an adult individual currently residing at 11 Montego Court, Dillsburg, York County, Pennsylvania 17019. 3. On January 11, 2010, a Divorce Complaint was filed by Wife to the above term and docket number. 4. On July 1, 2010, a Listing Contract was entered into by the parties agreeing to list the real estate located at 11 Montego Court, Dillsburg, Pennsylvania with Patt Boyer at Prudential Homesale Services Group. The property is currently listed for sale at $535,000.00. A copy of said Listing Contract is attached hereto as Exhibit "A". 5. Since the date the listing contract has been signed, there has been very little interest in the property and the realtor has recommended for the last several months that the price be reduced because the property is overpriced. On October 4, 2010, Patt Boyer recommended a reduction to $489,900.00 to stimulate interest in the property. A copy of Patt Boyer's e-mail is attached hereto as Exhibit "B". 6. Wife has consistently complained to her former counsel, Ann Levin, Esquire, and her current counsel, Barbara Sumple Sullivan, Esquire, that the property is too much of a burden for her to maintain yet she has refused to reduce the price. 7. During the minimal showings on the property, the consistent message from the prospective buyers has been that the property is listed at too high a price. 8. There is currently pending before the Court a Petition to modify alimony pendente lite, spousal support and child support and Husband believes and therefore avers that Wife's refusal to drop the list price is a delay tactic in retaliation for Husband's request to terminate payments to her. 9. Given the current market, the likelihood that the property will sell at the current list price is extremely unlikely since no offers have been made since the entry of the listing contract on July 1, 2010. 10. In correspondence to Wife's counsel on November 12, 2010, Husband's counsel advised that unless the parties could immediately agree on a reduction in price, a Petition would be filed with the Court to accomplish the reduction. 2 11. Wife's counsel in her letter dated November 8, 2010 has indicated that Wife may agree to a reduction and would revisit this issue around Thanksgiving. 12. Petitioner believes and therefore avers that Wife has no intention of agreeing to a reduction in the price and property will continue to languish on the market unless the list price is reduced as soon as possible. 13. Pursuant to Cumberland County Rules of Civil Procedure No. 208.2(d) it is believed that counsel for Respondent does not concur in this Petition. 14. Pursuant to Cumberland County Rules of Civil Procedure No. 208.3(a)(2), requiring Motions to state whether or not a Judge has ruled upon any other issue in the same or related matter, there has been prior involvement by the Court in this matter assigned to the Honorable Edward E. Guido. WHEREFORE, your Petitioner, John S. Kostukovich, is requesting that the Court enter an Order reducing the list price from $535,000.00 to $489,900.00, the amount recommended by the parties' realtor in order to place the property in a more saleable position in the current market. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: - (? By: (2az,- St. Co elly, Jr. . #15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner, John S. Kostukovich 3 VERIFICATION I, John S. Kostukovich, verify that the statements made in the foregoing pleading 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. Date: 41OWt J S. Kostukovich ???h???n LISTING CONTRACT XLS EXCLUSIVE RIGHT TO SELL REAL ESTATE This form recommended and approved for, but not restricted to use by, the members of the Pennsylvania Association of REALTORS® (PAR). 1 BROKER 3 SELLER rv 4 Does Seller have a Listing Contract with another Br ker? ? 5 If yes, explain: 6 7 1. 8 9 10 11 12 13 School Dist Present Use Book, Page, Recording I $ 4 0Cc 14 2. STARTING & ENDING DATES OF LISTING CONTRACT (ALSO CALLED "TERM") IS A. No Association of REALTORSO has set or recommended the term of this contract. By law, the length or term of a listing con- ct. 16 tract may not exceed one year. Broker and Seller have discussed and agreed upon the length or term of this fide 17 B. Starting Date: This Contract starts when signed by Broker and ?eJ?, s otherwise stated here: 18 C. Ending Date: This Contract ends on 19 3. DUAL AGENCY Seller agrees that Broker may also represent the buyer(s) of the Property. The Broker is a DUAL AGENT when 20 representing both Seller and the buyer in the sale of a property. 21 4. DESIGNATED AGENCY 22 ? Not Applicable 23 Applicable. Broker may designate licensees to represent the separate interests of Seller and the buyer. Licensee (identified 24 above) is the Designated Agent, who will act exclusively as the Seller Agent. If Property is introduced to the buyer by a licensee 25 in the Company who is not representing the buyer, then that licensee is authorized to work on behalf of Seller. If Licensee is also 26 the Buyer's Agent, then Licensee is a DUAL A NT. 27 5. BROKER'S FEE No Association of REALTO et or recommended the Broker's Fee. Broker and Seller have negotiated 28 the fee that Seller will pay Broker. Broker's Fee i % of the sales price AND S , paid by Seller. 29 6. COOPERATION WITH OTHER BROKERS 30 Licensee has explained Broker's company policies about cooperating with other brokers. Broker and Seller agree that Broker will pay 31 frroker's Fee a fee to another broker who procures the buyer, is a of a Multiple Listing Service (MLS), and who: 32 A. represents Seller (SUBAGENT). Broker will pay of/from the sale price. 33 B, represents the buyer (BUYER'S AGENT). Broker will pay of/from the sale price. 34 A Buyer's Agent, even if compensated by Broker for Seller, will represent the interests of the buyer. 35 C. ? does not represent either Seller or a buyer (TRANSACTION LICENSEE). 36 Broker will pay of turn the sale price. 37 7. PAYMENT OF BROKER'S FEE 38 A. Seller will pay Broker's Fee if Property, or any ownership interest in it, is sold or exchanged during the term of this 39 Contract by Broker, Broker's salespersons, Seller, or by any other person or broker, at the listed price or any price accept- 40 able to Seller. 41 B. Seller will pay Broker's Fee if a ready, willing, and able buyer is found by Broker or by anyone, including Seller. A willing buyer 42 is one who will pay the listed price or more for the Property, or one who has submitted an offer accepted by Seller. 43 C. Seller will pay Broker's Fee if negotiations that are pending at the Ending Date of this Contract result in a sale. 44 D. Seller will pay Broker's Fee for a sale t?°cCurs after the Ending Date of this Contract IF: 45 (1) The sale occurs within ,(/ of the Ending Date, AND 46 (2) The buyer was shown or negotiated to buy the Property during the term of this contract, AND 47 (3) The Property is not listed under an "exclusive right to sell contract" with another broker at the time of the sale. 48 E. If a buyer signs an agreement of sale then refuses to buy the Property, or if a buyer is unable to buy the Property because of fail- 49 ing to c]Q ale things required of the buyer in the agreement of sale (buyer default), Seller will pay Broker 50 r? of/from buyer's deposit monies, OR the Broker's Fee in Paragraph 5, whichever is less. 51 F. If the Property'or any part of it is taken by any government for public use (Eminent Domain), Seller will pay Broker's Fee from 52 any money paid by the government. 53 G. If a sale occurs, Broker's Fee will be paid upon delivery of the deed or other evidence of transfer of title or interest. If the Proper} 54 is transferred by an installment contract, Broker's Fee will be paid upon the execution of the installment contract. SS Seller Initia XLS Page 1 of 4 Broker/Licensee Initials: e vania Assn Cation of REALTORS' COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORSI& 2? LISTING PACKET ANY CHANGES TO THIS PAGE MUST BE MADE AND INITL4 LED ON EACH COPY 56 8. DUTIES OF BROKER AND SELLER 57 A. Broker is acting as a Seller's Agent, as described in the Consumer Notice, to market the Property and to negotiate with poten- 58 tial buyers. Broker will use reasonable efforts to find a buyer for the Property. 59 B. Seller will cooperate with Broker and assist in the sale of the Property as asked by Broker. 60 C. All showings, negotiations and discussions about the sale of the Property will be done by Broker on Seller's behalf. All written 61 or oral inquiries that Seller receives or learns about regarding the Property, regardless of the source, will be referred to Broker. 62 D. If the Property, or any part of it, is rented, Seller will give any leases to Broker before signing this Contract. If any leases are 63 oral, Seller will provide a written summary of the terms, including amount of rent, ending date, and Tenant's responsibilities. 64 E. Seller will not enter into or renew any leases during the tens of this Contract without first giving notice to Broker. 65 9. BROKER'S SERVICE TO BUYER 66 Broker may provide services to a buyer for which Broker may accept a fee. Such services may include, but are not limited to: 67 deed/document preparation; ordering certifications required for closing; financial services; title transfer and preparation services; 68 ordering insurance, construction, repair, or inspection services. Broker will disclose to Seller if any fees are to be paid by Buyer. 69 10. BROKER NOT RESPONSIBLE FOR DAMAGES 70 Seller agrees that Broker and Broker's salespersons are not responsible for any damage to the Property or any loss or theft of per- 71 sonal goods from the Property unless such damage, loss or theft is directly caused by Broker or Broker's salespersons. 72 11. DEPOSIT MONEY 73 A. Broker, or any person Seller and the buyer name in the agreement of sale, will keep all deposit monies paid by or for the buyer 74 in an escrow account until the sale is completed or the agreement of sale is terminated. If held by Broker, this escrow account 75 will be held as required by real estate licensing laws and regulations. Seller agrees that the person keeping the deposit monies 76 may wait to deposit any encashed check that is received as deposit money until Seller has accepted an offer. 77 B. If Seller joins Broker or Licensee in a lawsuit for the return of deposit monies, Seller will pay Broker's and Licensee's attor- 78 neys' fees and costs. 79 12. OTHER PROPERTIES 80 Seller agrees that Broker may list other properties for sale and that Broker may show other properties to prospective buyers. 81 13. CONFLICT OF INTEREST 82 A conflict of interest is when Broker or Licensee has a financial or personal interest where Broker or Licensee cannot put Seller's 83 interests before any other. If Broker, Licensee, or any of Broker's salespeople has a conflict of interest, Broker will notify Seller in 84 a timely manner. 85 14. PUBLICATION OF SALE PRICE 86 Seller is aware that the Multiple Listing Service (MIS), newspapers, and other media may publish the final sale price of the 87 Property after settlement. 88 15. SELLER WILL REVEAL DEFECTS & ENVIRONMENTAL HAZARDS 89 A. Seller (including Sellers exempt from the Real Estate Seller Disclosure Law) will disclose all known material defects and/or 90 environmental hazards on a separate disclosure statement. A material defect is a problem or condition that: 91 (1) is a possible danger to those living on the Property, or 92 (2) has a significant, adverse effect on the value of the Property. 93 The fact that a structural element, system or subsystem is near, at or beyond the end of the normal useful life of such a struc- 94 tural element, system or subsystem is not by itself a material defect. 95 B. If Seller fails to disclose known material defects and/or environmental hazards: 96 (1) Seller will not hold Broker or Licensee responsible in any way; 97 (2) Seller will protect Broker and Licensee from any claims, lawsuits, and actions that result; 98 (3) Seller will pay all of Broker's and Licensee's costs that result. This includes attorneys' fees and court-ordered payments 99 or settlements (money Broker or Licensee pays to end a lawsuit or claim). 100 16. IF PROPERTY WAS BUILT BEFORE 1978 101 The Residential Lead-Based Paint Hazard Reduction Act says that any seller of property built before 1978 must give the buyer an 102 EPApamphlet titled Protect Your Family From Lead in Your Home. The seller also must tell the buyer and the broker what the sell- 103 er knows about lead based paint and lead based paint hazards that are in or on the property being sold. Seller must tell the buyer 104 how the seller knows that lead-based paint and lead based paint hazards are on the property, where the lead-based paint and lead- 105 based paint hazards are, the condition of the painted surfaces, and any other information seller knows about lead-based paint and 106 lead-based paint hazards on the property. Any seller of a pre-1978 structure must also give the buyer any records and reports that 107 the seller has or can get about lead-based paint or lead-based paint hazards in or around the property being sold, the common areas, 108 or other dwellings in multi-family housing. According to the Act, a seller must give a buyer 10 days (unless seller and the buyer 109 agree to a different period of time) from the time an agreement of sale is signed to have a "risk-assessment" or inspection for pos- 110 sible lead-based paint hazards done on the property. Buyers may choose not to have the risk assessment or inspection for lead paint 111 hazards done. If the buyer chooses not to have the assessment or inspection, the buyer must inform the seller in writing of the 112 choice. The ct does not require the seller to inspect for lead paint hazards or to correct lead paint hazards on the prope . The Act 113 ?rot-ap gi n b 'It in 1978 or later. elier Initials• XLS Page 2 of 4 Broker/Licensee Initials: P ZlpFor m® by zipLogix 18070 Fifteen iNNe Road, Fraser, Michigan 48026 yBMzinLnaix.com LISTING PACKET ANY CHANGES TO THIS PAGE MUST BE MADE AND INITIALED ON EACH COPY 114 17. RECOVERY FUND 115 Pennsylvania has a Real Estate Recovery Fund (the Fund) to repay any person who has received a final court ruling (civil 116 judgment) against a Pennsylvania real estate licensee because of fraud, misrepresentation, or deceit in a real estate transac- 117 lion. The Fund repays persons who have not been able to collect the judgment after trying all lawful ways to do so. For com- 118 plete details about the Fund, call (717) 783-3658, or (800) 822-2113 (within Pennsylvania) and (717) 783-4854 (outside 119 Pennsylvania). 120 18. NOTICE TO PERSONS OFFERING TO SELL OR RENT HOUSING IN PENNSYLVANIA 121 Federal and state laws make it illegal for a seller, a broker, or anyone to use RACE, COLOR, RELIGION or RELIGIOUS 122 CREED, SEX, DISABILITY (physical or mental), FAMILIAL STATUS (children under 18 years of age), AGE (40 or older), 123 NATIONAL ORIGIN, USE OR HANDLINGnRAINING OF SUPPORT OR GUIDE ANIMALS, or the FACT OF RELA- 124 TIONSHIP OR ASSOCIATION TO AN INDIVIDUAL KNOWN TO HAVE A DISABILITY as reasons for refusing to sell, 125 show, or rent properties, loan money, or set deposit amounts, or as reasons for any decision relating to the sale of property. 126 19. ADDITIONAL OFFERS 127 Unless prohibited by Seller, if Broker is asked by a buyer or cooperating broker about the existence of other offers on the 128 Property, Broker will reveal the existence of other offers and whether they were obtained by the Licensee identified in this 129 Contract, by another Licensee working with Broker, or by a cooperating Broker. ONCE SELLER ENTERS INTO AN 130 AGREEMENT OF SALE, BROKER IS NOT REQUIRED TO PRESENT OTHER OFFERS. 131 20. TRANSFER OF THIS CONTRACT 132 A. Broker will notify Seller immediately in writing if Broker transfers this Contract to another broker when: 133 (1) Broker stops doing business, OR 134 (2) Broker forms a new real estate business, OR 135 (3) Broker joins his business with another. 136 Seller agrees that Broker may transfer this Contract to another broker. Broker will notify Seller immediately in writing 137 when a transfer occurs or Broker will lose the right to transfer this Contract. Seller will follow all requirements of this 138 Contract with the new broker. 139 B. Should Seller give or transfer the Property, or an ownership interest in it, to anyone during the terse of this Contract, all 140 owners will follow the requirements of this Contract. 141 21. NO OTHER CONTRACTS 142 Seller will not enter into another listing contract with another broker that begins before the Ending Date of this Contract. 143 22. ENTIRE CONTRACT 144 This Contract is the entire agreement between Broker and Seller. Any verbal or written agreements that were made before 145 are not part of this Contract. 146 23. CHANGES TO THIS CONTRACT 147 All changes to this Contract must be in writing and signed by Broker and Seller. 148 24. SPECIAL INSTRUCTIONS 149 The Office of the Attorney General has not pre-approved any special conditions or additional terms added by any parties. Any 150 special conditions or additional terms in this Contract must comply with the Pennsylvania Plain Language Consumer 151 Contract Act. 152 25. COPYRIGHT 153 In consideration of Broker's efforts to market Seller's Property as stated in this Contract, Seller grants Broker a non-exclu- 154 sive, world-wide license (the "License") to use any potentially copyrightable materials (the "Materials") which are related to 155 the Property and provided by Seller to Broker or Broker's representative(s). The Materials may include, but are not limited 156 to: photographs, images, video recordings, virtual tours, drawings, written descriptions, remarks, and pricing information 157 related to Seller's Property. This License permits Broker to submit the Materials to one or more multiple listing services, to 158 include the Materials in compilations of property listings, and to otherwise distnbute, publicly display, reproduce, publish and 159 produce derivative works from the Materials for any purpose that does not conflict with the express terms of this Contract. The 160 License may not be revoked by Seller and shall survive the ending of this Contract. Seller also grants Broker the right to sub- 161 license to others any of these rights granted to Broker by Seller. Seller represents and warrants to Broker that the License 162 granted to Broker for the Materials does not violate or infringe upon the rights, including any copyrights, of any person or 163 entity. Seller understands that the terms of the License do not grant Seller any legal right to any works that Broker may pro- 164 duce using the Materials. 165 / 5 av 166 167 ? • tc?"•"'?? c???i?l?Tll YV /?1 ??'? ?-1?'?i?: J.f 1? 168 169 ?1'? rl ?K?OCJIC%? I I t`?C`?/ 5(a K 170 171 6?;Pft ? XLS Page 3 of 4 Broker/Licensee Initials: ced ZZ?pForm®by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zioLoaix.com LISTING PACK):T 172 26. MARKETING OF PROPERTY X Sold A. Ygiere permitted, Broker, at Broker's option, may use: For sale sign X Sold sign ? Key in office /W Lock box 174 . t /,electronic advertising, including photographs `Property address in printlelectronic advertising. 175 . Broker will/ ? will not use a Multiple Listing Service (MLS) to advertise the Property to other real estate brokers and salespersons. 176 Seller agrees that Broker, Licensee, and the MLS are not responsible for mistakes in the MLS and/or advertising of the Property. 177 27. ITEMS INCLUDED/NOT INCLUDED IN THE PRICE OF THE PROPERTY 178 A. INCLUDED in the sale are all existing items permanently installed in the Property, free of liens, including plumbing; heating; 179 lighting fixtures (including chandeliers and ceiling fans); water treatment systems; pool and spa equipment; garage door openers 180 and transmitters; television antennas; unpotted shrubbery, plantings,. and trees; any remaining heating and cooking fuels stored 181 on the Property at the time of settlement; sump pumps; storage sheds; mailboxes; wall to wall carpeting; existing window 182 screens; storm windows and screen/storm doors; window covering hardware, shades and blinds; built-in air conditioners; built- 183 in appliances; and the range/oven, unless otherwise stated. Also included: 184 185 B. LEASED items (not owned by seller): 186 187 C. EXCLUDED fixtures and items: 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 201 2N 205 21( 211 21, 2E 211 ADDITIONAL INFORMATION (OPTIONAL) TITLE & POSSESSION A. Seller will give possession of Property to a buyer at settlement, or on B. At settlement, Seller will give full rights of ownership (fee simple) to a buyer except as follows: (1) Mineral Rights Agreements: (2) Other: C. Seller has: ? Mortgage with: Amount of balance $ Address: Phone: Acct. ? Equity Loan with: Amount of balance $ Address: Phone: Acct. #: ? Seller authorizes Broker to receive mortgage payoff and/or equity loan payoff information from lender(s). D. Seller has: ? Judgments ? Municipal Assessment ? Past Due Taxes ? Other: E. If Seller, at any time on or since January 1,1999,has been obligated to pay support under an order on record in any Pennsylvania county, list the county and the Domestic Relations Number or Docket Number: TAXES, UTILITIES, & ASSOCIATION FEES A. At settlement, Seller will pay one-half of the total Real Estate Transfer Taxes, unless otherwise stated here: B. Real Estate Property Tax Assessment $ Yearly Taxes $ Wage/Income Tax $ Per Capita Tax $ C. Estimated Utilities (trash, water, sewer, electric, gas, oil, etc.): D. Association Fees $ Include: BUYER FINANCING Seller will accept the following arrangements for buyer to pay for the Property: ? Cash ? Conventional mortgage ? FHA mortgage ? VA mortgage ? Seller's help to buyer (if any): 215 Seller has read the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa. Code §35.336. 216 Seller gives permission for Broker to send information about this transaction to the fax number(s) and/or e-mail address(es) listed below. 217 Seller has read the entire Contract before signing. All Sellers must sign this Contract 218 Return by facsimile (FAX) constitutes acceptance of this Contract. 219 NOTICE BEFORE SIGNING: IF SELLER HAS LEGAL QUESTIONS, SELLER IS ADVISED TO CONSULT AN ATTORNEY. 220 SELLER'S MAILING ADDRESS: 221 222 PHONE: FAX: E-MAIL: 223 SELLE DATE 7 224 SELLER _ DATE 225 BROKER(Compan ame) rudential esale Services Group r 226 ACCEPTED BY ` DATE XLS Page 4 of 4 Produced with ZapForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.ziaLoabc.com LISTING PACKET '3'/ ??? ., From: pattboyer@hotmail.com [mailto:pattboyer@hotmail.com] On Behalf Of Patt Boyer Sent: Monday, October 04, 2010 12:06 PM To: john@jskostcpa.com Subject: John, There has not been much activity over the past few months. I think $489,900 is a "great" price change and will stimulate interest. I'll call and email Suellyn. I'll need a separate email from you, as seller, changing the price. Thanks, Patt Patt Boyer, GRI, ABR, CSP, CRS, Broker-Appraiser Prudential Homesale Services Group 3435 Market St.; Camp Hill, PA 17011 Office - (717)761-7900 Direct- (717)307-3132 Cell - (717)579-8228 Licensed in PA www.pgttbMr.com pat ft atLbyer.com SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, LLP, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Petition on the following on the date and in the manner indicated below: VIA U.S. MAIL FIRST CLASS PRE-PAID Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 Dated: I I -aa - 10 By: JAMES, SMITH, DIETTERICK & CONNELLY, LLP Attorneys for Defendant Hershey, PA 17033-0650 (717) 533-3280 rr, IT I John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 x James Smith Dietterick & Connelly, LLP - e' P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW Defendant/Petitioner : IN DIVORCE PETITION TO MODIFY SUPPORT AGREEMENT DATED MAY 24, 2010 AND NOW, comes the Defendant, John S. Kostukovich, by and through his counsel, John J. Connelly, Jr., Esquire of James, Smith, Dietterick & Connelly, LLP and files this Petition to Modify Support Agreement as follows: 1. Petitioner is John S. Kostukovich, Defendant in the above-captioned action, (hereinafter referred to as "Husband"), who is an adult individual currently residing at 805 North Walnut Street, Mechanicsburg, Cumberland County, Pennsylvania 17055. 2. Respondent is Suellyn G. Kostukovich, Plaintiff in the above-captioned action, (hereinafter referred to as "Wife"), who is an adult individual currently residing at 11 Montego Court, Dillsburg, York County, Pennsylvania 17019. On May 24, 2010, the parties entered into a Support Agreement regarding child support for the parties' daughter, Tiana Lyn Kostukovich, born September 11, 1992, as well as spousal/alimony pendente lite to Wife. A copy of the Support Agreement dated May 24, 2010 is attached hereto as Exhibit "A" and hereinafter referred to as "Agreement". 4. The total amount of child support under said Agreement is One Thousand Three Hundred Dollars ($1,300.00) per month. 5. The total spousal support/alimony pendente lite payment attributable to Wife is Two Thousand Two Hundred Dollars ($2,200.00) per month broken down as follows: a. Nine Hundred Sixty-six Dollars ($966.00) per month mortgage payment; b. One Hundred Thirty Dollars ($130.00) per month homeowners' insurance; C. Seven Hundred Ninety Dollars ($790.00) per month county, township and school taxes; and d. Three Hundred Fourteen Dollars ($314.00) per month paid directly to Wife. 6. Under paragraph 14 of the Agreement, either party has a right to pursue a modification of the Agreement through the Court based on a change in circumstances. Husband believes and therefore avers that there has been a change in circumstances which warrants a modification of the Agreement through this Court since there is no support action pending and support is being paid through the Agreement. The changes in circumstances are set forth below. 7. . Husband has completed his year end financial information and his tax return for 2010 and has determined that his income has dropped by approximately $22,000.00 from 2009 thereby necessitating a modification in any Support Order going forward for the year 2011. 8. The support arrived at under the terms of the Agreement was based on Husband's 2009 Federal Income Tax Return. A copy of Husband's 2009 and 2010 tax returns are attached hereto as Exhibit "B" and "C" respectively. 9. There is currently pending before the Honorable Edward E. Guido Husband's Petition to terminate his responsibility to pay child support, spousal support or alimony pendente lite based on the current circumstances filed October 15, 2010 and scheduled for hearing before the Honorable Edward E. Guido on January 19, 2011 at 9:30 a.m. Husband is requesting that the 2 issue of a reduction effective the date of the filing of this Petition be addressed at the time of the hearing on January 19, 2011. 10. Pursuant to Cumberland County Rules of Civil Procedure No. 208.2(d) it is believed that counsel for Respondent does not concur in this Petition. 11. Pursuant to Cumberland County Rules of Civil Procedure No. 208.3(a)(2), requiring Motions to state whether or not a Judge has ruled upon any other issue in the same or related matter, there has been prior involvement by the Court in this matter assigned to the Honorable Edward E. Guido as referenced in'paragraph 8 hereof. WHEREFORE, your Petitioner, John S. Kostukovich, is requesting that the Court modify his support based on the current circumstances should a Support Order be deemed appropriate by the Court after making a determination on Petitioner's request for termination filed on October 15, 2010. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY,LLP Dated: --? - By: a o J Co elly, Jr. tt I . #15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner, John S. Kostukovich 3 VERIFICATION I, John S. Kostukovich, verify that the statements made in the foregoing pleading 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. Date: 1-3-11 Afn- S. Kostukovich EXHIBIT "A" SUPPORT AGREEMENT THIS AGREEMENT dated the _ day of 2010, between JOHN S. KOSTUKOVICH, (hereinafter referred to as "Husband" , and SUELLYN KOSTUKOVICH, (hereinafter referred to as 'Wife"), each intending to be legally bound hereby, covenant and agree as follows:. WHEREAS, Wife filed an action for child and spousal support/alimony pendente lite on January 7, 2010 in the Court of Common Pleas Cumberland County, Pennsylvania indexed to PACSES Case No. 193111400; and WHEREAS, the parties are the parents of one minor child, Tiana Lyn Kostukovich, born September 11, 1992, who is currently residing primarily with Wife; and WHEREAS, it is the intent of the parties to reduce to writing their Agreement thereby eliminating the necessity of the matter being heard by the Court. NOW, THEREFORE,. in consideration of the mutual covenants contained herein, the parties agree as follows: Husband agrees to pay to Wife as more particularly set forth and delineated herein the sum of Three Thousand Five Hundred Dollars ($3,500.00) per month in a combined child and spousal support/alimony pendente lite payment which shall include the direct payment of the mortgage, taxes and homeowners' insurance on the marital residence. 2. The amount of the child support for the parties' minor child, Tiana Lyn Kostukovich, shall be One Thousand Three Hundred Dollars ($1,300.00) per month. The spousal support/alimony pendente lite payment attributable to Wife shall be in the amount of Two Thousand Two Hundred Dollars ($2,200.00) payable as follows: a. A direct payment of the parties' mortgage in the average amount of Nine Hundred Sixty-six Dollars ($966.00) per month, the homeowners' insurance prorated in the amount of One Hundred Thirty Dollars ($130.00) per month and the county, township and school taxes prorated in the amount of Seven Hundred Ninety Dollars ($790.00) per month for a total contribution of One Thousand Eight Hundred Eight-six Dollars ($1,886.00). The remainder of Three Hundred Fourteen Dollars ($314.00) per month will be paid directly to Wife. The entire amount payable to Wife or for her benefit (Two Thousand Two Hundred Dollars ($2,200.00) per month) shall be considered income to Wife and shall be deductible to Husband. 4. The payment of One Thousand Three Hundred Dollars ($1,300.00) per month to Wife for the minor child shall have no tax. consequence. 5. The total amount payable directly to Wife in the foram of child and spousal support shall be One Thousand Six Hundred Fourteen Dollars ($1,614.00) with the remaining monies payable as set forth in paragraph 3 above directly to the mortgage company, homeowners' insurance company and real estate taxing authorities. 6. Said payments shall be due on the first (1") of each month and in no event no later than the fifth (5a) of each month. In the event Husband fails to make the payment on a timely basis, Wife has the right to enter this Agreement as an Order of Court in the Court of Common Pleas, Cumberland County, Pennsylvania. Any payments made by Husband under this Agreement, in the event of the filing of an action, shall be credited to him in any final Order. 2 7. Husband shall maintain the minor child on his medical insurance. Husband shall maintain Wife on his medical insurance until May 1, 2010 when Wife shall secure her own coverage through her employer. .8. Husband shall be responsible for eighty-five percent (85%) and Wife shall be responsible for fifteen percent (15%a) of all medical bills not covered by insurance after the first Two Hundred Fifty Dollars ($250.00) is paid by Wife on both her uncovered medical expenses and those of the minor child. The medical bills payable shall be as defined and determined by the policies of the Cumberland County Domestic Relations Office and Rules of Court. Medical bills not covered by insurance may include services for psychiatric and/or psychological treatment in the event said services are agreed to by the parties. 9. The said Agreement is effective with the January 7, 2010 payment. 10. It is presumed that Husband has made the mortgage payment for the months of January, February and March 2010 with his next mortgage payment being due in April 2010. It is also presumed that Husband has paid One Hundred Thirty Dollars ($130.00) per month for homeowners' insurance for those months as well as Seven Hundred Ninety Dollars ($790.00) for real estate taxes on a monthly basis. In addition, Husband has made direct payments to Wife in the amount of Four Thousand Dollars ($4,000.00) since January 7, 2010. For the months of January, February and March 2010, Husband would owe a total to Wife (without prorating the month of January) Ten Thousand Five Hundred Dollars ($10,500.00) ($3,500.00 x 3). Adding up all payments made by Husband as referenced above, he has paid a total of Nine Thousand Six Hundred Fifty-eight Dollars ($9,658.00) for the first three months of 2010 leaving a balance due to Wife in the amount of Eight Hundred Forty-two Dollars ($842.00) ($10,500.00 - $9,658.00) prior to his April 1, 2010 payment. 