The URL can be used to link to this page

Home My WebLink About10-2051 FLED-QI-t`' ICE OF THE PROTHr,"NCOTAP,'Y TANNER LAW OFFICES, LLC 1300 Market Street, Suite 10 Lemoyne, PA 17043 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 1010 MAR 23 PH 1:43 r . L. ? FRITZ J. FICHTNER, § Plaintiff § V. § ANGELA F. FICHTNER, § Defendant § IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 10 - -W51 0,iv;1 Ier14 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 will proceed without you and a decree in 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 at One Courthouse Square, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF MARITAL PROPERTY, LAWYER'S FEES, OR EXPENSES BEFORE A DIVORCE 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 1-800-990-9108 717-249-3166 $3gl• 5o PO ATE 000140(0 2# 09sSA TANNER LAW OFFICES, LLC 1300 Market Street, Suite 10 Lemoyne, PA 17043 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 FRITZ J. FICHTNER, § IN THE COURT OF COMMON PLEAS OF Plaintiff § CUMBERLAND COUNTY, PENNSYLVANIA V. § NO. ANGELA F. FICHTNER, § CIVIL ACTION - DIVORCE Defendant § AVISO USTED HA SIDO DEMANDADO EN LA CORTE. Si desea defenderse de las quesjas expuestas en las paginas siguientes, debe tomar accion con prontitud. Se la avisa que si no defiende, el caso puede proceder sin usted y decreto de divorcio o anulmiento puede ser emitido en su contra por la Corte. Una decision puede tambien ser emitida en su contra por cualquier otra queja o compensacion reclamados por el demandante. Usted puede perder dinero, o propiedades u otros derechos importantas para usted. Cuando la base para el divorcio es indignidades o rompimiento irreparable del matrimonio, usted puede solicitar consejo matrimonial. Una lista de consejeros matrimoniales esta disponible en la oficina del Prothonotary, en One Courthouse Square, Carlisle, Pennsylvania. SI USTED NO RELAMA PENSION ALIMENTICIA, PROPIEDAD MARITAL, HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE QUE EL DECRETO FINAL DE DIVORCIO O ANULAMIENTO SEA EMITIDO, USTED PUEDE PERDER EL DERECHO A RECLAMAR CUALQUIERA DE ELLOS. USTED DEBE LLEVAR ESTE PAPEL A UN ABOGADO DE INMEDIATO. SI NO TIENE ORNO PUEDE PAGAR UN ABOGADO, VAYA O LLAME A LA OFICINA INDICADA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. CUMBERLAND COUNTY BAR ASSOCIATION 32 South Bedford Street Carlisle, PA 17013 1-800-990-9108 717-249-3166 TANNER LAW OFFICES, LLC 1300 Market Street, Suite 10 Lemoyne, PA 17043 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 FRITZ J. FICHTNER, § Plaintiff § V. § ANGELA F. FICHTNER, § Defendant § IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. CIVIL ACTION - DIVORCE COMPLAINT UNDER SECTION 3301(c) OR 3301(d) OF THE DIVORCE CODE AND NOW, comes the Plaintiff, Fritz Fichtner, by and through his attorney, Tanner Law Offices, LLC, and represents as follows: 1. Plaintiff is Fritz J. Fichtner, an adult individual currently residing at 48 Coopers Way, Denver, Lancaster County, Pennsylvania 17517. 2. Defendant is Angela F. Fichtner, an adult individual currently residing at 25 Circle Place, Camp Hill, Cumberland County, Pennsylvania 17011. 3. Plaintiff and Defendant have been bona fide residents of the Commonwealth of Pennsylvania for at least six (6) months immediately prior to the filing of this Complaint. 4. Plaintiff and Defendant were married on August 21, 1982 in Cumberland County, Pennsylvania. 5. The marriage is irretrievably broken: Plaintiff and Defendant have lived separate and apart since March 12, 2008, and continue to live separate and apart as of the date of filing this Complaint. Plaintiff desires a divorce based upon the belief that Defendant will, after ninety (90) days from the date of the filing of this Complaint, consent to this divorce. 6. There have been no prior actions of divorce or for annulment between the parties. 7. Defendant is not a member of the Armed Forces of the United States of America or any of its Allies. 8. The Plaintiff has been advised of the availability of counseling and the right to request that the Court require the parties to participate in counseling. Knowing this, the Plaintiff does not desire that the Court require the parties to participate in counseling. 9. Plaintiff requests the Court to enter a decree of divorce. WHEREFORE, Plaintiff prays that a decree in divorce be entered divorcing Plaintiff from the bonds of matrimony between the said Plaintiff and Defendant. COUNT I - EQUITABLE DISTRIBUTION OF MARITAL PROPERTY UNDER SECTION 3502W OF THE DIVORCE CODE 10. Paragraphs 1 through 9 are incorporated herein by reference as though set forth in full. 11. Plaintiff and Defendant have acquired marital property as defined by the Divorce Code, which is subject to equitable distribution pursuant to Section 3502(a) of the Divorce Code. 12. Plaintiff and Defendant have been unable to agree as to the equitable division of said property, as of the date of the filing of this Complaint. 13. Plaintiff requests that this Court equitably divide, distribute or assign the marital property between the parties. WHEREFORE, Plaintiff respectfully requests that this Court enter an order of equitable distribution of marital property pursuant to Section 3502(a) of the Divorce Code. Respectfully submitted, B Y• 7; ? X, la?1' Tabetha A. Tanner, Esquire Supreme Court I.D. No.: 91979 Attorney for Plaintiff TANNER LAW OFFICES, LLC 1300 Market Street, Suite 10 Lemoyne, PA 17043 (717) 731-8114 VERIFICATION I verify that the statements made in this Divorce Complaint are true and correct. I understand that false statements made herein may subject me to penalties of Pa.C.S. §4904 relating to unsworn falsification to authorities. l f? "D 'Ate Fri ner, Plaintiff TANNER LAW OFFICES, LLC 1300 Market Street, Suite 10 Lemoyne, PA 17043 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 RM-OMCE OF THE p-THv \10TA i 2010 MAP 23 PM 1: 47 FRITZ FICHTNER, § IN THE COURT OF COMMON PLEAS OF Plaintiff § CUMBERLAND COUNTY, PENNSYLVANIA V. § NO. 10 - cloSl Civil _Ierm ANGELA FICHTNER, § CIVIL ACTION - DIVORCE Defendant § NOTICE If you wish to deny any of the statements set forth in this affidavit, you must file a counter-affidavit within twenty days after this affidavit has been served on you or the statements will be admitted. AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated on March 12, 2008 and have continued to live separate and apart for a period of at least two (2) years. 2. The marriage is irretrievably broken. 3. 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. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: 7iOlf? itz tner IN RE: The Marriage of FRITZ FICHTNER Plaintiff vs. ANGELA FICHTNER IN THE COURT OF COMMON PLEA CUMBERLAND COUNTY, PENNSYIIA . NO. 10 I? Defendant ` MOTION FOR APPOINTMENT OF MASTER the following claims: Defendant , moves the court to appoint a master with respect to ?X Divorce ? Distribution of Property ? Annulment ? Support ?X Alimony ? Counsel Fees ? Alimony Pendente Lite ? Costs and Expenses and in support of the motion states: I . Discovery is complete as to the claims (s) for which the appointment of a master is requested. 2. The defendant has appeared in the action (personally) (by his attorney,_ Lindsay Gingrich Maclay ,Esquire). 