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HomeMy WebLinkAbout14-0079 0 UPPER ALLEN TOWNSHIP, IN THE COURT COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Claimant C - V. NO -n o u -M ri HENDERSON GREEN' u,r Defendant - ra MUNICIPAL LIEN . . co r »' MUNICIPAL LIEN FOR PROPERTY MAINTENANCE NOW COMES Upper Allen Township, Cumberland County, Pennsylvania, by its Township Manager, Louis Fazekas, and files the within claim for charges assessed with respect to property maintenance rates against above named owner or owners and against the hereinafter described real estate as follows: STATEMENT OF CLAIM 1. This claim is filed by UPPER ALLEN TOWNSHIP, a first class township organized and existing in accordance with the laws of the Commonwealth of Pennsylvania. 2. The owner or reputed owner of the property, or party or parties responsible or liable, for which this claim is filed is the Defendant (s). 3. The authority under which the property maintenance rates were charged and assessed is the Township Ordinance 585 Section 189 -1, adopted 7 -1 -2004 Section 106.5 amended. a1.s� % la14Py boll S J ' 4. The authority under which this claim is filed is the Act of May 16, 1923, P.L. 207, Section 9, et seq. 53 P.S. §7143, as amended. 5. A description of the property against which this claim is filed is: 307 MOUNT ALLEN DRIVE Upper Allen Township Cumberland County Mechanicsburg, Pennsylvania 17055 Tax parcel Number: 42 -28- 2423 -025 6. This claim has not been the subject of any previous claim and judgment in the Court of Common Pleas of Cumberland County for property maintenance charges. 7. The total amount of the charges for which this claim is filed is Three Hundred, Sixty dollars ($360.00) plus costs. 8. The time period for which these charges are filed is June 10, 2013 & July 8, 2013. WHEREFORE, Claimant requests that a Municipal Lien be entered in its favor and against the Defendant in the amount of Three Hundred, Sixty dollars ($360.00) plus costs. UPPER ALLEN TOWNSHIP BY: Oen Feinour p Solicitor Upper Allen Township 100 Gettysburg Pike Mechanicsburg, PA 17055 Dated: (717) 766 -0756 Z: \Community Development\Administration \Lien \Property Maintenance Lien Form.doc UPPER ALLEN TOWNSHIP, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. : No. 14-79 MLD HENDERSON GREEN 307 MT ALLEN DRIVE MECHANICSBURG, PA Defendant : MUNICIPAL LIEN PRAECIPE TO SATISFY MUNICIPAL LIEN TO THE PROTHONOTARY: Please mark the Municipal Lien in the above -captioned matter satisfied and discontinued. Respectfully submitted, Dated: tat -4- 2. 26 /V Sthen Feinour, Esquire Solicitor for Upper Allen Township Supreme Court I.D. # 24580 Nauman, Smith, Shissler & Hall, LLP 200 North Third Street, 18th Floor Harrisburg, PA 17101 Phone: (717) 236-3010 e)(4 /6)0 3s ELIZABETH G. HUSKIN, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner, : CUMBERLAND COUNTY, PENNSYLVANIA vs. : DOMESTIC RELATIONS SECTION= .`,.; : DOCKET NO. 2014-00085 CIVIL -0 c-- r`' c-=' JOHN T. HUSKIN, JR., : PACSES NO. 630114571 z� ::)ca Defendant/Respondent.�,a c --n ORDER OF COURT 17n •zc c.,:.? �s. AND NOW, this 11th day of June, 2014, this matter having been heard b the Support Master on the Plaintiffs claim for alimony pendente lite, upon recommendation of the Master (see Support Master's Report and Recommendation attached hereto), it is ordered and decreed as follows: 1. For the period of February 27, 2014 through June 6, 2014 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $694.00 per month. 2. Effective June 7, 2014 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $829.00 per month. By the Court, T\t,k M. L. Ebert, Jr., cc: Elizabeth G. Huskin John T. Huskin, Jr. Christine Taylor Brann, Esquire For the Plaintiff Joanne Harrison Clough, Esquire For the Defendant DRO/rjs J. ELIZABETH G. HUSKIN, : IN THE COURT OF COMMON PLEAS OF Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA "--5 vs. : DOMESTIC RELATIONS SECTION -cam, : DOCKET NO. 2014-00085 CIVIL `= JOHN T. HUSKIN, JR., PACSES NO. 630114571 cr)v Defendant. r c) r,?a r-_ SUPPORT MASTER'S REPORT AND RECOMMENDATION Following a hearing held before the undersigned Support Master on June 9, 2014 the following report and recommendation are made: FINDINGS OF FACT 1. The Plaintiff is Elizabeth G. Huskin, who resides at 212 Willow Avenue, Camp Hill, Pennsylvania. 2. The Defendant is John T. Huskin, Jr., who resides at 909 Green Street, Apartment 101, Harrisburg, Pennsylvania. 3. The parties were married on July 10, 1993. 4. The parties separated on January 7, 2014. 5. The parties are the parents of Caroline D. Huskin, born December 14, 1995, and John T. Huskin, III, born June 9, 2004.1 6. Caroline graduated from high school on June 7, 2014. 7. On February 12, 2014 the Plaintiff filed a Complaint for spousal and child support.2 8. On January 7, 2014 the Plaintiff filed a Complaint for divorce which contained a claim for alimony pendente lite. 9. On February 27, 2014 the Plaintiff filed a demand for hearing on her claim for alimony pendente lite. 10. The Plaintiff is employed as a program manager for BCA Study Abroad, Inc. 11. The Plaintiff has a gross monthly salary of $4,630.42. 1 An older child, Katherine, is an emancipated college student and is not a subject of this action. 2 The Plaintiff had elected to proceed on a claim for alimony pendente lite and has withdrawn her claim for spousal support. 12. The Plaintiff has a deduction for health insurance coverage on her family of $268.48 monthly. 13. For tax year 2014 the Plaintiff's tax filing status will be head of household with her youngest and oldest children claimed as dependency exemptions. 14. The Plaintiff continues to reside in the marital home with the children. 15. The home is encumbered by a mortgage with a monthly payment of principal and interest of $1,225.00. 16. Real estate taxes and homeowners' insurance together average approximately $635.00 per month. 17. The parties intend to list the marital home for sale. 18. Real estate taxes on the residence are not current. 19. The Defendant is an attorney with the firm of Thomas, Thomas & Hafer in Harrisburg. 20. The Defendant has a gross bi-weekly salary of $3,846.15. 21. The Defendant receives a performance bonus at the end of each year. 22. The Defendant's performance bonus in 2013 was $32,000.00. 23. The Defendant's tax filing status for 2014 will be married/separate with his middle child, Caroline, claimed as a dependency exemption. 24. The Defendant paid the February mortgage payment of $1,225.00. 25. The Defendant made a payment of approximately $285.00 on cell phone bills in February. 26. The Defendant made a payment of $600.00 for fuel oil for the marital home in January, 2014. DISCUSSION Both parents have an obligation to support their child in accordance with their relative incomes and ability to pay. Depp v. Holland, 636 A.2d 204 (Pa. Super. 