11. So long as Husband is making the support payments as set forth herein, and Wife continues to reside in the marital residence, she will be entitled to deduct the real estate taxes and mortgage interest on any individual tax return filed by her. 12. In consideration of the fact that Husband has paid Wife's health insurance in the amount of Four Hundred Forty-four Dollars ($444.00) for the months of January, February and March 2010, and will be responsible for Wife's April 2010 health insurance payment, the arrearage due to Wife referenced herein shall be extinguished by the said payments. Therefore, as of April 1, 2010, no arrearages are owed to Wife. 13. The parties shall share expenses for extracurricular activities of the minor child eighty-five percent (85%) to Husband and fifteen percent (15%) to 'Wife. The minor child is enrolled in dance and has been for several years. The cost for dance is approximately Ninety Dollars ($90.00) per month. In the event the minor child would attend out of town shows which require overnight lodging and/or meals, these expenses shall be split between the parties as set forth herein only in the event both parties agree on the expenditure. 14. 'The provisions of this Agreement are subject to modification based on a change in circumstances. Either party has a right to pursue a modification through Domestic Relations, Husband by petitioning the Court to modify this Agreement and Wife by filing a Petition with Domestic Relations for a modification. In the event Husband files a Petition with the Court, the matter will be referred by the Court to Domestic Relations for the entry of an Order. 4 IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. WITNESS: Jo m ? ? lly, Jr., Esq ' e A s fo . ohn S. Kos ZWIITNS:, Esquire Attorneys for Suellyn G. Kostukovich r S. Kostukovich uellyn G ostukovic fz,j, EXHIBIT "B" KOSTY 02/1612010 9:57 AM 0 r° 104 Department of the Treasury-Intemal Revenue Service AoOwvy U.S. Individual Income Tax Return L (99) IRS Use Only-0o not write or staple in this space. Label L For the year Jan. 1-Dec. 31, 2009, or other tax year beginning 2009, ending 20 OMB No. 1545-0074 A Your first name and initial Last name Yousecurity number (See B John S Kostukovich instructions ' on page 14.) H a joint return, spouse s first name and initial Last name Spouse's social security number Use the IRS label. Otherwise H Home address (number and street). If you have a P.O. box, see page 14. Apt no. You must enter , please print E 1064 Tunber Ct your SSN(s) above. A or type. R E City, town or post office, state, and ZIP code. If you have a foreign address, see page 14. Checking a box below will not Presidential Mechanicsburg PA 17050 change your tax or refund. Election Campaign ? Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 14) ? You Spouse 1 Filin St t Single 4 X ea of hld ouse w' ual' ing person). (See page 1 the qualifying person is a child but not your dependent, enter t is g a us 2 Married filing jointly (even if only one had income) child's name here. ? Check only one 3 Married filing separately. Enter spouse's SSN above 5 ? Qualifying widow(er) with dependent child (see page 16) box. and full name here. ? - 6a Exem tions b Ti ri Yourself. If someone can claim you as a dependent, do not check box 6a .............. ...... S Boxes checked 1 ... ? on 6a and 6b p ouse . . ....... .. . No. of C "dren On 6C who: c Dependents: (4) o N (2) Dependent's (3) Dependent's qual• chid • lived with you 1 1 First name Last name social security number relationship to you or chid • did not live with tax a . isee you due to divorce If more than four Tiana L KOStukovich Daughter or separation (see page 18) dependents, see page 17 and ? We dents on 6c - check here ? not entered above d Total number of exemptions calmed ........... • Add numbeq on tines above 2 I 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ...................... . ................................. 7 ncome Be Taxable Interest. Attach Schedule B if required , , , , , • , , ... , .. ....... ......................... Be 145 Attach Form(s) W-2 here. Also attach Forms b 9a Tax-exempt interest Do not include on line 8a Ordinary dividends. Attach Schedule B if required ............. 8b .... .... ...................... 9a W-2G and 1099-R If tax b 10 Qualified dividends (see page 22) ..................... 9b Taxable refunds, credits, or offsets of state and local income taxes (see page 23) 10 329 was withheld. 11 Alimony received 11 If you did not 12 Business income or (loss). Attach Schedule C or C-EZ ........... 12 186,401 get a W-2, 13 Capital gain or (loss). Attach Schedule D ti required. If not required, check here ? ..... ........... .. ? 13 see page 22. 14 Other gains or (losses). Attach Form 4797 ........................... 74 15a IRA distributions 15a b Taxable amount (see page 24) 15b 16a Pensions and annuities 16a b Taxable amount (see page 25) 16b Enclose, but do not attach an 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 0 , y payment Also, 18 Farm income or (loss). Attach Schedule F ..................... ............................... 18 please use 19 Unemployment compensation In excess of $2,400 per recipient (see page 2n ........ ........................ 19 Form 10404. 20a Social security benefits 20a I b Taxable amount (see page 27) 20b 21 Other income. List type and amount (see page 29) .... ................ ...................... . ....... 21 22 Add the amounts in the far right column for lines 7 through 21. This is our total Income ? : 22 186,875 23 Educator expenses (see page 29) 23 Adjusted Gross 24 Certain business expenses of reservists, performing artists, and fee-basis govemment officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889 ........... . 25 26 Moving expenses. Attach Form 3903 .......................... . 26 27 One-half of self-employment tax. Attach Schedule SE 27 9,118 28 Self-employed SEP, SIMPLE, and qualified plans 28 6,708 29 Self-employed health insurance deduction (see page 30) 29 12,174 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipient's SSN ? 31a . 32 IRA deduction (see page 31) ................................. . 32 33 Student loan interest deduction (see page 34) 33 34 Tuition and fees deduction. Attach Form 8917 ............ 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 31a and 32 through 35 ......................... .... ..................... 36 2 8 , 0 0 0 37 -Subtract line 36 from line 22. This is our adjusted gross Income For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 97. DAA , , • • • ............... ..... ? 37 158,875 Form X040 (2009) KOSTY 02/1612010 9:57 AM Form 1040 (2009) John S Kostukovich p2nn Tax and 38 Amount from line 37 (adjusted gross income) ,,,,•,..,..,••,,,,,,.,•,,,.,.,,...•..,,.,.,•,. 38 158,875 Credits 39a Check You were born before January 2, 1945, Blind. Total boxes if. T 8 Spouse was born before January 2, 1945, 8 Blind. I checked ? 39a Standard b If your spouse item ms on a separate return or you were a dual-status alien, see page 35 and check here ? 39b Deduction for- 40a Itemized deductions (from Schedule A) or your standard deduction (see left margin) 0a ,350 • People who check any box on line b If you are increasing your standard deduction by certain real estate taxes, new motor vehicle taxes, or a net disaster loss, attach Schedule L and check here (see page 35) ? 40b ? 41 Subtract line 40a from line 38 . ............... . • , , ... , , , ...................................... 1 50,525 4ob or who r can be l i d 42 Exemptions. If line 38 is $125,100 or less and you did not provide housing to a Midwestern displaced individual, multiply $3,650 by the number on line 6d. Otherwise, seepage 37 42 7 , 3 0 0 c a me as a dependent, 43 Taxable Income. Subtract line 42 from line 41. If line 42 is mom than line 41, enter 4 .................................. ......... 43 143,225 see page 35. 44 Tax (see page 37). Check if any tax is from: a 11 Form(s) 8814 b 11 Form 4972 972 ......... 44 31,432 • All others: 45 Alternative minimum tax (see page 40). Attach Form 6251 .................................... 45 601 Ing le Married fi or ling 46 Add lines 44 and 45 lo. • , . , , , , , 46 32,033 $5,700 ?? y' 47 Foreign tax credit. Attach Form 1116 if required .............. 47 ... 48 Credit for child and dependent care expenses. Attach Form 2441 48 Married filing jointly or 49 Education credits from Form 8863, line 29 ........ 49 Qualifying widow(er) 50 Retirement savings contributions credit Attach Form 8880 • • 50 , $11,400 51 Child tax credit (see page 42) 51 Head of 52 Credits from Form: a F] 8396 b 8839 c 5695 ? ? 52 household, $8 350 53 Other credits from Form: a ? 3800 b 8801 c 53 , 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- , • , , , , , , , , , , , , , • 55 32,033 Other 56 Self-employment tax. Attach Schedule SE _ • • .. .... • • . .... 56 18,235 Taxes 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 59 mdllond taxes a ? AEIC payments b ? Household employment taxes. Attach Schedule H 59 60 Add limes 55 through 59. This is our total tax ? 60 50,268 61 Federal income tax withheld from Forms W-2 and 1099 61 Payments 62 2009 estimated tax payments and amount applied from 2008 return 62 9 , 5 9 6 63 Making work pay and government retiree ixedtts. Attach Schedule M ...... 63 If you have a 64a Earned Income credit (EIC) .... .... ...................... 64a qualifying b Nontaxable combat pay election 64b chikt, attach Schedule EIC. 65 Additional child tax credit. Attach Form 8812 . .................... 65 66 Refundable education credit from Form 8863, line 16 66 67 First-time homebuyer credit Attach Form 5405 ................. 67 68 Amount paid with request for extension to fie (see page 72) 68 69 Excess social security and tier 1 RRTA tax withheld (see page 72) 69 70 Credits from Forth: a ? 2439 b ? 4136 c ? 8801 d ? 8885 70 71 Add Ones 61, 62, 63, 64a, s 65 through 70. These are your total payments ................ ? 71 9,596 Refund 72 If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you overpaid 72 Direct deposit? 73a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here . • • .... ? ? 73a See page 73 ? b Routing number ? e _ Type: ? Checking ? Savings and fill in 73b, 73c, and 73d, ? d Account number or Form 8888. 74 Amount of line 72 you want applied to your 2010 estimated tax ? 1 74 Amount 75 Amount you owe. Subtract line 71 from line 60. For details on how to pay, see page 74 .. ? 75 41, 493 uvu vwe 7t; rsumaieu lax penalty (see page 14) 76 821 Third Party Do you want to allow another person to discuss this return with the IRS (see page 75)? Yes. Complete the following. No Designee Designee's Personal identification number (PIN) ? 15646 name ? John S Kos tukovieh Phone no. ? 717-730-0820 SI n Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of knowledge and belief, g they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return?' See page 15 Accour1t ant . Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation F? , Paid Preparer's signature 'John S Kostukovich Date 02/16/10 ssef-employed ? Preparer's SSN or PTIN P00098505 Preparer's Firth's name (or John S. Kostukovich, CPA EIN Use Only yours if self-employed), , 3900 Trindl a Rd Phone no. address, and ZIP code Camp Hill PA 17011-6912 717-730-0820 DAA Form 1040 (2009) KOSTY 02/1612010 9:57 AM SCHEDULE C Profit or Loss From Business OMB No. 1545-0074 (Form 1040) (Sole Proprietorship) 2009 Department of the Treasury ? Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. Attachment Internal Revenue Service (99) ? Attach to Form 1040, 1040NR, or 1041. ? See Instructions for Schedule C (Form 1040). Sequence No. 09 Name of proprietor Social security number (SSN) John S Kostukovich A Principal business or profession, including product or service (see page C-2 of the instructions B Enter code from pages C-9, 10, & 11 Accounting Services ? 541211 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), if any John S Kostukovich, CPA E Business address (including suite or room no.) ? 3900 Trindle Road ...............................................................:.............................. City, town or post office, state, and ZIP code Camp Hill PA 17011 F Accounting method: (1) X Cash (2) 11 Accrual (3) Other (specify) ? G Did you "materially participate" in the operation of this business during 2009? If "No," see page C-3 for limit on losses Yes No ........ X ?. H If you started or acquired this business during 2009, check here ............:............ ... ,Pdrt 1 Income 1 Gross receipts or sales. Caution. See page CA and check the box if. • This income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, or • You are a member of a qualified joint venture reporting only rental real estate ? 1 496,224 income not subject to self-employment tax. Also see page C-3 for limit on losses. 2 Returns and allowances 2 373 13 ........... Subtract line 2 from line 1 . ..................................................... 3 495,851: 4 ••,•••..... Cost of goods sold (from line 42 on page 2) 4 5 Gross profit Subtract line 4 from line 3 ................... .. ............ . . 5 495,851 6 .. . ......................... Other income, including federal and state gasoline or fuel tax credit or refund (see page G4 6 7 Gross Income. Add lines 5 and 6 .......................................... .......... ............. ? 7 495,851 Part 11 Exoenses- Enter exnenSeS fnr hi minacs mini of vni it hmmn nnhi nn line QA 8 Advertising .................... 8 152 18 Office expense ...... 18 17 436 9 Car and truck expenses (see ................. 19 Pension and profit-sharing plans 19 , 2,440 page C-4) , • .. , , • . • ... , , , . 9 5 , 3 8 7 20 Rent or lease (see page C-6): 10 Commissions and fees 10 a Vehicles, machinery, and equipment 20a 2 874 11 Contract labor (see page C-4) . • . 11 828 b Other business property 20b , 2 8 8 0 0 12 Depletion 12 21 Repairs and maintenance 21 , 8 615 13 Depreciation and section 179 22 Supplies (not included in Part III) 22 , 8 , 574 expense deduction (not 23 Taxes and licenses 23 12,910 included in Part III) (see page 24 Travel, meals, and entertainment: C-5) ........................... 13 174 a Travel ......... 24a 2 823 14 Employee benefit programs ...................... b Deductible meals and , (other than on line 19) 14 3,552 entertainment (see page C-6) 24b 2 2 0 8 15 Insurance (other than health) 15 11,980 25 Utilities 25 , 9 036 16 Interest 26 Wages (less employment credits) 26 , 153 , 610 a Mortgage (paid to banks, etc.) 16a 27 Other expenses (from line 48 on b Other ......................... 16b 247 page 2) ................... 27 47 873 17 Legal and professional .......... , services ....................... 17 28 Total expenses before expenses for business use of home. Add lines 8 through 27 ? ............... 28 319,519 29 Tentative profit or (loss). Subtract line 28 from line 7 .................. .. .. .. 29 176,332 30 Expenses for business use of your home. Attach Form 8829 .................................................... 30 31 Net profit or (loss). Subtract line 30 from line 29. • If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see page C-7). Estates and trusts, enter on Form 1041, line 3. 31 176,332 4 ,-w, y..., I-— vv w w'c oc. ? 32 If you have a loss, check the box that describes your investment in this activity (see page C-7). • if you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see the line 31 instructions on page C-7). 32a 8 All investment is at risk. Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not • if you checked 32b, you must attach Form 6198. Your loss may be limited. at risk. For Paperwork Reduction Act Notice, see page C-9 of the instructions. Schedule C (Form 1040) 2009 DAA KOSTY 0211612010 9:57 AM John S Kostukovich Schedule C (Form 1040) 2009 Accounting Services Page 2 Part III Cost of Goods Sold (see page C-8) 33 Method(s) used to value closing inventory: a QX Cost b ? Lower of cost or market c ? Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If "Yes," attach explanation ............................................................................................. E] Yes nX No 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation 35 36 Purchases less cost of items withdrawn for personal use 36 ....................................................... 37 Cost of labor. Do not include any amounts paid to yourself 37 38 Materials and supplies ....................................................................................... 38 39 Other costs ................................................................................................. 40 Add lines 35 through 39 ..................................................................................... 41 Inventory at end of year ...................................................................................... 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ..................... 1 42 1 art IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 on page C-5 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) ? .......................... 44 Of the total number of miles you drove your vehicle during 2009, enter the number of miles you used your vehicle for: a Business b Commuting (see instructions) c Other 45 Was your vehicle available for personal use during off-duty hours? Yes No 46 Do you (or your spouse) have another vehicle available for personal use? ........................................... ..... Yes No 47a Do you have evidence to support your deduction? ................................................................. ..... Yes No b If "Yes," is the evidence written? .............. .. . ... ...................................... . . . . . . ............... ..... Yes No .art V -' Other Expenses. List below business expenses not included on lines 8-26 or line 30. Bank .charges ............................. .. .. .. ..... . . 22 6 .. ... .. . .... .. .................................... Client Gifts ............................................................................................ ... . 2,314 Continuing Education ............................................ .. 2,954 Copier Costs ............................................................................................ 4.002 Per return/e-filing.. fees ..................................................................... ... ... 4, 595 TeleQhone ...................... .................................................................... ... 7,050 . .. Licenses Fees Permits .. ...................... ... .... . ... 602 ii . . .. .. .......................................................................... e „Milage Reimbursements .............. ...................................................................... . ... . 11560 . Mis cellaneous 1,076 ........................... c...s... Computer Servieoftware 17,168 Trash Removal ............................................................................... . 1,305 Dues & Subscriptions ....... ........ .. .: .... .. 157 . . ... .. ............................................... Cleaning .................................................................................................... ... . 2,240 Grass Cutting ................................. .......... . .. 670 .. .... ........................................ Paper Shredding ......................................................... . ... 1,060 ......... ....... Security ......................................... ...................... ... 561 ...................................... Amortization ..................................................................................................................... ... ... 333 .................................................................................................................. ... ... 48 Total other expenses. Enter here and on page 1, line 27 . ... . . . .. . .. . ....... . . . . ............................... 48 47,873 DAA Schedule C (Form 1040) 2009 KOSTY 02116/2010 9:57 AM SCHEDULE C Profit or Loss From Business OMB No. 1545-0074 (Form 1040) (Sole Proprietorship) 2009 10- Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. IDntern I RevenueeService ry (99) 11, Attach to Form 1040, 1040NR, or 1041. 10, See Instructions for Schedule C Form 1040). Sequen en No. 09 Name of proprietor Social security number (SSN) John S Kostukovich A Principal business or profession, including product or service (see page C-2 of the instructions B Faster code from pages G9, 10, & 11 Financial Services ? 523900 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), if any E Business address (including suite or room no.) ? 1064 TunberX Ct . ...... . City, town or post office, state, and ZIP code kEChanicsbur PA 17050 F Accounting method: (1) X Cash (2) Accrual (3) Other (specify) ? ............................. ......... G Did you "materially participate" in the operation of this business during 2009? If "No," see page C-3 for limit on losses X Yes No H If you started or acquired this business during 2009, check here .............................. ......... ............................ ? <Part I Income 1 Gross receipts or sales. Caution. See page C-4 and check the box if. • This income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, or • You are a member of a qualified joint venture reporting only rental real estate ? EJ 1 3 , 059 income not subject to self-employment tax. Also see page C-3 for limit on losses. 2 Returns and allowances ..................................................................................... 2 3 Subtract line 2 from line 1 ................................................................................... 3 13,059 4 Cost of goods sold (from line 42 on page 2) 4 5 Gross profit. Subtract line 4 from line 3 5 13,059 6 Other income, including federal and state gasoline or fuel tax credit or refund (see page C-4) ........................... 6 7 Gross income. Add lines 5 and 6 ..................................................... ? 7 13,059 -;fait 11 Excesses. Enter expenses for business use of vnur hnmP nnty nn line in 8 Advertising 8 . 18 Office expense ................... 18 9 Car and truck expenses (see ... . 19 Pension and profit-sharing plans 19 page C-4) 9 599 20 Rent or lease (see page C-6): 10 Commissions and fees 10 a Vehicles, machinery, and equipment 20a 11 Contract labor (see page C-4) , , . 11 b Other business property 20b 12 Depletion ...................... 12 21 Repairs and maintenance 21 13 Depreciation and section 179 22 Supplies (not included in Part III) 22 expense deduction (not 23 Taxes and licenses 23 included in Part 111) (see page C-5) ........................... 13 24 Travel, meals, and entertainment: a Travel ................ 24a 545 14 Employee benefit programs (other than on line 19) 14 ............... b Deductible meals and entertainment (see page C-6) 24b 15 Insurance (other than health) 15 1,846 25 Utilities 25 16 Interest: .............................. 26 Wages (less employment credits) 26 a Mortgage (paid to banks, etc.) 16a 27 Other expenses (from line 48 on b Other ......................... 16b page 2) ............................. 27 17 Legal and professional services ....................... 17 28 Total expenses before expenses for business use of home. Add lines 8 through 27 1110- .......................... 28 2 990 29 Tentative profit or (loss). Subtract line 28 from line 7 29 10,069 30 Expenses for business use of your home. Attach Form 8829 .................................................... 30 31 Net profit or (loss). Subtract line 30 from line 29. e If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see page C-7). Estates and trusts, enter on Form 1041, line 3. 31 10,069 u a iris, you must go io iine sz. 32 If you have a loss, check the box that describes your investment in this activity (see page C-7). e If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see the line 31 instructions on page C-7). Estates and trusts, enter on Form 1041, line 3. • If you checked 32b, you must attach Form 6198. Your loss may be limited. For Paperwork Reduction Act Notice, see page C-9 of the instructions J 32a All investment is at risk. 32b Some investment is not at risk. Schedule C (Form 1040) 2009 DAA KOSTY 02/16/2010 9:57 AM Name(s) shown on return. Do not enter name and social security number ff shown on other side. Attachment Sequence No. 13 Your social security number Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1. Part 11, 11, Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See page E-1. 27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed F] Yes Q No partnership expenses? If You answered "Yes." see Daoe E-7 before comDletina this section. 28 (a) Name (b) Ester P for partnership; S for S corlyalion (c) Check if foreign artnershr (d) Employer identfcation number (e) Check if any amount is not at risk A 3900 Trindle Road LLC P B C D Passive Income and Loss Non p assive Income and Loss (1) Passive loss allowed (attach Form 8582 if required) (g) Passive income from Schedule K-1 (h) Nonpassive loss from Schedule K-1 (i) Section 179 expense deduction from Form 4562 Non (j) passive income from Schedule K-1 A 478 478 B C D 29a Totals 478 b Totals 478 30 Add columns (g) and 0) of line 29a ... .............. . 30 478 31 Add columns (f), (h), and (i) of line 29b .......... ............... ........................... r .... . ........ ........ 31 478 32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and include in the total on line 41 below 32 0 rrom tstates ana 1 rut I (b) Employer 33 (a) Name identification number A B Passive Income and Loss Non save Incom e and Loss (c) Passive deduction or loss allowed (attach Form 8582 If required) (d) Passive income from Schedule K-1 (e) Deduction or loss from Schedule K-1 (f) Other income from Schedule K-1 A B 34a Totals b Totals 35 Add columns (d) and (f) of line 34a 35 36 Add columns c and a of line 34b 36 37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and include in the total on line 41 below ................. .......................................... 37 Part IT, Income or Loss From Real Estate Mort a e Investment Conduits REMICs -Resid ual Holder 38 (a) Name (b) Employer identification number (c) Excess inclusion from Schedules Nine 2c (see page E-8) (d) Taxable income (net loss) from Schedules Q, line 1b (e) Income from Schedules Q, line 3b 39 Combine columns d and a only. Enter the result here and include in the total on line 41 below ................... 39 ra>z:v aummary 40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below 41 Total income or (loss). Combine lines 26, 32, 37, 39, & 40. Enter the result here & on Form 1040, line 17, or Form 1040NR, line 18 ? 41 42 Reconciliation of farming and fishing income. Enter your gross farming and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code U; and Schedule K-1 (Form 1041), line 14, code F (see page E-8) 42 43 Reconciliation for real estate professionals. If you were a real estate professional (see page E-2), enter the net income or (loss) you reported anywhere on Form 1040 or Form 1040NR from all rental real estate activities in which you materially participated under the passive activity loss rules ...... , ..... 43 DAA Schedule E (Form 1040) 2009 KOSTY 02/1612010 9:57 AM SCHEDULE SE OMB No. 1545-0074 (Form 1040) Self-Employment Tax 2009 Department of the Treasury Attachment Internal Revenue Service 99 ? Attach to Form 1040. ? See Instructions for Schedule SE Form 1040. Sequence No. 17 Name of person with self-employment income (as shown on Form 1040) Social security number of person John S Kostukovich with self-employment income ? Who Must File Schedule SE You must file Schedule SE if. • You had net earnings from self-employment from other than church employee income (line 4 of Short Schedule SE or line 4c of Long Schedule SE) of $400 or more, or • You had church employee income of $108.28 or more. Income from services you performed as a minister or a member of a religious order is not church employee income (see page SE-1). Note. Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use either "optional method" in Part II of Long Schedule SE (see page SE-4). Exception. If your only self-employment income was from earnings as a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not file Schedule SE. Instead, write "Exempt-Form 4361" on Form 1040, line 56. May I Use Short Schedule SE or Must I Use Long Schedule SE? Note. Use this flowchart only If you must file Schedule SE. If unsure, see Who Must File Schedule SE, above. Did you receive wages or tips In 2009? 1 No Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? Yes Yes I I Was the total of your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from self-employment more than $106,800? No Are you using one of the optional methods to figure your net earnings (see page SE-4)? No Did you receive church employee income reported on Form W-2 of $108.28 or more? ? No You may use Short Schedule SE below + No Yes Yes Did you receive tips subject to social security or Medicare tax that you did not report to your employer? No Yes No Did you report any wages on Form 8919, Uncollected Social Yes Security and Medicare Tax on Wages? I You must use Long Schedule SE on page 2 1 Section A-Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. 1a Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 6b, or listed on Schedule K-1 (Form 1065), box 20, code Y 1b 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1. Ministers and members of religious orders, see page SE-1 for types of income to report on this line. See page SE-3 for other income to report 2 186,401 ...................................................... 3 Combine lines 1a, 1b, and 2 .. ... 3 186, 401 ....................................................................... 4 Net earnings from self-employment. Multiply line 3 by 92.35% (.9235). If less than $400, do not file this schedule; you do not owe self-employment tax ? 4 172,141 5 Self-employment tax. If the amount on line 4 is: • $106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 56. • More than $106,800, multiply line 4 by 2.9% (.029). Then, add $13,243.20 to the result. Enter the total here and on Form 1040, line 56. 5 18,235 ................................................................ 6 Deduction for one-half of self-employment tax. Multiply line 5 b 50% (.50). Enter the result here and on Form 1040, line 27 6 9 , 118 For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule SE (Form 1040) 2009 DAA KOSTY 02116/2010 9:57 AM 6251 Alternative Minimum Tax-Individuals OMB No. 1545-0074 Form Department of the Treasury Internal Revenue Service 99 ? See separate instructions. 10, Attach to Form 1040 or Form 1040NR. 2009 Attachment 32 uenoe No. Name(s) shown on Form 1040 or Form 104ONR John S Kostukovich Your social security number Part I Alternative Minimum Taxable Income See instructions for how to complete each line. 1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41 (minus any amount on Form 8914, line 6), and go to line 2. Otherwise, enter the amount from Form 1040, line 38 (minus any amount on Form 8914, line 6), and go to line 7. (If less than zero, enter as a negative amount.) 1 158,875 2 Medical and dental. Enter the smaller of Schedule A (Form 1040), line 4, or 2.5% (.025) of Form 1040, line 38. If zero or less, enter -0 2 3 Taxes from Schedule A (Form 1040), lines 5, 6, and 8 .............. . . .. .. . ....... ...... ..... 3 . .. . ...... 4 Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet on page 2 of the instructions 4 5 Miscellaneous deductions from Schedule A (Form 1040), line 27 5- 6 If Form 1040, line 38, is over $166,800 (over $83,400 If married filing separately), enter the amount from line 11 of the Itemized Deductions Worksheet on page A-11 of the instructions for Schedule A (Form 1040) 6 ) 7 If filing Schedule L (Form 1040A or 1040), enter as a negative amount the sum of lines 6 and 20 from that schedule 7 ) 8 Tax refund from Form 1040, line 10 or line 21 ..... 8 329) 9 Investment interest expense (difference between regular tax and AMT) 9 10 Depletion (difference between regular tax and AMT) 10 11 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount .................................. 11 12 Alternative tax net operating loss deduction ...................................... 12 ) 13 Interest from specified private activity bonds exempt from the regular tax 13 14 Qualified small business stock (7% of gain excluded under section 1202) .. 14 15 Exercise of incentive stock options (excess of AMT income over regular tax income) ....... . . ..... . .. . . . .. . .... 15 16 Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A) ......................... 16 17 Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6) 17 18 Disposition of property (difference between AMT and regular tax gain or loss) 18 19 Depreciation on assets placed in service after 1986 (differencebetween regular tax and AMT) 19 -122 20 Passive activities (difference between AMT and regular tax income or loss) . .................. 20 0 21 Loss limitations (difference between AMT and regular tax income or loss) ..................... 21 0 22 Circulation costs (difference between regular tax and AMT) ....................................................... 22 23 Long-tens contracts (difference between AMT and regular tax income) - ............................................ 23 24 Mining costs (difference between regular tax and AMT) .......................................................... 