3. The staturory ground (s) for divorce are 3301(c) or 3301(d) 4. Delete the inapplicable paragraph (s): A ?X B ?X C ? a. The action is not contested. b. An agreement has been reached with resnect to the following claims: C. The action is contested with respect to the following claims: The valuation and equitable distribution of marital property; alimony 5. The action does not involve 6. The hearing is expected to take complex issues of law or fact. days 7. Additional information, if anv, relevant to the motion: Date: 8/2/11 Attorney for Plaintiff Tabetha A. Tanner Print Name ORDER APPOINTING MASTER AND NOW 20 , Esquire, is appointed master with respect to the following claims: By the Court, c°•i "'1 Cry TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 -ED-OFFICE tTIE i'owONOTAF, ?M 10* 2? CUMBERLAND COUNT' SYLVANIA PENN in ice: i ne marriage of § FRITZ FICHTNER, § Plaintiff § V. § ANGELA FICHTNER, § Defendant § IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 10-2051 IN DIVORCE INVENTORY OF FRITZ FICHTNER, PLAINTIFF Plaintiff files the following inventory of all property owned or possessed by either parry at the time this action was commenced and all property transferred within the preceding three (3) years. Plaintiff verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: lJ? ?l ;FFichtnner-, Plaintiff ASSETS OF THE PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages. (X) 1. Real property (X) 2. Motor vehicles (X) 3. Stocks, bonds, securities and options () 4. Certificates of deposit (X) 5. Checking accounts, cash (X) 6. Savings accounts, money market and savings certificates () 7. Contents of safe deposit boxes O 8. Trusts (X) 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries) (X) 10. Annuities O 11. Gifts O 12. Inheritances () 13. Patents, copyrights, inventions, royalties () 14. Personal property outside the home () 15. Business (list all owners, including percentage of ownership and officer/director positions held by a party with company) () 16. Employment termination benefits - severance pay, worker's compensation claim/award () 17. Profit sharing plans () 18. Pension plans (indicate employee contribution and date plan vests) (X) 19. Retirement plans, Individual Retirement Accounts () 20. Disability payments () 21. Litigation claims (matured and unmatured) () 22. MilitaryN.A. benefits O 23. Education benefits () 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) () 26. Other - credit card debts/cash advances MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have a legal or equitable interest individually or with any other person as of the date this action was commenced: Item Number Description of Property 1 • 45 Circle Place Camp Hill, PA 17011 2. 2004 Jayco EXP M-25 E camper 3. 2001 Mercury Sable LS Car 4. 1996 Dodge 1500 Ram Truck 5. 1992 Dodge Stealth R/T car Names of All Owners Plaintiff/Defendant Plaintiff/Defendant Plaintiff/Defendant Plaintiff/Defendant Plaintiff/Defendant 6. 1990 Sea Sprite Boat 7. Life Insurance Policy 8. Vanguard IRA 9. SERS Annuity 10. Scottrade Account 11. Commerce Bank Account 12. PSECU Bank Account 13. Household furnishings Plaintiff/Defendant Plaintiff Plaintiff Plaintiff Defendant Plaintiff/Defendant Plaintiff/Defendant Plaintiff/Defendant A NON-MARITAL PROPERTY Plaintiff lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property. Item Number Description of Property Names of All Owners None. 1 $55,000 pre-marital value of Plaintiff the current marital residence PROPERTY TRANSFERRED Item Number Description Date of Consideration Person to Whom of Property Transfer Transferred 6. 1990 Sea Sprite Boat 07/10 $25200.00 Unknown LIABILITIES Item Number Description of Property Names of Names of All Creditors All Debtors None. 'iJl ? I?J? TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 2 Camp Hill, PA 17011 Telephone: (717) 731-8114 1'?JtK1ERLAl4D COUNT`( Facsimile: (717) 731-8115 PENNSYLVANIA In Re: The marriage of § IN THE COURT OF COMMON PLEAS FRITZ FICHTNER, § CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff § V. § CIVIL ACTION - LAW ANGELA FICHTNER, § NO. 10-2051 Defendant § IN DIVORCE EXPENSE STATEMENT OF FRITZ FICHTNER, PLAINTIFF EXPENSES HOME Monthly Monthly Monthly Total Children Parent Household Expenses $460.00 Mortgage or Rent Maintenance (HELOC) UTILITIES Electric Gas Oil Telephone Water Sewer Cable TV Internet Trash/Recycling EMPLOYMENT Lunch TAXES Real Estate Personal Property Monthly Monthly Monthly INSURANCE Total Children Parent Homeowners/Renters Automobile $58.00 Life Accident/Disability Health - Medicare Part B $96.00 Dental $37.00 Long-Term Care $250.00 AUTOMOBILE Lease or Loan Payments Fuel $200.00 Repairs $100.00 Memberships $5.00 MEDICAL Doctor Dentist Hospital Medicine Counseling/Therapy Orthodontist Special Needs (glasses, etc.) EDUCATION Tuition Room/Board Other PERSONAL Credit Card Transfer Loan Convenience Checks Clothing Food/Toiletries Haircare Memberships Church MISCELLANEOUS Child Care $20.00 $97.00 $40.00 $20.00 Monthly Total $125.00 $40.00 $210.00 $10.00 $10.00 Monthly Monthly Children Parent Household Summer Camp Papers/Books/Magazines Entertainment Pet Expenses Vacation Gifts Legal Fees/Prof. Fees Children's Parties Children's Allowances Other Child Support/PA Child Spousal Support Payments OTHER ADL Laundromat Accountant Repairs to Marital Residence TOTAL MONTHLY EXPENSES $100.00 $8.00 $15.00 $250.00 $23.00 $292.00 Monthly Monthly Monthly Total Children Parent $2,430.00 $125.00 $5,021.00 TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 In Re: The marriage of § FRITZ FICHTNER, § Plaintiff § V. § ANGELA FICHTNER, § Defendant § IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 10-2051 IN DIVORCE EXPENSE STATEMENT OF PLAINTIFF, FRITZ FICHTNER I, Fritz Fichtner, verify that the statements made in this Expense Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to falsification to authorities. 71 Date: 6 -2J rer, Plaintiff TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 -3 A 10: 26 Camp Hill, PA 17011 Telephone: (717) 731-8114 ? `E ! AND COUNTY N?"+SYLVANIA Facsimile: (717) 731-8115 In Re: The marriage of § IN THE COURT OF COMMON PLEAS FRITZ FICHTNER, § CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff § V. § CIVIL ACTION - LAW ANGELA FICHTNER, § NO. 10-2051 Defendant § IN DIVORCE INCOME STATEMENT OF FRITZ FICHTNER PLAINTIFF Employer: Lancaster County Motors Retired/Part-time driver Pay Period (weekly, biweekly, etc.): Weekly Gross Pay per Pay Period: $53.54 Part-time work (driver) Itemized Payroll Deductions: Federal Withholding N/A FICA N/A Local Wage Tax $0.54 State Income Tax $1.64 Mandatory Retirement N/A Health Insurance N/A Life Insurance N/A PA Child Support N/A Union Dues N/A Other Social Security Tax $3.32 Medi. Tax $0.78 SUI/SDI $.05 Net Pay per Pay Period: $47.21 INCOME: Part-time Employment Pension Distributions Social Security IRA Distributions TOTAL INCOME PROPERTY OWNED Checking accounts Savings accounts Stocks/bonds Real estate Vehicles Vanguard IRA Other MONTHLY GROSS MONTH YEAR $232.00 $ 204.50 $2,888.00 $2,388.00 $1,571.00 $1,475.00 $ 708.00 $4,775.50 Description Value Commerce Bank $1,896 as of 3/12/08 PSECU $384 as of 3/12/08 Scott Trade Unknown Marital Residence $234,000 2004 Jayco camper $9,620 2001 Mercury Sable $4,455 1996 Dodge 1500 $3,810 1992 Dodge Stealth $3,370 $29,000 Household Items Unknown Ownership H W J X X X X X X X X X X INSURANCE Company Policy No. Medical Blue Shield Y PEBT United Behavioral Health PEBT Aetna Medicare Health/Accident Disability Income Dental United Concordia Dental Other (Long Term Care Insurance) Genworth Financial Coverage H W J X X X X X TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 In Re: The marriage of § IN THE COURT OF COMMON PLEAS FRITZ FICHTNER, § CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff § V. § CIVIL ACTION - LAW ANGELA FICHTNER, § NO. 10-2051 Defendant § IN DIVORCE INCOME STATEMENT OF PLAINTIFF. FRITZ FICHTNER I, Fritz Fichtner, verify that the statements made in this Income Statement are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to falsification to authorities. Date: ? 