1994). The Plaintiff has gross monthly income for support purposes of $4,630.00. With a tax filing status of head of household and claiming her youngest and oldest children as 2 dependency exemptions for federal income tax purposes, she has net monthly income for support purposes of $3,709.00.3 The Defendant has a gross monthly salary of $8,333.00. He also receives a productivity bonus at the end of each year. His bonus in 2013 was $32,000.00, or an average of $2,667.00 per month. His total gross monthly income for support purposes is $11,000.00. With a tax filing status of married/separate and claiming his younger daughter, Caroline, as a dependency exemption, he has net monthly income for support purposes of $7,550.00.4 With combined net monthly income of $11,259.00 the requirement for the basic support of two children is $1,501.00 per month.5 The Defendant's proportionate share of that amount is $1,420.00. The adjustment for health insurance coverage provided by the Plaintiff increases the monthly obligation for the support of Caroline and John to $1,528.00 per month.6 The parties have stipulated that Caroline graduated from high school at the age of 18 on June 7, 2014 and is now emancipated for support purposes. With the incomes of the parties as set forth above and only one child, John, now subject to support, the Defendant's child support obligation is reduced to $1,079.00 per month effective June 7, 2014.7 The Plaintiff has withdrawn her claim for spousal support and has elected to proceed on her claim for alimony pendente lite. Alimony pendente lite is defined as "alimony or maintenance during the pendency of a divorce proceeding so as to enable a dependent spouse to proceed with or defend against the action." Jayne v. Jayne, 663 A.2d 169, 176 (Pa. Super. 1995). The determination of whether to award a spouse alimony pendente lite has traditionally been a matter of sound discretion of the trial court. Litmans v. Litmans, 673 A.2d 382 (Pa. Super. 1996); Clouse v. Clouse, 50 Cumberland L.J. 16 (2001). Factors to consider in determining entitlement to an award of alimony pendente lite include the separate estate and income of the claimant, the ability of the other party to pay, and the character, situation and surroundings of the parties. Litmans v. Litmans, supra. Generally a spouse seeking alimony pendente lite who has sufficient assets to meet the needs of the pending litigation and who is equally situated with the other spouse to maintain or defend the action will not be awarded alimony pendente lite. Powers v. Powers, 615,A.2d 459 (Pa. Super. 1992). Once entitlement to an award of alimony pendente lite is established the calculation of the amount of the award is made pursuant to the support guidelines. Little v. Little, 47 Cumberland L.J. 131 (1998). 3 See Exhibit "A" for tax deductions from gross income. 4 See Exhibit "A" for tax deductions from gross income. 5 See Pa.R.C.P. 1910.16-3. 6 See Exhibit "B" for the guideline calculation. See Exhibit "C" for the guideline calculation. 3 While the Plaintiffs monthly expenses as set forth on her Exhibit 5 may be somewhat inflated, in the opinion of this Master, the Plaintiffs income combined with the child support she receives is insufficient to meet her needs. Secondly, in the opinion of this Master, the Defendant has present ability to pay an award of alimony pendente lite. Therefore, an award will be made. For the period of February 27, 2014 through January 6, 2014, with the net incomes of the parties as set forth above and a child support obligation of $1,528.00, the Defendant's obligation for alimony pendente lite is $694.00 per month.8 Effective June 7, 2014 with the child support obligation decreased to $1,079.00 per month, the obligation for alimony pendente lite is increased to $829.00 per month.9 The Plaintiff has requested an adjustment in the monthly obligation for the mortgage on the marital home. The parties have agreed to list the home for sale. The real estate taxes are not current. The mortgage payment consisting of principal and interest is $1,225.00 per month. Because this does not exceed 25% of the total of the Plaintiffs net monthly income, child support, and alimony pendente lite, an adjustment is not recommended.10 The Defendant has requested credit for payment of the February mortgage, a cell phone bill, and a fuel oil bill." At the conference the Defendant was given a credit of $1,377.88 for the mortgage and a portion of the cell phone bill. In the opinion of this Master, this credit is appropriate. No additional credit will be given. RECOMMENDATION A. For the period of February 12, 2014 through June 6, 2014 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit for the support of his children, Caroline D. Huskin, born December 14, 1995, and John T. Ruskin, III, born June 9, 2004, the sum of $1,528.00 per month. B. Effective June 7, 2014 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as support for his son, John T. Huskin, III, the sum of $1,079.00 per month. C. The Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit the additional sum of $136.00 per month on accrued arrears. D. The Plaintiff shall provide health insurance coverage for the benefit of said child as is available to her through employment or other group coverage at a reasonable cost. 8 See Exhibit "D" for the calculation. 9 See Exhibit "E" for the calculation. 10 See Pa.R.C.P. 1910.16-6(e). 11 The fuel oil bill was paid prior to the initiation of the support action. 4 E. The monthly support obligation includes cash medical support in the amount of $250.00 annually for unreimbursed medical expenses incurred for said child. Unreimbursed medical expenses of said child that exceed $250.00 annually shall be allocated between the parties. The party seeking allocation of unreimbursed medical expenses must provide documentation of expenses to the other party no later than March 31st of the year following the calendar year in which the final medical bill to be allocated was received. The unreimbursed medical expenses are to be paid as follows: 67% by Defendant and 33% by Plaintiff. F. For the period of February 27, 2014 through June 6, 2014 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $694.00 per month. G. Effective June 7, 2014 the Defendant shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $829.00 per month. H. The Plaintiffs claim for spousal support is dismissed. June 11, 2014 Date cc: Elizabeth G. Huskin John T. Huskin, Jr. Christine'Taylor Brann, Esquire For the Plaintiff Joanne Harrison Clough, Esquire For the Defendant DRO/rj s (\\, a,ak 0,„.(2„, Michael R. Rundle Support Master 5 In the Court o Common Pleas of Cumberland County, Pennsylvania Tax Detail Re8� rt , Plaintiff Name: Elizabeth G. Huskin Defendant Name: John T. Huskin Docket Number: PACSES Case Number: 896114471 Other State ID Number: Tax Year: Current: 2014 Defendant Plaintiff 1 Tax Method 1040 ES 1040 ES � 2. Fling Status Married Filing Separately Head of Household 3 VVhoC|ainna�h� ExannpUono Customize 4.Numberc�E�emnpt�n� 2 3 5.MonthlyTo�ab|� Income . �11OOUOD �4G3042 $4,630.42 6.DeductionsNet�od Standard Standard 7.DeductionAmount $516.67 $758.33 8 Exemption/\nnount $658.34 $987.51 ��S824�8 9.IncomeK4|NU8��eduotiono�ndEx�mpbono $9,824.99 �288458 $2,884.58 1O. Tax on Income $2,238.27 $378.73 lOa. Tax on Dividend Income - - 11. Alternative Minimum Tax (AW1T) - - 12. Child Tax Credit - - 13. Earned Income Credit (BC) - - 14' Manual Adjustments - 15.Federal\n�omeTa�e� 8�238�� $2,238.27 $378.73 16, State Income Taxes $337.70 $142.15 17.FICAPmyment� $764.00 $354.23 18.CityVVh�reTaxemApp|y Select Select 19.Local $110.00 $46.30 TOTAL Taxes $3,449.97 $921.41 mupportoalc 2014 EXHIBIT "A" In the Court of Common Pleas of Cumberland County, Pennsylvania Support Guideline Worksheet (Revised August 9, 2013) Rule 1910.16-1, et seq. Docket Number: Defendant Name: John T. Huskin PACSES Case Number: 896114471 Plaintiff Name: Elizabeth G. Huskin Other Case ID Number: Defendant Plaintiff 1. Number of Dependents in this Case 2 2. Total Gross Monthly Income $11000.00 $4,630.42 3. Less Monthly Deductions $3,449.97 $921,41 4. Monthly Net Income Line 2 minus Line 3 $7,550.03 $3,709.01 5. Combined Total Monthly Net Income Amounts on Line 4 Combined $11,259.04 6. Plus Child's Monthly Soc. Sec. Retirement or Disability Derivative Benefit. - - 7. Adjusted Combined Total Monthly Net Income 8. PRELIMINARY Child Su ..ort Obligation