24 25 Research and experimental costs (difference between regular tax and AMT) 25 26 Income from certain installment sales before January 1, 1987 26 ) 27 Intangible drilling costs preference ........................ 27 28 Other adjustments, including income-based related adjustments 28 29 Alternative minimum taxable income. Combine lines 1 through 28. (If married filing separately and line 29 is more than $216,900 see page 8 of the instructions.) ............................. . .......... . ........... . . . . . • ... 29 158,424 , ` Part II :-. Alternative Minimum Tax AMT 30 Exemption. (If you were under age 24 at the end of 2009, see page 8 of the instructions.) IF your filing status is ... AND line 29 is not over... THEN enter on line 30... Single or head of household $112,500 $46,700 Married filing jointly or qualifying widow(er) 150,000 70,950 Married filing separately 75,000 35,475 0 3 5 , 219 If line 29 is over the amount shown above for your filing status, see page 8 of the instructions. 31 Subtract line 30 from line 29.1 more than zero, go to One 32 9 zero or less, enter -0• here and on lines 34 and 36 and sldp the rest of Part II . .................. 31 123,205 32 • If you are filing Form 2555 or 2555-EZ, see page 9 of the instructions for the amount to enter. • If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT if necessary) complete Part III on the back and enter the amount from line 55 here • • • • • • • • 32 32,033 , , . • All others: If line 31 is $175,000 or less ($87,500 or less if married filing separately), multiply line 31 by 26% (.26). Otherwise, multiply line 31 by 28% (.28) and subtract $3,500 ($1,750 1 married filing separately) from the result. 33 Alternative minimum tax foreign tax credit (see page 9 of the instructions) ........................................... 33 34 Tentative minimum tax. Subtract line 33 from line 32 ................................. 34 32,033 35 Tax from Form 1040, line 44 (minus any tax from Form 4972 and any foreign tax credit from Form 1040, line 47). If you used Schedule J to figure your tax, the amount from line 44 of Form 1040 must be refigured without using Schedule J (see page 11 of the instructions) ........................ 35 31, 432 36 AMT. Subtract line 35 from line 34. If zero or less enter -0-. Enter here and on Form 1040, line 45 36 601 For Paperwork Reduction Act Notice, see page 12 of the instructions. Form 6251 (2009) DAA KOSTY 07/16/2010 9:57 AM Form 4562 Department of the Treasury Internal Revenue Service (99) ? See Depreciation and Amortization (Including Information on Listed Property) to Name(s) shown on return John S Kostukovi 2009 Business or activity to which this form relates Accounting Services Part I Election To Expense Certain Property Under Section 179 Nntae If vnu have anv IIStPH nronerty_ cmminlete Part V before you complete Part I. 1 Maximum amount. See the instructions for a higher limit for certain businesses .................................... 2 Total cost of section 179 property placed in service (see instructions) 3 Threshold cost of section 179 property before reduction in limitation (see instructions) ............................. 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0 ....................................... 5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married fill separately, see instructions .......... 6 (a) Description of property (b) Cost (business use only) (c) Elected cost 7 Listed property. Enter the amount from line 29 .... . .. . . . . . . . . . . .... L7 I 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 .............................. 9 Tentative deduction. Enter the smaller of line 5 or line 8 10 Carryover of disallowed deduction from line 13 of your 2008 Form 4562 .......................................... 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) .. , . 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 13 Carryover of disallowed deduction to 2010. Add lines 9 and 10, less line 12 .......::.. ? 13 Note: Do not use Part II or Part III below for listed property. Instead, use Part V. Part 11 Special Depreciation Allowance and Other Depreciation (Do not include listed pro 14 Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions) . .......................................................................... 15 Property subject to section 168(fx1) election ........................................................ 250,000 1 3 I 800,000 r Part III ! MACRS Depreciation (Do not include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2009 ................................ 17 0 18 If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here ? I I Section R-Assets Placed in Service During 2009 Tax Year Usina the General Depreciation Svstem (a) Classification of property (b) Month and year placed in service (c) Basis for depreciation (businessrnvestment use only-see, instructions (d) Recovery period (e) Convention (t) Method (g) Depreciation deduction 19a 3 -year property b 5 -year property c 7-year property 10-year property 15 ear property f 20-year property 25 ear property 25 yrs. S/L h Residential rental 27.5 yrs. MM S/L property 27.5 yrs. MM S/L i Nonresidential real 39 yrs. MM S/L property MM S/L Section C-Assets Placed in Service Durina 2009 Tax Year Usinii the Alternative Depreciation Svstem b 1 c 4 12 S/L Part IV Summary (See instructions.) 21 Listed property. Enter amount from line 28 ........:........................ ... 21 174 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations-see instructions ..................... 22 174 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs ....... 23 For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2009) DAA KOSTY 02116!2010 9:57 AM John S Kostukovich Form 4562 (2009) Page 2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A-Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles. ) 9A- n... ., -AA-e f.. n n,v.A B - , r?nimnrl9 X V. N. 7Ah If "Yp4 " k the pViripnep writtan7 X Y. Nn (a) (b) (ce (d) (e) (fl (9) (h) Y) Type of property Date placed in Bu ss/ investment use Cost or other Basis for depreciation Recovery Method/ Depreciation Elected section (list vehicles service percentage basis (businessrinvestment period Convention deduction 179 cost first) use only) 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use (see instructions) ........................ 25 9a D-rh. nceri m n fj- t;no% in p n, .nfipri hneinpcc ?ICO• Vehicl e >60001 s 05/04/06 76.39% 29,354 1,509 5.0 20ODBHY 174 Lapto 09/30/07 100.00% 1,256 5.0 20ODBHY in a aualified business use: c 7/07/041 16.71 S/L- I I %I I I s?- 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 28 174 29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 .....................................................:. 29 Section B--information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner, or related person. If you provided vehicles to your employees, first answer the questions in Section C to see K you meet an exception to completing this section for those vehidm. 30 Total businessriinvestment miles driven during the year (do not include (a) Vehicle 1 (b) Vehicle 2 (c) Vehicle 3 (d) Vehicle 4 (e) Vehicle 5 (t) Vehicle 6 commuting miles) 31 ., Total commuting miles driven during the year .. 32 Total other personal (noncommWng) miles driven 33 Total miles driven during the year. Add lines 30 through 32 34 Was the vehicle available for personal Yes No Yes No Yes No Yes No Yes No Yes No use during off-duty hours? 35 Was the vehicle used primarily by a more than 5% owner or related person? 36 Is another vehicle available for personal use? ...... Section C--{,questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine If you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). 37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by Yes No your employees? .................................................. .......................................................... 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners ......................... 39 Do you treat all use of vehicles by employees as personal use? ................................................................. 40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? ........................................................................ 41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) ............................ Note: If our answer to 37, 38, 39, 40, or 41 is "Yes," do not complete Section B for the covered vehicles. Part VI ! Amortization (a) I (b) I (c) I (d) I Amortization ( (f) Date amortization Amortizable Code period or Amortization for this year Description of costs begins amount section percentage 42 Amortization of costs that begins durina vour 2009 tax vear (see instructions): 43 Amortization of costs that began before your 2009 tax year ................................................... 43 333 44 Total. Add amounts in column (f). See the instructions for where to report ........................................ 44 333 Form 4562 (zoos) DAA KOSTY 0211612010 9:57 AM Farm 8582 Department of the Treasury Internal Revenue Service Name(s) shown on return Passive Activity Loss Limitations ? See separate Instructions. ? Attach to Form 1040 or Form 1041. John S Kostukovich 2009 Attachment $8 Sequence No. Identifying number Part l _ 2009 Passive Activity Loss Caution: Complete Worksheets 1, 2, and 3 on page 2 before completing Part I. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.) la Activities with net income (enter the amount from Worksheet 1, column (a)) ................................................................... la 478 b Activities with net loss (enter the amount from Worksheet 1, column (b)) ..................................... ib c Prior years unallowed losses (enter the amount from Worksheet 1, column (c)) ................................................................... 1c 4,392' d Combine lines 1 a, 1 b, and 1c . .. . . .... . . . . . Id - 3 , 914 Commercial Revitalization Deductions From Rental Real Estate Activities 2a Commercial revitalization deductions from Worksheet 2, column (a) 2a b Prior year unalowed commercial revitalization deductions from Worksheet 2, column (b) 2b ..................................................... c Add lines 2a and 2b 2c All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column (a)) ................................................................... 3a b Activities with net loss (enter the amount from Worksheet 3, column (b)) 3b ..................................................................... c Prior years unallowed losses (enter the amount from Worksheet 3, column (c)) ........, ........................................................... 3c d Combine lines 3a. 3b and 3c ........:............. .................................................. ........ 3d 4 Combine lines 1d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582. Report the losses on the forms and schedules normally used 4 - 3 , 914 ................................................... If line 4 is a loss and: • Line 1 d is a loss, go to Part II. • Line 2c is a loss (and line 1d is zero or more), skip Part 11 and go to Part III. • Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part III. Instead, go to line 15. Part 11 Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part 11 as positive amounts. See page 8 of the instructions for an example. 5 Enter the smaller ofthelossonline 1dortheloss online 4 ............................................. 5 3,914 6 Enter $150,000. If married filing separately, see page 8 6 150,000 7 Enter modified adjusted gross income, but not less than zero (see page 8) 7 167,993 Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract line 7 from line 6 8 9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If maned filing separately, see page 8 9 10 Enter the smaller of line 5 or line 9 10 0 If line 2c is a loss, go to Part III. Otherwise, go to line 15. Part Ill Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers in Part III as positive amounts. See the example for Part II on page 8 of the instructions. 11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions ............... 11 12 Enter the loss from line 4 .................................................................................... 12 13 Reduce line 12 by the amount on line 10 .....................' - ............................. ' .....' ' . ' ' ' 13 14 Enter the smallest of line 2c (treated as a positive amount), line r line ........ . . . .... 1 1 , o 113 , .......... 14 Part IV Total Losses Allowed 15 Add the income, if any, on lines 1a and 3a and enter the total ................................................... 15 478 16 Total losses allowed from all passive activities for 2009. Add lines 10, 14, and 15. See page 11 of the instructions to find out how to report the losses on our tax return ............................................ 16 478 For Paperwork Reduction Act Notice, see page 12 of the instructions. Fonn 8582 (2009) DAA OMB No. 1545-1008 KOSTY 02116/2010 9:57 AM John S Kostukovich Fort 8582 (2009) rage c Caution: The worksheets must be filed with your tax return. Keep a copy for your records. Worksheet 1-For Form 8582, Lines 1a, 1b, and 1c (See pages 7 and 8 of the instructions.) Current year Prior years Overall gain or loss i i f Name o act v ty (a) Net income (b) Net loss (c) Unallowed (d) Gain (e) Loss line 1a line 1b loss line 1c 3900 Trindle Road LLC 478 4,392 3,914 Total. Enter on Form 8582, lines 1a, 1b, and lc .............................. ? 478 4,392 , Worksheet 2-For Form 8582, Lines 2a and 2b See page 8 of the instructions.) Name of activity (a) Current year deductions line 2a) (b) Prior year unallowed deductions line 2b (c) Overall loss Total. Enter on Form 8582, lines 2a and 2b ? Worksheet 3-For Form 8582, Lines 3a 3b and 3c See page 8 of the instructions. f tivit N Current year Prior years Overall gain or loss ame o ac y (a) Net income (line 3a (b) Net loss line 3b (c) Unallowed loss (line 3c (d) Gain (e) Loss Total. Enter on Form 8582, lines 3a, 3b, and 3c ? Worksheet 4-Use this worksheet i f an amount is shown on Form 85 82 line 10 or 14 See a e'9 of the instructions. Name of activity Form or schedule and line number to be reported on (see instructions) (a) Loss (b) Ratio (c) Special allowance (d) Subtract column (c) from column (a) Total ? 1.00 Worksheet 5-Allocation of Unallowed Losses See a e 9 of the ins tructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Unallowed loss 3900 Trindle Road LLC Sch E2 3,914 1.0000 3,914 Total ? 3 , 914 1.00 3,914 DAA Form 8582 (2009) KOSTY 02116/2010 9:57 AM John S Kostukovich Page 3 Form 8582(2009) Worksheet 6-Allowed Losses See pages 9 and 10 of t he instructions. _ Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Unallowed loss (c) Allowed loss 3900 Trindle Road LLC Sch E2 4,392 3,914 478 Total - - ..................? . ? 4,392 , 3,914 478 Worksheet 7-Activities With Losses Reported on Two or More Forms or Schedules (See page 10 of the instructions.) Name of activity: (a) (b) (c) Ratio (d) Unallowed (e) Allowed loss loss Form or schedule and line number to be reported on (see instructions): 1a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from form or schedule ? ................................ c Subtract line 1 b from line 1a. If zero or less, enter -0 ? Form or schedule and line number to be reported on (see Instructions): .................................... 1a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from form or schedule ? ................................ c Subtract line 1b from line Ia. If zero or less, enter -0- ? Form or schedule and line number to be reported on (see instructions): .................................... 1a Net loss plus prior year unallowed loss from forth or schedule ? b Net income from form or schedule I.. ................................ c Subtract line 1b from line 1a. If zero or less, enter -0 ............ ? Total .............................................. ............ ? 1.00 Form 8582 (2009) DAA KOSTY 02/16/2010 9:57 AM AMT Version Form 8582 Passive Activity Loss Limitations OMB No. 1545-1008 Department of the Treasury ? See separate instructions. Attachment 2009 Internal Revenue Service (99) ? Attach to Form 1040 or Form 1041. Sequence No. 88 Name(s) shown on return Identifying number John S Rostukovich Part 1 2009 Passive Activity Loss Caution: Complete Worksheets 1, 2, and 3 on page 2 before completing Part I. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.) 1a Activities with net income (enter the amount from Worksheet 1, column (a)) 1a 478 b Activities with net loss (enter the amount from Worksheet 1, column (b)) lb c Prior years unallowed losses (enter the amount from Worksheet 1, column (0) .................. 1c 4,163 d Combine lines 1a, 1b, and 1c ................................................................................. 1d - 3 , 6 8 5 Commercial Revitalization Deductions From Rental Real Estate Activities 2a Commercial revitalization deductions from Worksheet 2, column (a) 2a ......,........ b Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b) 2b c Add lines 2a and 2b 2c All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column (a)) ...........................................3.....:.................. 3a b Activities with net loss (enter the amount from Worksheet , column (b)) .......................................................................... 3b ? c Prior years unallowed losses (enter the amount from Worksheet 3, column (c)) ................................................................... 3c ...................... . . .. . . . . .. . . . . . . . d Combine lines 3a, 3b, and 3c ................................................ 3d 4 Combine lines 1d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582. Report the losses on the forms and schedules normally used 4 - 3 , 6 8 5 ................................................... If line 4 is a loss and: • Line 1d is a loss, go to Part 11, • Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III. • Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part III. Instead, go to line 15. Part 11 - Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part II as positive amounts. See page 8 of the instructions for an example. 5 Enter the smaller of the loss on line 1 d or the loss on line 4 . . . ............. ......:........................ 5 3 , 6 8 5 6 Enter $150,000. If married filing separately, see page 8 6 150, D00 ........................... 7 Enter modified adjusted gross income, but not less than zero (see page 8) 7 167,993 Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract line 7 from line 6 8 9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see page 8 9 10 Enter the smaller of line 5 or line 9 10 0 ........................................................................... If line 2c is a loss, go to Part III. Otherwise, go to line 15. Part III Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers in Part III as positive amounts. See the example for Part 11 on page 8 of the instructions. 11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11 ............... 12 Enter the loss from line 4 12 .................................................................................... 13 Reduce line 12 by the amount on line 10 13 ...................................................................... 14 Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13 . . . . . . . . . . .. . ....................... 14 Part IV Total Losses Allowed 15 Add the income, if any, on lines 1a and 3a and enter the total 15 478 ................................................... 16 Total losses allowed from all passive activities for 2009. Add lines 10, 14, and 15. See page 11 of the instructions to find out how to report the losses on your tax return ............................................ 16 478 For Paperwork Reduction Act Notice, see page 12 of the instructions. Form 8582 (2009) DAA KOSTY 0211612010 9:57 AM AMT Version John S Kostukovich Page 2 Form 8582(2009) Caution: The worksheets must be filed with your tax return. Keep a copy for your records. wnrkchc±at 1-Fnr Form 8582. Lines 1a. 1b. and 1c (See pages 7 and 8 of the instructions.) Current year Prior years Overall gain or loss Name of activity (a) Net income line 1a (b) Net loss line 1b (c) Unallowed loss (line 1c (d) Gain (e) Loss 3900 Trindle Road LLC 478 4,163 3,685 Total. Enter on Form 8582, lines 1a, 1b, and 1c .............................. ? 478 1 1 4 ,163 wnrkchpPt 2-For Form 8582. Lines 2a and 2b (See Daue 8 of the instructions.) Name of activity (a) Current year deductions line 2a) (b) Prior year unallowed deductions (line 2b) (c) Overall loss Total. Enter on Form 8582, lines 2a and 2b ? Worksheet 3-For Form 8682, Lines 3a 3b and 3c See a e 8 of the instructions. Current year Prior, years Overall gain or loss Name of activity (a) Net income (line 3a) (b) Net loss (line 3b) (c) Unallowed loss (line 3c) (d) Gain (e) Loss Total. Enter on Form 8582, lines 3a, 3b, and 3c ? Worksheet 4-Use this worksheet i f an amount is shown on Form 85 82 line 10 or 14 See a e 9 of the instructions. Name of activity Form or schedule and line number to be reported on (see instructions) (a) Loss (b) Ratio (c) Special allowance (d) Subtract column (c) from column (a) Total ? 1.00 Worksheet 6-Allocation of Unallowed Losses See a e 9 of the ins tructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Unallowed loss 3900 Trindle Road LLC Sch E2 3,685 1.0000 3,685 Total ? 3 685 1.00 3,685 DAA Form 8582 (2009) KOSTY 02/1612010 9:57 AM John S Kostukovich Form 8582 (2009) 3 Worksheet 6-Allowed Losses See pages 9 and 10 of t he instructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Unallowed loss (c) Allowed loss 3900 Trindle Road LLC Sch E2 4,163 3,685 478 Total ? 4,163 , 3,685 478 Worksheet 7 -Activities With Losses Reported on Iwo or more corms or acneuures toe", Ndyc iv vi ais aiauULAIViia.j Name of activity: Form or schedule and line number to be reported on (see instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from form or schedule ? c Subtract line 1b from line 1a. If zero or less, enter -0- Form or schedule and line number to be reported on (see instructions): .................................... 1a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from forth or schedule ? (a) (b) (c) Ratio (d) Unallowed (e) Allowed loss c Subtract line 1b from line 1a. If zero or less, enter -0 ? Form or schedule and line number to be reported on (see instructions): .................................... 1a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from form or schedule ? c Subtract line 1b from line 1a. If zero or less, enter -0- Total AMT Version 1.00 Forth 8582 (2009) DAA KOSTY 0211612010 9:57 AM Form 1040 I Two Year Comparison Report - Page 1 2008 & 2009 Name John S Kostukovich Taxpayer Identification Number 2008 2009 Differences Filing Status MFJ HH Salaries and wages 1 1• 9,343 -9,343 . 2. Interest income 2. 1,767 145 -1,622 ........................................ 3. Tax exempt interest income 3• Dividend income 4 4• . ....................................... 5. Qualified dividend income 5• 6. Taxable state/local refunds 6. 860 329 -531 7. Alimony received 7. 1 8. Business income/loss 8. 188,849 186,401 -2,448 n ............................... 9. Capital gainAoss 9• c .............. 10. Other gains/losses 10. 0 11. Taxable IRA distributions 11. m ................................. 12. Taxable pensions 12• e 13. Rent and royalty income including farm rental 13. 14. Partnership/S corp income 14. 15. Estate or trust income 15. 16. Farm incomelloss 16. ...................................... 17. Unemployment compensation 17. 18. Taxable social security 18. .................................. 19. Other income 19• 20. Total Income 20. 200,819 186,875 -13,944 - A 21. Moving expenses 21. d 22. SE tax adjustment 22• 8,843 91118 275 j 23. SEP/SIMPLE/Qualified plans deductions 23. 10,500 6,708 -3,792 u s 24. SE health insurance 24. 4,116 12,174 8,058 t 25. Forfeited interest 25• 26. Alimony paid 26. e n ........................................... 27. IRA deductions 27. t ......................................... 28. Student loan interest 28• s 29. Other adjustments 29. ........................ 30. Adjusted gross in"' 30. 177,360 158,875 -18,485 D 31. Medical 31. e ................................................ 32. Taxes 32. 17,385 6,851 -10,534 d ................................................. 33. Interest 33. 17,582 -17,582 u 34. Contributions 34. 1,950 -11950 F 35. Casualty losses 35. t 36. Miscellaneous expenses 36. I 37. Allowable itemized deductions 37. 36,743 6,851 -29,892, U .......................... 38. Standard deduction 38. 11,900 8,350 -3,55G " n ..................................... 39. Deduction taken 39. 36,743 8,350 -28,393 S 40. Exemptions 40. 10,500 7,300 -3,200 1 41. Taxable income 41. 130,117 143,225 13,108 KOSTY 02116/2010 9:57 AM Form 1040 Two Year Comparison Report - Page 2 2008 & 2009 Name Taxpayer Identification Number John S Kostukovich 42. Taxable income from 2YR page 1, line 41 43. Tax on taxable income .................................. 44. Alternative minimum tax ................................ 45. Child care credit ........................................ 46. Education credits ....................................... 47. Retirement savings credit ................................ T 48. Child tax credit ......................................... a 49. General business credit ................................. X 50. Other credits ........................................... 51. Total credits C 52. Net tax liability 0 53. Self-employment taxes . .................................. m 54. Other taxes ............................................ p 55. Total tax ............................................... u 56. Income tax withheld .................................... t 57. Estimated tax payments .........:....................... a 58. Earned income credit ................................... t 59. Additional Child tax credit ............................... 1 60. Other refundable tax credits ............................. o . 61. Other payments ........................................ n 62. Total payments 63. Tax duel-refund ....................................... 64. Penalties and interest ................................... 65. ... Net tax duel-refund ................................. 66. Refund applied to estimated tax payments ............. 67. Refund received ........................................ 68. Marginal tax rate .......... • 69. Effective tax rate . ....... 2008 2009 Differences 130,117 143,225 13,108 25,217 31,432 6,215 601 601 52. 25,217 32,033 6,816 53. 17,686 18,235 549 54. 55. 42,903 50,268 7,365 56. 57. 10,947 9,596 -1,351 42,000 -42,000 52,947 9,596 -43,351 -10,044 40,672 50,716 622 821 199 -9,422 41,493 50,915 9,596 -9,596 25.0 28.0 33 % 350 KOSTY 0211612010 9:57 AM Form 1040 Two Year Comparison Report - Schedule C 12008 & 2009 Name Taxpa er identification number John S Kostukovich Principal business or profession Unit Accountina Services 1 1. Gross receipts or sales ....................................... 2. Returns and allowances ...................................... 3. Cost of goods sold .......................................... 4. Gross profit ................................................. 5. Other income ................................................ 6. Gross Income ............................................... 7. Advertising .....................................:............ 8. Car and truck expenses ............................... 9. Commissions and fees ....................................... 10. Contract labor ................................................ 11. Depletion .......................................... 12. Depreciation and section 179 expense deduction 13. Employee benefit programs 14. Insurance (other than health) ................................. 15. Interest - mortgage (paid to banks, etc.) ....................... 16. Interest - other . ........................................:...... 17. Legal and professional services 18. Office expense ........................................... 19. Pension and profit-sharing plans 20. - Rent or lease - vehicles, machinery, and equipment 21. Rent or lease - other business property ........ 22. Repairs and maintenance 23. Supplies (not included in cost of goods sold) ....... . 24. Taxes and licenses ........................................... 25. Travel ....................................................... 26. Total meals and entertainment ................................. 26a. Nondeductible meals and entertainment ........................ 26b. Deductible meals and entertainment ........................... 27. Utilities ...................................................... 28. Wages (less employment credits) ............................. 29. Other expenses .............................................. 30. Total expenses .............................................. 31. Tentative profit (loss) 32. Expenses for business use of home ........................... 33. Net profit or (loss) .......................................... 34. Inventory - Beginning of year .... ... .......................... 35. Purchases ................................................... 36. Labor ....................................................... 37. Materials .................................................... 38. Other costs .................................................. 39. Goods available for sale (sum of lines 3438) ................. 40. Inventory - End of year ............................. 2008 2009 Differences 481,736 496,224 14,488 680 373 -307 481,056 495,851 14,795 481,056 495,851 14,795 360 152 -208 10,286 5,387 -4,899 828 828 3,398 174 -3,224 8,356 3,552 -4,804 12,880 11,980 -900 18. 18,881 17,436 -1,445 19. 2,764 2,440 -324 20. 3,270 2,874 -396 21. 28,800 28,800 22. 11,299 8,615 -2,684 23. 4,684 8,574 3,890 24. 17,010 12,910 -4,100 25. 9,918 2,823 -7,095 26. 6,816 4,415 -2,401 26a. 3,408 2,207 -1,201 26b. 3,408 2,208 -1,200 27. 9,410 9,036 -374 158,104 153,610 -4,494 29. 18,953 47,873 28,920 30. 321,781 319,519 -2,262 159,275 176,332 17,057 159,275 176,332 17,057 KOSTY 02/1612010 9:57 AM L Form 1040 I Two Year Comparison Report - Schedule C 2008 & 2009 Name Taxpayer identification number John S Kostukovich Principal business or profession Financial Services Income 2008 1. Gross receipts or sales . , , 1. 31,221 2. Returns and allowances 2. 3. Cost of goods sold .......................................... 3, 4. Gross profit ................................................. 4. 31,221 5. Other income .. ......................................... 5. - 6. Gross income 6. 31,221 7. Advertising ......................... 7. 8. Car and truck expenses ....................................... 8. 657 9. Commissions and fees ....................................... 9, - 10. Contract labor 10. 11. Depletion 11. 12. Depreciation and section 179 expense deduction 12. _ 13. Employee benefit programs 13. 14. Insurance (other than health) ... 14. 990 15. Interest - mortgage (paid to banks, etc.) 15. _ 16. Interest - other 16. 17. Legal and professional services .......................... 17. - 18. Office expense ............................................... 18. - 19. Pension and profit-sharing plans 19. 20. Rent or lease - vehicles, machinery, and equipment 20. 21. Rent or lease - other business property ........................ 21. - 22. Repairs and maintenance 22. 23. Supplies (not included in cost of goods sold) .. 23. _ 24. Taxes and licenses ........................................... 24. - 25. Travel ........................................................ 25. - 26. Total meals and entertainment 26. 26a. Nondeductible meals and entertainment ........................ 26a. 26b. Deductible meals and entertainment ........................... 26b. - 27. Utilities ...................................................... 27, 28. Wages (less employment credits) 29. Other expenses 29, 30. Total expenses ...........................,.................. 30. 1 , 64T 31. Tentative profit (loss) 31. 2 9,-57 4 32. Expenses for business use of home 32. ........................... 33. Net profit or (loss) ... 33, 2 9, 5 7 4 34. Inventory - Beginning of year .................................. 35. Purchases 36. Labor ....................................................... 37. Materials .................................................... 38. Other costs .................................................. 39. Goods available for sale (sum of lines 3438) ................. 40. Inventory - End of year ........................................ Unit 2 2009 13,059 13,059 13,059 599 1,846 545 9 10,069 10,069 -18,162 -18,162 -18,162 -5 6 545 1,343 -19,505 -19,505 f KOSTY 01/0212011 12:03 PM Department of the Treasury-Intemal Revenue Service LL 2010 1040 U.S. Individual Income Tax Return 1(99) RS Use ON not write or staple in this space. P For the year Jan. 1-Dec. 31, 2010, or other tax year beginning 2010, ending .20 OMB No. 1545-0074 Name; R Your first name and initial Last name Your social sscurl number Address, N John S Koatukovich and SSN T If a joint return, spouse's first name and initial Last name S socfaI security number C ?s H See separate L E Home address (number and street). If you have a P.O. box, see instructions. Aptn. - Make sure the SSN(s) above t l 6 instructions, A 3900 Trindle Road c are correc . and on ine L City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. Checking a box below will not Y C Hill PA 17011 change your tax or refund. Presidential Election Campaign ? Check here if you, or your spouse if filing jointly, want $3 to go to this fund . . . ... Spouse . ........... ? You J 1 ead o household (with qual' 'ng person).?See instructions. I Single 4 the qualifying person is a child but not your ependent, enter is Filing Status 2 Married filing jointly (even if only one had income) child's name here . ? 3 X Married fling separately. Enter spouse's SSN above 5 FJ Qualifying widow(er) with dependent child Check only one box, and fun name hen:. ? Suell Kostukovich 6a X Yourself. If someone can claim you as a dependent, do not check box 6a oBoxe and ck 1 J Exemptions b Spouse .............................................................. .......................... No. of children on 6c who: c Dependents: (2) Dependent's (4) v n (3) Dependent's qual. child • lived with you social security number for child relationship to you tax or. see • did not live with t o divorce pop 1 youdue 1 First name Last name et y ? separation If more than four (see Instructions) dependents, see instructions and Dependents on 6c check here ? not entered above d Total number of exem lions claimed ........................... ........... .......... ............. ...... Add num on ... Ones above 1 7 Attach Form(s) W-2 salaries tips etc Wages 7 Income Be ....................... , . , , Taxable interest. Attach Schedule B if required . ..... . . . . . . . . . . . ..................... ..................... ............ ........... Be 2 Attach Form(s) W-2 here. Also b 9a Tax-exempt interest. Do not include on line Be .... Ordinary dividends. Attach Schedule B if required .. 8b 9a attach Forms W-2113 and b 10 ..... . ......... Qualified dividends .......................................... Taxable refunds, credits, or offsets of state and local income taxes . . ...... 9b .. .... , ...... 10 27 1099-R If tax was withheld. 11 Alimony received ........... 11 12 .. Business income or (loss). Attach Schedule C or C-EZ . . . ... . . . . . . . . . . . . . . . . .......... 12 163,223 If you did not t W 2 13 . ....... Caplta gain or (loss). Attach Schedule D n regwed. tl not required, check here ? LJ 13 ge a - , see page 22. 14 ...... Other gains or (losses). Attach Form 4797 ..................... ....... 14 15a IRA distributions 15a ..................... ...................... b Taxable amount ........... 15b 16a ............. Pensions and annuities 16a . b Taxable amount ........... 16b Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17 0 not attach, any 18 Farm income or (loss). Attach Schedule F 18 payment. Also, 19 Unemployment compensation . ...... , ... , 19 Form 1u040-V. 20a Social security benefits 120a I I b Taxable amount 20b 21 Other income. List type and amount 21 22 ........................................................... Combine the amounts in the far right column for lines 7 through 21. This is ur total income ? 22 163 , 252 23 Educator expenses. CAUTION: See instructions 23 Adjusted Gross 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Form 3903 26 27 .......................... One-half of self-employment tax. Attach Schedule SE .. 27 8 , 8 0 8 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 to Recipient's SSN ? 31a 25,974 32 IRA deduction 32 33 .................................. Student loan interest deduction .. 33 34 Tuition and fees. CAUTION: See instructions 34 35 ................... Domestic production activities deduction. Attach Form 8903 .. 35 36 Add lines 23 through 31a and 32 through 35 36 34,782 37 Subtract line 36 from line 22. This is our, ad usted roes income ..................... ....... ? 37 12 8 , 4 7 0 For ?gsclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate Instructions. Form 1040 (2010) KOSTY 01/02/2011 12:03 PM Form 1040 (2010) John S KOStukoViCh om line 37 (adjusted gross income) t f 38 A ........ ... 38 age 2 128, 470 Tax and Credits 39a b ................... moun r Check You were born before January 2, 1946, Blind. if: L 8 Spouse was born before January 2, 1946, Blind. If your spouse itemizes on a separate return or you were a dual-status alien, check d deductions (from Schedule A) or your standard deduction ( iz It Total boxes J checked ? 39a here ........... ? 39b see instructions) A 0' 9,304 40 41 em e t line 40 from line 38 bt S .. ....... ... ... 41 119,166 42 . . . . . . ........... ..................... rac u the number on line 6d 650 b Multi l $3 E ti .................. ." 42 3!650 43 y p y , ons. xemp enter If line 42 is more than fine 41 Subtract line 42 from line 41 Income T bl 43 115,516 44 , . . axa e ....... tax is from a [] Form(s) 6814 b ? Form 4972 Check If an see intr ) Tax ............... 27,011 45 y . . ( Akemative minimum tax (see instructions). Attach Form 6251 45 857 46 ....... Add lines 44 and 45 ......................... .......... ? 46 27, 868 47 .............................................. Foreign tax credit. Attach Form 1116 if required ...... 47 ........ 48 Credit for child and dependent care expenses. Attach Form 2441 48 49 line 23 Education credits from Form 8863 49 50 , ........................ Retirement savings contributions credit. Attach Form 8880 50 51 ........ Child tax credit (see instructions) 51 52 Residential energy credits. Attach Form 5695 52 53 Other credits from Form: a ? 3800 b [] 8801 c W 54 These are your total credits Add lines 47 through 53 54 55 . ............... Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . ......................... ......................... 10. 55 27,868 56 Self-employment tax Attach Schedule SE 5s 17,615 Other 57 '(? Unreported social security and Medicare tax from Form: a LJ 4137 b 8919 57 Taxes 58 .. etc. Attach Form 5329 if required other qualified retirement plans Additional tax on IRAs ......... 58 59 , , box 9 b ? Schedule H c [] Form 5405, line 16 a 0 Form(s) W-2 59 60 , Add lines 55 through 59. This is your total tax ? 60 45,483 61 Federal income tax withheld from Forms W-2 and 1099 61 Payments 62 2010 estimated tax payments and amount applied from 2009 return 62 2 5 , 8 0 0 63 Making work pay credit. Attach Schedule M 63 If you have a Earned income credit (EIC) 64a ..................... quaiifyrcrg b Nontaxable combat pay election 64b child, attach 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 Form 5405, line 10 ............. 67 68 Amount paid with request for extension to file .................. . . . 68 69 Excess social security and tier 1 RRTA tax withheld ............... 69 70 Credit for federal tax on fuels. Attach Form 4136 70 71 Credits from Forth: a 11 2439 b [] 8839 c [] 8801 d 8885 71 72 Add lines 61, 62, 63, 64a, and 65 through 71. These are your total payments ........ ........... ...... ? 72 2 5 , 8 0 0 Refund 73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid , , , , . , ... 73 74a Amount of line 73, ou want refunded to you. If Form 8888 is attached, check here ? H 74a Direct deposit? ? b Routing number ? c Type: Checking ? Savings See ? d Account number instructions. 75 Amount of line 73 you want applied to your 2011 estimated tax ? 1 75 Amount 76 Subtract line 72 from line 60. For details on how to pay, see instructions ? 76 19,858 You Owe 77 ,,,, , , , ,,,,,, , , , Estimated tax penalty (see instructions) .......................... 77 , , , , , , 175 1, Do you want to allow another person to discuss this return with the IRS (see instructions)? X Yes. Complete below. No Third Party Personal identification number (PIN) ? 15646 Designee Dasignae?s me ? John S Kostukovich Phoneno. ? 717-730-0820 SI 9n na 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, er) is based on all Information of which preparer has any knowledge n tax a th r th f D l ti they are p y preparer (o e a ara on o ec true, correct, and complete. . Here Your signature Date Your occupation Daytime phone number Joint return? Accountant See page 1 . 5 Keep a copy Spouse's signature. If a joint retum, both must sign. Date Spouse's occupation for your records. Print/Type preparers name Prgorer's-signature 1 Date Check if PTIN Paid John s xostukovich John S Kostukovich 01/02/11 self-emw ed P00098505 Preparer Firm's name ? John S. Kostukovich, CPA Finn' w 00, Use Only Firm's address ? 3900 Trindle Rd Phone no. Came Hill PA 17011-6912 717-730-0820 Form 1040 (2olo) DAA KOSTY 01/0212011 12:03 PM SCHEDULE A Itemized Deductions OMB NO.15"5 X14 (Form 1040) 2010 Department of the Treasury ? Attach to Form 1040. ? See Instructions for Schedule A (Form 1040). SAe%e& o. 07 eW Internal Revenue Service 99 Your social security number Name(s) shown on Form 1040 John S Ko stukovich Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see page A-1) ................. 1 Dental 2 Enter amount from Form 1040, line 38 2 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 You 5 State and local income taxes 5 8,692 Paid 6 Real estate taxes (see page A-3) ................................ 6 (See 7 New motor vehicle taxes from line 11 of the worksheet on page A-2.) back (for certain vehicles purchased in 2009) ..................... 7 8 Other taxes. List type and amount ? ...................... ...... See Statement 1 8 70 ............................................ dd lines..5 through.. 8- 9 Add' 9 8,762 Interest 10 Home mortgage interest and points reported to you on Form 1098 10 427 You Paid 11 Home mortgage interest riot reported to you on Form 1098. If paid to the (See person from whom you bought the home, see page A-0 and show that page A-4.) person's name, identifying no., and address ? ........................ Note. .............................................................. Your mortgage 11 interest .............................................................. 12 Points not reported to you on Form 1098. See page A-4 for deduction may ...... special rules 12 be limited (see ............................................ 13 Mortgage insurance premiums (see page A-4) 13 page A-4). ....... 14 Investment interest. Attach Form 4952 if required. (See page A-5.) 14 , .................................................. 15 Add lines 10 through 14 .......................................... ..... ....................... 15 427 GIBS to 16 Gifts by cash or check. If you made any gift of $250 or more, Charity see page A-6 ................................................. 16 115 If you made a 17 Other than by cash or check. If any gift of $250 or more, see gift and got a page A-6. You must attach Form 8283 If over $500 17 benefit for it, 18 Carryover from prior year ........................ 18 see page A 6. ........ 19 Add lines 16 through 18 .......................................... ............................ 19 115 Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Forth 4684. (See page A-7.) ........ ............................ 20 Job Expenses 21 Unreimbursed employee expenses--job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-EZ If required. See page A-7.) ? ................................. Miscellaneous .. 21 Deductions ........................................................ 22 Tax preparation fees : 22 ................ . ......................... (See 23 Other expenses-investment, safe deposit box, etc. List type page A-7.) and amount ? ........................................ ....... 23 ............................................ 24 Add lines 21 through 23 24 ........................................ 25 Enter amount from Form 1040, line 38 25 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 on page A-8. List type and amount ? ............. .. . Miscellaneous Deductions ..................... ................................... ............................. 28 . Total 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount Itemized line 40 on Form 1040 .. .. 29 9,304 ........................................... , ....................... .. Deductions 30 If you elect to itemize deductions even though they are less than your standard deduction, check here ........................... ? For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule A (Forth 1040) 2010 DAA KOSTY 01102J2011 12:03 PM SCHEDULE C Profit or Loss From Business OMB No. 1545-0074 (Form 1040) (Sole Proprietorship) 2010 ? Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. Attachment 09 II t ITRevenue S rv ery (99) 0- Attach to Form 1040, 104ONR, or 1041. DO- See Instructions for Schedule C Form 1040. Sequence No. Social secu number (SSN) Name of proprietor John S Kostukovich A Principal business or profession, including product or service (see page C-2 of the instructions B : Enter code from, pages G9, 10, 8,11 Accounting Services ? 541211 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), if any John S Kostukovich, CPA E Business address (including suite or room no.) ? 3. 900 Trindle Road ............ .... City, town or post office, state, and ZIP code C H3.11 PA 17 011 F Accounting method: (1) Cash (2) Accrual (3) Other (specify) ? ................. .......... ... ....... C Y ... No G Did you "materially participate" in the operation of this business during 2010? If "No," see page C-3 for limit on losses es H If you started or acquired this business during 2010, check here ................................................. .......... .......... ? Part I Income 1 Gross receipts or sales. Caution. See page C-4 and check the box if: e This income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, or ? rental real estate onl ortin e re t i t d lifi 1 481,347 y g p ven ur n jo e e You are a member of a qua income not subject to self-employment tax. Also see page C-3 for limit on losses. 2 220 2 Returns and allowances .................................................................................... .. 3 481,127 3 Subtract line 2 from line 1 e 2) 42 on a li f ld 4 p g ne rom ( 4 Cost of goods so ........................ 127 481 om line 3 t li 4 f bt fi S 5 , ne r rac t u ...................................................................... 5 Gross pro .. asoline or fuel tax credit or refund (see page G4) ral and state f di d i l i 6 g .................................. ng e e nc u ncome, 6 Other .. 7 Gross Income. Add lines 5 and 6 .......................................................................... ? 7 481,127 Part 11 Expenses. Enter a nse s for business use of our home only on line 30. i i 8 786 3 . . ........ 18 Office expense ... 18 17 , 7 84 ng 8 Advert s , .. . ...... ............. 19 Pension and profit-sharing plans 19 1,043 9 Car and truck expenses (see page C-4) 9 6,026 20 Rent or lease (see page C-6): ...................... d f i i 10 , and equipment a Vehicles, machinery 20a 840 ees ons an ss 10 Comm 4) C l b 11 3,169 , b Other business property 20b ?8,800 - or (see page 11 Contract a l i 12 21 Repairs and maintenance 21 2 , 9 9 6 on 12 Dep et .......... ............. n 179 ti i d ti D 22 Supplies (not included in Part 111) 22 2,620 sec o on an eprec a 13 n (not ti d d 23 Taxes and licenses 23 16,221 uc o expense e included in Part III) (see page 24 Travel, meals, and entertainment: C 5 13 2, 810 a Travel ................ ... 24a 3,927 - ) .................... ............ ....... 14 Employee benefit programs b Deductible meals and li 19) th th 14 14 , 3 2 9 entertainment (see page C-6) 241b 2,522 ne er an on (o (other than health) 15 I 15 6,697 25 Utilities 25 7,453 nsurance est: 16 I t 26 Wages (less employment credits) 26 179,428 n er a Mortgage (paid to banks, etc.) 168 27 Other expenses (from line 48 on b Oth 16b 250 page 2) ........................... ... 27 43,221 er .................... 17 Legal and professional services ........................ 17 614 28 Total expenses before expenses for business use of home. Add lines 8 through 27 ? 28 344,536 29 Tentative profit or (loss). Subtract line 28 from line 7 .......................................................... 29 136,591 30 Expenses for business use of your home. Attach Form 8829 ................................................... 30 ... 31 Net profit or (loss). Subtract line 30 from line 29. e If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (ff you checked the box on line 1, see page C-7). Estates and trusts, enter on Form 1041, line 3. 31 136,591 e If a loss, you must go to line 32. 32 If you have a loss, check the box that describes your investment in this activity (see page C-7). e If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see the line 31 instructions on page C-7). 32a 8 All investment is at risk. Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not e If you checked 32b, you must attach Form 6198. Your loss may be limited. at risk. For Paperwork Reduction Act Notice, see your tax return instructions. Schedule C (Form 1040) 2010 DAA KOSTY 0110212011 12:03 PM John S Rostukovich ' Schedule C (Form 1040) 2010 Accounting Services Page 2 Part III' Cost of Goods Sold (see page C-8) - 33 Method(s) used to value, closing inventory: a ® Cost b ? Lower of cost or market c 11 Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? ? Yes ® No If "Yes" attach explanation ...................................................................................... ...... . attach explanation inventor i l ' 35 .......... . .... y, ng s c os 35 Inventory at beginning of year. If different from last year l s 36 use ona 36 Purchases less cost of items withdrawn for per lf 37 ......... ....... • . , ................................ 37 Cost of labor. Do not include any amounts paid to yourse 38 ........................................................................... 38 Materials and supplies • • • • . 39 ...................................................................................... . 39 Other costs 40 40 Add lines 35 through 39 ................... ...................... 41 41 Inventory at end of year ....................................................................................... 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 .................. ... 42 lete this part only if you are claiming car or truck expe Com l hi V nses on line 9 p c e. e Part IV Information on Your and are not required to file Form 4562 for this business. See the instructions for line 13 on page C-5 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) ? 44 Of the total number of miles you drove your vehicle during 2010, enter the number of miles you used your vehicle for: . a Business b Commuting (see instructions) c Other ............... ............... 45 Was your vehicle available for personal use during off-duty hours? Yes No ........................................... 46 Do you (or your spouse) have another vehicle available for personal use? Yes No ...... 47a Do you have evidence to support your deduction? ....................... Yes No b If "Yes" is the evidence written? .......................................................... ..................... ...... Yes No Part V Other Expenses. List below business expenses not included on lines 8-26 or line 30. 896 ........................................................................................... Sank charges ....... .. .... ift.... i C .... 2.038 s nt G e l 495 1 .Coat nuag $ducat ion , ........................................................................... ........ ..... .. .................. .. t i 3.065 3, 065 s er Cos Cop ... 333 5 fees in fil / , e- .................................................................... Per return g.. . .................. ... h l ..... 6.149 ................................................................. one Te ep . . . . . . . . .. . . . . . . ..... 565 is s Permit F i e ees nses c L 107 1 b i emeats R il . m urs e ........................................................................ M eage... . . . . . . . . . . . ........ . . . .. . . ne . . ll Mi ..... 1.073 ous a sce 11 445 rvi c e s/Software S t , ................................................................. e Compu er... ..... 79 l h R emova ................................................................................. Tras .. ... . .... ..... 468 ions t & ri b S p ............................................................................ s c u s ClDue ain ..... 3,100 .... . . . . ................................................................................... .. . . .... ea .... . 614 3 i i a , scap a ag ............................................................................................ ..... 901 l t t C on ro Pes 842 : it ................... Secur y .............................................................................. .. ..... 334 tion Amorti za 48 Total other expenses Enter here and on page 1 line 27 ..... 48 43,221 DAA Schedule C (Form 1040) 2010 KOSTY 01/02/2011 12:03 PM SCHEDULE C Profit or Loss From Business OMB No. 154SM74 (Form 1040) (Sole Proprietorship) 2010 Op- Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. Attachment Attach to Form 1040, 104ONR, or 1041. ? See Instructions for Schedule C Form 1040. Sequence No. Dipe tmRevenuthe e Serv?cery (99) ? 09 Social security number (SSN) Name of proprietor John S Kostukovich A Principal business or profession, including product or service (see page C-2 of the instructions B Enter code from pages G9, 10, & 11 Financial Services ? 523900 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), If any E F G H Business address (including suite or room no.) ? 3.9.0.0 Trindle Road ........... . .. • City, town or post office, state, and ZIP code Cam Hill PA 17011 Accounting method: (1) P;J Cash (2) 11 Accrual (3) Other (specify) ? ............... Did you "materially participate" in the operation of this business during 2010? If "No; see page C-3 for limit on losses If you started or acquired this business duri2010, check here ............................................... .. • ............................... . ..........••... ® . .. _ .. • • Yes No ...................... , Part I Income 1 Gross receipts or sales. Caution. See page C-4 and check the box if: e This income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, or rental real estate . • • . ? onl ortin re re t i t lifi d ? 1 29,394 y g p ven u n jo e e You are a member of a qua income not subject to self-employment tax. Also see page C-3 for limit on losses. 2 Returns and allowances .................................................................................. .... 3 29,394 3 Subtract line 2 from line 1 e 2) 42 li 4 4 on pag ne ..................................•...•......................... Cost of goods sold (from li 3 4 f li ..... 5 29,394 5 ne rom ne Gross profit. Subtract asoline or fuel tax txed'd or refund (see page C-4) te d t f d l i 6 6 7 ............................... an s a g era ng e Other income, includ Gross income. Add lines 5 and 6 ......................................................................... .. . ? 7 29,394 Part n Expenses. Enter a enses for business use of our home on on iine 30. 8 18 Office expense ...... ..... 18 8 Advertising . . . . . . . . . . ..... ... ......... 19 Pension and profit-sharing plans 1 9 Car and truck expenses (see page C-4) 9 20 Rent or lease (see page C-6): d f 10 ry, a Vehicles, machinery, and equipment 20a 10 ees Commissions an 4 C 11 b Other business property 20b 11 ) .. _ . - Contract labor (see page 12 21 Repairs and maintenance 21 12 Depletion ....................... 179 ti d i i 22 Supplies (not included in Part III) 22 13 on sec on an Deprec at i ot d d 23 Taxes and licenses 23 on (n uct expense e included in Part III) (see page 24 Travel, meals, and entertainment: 13 a Travel ....... ..... 24a C-5) ..... ................... 14 ...... Employee benefit programs li 19 14 b Deductible meals and entertainment (see page C-6) 24b ne ) (other than on n health) th th I 15 2 , 7 6 2 25 Utilities 25 15 er a nsurance (o I t 26 Wages (less employment credits) 26 16 nteres : a Mortgage (paid to banks, etc.) 168 27 Other expenses (from line 48 on O h 16b page 2) ......................... ..... 27 b er t .......................... 17 Legal and professional ...................... services . 17 28 29 30 . Total expenses before expenses for business use of home. Add lines 8 through 27 Tentative profit or (loss). Subtract line 28 from line 7 ........................................................ Expenses for business use of your home. Attach Form 8829 ? 28 2,762 29 26,632 .. 30 31 Net profit or (loss). Subtract line 30 from line 29. e If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see page C-7). Estates and trusts, enter on Form 1041, line 3. 31 26,632 J e If a loss, you must go to line 32. 32 If you have a loss, check the box that describes your investment in this activity (see page C-7). e If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see the line 31 instructions on page C-7). 32a 8 All investment is at risk. Estates and trusts, enter on Form 1041, line 3. 32b Some investment is not e if you checked 32b, you must attach Form 6198. Your loss may be limited. at risk. For Paperwork Reduction Act Notice, see your tax return instructions. Schedule C (Form 1040) 2010 DAA KOSTY 0110212011 12:03 PM Schedule E (Form 1040) 2010 Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number Joha S Kostukovich ''. Caution The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1. Part 'll; Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See page E-1. 27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year Yes ? No unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed v v w..[......,n...nin{inn }hie -4inn parmerbrnp WAPUl:aca: ., yvu -- (a) Name 28 (b) Enter Ptor partnership; S for S wrpwaw (c) Check if foreign partnership (d) Employer identification number f (e) Check' any amount is not at risk A 3900 Trindle Road LLC P B C D Passive Income and Loss Non We Income and Loss (f) Passive loss allowed (attach Form 8582 If required) (g) Passive income from Schedule K-1 (h) Nonpassive loss from Schedule K-1 (1) Section 179 expense deduction from Form 4562 0) Nonpassive income from Schedule K-1 A 978 978 B c - D 29a Totals 978 b Totals 978 29 30 978 30 a Add columns (g) and 0) of line f li 29b 31 978 31 32 ne ........................................................ Add columns (f), (h), and (i) o Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the -.14 V,-- -A inr6 uA. in fho fnrol nn line 41 helnW .................. 32 0 From (b) Employer 33 (a) Name identification number A B Passive Income and Loss Non aasive Income and Loss (c) Passive deduction or loss allowed (attach Form 8582 if required) (d) Passive income from Schedule K-1 (e) Deduction or loss from Schedule K-1 (f) Otter income from Schedule K-1 A B 34a Totals b Totals - 34a f li f d d 35 - 35 ne ) o ............................................................................. ) an ( Add columns ( ) of line 34b d ( l 36 36 37 e umns (c) an ............................................................................. Add co Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and inAi A in fho tntal nn ling Al hPlnw - - - .................... . 37 Part N Income or Loss From Real Estate Mortgage Investment consults KtlYlics @s10u a1 moloer 38 (a) Name (b) Employer (c) Excess inclusion from identification number Schedules Q, line 2c (see Page E-8) (d) Taxable income (net loss) from Schedules Q, line 1b (e) Income from Schedules Q, line 3b 39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below ...................... 39 Part V Summary 40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below ......... . . . . ... . . .. . 40 41 Total income or (loss). Combine lines 26, 32, 37, 39, & 40. Enter the result here & on Form 1040, line 17 or Form 1040NR, line 18 ? 41 42 Reconciliation of farming and fishing income. Enter your gross farming and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code U; and Schedule K-1 (Form 1041), line 14, code F (see page E-8) ......... .. 42 43 Reconciliation for real estate professionals. If you were a real estate professional (see page E-2), enter the net income or (loss) you reported anywhere on Form 1040 or Form 1040NR from all rental real estate activities in which you material) participated under the passive activity loss rules .............. 43 DAA Schedule E (Form 1040) 2010 KOSTY 01102/2011 12:03 PM SCHEDULE SE OMB No. 1545-0074 (Form 1040) Self-Employment Tax 2010 Department of the Treasury Attachment Seq internal Revenue service 99 ? Attach to Form 1040 or Form 1040NR. Do- See Instructions for Schedule SE Form 1040. uence No. 7 Na_ me of person with self-employment income (as shown on Form 1040) Social security number of person John S Kost ukovlch with self-employment income ? Before you begin: To determine if you must file Schedule SE, see the instructions on page SE-1. May I Use Short Schedule SE or Must I Use Long Schedule SE? Note. Use this flowchart only V you must file Schedule SE. If unsure, see Who Must File Schedule SE, on page SE-1. Did you receive wages or tips in 2010? ?----? No Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? Yes Yes I I Was the total oi' your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from self-employment more than $106,8007 No Are you using one of the optional methods to figure your net earnings (see page SE-4)7 No Did you receive church employee income (see page SE-1) reported on Form W-2 of $108.28 or more? ? No You may use Short Schedule SE below Y? I + No Y Did you receive tips subject to social security or Medicare tax that you did not report to your employer? es No Yes Yes No Did you report any wages on Forth 8919, Uncollected Social Security and Medicare Tax on Wages? I You must use Long Schedule SE on page 2 Section A-Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. 1a Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form A d 14 1 65 b , co e ox ), 0 b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve or listed on Schedule K-1 (Form 1065), box 20, code Y line 6b included on Schedule F t P 1b ) ....... , , s rogram paymen 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Forth 1065-B), box 9, code J1. Ministers and members of religious orders, see page SE-1 for types of income to report on this SE-3 for other income to report li S 2 163,223 ee page ne. 3 Combine lines 1a, 1 b, and 2. Subtract from that total the amount on Form 1040, line 29, or Form 1040NR, line 29, and e SE-3) lt (see a t th 3 163, 223 p g e resu en er ............................................................................... 4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do ? ou have an amount on line 1 b chedule unless l thi t f 4 150,736 . . ........... . .. . . . . ...... . ........................ y i s s no e Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see page SE-3. 5 Seif-employment tax. If the amount on line 4 is: • $106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 56, or Form 104ONR, line 54 • More than $106,800, multiply line 4 by 2.9% (.029). Then, add $13,243.20 to the result. line 54 or Form 104ONR line 56 r the total here and on Form 1040 E t 5 17,615 , , , n e .............. ..... ....................... 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.50). Enter the result here and on Form 1040, line 27, or Form 104ONR line 27 6 8,808 For Paperwork Reduction Act Notice, see your tax return instructions. Schedule SE (Form 1040) 2010 DAA KOSTY 0110212011 12:03 PM Form 6251 Alternative Minimum Tax-Individuals ? See separate instructions. 2010 r Department of the Treasury Internal Revenue Service (99) No- Attach to Form 1040 or Form 1040NR. ntta Se uencernmenNo. 32 Name(s) shown on Form 1040 or Form 1040NR Your social security number John S Kostukovich Part I Alternative Minimum Taxable Income See instructions for how to complete each line ) 1 If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41 and go to line 2. Otherwise, enter the enter as a negative amount.) line 38 and go to line 6. (if less than zero amount from Form 1040 1 119,166 , , 2 Medical and dental. Enter the smaller of Schedule A (Form 1040), line 4, or 2.5% (.025) of Form 1040, line 38. If enter -0- zero or less ....... , .................................................................................... 6 and 8 lines 5 3 Taxes from Schedule A (Form 1040) 3 ,762 , , , .............................................................. from line 6 of the worksheet on page 2 of the instructions if any 4 Enter the home mortgage interest adjustment 4 0 .. , , line 27 5 Miscellaneous deductions from Schedule A (Forth 1040) 5 , .................................................... enter as a negative amount the sum of lines 6 and 17 from that schedule Schedule L (Forth 1040A or 1040) 6 If filin 6 ) , g line 10 or line 21 7 Tax refund from Forth 1040 ) , 8 Investment interest expense (difference between regular tax and AMT) .............................................. 9 Depletion (difference between regular tax and AMT) ............................................................... line 21. Enter as a positive amount 10 Net operating loss deduction from Form 1040 10 , .............................. • ...... 11 Alternative tax net operating loss deduction 11 ....................................................................... 