11 Fri z Fichtner, Plaintiff Form 1 Name, Address, and SSN See separate instructions. Presidential Campaign Filing Status Check only one box. Exemptions Department of the Treasury - Internal Revenue Service U.S. Individual Income Tax I For the year Jan 1 - Dec 31, 2010, or other tax year beginni O 9 IRS Use Only - Do not write or staple in Your first name MI Last name Your aeew seetray r mdw Fritz J Fichtner 195-30-7531 If a joint return, spouse's first name MI Last name apousa s sodw sacuray tKaelbar Angela F Fichtner 202-36-6535 Home address (number and street). If you have a P.O. box, see instructions. Apartment no. Make sure the SSN(s) 48 Coopers Way . above and on line 6c city, town or post office. If you have a foreign address, see instructions. State ZIP code are correct. Denver Checking a box below will not PA 17 517 change your tax or refund. ' Check here if you, or your spouse if filing jointly, want $3 to go to this fund? . .............. ? El You []Spouse 1 Single 4 Head of household (with qualifying person). (See 2 X Married filing jointly (even if only one had income) instructions.) If the qualifying person is a chid but not your.) enter this child's 3 Married filing separately. Enter spouse's SSN above & full name here. ? name here .. ? 5 n Qualifying widow(er) with dependent child 6a X Yourself. If someone can claim you as a dependent, do not check box 6a ............ b Spouse .................................... . c Dependents: (2) Dependent's (3) Dependent's n on ec wha social security number relationship to you child e piler • lived a for "'m'yO1' (1) First name Last name did nt ; i ` s e t?)epuu d wbdFon w or seper o (fN fnstrs) "WW abov Add roanbarr If more than four dependents, see instructions and check here ... ?? a I oial nUMDer Ot exemptions claimed -, I - . . ' ........................................... . above.... Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ...................................... .. . 8a Taxable interest. Attach Schedule B if required ............................. . b Tax-exempt interest. Do not include on line 8a .............. 8b Attach Form(s) 9 a Ordinary dividends. Attach Schedule B if required ................................ . W-1 here. Also afth Forms ... b Qualified dividends ...................................... . . I 9bl .. . W- 2G and 1099-R 10 Taxable refunds, credits, or offsets of state and local income taxes ................. . .. ... 1 if tax was withheld. 11 Alimony received ................................................................. .. 1 If you did not 12 Business income or (loss). Attach Schedule C or C•EZ ............................... ... 1 get a W-2 13 Capital gain or (loss). Aft Sch D if reqd. If not read, ck here .......................... 11. 1 see instructions. 14 Other gains or (losses). Attach Form 4797 .......................................... . . . 1 15a IRA distributions ............ 15a l _J b Taxable amount ........ . . ... 16a Pensions and annuities ...... 16a 34 658 . I b Taxable amount ........ . . ... 11 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 1' Enclose, but do 18 Farm income or (loss). Attach Schedule F ................................. . 11 net attach, any payment Also 19 .. ....... Unemployment compensation .............. ... , , . , .... , , . , , , , ... . , , 1t , please use 20a Social security benefits ........... 1 20 a l 18, 8 5 8 . b Taxable amount .......... ... 21 Form 10404. 21 Other income ------------- r 22 ----------------------- Combine the amounts in the far right column for lines 7 through 21. This is ur total income ............ - . ? Z Adjusted 23 24 Educator expenses ... ................................... C 23 G ertain business expenses of reservists, performing artists, and fee•basis ff ross government o icials. Attach Form 2106 or 2106-EZ .................... 24 Income 25 Health savings account deduction. Attach Form 8889 ........ 25 26 Moving expenses. Attach Form 3903 ....................... 27 One-half of self-employment tax. Attach Schedule SE ...... , . 27 28 Self-employed S,EP, SIMPLE, and qualified plans ............ 28 29 Self-employed health insurance deduction .................. 29 30 Penalty on early withdrawal of savings ..................... 30 31 a Alimony paid b Recipient's SSN .... ? 31 a 32 IRA deduction .................. ............... 32 33 Student loan interest deduction ............................ 33 34 Tuition and fees. Attach Form 8917 ........................ 34 35 Domestic production activities deduction. Attach Form 8903 .............. 35 36 Add lines 23 : 31a and 32.35 ............................................................... 36 37 Subtract line 36 from line 22. This is our adjusted roes income ...... . .............. ? 37 BM For Disclosu re Priva Act and Pa & R d ta , e c MVW -? 2 No. of chedren e I. ? 2 2,784. 9a 0 1 2 3 4 5b 8,500. 5b 34,634. 7 3 II )b 15,645. 61.5 cY P-1 __ u on Act Notice, see separate instructions. FDIA0112 12!22110 ol, JvJ. Form 1040 (2010) corm w41111 10 Fritz J & An ela F Fichtner 195-30-7531 Page 2 Tax and 38 Amount from line 37 (adjusted gross income) ..................... . . ................... 38 61,563. Credits 39a Check _L XX You were born before January 2, 1946, Blind. Total boxes if: L Spouse was born before January 2, 1946, 8 Blind. checked ? 39a 1 b If your spouse Itemizes on a separate return, or you were a dual-status alien, check here ..... , .. ? 39b - 40 Itemized deductions (from Schedule A) or your standard deduction (see instructions) .................... 40 12,500. 41 Subtract line 40 from line 38 .......................................................... 41 49,063. 42 Exemptions. Multiply $3,650 by the number on line 6d ......... . ........................ 42 7,300. 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- ............. ................................. 43 41,763. 44 Tax (see instrs). Check if any tax is from: a H 1=orm(s) 8814 b Form 4972 ........................... 44 5,429. 45 Alternative minimum tax (see instructions). Attach Form 6251 ........................... 45 46 Add lines 44 and 45 ................................................................. ? 46 5,429. 47 Foreign tax credit. Attach Form 1116 if required ............. 47 48 Credit for child and dependent care expenses. Attach Form 2441 .......... 48 49 Education credits from Form 8863, line 23 ............ . ... . . 49 1 160 . 50 Retirement savings contributions credit. Attach Form 8880 ... 50 51 Child tax credit (see instructions) .......................... 51 S2 Residential energy credits. Attach Form 5695 ............... 52 248. 53 Other crs from Form: a F? 3800 b E] 8801 c S3 54 Add lines 47 through 53. These are your total credits ................................... 54 1,408. 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- .................. ? 55 4,021. Other 56 Self-employment tax. Attach Schedule SE ................ , 56 ..................................... . BXeS 57 Unreported social security and Medicare tax from Form: a [] 4137 b n 8919 ........................ 57 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required .... . ... . ........ . . 56 598 ® Form(s) W-2, box 9 b [] Schedule H c ? Form 5405, line 16 ..... 59 60 Add lines 55-59. This is our total tax ........ , .. ............................... ? 60 4,021. Payments 61 Federal income tax withheld from Forms W2 and 1099 ...... 61 6,000. 62 2010 estimated tax payments and amount applied from 2009 return ........ 62 If you have a L 63 Making work pay credit. Attach Schedule M .............. . .. 63 173. qualifying 64a Earned income credit (EIC) ................................ 64a child, attach b Nontaxable combat pay election ..... ? 64bl Schedule E1C. ? 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 fife ..... . .... . .... 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 n 8839 c ? 880i d ? 8885 . 71 72 Add Ins 61-63 64a & 65.71. These are your total parts ... . ..................................... ? 72 6 17 3 . Refund 73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid ........... 73 2,152. 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here .. ? 74a --2,152. ? b Routing number .. , ..... XXXXXXXXX ? c Type: Checking saving's Direct deposit? ? d Account number ....... XXXXXXXXXXXXXXXXX See instructions. 75 Amount of line 73 you want applied to Your 2011 estimated tax .... , . , . ? 