based on Adjusted Income (Line 7) - 9. Less Child's Monthly Social Security Retirement or Disability Derivative_ Benefit (Line 6) (-) 10. Basic Child Support Obligation " From Rule 1910.16-3 Basic Child Support Schedule (Table Rev. 9/2013) $2,118.00 11. Net Income as a Percentage of Combined Amount 67.06 32.94 12. Each Parent's Monthly Share of the Child Support Obligation $1,420.33 $697.67 13. Adjustment for Shared Custody Rule 1910.16-4 (c) (# of Overnights: - ) - - $108.03 - 14. Adjustment for Child Care Expenses Rule 1910.16-6 (a) 15. Adjustment for Health Insurance Premiums Rule 1910.16-6 (b) 16. Adjustment for Unreimbursed Medical Expenses Rule 1910.16-6 (c) 17. Adjustment for Additional Expenses Rule 1910.16-6 (d) - 18.Total Obligation with Adjustments ine 12 minus Line 13, plus Lines 14,15,16,17 $1,528.36 - 19. Less Split Custody Counterclaim Rule 1910.16-4 (d) 20. Obligors Support Obligation Line 18 minus Line 19, $1,528.36 Prepared by: mrr Date: 6/10/2014 Summary Repo PACSES Multiple Family Adjustment S2. Spousal Support Award S3. Adjustment for Excess Mortgage Payments (If Applicable) S4. Custodial Parent Spousal Support Obligation (if Applicable) S5. Adjusted Support Obligation Line 20 (or Si, if applicable) plus Line S2 and S3 minus S4 (if applicable) (-) TAX INFORMATION S6. Defendant S7. Plaintiff Tax Method 1040 ES 1040 ES Filing Status Married Filing Separately Head of Household S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly: $1 528.36 $351.75 Exemptions 2 3 Monthly: Weekly: S9. Justification for Deviating from Guidelines Calculation and/or Other Case Comments: SupportCalc 2014 EXHIBIT "B" In the Court of Common Pleas of Cumberland County, Pennsylvania Support Guideline Worksheet (Revised August 9, 2013) Rule 1910.16-1, et seq. Defendant Name: John T. Huskin Docket Number: PACSES Case Number: Plaintiff Name: Elizabeth G. Huskin Other Case ID Number: 896114471 Defendant Plaintiff _ 1. Number of Dependents in this Case 1 2. Total Gross Monthly Income $11000.00 $4,630.42 3. Less Monthly Deductions $3,449.97 $921.41 4. Monthly Net Income Line 2 minus Line 3 $7,550.03 $3,709.01 5. Combined Total Monthly Net Income Amounts on Line 4 Combined $11,259.04 6. Plus Child's Monthly Soc. Sec. Retirement or Disability Derivative Benefit. - - - 7. Adjusted Combined Total Monthly Net Income 8. PRELIMINARY Child Su • • ort Obli • ation based on Ad'usted Income (Line 7) 9. Less Child's Monthly Social Security Retirement or Disability Derivative (.) Benefit (Line 6) - $1,501.00 10. Basic Child Support Obligation From Rule 1910.16-3 Basic Child Support Schedule (Table Rev. 9/2013) 11. Net Income as a Percentage of Combined Amount 67.06 32.94 12. Each Parent's Monthly Share of the Child Support Obligation $1,006.57 $494.43 13. Adjustment for Shared Custody Rule 1910.16-4 (c) (# of overnights: - ) - - $72.02 - - 14. Adjustment for Child Care Expenses Rule 1910.16-6 (a) 15. Adjustment for Health Insurance Premiums Rule 1910.16-6 (b) 16. Adjustment for Unreimbursed Medical Expenses Rule 1910.16-6 (c) 17. Ad'ustment for Additional Ex • enses Rule 1910.16-6 (d) 18. Total Obligation with Ad'ustments Line 12 minus Line 13, plus Lines 14,15,16,17 $1,078.59 19. Less Split Custody Counterclaim Rule 1910.16-4 (d) - 20. Obligor's Support Obligation Line 18 minus Line 19, $1,078.59 Prepared by: mrr Date: 6/10/2014 Summary Report S1. PACSES Multiple Family Adjustment S2 Spousal Support Award S3. Adjustment for Excess Mortgage Payments (If Applicable) S4. Custodial Parent Spousal Support Obligation (if Applicable) S5. Adjusted Support Obligation Line 20 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) (-) Monthly: $1 078.59 Weekly: $248.24 TAX INFORMATION S6. Defendant S7. Plaintiff Tax Method 1040 ES 1040 ES Filing Status Married Filing Separately Head of Household S8. Total Support Amount if Deviating from Guidelines Calculation Exemptions 2 3 Monthly: Weekly: S9. Justification for Deviating from Guidelines Calculation and/or Other Case Comments: SupportCalc 2014 EXHIBIT "C" In the Court of Common Pleas of Cumberland County, Pennsylvania Spousal Support Calculation Rule 1910.16 (PACSES FORMAT) Plaintiff Name: Elizabeth G. Huskin Defendant Name: John T. Huskin Docket Number: PACSES Case Number: 896114471 Other State ID Number: 1. Obligor's Monthly Net Income $7,550.03 2. Less All Other Support 3. Less Obligee's Monthly Net Income $3,709.01 4. Difference $3,841.02 5. Less Child Support Obligation for Current Case Without Part II Substantial or Shared Custody Adjustment $1,528.36 6. Difference $2,312.66 7. Multiply by 30% or 40% 30.00% 8. Income Available for Spousal Support $693.80 9. Adjustment for Other Expenses 10. AMOUNT OF MONTHLY SPOUSAL SUPPORT OR APL $693.80 Prepared by: mrr Date: 6/10/2014 SupportCalc 2014 EXHIBIT "D" In the Court of Common Pleas of Cumberland County, Pennsylvania Spousal Support Calculation Rule 1910.16 (PACSES FORMAT) Plaintiff Name: Elizabeth G. Huskin Defendant Name: John T. Huskin Docket Number: PACSES Case Number: 896114471 Other State ID Number: 1. Obligor's Monthly Net Income $7,550.03 2. Less All Other Support - 3. Less Obligee's Monthly Net Income $3,709.01 4. Difference $3,841.02 5. Less Child Support Obligation for Current Case Without Part II Substantial or Shared Custody Adjustment $1,078.59 6. Difference $2,762.43 7. Multiply by 30% or 40% 30.00% 8. Income Available for Spousal Support $828.73 9. Adjustment for Other Expenses - 10. AMOUNT OF MONTHLY SPOUSAL SUPPORT OR APL $828.73 Prepared by: mrr SupportCalc 2014 Date: 6/10/2014 EXHIBIT "E" ELIZABETH G. HUSKIN, : IN THE COURT OF COMMON PLEAS OF Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA vs. JOHN T. HUSKIN, JR., Defendant. : DOMESTIC RELATIONS SECTION : DOCKET NO. 2014-00085 CIVIL : PACSES NO. 630114571 INDEX OF EXHIBITS Plaintiffs Exhibit No. 1 — Earning statement Plaintiffs Exhibit No. 2 — 2013 W-2 Plaintiffs Exhibit No. 3 — 2013 Joint marital tax return Plaintiffs Exhibit No. 4 — Defendant's 2012 W-2 Plaintiffs Exhibit No. 5 — Expense statement Plaintiffs Exhibit No. 6 — Defendant's pay statement of February 14, 2014 Defendant's Exhibit No. 1 — Income statement Defendant's Exhibit No. 2 — Expense statement Defendant's Exhibit No. 3 — Pay statements Defendant's Exhibit No. 4 — 2013 W-2 BCA STUDY ABROAD, INC 50 Alpha Dr Elizabethtown, PA 17022 Pay to the order of: Elizabeth Huskin 100614 Check date: 05/30/14 $ *************0.00 **Zero and 00/100*********************************************************************** Elizabeth Huskin 212 Willow Ave Camp Hill, PA 17011 110 Elizabeth Huskin NON NEGOTIABLE Check date: • 05/30/14 Check #: 100614 Period begin: 05/01/14 Period end: 05/31/14 Wages Total Hrs Amount Withholdings. Amount Deductions Amount SALARY FUTA EXEM 4,630.42 FICA -SS 270.44 FICA -MED 63.25 FIT 257.00 Pennsylvania SIT 133.91 Pennsylvania SUI 3.24 Pennsylvania Camp Hill, Borough of EIT 87.24 Pennsylvania Elizabethtown, Borough of 4.33 403-b Plan CAFE PLAN 231.52 268.48 Totals 4,630.42. 