12 Interest from specified private activity bonds exempt from the regular tax 12 .................. • ............. , . • , • 13 Qualified small business stock (7% of gain excluded under section 1202) 13 14 Exercise of incentive stock options (excess of AMT income over regular tax income) 14 15 Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A) 15 ..... . .. . .......................... • . 16 Electing large partnerships (amount from Schedule K-1 (Forth 1065-B), box 6) 16 ................................ • ....... 17 Disposition of property (difference between AMT and regular tax gain or loss) 17 18 Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) 18 702 .............. 19 Passive activities (difference between AMT and regular tax income or loss) 19 0 ....... . ............................... • . • 20 Loss limitations (difference between AMT and regular tax income or loss) 20 0 21 Circulation costs (difference between regular tax and AMT) 21 ............................. 22 Long-term contracts (difference between AMT and regular tax income) 22 ...... . ............... • ..... • .... , . • , ... • • • • • • . 23 Mining costs (difference between regular tax and AMT) 23 .......................................... . .... • .. • ... , , , .. • , 24 Research and experimental costs (difference between regular tax and AMT) 24 25 Income from certain installment sales before January 1, 1987 25 26 Intangible drilling costs preference 26 27 Other adjustments, including income-based related adjustments 27 28 Alternative minimum taxable income. Combine lines 1 through 27. (If marred filing separately and line 28 is more than $219,900, see page 8 of the instructions. 28 1281603 Part II Alternative Minimum Tax (AMT) 29 Exemption. (If you were under age 24 at the end of 2010, see page 8 of the instructions.) IF your filing status is ... AND line 28 is not over ... THEN enter on line 29 ... Single or head of household $112,500 $47,450 Married filing jointly or qualifying widow(er) 150,000 72,450 Married filing separately 75,000 36,225 9 2,824 If line 28 is over the amount shown above for your filing status, see page 8 of the instructions. 30 Subtract line 29 from line 28. If more than zero, go to line 31. If zero or less, enter -0- here and on lines 33 and 35 and skip the rest of Part II. 30 105,779 ..................................................................... 31 • If you are filing Form 2555 or 2555-EZ, see page 9 of the instructions for the amount to enter. • If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Sc Wule D (Form 1040) (as refigured li 54 h f .............. 1 7 , 8 6 8 rom ne ere. for the AMT, if necessary), complete Part III on the back and enter the amount • All others: If line 30 is $175,000 or less ($87,500 or less if maned fling separately), multiply line 30 by 26% (.26). Otherwise, multiply line 30 by 28% (.28) and subtract $3,500 ($1,750 if marred fling separately) from the result. 32 Alternative minimum tax foreign tax credit (see page 9 of the instructions) 2 .... . . ..... . ....... . ... . ... 33 Tentative minimum tax. Subtract line 32 from line 31 33 27,868 ............................................................... 34 Tax from Forth 1040, line 44 (minus any tax from Form 4972 and any foreign tax credit from Form 1040, line 47). If you used Schedule J to figure your tax, the amount from line 44 of Form 1040 must be refigured without using Schedule J (see page 11 of the instructions) 4 7,011 ...... . .. ........................... 35 AMT. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Forth 1040, line 45 35 857 For Paperwork Reduction Act Notice, see your tax return instructions. Form 6251 (2010) DAA KOSTY 01/02/1011 12:03 PM Form 4562 Department of the Treasury Internal Revenue Service Depreciation and Amortization (Including Information on Listed Property) ? See separate instructions. ? Attach to your to 2010 chment uence No. 67 Name(s) shown on return I IderNl in number John S Kostukovich Business or activity to which this form relates Accounting Services Part I Election To Expense Certain Property Under Section 179 Note: If you have any listed property, complete Part V before you complete Part I. 1 Maximum amount (see instructions) 1 500,000 2 Total cost of section 179 property placed in service (see instructions) 2 3 Threshold cost of section 179 property before reduction in limitation (see instructions) ................... • . 3 2,000,000 .......................................... 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- 4 5 Dollar lirnitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If marred fill separately, see instructions .. • .... • .. 5 R (a) Description of property (b) Cost (business use ordy;l (c) Elected cost 7 Listed property. Enter the amount from line 29 ........ . ................................. 7 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 ........................ . . . .. . 8 _., 9 Tentative deduction. Enter the smaller of line 5 or line 8 .......... ., - ........................................... 9 10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562 ..................... • .. , ...... , .... , ...... 10 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 ........ ... .. 12 13 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12 ............. ? 13 Note: Do not use Part II or Part III below for listed property. Instead, use Part V. Part 11 Special Depreciation Allowance and Other Depreciation Do not include listed roe See instructions 14 Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions) 14 15 Property subject to section 168(fK1) election .................................................................. 15 Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2010 ................................n Ir 17 0 18 If you are electing to group any assets placed in service during the tax year into one or more general asset accounts check here ? I I t _ n w_-ter.. IN-- A t.. Q-11- n...rnn 911111in TAU Yanr llsina the General DeDreciation System (a) Classification of property (b) Month and year placed in service (c) Basis for depreciation (businessrnve0nent use only-see instructions (d) Recovery (e) Convention (f) Method (g) Depreciation deduction ert ear ro 19 3- y y p p a 5- ear erty ro y p p roperty 7- ear c y p roperty d 1 0- ear y p ear property e 15- y ear f 20- erty ro y p p 25-year property 25 yrs. S/L h Residential rental 27.5 yrs. MM S/L property 27.5 rs. MM S/L i Nonresidential real 39 MM S/L property MM S/L es..e.... e'-e...#. Plaead In Rarvir-R nurinn 2010 Tax Year usina the AlternaltlVe Uepreeiauon syszem 20a Class life S/L _ b 12-year 12 yrs. I S/L c 40-year 40 rs. MM S/L 21 Listed property. Enter amount from line 28 21 2,810 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations-see instructions 22 2,810 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs ....... ..... 2For Paperwork Reduction Act Notice, see separate instructions. Forth 4562 (2010) DAA KOSTY 01/0212011 12:03 PM John S Kostukovieh Paget Form 4562 (2010) Part V Listed Property (include automobiles, certain other vehicles, certain computers, and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns a throw h c of Section A all of Section B and Section C if applicable. Section A-Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles. ) 24a Do ou have evidence to sup the businessfinvestment use claimed? X Yes No 24b If -Yes," is the evidence written? X Yes No (a) (b) (c) (d) (e) M (9) (h) (1) Business) Basis for depreciation Recovery Method/ Depreciation Elected section 179 Type of property Date placed investment use Cost or other basis (business/investment period Convention deduction cod gist vehicles first) in service percentage use only) 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use (see instructions) 25 26 Yro useu more WWI J V 70 Hi a uanucu v See St atement 0/6 15,308 14,052 2,810 o? in a aualified business use: S/L- %I 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 .... . ........... . . . . . 28 2 , 810 29 Add amounts in column (i) line 26 Enter here and on line 7 page 1 ...... ............................................. 29 Section B-tnfomtation on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles _ s ___. __ +_ -1-C- +k;, ---inn fnr fhnm vPhiHaa :O y 30 our em io ees, rn51. BrrHWer UIC UQauvlaw In Vc vr, v w w Total businessfinvestment miles driven during ear (do not include commuting miles) the v .. .... .. ?..... .... (a) Vehicle 1 12,051 ?..-_ .._.. .- _-_ (b) Vehicle 2 -- ------ - (c) Vehicle 3 (d) Vehicle 4 (e) Vehicle 5 M Vehicle 6 31 .......... y Total commuting miles driven during the year 1,560 . , . 32 Total other personal (noncommuting) miles driven 4,285 ........................................... 33 Total miles driven during the year. Add lines 30 through 32 17 , 8 9 6 34 ....... , . Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No hours? durin off-dut X g y ............................. 35 Was the vehicle used primarily by a more than 5% owner or related person? X 36 Is another vehicle available fqr_ personal use? ........ X Section C-Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). 37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by Yes No your employees? ............................................................................................................ 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners ............................. 39 Do you treat all use of vehicles by employees as personal use? ................................................................... 40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? ......................................................................... 41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) X .............................. Note: H your answer to 37, 38, 39, 40, or 41 is "Yes," do not complete Section B for the covered vehicles. ran r\ nrnvnrcaarvn (b) (c) (d) Amortization (a) Date amortization Amortizable amount Code section period or Amortization for this year Description of costs begins percentage 42 Amortization of costs that begins during your 2010 tax year (see instructions): 43 Amortization of costs that began before your 2010 tax year 44 Total Add amounts in column (f). See the instructions for where to report .. 44 334 Form 4562 (2010) DAA KOSTY 0110712011 12:03 PM Form 8582 Department of the Treasury Intemal Revenue Service Name(s) shown on return Passive Activity Loss Limitations ? See separate instructions. Attach to Form 1040 or Form 1041. Identifying number OMB No. 1545-101 2010 Attachment John S Kostukovich r' Part 1 2010 Passive Activity Loss Caution: Complete Worksheets 1 2 and 3 on page 2 before completing Part I. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.) 1a Activities with net income (enter the amount from Worksheet 1, column (a)) 1a 978 .................................................................... b Activities with net loss (enter the amount from Worksheet 1, column (b)) 1b ........................................................................... c Prior years unallowed losses (enter the amount from Worksheet 1, column (c)) 1c 3 , 914 d Combine lines 1a, 1b, and 1c .................................................................................. 1d - 2 , 9 3 6 Commercial Revitalization Deductions From Rental Real Estate Activities 2a Commercial revitalization deductions from Worksheet 2, column (a) 2a b Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b) 2b r_ Add tinPC 2a and 2b 2C All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column (a)) .................................................................... 3a b Activities with net loss (enter the amount from Worksheet 3, column (b)) ............................................................:.............. 3b c Prior years unallowed losses (enter the amount from Worksheet 3, column (c)) 3c ......................................................... d Combine lines 3a, 3b, and 3c .................................................................................. 3d 4 Combine lines 1 d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete For 8582. Report the losses on the fors and schedules normally used 4 -2,936 ....................................... If line 4 is a loss and: • Line 1 d is a loss, go to Part II. • Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III. • Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts Wand III and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part III Instead go to line 15. Part It Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part II as positive amounts. See page 9 of the instructions for an example. 5 Enter the smaller of the loss on line 1d or the loss on line 4 ...... , , , , , , 5 2,936 6 Enter $150,000. If married filing separately, see page 9 6 75,000 7 Enter modified adjusted gross income, but not less than zero (see page 9) 7 137,278 Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract line 7 from line 6 L -8 9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see page 9 H10 10 Enter the smaller of line 5 or line 9 0 ............................................................. If line 2c is a loss go to Part III Otherwise go to line 15. Part Ill Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers in Part III as positive amounts. See the example for Part II on page 9 of the instructions. 11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11 12 12 Enter the loss from line 4 ................................................................. .................... 13 Reduce line 12 by the amount on line 10 13 ........................................................................ 14 Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13 . . . . . . . ................................ 14 Part N Total Losses Allowed 15 Add the income, if any, on lines 1a and 3a and enter the total ...................................................... 15 978 16 Total losses allowed from all passive activities for 2010. Add lines 10, 14, and 15. See page 11 of the instructions to find out how to report the losses on our tax return .............................................. 16 978 For Paperwork Reduction Act Notice, see page 13 of the instructions. Form 8582 (2010) DAA KOSTY 01/02/2011 12:03 PM John s Kostukovich Page 2 Form 8582 2010 Caution: The worksheets must be filed with our tax return. Kee a co for our records. Worksheet 1-For Form 8582, Lines 1a, 1b, and 1c See page 8 of the instructions. Current year Prior years overall gain or loss Name of activity (a) Net income (b) Net loss (c) Unallowed (d) Gain (e) Loss line 1a line 1b loss line 1c 3900 Trindle Road LLC 978 3,914 2,936 Total. Enter on Form 8582, lines 1a, 1b, I 3,9141 and 1c ? 978 Worksheet 2--For Form 8682, Lines 2a and 2b See a e 8 of the instructions. Name of activity (a) Current year (b) Prior year (c) Overall loss deductions (line 2a unallowed deductions (line 2b Total. Enter on Form 8582, lines 2a and 2b .............. ? _A - /L--- . .. Q .,f 4he inc+n?ctinnc 1 Wor"neeT N-rui rurni vain 1- n,w Current year Prior years Overall gain or loss Name of activity (a) Net income line 3a (b) Net loss line 3b (c) Unallowed loss line 3c (d) Gain (e) Loss Total. Enter on Form 8582, lines 3a, 3b, and 3c ? Worksheet 4-Use this worksheet if an amount is shown on Form 868 2 line 10 or 14 See page 9 of the instructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Special allowance (d) Subtract column (c) from column (a) Total ? 1.00 Worksheet 5-Allocation of Unaliowed Losses See a e 10 of the ins tructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Unallowed loss 3900 Trindle Road LLC Sch E2 2,936 1.0000 2,936 T..e, ? 2,936 1.00 2,936 - Form 5552 (2010) DAA KOSTY 01102/2011 12:03 PM John S Kostukovich Form 8582 (2010) Worksheet 6-Allowed Losses (Se Name of activity 3900 Trindle Road LLC Form or schedule and line number (a) Loss (b) Unallowed loss (c) Allowed loss to be reported on (see ins tructlons Sch E2 3,914 2,936 978 Of 3,9141 2,936 978 Total ......... snore 7-Activities With Losses Reported on Two or ore Forms or Schedules (See page 10 of the Instrucfions. Name of activity: (a) (b) (c) Ratio (d) Unallowed (e) Allowed loss loss Form or schedule and line number to be reported on (see instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule b Net income from form or schedule Pr c Subtract line 1b from line 1a. If zero or less, enter -0- Form or schedule and line number to be reported on (see Instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule ............ No. b Net income from form or schedule 1101 c Subtract line 1 b from line 1 a. If zero or less, enter -0- Form or schedule and line number to be reported on (see instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule ............ 110. b Net income from form or schedule 00. ................................ c Subtract line 1 b from line 1 a. If zero or less, enter -0- 10. ON. 1.00 Form 8582 (2010) DAA KOSTY 0110212011 12:03 PM AMT Version Q c82 Passive Activity Loss Limitations OMB No. 1545-1008 Forv:7 2010 111- See separate instructions. h T Attachment $$ N reasury e Department of t Internal Revenue Service (99) ? Attach to Form 1040 or Form 1041. o. Sequence Identifying number Name(s) shown on return John S Kostukovich =- `Part 1 2010 Passive Activity Loss Caution: Complete Worksheets 1 2 and 3 on page 2 before completing Part I. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.) 1a Activities with net income (enter the amount from Worksheet 1, 1a 1,005 column (a)) .................................................................... b Activities with net loss (enter the amount from Worksheet 1, column b 1b c Prior years unallowed losses (enter the amount from Worksheet 1, 1c 3, 685 .............................................. column (c)) .................. 1d -2.680 ....... d Combine lines 1a, 1b, and 1c ........................................................................... Commercial Revitalization Deductions From Rental Real Estate Activities 2a Commercial revitalization deductions from Worksheet 2, column (a) 2a b Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b) ........................................................ 2b 2c c Add lines 2a and 2b .......................................................................................... All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column (a)) 3a .................................................................... b Activities with net loss (enter the amount from Worksheet 3, column ........................................................................ 3b (b)) ... c Prior years unallowed losses (enter the amount from Worksheet 3, column (c)) 3c .................................................................. 3d d Combine lines 3a, 3b, and 3c .................................................................................. 4 Combine lines 1d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582. 4 6 8 0 - 2 Report the losses on the fors and schedules normally used , If line 4 is a loss and: • Line 1 d is a loss, go to Part II. • Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III. • Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part 111. Instead, o to line 15. ecial Allowance for Rental Real Estate Activities With Active Participation Part 11 S p Note: Enter all numbers in Part 11 as positive amounts. See page 9 of the instructions for an example. 5 Enter the smaller of the loss on line 1 d or the loss on line 4 .. . . . ............................................ 5 2 , 6 8 0 6 Enter $150,000. If married filing separately, see page 9 6 75,000 7 Enter modified adjusted gross income, but not less than zero (see page 9) 7 137,278 Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract line 7 from line 6 8 ........................................... ............ 9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see page 9 9 10 10 Enter the smaller of line 5 or line 9 - 0 If line 2c is a loss, o to Part III. Otherwise, to line 15. Part Ill Special Allowance for Commercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers in Part III as positive amounts. See the example for Part II on page 9 of the instructions. If married filing separately, see instructions on line 10 'rf an nt th d b 11 ... . y, e amou , y 11 Enter $25,000 reduce 4 12 12 Enter the loss from line li 10 13 ........................................................................ ne 13 Reduce line 12 by the amount on 14 Enter the smallest of line 2c treated as a positive amount), line 11, or line 13 ....................................... 14 Part N Total Losses Allowed 15 Add the income, if any, on lines 1a and 3a and enter the total 15 ........................................... 11005 16 Total losses allowed from all passive activities for 2010. Add lines 10, 14, and 15. See page 11 of the instructions to find out how to report the losses on your tax return .................... _. ..................... 16 1, 0 0 5 For Paperwork Reduction Act Notice, see page 13 of the instructions. Form 8582 (2010) DAA KOSTY 01/0212011 12:03 PM AMT Version John S Kostukovich Form 8582(2010) Page 2 Caution: The worksheets must be filed with your tax return. Keep a copy for your records. 1-F F 8582 Lines 12 1b and 1c See a e 8 of the instructions. Worksheet or orm , I Current year Prior years Overall gain or loss Name of activity (a) Net income line 1a (b) Net loss line 1b (c) Unallowed loss line 1c (d) Gain (e) Loss 3900 Trindle Road LLC 1,005 3,685 2,680 Total. Enter on Form 8582, lines la, 1b, .................. . and 1c ........... ? 1, 005 31685 1 Worksheet 2--For Form 8582, Lines 2a and 2b See a e 8 of the instructions. Name of activity (a) Current year deductions (line 2a) (b) Prior year unallowed deductions line 2b (c) Overall loss Total. Enter on Form 8582, lines 2a and 2b ................... ? -_ e..? 0. oGO9 1 inn 4t %h 2nri *4r (.pp- nano 8 of the instructions.) tWVrr.*11WG1 --- - - Current year Prior years Overall gain or loss Name of activity (a) Net income line 3a (b) Net loss line 3b (c) Unallowed loss line 3c (d) Gain (e) Loss Total. Enter on Form 8582, lines 3a, 3b, and 3c ? Worksheet 4-Use this worksheet if an amount is shown on Form 858 2 line 10 or 14 See page 9 of the instructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Special allowance (d) Subtract column (c) from column (a) Total ? 1.00 Worksheet "llocation of Unallowed Losses See Pag e 10 of the ins tructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Unallowed loss 3900 Trindle Road LLC Sch E2 2,680 1.0000 2,680 Total ? 2,680 1.00 2,680 Form 8582 (2010) DAA KOSTY 01102/2011 12:03 PM AMT Version John S Kostukovich Page 3 Form 8582 2010 ic?__ .. .. 4A ..?+ho inc+n?rtinnc worksheet ti wuowea wssOS is) I-, e G v vi a Sri Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Unallowed loss (c) Allowed loss 3900 Trindle Road LLC Sch E2 3,685 2,680 1,005 T??r ? 3,685 2,680 1,005 Worksheet 7-Activities With Losses Reported on Two or More Forms or Schedules (See page 1U of the instructions.) Name of activity: (a) (b) (c) Ratio (d) Unallowed loss (e) Allowed loss Form or schedule and line number to be reported on (see instructions): is Net loss plus prior year unallowed loss from form or schedule ? b Net income from form or l schedu e c Subtract line 1b from line 1a. If zero or less, enter 0 ? Form or schedule and line number to be reported on (see Instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule ? b Net income from form or l ? h d u e sc e c Subtract line 1b from line 1a. If zero or less, enter-0- ? Form or schedule and line number to be reported on (see instructions): ................ 1a Net loss plus prior year unallowed loss from forth or schedule ? ................ b Net income from forth or dule ? h sc e c Subtract line 1b from line 1a. If zero or less, enter -0 - .............. ? TMA 1.00 Form 85582 (2010) DAA SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, LLP, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Petition on the following on the date and in the manner indicated below: VIA U.S. MAIL, FIRST CLASS, PRE-PAID Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 P Dated: f - i By: JAMES, SMITH, DIETTERICK & CONNELLY, LLP o J onn y, Jr. orn 15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 0 Attorneys for Defendant F?LCp- OFFICE OF THE Pp.0T1f0130T11P-Y 61011 JAN 5 Gumva Cc SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner !A n n Intl rigo IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION - LAW IN DIVORCE RULE TO SHOW CAUSE s t? AND NOW, this -rday of L/?1w .' 4' , 2011, upon consideration of the foregoing Petition, it is hereby ORDERED that: (1) A Rule is issued upon the Plaintiff, Suellyn G. Kostukovich, to show cause why the Defendant, John S. Kostukovich, is not entitled to the relief requested; (2) The Plaintiff, Suellyn G. Kostukovich, shall file an Answer to Petition within ?d days of this date; .5W"15 16201i 1 twor By the Court, J. Distribution: ?Barbara Sumple-Sullivan, Esquire, 549 Bridge Street, New Cumberland, PA 17070-1931 oa W ?John J. Connelly, Jr., Esquire, P.O. Box 650, Hershey, PA 17033 00pos in Pe jt?/11 D?s SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, CIVIL ACTION - LAW 3 Defendant : IN DIVORCE = ° - rn r rri o AFFIDAVIT OF CONSENT -: o a U o c7 .. ,ern 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code,Vas edn January 11, 2010. 2. The marriage of the Plaintiff and Defendant is irretrievably broken, and ninety days have elapsed from the date of both the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of Notice of Intention to request entry of the Decree. I verify that the statements made above are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904, relating to unworn falsification to authorities. Date: January 13, 2011 J Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 717)774-1445 SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant FILED-OFFICE OF THE PROTHONOTARY ZOt1 "' " . 3' J' , fJy IN THE FO-URTIOW S CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION -LAW AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on January 11, 2010. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: I I ' SUELL G. KO OVICH John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant/Petitioner SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner _F!LED -0I=F ICE- IHII JAN 19 PM 3. 03 P- EN14SYLVAIN Ii', IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO WITHDRAW DEFENDANT'S PETITION TO MODIFY SUPPORT AGREEMENT DATED MAY 24 2010 TO THE PROTHONOTARY: Please withdraw the Petition to Modify Support Agreement dated May 24, 2010, filed by Defendant/Petitioner, John S. Kostukovich, on January 3, 2011, in the above-captioned action. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: - g - P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 By: Jo onn N y, Jr. (:?a' 6K& A e LD 1561 S Attorneys for Defendant/Petitioner John S. Kostukovich SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Praecipe to Withdraw Petition to Modify Support Agreement dated May 24, 2010 on the following on the date and in the manner indicated below: VIA U.S. MAIL. FIRST CLASS. PRE-PAID Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 Dated: H ?-I I JAMES, SMITH, DIETTERICK & CONNELLY, LLP B Y• J nn y, Jr. o e 15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant/Petitioner SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner TI(Ic "1" 19 PH 3: t? IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO WITHDRAW DEFENDANT'S PETITION FOR SPECIAL RELIEF TO THE PROTHONOTARY: Please withdraw the Petition for Special Relief, filed by Defendant/Petitioner, John S. Kostukovich, on November 23, 2010, in the above-captioned action. Respectfully submitted, Dated: (-19-(( By: JAMES, SMITH, DIETTERICK & CONNELLY, LLP ard\elly, Jr. I.D 1561 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner John S. Kostukovich SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Praecipe to Withdraw Petition for Special Relief on the following on the date and in the manner indicated below: VIA U.S. MAIL, FIRST CLASS, PRE-PAID Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 Dated: 12-1 ? By: JAMES, SMITH, DIETTERICK & CONNELLY, LLP J hn onne , Jr. tto I.D 5615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 1 John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant/Petitioner SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner 1 t r- r. C1 9f#s3 Cat I ,f; .,. 19 PH ,?. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 10-293 CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO WITHDRAW DEFENDANT'S PETITION TO MODIFY SUPPORT AGREEMENT DATED MAY 24.2010 TO THE PROTHONOTARY: Please withdraw the Petition to Modify Support Agreement dated May 24, 2010, filed by Defendant/Petitioner, John S. Kostukovich, on October 15, 2010, in the above-captioned action. Respectfully submitted., JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: I - I By: _a Z4 J rut y, Jr. A e D 15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant/Petitioner John S. Kostukovich SUELLYN G. KOSTUKOVICH, Plaintiff/Respondent V. JOHN S. KOSTUKOVICH, Defendant/Petitioner IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Praecipe to Withdraw Petition to Modify Support Agreement dated May 24, 2010 on the following on the date and in the manner indicated below: VIA U.S. MAIL. FIRST CLASS. PRE-PAID Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 Dated: l g -(? By: r JP.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 JAMES, SMITH, DIETTERICK & CONNELLY, LLP . C nn ly, Jr. e 1561.5 John J. Connelly, Jr., Esquire Attorney I.D. No. 15615 James Smith Dietterick & Connelly, LLP P.O. Box 650 Hershey, PA 17033 Attorneys for Defendant SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant -0 Ffrt IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE DEFENDANT'S PRE-TRIAL STATEMENT Date of Marriage: July 26, 1986 Date of Separation: July 12, 2009 Divorce Complaint filing date: January 11, 2010 1. ASSETS A. Marital Property 1. Marital Residence: 11 Montego Court, Dillsburg, Pennsylvania This property is currently listed for sale at a listing price of $499,900.00. There is a mortgage with First National Bank with an approximate balance as of January 24, 2011 of $290,000.00. 2. Commercial Building: 3900 Trindle Road, Mechanicsburg, Pennsylvania with a fair market value of $460,000.00 and an approximate mortgage balance of $460,000.00 with First National Bank. 3. Bahamas Timeshare with an approximate value of $20,000.00. 4. Bluegreen Timeshare is a liability with a zero value. 5. 2006 Ford Expedition. Vehicle is in Husband's possession with an estimated value as of date of separation of $18,000.00 and had a loan balance of $21,600.00 for a negative equity of $3,600.00. 6. 2006 Mercedes SLK350. Vehicle is in Husband's possession with an estimated value as of date of separation of $25,000.00 and had a loan balance of $19,000.00 for equity of $6,000.00. 7. Mazda 3 in Wife's possession. The title to the vehicle was transferred to Wife with a value of approximately $15,200.00. 8. 2008 Lexus IS250 in Wife's possession. The Lexus was in an accident for a total loss. After payoff of the loan, Wife received a net value of $15,666.69. 9. Bank Account - Each party received $25,000.00 from a joint bank account on July 14, 2009. B. Non-marital Property of Husband 1. 2005 VX 100 Jet Ski with an estimated value of $4,260.00. 2. 1997 GP 1200 Jet Ski with an estimated value of $1,475.00. Husband paid $1,000.00 since the parties' date of separation on repairs to the above referenced jet skis. 3. 1995 Triton 2 bay Jet Ski Trailer - value to be determined. 4. John S. Kostukovich, CPA office contents - appraised value of $5,480.00. C. Non-marital Property of Wife Unknown. 2. EXPERT WITNESSES Husband knows of no expert witnesses at this time except for appraisers/real and personal property. However, Husband reserves the right to supplement this answer should such become available or necessary. In particular, in the event the parties are unable to reach an agreement with respect to the value of the marital residence and office building, Husband reserves the right to call upon a real estate appraiser. 3. NON-EXPERT WITNESSES With the exception of the parties, Husband knows of no non-expert witnesses at this time. However, Husband reserves the right to supplement this answer should such become available and necessary. 4. EXHIBITS To be set forth prior to hearing. 5. NET INCOME A. Plaintiff/Wife - to be determined. B. Defendant/Husband - See Husband's 2010 Income Tax Return attached hereto as Exhibit "A". 6. EXPENSES See Husband's expenses attached hereto as Exhibit "B". 7. PENSIONS/RETIREMENT A. PlaintifVWife - It is believed that Wife has a SIMPLE IRA with an approximate value of $106,000.00 as of December 31, 2010. B. Defendant/Husband - Husband has a SIMPLE IRA with an approximate value of $112,000.00 as of December 31, 2010. 8. COUNSEL FEES Defendant/Husband has not raised a claim for counsel fees. Plaintiff/Wife raised a claim for counsel fees in the filing of the Divorce Complaint. 9. PERSONAL PROPERTY DISPUTE There are personal property items in the marital residence which are currently in dispute with a value to be determined. 