75 Amount 76 Amount you owe. Subtract line 72 from line 60. For details on how to pay see instructions ................ ? 76 You Owe 77 Estimated tax penalty see instructions 77 Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? .......... ? Yes. Complete below. X No Designee Designee's no. P rm I idea tifcation bell under penalties of perjury, I declare that I have examined this return and my (PIM krawledge and egr@ belief, they ara true, correct, and cornPlets. Declaration of PreParer (otherthan tazn??? and statements, and to the best of payer) is based on all information of which preparer has any knowledge. Here Joint return? Your signature Date Your occupation Daytime phone number See instructions. Retired Keep a copy , Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your records. Homemaker Print/Type preparer's name Preparer's signature Date Check if PnN Paid self-em prepalreeS Firm's name Self-Prepared Use 011iy Firm's address 61 Firm's FIN ? Form 1040 (2010) FDIA0112 12/22110 Form a trmelRe,roolueeSe reasury ( Education Credits (American Opportunity and Lifetime Lealming Credits) ? See separate Instructions to find out If you are eligible to take the credits. ? Attach to Form 1040 or Form 1040A. OMB No. 1546.0074 2010 Name(s) shown on retum Yaw aodd ssawfty ra"M - - - Fritz J & Angela F Fichtner 1 195-30-7531 CAUTION! You cannot take both an education credit and the tuition and fees deduction (see Form 8917) for 6* mm sW*W for the same year. - American Opportunity Credit Caution: You cannot take the American o rtuni credit for more than 4 tax years for tale SAW ShNA nt 1 (a) Student's name (as shown on page 1 (b) Student's social securit (c) Qualified (d) Subtract $2,000 f h (e) Multiply the (f) If column (d) is of your tax return) y number (as shown expenses (see instructions). Do rom t e amount in column (c). If zero amount in column (d) by 25% (.25) zero, enter the amount from on page 1 of not enter more or less, enter -0- column (c). Other- First name your tax return) than $4,000 for wise, add $2,000 to _ Last name each student. the amount in ..-h..,, /-N 2 Tentative American opportunity credit Add the amounts on line 1, column (f). If you are taking the lifetime learning credit for a dl'fferent student o to Part II• otherwise o to Part III ................................. ? 2 Lifetime Learning Credit. Caution: You csnnot take the American opportunity credit and the lifetime learning credit for the ssvme str %*ntin the same year. $ (a) Student's name (as shown on page 1 of your tax return) (b) Student's social (c) Qualified security number (as expenses shown on page 1 of (see instructions) First name Last name your tax return) Angela F Fichtner 202-36-6535 5.801 4 Add the amounts on line 3, column (c), and enter the total ................................................. 4 5,800. 5 Enter the smaller of line 4 or $10,000 .................................................................... 5 5,800. 6 Tentative lifetime looming credit. Multiply line 5 by 20% (.20). If you have an entry on line 2, go to Part III; otherwise o to Part 1V 6 1,160. 1A For Paperwork Reduction Act Notice, see your tax return Instructions. FDIA3601 12/31/10 Form 8863 (2010) ?tir.r a ?.??,v4 rr?LZ U e, Angela r r*icntner 195-30-7531 Paget 7 Enter the amount from line 2 ............................................................................ 8 Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er) ...................................................... ks, 9 Enter the amount from Form 1040, line 38,' or Form 1040A, line 22 ............. 10 Subtract line 9 from line 8. If zero or less, stop; you cannot take any education credit ............................................................. 10 11 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) ................ ..................................... 11 12 If line 10 is: • Equal to or more than line 11, enter 1.000 on line 12 .................................. • . Less than line 11, divide line 10 by line 11. Enter the result as a decimal (rounded to at least three places) ........................................................... _ 12 13 Multiply line 7 by line 12. Caution, If you were under age 24 at the end of the year and meet the cond ons in the instructions, you cannot take the refundable American opportunity credit. Skip line 14, enter the amount from line 13 on line 15, and check this box .......................... . ...... ? 13 14 Refundable !American opportunity credit. Multiply line 13 by 40% (.40). Enter the amount here and on Form line 66, or Form 1 A, line 43. Then go to tine 15 below .................... .... 14 15 Subtract line 14 from line 13 ............................................................................ 16 Enter the amount from line 6 if any. If you have no entry on line 6, skip lines 17 t amount from line 15 on line 9 of the Credit Limit Worksheet (see in tr ti s uc ons) .... . . ... 16 1, 160 . 17 Enter: $120,000 if married filing jointly; $60,000 if single, head of household, or qualifying widow(er) ...................................................... 0 0 . 18 Enter the amount from Form 1040, line 38,• or Form 1040A, line 22 ............. Fi 63 . i 19 Subtract line 18 from line 17. If zero or less, skip lines 20 and 21, and enter zero online 22 ............................................................. 3 7. 20 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) ..................................................... O 0. 21 If line 19 is: • Equal to or more than line 20, enter 1.000 on line 21 and go t o line 22 •' ' Less than line 20, divide line 19 by line 20. Enter the result as a decimal (rounded to at least three places) ..................................................................................... ....... 21 1.000 22 Multiply line 16 by line 21. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) .... ..... 22 1,160. 23 Nonrefundable education credits. Enter the amount 'from line 11 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 49, or Form 1040A, line 31 ................................ ....... 23 1,160. ` If you are filing Form 2555, 2555-EZ, or AIM, or you are excluding inoome from Puerto Rico, see Pub 970 for the amount to enter. Form 8863 (2010) FDIA3601 12/31110 569 OW No. 1545A074 Form Departrnent of the Treasury Internal Revenue Service Residential Energy Credits " See Instructians. P- Attach to Form 1b40 or Form 1040NR. 201 0 AftsdneM Sequence No. Name(s) shown on return Fritz ,J & Angela F Fichtner 1 Your mdal "fir yr numbw 195-30-7531 Nonbusiness Energy Property Credit (See instructions before completing this part.) 1 Were the qualified energy efficiency improvements or residential energy property costs for your main home located in the United States? (see instructions) ......................................................... ? 1 Yes No Caution: ifyou checked the No' box, you cannot claim the nonbusiness energy property credit. Do not complete Part 1. 2 Qualified energy efficiency improvements (see instructions). a Insulation material or system specifically and primarily designed to reduce the heat loss or gain of your home ............................................................................................ a 50. b Exterior windows (including certain storm windows) and skylights .......................................... 2b c Exterior doors (including certain storm doors) .......................................................... . 2c d Metal roof with appropriate pigmented coatings or asphalt roof with appropriate cooling granules that are specifically and primarily designed to reduce the heat gain of your home, and the roof meets or exceeds the Energy Star program requirements in effect at the time of purchase or installation ........................... 2d 3 Residential energy property costs (see instructions). a Energy-efficient building property ....................................................................... 