819.41 500.00 Direct deposit detail: 5708897979 Year to Date 3,311.01 Net Check Direct Deposit Total Pay 0.00 3,311.01 3,311.01 Wages. Total Hrs Amount Withholdings Amount Deductions Amount SALARY FUTA EXEM 23,152.10 FICA -SS 1,352.20 FICA -MED 316.24 FIT 1,369.00 Pennsylvania SIT 669.55 Pennsylvania SUI 16.20 Pennsylvania Camp Hill, Boro 436.20 Pennsylvania Elizabethtown, B 21.65 403-b Plan CAFE PLAN 3,009.78 1,342.40 Totals 23,152.10 4,181.04 4,352.18 Direct deposit detail: 9620394317 5708897979 2,342.92 12,275.96 Net Check Direct Deposit Total Pay 0.00 14,618.88 14,618.88 0862411 Fax tetum With Employee's I oils mo Isis -none a s roc. sea rho. 467-47-5165 1 !Millis tips, other comp. 3879'f 16 2 Federal bicome tax withheld 368 j 00 3 social security wages 52685.72 4 Social sccudly tax withheld 3266 51 b Employer lD number (EIN) 35-2046260 5 Medico* wages end tips 52685.72 8 Medicare rix withheld 763.94 c Employers nems, address, and BCA STUDY ABROAD, 50 ALPHA DR ELIZABETHTOWN ZIP code INC PA 17022 d Control number d Control number 5 a Employee's name, address, and ELIZABETH 212 WILLOW AVE CAMP HILL ZIP code Sutf. HUSKIN PA ' 17011 7 Social security tpa 8 Allocated tips 10 Dependent care bertetds i0 Deperndenht care benefits 4t IVongkla led phos 12a Code C 12.99 15 Statutory employee 14 Other CAF I LST SUI 2892.31 51.96 38.89 12b Code ,E 13894.56 12c Code Rettleflfelplan N. 124 Cods Tort .ly sick pry PA 19137 4597 15 State FQg8gY8r j sista ID 1617.02 17 State tnrmtnt jpx 52672.73 16 State waceD_tina. etc. 1617.02 17SStlse)�e trireme to 18 Local wages, lips, etc. 52672.73 9 Local Income tax 1053.48 20 Locality name 36 Form W-2 Wage and 'tax Statement QQ��(� This information Is being furnished to the Internal alas Servi a DAA pL of the Treasury - IRS FopsriacoA lo iarrcfurt rttar W Statement o . a rm 1 opy 2 -To Be Filed Withogee's 8Y. or Local Income T=X .,r .. ,t gfeeC-Efr�EMPOYEeba t9o lir7 ,, ,.' S . lla :�;• s ; . ., , ODS/Se I 41-0852411 164.5-01308 Employee's sea o. 467-47-5165 Wages, tips, other 38791.16 2 Federal Ikieone fax withheld 36$1.00 3 Social $ecurxy wages 52065.72 4 sedan security tax withheld 3268.51 b Empiayer ID nhmlber (ERN} 35-2046260 5 Medicare wages and Bps 52685.72 6 MedImre tax withheld 763.94 C Employer* name, address, and ZIP code BCA STUDY ABROAD, INC 50 ALPHA DR ELIZABETHTOWN PA 17022 d Control number 5 e Employee's mane, address, and ZIP cods Suit. EUZABETH HUSKIN 212 WILLOW AVE CAMP HILL PA 17011 7 Social security tips 8 Allocated tips PLAINTIFF'S EXHIBIT 10 Dependent care bertetds it 14ongtrattied pians 12a Code C 12.99 18 Statutory employee 14 Other 2892.91 LST 51.86 5(11 38.89 12b Code , 13894.56 12c Code Room:nerd pen X 124 Code ?hld.pwtyslcikpsy PA J9137 4597 15_Stale Prnhypyes state Ip number Rslle sae plan X 52672.73 16 State wanes tine da , 1617.02 17 State tnrmtnt jpx 18 Local wages, cap. etc. 52672.73 19 Loral Income tax 1053.48 20 Locally name 36 FopsriacoA lo iarrcfurt rttar W Statement o . a rm 1 opy 2 -To Be Filed Withogee's 8Y. or Local Income T=X State, 41-0!352411 R I OMB No 1545-0008 a Employee's sok, sea. no. 1 Wages, tips, otter corp. 3879116 . 2 Federal Income lax withheld 3681.00. 467-47-5165 3 Social security novas 4 Social security lax withheld 3266 51 b Employer ID number (ERN) 52685 72 35-2046260 5 Median upas and Ups 52685.72 8 Medicare lax Withheld 763.94 c Employers name, address, and BCA STUDY ABROAD, 50 ALPHA DR ELIZABETHTOWN ZIP code INC - d Control number 5 PLAINTIFF'S EXHIBIT e Employee's name, address, and ELIZABETH 212 WILLOW AVE CAMP HILL ZIP code HUSKIN 4 Z PA 17011 7 Social security tips 8 Allocated tips 9 10 Dependent care benefits 11 Nongwltkd plans 12a Coda C 12.99 13 Statutory employee 14 Other CAFT 2892.81 LST 51.98 SUI 38.89 12b Code E. 13894.56 Rslle sae plan X 12c Code T -Pett' sick Pry 12d Coda PA 19137 4597 16 State Employers sesta ID nur3berr_ 20 Locality none 36 52672.73 16 Elate WSW lies Me 1617.02 17 state Income ter, 18 Local wages, Spa, etc. 52672.73 19 Local Income tax 1053.48 20 Locality name 38 Form W-2 Wage DAA Tax m 2013 Dept. of the Treasury - IRS o Bit Filed With Employee's State 41-0852411 taw. or Local income tax Keturn. I Awn No 1545n008 a Employee's sec. sec. no. 467-47-5165 1 Wages, Ilps. ootrer76 2 Federal incom33.1kes hes 3 Social security wages _52685.72 4 Social security tax withheld 3266.51 b Employer ID number (EIN) 35-2046260 5 Medicare wages and Ups 52685.72 8 Medicare lax withheld 763.94 c Employer's name, address, and ZIP code BOA STUDY ABROAD, INC 50 ALPHA DR ELIZABETHTOWN PA 17022 d Control number 5 e Employee's name, address and ZIP code Suff. ELIZABETH HUSKIN 212 WILLOW AVE CAMP HILL PA 17011 7 Social security Ups 8 Allocated tips 9 10 Dependent care benefits 11 Nanquaeled plans 12a Code C 12.99 12b Code F 1$894.56 13 Statutory employes 14 Other CAFT 2892.31 120 Cala Manna gun X LST 51.96 SU! 38.89 'h6d-psrty sick pay 12d Code PA 19137 4597 52672.73 1617.02 18 Local wages, tIps,etc. 5272.73 19 Leal income tax 1053.48 20 Locality none 36 D�espLkof !thee Tt� easuy - IRS Fonn W-2 Wage igiebb and pmu rasainVnI DAA OAA nd Tax Statement 2013 Dept. of the Treasury - IRS 040 Department of the Treasury—internal Revenue Sento (99) u.U.S. Individual income Tax Return O 2 O 1 3 OMB No. 1545-0074 IRS use Only—Do not write orstaple lnthis space. Forthe yen ,lan. 1—Dec. 31, 2013, or other tax year beginning , 2013, ending , 20 See separate instructions. Your first name and initial John T Last name Ruskin, Jr. Your social security number 217-56-1790 If a joint return, spouse's first name and initial Elizabeth G Last name Huskin Spouse's social security number 467-47-5165 Home address (number and street). if you have a P.O. box, see instructions. 212 Willow Ave. Apt no. . Make sure the SSN(s) above and on line 6c are correct City, town or post office. state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Camp Hill PA 17 011 presidential Election Campaign Check hare If you, oryour spouse If filing Jointly, elowwitogotothis fund. Checking a box below will not change your tax or Foreign country name Foreign province/state/county Foreign postai code refund. • You ■ Spouse Filing Status Check only one box. 1 ❑ Single 2 ® Married filing jointly (even if only one had income) 3 0 Married filing separately. Enter spouse's SSN above and full name here. ► 4 0 Head of household (with qualifying person). (See Instructions.) if • the qualifying person Is a child but not your dependent, enter this child's name here. ► 5 0 Qualifying widower) with dependent child Exemptions If more than four dependents, see instructions and check here ► 0 6a ® Yourself. If someone can claim you as a dependent, b ®t3 do not check box 6a c Dependents: (1) first name Last name C2) Dependent's social seemly number (3) Dependent's relationship to you (4) / If child tinder age 17 qualifying for child lax credit (see instructions) Katherine L Ruskin 623-76-7128 Daughter ■ Caroline D Ruskin ' 613-90-9131 Daughter ■ John T Huskin, III 173-82-7822 Son n ■ Income Attach Forms) W-2 here. Also attach Forms W -2G and 1099-R If tax was withheld. If you did not get a W-2, see Instructions. Adjusted Gross Income d 7 8a b 9a b 10 11 12 13 14 15a 16a 17 18 19 20a 21 22 23 24 i Boxes checked oneaand eb 2 No. of children • •lived with you 3 • did not live with you due to divorce (seehietruotions) Dependants on So not entered above Total number of exemptions claimed tinesabove 1. Wages, salaries, tips, etc. Attach Form(s) W-2 Taxable interest. Attach Schedule B if required Tax-exempt interest. Do not include on line 8a . . l 8b I 7 8a 155,391. 1. Ordinary dividends. Attach Schedule B if required Qualified dividends 19b 238 . 322. Taxable refunds, credits, or offsets of state and local income taxes Alimony received Business income or {loss). Attach Schedule C or C -EZ Capital gain or (loss). Attach Schedule D if required. if not required, check here P. Other gains or (losses). Attach Form 4797 IRA distributions . 15a I b Taxable amount Pensions and annuities 18a b Taxable amount . . . Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (loss). Attach Schedule F Unemployment compensation Social security benefits i 20a I I b Taxable amount . . Other income. List type and amount Combine the amounts in the far right column for lines 7 through 21. This is your total income P. Educator expenses Certain business expenses of reservists, performing artists, and fee -basis government officials. Attach Form 2106 or 2106 -EZ 25 Health savings account deduction. Attach Form 8889 . 