10. DEBTS Marital Residence - First National Bank - balance as of January 24, 2011 - $290,000.00 11. PROPOSED RESOLUTION Husband proposes a 55/45 split of all marital assets. No award of alimony is appropriate as Wife is cohabitating with her boyfriend. 12. ESTIMATED LENGTH OF TRIAL One day. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated By: ,Tohn o elly, Jr. rn #15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant, John S. Kostukovich VERIFICATION I, John S. Kostukovich, verify that the statements made in the foregoing pleading 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. Date: S. Kostukovich ?XN??' -? KOSTY 01ft1=w 1 12:03 PM E Department of the Treasury-Internal Revenue service wo 1040 U.S. individual income Tax Return L P For the year Jan. 1-0m. 31, 2010, or other tax year iming Name, R Your first name and Initial fast name Address, N John S Kostukovich and SS N I T If a 0118anh, sr...s ad ream aq WN Last name C See separate L instnXtions E A R L Y Election .Campaign ? 1 Filing Status 2 Check only one 3 6a ExempfiOnS b If more than four dependents, see instructions a check here ? IRS Use 20 Horne address (muniber and street). If you have a P.O. box, sae instrucdions. Apt no. 3900 Trindle Road City, town or post office, state. and ZIP code. If you have a foreign address, see instnxtions. Camp Hill PA 17011 Check here if you, or your spouse if filing jcintiy, want $3 to go to this fund ................... ? mite or Your socivi security number spouse's social securitir nrmh6er - - Make sure the SSN(s) above and on line 6c are correct. Checking a box below will not refund. change your tax Sohhs ?'"? You Sirge 4 Zwqualalyin rroug senoia twit guar person). See the person rs a cMd not your ' Married SW jointly (even if only one had income) child's name here. 110- Married fling separately. Enter spouse's SSN above 5 Quaifying widow(er) with dependent cold and fill name hen:. ? Snell Kosttlkovich, Yourseif. If someone can claim you as a dependent, do not check box 6a .1 spouse .................................... [ (2) Dependent's I (3) Dependents Frst name Last name I ? securty number relaffiDnft to you c Dependents: enter BOM on 6B die?Ob 1 ND. of Idren ? tl 01160 c • lived with you • T • did not Iva with you due tD divorce orsepavilon heeeons) Dapaularb on 6c NA ateredd ati e d Total number of exemptions daimed ... . .................................. . linellwa ens on 1 7 wages, salaries, tip's, etc. Attach Form(s) w-2 ........... .. .............. 7 ncome 8a Taxable Interest Attach Schedule B if required ............ Attach Form(s) W-2 here. Also attach Famine b 9a Tax-exempt interest. Do not Include on line 8a Ordinary dividends. Attach Schedule B if required .............. 8b ... . ......... ' ............ VW-2G and 1009-11 if tax b 10 Qualified dividends ........... Taxable refunds, credits, or offsets of state and local income taxes gb .. ................................ 10 2 7 was wfthhekL 11 Alimony received ......................... . ....... .. . .. . . . . . 11 If you did not 12 Business income or Qoss). Attach Schedule C or C-EZ .......... ... ................ ............ 12 163 , 223 get a W-2, 13 Caplal gain or (loss). AVWh Sdredule D If mclulmd, If not recliked, died here ? see page 22. 14 Other gains or (losses). Attach Form 4797 . 14 15a IRA distributions ............. 15a b Taxable amount 15b E 16a Pensions and annuities 16a b Taxable amount 161b nclose, but do not attach any 17 Rental real estate, royalties, partnerships, S corporations, trusts, eta Attach Schedule E ............ 17 0 , payment. Also, 18 Farm income or (loss). Attach Schedule F 1l3 please use 19 Unemployment compensation 19 Form 1040-V. 20a Social seaaity berieflts ?20a 1 b Taxable amount 21 Other income. List type and amount 21 22 23 Combine the amounts in the far ht column for lines 7 ffirroMugh 21. Thi Educator expenses. CAUTION: See instructions s Is 23 ur total Income ? 22 163,252 Adjusted Gross 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 21064EZ 24 Income 25 Health savings account deduction. Attach Form 8889 ............ .. 25 26 Moving expenses. Attach Form 3903 26 27 One-half of self-employment tax. Attach Schedule SE ............ . 27 81808 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 Recipients SSN ? 313 25,974 32 IRA deduction ..................... 32 33 Student loan interest deduction .. ....................... . 33 34 Tuition and fees. CAUTION: See instructions 34 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lanes 23 through 31a and 32 through 35 .......... ' ... ...... .......... . . .. . . . . . . . 36 34,782 37 Subtract: line 36 from line 22. This is r you J"4 gross income • ? omr? Pdwdcy Act, and Paperwork Reduction Act NDft see separate hnstruc0one • .... • • ............. • . . . .. 10. . 37 128,470 Form 1 (2010) KOSTY 01!02!2011 1203 PM Form 1040 (201ol John 3 Kostukovich D.- Tax and 38 Amount from line 37 (adjusted gross income) . . . . . . . . ... ...... . . . . . . .. . .. . . . . . . . . , ........ .... 38 128,470 Credits 39a b 40 Check You were born before January 2, 1946, Blind. Total boxes if Spouse was born before January 2, 1946, ? Bind. J checked.* 39a If your spouse itemizes on a separate return or you were a clual-stalus alien, ah" here ? 39b ........... Itemized deductions (from Schedule A) or your standard deduction see Instructions ( ) ........ ..? 0' . 9,304 41 Subtract fine 40 from line 38 ...... . ........................................... ........... .. 41 119,166 42 Exemptions. Multiply $3,650 by the number on line 6d ..................................... .. 42 3 , 650 43 . Tamble hroDrm Subtraet tie 42 imm ire 41. It irie 42 is more gran ire 41, erw -0 .. . 43 115,516 44 Tax (see krr.. Check 9 any tax is fmrn: a [] Farm(} 8814 b [] F o. 4972 . . ... . .. . ..................... .... 44. 27,011 45 Alternative minimum-tax (see instructions). Attach Form 6251 ........................... .. 45 857 46 . . Add lines 44 and 45 .. „ - „ . , .......................................... .............. .... ? 46 27,868 47 48 49 50 51 52 53 54 Foreign tax credit Attach Form 1116 if required 47 Credit for child and dependent care expenses. Attach Form 2441 48 Education credits from Form 8863, line 23 49 ........................ Retirement savings contributions credit Attach Form 8880 50 Child tax credit (see instructions) 51 Residential energy credits. Attach Form 5695 52 Otter credits from Form: a ? 3800 b ? 8801 c ? 53 Add lines 47 through 53. These are your total credits 4 55 Subtract fine 54 from line 46. If One 54 is more than line 46, enter -0 ............ .. .. 55 V7,868 Other 56 Sel an*p rent tax. Attach Schedule SE ........ .. ........ ... ... .... .... 56 17,615 Taxes 57 Unreported social security and Medicare tax from Form: a ? 4137 b IT 8919 ..... _ _ _ ... 57 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 9 required 58 59 a ? Form(s) W-2, box 9 b ? Schedule H c ? Form 5405, line 16 59 60 Add tines 55 th tr59. This is blal tat ? tip 45 , 4 83 61 Federal income tax withheld from Forms W-2 and 1099 61 Payments 62 2010 estimated tax payments and amount applied from 2009 return .... 62 2 5 , 8 0 0 < - 63 Making work pay credit Attach Schedule M ....................... 63 If you have a R a Earned income cr 0 (EEC) 64a quvjfAv chid. attach Schedule EIC. b 65 Nontaxable combat pay election .. 64b Additional child tax credit. Attach Form 8812 65 66 American opportunity credit from Form 8863, line 14 66 67 First-time homebuyer credit from Form 5405, line 10 67 68 Amount paid with request for extension to file ..................... 68 69 Excess social security and tier 1 RRTA tax withheld ............... 69 70 Credit for federal tax on fuels. Attach Form 4136 70 71 Credits from Form: a ? 2439 b ? WW c ? 8801 d ? 8885 71 72 Add foes 61, 6Z a 644 and 65 dvmo 71. Them am your total payments ... . .. . . ...... . . . ........ ? 72 2 5 , 8 0 0 Refund 73 If line 72 Is more than line 60, subtract line 60 from line 72. This Is the amount you overpaid 73 74a Amount of line 73 you want refunded to ou. If Form 8888 Is attached, check here ? ? 74a Direct deposit' See trsheutlons. ? b ? d 75 Routing number ? c T : Checking ? savings Account number Amount of line 73 you want [led to yotr 2011 estirnated tack ? 75 Amount 76 Subtract line 72 from line 60. For details on how to pay, see instructions _ ...... .................. ? 76 19,858 . w vVVe rl csmuaieu (OA penany tree uisuucoonsl 77 175 Third Patty CO you want to allow another person to discuss this return with the IRS see insiructions)? LA Yes. Complete Wow. No Designee Designee's Personal id&Ocation number (PIN) ? 15646 name ? John S Kostukovieh Phone no. ? 717-730-0820 Si rl Under penalties; of pwy I dedme that I have r?carnined this Tetuan and acmmp "Aug schedules and std. and tD the best of my and belief, g they are true, corned, and complete Dedaratbn of peparer (other than Is based on an timmafion of which preparar has any Here Your signature Date Your occupation Deydme phone number rpt See page 15. Accountant 1 fi3r a copy Spouse's signatum. if a joint return, both must sign. Date Spouses occupation your Print/Type preparer's name Paid John a Rost Preparer Fumy mare ? Use Only Funs address ? Rp. ers,.signahrs John S. Kostukovich, CPA 3900 Trindle Rd Camp Sill $ Date cheek P nN 01/02/11 s "Micyea P00098505 Phone no. PA 17011-6912 717-730-0820 Form 1040 (2010) DAA KOS3Y 01M212011 1203 PM SCHEDULE A Itemized Deductions OMB N0.1545-W74 (Form 1040) 2010 ? Attach to Form 1040. ? See ha;tnxxiwns for Schedule A (Form 1040). m. 07 Name(s) sriovm on Form 1040 Your social secur ity nu John s Kostukovich Medical Caufion. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see page A-1) i Dental 2 Enter arrant from Form 1040, lne 38 2 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 You 5 State and local income taxes 5 8,692 Paid 6 Real estate taxes (see page A-3) ................................ 6 (See 7 New motor vehicle taxes from line 11 of the worksheet on page A-2.) back (for certain vehicles purchased in 2009) ..................... 7 8 Other taxes. List type and amount ? ...................... See Statement 1 . . . . . . . $ 70 9 Add tines 5 through 8 g 8,762 Interest 10 Home mortgage interest and points reported to you on Form 1098 10 427 You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid iD the (See person from whom you bought the home, see page A-4 and show that page A-4.) person's name, identifying no., and address ? Norte .................................................... Your mortgage i .............................................................. . .......... . .................................... . 17 nterest deduction may . .. .... 12 Points o reported to you on Form 1098. See page A-4 for be limited (see ? sP a' 12 page A-4). 13 Mortgage Insurance premiums (see page A-4) ............. . 13 . ... 14 Investment interest. Attach Form 4952 If required. (See page A-5-) .................................................... 14 15 Add lines 10 through 14 ........................................... ..... . .................... . 15 427 Gifts to 16 G'fits by cash or check. If you made any gift of $250 or more, Charity see page A$. ... ............................... 16 115 If you made a 17 Other than by cash or check. If any gift of $250 or more, see gift and got a page A$. You must attach Forth 8283 9 over $500 17 benefit for it, ............... 18 Carryover from prior year i6 see page A-6. ....................................... 19 Add lines 16 through 18 ............................................................. ......... 19 115 Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See page A-7.) ........ ................... ......... 20 Job Expenses 21 Unrelinbutsed employee expenses--job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-EZ If required. See page A-7.) ? Miscellaneous ................. . Ded ti ................................................... . .......... uc ons 22 Tax preparation fees ........................................... 22 (See 23 Other expenses-investment, safe deposit box, etc. List type page A-7.) and amount ? ............................................... .............................................................. 23 24 Add lines 21 through 23 24 25 Enter amount from Form 1040, fine 38 25 26 Multiply rim 25 by 2°k (.02) ..................................... 26 27 Subtract lure 26 from line 24. If line 26 is more fhan line 24, enter -8 27 Other Miscellaneous 28 Other-from list on page A-8. List type and amount ? ........ ................... ........ . Deductions .................................................... Total 29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount Itemized on Form 1040, fine 40 ............................................ ................... ......... 29 9,304 Deductions 30 If you elect to itemize deductions even though they are less than your standard deduction, check here - ......... ? For Paperwork Reduction Act Notice, see Form 1040 instructions. Sche dule A !Form 10401201 n DAA KOSTY 01/02IM11 12:13 PM SCHEDULE C Profit or Loss From Business OMB No. 1545-0074 (Form 1040) (Sole Proprietorship) AO O ? Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-6. L Afta&jwnt to Reve°tnue 3ervios 99) 10, Attach to Form 1040, 104ONR, or 1041. 0' See instructions for Schedule C (Form 1040). Sequerim No. 09 Name of proprietor social security number (SSN) John S Kostukovich A principal business or profession, including product or service (see page C-2 of the instructions B Enter code from.pep@s 10, 11 Accounting Services `? 541211 C Business name. If no separate business name, leave blank. D Employer ID number (EN), N any John S Kostukovich, CPA E Business address (including suite or room no.) ? 3900 Trindle Road .................................... ................................................ City, town or post office, state, and ZIP code Hill PA 17011 F Accounting method: (1) Cash (2) Accrual (3) Other (specify) ? G Did you "materially participate" in the operation of this business during 2010? ff "No; see page C-3 for limit on losses Yes No H ff you started or acquired this business during 2010, check here ..................................................................... ? Income 1 Gross receipts or sales. Caution. See page C-4 and check the box if • This income was reported to you on Form W-2 and the 'Statutory employee" box on that form was checked, or • You are a member of a qualified joint venture reporting only rental real estate .. • ..... • . • . • .. ? 1 481,347 income not subject to self-employment tax. Also see page C-3 for limit on losses. 2 Returns and allowances ............................................ ......................................... 2 220 3 Subtract line 2 from line 1 ..................................................................................... 3 481,127 4 Cost of goods sold (from line 42 on page 2) ................................. 4 . 5 Gross profit Subtract line 4from line 3 ........................................................................ 5 481,127 6 O#w irxorne, inducing federal and stale gas*ie or fuel tar credit or refund (see page C41) ................................... 6 . 7 Gross Income. Add lines 5 and 6 . . .. . .................................................................... ? 7 481,127 Pan V Expenses. Enter a enses for business use o f our home on on line 30. 8 Advertising 8 3 , 7 8 6 18 Office expense ........................ 18 17 , 7 84 9 Car and truck expenses (see 19 Pension and praft-sharing plans 19 1,043 page C-4) ................. 9 6 , 02 6 20 Rent or lease (see page C-6): 10 Commissions and fees 10 a Vehicles, machinery, and equipment 20a 840 11 Contract labor (see page C-4) .... 11 3,169 b Other business property 20b 28,800 12 Depletion 12 21 Repairs and maintenance 21 2,996 13 Depreciation and section 179 22 Supplies (not included in Part 111) 22 2,620 expense deduction (not 23 Taxes and licenses 23 16,221 included in Part III) (see page 24 Travel, meals, and entertainment: C-5) ........................... 13 2,810 a Travel ..................... 24a 3,927 14 Employee benefit programs .......... b Deducflole meals and (other than on tine 19) .. _ ...... . 14 14 , 3 2 9 entertainment (see page C-6) 24b 2 , 522 15 Insurance (other than health) 15 6,697 25 Utilities 25 7,453 16 Interest: 26 Wages (less employment credits) 26 179 , 428 a Mortgage (paid to banks, etc.) 16a 27 tither expenses (from line 48 on b Other ....................... 16b 250 page 2) ................. 27 43 221 ... 17 Legal and professional ............ , services . ....................... 17 614 28 Total expenses before expenses for business use of home. Add lines 8 through 27 ....... ? 28 344,536 ...................... 29 Tentative profit or (kiss). Subtract line 28 from line 7 29 136,591 ...................... .......... : .... ..................... 30 Expenses for business use of your home. Attach Form 6829 30 ......................... ............................ 31 Net profit or (loss). Subtract line 30 from line 29. • If a profit, enter on both Form 1040, One 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (If you checked the box on line 1, see page C-7). Estates and trusts, enter on Form 1041, fine 3. 31 136,591 • If a loss, you must go to line 32. J 32 If you have a loss, check the box that describes your investment in this activity (see page G7). • If you checked 32a, enter the loss on both Form 1040, One 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see the lira 31 instructions on page C-7). 32a 8 At immestmerft is at fc. Estates and trusts, enter on Form 1041 line 3 , . 32b Sours investment is not • If you checked 32b, you must attach Form 6198. Your loss may be limited. at risk For Paperwork Reduction Act Notice, see your tau return instructions. Schedule C (Form 1040) 2010 DAA KOM 01!0212011 12.03 PM John S Kostukovich Schedule C (Form 1040) 2010 Accounting Services Page 2 Pasta N( Cost of Goods Sold (see page C-8) 33 Method(s) used to value, dosing inventory: a ® Cost b ? Lower of cost or market c ? Other (attach explanation) 34 Was tore any change in determining quantities, costs, or valuations between opening and dosing inventory? If 'Yes,' attach explanation ? Yes ® No ................. ............. ................... ............................................ 35 Inventory at beginning of year. If different from last year's dosing inventory, attach explanation 36 Purchases less cost of items withdrawn for personal use 36 .......................................................... 37 Cost of labor. Do not include any amounts paid to yourself 37 ............................................. 38 Materials and supplies 38 9 39 Other costs 39 40 Add lines 35 through 39 40 41 Inventory at and of year 41 h 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ........................ 1 42 1 s; fallt: . Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 on page C-5 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) ? ............................. 44 Of the total number of miles you drove your vehicle during 2010, enter the number of miles you used your vehicle for: a Business ...... b Commuting (see Instructions) c Other 45 Was your vehicle available for personal use during off-duty hours? Yes No ..................................................... 46 Do you (or your spouse) have another vehicle available for personal use? 1 Yes No ....................................... 47a Do you have evidence to support your deduction? Yes No ......................................... b If "Yes' Is the evidence written? ................... Yes No jt r * : Other Expenses. List below business nses not included on lines 8-26 or line 30. Bank charges 896 ................................................................................................ Client Gifts 2,038 Continuing Education .............................................................. ........... 1•495 . Copier Costs .-• ....... ............ .... . 3,065 .... . .......................... . ........ ........... Per retura/e-filing fees . ....................... 5•333 Telephone ........................................................................................:. . . . . 6,149 .... . . . Licenses Fees Permits 565 Mileage Reimbursements ..................... ........................ ............ 1,107 ... ................. . Miscellaneous . ... ............ 1,073 ............. . Computer Services/Software 11,445 Trash Removes]. . 796 ........................................ Dues & Subscriptions.. ........ 468 . ........................ ................ Cleaning ................. ..................................................... . 3,100 ......... ................ Landscaping ........................................................... .................... .... 3 , 614 . ....... ....... Peat Control ...................................................... .......... .... 901 ... ............ .................................. Secur.................. ...... . 842 .... . ............................................. Amortization 334 48 Total other expenses. Enter hers and on page 1, line 27 ............................. ..................... AM 43,221 EM Schedule C (Form 1040) 2010 KOSTY 01102=11 1203 PM ~ SCHEDULE C Profit or Loss From Business OMB No. 1545-0074 (Form 1040) (Sole Proprietorship) 2010 ? Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. Department of the Tn?eaary Int.MW Revenue Serve (99) ? Attach to Form 1040, 104ONR, or 1041. ? See Instructions for Schedule C orm 1040). Attachmern Sequence No. 09 Name of proprietor Social security number (SSN) John S Rostukovich A Principal business or profession, including product or service (see page G2 of the instructions B Brier code from papas G9, 1Q 611 Financial Services ? 52 3900 C Business name. If no separate business name, leave blank D Employer 11) number (MNJ If any E Business address (including suite or room no.) ? 3900 Trindle Road .......................................................... City, town or post office, state, and ZIP code Camp Hill PA 1701 ............. 1 ........................ F Accounting method: (1) Cash (2) Accxual (3) other (specify) ? .......................... G Did you "materially participate' in fhe operation of this business during 20107 If "No; see page C-3 for limit on losses .... .......... Yes No H If )2u started or acquired this business during 2010, check here .......................................... ? Pa-71.77. _ income 1 Gross receipts or sales. Caution. See page C-4 and check the box If: • This income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, or • You are a member of a qualified joint venture reporting only rental real estate .. • • • • • . • • • • • • • ? F 1 29,394. income not subject to self-employment tax. Also see page C-3 for Limit on losses. 2 Returns and allowances 2 3 Subtract line 2 from line 1 3. 29,394 4 Cost of goods sold (from line 42 on page 2) 4 5 Gross profit Subtract fine 4 from line 3 .......... ............ . ............. .... .................. . 5 29,394 ....... 6 Other arcome, indu ft federal and state gasoline or fuel tax credit or refund (see page G4) ...... 6 7 Gross Income. Add lines 5 and 6 ..... • ............ • . , , ,.. . . . . . . . . .. .. .................. ............... .. 10- 7 29,394 Part>11`<? . Enter a enses for business use o f your home on on line 30. 8 Advertising 8 18 Office expense ... , .. , , 18 9 Car and track expenses (see 19 Pension and profit-sharing plans 19 page C-4) 9 20 Rent or Lease (see page C-6): 10 Commissions and fees 10 a Vehicles, machinery, and equipment 20a 11 Contract labor (see page C-4) .. 11 b Other business property 20b 12 Depletion .. .. 12 21 Repairs and maintenance 21 .. ................. 13 Depreciation and section 179 ........ 22 Supplies (not included in Part III) ...... 22 expense deduction (not 23 Taxes and licenses .............. ...... 23 included in Part Ill) (see page 24 Travel, meals, and entertainment: Cam) .................. . . 13 a Travel ......................... ...... 24a . . ..... 14 Employee benefit programs b Deductible meals and (other than on One 19) ......... 14 entertainment (see page C-6) 24b .. 15 Insurance (other than health) 15 2,762 25 Utilities 25 16 Interest ...................... 26 Wages (less employment credits) ...... 26 a Mortgage (paid to banks, etc.) 16a 27 Other expenses (from line 48 on b Other ..................... 16b page 2) ........................ ...... 27 ..... 17 Legal and professional services ........................ 17 28 Total expenses before expenses for business use of home. Add lines 8 through 27 ? 28 2,762 29 Tentative profit or (loss)- Subtract line 28 from line 7 29 26,632 30 Expenses for business use of your home. Attach Form 8829 ............. .................................. 30 ...... 31 Net profit or (loss). Subtract One 30 from fine 29. • If a profit, enter on both Form 1040, line 12, and Sc hedrile SE, fine 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see page C-7). Estates and trusts, enter on Form 1041, lure 3. 31 26,632 • if a loss, you must go to fine 32. 32 ff you have a loss, check the box that describes your investment in this activity (see page C-7). • If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, 8ne 13 (if you checked the box on line 1, see the fine 31 instructions on page C-7). 32a AU kwestment is at risk. Estates and trusts, enter on Form 1041, lire 3. 32b Some invesurrert is not 8 • If you checked 32b, you must attach Form 6198. Your loss may be limited. at risk. For Paperwork Reduction Act Notice, see your tax return instructions. Schedule C (Form 1040) 2010 DAA KOSTY 91!02!2011 12:03 PM Schedule E Form 1040 2010 AttachmentSequence No. 13 Name(s) shown on ream. Do not end name and social sewity number N shown on other side. I Your social security number Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1. Income or LOSS From Partnerships and S CorporatiORS Note. If you report a loss from an at-risk activity for which any amourrt is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See page E-t. 27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Fort 8582), or unreimbursed ? Yes Q No DarirtershiD expenses? If you answered 'Yes.' see Daae E-7 befiore comoletino this section. 28 (a) Name (b) biter Ptr pails ershipl 3 (c) Check if foreign (d) Employer ide tifm? (e) Check ti anum rim Is A 3900 Trindle Road LLC P B C D Passive Income and Loss N ive Income and Loss (f) Passive foss alowed (attach Form 8582 If required) (g) Passive income from Schedule K-1 (h) Nonpassive loss from Schedule K-1 0) Section 179 expense deduction from Form 4562 (D Nonpasshe income from Schedule K-1 A 978 978 B C D 29a Totals 9 7 8 b Totals 978 30 Add columns (g) and 0? of line 29a . .. . . . . . . . . . . . ..... _ ......... ......................... . :...... 30 978 31 Add columns (f), (h), and (1) of line 29b . . . . . . 31 978 32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and include in the total on line 41 bekm 32 0 MS From Estates 33 (a) Name I (b) Employer iden8flafton number A B Passive Income and Loss N hoe Income and Loss (c) Passive deduction or loss allowed (attach Form 8582 If raWred) (d) Passive Income from Schedule K-1 (e) Deduction or lass from Schedule K-1 Other income from Schedule K-1 A B 34a Totals b Totals i, 35 Add columns (d) and (f) of line 34a 35 36 Add columns (c) and (e) of line 34b .................................................... ......................... 36 37 Total estate and trust income or Qoss). Combine lines 35 and 36. Enter the result here and Include in the total on line 41 below ............................................................................. 37 1 111' income or toss rrom Keel rzzaLe ww age Invesuneni t;ona its Remius eslauai homer 38 (a) Name (b) Employer identlflcation number (c) E,xoess inclusion from (d) Taxable income (net toss) Schedules 0.1m e 2c Erie 16 (sea page ?$} (e) Uwomra from Schedules Q, lane 36 39 Combine columns d and e only. Enter the result here and include In the total on line 41 below cart V tiumma 40 Net farm rental income or (loss) from Form 4835. Also, complete fire 42 below 40 41 Total Income or (loss}. Combine lines 26, 32, 37, 39, 3 40. Enter the result here & on Form 1040, line 17, or Form 1040N kte 18 11- 41 42 Reconciliation of farming and fishing Income. Enter your gross farming and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code U; and Schedule K-1 (Form 1041), fine 14, code F (see page E-8) 42 43 Reconciliation for real estate ofiessionals. If pr' You were areal estate - professional (see page E-2), enter the net income or (loss) you reported anywhere on Form 1040 or Forth 104ONR from all rental real estate activities in which you materially participated under the passive activity loss rules 43 DAA Schedule E (Form 1040) 2010 KOSTY 01/02/2011 12:03 PM SCHEDULE SE OMB No. 1545-0074 (Form 1040) Self-Employment Tax 201 0 Deparbnent of the Tresscay Irrtemal Revenue Service 99 10- Attach to Form 1040 or Form 1040NR. 10, See Instructions for Schedule SE Form 1040. ? Sequence No. 17 Name of person with self-employment income (as shown on Form 1040) Social security number of person John` S Kost;ukovieh withsW-employment income ? Before you begin: To determine if you must file Schedule SE, see the instructions on page SE-1. May I Use Short Schedule SE or Must 1 Use Long Schedule SE? Note. Use this flowchart only iF you must file Schedule SE. If unsure, see Who Must File Schedule SE, on page SE-1. I Did you receive wages or tips in 2010? i No Are you a rnnider, member of a religious order, or GWtsfian Science practl loner who received IRS approval not to be taxed on earnings Gnm these sasoes, but you owe seti-ernployment tax on other earnings? Yes Yes Y Was the total of your wages and tips subject to sodas -sky or railroad redrernent (tier 1) tax plus your net eanngs from more than $106,800? No Are you using one of the optional maniacs to figure your net earnings (see page SE-4)? No Did you receive d-rh ernployee inc- (sae page SE-1) reported on Form W-2 of $108.28 or more? No You may use Short Sehe&& SE below No Y? Did you receive tips subject to social security or Medicare tax Yes OW you did not report t0 your employer? No Yes No Did you repot arty wages on Form 8918, Urxnkedsd Sold Yea SurDAy and =any -.m Tax on Wages? I You must use Long Schedule SE on page 2 1 Section A--Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. 1a Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1. (Form 1065), box 14, code A ........................................................................................ to b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 6b, or fisted on Schedule K-1 (Form 1065), box 20, code Y .... ....... 1b 2 . Net profit or (loss) from Schedule C, line 31; Schedule C-E7_ line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Forth 1085-8), box 9, code J1. Ministers and members of religious orders, see page SE-1 for types of income to report on this rive. See page SE-3 for other income to report 2 163 , 223 3 Combine fines 1 a, 1 b, and 2. Subtract from that total the amount on Form 1040, line 29, or Form 104ONK line 29, and ender the result (see page SE-3) ...................... ......... ........................................... 3 163,223 4 .... Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do not file this schedule unless you have an amount on fine lb .................... ........... ? 4 150 , 736 Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1 b, see page SE-3. 5 Self-employment tax, ff the amount on line 4 is: • $106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 56, or Form 1040NR, line 54 • More than $106,800, multiply fine 4 by 2.9% (.029). Then, add $13,24320 to the resutL Enter the total here and on Farm 1040, line 56, or Form 104ONR, line 54 5 17 , 615 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.50). Enter the result here and on Form 1040, rare 27, or Form 104ONR line 27 6 8,808 1: For Paperwork Reduction Act Notice, see your fax return insbuctilons. Schedule SE (Form 1040) 2010 DAA KOSTY 01WIM11 12:03 PM 6251 Alternative Minimum Tax-4ndividuals OMB No. 1545-0074 Form Department of the Treasury Internal Revenue Service 99 0- See separate instructions. ? Attach to Form 1040 or Form 1040NR. 20A 1 0 Attaclunert Sequence No. 32 Name(s) shown on Form 1040 or Form 1040NR John S Kostukovich Your social security number 'Part 1 :. Armmative Minimum Taxable Income See instructions for how to complete each line. 1 If Ming Schedule A (Form 1040), enter the amount from Form 1040, line 41 and go to line 2. Othervvise, enter the amount from Form 1040, line 38 and go to line 6. (If less than zero, enter as a negative amount.) 1 119,166 2 Medical and dental. Enter the Smaller of Schedule A (Form 1040), line 4, or 2.5% (.025) of Form 1040, line 38. If zero or less, enter -0- ............ .................. ......... ..... .. .. ....... ..... ....... 2 ....... .. . ... ........... 3 Taxes from Schedule A (Form 1040), Ines 5, 6, and 8 ... ...... .. . 3 8 , 7 62 , . ....................... . .......... 4 Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet on, page 2 of the instructions 4 0 5 Miscellaneous deductions from Schedule A (Form 1040), line 27 .... .... . .. ... 