3a b Qualified natural gas, propane, or oil furnace or hot water boiler ........................................... 3b c Advanced main air circulating fan used in a natural gas, propane, or oil furnace ............................. 3c 375. 4 Add lines 2a through 3c ................................................................................. 4 825. 5 Multiply line 4 by 30% (.30) ............................................................................. 5 248. 6 Maximum credit amount. (If you jointly occupied the home, see instructions) ............................................... 6 1,500. 7 Enter the amount, if any, from your 2009 Form 5695, line 11. Otherwise enter -0. ........................... 7 450. 8 Subtract line 7 from line 6 .............................................. 8 1,050. 9 Enter the smaller of line 5 or line 8 ...................................................................... 9 248. 10 Limitation based on tax liability. Enter the amount from the Credit Limit Worksheet (see instructions) .......... 10 4,269. 11 Nonbusiness energy property credit. Enter the smaller of line 9 or line 10. Also include this amount on Form 1040, line 52, or Form T040NR line 49 ............................................................. 11 248. BAA For Paperwork Reduction Act Notice, see your tax return instructions. Form 5M (2010) FDiA5712 01/07n1 Form 5685 (2010) FRITZ J & ANGELA F FICHTNER 195-30-7531 Page 2 r-Residentinl Energy Efficient Property Credit (See instructions before completing this part.) Note. Skip lines 12 through 21 if you only have a credit carryforward from 2it9. 12 Qualified solar electric property costs ................................................................... . 13 Qualified solar water heating property costs .............................................................. 1 13 14 Qualified small wind energy property costs ............................................................... 114 15 Qualified geothermal heat pump property costs ................... .......... , ...................1 15 16 Add lines 12 through 15 .................................................................................1 16 17 Multiply line 16 by 30% (.30) ............................................................................ 17 18 Qualified fuel cell property costs ............................................. 18 19 Multiply line 18 by 30% (.30) ................................................. 19 20 Kilowatt capacity of property on line 18 above ? X $1, 000 ... 20 21 Enter the smaller of line 19 or line 20 ................................................................ 21 22 Credit carryforward from 2009. Enter the amount, if any, from your 2009 Form 5695, line 28 .................. 23 Add lines 17, 21, and 22 ................................................................................ 24 Enter the amount from Form 1040, line 46, or Form 1040NR, line 44 ............124 25 1040 filers: Enter the total, if any, of your credits from Form 1040, lines 47 through 50; line 11 of this form; line 12 of the Line 11 worksheet in Pub 972 (see instructions)* Form 8396, line 9, Form 8859, line 3; Form 8834, line 22; Form 4910, line 21; Form 8936, line 14; and Schedule R, line 22. 104ONR filers: Enter the amount, if any, from Form 1040NR, lines 45 through 47; line 11 of this form; line 12 of the Line 11 worksheet in Pub 972 (see instructions); Form 8396, line 9; Form 8859, line 3; Form 8834, line 22; Form 8910, line 21; and Form 8936, line 14. 26 Subtract line 25 from line 24. If zero or less, enter -0- here and on line 27 ................................. . 27 Residential energy efficient property credit Enter the smaller of line 23 or line 26. Also include this amount on Form 1040, line 52, or Form 1e40NR,line 49 .......................................................... 28 Credit carryforward to 2011. If line 27 is less than line 23, Subtract line 27 from line 23 ................................... Form 5695 (2010) FDIA5712 01/07/11 SCHOULE M (Form 1040A or 1040) Irimrna?i1°nRe ol the Treasury (99) Name(s) shown on return Making Work Pay Credit ? Attach to Form 1040A or 1040. ? See separate instructions. & Angela F Fichtner OMB No. 1$46.0074 2010 You'smial security number 195-30-7531 Caution: To take the making work It credit, you must Include your social security number (if frtinp a joint return, the number of either you or your spouse) on your tax re m. A social security number does not include an identitfcabon number Issued by the IRS. Only Hre Social Securi4e Administration issues social security numbers. Caution: You cannot take the making work pay credit if you can be claimed as someone else's dependent or if you area nonresident alien. lunpertant; Check the 'No' box on line 1 a and see the instructions if: (a) You have a net loss from a business, (b) You received a taxable scholarship or fellowship grant not reported on a Form W-2, (c) Your wages include pay for work performed while an inmate in a penal institution, (d) You received a pension or annuity from a nonquaiified deferred compensation plan or a nongovernmental section 457 plan, or (e) You are filing Form 2555 or 2555-EZ. 1 a Do you (and your spouse if filing jointly) have 2010 wages of more than $6,451 (=12,903 if married filing jointly)? Yes. Skip lines 1 a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5. HX No. Enter your earned income (see instructions) .......... . ..... . .......... Is 2,784 b Nontaxable combat pay included on line 1 a (see instructions) ................................ ( 1 bl 2 Multiply line la by 6.2% (.062) ............................................... 2 17.3 3 Enter $400 ($800 if married filing jointly) ...................................... 3 800 4 Enter the smaller of line 2 or line 3 (unless you checked 'Yes' on line 1 a) ................................... 5 Enter the amount from Form 1040, line 38", or Form 1040A, line 22 ........... . . 5 61,563. 6 Enter $75,000 ($150,000 if married filing jointly) ............................... 6 150, 000. 7 Is the amount on line 5 more than the amount on line 6? 8 No. Skip line 8. Enter the amount from line 4 on line 9 below. Yes. Subtract line 6 from line 5 ........................................... 8 Multiply line 7 by 2% (.02) ..............................................................................1 8 9 Subtract line 8 from line 4. If zero or less, enter -0. ....................................................... 10 Did you (or your spouse, it filing jointly) receive an economic recovery payment in 2010? You may have received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received social security benefits, supplemental security income, railroad retirement benefits, or veterans disability compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions). Q No. Enter -0- on line 10 and go to line 11. FlYes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010. Do not enter more than $250 ($500 if married filing jointly) ............................................. 11 Alatdn work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on Form X, line 63; or Form 1040A, line 40 .............................................................. 173. *If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico see instructions SAA For Paperwork Reduction Act Notice, see your tax return Instructions. Schedule M (Form 1040A or 1040) 2010 FDIA8501 09/20/10 Form 1040 Social Security Benefits Worksheet 2010 Lin! 20 Keep for your records Name(s) Shown on Return Social Security Number Fritz J & Angela F Fichtner 195-30-7531 Social Security/Railroad Retirement benefits received in 2010 ............. ? F T Taxpayer Spouse A Total net benefits from Box 5 of all SSA-1099 forms .................... 18,858. B Total federal tax withheld from box 6 of all SSA-1099 forms C Total Medicare B premiums withheld from all SSA-1099 forms .......... 