26 Moving expenses. Attach Form 3903 27 Deductible part of self-employment tax. Attach Schedule SE 28 Self-employed SEP, SIMPLE, and qualified plans . 29 Self-employed health insurance deduction . . ' . 30 Penalty on early withdrawal of savings 31a Alimony paid b Recipient's SSN ► 32 IRA deduction 33 Student loan interest deduction 34 Tuition and fees. Attach Form 8917 35 Domestic production activities deduction. Attach Form 8903 36 Add lines 23 through 35 37 Subtract line 36 from line 22. This is your adjusted gross' income ► 23 24 25 26 27 28 29 30 31a 32 33 34 35 10 176. 11 12 0. 13 1,674. 14 15b 16b 17 18 19 20b 21 22 157,564. 36 37 157,564. For Disclosure, Privacy Act, and Paperworic Reduction Act Notice, see separate instructions. SAA REV 05/02tI4 TTMac Form 1040 (2013) Form 1040 (2013) Pace 2 Tax and 38 Amountfromline 37 (adjusted gross income) 38 157 ,564. Credits 39a Check t if: t ■ You were born before January 2, 1949, ■ Spouse was born before January 2, 1949, ■ ■ Blind. Blind. J Total boxes decked ► 39a `; ; ;;: , ` :''. 40 33,612. standard Deduction • People who chebox okrt are 39a or 39b or claimedwho edas a Lb If your spouse itemizes on a separate return 40 Itemized deductions (from Schedule A) 41 Subtract line 40 from line 38 42 Exemptions. If line 38 is $150,000 or less, multiply q3 Taxable income. Subtract line 42 from tine 44 Tax (see instructions). Check if any from: a or or ■ you were a dual -status your standard deduction $3,900 by the number 41. If line 42 is more Form(s) 8814 b on ■ alien, check (see left line Si Otherwise, than line 41, enter Form 4972 c here I. 3903 margin) . . see instructions -0- . . ■ 41 123 ,952. 42 19,500. 43 104,452. 44 17 ,780. dependent, see instnictione. • All other' Single 45 Alternative minimum tax (see instructions). Attach Form 6251 46 Add lines 44 and 45 47 Foreign tax credit. Attach Form 1116 if required . . . . 47 ► 45 46 17,780. or Married filing 48 Credit for child and dependent care expenses. Attach Form 2441 48 214 . separate$6,100 49 Education credits from Form 8863, line 19 49 1,500 . Married filing 60 Retirement savings contributions credit. Attach Form 8880 60 °' Jointly or (�uai+twing 51 Child tax credit. Attach Schedule 8812, if required . . . 51 2 62 Residential energy credits. Attach Form 5695 . . 52 Head of 53 Other credits from Form: a ■ 3800 b ■ 8801 c ■ 53 household, $8.950 54 Add lines 47 through 53. These are your total credits 65 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- ► 54 1,714 . 55 16 , 066. Other 56 Self-employment Taxes 57 Unreported social 58 Additional tax on 59a Household employment b First-time homebuyer 60 Taxes from: a 61 Add lines 55 through tax. Attach Schedule security and Medicare IRAs, other qualified taxes from credit repayment ■ Form 8959 b 60. This is Schedule ■ your SE tax from Form: retirement plans, H Attach Form Form 8960 c ■ total tax a 0 4137 b etc. Attach Form 5329 if 5405 if required Instructions; enter code(s) III8919 required _ . . . . __ _ - �� ' 56 57 . 58 59a 59b 60 61 16,066. Payments 62 Federal income tax withheld from Forms W-2 and 1099 . . 62 15,487. ?'' .::; ...:... ':';.; 63 2013 estimated tax payments and amount applied from 2012 return 63 If you have a 64a Earned income credit (EIC) 64a chalihatt child, attach b Nontaxable combat pay election 64b .. . Schedule EiC. 65 Additional child tax credit. Attach Schedule 8812 66 66 American opportunity credit from Form 8863, line 8 . . . 66 1, 000. 67 Reserved 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 Fomr, a ■ 2439 b ® Reserved c ■ 8885 d ■ 71 72 Add lines 62, 63, 64a, and 65 through 71. These are your total payments OPy 72 16,487. Refund 73 if line 72 is more than 74a Amount of line 73 you Direct deposit? ► b Routing number line 61, subtract line 61 from line 72. This is the amount you overpaid want refunded to you. If Form 8888 is attached, check here . ► ❑ 1 0. 2 3 0 7 1 6 4 I ►c Type: ® Checking 0 Savings 73 4 21. 74e 421 . See ► d Account number 1 5 7 0 8 8 9 7 9 7 9 1 Instructions. 76 Amount of line 73 you want applied to your 2014 estirnated tax11•• 1 75 1,., Amount 76 Amount you owe. Subtract line 72 from line 61. For details on how to pay, see instructions ► You Owe 77 Estimated tax penalty (see instructions) 1 77 76 ;`...... Third Party Designee Sign Here Do you want to allow another person to discuss this return with the IRS (see instructions)? 0 Yes. Complete below. Designee's Phone Personal identification name ► no. ► number (PIN) ► © No Under penalties of perjury. I declare that I have examined this return and accompanying schedules and statements, end to the best of my knowledge and belief, they me true, correct, and complete. Declaration of preparer (other than taxpayer) Is based on all Information of which preparer has any knowledge. Joint return? See Your signature instructions. Keep a copy for Spouse's signature. If a joint return, both must sign. your records. Date Your occupation Attorney Date Spouse's occupation Program Manager Paid Preparer Use Only Print/i'ype preparer's name Preparer's signature Date Daytime phone number (717)877-8702 lithe IRS sent you an identity Protection PIN, enter It here (see inst.' Check 0 if self-employed PTIN Firm's name to. Self—Prepared Firm's EIN ► Firm's address ► Phone no. HEVo5N2i14T7Mac Form 1040 (2013) SCHEDULE A (Form 1040) Department of the Treasury Internal Revenue Service (99) Itemized Deductions to Information about Schedule A and its separate instructions is at www.irs.gov/schedulea. Attach to Form 1040. OMB No. 1545-0074 �� 13 Attachment quenncece No. 0 Se7 Name(s) shown on Form 1040 Your social security number John T Ruskin, Jr. & Elizabeth G Buskin 217-56-1790 Caution. Do not include expenses reimbursed or paid by others. Medical 1 Medical and dental expenses (see instructions) • 1 and 2 Enter amount from Form 1040, line 38 1 2 Dental 3 Multiply fine 2 by 10% (.10). But If either you or your spouse was _� Expenses born before January 2, 1949, multiply line 2 by 7.5% (.075) instead 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- 4 Taxes You 5 State and local (check only one box): Paid a .3 Income taxes, or5 b ■ General sales taxes } 9 , 47 7 . 6 Real estate taxes (see instructions) 6 6,409. `. 7 Personal property. taxes 7 8 Other taxes. List type and amount ► _ _ _ _ — Y -- —----------- --� _ ------ -- — ----- 8 9 9 Add lines 5 through 8 15,886. Interest • 10 Home mortgage interest and points reported to you on Form 1098 10 9,419. You Paid 11 Home mortgage interest not reported to you on Form 1098.1f paid to the person from whom you bought the home, see instructions :'- Note. and show that person's name, identifying no., and address ► =°` Your mortgage interest deduction may _ _ 11 ::. be limited (see 12 Points not reported to you on Form 1098. See instructions for instructions). special rules 12 13 Mortgage insurance premiums (see instructions) 13 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 '"i 15 Add lines 10 through 14 15 9,41.9. Gifts to 16 Gifts by cash or check. If you made any gift of $250 or more, _ -.. Charity see instructions 16 ,3,905. If you made a 17 Other than by cash or check. If any gift of $250 or more, see gift and got a instructions. You must attach Form 8283 if over $500 . . . 17 7 8 0 . S% benefit for it, 18 Carryover from prior year 18 see instructions. 19 Add lines 16 through 18 19 4, 685. Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions!) 20 Job Expenses 21 Unreimbursed employee expenses—job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106 -EZ if required. '' Miscellaneous (See instructions.) ► Deductible_ expenses from Form 2106 21 6, 647. Deductions 22 Tax preparation fees 22 126. %;;=-' 23 Other expenses—investment, safe deposit box, etc. List type - and amount ► 24 Add lines 21 through 23 24 6,773. 25 Enter amount from Form 1040, line 38 1251 157,564. 26 Multiply line 25 by 2% (.02) 26 3 1151. 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- 27 3, 622 . Other Miscellaneous 28 Other -from list in instructions. List type and amount ► M__________w_» -----------___ Deductions 28 Total 29 Is Form 1040, line 38, over $150,000? Itemized ■ No. Your deduction is not limited. Add the amounts in the far right column Deductions for lines 4 through 28. Also, enter this amount on Form 1040, line 40. . . 29 33,612. M Yes. Your deduction may be limited. See the Itemized Deductions 1 Worksheet in the instructions to figure the amount to enter. 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. CAA REV 03N3/14TTMac Schedule A (Form 1040) 2013 SCHEDULE C -EZ (Form 1040) Department of the Treasury Internal Revenue Service (99) Net Profit From Business (Sole Proprietorship) ► Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. ► Attach to Form 1040, 1040NR, or 1041. ► See instructions on page 2. OMB No. 1545-0074 Name of proprietor John T Ruskin, Jr. 2©13 Attachment Sequence No. 09A Social security number (SSN) 217-56-1790 Part I General Information You May Use Schedule C -EZ Instead of Schedule C Only If You: • Had business expenses of $5,000 or less. • Use the cash method of accounting. • Did not have an inventory at any time during the year. • Did not have a net loss from your business. • Had only one business as either a sole proprietor, qualified joint venture, or statutory employee. And You: • Had no employees during the year. • Are not required to file Form 4562, Depreciation and Amortization, for this business. See the instructions for Schedule C, line 13, to find out if you must file. • Do not deduct expenses for business use of your home. • Do not have prior year unallowed passive activity tosses from this business. A Principal business or profession, including product or service Attorney fee C Business name. If no separate business name, leave blank. B Enter business code (see page 2) I9I9I9I9I919 D Enter your EIN (see page 2) E Business address (including suite or room no.). Address not required if same as on page 1 of your tax return. 212 Willow Ave. City, town or post office, state, and ZIP code Camp Hill, PA 17011 F Did you make any payments in 2013 that would require you to file Form(s) 1099? (see the Schedule C instructions) G if "Yes," did you or will you file required Forms 1099? CI Yes ®No ED Yes No Part II Figure Your Net Profit Gross receipts. Caution. If this income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, see Statutory Employees in the instructions for Schedule C, line 1, and check here 1 4,021. 2 Total expenses (see page 2). If more than $5,000, you must use Schedule C 2 4, 021. 3 Net profit Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 and Schedule SE, line 2 (see instructions). (Statutory employees, do not report this amount on Schedule SE, line 2) Estates and trusts, enter on Form 1041, line 3 3 0. Part III Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2. 4 When did you place your vehicle in service for business purposes? (month, day, year) ► 5 Of the total number of miles you drove your vehicle during 2013, enter the number of miles you used your vehicle for: a Business 7 b b Commuting (see page 2) c Other Was your vehicle available for personal use during off-duty hours? Do you (or your spouse) have another vehicle available for personal use? Do you have evidence to support your deduction? If "Yes," is the evidence written? ❑Yes No ❑Yes No ❑Yes No ❑ Yes ❑ No For Paperwork Reduction Act Notice, seethe separate instructions for Schedule C (Form 1040). BAA REV03ro3n4Truac Schedule C -EZ (Form 1040) 2013 Form 24411 Department of the Treasury Internal Revenue Service (99) Name(S) shown on return Child and Dependent Care Expenses ► Attach to Form 1040, Form 1040A, or Form 1040NR. ► Information about Form 2441 and its separate instructions is at www.hs.govlonn2441. OMB No. 1545-0074 2013 Attachment Sequence No. 21 Your social security number John T Hoskin, Jr & Elizabeth G Huskin 217-56-1790 Persons or Organizations Who Provided the Care—You must complete this part. (If you have more than two care providers, see the instructions.) Part I 1 (a) Care provider's name (b) Address (number, street, apt. no. city, state, and ZIP code) (c) Identifying number (SSN or HN (d) Amount paid (see instructions) Churches Affiliated Child Care Center 417 3 22nd Street__ _____,_....-____• Camp Hill PA 17011 25-1569477 1,099 . 173-82-7822 1,068. Did you receive No --110. Complete only Part II below. dependent care benefits? Yes ..+..._► Complete Part III on the back next. Caution. If the care was provided in your home, you may owe employment taxes. If you do, you cannot file Form 1040A. For details, see the instructions for Form 1040, line 59a, or Form 1040NR, line 58a. Part II Credit for Child and Dependent Care Expenses 2 Information about your qualifying person(st.,if you have more than two qualifying persons, see the instructions. (a) Qualifying person's name First Last (b) Qualifying person's social security number (o) Qualified expenses you incurred and paid in 2013 for the person listed in column (a) John T Huskin 173-82-7822 1,068. 3 Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount '.';s:'=,> from line 31 3>:.. 1, 068. 4 Enter your earned income. See instructions 4 116,600. 5 If married filing jointly, enter your spouse's earned income (if you pr your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4 . 5 38,7 91. L. 6 Enter the smallest of line 3, 4, or 5 6 1, 068 . 7 Enter the amount from Form 1040, line 38; Form :<f== 1040A, line 22; or Form 1040NR, line 37 17 157, 564. 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7 If line 71s: If line 7 is: But not Decimal But not Decimal Over over amount is Over over amount is 60-15,000 .35 $29.000-31,000 .27 15,000-17,000 .34 31,000-33,000 .26 ''-,y• .< 17,000-19,000 .33 33,000-35,000 .25 8 X .20 19,000-21,000 .32 35,000-37,000 .24 21,000-23,000 .31 37,000-39,000 23 , 23,000-25,000 .30 39,000-41,000 .22 25,000-27,000 .29 41,000-43,000 .21 _ 27,000-29,000 .28 43,000—No limit .20 9 Multiply line 6 by the decimal amount on line 8. if you paid 2012 expenses in 2013, see the instructions 9 214 . 10 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions _ I lo 1 17,780. :. 11 Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 48; Form 1040A, line 29; or Fonit 1040NR, line 46 . . . . 11 214 . For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 03/03/14111W Form 2441 (2013) 8863 Education Credits Form (American Opportunity and Lifetime Learning Credits) • ► Information about Form 8883 and its separate instructions Is at www.irs.gov/form8863. Department of tee Treasury Internal Revenue Service (99) OsAttach to Form 1040 or Form 1040A. OMB No. 1545-0074 20013 Attachment Sequence No. 50 Name(s) shown on return John T Huskin, Jr. & Elizabeth•G Huskin Your social security number 217-56-1790 A CAUTION Complete a separate Part Ill on page 2 for each student for whom you are claiming either credit before you complete Parts I and II. Part I Refundable American Opportunity Credit 1 After completing Part III for each student, enter the total of all amounts from all Parts Ili, line 30 . 