5 ..................... ............. . .. . 6 If Ming Schedule L (Form 1 D40A or 1040), enter as a negative amount the sum of lines 6 and 17 from that schedule 6 7 Tax refund from Forth 1040, line 10 or fine 21 .......... . . . . .......... . 7 27' . . . . . . . . . . . . .......................... ..... 8 Investment interest expense (difference between regular tax and AMT) ............ ....... ..... . .. 8 ........... . ... ... . 9 Depletion (difference between regular tax and AMT) ............ 9 ............................... 10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount 10 11 Alternative tax net operating kus deduction .. ..... ........... t1 ............. . . 12 Interest from specified private activity bonds exempt from the regular tax 12 13 Qualified small business stock (7% of gain excluded under section 1202) 13 14 Exercise of incentive stock options (excess of AMT Income over regular tax income) ............... . . 14 .. . ............... 15 Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A) ..................... 15 ...... .............. 16 Electing large partnerships (amount from Schedule K-1 (Forth 1065-B), box 6) ................................. 16 . 17 Disposition of property (difference between AMT and regular tax gain or loss) 17 18 Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) ............:......... . 18 702 . .. 19 Passive activities (difference between AMT and regular tax income or loss) ............ ................. . 19 0 . . 20 Loss imitations (difference between AMT and regular tax income or loss) 20 0 21 Circulation costs (difference between regular tax and AMT) ........... 21 22 Long-term contracts (difference between AMT and regular tax income) 22 23 Mining costs (difference between regular tax and AMT) ......................................... .... ... 23 .......... . . 24 Research and. experimental costs (difference between regular tax and AMT) ................. 24. ......................... 25 Income from certain Installment sales before January 1, 1987 ......................... .. ..... . . .. 25 . .. . ... . . 26 Intangible drilling costs preference .................................. . . ... 26 ..... .. .. 27 Other adjustments, indudiing Income-based related adjustments ............................................ ........ 27 . 28 Aiternalive minimum tweable incorne. Combine lines 1 through 27. (If married filing separately and line 28 is more than $219,900, see page 8 of the instnuctions. 28 12 8 , 6 03 Patt;lit= Atternative Minimum Tax 29 Exemption. (If you were under age 24 at the end of 2010, see page 8 of the instructions.) IF your flung status Is ... AND Ilse 28 is not over ... THEN enter on ins 29 ... Single or head of household $112,500 $47,450 Married fling jointly or qualifying widow(er) 150,000 72,450 Marred fling separately ............. ......... 75,000 ..... 36225 9 2,824 If line 28 is over the amount shown above for your filing status, see page 8 of the instructions. 30 Subtract line 29 from line 28. If more than zero, go to line 31. If zero or less, enter -0- here and on lines 33 and 35 and skip the rest of Part 11. . . . ........ .. .................................. . . . 30 105, 779 31 • If you are fling Fomn 2555 or 2555-E7, see page 9 of the instructions for the amount to enter. • if you reported capital gain distributions directly on Form 1040, Ifne 13; you reported qualified dividends on Form 1040, One 9b; or you had a gain on both Isles 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT U necessary) complete Part III on the beck and enter the arnart from fine 54 here .......... 31 2 7 , 8 68 , , . All others: 9 line 30 is $175,()00 or less ($87,500 or less I married icing separately), multiply fine 30 by 26% (25). Offe wise, multiply lire 30 by 28% (.28) and subtract $3,500 ($1,750 iT married filkV separately) from ft result 32 Alternative minanum tax foreign tax credit (see page 9 of the instructions) ............................................ 32 33 Tentative minimum tax. Subtract line 32 from line 31 ............................................................... 33 27, 868 34 Tax from Form 1040, fire 44 (minus any tax from Form 4972 and any foreign tax credit from Form 1040, line 47)- If you used Schedule J to figure your tax, the amount from line 44 of Forth 1040 must be refigured without using Schedule J (see page 11 of the instructions) .......................................................... 34 27,011 35 AMT. Subtract line 34 from line 33. If zero or less enter -0-. Enter here and on Form 1040, line 45 35 857 For Paperwork Reduction Act Notice, see yc w tax return instructions. For, 6251 (2olo) DAA KOSTY 0110212911 12:03 PM Form 4562 r R °rfu?e TService?"y Depreciation and Amortization OMB No.154SQ172 (Including Inforrnation on listed Property) 2010 See separate hrstructiorts ? Attach to your tax return. S erroe m, 67 Name(s) shown an return tdenti h number' John S Kostukovich Busaiess or ach* to which this foam relates Accounting Services Pad 1': Election To Expense Certain Property Under Section 179 Note: If you have anv listed property, complete Part V before you oomolete Part I. 1 Maximum amount (see instructions) 2 Total cost of section 179 property placed in service (see instructions) 3 Threshold cost of section 179 property before reduction In Orrdtation (see instructions) 4 Reduction in limitation. Subtract line 3 from line 2. If zem or less, enter -0- .......................................... 5 Dollar kniation for tax year, Subtract fine 4 firm line 1. If zero or less ender -0-. If married see hstructions ............ 6 (a) Description of property (b) Cost (business use only) (c) Bected cost 500,000 1 3 1 2.000.000 7 Listed property. Enter the amount from line 29 7 .......................................... 8 Total erected cost of section 179 property. Add amounts in column (c), lines B and 7 8 ................................. 9 Tentative deduction. Enter the smaller of line 5 or line 8 g .......................................................... 10 Carryover of disallowed deduction from One 13 of your 2009 Form 4562 1 ............................................ 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 1 12 Section 1.79 expense deduction. Add lines 9 and 10, but do not enter more than line 11 .. _ _ . _ . , ... 13 Carryover of disallowed deduction to 2011. Add fines 9 and 10, less line 12 . ? 13 Note: Do not use Part II or Part III below for listed property. Instead, use Part V. Special De 6 pre Allowance and Other De ciation Do not include listed pro e 14 Special depreciation allowance for qualified property (other than Mad property) placed in service during the tax year (see instructions) 1 .............................................. 15 Property subject to section 168(f)(1) election 1 16 Other depreciation (including ACRS) .......................................................... _ _ _ .---- 1 Section A 17 MACRS deductions for assets placed In service in tax years beginning before 2010 .................. 17 - 0 ................ 18 - 9 you are electing to group any assets placed in service during the tax veer into one or more general asset acoourgs check here ? I I _ Section B- /Assets Placed in SeMce During 2010 Tax Year Usim the General Dei3mciation Svsbam (a) Clwalcaf- of property (b) Month and year Paced In service (c) Basis for detxeciaMon (? use (d) R POW (e) Convention (f) Method (g) Dep vclatlon deduction 19a r qpqrty b 51ear property c 7 -year property d 1 Oyear property e 15JAMr property f 20ye2r property 25-yew property 25 yrs. S/L h Residential rental 27.5 Yrs. mm SIL property 275 yrs. MM SIL r Nonresidential real 39 MM SAL property MM S/L aasaon L-masers rwceu in aervrce uunng aiu rat Tear using q1e Alternative Deareciatien SvstBm 20a Class life S/L b 12-year 12 E S/L c 40- r V? 40 yrs. mm S/L 21 Listed property. Enter amount from line 28 22 Total. Add amounts from line 12, lines 14 through 17, Imes 19 and 20 in column (g), and line 21. Enter here and on the appropriate fines of your return. Partnerships and S corponations-see instructions ........................ 23 For assets shown above and placed in service during the current year, enter the For Paperwork Reduction Act Notice, see separate Instructions. DNA 810 2,810 Form 4%2 (2010) KOSTY 01/022011 12:03 PM John S Kost:ukovich Form 4,62 (2010) Page 2 P Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of action A, all of Section B, and Section C if apprltable. Section A-Depreciation and Other Information (Caution: See the instructions for limits for Dessenaer automobiles. I 24a - Do you h ave OvAdenoe to SW Up businesstmvest ent use claimed? Yes No 24b if -Yes,' is the evidence written? X Yes No (a) (b) (`) (d) (a) M (9) (h) (I). Type or ixep' Date placed irnr? ttt use cost or other bags Basis for depneciatiwr Recovery Meth" Depreciation Elsctsd seam 179 W Whiles tFs4i in service percentage (1cusiness&westment period. Convention deduction cost use Only) 25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use see instructions) ...................... 25 See S used more than 50% in 15,3081 14,052 E S/L- I I %I I I I S/L- 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 ...................... 29 Add amounts in column M. line 26. Enter here and on line 7. Daoe 1 _ 2,810 2,810 Section 13-4nformation on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other °mors than 5% owner; or related person. N you provided vehicles to your emDlovees. first answer the auestions in Seefion C in see iF vnu meat an err,antinn to rnrnnlafinn thie Qw4inn fn *h - -k64- (a) (b) (c) (d) (e) (f) 30 Total business/investment miles driven during Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 the year (do not include oommutng mites) ... 12,051 31 Total commuting miles driven during the year 1,560. 32 Total other personal (noncommuting) miles driven ........................:............ ...... 4, 285 33 Total miles driven during the year. Add lines 30 through 32 ................. ............. ..... 17,896 34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No during off-duty hours? ....................... ...... X 35 Was the vehicle used primarily by a more than 5% owner or related person? ............ ...... X 36 Is another vehicle available for personal use? .. ...... X section c--questions for employers who Provide vehicles for use by Their Employees Answer these questions to determine if you meet an exception to compieting Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). . 37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by Yes No your employees? ......................................................... 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners X 39 Do you treat all use of vehicles by employees as personal use? ................. .................................................. 40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? X ......................................................................... 41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) X ........... . Note: If your answer to 37, 38, 39, 40, or 41 is `Yes' do not complete Section B for the covered vehicles.a ROK Amortization (a) (b) (o) (d) Amortization {f) Description of costs Date amortization Amortizable amount Code section period or pmr tion for this year beghs begin parcertage Zulu tax 43 Amortization of costs that began before your 2010 tax year ........................... . ............. . ........ 43 334 44 Total. Add amounts in column (fl. See the instructions for where to report 44 334 DAA Form 4562 (2olo) KOSTY 01/0212011 1 2 03 PM Form 8582 Passive Activity Loss Limitations Departrnent of the Treasury ? See separate Instructions. Internal Revenue Service (99) ? Attach to Form 1040 or Form 1041. OMB No. 1545.10 2010 Attachment 8 Sequence No. Name(s) shown on return Identifying number John S Kostukovich fait -.2010 Passive Activity Loss Caution: Complete Worksheets 1 2, and 3 on page 2 before completing Part 1. Rental Real Estate Activities With Active P"cipation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.) la Activities with net income (enter the amount from Worksheet 1, column (a)) 1a 978 b Activities with net loss (enter the amount from Worksheet 1, column (b)) 1b c Prior years unalbwed losses (enter the amount from Worksheet 1, 1c 3,914 column (c)) ......................................'............. .. d Combine lines la, 1 b, and 1 c ......................................... id -2,936 Commercial Revitalizadan Deductions From Rental Real Estate Activities 2a Commercial revitalization deductions from Worksheet 2, column (a) 2a .................. b Prior year unalluv d commercial revitalization deductions from Worksheet 2, column (b) 2b c Add lines 2a and 2b .......................................................................................... 2c All Other Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column (a)) 3a ................................................... ................. b Activities with net loss (enter the amount from Worksheet 3, column (b)) 3b .......... .. C Prior years unallowed losses (enter the amount from Worksheet 3, . .. .... column (c)) 3c ' * d Combine lines 3a, 3 and 3c ................................ .................... 3d 4 Combine lines td, 2c, and 3d. If the result is net income or zero, all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582. Report the losses on the forms and schedules normally used 4 - 2 , 936 If line 4 is a loss and: • Line 1d is a loss, go to Part 11. • Line 2c is a loss (and line 1d is zero or more), side Part II and go to Part III. • Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and 111 and go to line 15. Caution: If your filing status is marred filing separately and you lived with your spouse at any time during the year, do not complete Part 11 or Part Ill. Instead, oo to line 15. Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part 11 as positive amounts. See page 9 of the instructions for an example. 5 Enter the smaller of the loss on line 1d or the loss on fine 4 . . ...................... . . . . ................... . 5 2 , 936 6 Enter $150,000. If married filing separately, see page 9 6 75,000 ................ 7 Enter modified adjusted gross income, but not less than zero (see page 9) 7 137,278 Note: If fine 7 is greater than or equal to fine 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8. 8 Subtract One 7 from line 6 9 Multiply lure 8 by 50% (-5). Do not enter more than $25,000. If married filing separately, see page 9 ................... g 10 Enter the smaller of line 5 or fine 9 ............................................................................ 10 0 If line 2c Is a loss, go to Part Ill. Otherwise go to line 15. tt ti! Special Allowance fix Convnercial Revitalization Deductions From Rental Real Estate Activities Note: Enter all numbers in Part III as positive amounts. See the example for Part II on page 9 of the instnuctions. 11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11 12 Enter the loss from line 4 12 13 Reduce line 12 by the amount on One 10 . ..................... ... ................... .............. 13 14 Ester the smallest of line 2c treated as a post hoe amount), line 11, or fine 13 : 14 ........ Pmt $ Total Losses Allowed 15 Add the income, If any, on lines 1a and 3a and enter the total 15 978 16 Total losses allowed from all passive activities for 2010. Add lines 10, 14, and 15. See page 11 of the Instructions to find out haw to report the losses on your tax return .............................................. 16 978 For Paperwo* Reduction Act Notice, see page 13 of the instructions. Form 8582 2010 ( ) DAA KOSTY a1/o212o11 12:03 PM John S Kostukovich Form 8582 (2010) Page 2 Caution: The worksheets must be filed with your tax retum. Keep a copy for your records. Worksheet 1-For Form 8582, Lines 1a, 1b, and 1c (See oaae 8 of the instructions.) Name of activity Current year Prior years Overall gain or loss (a) Net Income Pine 1 a (b) Net loss Pine 1 b (c) Unaliowed loss line 1 c (d) Gain (e) Loss 3900 Trindle Road LLC 978 3,914 2,936 Total. Enter on Form 8582, lines 1a, 1b, and lc ._..... ....................... ? 978 3,914 Worksheet 2--For Form 8682, Lines 2a and 2b See page 8 of the instructions. Name of activity (a) Current year deductions {line 2a (b) Prig' year unallowed deductions Ohm 2b (c) Overall loss Total. Enter on Form 8582, Ines 2a and 2b ............................ .......... ...... ? Worksheet 3--For Form 8582. Lines 3a. 3b. and 3c (See Mae 8 of the instrucfinns_) Name of activity Current year Prior years Overall gain or loss (a) Net income (Ina 3a (b) Net loss line 3b) (c) Unailowed loss Pine 3c (? Gain (e) Loss Total. Enter on Form 8562, lines 3a, 3b, and 3c ? Worksheet 4--Use this worksheet if an amount is shown on Form 85 82, line 10 or 14 See page 9 of the instructions. Name of activity Form or schedule and lire number to be reported on see lm&uc Ions (a) Lass (b) Ratio (c) special allowance (d) Subtract column (c) from column (a) Total ? 1.00 Worksheet S--AUiocation of Unallowed Losses See a 10 of the ins tructions. Name of activity Form or schedule and line number to be reported on see instructions (a) Loss (b) Ratio (c) Unallowed foss 3900 Trindle Road LLC Sch E2 2,936 1.0000 2,936 Total ? 2,9361 1.00 2,936 DM Form 8582(201o) 1(0.STY 01/0212611 12:03 PM John S Kostnkovich Form $582 (2010) Page 3 Werilmhant 6-Alinwpd Lriccpc IRPP nana 10 of the ingtnw-hnnS Name of activity Form or schedule and One number to be reported on see instructions (a) Lass (b) UnaOowed loss (c) Allowed loss 3900 Trindle Road LLC Sch 82 3,914 2,936 978 Total ? 3,914 2, 936 978 Worksheet 7-ACUV t-reS Witn Losses Reportea on Two or more ForrnS or ueneaulles (see page 'I U o? the instructions.) Name of activity: Form or schedule and One number to be reported on (see instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from form or schedule ................................ 01 c Subtract fine 1 b from line Ia. If zero or less, enter -0- Form or schedule and One number to be reported on (see instructions): ..................................... 1a Net loss plus prior year unallowed loss from form or schedule ? b Net Income from form or schedule ? ................................ c Subtract line 1 b from One I a. If zero or less. enter -0- Form or schedule and One number to be reported on (see instructions): ..................................... 1a Net loss plus prior year unallowred loss from form or schedule ? ................ b Net income from form or schedule ? ................................ c Subtract line ib from line 1a. If zero or less, enter -0- 11- Form 8582 (2olo) DAA KOSTY 0110=11 12:03 PM AMT Version Form 8582 Passive Activity Loss Limitations Department of the Treasury ? See separate instructions. Internal Revenue Service (99) ? Attach to Form 1040 or Form 1041. OMB No. 1545-1008 2010 Attachment Sequence No. 88 Name(s) shown on return Identifying number John S Kostukovich 2010 Passive Activity Loss Caution: Com late Worksheets 1, 2, and 3 on page 2 before corn letin Part 1. Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.) 1a Activities with net income (enter the amount from Worksheet 1, column (a)) ............................................... la 1,005 b Activities with net loss (enter the amount from Worksheet 1, column (b)) ........................................................................... 1b c Prior years unallowed losses (enter the amount from Worksheet 1, column (c)) is 3,685" ........................................................ d Combine lines la,lb,andlc ........................ -., ........ 1d -2,680 Commercial Revitalization Deductions From Rental Real Estate Activities 2a Commercial revitalization deductions from Worksheet 2, column (a) 2. .................. b. Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b) 2b c Add lines 2a and 2b .......................................................................................... 2c AN 0111w Passive Activities 3a Activities with net income (enter the amount from Worksheet 3, column (a)) 3a .................................................................... b Activities with net loss (enter the amount from Workmheet 3, column (b}) 3b ..................................................................... c Prior years unallowed losses (enter the amount from Worksheet 3, column (c)) 3c ....................................................... d Combine lines 39, 3b and 3c .................................... .......... ........ ............................ 3d 4 Combine lines 1d, 2c, and 3d: If fie result is net income or zero, all losses are allowed, including . any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582. Report the losses on the forms and schedules normally used 4 -2,680 ............ ........... If line 4 is a loss and: • Line 1 d is a loss, go to Part 11. • Line 2c is a loss (and line 1d is zero or more), skip Part Il and go to Part III. • Line 3d is a loss (and lines ld and 2c are zero or more), skip Parts II and Ill and go to fine 15. Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part 11 or Part III. Instead o to line 15. r i Special Allowance for Rental Real Estate Activities With Active Participation Note: Enter all numbers in Part Ii as ositive amounts. See page 9 of the Instructions for an example. 5 Enter the smaller of the loss on line 1 d or the loss on line 4 . . . . . . . . . . .. ........ . ........... .............. 5 2 , 6 8 0 6 Enter $150,000. If married filing separately, see page 9 6 75,000 7 Enter modified adjusted gross income, but not less than zero (see page 9) 7 137,278 ..... ....... Note: If fine 7 is greater than or equal to fine 6, skip fines 8 and 9, enter -0- on line 10. otherwise, go to fine 8. 8 Subtract line 7 from line 6 g ........ 9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. tf married filing separately, see page 9 9 10 Enter the smaller of line 5 or One 9 ID 0 .............................................................. ... ... ......... If line 2c is a loss, to to Part Ill. Othervvise, go to One 15. _ Special Allowance for Commercial Revitalaation Deductions From Rental Real Estate Activities Note: Enter all numbers in Part III as positive amounts. See the example for Part 11 on page 9 of the instructions. 11 Enter $25,000 reduced by the amount, ff any, on line 10. If married filing separately, see instructions ................... 11 12 Enter the loss from line 4 ...................................................................................... 12 13 Reduce line 12 by the amount on line 10 13 14 Enter the smallest of line 2c treated as a silive mount), line 11, or line 13 ........................ 14 .... . Total Losses Allowed 15 Add the income, If any, on Ones 1a and 3a and enter the total 15 1,005 16 Total losses allowed from all passive activities for 2010. Add lines 10, 14, and 15. See page 11 of the instructions to fcrd out how to report the losses on your tax return .............................................. 16 11005 For Paperwork Reduction Act Notlce,.see page 13 of the instructions. Form 8582 (2010) DAA KOSTY 01/022011 12:03 PM John S Kostukcvich AMT Version 2 Worksheet 1--For Form 8582, Lines 1a, 1b, and 1c (See page 8 of the instructions.) Name of activity Current year Prior years Overall gain or loss (a)'Net income fie is (b) Net loss Pine 1b (c) Unallowed loss line 1c (? Gain {e} Loss 3900 Trindle Road LLC 11005 3,685 2,680 l Total. Enter on Fonn 8582, fines 1a, 1b, and 1c .............................. ? 11005 3,685 Worksheet 2-For Form 8682, Lines 2a and 2b See page 8 of the instructions. Name of activity (a) current Year deductions (line 2a) (b) Prig' year unailowed deductions line 2b (c) overau loss Trial. Enter on Form 8582, lines 2a and 2b ........................................ .. Worksheet 3-For Form 8682, Lin. 3a, 3b and 3c See a e 8 of the instructions. Name of activity Current Yew Prior years overall gain or lass (a) Net income (line 3a (b) Net loss Pine 3b) (c) Unallowed loss line 3c (? Gain (e) Loss Total. Eater on Form 8582, lines 3a, 3b, and 3c ? Worksheet 4-Use this worksheet If an amount is shown on Form 858 2 line 10 or 14 See a e 9 of the instructions. activity Name of Form or schedule and fine number on to be reported see Instructions (a) Loss (b) Ratio a(C) special llowance (d) Subtract column (c) from column (a) Total ? 1.00 Worksheet 6-Allocation of Unallowed Losses See a e 10 of the ins trimbons. Name of activity Form or schedule and One number to be reported on see instructions (a) Loss (b) Ratio (c) Unallowed loss 3900 Trindle Road LLC Sch E2 2,680 1.0000 2,680 Total ? 2,6801 1.00 2,680 oaa Form 8582 (2010) KOM 01/02/2D11 12:03 PM AMT Version John S Kostukovich Form 8582 (2010) Page 3 Worksheet 6-Allowed Losses (See Daoe 10 of the instructions.) Name of activity Form or schedule and Bne number to be reported on see instrucfions (a) Loss (b) Una[lowed loss (c) Allowed loss. 3900 Trindle Road LLC Sch R2 3,685 2,680 1,005 Total ? 3,685, 2,680 11005 vvvrrucIRML r---M c.-uvrues vvin Losses me.poriea on Iwo or more roans or scneauies (bee page I U of the instructions.) Name of ac bvffy (a) (b) (c) Ratio (d) Unallowed (e) Allowed loss Form or schedule and line number to be reported on (see instructions): ..................................... 1 a Net loss plus prior year unallaNed loss from form or schedule ? ................ b Net income from form or schedule ? ................................ c Subtract line 1b from line 1a. If zero or Jess, enter -0- Form or schedule and line number to be reported on (see instructions). • ..................................... 1a Net loss plus prior year unalloyed loss from form or schedule ? ................ b Net income from form or schedule ? ................................ c Subtract fine 1b from line 1a. If zero or less, enter -0- Form or schedule and Une number to be reported on (see Inst uctfors): ..................................... 4a Net loss plus prior year unallowed loss from form or schedule ? ................ b Net income from form or schedule ? . ................................ c Subtract line 1b from line 1a. If zero or less, enter -0- 11. Form 8582 (2010) DAA KOSTY KostukoAch, John S 1/2/2011 12:03 PM ?s Federal Statements Statement 1 - Schedule A. Line 8 - Other Taxes Description Personal LST Total Amount $ 20 50 $ 70 KOST Kostukovich, John S 1/2/2011 12:03 PM Federal Statements Accounting Services Statement 2 - Form 4562. Line 26 - Property Used More Than 50% in a Qualified Bujiness Property Type Date Bus % Cost Dep Basis Per Method Deduct Sec 179 Vehicle 5/05/10 100.00 $ 14,052 $ 14,052 5.0 20ODBHY $ 2,810 $ Vehicle >60001bs 5/04/06 67.34 Laptop 9/30/07 100.00 1,256 5.0 20ODBHY Total $ 15,308 $ 14,052 $ 2,810 $ 0 2 , y '3 11' EXHIBIT "B" EXPENSES OF JOHN S. KOSTUKOVICH Monthly Total EXPENSES Home Mortgage or Rent $1,235.00 UTILITIES Electric $75.00 Gas $80.00 Water $35.00 Cable TV $35.00 Internet $45.00 INSURANCE Homeowners/Renters $25.00 Automobile $140.00 Life $163.00 Accident/Disability $147.00 AUTOMOBILE Lease or Loan Payments $1,057.00 Fuel $150.00 Repairs $110.00 Memberships $5.00 Monthly Total MEDICAL Medical Insurance $858.00 Doctor $50.00 Dentist $40.00 Counseling/Therapy $85.00 Special Needs (glasses, etc.) $30.00 PERSONAL Clothing $225.00 Groceries $460.00 Haircare $15.00 Memberships $30.00 Dry Cleaning $115.00 MISCELLANEOUS Papers/Books/Magazines $15.00 Entertainment $400.00 Vacations $750.00 Gifts $190.00 Legal Fees/Prof. Fees $1,000.00 Charitable contributions $80.00 Children's Allowances $550.00 Other Child Support $1,300.00 Alimony pendente lite payments $2,200.00 TOTAL MONTHLY EXPENSES $11,695.00 SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly, LLP, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of Defendant's Pre-trial Statement on the following on the date and in the manner indicated below: VIA FACSIMILE AND VIAU.S. MAIL, FIRST CLASS, PRE-PAID E. Robert Elicker, II, Esquire Barbara Sumple-Sullivan, Esquire Cumberland County Divorce Master 549 Bridge Street 9 North Hanover Street New Cumberland, PA 17070 Carlisle, PA 17013 JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: ? " 9' 1 ( By: t J. o ellyJr. e #15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff V. JOHN S. KOSTUKOVICH, Defendant CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 : CIVIL ACTION -LAW 70 Co ?rn _t 0 C_ 1V sa. w r? z r- rr' ?C3 WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(c) OF THE DIVORCE CODE I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C.S.§4904 relating to unsworn falsification to authorities. c?-3 DATE: SUEL N G. OSTUKOVICH Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff V. JOHN S. KOSTUKOVICH, Defendant CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 : CIVIL ACTION -LAW WAIVER OF NOTICE OF INTENTION TO REOUEST ENTRY OF A DIVORCE DECREE UNDER 43301(c) OF THE DIVORCE CODE I consent to the entry of a final decree of divorce without notice. rn Co C_ te z, r-- r. -Orr; C:) N) 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C.S.§4904 relating to unsworn falsification to authorities. DATE: J S. KOSTUKOVICH SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 10-293 ° JOHN S. KOSTUKOVICH, CIVIL ACTION - LAW rr,CU ?• z e' Defendant .rrI cam-, -:ar-ELL ?J I ? v c, r ° STIPULATION 3z-,C-- -7 °r' 4 c7 s" AND NOW comes Barbara Sumple-Sullivan, Esquire, counsel for Plaintiff, Suellyn G. Kostukovich and John J. Connelly, Jr., Esquire, counsel for Defendant, John S. Kostukovich, who stipulate and agree that the Court shall enter the attached Order to implement the alimony provisions of the parties' Marital Settlement Agreement dated July 28, 2011. Suellyn . Kostukovich Plaintiff Barbara Sumple-Sullivan, Esquire Attorney for Plaintiff John ostukovich De ndant J hn . nne , Jr., squire to e for D fendant SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW W Defendant' IN DIVORCE cn -"' pti INTERIM REPORT ot Sr n nt x - AND NOW, this "o fK day of Au ? N - y gust, 2011, based upon the Stipulation of the pars' entered on July 28, 2011 in the above matter and attached hereto, pursuant to paragraph 1 of said Stipulation, the Master has put on the record that his appointment to address all of the economic issues in this case will remain in place until the closing on the property located at 1 I Montego Court, Dillsburg, Pennsylvania, be sold to Harry H. Fox, Jr. In the event that the property does not close and remains on the market, the Master reserves jurisdiction for all pending economic claims. Said claims are reserved pursuant to the language in the proposed Decree in Divorce attached hereto. E. Robert Elicker, III, Esquire Cumberland County Divorce Master 9 North Hanover Street Carlisle, PA 17013 SUELLYN G. KOSTUKOVICH, Plaintiff VS. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,.PENNSYLVANIA NO. 10 - 293 CIVIL IN DIVORCE THE MASTER: Today is Thursday, July 28, 2011. This is the date set for a Master's hearing in the above-captioned divorce proceedings. Present in the hearing room are the Plaintiff, Suellyn G. Kostukovich, and her counsel Barbara Sumple-Sullivan and the Defendant, John S. Kostukovich, and his counsel John J. Connelly, Jr. The action was commenced by the filing of a complaint in divorce on January 11, 2010. The divorce complaint raised grounds for divorce of irretrievable breakdown of the marriage and economic claims of equitable distribution, alimony, alimony pendente lite, and counsel fees and expenses. With respect to grounds for divorce, the parties have previously signed and filed affidavits of consent. The Master has been provided today waivers of notice of intention to request entry of divorce signed July 28, 2011. The Master's office will file the waivers with the Prothonotary's office. The divorce can, therefore, conclude under Section 3301(c) of the Domestic Relations Code. 1 With respect to the economic claims, the parties have reached an agreement resolving those claims. The agreement is going to be placed on the record in the presence of the parties. The agreement as stated on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. The parties are going to return later today with counsel to review the agreement for typographical errors, make corrections as necessary, and then sign the agreement affirming the terms of settlement as stated on the record. The parties, however, are bound by the agreement when they leave the hearing room even though there is no subsequent signing of the agreement. Upon receipt of the completed agreement, the Master, at the request of counsel, will transmit the file to the Prothonotary's office so that counsel can file a praecipe to transmit the record to the Court requesting a decree in divorce. The Master will not vacate his appointment until the Master has been advised that all claims raised in the agreement have been resolved. The agreement will address the issue regarding the Master's vacation with respect to the pending sale of a piece of real estate owned by the parties. 