1,158. Note: If self-employed, Medicare Part B premiums are deductible as Self-Employed Health Insurance. If self-employed, enter Part B premiums on the business activity form (Schedule C, F, etc), not on Line C above. D Total Medicare D premiums withheld from all SSA-1099 forms .......... E Total net benefits from Box 5 of all RR8.1099 forms .................... F Total federal tax withheld from box 10 of all RR8.1099 forms 0 Total Medicare premiums from Box 11 of all RRB-1099 forms ........... 1 Add amounts from line A and line E above. Also enter this amount on Form 1040, line 20a ................................................................. 1 18,858. 2 Enter one-half of line 1 .............................................................. 2 9,429. 3 Add the amounts on Form 1040, lines 7 (before adoption benefits exclusion) , 8a (before U.S. savings bond interest exclusion), 8b, 9a, 10 through 14, 15b, 16b, 17 through 19, and line 21. Also include certain income of bona fide residents of American Samoa or Puerto Rico ......................................... 3 45,918. 4 Enter the total of any exclusions/adjustments for: e Foreign earned income or housing exclusion ...................................... 4 5 Add lines 2, 3, and 4 ................................................................ 5 55,347. 6 Amount from Form 1040, lines 23 through 32, plus any write-in amounts on line 36 (other than foreign housing deduction) ..................................... 6 7 Subtract line 6 from line 5 ........................................................... 7 55,347, 8 Enter $25,000 ($32,000 if married filing jointly; $0 if married filing separately and you lived with your spouse at any time in 2010) .................................. 8 32,000. 9 Subtract line 8 from line 7. If zero or less, enter -0................................... 9 23,347. If line 9 Is zero or less, stop here; none of your social security benefits are taxable. Enter -0- on Form 1040, line 20b. If you are married filing separately and you lived apart from your spouse for all of 2010, enter 'D' to the right of the word 'benefits' on line 20a. If line 9 Is more than zero, go to line 10. 10 Enter $9,000 ($12,000 if married filing jointly; $0 if married filing separately and you lived with your spouse at any time in 2010) .................................. 10 12,000. 11 Subtract line 10 from line 9. If zero or less, enter -0 . ................................. 11 11,347. 12 Enter the smaller of line 9 or line 10 ................................................. 12 12,000. 13 Enter one-half of line 12 ............................................................. 13 6,000. 14 Enter the smaller of line 2 or line 13 ................................................. 14 6,000. 15 Multiply line 11 by 85% (.85). If line 11 is zero, enter -0.............. ................ 15 9,645. 16 Add lines 14 and 15 ......................................................... ... 16 15,645. 17 Multiply line 1 by 85% (.85) .......................................................... 17 16, 029. 18 Taxable social security benefits, Enter the smaller of line 16 or line 17 ............... 18 15,645. If prior year lump-sum benefits were received, go to line 19, otherwise, skip line 19 and enter the amount from line 18 on line 20. 19 Taxable benefits with lump sum election. Enter the amount from fine 20 of the Lump-Sum Social Security Worksheet ................................................ 19 20 Taxable Social Security benefits. Enter the smaller of line 18 or line 19 Also enter this amount on Form 1040, line 20b ................................. _ 20 15,645. Tax Payments Worksheet 2010 b- Keep for your records Name(s) Shown on Return Social Security Number Fritz J & Angela F Fichtner 195-30-7531 Estimated Tax Payments for 2010 (If more than 4 payments for any state or locality, see Tax Help) Federal State Local Date Amount Date Amount ID Date Amount ID 1 04/15/10 04/15/10 04/15/10 2 06/15/10 06/15/10 06/15/10 3 09/15/10 09/15/10 09/15/10 4 01/18/11 01/18/11 01/18/11 5 To t Estimated Pa yments .... Tax Payments Other Than Withholding (If multiple states, see Tax Help) Federal State ID Local ID 6 Overpayments applied to 2010 ...... 7 Credited by estates and trusts ...... 8 Totals Lines 1 through 7 ........... 9 2010 extensions ..................... Taxes Withheld From: Federal State Local 10 Forms W-2 ....................................... 86. 28. 11 Forms W-2G ..................................... 12 Forms 1099-R ................................... 6,000. 13 Forms 1099-MISC and 1099-G .................. 14 Schedules K-1 ................................... 15 Forms 1099-INT, DIV and OID .................. . 16 Social Security and Railroad Benefits 17 Form 1099.6 ............ St .... Loc ....... 18a Other withholding ....... St Loc b Other withholding ....... St Loc c Other withholding ....... St _ Loc 19 Total Withholding Lines 10 through 18c........ 6,000. 86. 28 20 Total Tax Payments for 2010 ................... 6 , 000, 86. . 28 . Prior Year Taxes Paid In 2010 (If multiple states or localities, see Tax Help) State ID Local ID 21 Tax paid with 2009 extensions ........................ 22 2009 estimated tax paid after 12/31/09 .............. . _ 23 Balance due paid with 2009 return .................... 24 Other (amended returns, installment payments, etc) . _ Education Tuition and Fees Summary 2010 ? Keep for your records Name(s) Shown on Return Your Social Security No. Fritz J & Angela F Fichtner 195-30-7531 Part I - Qualified Education Expense Summary (a) Student's name First Name MI (b) Qualified Education (c) Qualified for: (d) Elected Credit or (e) Elected Credit or Last Name Suffix Expenses Deduction Deduction Social Security Number Yes No if manual if automatic Angela F 51 800. Amer Opp Cr . ? X _ Fichtner 5, 800. . Lifetime Cr..... ? X i X 202-36-6535 5,800. 5,800. Tuition Ded .... ? Amer Opp Cr .. ? X Lifetime Cr ..... ? Tuition Ded .... ? Amer Opp Cr .. ? Lifetime Cr ..... ? Tuition Ded .... ? Total qualified expenses ........ 5,800. Amer Opp Cr '800. Lifetime Cr 5,800- Tuition Ded Part it - Optimize Education Expenses for the Lowest Tax Automatic 1 Launch OPTIMIZER - Check to launch Automatic Education Expense Optimizer now ........... ?a 2 Automatic - Check to use the Credit choices calculated in Part I, column (e) above ............ ?aX or 3 Manual Check to use the Credit choices you entered in Part I, column (d) above .............. ?0 Fritz J & Angela F Fichtner 195-30-7531 Part 111- Summary of Net Tax, Deduction, and Credits Net Tax Liability based on the Credit combination selected in Part 11 1 Total tax ....................................................................... 1 4, 021. 2 Making work pay and government retiree credit... , . 2 173. 3 Earned income credit (EIC) .......................... 3 4 Additional child tax credit . ........................... 4 5 First-time homebuyer credit from Form 5405 ........ 5 6 Credit for federal tax paid on fuels from Form 4136 6 7 Refundable credit from Form 8801 ................... 7 8 Health Coverage Tax Credit from Form 8885 ........ 8 9 Net tax Liability without carryfonaards ..................................... ? 9 3,848. Credit Carryforwards 10 a General Business Credit ... 10a b Mortgage interest credit .... b c Foreign tax credit .......... c d Residential Energy Credit .. d e Other carryover ............. e f Other carryover ............. f Total Carryovers ..................................... 10 11 Net tax liability with carryforwards ......................................... ? 11 3,848. Tuition and Fees Deduction Summary 12 Total 2010 tuition and fees paid for purposes of deduction .................... 12 13 Modified adjusted gross income ............................................... 13 14 Maximum deduction allowed ................................................... 