2 ' Enter:. $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er) 2 180, 000. 1 2,500. 3 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you are filing Form 2555, 2555 -EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter 4 Subtract line 3 from line 2. If zero or less, stop; you cannot take any education credit 5 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) 6 If line 4 is: • Equal to or more than line 5, enter 1.000 on line 6 • Less than line 5, divide line 4 by line 5. Enter the result as a decimal (rounded to at least three places) 7 Multiply line 1 by line 6. Caution: If you were under age 24 at the end of the year and meet the conditions described in the instructions, you cannot take the refundable American opportunity credit; skip line 8, enter the amount from line 7 on line 9, and check this box . . . . ► 0 8 Refundable American opportunity credit. Multiply line 7 by 40% (.40). Enter the amount here and on Form 1040, line 66, or Form 1040A, line 40. Then go to line 9 below Nonrefundable Education Credits 9 Subtract line 8 from line 7. Enter here and on line 2 of the Credit Limit Worksheet (see instructions) 10 After completing Part III for each student, enter the total of all amounts from all Parts III, line 31. If zero, skip lines 11 through 17, enter -0- on line 18, and go to line 19 11 Enter the smaller of line 10 or $10,000 12 Multiply line 11 by 20% (.20) 13 Enter: $127,000 if married filing jointly; $63,000 if single, head of household, or qualifying widow(er) 13 14 Enter the amount from Form 1040, line 38, or Form 1040A, line 22. If you are filing Form 2555, 2555 -EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter 15 Subtract line 14 from line 13. If zero or less, skip lines 16 and 17, enter -0- on line 18, and go to line 19 16 Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) 17 If line 15 is: • Equal to or more than line 16, enter 1.000 on line 17 and go to line 18 • Less than tine 16, divide line 15 by line 16. Enter the result as a decimal (rounded to at least three places) 18 Multiply line 12 by line 17. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) ► 19 Nonrefundable education credits. Enter the amount from line 7 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 49, or Form 1040A, line 31 Part II 3 4 5 157,564. 22,436. 20,000. 14 15 16 6 1.000 7 2,500. 8 1,000. 9 1,500. 10 11 12 18 19 For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV03A3114TtMac 1,500. Form 8863 (2013) Farm 8883 (2013) Page 2 Names) shown on return John T Ruskin, Jr. & Elizabeth G Ruskin Your social security number 217-56-1790 A CAUTION Part III Complete Part III for each student for whom you are claiming either the American opportunity credit or lifetime learning credit Use additional copies of Page 2 as needed for each student. Student and Educational institution Information See instructions. 20 Student name (as shown on page 1 of your tax return) Katherine L Buskin 21 Student social security number (as shown on page 1 of your tax return) 623-76-7128 22 Educational institution information (see instructions a. Name of first educational institution Pennsylvania State University b.. Name of second educational institution (if any) (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. 103• Shields Building University Park PA 16802 (1) Address. Number and street (or P.O. box). City, town or post office, state, and ZIP code. If a foreign address, see instructions. Did the Form 1098-T Did the (2) student receive © yes • No (2) student receive Form 1098-T ■Yes • No from this institution for 2013? from this institution for 2013? (3) Did the student receive Form 1098-T (3) Did the student receive Form 1098-T from this institution for 2012 with Box 0 Yes ri No from this institution for 2012 with Box 2 ■ Yes • Ido 2 filled in and Box 7 checked? tilled In and Box 7 checked? If you checked "No" in both (2) and (3), skip (4). If you checked "No" in both (2) and (3), skip (4). (4) If you checked "Yes" in (2) or (3), enter the institution's federal identification number (from Form 1098-1). 24-6000376 (4) If you checked "Yes" in (2) or (3), enter the institution's federal identification number (from Form 10984). 23 Has the Hope Scholarship Credit or American opportunity Yes - Stom credit been claimed for this student for any 4 tax years 0 Go to line 31 for this student. 0 No - Go to line 24. before 2013? 24 Was the student enrolled at least half-time for at least one academic period that began In 2013 at an eligible educational Institution in a program leading towards a ❑X Yes - Go to line 25. ❑ No - Stop! Go to line 31 postsecondary degree, certificate, or other recognized for this student. postsecondary educational credential'? (see instructions) 25 Did the student complete the first 4 years of post -secondary Yes Stopl education before 2013? ❑ Go to line 31 for this student. No - Go to line 26. 26 Was the student convicted, before the end of 2013, of a Yes - Stopl No - See Tip below and felony for possession or distribution of a controlled ❑ Go to line 31 for this 0 Complete either lines 27-30 substance? student, or line 31 for this student. When you figure your taxes, you may want to compare the American opportunity credit and lifetime learning credits, and choose the credit for each student that gives you the lower tax liability. You cannot take the American opportunity credit and the lifetime learning credit for the same student in the same year. If you complete lines 27 through 30 for this student, do not complete line 31. m American Opportunity Credit 27 Adjusted qualified education expenses (see instructions). Do not enter more than $4,000 . 28 Subtract $2,000 from line 27. If zero or less enter -0- 29 Multiply line 28 by 25% (.25) 30 If line 28 Is zero, enter the amount from line 27. Otherwise, add $2,000 to the amount on line 29 and enter the result. Skip line 31. Include the total of all amounts from all Parts Iii, line 30 on Part I, line 1 . 27 28 29 4,000. 2,000. 500. 30 2,500. Lifetime Learning Credit 31 Adjusted qualified education expenses (see instructions). Include the total of all amounts from alt Parts Ill, line 31, on Part Il, line 10 31 orm 88M3 (2013) Form 2106 Department of the Treasury Internal Revenue Service (99) Employee Business Expenses ►Attach to Form 1040 or Form 1040NR. ► Information about Form 2100 and its separate instructions is available at www.hs.gov/fo,m2106 OMB No. 1545-0074 Your name John T Huskin, Jr. Occupation in which you incurred expenses Attorney 20013 Attachment Sequence No. 129 Social security number 217-56-1790 Part I Employee Business Expenses and Reimbursements Step 1 Enter Your Expenses Column A Other Than Meals and Entertainment Column B Meals and Entertainment 1 Vehicle expense from line 22 or line 29. (Rural mail carriers: See instructions.) 2 Parking fees, tolls, and transportation, including train, bus, etc., that did not involve overnight travel or commuting to and from work . 3 Travel expense while away from home overnight, Including lodging, airplane, car rental, etc. Do not include meals and entertainment . 4 Business expenses not included on lines 1 through 3. Do not include meals and entertainment 5 Meals and entertainment expenses (see instructions) 6 Total expenses. In Column A, add lines 1 through 4 and enter the result. in Column B, enter the amount from line 5 1 4,027. 2 720. 3 4 5 851. 1,130. 6 5,598. 