2 The parties were married on July 26, 1986, and separated July 12, 2009. They are the natural parents of two children, both of whom are emancipated. Mr. Connelly. MR. CONNELLY: The parties have arrived at the hearing room this morning at approximately 9:00 a.m. and have continuously, through their counsel, negotiated a resolution which we are now putting on the record at 1:15 p.m. after a short lunch break. Based on the assets as listed in each of the parties' inventories, I will put on the record the distribution as agreed to by the parties. 1. The parties are the owners of real estate located at 11 Montego Court, Dillsburg, Pennsylvania. They have entered into an agreement with Harry H. Fox, Jr., to acquire the property for a purchase price of $360,000.00. The terms of the agreement include a $10,000.00 deposit within 72 hours of the execution of the agreement. The agreement is an as is purchase, cash, no conditions for financing. Mr. Fox has also agreed to pay the entire transfer tax of 2% on the transaction. The parties acknowledge that there is a mortgage balance of approximately of $290,000.00 on the property. There are going to be some real estate taxes due and owing, which husband has agreed to pay in full at the time of closing. Wife shall be guaranteed the sum of $49,5000.00 from the proceeds, thereafter husband shall receive $17,500.00 from the proceeds, and should any proceeds be left after the payment of incidental closing costs, the balance will go to wife. The Master has put on the record that his appointment to address all of the economic issues in this case will remain in place until the closing on the property to be sold to Mr. Fox. In the event that the property does 3 not close and remains on the market, the Master reserves jurisdiction for all pending economic issues. The parties have agreed that pending the sale after August 1, 2011, as to the mortgage payment, they will share the expense 60% to husband and 40% to wife. As to the utilities, from July 1 until closing, husband shall pay 60% of the utility expense and wife shall pay 40%. Wife is responsible for utilities up until June 30, 2011. It is anticipated that any expenses accumulated for the mortgage payments from August 1 or the utilities from July 1 will be apportioned at the time of closing 60/40 as referenced herein. 2. Husband has in his name a simple IRA with Genworth Financial which has a balance as of June 30, 2011, of $125,985.00. Wife has a simple IRA with Equity Services which as of June 30, 2011, has a balance of $121,069.00. The parties agree that wife will receive a total of 57.5% of the entire balance of both accounts. The total accounts are $247,054.00. Wife's 57.5% share is $142,056.05 deducting from that the June 30 balance in her account as of June 30, 2011, she is entitled to $20,987.00 in a roll over from husband's Genworth simple IRA. Within husband's simple IRA he has a cash account from which the roll over will occur. The roll over amount will include any interest generated by this money from June 30, 2011, until it is received by wife either in the form of a direct payment or in the form of a roll over. Husband will be responsible for implementing the QDRO or other Court order necessary to transfer these funds to wife. 3. The parties are the owners of several timeshares, Bluegreen and Bahamas. Husband will assume sole responsibility and ownership of both timeshares and will indemnify and hold wife harmless on the timeshares and will arrange to have her name removed from all liability and ownership within sixty (60) days of today's date. 4. Each party shall keep as their sole and separate property the following motor vehicles. Husband shall retain the 2006 Mercedes and the 2006 Ford Expedition. Wife will retain the proceeds from the insurance on the 2008 Lexus and will retain her vehicle which was acquired after separation, the 2010 Mazda 6. The only vehicle that has a balance on which wife has a responsibility is the 2006 Mercedes. Husband shall arrange to have wife's name removed from the said debt and shall indemnify and hold her harmless pending removal. He shall remove her name from the vehicle within sixty (60) days of today's date. 4 5. Husband will Retain the 2005 and 1997 jet skis and the 1995 trailer for the jet skis. 6. Husband shall retain as his sole and separate property Kostukovich Financial Group, LLC, including any assets contained therein whether personal property, checking/savings accounts or accounts receivable. Wife is not a guarantor on any loans, lines of credit or other financial obligations relating to this entity. 7. The parties hold stock in a company known as 3900 Trindle Road, LLC, which is the owner of an office building at 3900 Trindle Road. Husband shall immediately take steps to have wife's name removed from any financial obligations against said property and will present to wife a resignation of her position and a transfer of any stock shares in her interest in 3900 Trindle Road, LLC, in order to complete the ownership of the said property in husband's name individually through the limited liability company. Wife shall only be obligated to sign the resignation in the event that she is released fully from the First National Mortgage. 8. Each party shall retain any interest they may have in any life insurance policies. Husband agrees that he will name wife as beneficiary to the extent of his then existing alimony obligation which will be referred to herein. 9. Husband will pay to wife in the form of alimony, the sum of $2,200.00 per month for a period of sixty (60) months. The said alimony is non-modifiable as to duration or amount except that it shall terminate at the end of the sixty (60) month period or in the event wife cohabits or remarries or the death of either party. The alimony payments are includable to wife as income and deductible to husband on his tax return. 10. There is currently in place an APL obligation which currently has an arrearage of approximately of $4,400.00. After credits to husband for certain payments made directly on the parties' real estate, husband will pay to wife on or before Friday July 29, 2011, the sum of $3,500.00 in full satisfaction of the APL arrearage. Wife shall take steps to immediately terminate this order. It shall be replaced by the alimony payment beginning August 1, 2011, which shall be also paid by August 1, 2011, directly to wife. The actual alimony payments as entered at Domestic Relations shall begin on September 1, 2011, for a period of fifty-nine (59) months. Because husband will be making a direct payment to wife, wife shall promptly terminate the APL order so that effective August 1, 2011, alimony begins. The reason the 5 fifty-nine (59) months is established as of September 1, is because the August 1, payment will be made directly to wife. Counsel for wife will draft a separate alimony order establishing the $2,200.00 a month payment for fifty-nine (59) months beginning September 1, 2011. 11. Each of the parties will retain all personal property currently in their possession. Neither party shall make a claim to any personal property held by the other at the time of the execution of this agreement. The parties indicated off the record that there were certain items of personal property left in the house. Husband has certain client records from his CPA practice as well as tools; wife has clothing, furniture and other items at the residence. Each of the parties will take steps to promptly remove the items referenced on the record so that Mr. Fox, when concluding the closing, will not have to remove remove any items. 12. The parties have had an off the record discussion about how to handle deductions for real estate taxes for the year 2011 as well as a refund of the homeowner's insurance which will occur after closing. Husband agrees that he will direct that the refund on the homeowner's insurance go to wife and that wife will have the deduction for the real estate taxes paid on the home from January 1 through June 30, 2011. Husband shall be entitled to deduct on his return any real estate tax he pays at the time of the closing. 13. Wife holds title to a 2009 Mazda 3 vehicle that is being used by the parties' daughter Tiana. The parties agree that this shall be Tiana's vehicle and at a point in time when appropriate, given the cost of car insurance, the vehicle will be transferred to Tiana. The time frame of the transfer to Tiana is uncertain; however, in the event wife would sell or trade the said vehicle, husband shall be entitled to 45% of the sale or trade value and wife shall be entitled to 55% of the sale or trade value. In the event the vehicle is traded for a vehicle for Tiana, there would be no sharing of the distribution of the proceeds, but the new vehicle must be in Tiana's name. 14. Each party waives any claim against the other for any counsel fees, costs or expenses in this matter. 15. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital 6 relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. 16. In order to complete the terms of this agreement as dictated, each party shall execute, upon presentation, any documents necessary to effectuate the terms. 17. At the time of the separation of the parties there were a number of bank accounts that the parties have previously divided to their mutual satisfaction and have been factored into the resolution contained on the record. MS. SUMPLE-SULLIVAN: Suellyn, you've been in the hearing room today while attorney Connelly has read the settlement into the record. Did you hear the terms of the settlement? MS. KOSTUKOVICH: Yes. MS. SUMPLE-SULLIVAN: Do you understand the terms of the settlement? MS. KOSTUKOVICH: Yes. MS. SUMPLE-SULLIVAN: And are you in agreement with the terms of the settlement? MS. KOSTUKOVICH: Yes. MR. CONNELLY: Mr. Kostukovich, you've been working with me over the last four days and prior to that for months trying to come up with a resolution in this case; is that correct? 7 MR. KOSTUKOVICH: Yes. MR. CONNELLY: Did we deal with it again today from the beginning of this morning up until the time you heard it on the record? MR. KOSTUKOVICH: Yes. MR. CONNELLY: Do you understand the terms of the agreement as dictated? MR. KOSTUKOVICH: Yes. MR. CONNELLY: Do you concur and agree that the terms are acceptable to you as a final resolution of the economic issues in this case? MR. KOSTUKOVICH: Yes. MR. CONNELLY: Do you understand that in the event that the Harry Fox purchase of your real estate does not go through, this matter could return to the Master to address all the pending economic issues as contained in this agreement? MR. KOSTUKOVICH: Yes. MR. CONNELLY: And that this is contingent upon the sale of the house? MR. KOSTUKOVICH: Yes. THE MASTER: Thank you. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend 8 to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed b:y law and in particular Section 3105 of the Domestic Relations Code. WITNESS •? DATE: Barbara Sumple-Sullivan uel`lyn G. Kostukovich Attorney for Plaintiff L? J h J. Conne y, J John S. Kostukovich A t rney for fen ant 9 SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW = Defendant : IN DIVORCE rn'= V cn?- -- C v PRAECIPE TO TRANSMIT RECORD - -0 D v c? c~. To the Prothonotary: Transmit the record, together with the following information, to the Court for entry of a Divorce Decree: 1. Ground for divorce: irretrievable breakdown under Section ( x ) 3301(c) ( ) 3301(d) of the Divorce Code. 2. Date and manner of service of the Complaint: Upon counsel for Defendant as evidenced by the Acceptance of Service dated January 14, 2010 and filed of record on January 22, 2010. 3. Complete either paragraph (a) or (b). (a) Date of execution of the Affidavit of Consent and Waiver of Counseling required by Section 3301(c) of the Divorce Code: by Plaintiff: January 14, 2011; by Defendant: January 13, 2011. (b) (1) Date of execution of the Plaintiffs Affidavit required by Section 3301(d) of the Divorce Code: (2) Date of service of the Plaintiffs Affidavit upon the Defendant: 4. Related claims pending: All claims have been settled pursuant to a Marital Settlement Agreement dated July 28, 2011. 5. Date and manner of service of the notice of intention to file Praecipe to Transmit Record, a copy of which is attached, if the decree is to be entered under Section 3301(d) of the Divorce Code: 6. Date and manner of service of Notice of Intention to file Praecipe to Transmit Record, a copy of which is attached, if the decree is to be entered under Section 3301(d) of the Divorce Code: or, date of execution of Waiver of Notice of Intention to Request Entry of a Divorce Decree under Section 3301(c) of the Divorce Code: by Plaintiff. July 28, 2011; by Defendant: July 28, 2011. and, date of filing of the Waiver of Notice of Intention to Request Entry of a Divorce Decree: by Plaintiff. July 29, 2011; by Defendant: July 29, 2011. Dated: By: (-U--L? . JT JAMES, SMITH, DIETTERICK & CONNELLY, LLP J. ,Conn '0y, Jr. rn . #15615 P.O. Box 650 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant , R SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA ,-y V. NO. 10-293 c JOHN S. KOSTUKOVICH, CIVIL ACTION -LAW ? ? Defendant ORDER FOR PAYMENT OF ALIMONY 77 AND NOW, this /Cv day of August, 2011, to implement a portion o parties' Marital Settlement Agreement dated July 28, 2011, and upon the stipulation of their counsel, we hereby order as follows: 1. The Defendant, John S. Kostukovich, (hereinafter "Husband") shall pay Alimony to the Plaintiff, Suellyn G. Kostukovich, (hereinafter "Wife") in the amount of Two Thousand Two Hundred Dollars ($2,200.00) per month, commencing August 1, 2011. 2. The term of the Alimony payments shall be for sixty (60) months. It is acknowledged that Husband has directly made the August 1, 2011 Alimony payment directly to Wife. Therefore, the Alimony payments through Domestic Relations shall begin September 1, 2011 and continue for fifty-nine (59) months. 3. The amount and term of Alimony is non-modifiable in duration and amount and is subject to termination only in strict accordance with the provisions of the Marital Settlement Agreement entered into by the parties on July 28, 2011, which provides for termination after sixty (60) months, in the event of Wife's cohabitation or remarriage, or in the event of Husband or Wife's death. 4. The payments from Husband to Wife pursuant to this Order shall continue to be made through Domestic Relations. The Alimony Pendente Lite Order/action rn S r docketed to Cumberland County PACSES Case No. 625111393, shall terminate as 41 of June 31, 2011 and shall be replaced by this Order. Plaintiff acknowledges that the arrearage due and owing in the Alimony Pendente Lite matter, as modified by the parties' Marital Settlement Agreement dated July 28, 2011, was paid in full by Husband directly to Wife. 5. Both parties will treat the payments made pursuant to this Order as Alimony for the purposes of federal income tax whereby Wife shall include the payments in her income for taxes and Husband shall be entitled to deduct the payments for tax purposes. 6. The Court will retain Jurisdiction of this matter for purposes of enforcing and administering the Alimony provisions of the parties' Marital Settlement Agreement as may be necessary in the future. THE COUR : J. my SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW moo rn x,. ='?` i Defendant rn D- -? STIPULATION z ° o AND NOW comes Barbara Sumple-Sullivan, Esquire, counsel for Plaintiff, Suellyn G. Kostukovich and John J. Connelly, Jr., Esquire, counsel for Defendant, John S. Kostukovich, who stipulate and agree that the Court shall enter the attached Order to implement the alimony provisions of the parties' Marital Settlement Agreement dated July 28, 2011. .C n l"W?L u'X SuellynllG. Kostukovich Plaintiff Barbara Sumple-Sullivan, Esquire Attorney for Plaintiff John ostukovich De ndant squire J hn . nin kfendant to e for D IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SUELLYN G. KOSTUKOVICH V. JOHN S. KOSTUKOVICH NO. 10-293 DIVORCE DECREE AND NOW, 7 it is ordered and decreed that SUELLYN G. KOSTUKOVICH , plaintiff, and JOHN S. KOSTUKOVICH 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.") The parties' Marital Settlement Agreement dated July 28, 2011 is hereby incorporated, but not merged, into this Decree in Divorce. All economic issues are preserved pursuant to the agreement of the parties entered into by stipulation on July 28, 2011, attached hereto and made a part hereof. ?? 1zL Prothonotary Attest: J. <?,/e -/??1&517 ?tohte to Cb fvdf O 740 j rk r._ . fi... . 4J1~'t 711 iL- f 39A,1-1 4~ .'t r I OCT 28 AM 10' John J. Connelly, Jr., Esquire Attorneyl.D. No. 15615 ~U M BE R LA i:D, James Smith Dietterick & Connelly, LLP F.-N N &Y-!~f~r~1 P.O. Box 650 _ Hershey, PA 17033 Attorneys for Defendant SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COLJNTY, PENNSYLVANIA v. : NO. 10-293 JOHN S. KOSTUKOVICH, : CNIL ACTION - LAW ~ Defendant : IN DIVORCE ~ PETITION TO REVOKE APPOINTMENT OF MASTER 1. On August 26, 2010, E. Robert Elicker, III, Esquire, was appointed Master in the above-captioned matter to consider the issues raised in the proceedings. 2. A settlement was reached between the parties pursuant to a Marital Settlement Agreement dated July 28, 2011. 3. Pursuant to paragraph 1 of said Agreement, the Master has put on the record that his appointment to address all of the economic issues in this case will remain in place until the closing on the property located at 11 Montego Court, Dillsburg, Pennsylvania, be sold to Harry H. Fox, Jr. 4. The property located at 11 Montego Court, Dillsburg, Pennsylvania has been sold and all economic issues have been addressed. 5. The undersigned therefore requests that the appointment of E. Robert Elicker, III, Esquire be revoked. Respectfully submitted, JAMES, SMITH, DIETTERICK & CONNELLY, LLP i ~ Dated: By: I Jo Conne y, Jr. ' A ey D. 15615 P.O. Box 0 Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant, John S. Kostukovich . . . SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff : CLTMBERLAND COLTNTY, PENNSYLVANIA ~ v. : NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE . I, John J. Connelly, Jr., Esquire, of James, Smith, Dietterick & Connelly LLP, attorney for the Defendant, John S. Kostukovich, hereby certify that I have served a copy of the foregoing Petition to Revoke Appoinrinent of Master on the following on the date and in the manner indicated below: U.S. MAIL, FIRST CLASS. PRE-PAID Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 JAMES, SMITH, DIETTERICK & CONNELLY, LLP Dated: By: c ~ Q- -M -1V o J. o elly, Jr. tto ey I.D. 15615 P. . Bo Hershey, PA 17033-0650 (717) 533-3280 Attorneys for Defendant SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE ORDER AND NOW, this day of 2011, the appointment of E. Robert Elicker, 111, Esquire, as Master in the above-captioned proceeding is hereby revoked. BY THE COURT: J. ??? Distribution: 1 l Q John J. Connelly, Jr., Esquire, P.O. Box 650, Hershey, PA 17033 Barbara Sumple-Sullivan, Esquire, 549 Bridge Street, New Cumberland, PA 17070-1931 ? E. Robert Elicker, III, Esquire, 9 North Hanover Street, Carlisle, PA 17013 - in b` le ' -?lYd C-1 _-C M 7 -._ry h7 y. jz•..i SUELLYN G. KOSTUKOVICH, Plaintiff V. JOHN S. KOSTUKOVICH, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 10-293 CIVIL ACTION - LAW IN DIVORCE STIPULATION FOR ENTRY OF A OUALFIED DOMESTIC RELATIONS ORDER AND NOW, this3I Cday of 0 C.-AZ , 2011, upon consideration of the attached Stipulation, it is hereby ORDERED, ADJUDGED AND DECREED as follows: 1. Parties: The parties hereto were husband and wife and a divorce action was finalized in this Court at the above-referenced docket number. The parties were married on July 26, 1986, and divorced on August 17, 2011. 2. Participant Information: The Participant's name, mailing address, social security number and date of birth are: John S. Kostukovich 3900 Trindle Road Camp Hill, PA 17011 SS #xxx-xx-7548 Date of Birth: June 20, 1962 3. Alternate Payee Information: The alternate payee's name, mailing address, social security number and date of birth are: Suellyn G. Kostukovich 104 Franklin Square Mechanicsburg, PA 17050 SS #xxx-xx-5895 Date of Birth: January 1, 1962 The alternate payee is the former wife of the Participant. 4. Plan Information: This Order applies to benefits under the John S. Kostukovich CPA Simple Plan. 5. Assignment of Benefits: The Participant assigns to the Alternate Payee an interest in the Participant's Simple Plan. The Alternate Payee is entitled to a direct payment in the amount specified herein. 6. Effect of this Order as a Qualified Domestic Relations Order: This Court has personal jurisdiction over the parties. 7. State Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable Domestic Relations laws of the Commonwealth of Pennsylvania. 8. Provisions of Marital Property Rights: This Order relates to the provision of marital property rights as a result of the Order of Divorce between the Participant and the Alternate Payee. 9. Amount of Alternate Payee's Benefits: The Alternate Payee shall not be treated as the Participant's spouse under the Plan. Alternate Payee shall receive a one time payment of Twenty Thousand Nine Hundred Eighty-Seven Dollars ($20,987.00) from Participant's account. The form of the payment shall be in a lump sum payment. This sum shall be allocated to Alternate Payee as of June 30, 2011, and shall include all interest, earning and/or losses on that amount from June 30, 2011 through the date of distribution. The Alternate Payee shall receive the $20,987.00 payment in proportionate shares from the various funds in the John S. Kostukovich CPA Simple Plan. 10. Commencement Date and Form of Payment to Alternate Payee: The Alternate Payee shall receive a one time payment of $20,987.00 as prescribed in Paragraph 9 above. The benefits shall be paid to alternate payee as soon as administratively feasible following the date this Order is approved as a QDRO by the Plan Administrator. 11. Savings Clause: This Order is not intended, and shall not be construed in such a manner as to require the Plan: a. to provide any type or form of benefits or any option not otherwise provided under the Plan; b. to provide increased benefits to the Alternate Payee; C. to pay any benefits to the Alternate Payee which are required to be paid to another alternate payee under another order previously determined to be a QDRO; or d. to make any payment or take any action which is inconsistent with any federal or state law, rule, regulation or applicable judicial decisions. 12. Certification of Necessary Information: All payments made pursuant to this Order shall be conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator of such information as the Plan Administrator may reasonably require from such parties. 13. Continued Qualified State of Order. It is the intention of the parties that this QDRO continue to qualify as a QDRO under Section 414 (P) of the Code, as it may be amended from time to time, and the Plan Administrator shall reserve the right to reconfirm the qualified status of the Order at the time benefits become payable hereunder. 14. Tax Treatment of Distributions Made Under this Order: For purposes of Sections 402 (a)(1) and 72 of the Code, or any successor Code section, any Alternate Payee who is the spouse or former spouse of the Participant shall be treated as the distribute of any distribution or payments made t the Alternate Payee under the terms of this Order, and as such, will be required to pay the appropriate federal income tax on such distribution. 15. Parties Responsibilities in Event of Error: In the event that the Plan inadvertently pays the Participant any benefits that are assigned to the Alternate Payee pursuant to the terms of this Order, the Participant shall immediately reimburse the Alternate Payee to the extent that the Participant has received such benefit payments by paying such amounts directly to the Alternate Payee within ten (10) days of receipt of notice of said inadvertent payment. 16. Effect of Plan Termination: In the event of a Plan termination prior to the distribution of funds to the Alternate Payee, the Alternate Payee shall be entitled to receive his or her portion of the Participant's benefits as stipulated herein in accordance with the Plan's termination provisions for participants and beneficiaries. 17. Continued Jurisdiction: The Court retains jurisdiction over this matter to amend this Order to establish or maintain its status as a Qualified Domestic Relations Order under Code Section 414 (p), as amended, and the original intent of the parties as stipulated herein. The Court shall also retain jurisdiction to enter such further orders as are necessary to enforce the assignment of benefits to the Alternate Payee as set forth herein. By th urt, J. lno o 0141111,838w n3 LZ `114V t- noKtta a?1.?3 3 SUELLYN G. KOSTUKOVICH, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 10-293 JOHN S. KOSTUKOVICH, : CIVIL ACTION - LAW Defendant : IN DIVORCE STIPULATION Pursuant to the Property Settlement Agreement put on the record at the Divorce Master's Office on July 28, 2011, the parties hereby agree and stipulate that the Court may sign the attached Qualified Domestic Relations Order. Date /d Ld/1, Date t u r Date N V up Date v &rham &mple- 1 t Ivan, ? V o ohnJ• &ne(1y,J,, J Kostukovich J hn . Co lly, Jr., Esquire 11 0 n M? l?P`651 !r tt I Barbara Sumple Sullivan, Esquire IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SUELLYN G. KOSTUKOVICH (now known as SUELLYN GILTZ), Plaintiff/Respondent ) NO. 10-293 CNIL TERM v. ) JOHN S. KOSTUKOVICH, ) CIVIL ACTION -LAW Defendant/Petitioner ) IN DIVORCE c~ ~ 'r Y ~ 3 ~ _~ _ ~~ ~ -pe ~,? r-r, NOTICE TO PLEAD -<x' ~~ o ~' ' ~~~ ~~ ~ ~„ __~- TO: Suellyn Giltz, Plaintiff > ~ c- ~`""-; ~: 115 Rutledge Alley '' ~ ~ ~' Mechanicsburg, PA 17050 ~~ - . c,a ~~' You are hereby notified to file a written response to the enclosed Petition to Terminate Alimony within twenty (20) days from service hereof or a judgment maybe entered against you. Date: ~Jbv ~ ~ ~ D /~ c . Howett, Jr., Es re HOWETT, KISSINGER & HOLST, P.C. 130 Walnut Street P.O. BOX 810 Harrisburg, PA 17108 Telephone: (717) 234-2616 Counsel for Defendant/Petitioner John S. Kostukovich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SUELLYN G. KOSTLJKOVICH, ) (now known as SUELLYN GILTZ), ) Plaintiff/Respondent ) v. ) JOHN S. KOSTUKOVICH, ) Defendant/Petitioner ) NO. 10-293 CNIL TERM n c ~ - Z ~ xr o "~ r-- `n ~~ -<~ ~ a om, ~~ ~, r- -~- .cc~ --! r_? ~-,, Ara z~ ~ ~_~€ ~c _. ~~ ~~~' ....~ C,+J ~ , c ~-~ CNIL ACTION -LAW IN DNORCE PETITION TO TERMINATE ALIMONY AND NOW, comes Defendant, John S. Kostukovich, by and through his counsel, John C. Howett, Jr., Esquire of Howett, Kissinger & Holst, P.C., who states the following in support of the within Petition: 1. Petitioner John S. Kostukovich was Defendant in the above-captioned divorce action and resides at 5 Springdale Way, Mechanicsburg, Pennsylvania, 17050. 2. Respondent Suellyn Giltz (formerly Suellyn G. Kostukovich) was Plaintiff in the above-captioned divorce action and resides at 115 Rutledge Alley, Mechanicsburg, Pennsylvania, 17050. 3. The parties hereto, formally husband and wife, entered into a Marital Settlement Agreement on Thursday, July 28, 2011 at a master's hearing which was placed on the record and is a matter of record in the above-captioned case. 4. Paragraph 9 of said Agreement reads in its entirety as follows: "Husband will pay to wife in the form of alimony, the sum of $2,200.00 per month for a period of sixty(60) months. The said alimony is non- modifiable as to duration or amount except that it shall terminate at the end of the sixty (60) month period or in the event wife cohabits or remarries or the death of either party. The alimony payments are includeable to wife as income and deductible to husband on his tax return." 5. Petitioner has made all such alimony payments through and including the payment due on November 1, 2012. 6. Petitioner believes and therefore avers that Respondent has, for some extended period of time, been residing and cohabiting with one Gary Gouse at his residence at 115 Rutledge Alley, Mechanicsburg, Pennsylvania, 17050. 7. Petitioner believes and therefore avers that Respondent began cohabiting at a date prior to November 1, 2012 and therefore owes Petitioner $2,200.00 for the alimony she received on November 1, 2012 and the same amount for each month prior thereto when she was cohabiting and thus ineligible for alimony pursuant to said paragraph 9. 8. The aforesaid settlement agreement was specifically incorporated in to the divorce decree entered on August 17, 2011 and is, pursuant to 23 Pa.C.S.A. §3105(a), an Order of Court. 9. Respondent, having received alimony to which she is not entitled pursuant to said Order of Court is in violation thereof. 10. Petitioner has and will continue to incur counsel fees in the enforcement of his rights pursuant to said Order for which Respondent should be obligated to pay. WHEREFORE, Petitioner requests this Honorable Court to: a. Terminate Respondent's right to receive any further alimony from and after the date she began cohabiting. b. Direct Respondent to return to Petitioner the alimony payment for the month of November, 2012 and for all prior months in which she is found to have cohabited. VERIFICATION I, John S. Kostukovich, hereby swear and affirm that the facts contained in the foregoing Petition to Terminate Alimony are true and correct to the best of my knowledge, information and belief and are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: ---'~-~ John ostukovich c. Direct Respondent to pay to Petitioner an amount determined by this Court to be just and reasonable for counsel fees. Respectfully submitted, Date: ~,J' ~ ~ ~ ~ 20 f ~?~--- hn C. Howett, Esquire HOWETT, KISSINGER & HOLST, P.C. 130 Walnut Street P.O. Box 810 Harrisburg, PA 17108 Telephone: (717) 234-2616 Counsel for Defendant/Petitioner John S. Kostukovich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SUELLYN G. KOSTUKOVICH, ) (now known as SUELLYN GILTZ), ) Plaintiff/Respondent ) v. ) JOHN S. KOSTUKOVICH, ) Defendant/Petitioner ) NO. 10-293 CIVIL TERM CNIL ACTION -LAW IN DNORCE AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF ~ ~A~~ ) :: ~~., :_ _, ~_, ~ -> ~ - --- ~.._ _ .; I, Jean Morrison, being duly sworn according to law, depose and say that I am a competent adult over the age of 21, not a party to this lawsuit, and that I served a true and correct copy of the Petition to Terminate Alimony on Suellyn Giltz, on the ~3~-cf day of iG''d y m 6~r _, 2012. ,~ s s/~. ~ a s /eav,"r~y //.s /~u ~/e ~/y ~ ..~ //may ~ ~'1~~~r_s /~P r Gu Y wlS ,,Q~ r/~Po/ ~/~ ~ ~ a r a ~ e r~ 6 k ~J /',~ /'9oS0 Q~ 6,`30 Q ,`n. ,~~Q~ ~dZG~TiOh~ ~'-'_" J Morrison SWORN to and subscribed before me this , ~ day of P; ;,,1-~ ctiL~c .- , 2012. ;r-, Nota Public ~~onr~A~n+ aF ~n~sru+~ NaTAR~. s i DONNA J. KNISEIx NOTARY PUBLIC CRY OF HARRISBURG, DAUPHIN COUNTY NiV COMMISSION EXPIRES APRIL 28, 2016 SUELLYN KOSTUKOVICH IN THE COURT OF COMMON PLEAS OF alk/a SUELLYN GILTZ, :CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V : ~~°: ~. _. ; . ~ :-=- ~ . JOHN S. KOSTUKOVICH, nom' N0.2010 - 0293 CIVIL TERM ~ ;~~i~~ Defendant may„ ~ , ~ri f r~~ ~ ate; ORDER OF COURT ~-.. ~:- ~~ ._ __, a~,a ~. AND NOW, this 28~ day of NOVEMBER, 2012, a hearing on Defendant's Petition to Terminate Alimony is scheduled for TUESDAY, JANUARY 15, 2013, at 1:30 p.m. in Courtroom # 3 B Court, Edward E. Guido, J. / Suellyn Giltz 115 Rutledge Alley Mechanicsburg, Pa. 17050 / John C. Howett, Jr., Esquire P.o. BoX 810 Harrisburg, Pa. 17108 CoP;~ M~i~ „Ia9~p~ :sld In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION SUELLYN G. GILTZ ) Docket Number: 10-293 CIVIL Plaintiff ) vs. ) PACSES Case Number: 193111400 JOHN S. KOSTUKOVICH ) Defendant ) Other State ID Number: C1 ` .r —cs x ` ORDER TO CREDIT ARREARS r- .�> x- C AND NOW, on this 14TH DAY OF MAY, 2013 IT IS HEREBY ORDE&b that, _ > credit be given on the,above.captioned case in the amount of$8,800.00. Thee isw? -4r O is not an agreement of the parties to the credit. This credit is for: ® Direct Payments. ❑ Purchases made or services performed by the Defendant on behalf of the Plaintiff or children. ❑ Time children resided with the Defendant as agreed upon by parties, or addressed in a partial custody order for the following time periods: From to From to From to ❑ Other: Plaintiff Date Defendant Date BY THE CART• 14TH DAY OF MAY. 2013 Date Edward E. Guido JUDGE Form FI-002 Service Type M Worker ID 21005 HE••16...L.1J .U (CAL Barbara Sumple-Sullivan,Esquire Supreme Court#32317 549 Bridge Street New Cumberland,PA 17070 rUMBERLAND COUNTY (717)774-1445 — OF NSYI VANIA SUELLYN G. KOSTUKOVICH, IN THE COURT OF COMMON PLEAS (now known as SUELLYN GILTZ) CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. NO. 10-293 JOHN S. KOSTUKOVICH, CIVIL ACTION - LAW Defendant PRAECIPE TO WITHDRAW Please withdraw the pending Petition to Terminate Alimony filed on November 20, 2012. Respectfully submitted, Dated: O zv1 ' Brian C. Lins ach, Esquire Stone, Duncan & Linsenbach, PC 8 N. Baltimore Street Dillsburg, PA 17019 (717)432-2089 Attorney for Petitioner PRAECIPE TO WITHDRAW Please withdraw the pending Counterclaim to the Petition to Terminate Alimony filed on December 17, 2012. Respe lly m' ed, Dated: Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Respondent