14 15 Allowable Tuition and Fees Deduction (lesser of line 12 or line 14) 15 American Opportunity, Lifetime Learning Credits Summary 16 Tentative American Opportunity Credit ........................................ 16 11 Tentative Lifetime Learning Credit ............................................. 17 1,160. 18 Total Education Credits (after limitations) ..................................... 18 1,160. Federal Carryover Worksheet 2010 ? Keep for your records Name(s) Shown on Return Social Security Number Fritz J & Angela F Fichtner 195-30-7531 2009 State and Local Income Tax Information (See Tax Help) (a) (b) (c) (d) (e) (f) State or Paid With Estimates Pd Total With. Paid With Total Over- Local ID Extension After 12131 held/Pmts Return n wmonf PA 67. (9) Applied Amount Totals .... 67. Other Tax and Income Information 2009 2010 1 Filing status ................................................... 2 Number of exemptions for blind or over 65 (0 - 4) ........ , ... 1 2 2 MFJ 1 2 MFJ 1 3 Itemized deductions after limitation ........................... 3 8,220. 114673. 4 Check box if required to itemize deductions .................. 5 Adjusted gross income ........................................ 4 5 54,348. 61,563. 6 Tax liability for Form 2210 or Form 2210-F ................... 6 3,744. 3,848. 7 Alternative minimum tax ...................................... 7 8 Federal overpayment applied to next year estimated tax ..... 8 QuickZoom to the IRA Information Worksheet for IRA information ............................ ? 8, . Excess Contributions 2009 2010 9 a Taxpayer's excess Archer MSA contributions as of 12/31 .... 9 a b Spouse's excess Archer MSA contributions as of 12/31 ...... b log Taxpayer's excess Coverdell ESA contributions as of 12/31 .. log b Spouse's excess Coverdell ESA contributions as of 12/31 ... b 11 a Taxpayer's excess HSA contributions as of 12/31 ............ 11 a b Spouse's excess HSA contributions as of 12!31 .............. b Loss and Expense Carryovers 2009 2010 12 a Short-term capital loss ........................................ 12a b AMT Short-term capital loss ................. . ....... . ........ b 13a Long-term capital loss ........................................ 13a b AMT Long-term capital loss ................................... b 14a Net operating loss available to carry forward ................. 14a b AMT Net operating loss available to carry forward ............ b 15a Investment interest expense disallowed ...................... 15a b AMT Investment interest expense disallowed ................. 16 N b onrecaptured net Section 1231 losses from: a 2010 .... 16a b 2009 .... b c 2008 .... c d 2007 .... d e 2006 .... e f 2005.... f ®? Federal Carryover Worksheet page 2 2010 Fritz J & Angela F Fichtner 195-30-7531 Loss and Expense Carryovers (cont'd) 2009 2010 17 AMT Nonrecap'd net Sec 1231 losses from: a 2010 .... 17a b 2009 .... b c 2008 .... C d 2007 .... d e 2006 .... e f 2005.... f Credit Carryovers 2009 2010 18 General business cred 19 Adoption credit from: it ....................................... a 2010 .............................. b 2009 .............................. 18 198 b c 2008 .............................. C d 2007 .............................. d e 2006 .............................. e 20 Mortgage interest cred f 2005. .......................... it from: a 2010 ..................... f 208 -? b 2009 ..................... b c 2008 ..................... C d 2007 ..................... d -? 21 Credit for prior year minimum tax ............................. 21 22 District of Columbia first-time homebuyer credit .............. 22 23 Residential energy efficient property credit ................... 23 0. Other Carryovers 2009 2010 24 Section 179 expense deduction disallowed ................... 24 25 Excess a Taxpayer (Form 2555, line 46) ........... 25 a foreign b Taxpayer (Form 2555, line 48) ........... b housing c Spouse (Form 2555, line 46) ............ C deduction: d Spouse (Form 2555, line 48) ............ d Federal Carryover Worksheet page 3 2010 Fritz J & Angela F Fichtner 195-30-7531 Charitable Contribution Canryovers 26 2009 Carryover of Other Property Capital Gain charitable contributions from: (S)50% (b) 30% (c) 30% (d) 20% a 2009 ......................... b 2008 ......................... c 2007 ..................... ... d 2006 ......................... e 2005 ......................... 27 2010 Carryover of Other Property Capital Gain charitable contributions from: (a) 50% (b) 30% (c) 30% (d) 20% a 2010 ......................... b 2009 ......................... c 2008 ......................... d 2007 ........... e 2006 ......................... 28 Amount overpaid less earned income credit ............................................. 2,256. 2009 State Capital Loss Carryovers (For users not transferring from the prior year) Stara 10 Short-term Capital Loss for State AMT Shod=dean Capital Loss for State Long-tom Capital Loss for State AMT LonU term Capital Loss for State Capital Loss (combined for Stale AMT Capital Loss (combined) for State LANCASTER000NTY MOTORB.INC. EAST PETERSBURG, PA 17820 z :" 100 13 223 lyya>.; }mrm:.>:>'::Fb!!:;i.';.":?rm!MI!i...::..;:Yttf: REG 410 85000 3485 129473 I 1 I I I I I I I I 2010 7 Social security tips Form W-2 Wage and Tax Statement 1 Wages, tips, other comp. 2 Federal income tax withheld ( ' Rev.March 20101 2784 15 c Employer s name, address, and ZIP coda 8 Allocated tips . 3 Social security wages 4 Social security tax withheld LANCASTER COUNTY MOTORS 2784.15 172.6: PO BOX 404 9 Advance EIC payment 5 Medicare wages and tips 8 Medicare tax withheld EAST PETERSBURG PA 17520 2784.15 40.3' 10 Dependent care benefits 11 Nonqualified plans 12e See Instructions for box 12 e e Employee's name, address, and ZIP code Suff. 13 Statutory Rat rement Third-pane employee Plan Sick pay 14 Othei 12b UI 2.23 a FRITZ J FICHTNER b Employer Identification number 12c 48 COOPERS FLAY 23-1416596 & DENVER PA 17 517 d Emplo as's social security no. 19-30-7531 12d g 15 State Employer's state I.D. no. t1 . 18 State wages, tips, etc. 17 State Income ta x 18 Local wages ps , , etc. tii 19 Local Income t ax 2 0 L o n ame c.allity ... PA.. C r 16.5.p.7..r17 ............................................... r C ........................ 27.8..4.... a .... C Q 1 p ...........................Rwi. ?. A... ........... ? l s, C f .(. ........... ?f 1874..15.... ................... r r p ..?.l.n.JR?.... t ? T 7 t c. .,I.irJM11C IR ........ Opy O Be Filed With Employee's tale, City, or tR@ r1COme alt alum OMB No. 1-0008 520 L87B 545 8 Dep t. • nawry - Name:: FRITZ I FICHTNER Member's Effective Date of Annuity: 03-22-1997 , Social Security Number: XXX-XX-7531 Date of Birth: 03-13-1937 Elected Retirement Option: Option 3 - Provides you a monthly Annuity for as long as you live and, following your death, provides your Designated Survivor with a lifetime monthly Annuity of approximately one-half of your monthly Annuity. Under this option, once you retire you cannot change your option selection or your Designated Survivor unless your Survivor predeceases you, you divorce or you marry. Contact Your Regional Retirement Counseling Center at 1-800-633-5461 for additional information. The full terms of the retirement contract are set forth in the member's retirement package. Total Gross Annuity I 4'a"VCtons and WiMoldings Federal Income Tax +?R??7k?F$llranQr6 °?"1'ikliTt Other Authorized Amounts Total Net Annuity $34,658.40 Not 211 retirement options include a Death Benefit, but if yo,tjr qp does, you need to keep your Beneficiary designation currentitti Beneficiary fQr?n ens,#IASIM t, - ..??ow#tor-d witft Beneficiary. pildpfo 3'? ;, A,R.Wed,Member BeneficiaryNomination ($ER'r.4.00 farm-Is avoii]414 on the SERS website through the "Forms" link. $6,0W00 'o $0.00 $28,658.40 Do NOT use this document for tax filing -- You should receive a 1099-R form by 1AV11 for tax reporting. If you are unclear about whether your retirement option irieW a Death Benefit requiring an up-to-date Beneficiary form, coht&tct your Retirement Counselor at 1-800-633-5461. New IRS Tax Tables may affect your withholding New Federal Income Tax Tables went into effect January 1, 2011. You may choose to change the amount of money withheld from your retirement benefit for Federal Income Tax or choose not to have money withheld by submitting a SERS-W-4P form or an IRS 74P form. If you do not submit a new form, SERS will withhold taxes from your retirement, payment based on the new tkx tables below ("New Table" column) effective with your January 2011 payment. Tables in Effect New Table Through 12/31110 Effective 1/1/11 -gross _M_onthly _Annuity? $2,888.20 $2,888.20 Less Deductions and Withholdings Federal Income Tax 500.00 500.00 Health Insurance Premium 0.00 0.00 OtherAuthorized Amounts 0.00 0.00 Net Monthly Annuity $2,388.20 $2,388.20 Your latest W4-P form on file-With SERS lists the following Federal Income Tax withholding instructions: Filing Status Allowances Additional Fixed Amount Married 2 Amount $500.00 $0.00 monthly payme to it is I Mt for you tt y+attr ?'? farh;,toa rt«,'Zendt < yowfw, ial institution rather than by a check mailed to your to your mailing address. SERS mails important information;' in your member record. For your convenience, we have p itfbr use if your mailing address should change. For your FORM SSA-1099 - SOCIAL SECURITY BENEFIT STATEMENT PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME. 201 0 • SEE THE REVERSE FOR MORE INFORMATION. Box 1. Name I Box 2. Beneficiary's Social Security Number FRITZ J FICHTNER JR 195-30-7531 Box 3. Benefits Paid in 2010 Box 4. Benefits Repaid to SSA in 2010 x . - tiW r W '0' e.x . ni, us $18;858.00 NONE $18,868:00 DESCRIPTION OF AMOUNT IN BOX 3 DESCRIPTION OF AMOUNT IN BOX 4 Paid by check or direct deposit $17,700.00 NONE Medicare Part B premiums deducted from your benefits $1,158.00 Total Additions $18,858.00 Benefits for 2010 $18,858.00 Box 6. Voluntary Federal Income Tax Withheld NONE Box 7. Address FRITZ J FICHTNER JR P 0 BOX 53 BOWMANSVILLE PA 17507.0053 Box 8. Claim Number (Use this number if you need to contact SSA.) i 195-30-7531A S' Form SSA-1099-SM (1-2011) fWWROFFMSFURNIN SOCIAL SECURITY ADMINISTRATION C PRESORTED FIRST-CLASS MAIL MID-ATLANTIC PROGRAM SERVICE CENTER M09 POSTAGE AND FEES PAID 300 SPRING GARDEN ST 1 SOCIAL SECURITY PHILADELPHIA PA 19123-2999 ADMINISTRATION PERMIT NO. G-11 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE,. $300 FRITZ J FICHTNER JR P 0 BOX 53 BOWMANSVILLE PA 17507-0053 2 l+ J W IN RE: The Marriage of FRITZ FICHTNER vs. Plaintiff ANGELA FICHTNER the following claims: % ca a IN THE COURT OF COMMON PLEA„ CUMBERLAND COUNTY, PENNSY19WIA cn r-- ? NO. to -,? rv Defendant MOTION FOR APPOINTMENT OF MASTER Defendant , moves the court to appoint a master with respect to ?X Divorce ? Distribution of Property ? Annulment ? Support X? Alimony ? Counsel Fees ? Alimony Pendente Lite ? Costs and Expenses and in support of the motion states: 1. Discovery is complete as to the claims (s) for which the appointment of a master is requested. 2. The defendant has appeared in the action (personally) (by his attorney,_ Lindsay Gingrich Maclay Esquire). 3. The staturory ground (s) for divorce are 3301(c) or 3301(d) 4. Delete the inapplicable paragraph (s): A ?X B ?X C ? a. The action is not contested. b. An aereement has been reached with resnect to the following claims: C. The action is contested with respect to the following claims: The valuation and equitable distribution of marital property; alimony 5. The action does not involve 6. The hearing is expected to take complex issues of law or fact. days 7. Additional information, if anv, relevant to the motion: Date: 8/2/11 Attorney for Plaintiff Tabetha A. Tanner Print Name ORDER APPOINTING MASTER ?r k Ca C" --f t7 r c- t C i r't = - a*) r -0 n CD c = "I _ C) C5 C) e- •• ?tT` --1 "' AND NOW 20 // _1? Esquire, is appointed master with respect to the following claims: Li r,d? Mad". EM- By the Court, • J. FILED-OFFICE Lindsay Gingrich Maclay, Esquire OF THE PROTHONOTARY" Daley Zucker Meilton Miner & Gingrich, LLC 2011 AUG 26 AN $: 57 635 N. 12`h Street, Suite 101 Lemoyne, PA 17043 CUMBERLAND COUNTY (717) 724-9821 PENNSYLVANIA ImaclUAdzmmglaw.com IN THE COURT OF COMMON PLEASE OF CUMBERLAND COUNTY, PENNSYLVANIA FRITZ FICHTNER, Plaintiff Docket No. 2010-2051 V. CIVIL ACTION ANGELA FICHTNER, (In Divorce) Defendant TO: E. Robert Elicker, II, Esquire, Divorce Master Tabetha A. Tanner, Esquire, Attorney for Plaintiff CERTIFICATION [ X ] I certify that discovery is incomplete as to the claims for which the Master has been appointed. The following information is missing: A. Counsel for Plaintiff and Defendant were unaware of the existence of a pre- nuptial agreement. Counsel for Defendant became aware of said agreement on August 23, 2011 during a telephone conversation with Defendant and has since sent opposing counsel a photocopy of said agreement. B. Counsel for Defendant needs additional information pertaining to the sale and disposition of a 1990 Sea Sprite boat, a marital asset listed on Plaintiff's Inventory and Appraisement, which was sold by Plaintiff after separation. C. Counsel for Defendant needs additional information pertaining to a Commerce Bank checking account listed on Plaintiff's Inventory and Appraisement, as Defendant was unaware of the existence of said account until receipt of Plaintiff's Inventory. D. Counsel for Defendant needs additional information pertaining to the PSECU Bank account listed on Plaintiff's Inventory and Appraisement. In order to complete discovery, Defendant, Angela Fichtner, through counsel, is in the process of preparing Interrogatories and Requests for Production of Documents which will be propounded on Plaintiff through counsel on or before August 31, 2011. Plaintiff's responses will then be due thirty (30) days after service of said discovery. It is therefore anticipated that discovery will be complete within forty-five (45) days from today's date. Respectfully submitted, DALEY ZUCKER WILTON MINER & GINGRICH. LLC Date: 25 2DI By: V ` n say Gi gr'ch M lay, Esquire Supreme Court I.D. 7954 635 N. 12th Street, Suite 101 Lemoyne, PA 17043 (717) 724-9821 Attorneys for Defendant Tanner Law Offices, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 Telephone: (717) 731-8114 Facsimile: (717) 731-8115 ttanner@tanner-law.com 11,113 F1"0 20 AF, 11' 1 ' Cfly1 tUrn'NT `i" g? E 1'4??15YL1?'ANIA In Re: The marriage of § IN THE COURT OF COMMON PLEAS FRITZ FICHTNER, § CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff § V. § CIVIL ACTION - LAW ANGELA FICHTNER, § NO. 10-2051 Defendant § IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Please transmit the record, together with the following information, to the court for entry of a divorce decree: Ground for Divorce: irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and Manner of Service of the Complaint: United States Postal Service, first class mail, postage prepaid, certified, restricted delivery. Return receipt dated March 27, 2010. 3. Date of Execution of the Affidavit of Consent Required by Section 3301(c) of the Divorce Code: by Plaintiff on December 20, 2012; by Defendant on December 27, 2012. 4. Related Claims Pending: no other marital claims pending. All marital claims were settled by the enclosed Marital Settlement Agreement dated December 27, 2012, to be incorporated but not merged into the Divorce Decree. 5. Date of Filing Waivers of Notice: Plaintiff's Waiver of Notice was filed on December 31, 2012. Defendant's Waiver of Notice is filed with this Praecipe to Transmit. Respectfully submitted, ?wa 4- Tabetha A. Tanner, Esquire Attorney for Plaintiff Supreme Court I.D. No. 91979 TANNER LAW OFFICES, LLC 3507 Market Street, Suite 303 Camp Hill, PA 17011 (717) 731-8114