1,130. Note: If you were not reimbursed for any expenses in Step 1, skip line 7 and enter the amount from line 6 on line 8. Step 2 Enter Reimbursements Received From Your Employer for Expenses Listed in Step i 7 Enter reimbursements received from your employer that were not reported to you in box 1 of Form W-2. Include any reimbursements reported under code "L" in box 12 of your Form W-2 (see instructions) 7 Step 3 Figure Expenses To Deduct on Schedule A (Form 1040 or Form 1040NR) 8 Subtract line 7 from line 6. If zero or less, enter -0-. However, if line 7 is greater than line 6 in Column A, report the excess as income on Form 1040, line 7 (or on Form 1040NR, line 8) Note: If both columns of line 8 are zero, you cannot deduct employee business expenses. Stop here and attach Form 2106 to your return. 9 In Column A, enter the amount from line 8. In Column B, multiply line 8 by 50% (.50). (Employees subject to Department of Transportation (DOT) hours of service limits: Multiply meal expenses incurred while away from home on business by 80% (.80) instead of 50%. For details, see instructions.) 8 5,598. 1,130. 5,598. 565. 10 Add the amounts on line 9 of both columns and enter the total here Also, enter the total on Schedule A (Form 1040), line 21 (or on Schedule A (Form 1040NR), line 7). (Armed Forces reservists, qualified performing artists, fee -basis state or local government officials, and individuals with disabilities: See the instructions for special rules on where to enter the total) ► 10 For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 03/03/14TTMac 6,163. Form 2106 (2013) Form 2106 (2013) Vehicle Expenses Section A—General information (You must complete this section if you are claiming vehicle expenses.) 11 Enter the date the vehicle was placed in service Part II 12 Total miles the vehicle was driven during 2013 13 Business miles included on line 12 Page 2 (a) Vehicle 1 (b) Vehicle 2 14 Percent of business use. Divide line 13 by line 12 15 Average daily roundtrip commuting distance 16 Commuting miles included on line 12 17 Other miles. Add lines 13 and 16 and subtract the total from line 12 . 18 Was your vehicle available for personal use during off-duty hours? 19 Do you (or your spouse) have another vehicle available for personal use? 20 Do you have evidence to support your deduction? 21 If "Yes," is the evidence written? 11 02/26/2012 12 28, 210 miles 13 14 18, 221 miles 64.59 %' 16 4 miles 16 1, 200 miles 17 8, 789 miles miles miles o' miles miles miles ®Yes ❑ No E) Yes ❑ No ® Yes ❑ No ® Yes ❑ No Section B—Standard Mileage Rate (See the instructions for Part ii to find out whether to com 22 Multiply line 13 by 58.59 (.565). Enter the result here and on line 1 Section C—Actual Expenses 23 Gasoline, oU, repairs, vehicle insurance, etc 24a Vehicle rentals b Inclusion amount (see instructions) c Subtract Ilne 24b from fine 24a 25 Value of employer-provided vehicle (applies only if 100% of annual lease value was included on Form W-2—see instructions) . . . 26 Add lines 23, 24c, and 25. . 27 Multiply line 26 by the percentage on line 14 . . . . . . . . 28 Depreciation (see instructions) . 29 Add lines 27 and 28. Enter total here and on line 1 p lete this section or Section C.) (a) Vehicle 1 I22I (b) Vehicle 2 23 2,947. 24a 24b 24c 25 26 27 28 29 2,947. 1,903. 2,124. 4,027. Section D,—Depreciation of Vehicles se this section only if you owned the vehicle and are completing Section C for the vehicle.) 30 Enter cost or other basis (see instructions) 31 Enter section 179 deduction and special allowance (see instructions) 32 Multiply line 30 by line 14 (see instructions if you claimed the section 179 deduction or special allowance) 33 Enter depreciation method and percentage (see instructions) . 34 Multiply line 32 by the percentage on line 33 (see instructions) . . 35 Add lines 31 and 34 . . . . 36 Enter the applicable limit explained in the line 36 instructions . . 37 Multiply line 36 by the percentage on line 14 38 Enter the smaller of line 35 or line 37. If you skipped lines 36 and 37, enter the amount from line 35. Also enter this amount on line 28 above (a) Vehicle 1 (b) Vehicle ? 30 29,000. 31 32 10,291. 33 200 DB 26.00 34 35 2,676. 2,676. 36 5,100. 37 38 3,294. 2,124. REV 03(03114 TrMdc Form 2106 (2013) Form 2106 -EZ Department of the Treasury Internal Revenue Service (99) Unreimbursed Employee Business Expenses ► Attach to Form 1040 or Form 1040NR. ► Information about Form 2106 and its separate instructions is available at www.irs.gov/fonn2106. Your name Elizabeth G Huskin OMB No. 1545-0074 2013 Attachment Sequence No. 129A Occupation in which you incurred expenses Program Manager Social security number 467-47-5165 You Can Use This Form Only if All of the Following Apply. • You are an employee deducting ordinary and necessary expenses attributable to your job. An ordinary expense is one that is common and accepted in your field of trade, business, or profession. A necessary expense is one that is helpful and appropriate for your business. An expense does not have to be required to be considered necessary. • You do not get reimbursed by your employer for any expenses (amounts your employer included in box 1 of your Form W-2 are not considered reimbursements for this purpose). • If you are claiming vehicle expense, you are using the standard mileage rate for 2013. Caution: You can use the standard mileage rate for 2013 only If: (a) you owned the vehicle and used the standard mileage rate for the first year you placed the vehicle In service, or (b) you leased the vehicle and used the standard mileage rate for the portion of the lease period after 1997. Part I Figure Your Expenses 1 Complete Part II. Multiply line 8a by 56.50 (.565). Enter the result here 2 Parking fees, tolls, and transportation, including train, bus, etc., that did not involve overnight travel or commuting to and from work 3 Travel expense while away from home overnight, including lodging, airplane, car rental, etc. Do not include meals and entertainment 4 Business expenses not included on lines 1 through 3. Do not include meals and entertainment 5 Meals and entertainment expenses: $ 32 . x 50% (.50). (Employees subject to Department of Transportation (DOT) hours of service limits: Multiply meal expenses incurred while away from home on business by 80% (.80) instead of 50%. For details, see instructions.) 6 Total expenses. Add lines 1 through 5. Enter here and on Schedule A (Form 1040), line 21 (or on Schedule A (Form 1040NR), line 7). (Armed Forces reservists, fee -basis state or local government officials, qualified performing artists, and individuals with disabilities: See the instructions for special rules on where to enter this amount ) 1 2 3 145. 4 323. 5 16. 6 484. Part II Information on Your Vehicle. Complete this part only if you are claiming vehicle expense on line 1. 7 When did you place your vehicle in service for business use? (month, day, year) ► 8 Of the total number of miles you drove your vehicle during 2013, enter the number of miles you used your vehicle for: a Business b Commuting (see instructions) c Other 9 Was your vehicle available for personal use during off-duty hours? 0 Yes 0 No 10 Do you (or your spouse) have another vehicle available for personal use? 0 Yes 0 No 11a Do you have evidence to support your deduction? 0 Yes 0 No b If "Yes," is the evidence written? 0 Yes 0 No For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 03/03/14 TTMac Form 2106 -EZ (2013) Form 8283 (Rev. December 2013) Department of the Treasury Internal Revenue Service Noncash Charitable Contributions ► Attach to your tax return if you claimed a total deduction of over $500 for all contributed property. ► Information about Form 8283 and its separate instructions is at www.irs.govlform8283. OMB No. 1545-0908 Attachment Sequence No.155 Name(s) shown on your income tax return Identifying number John T Ruskin, Jr. & Elizabeth G Buskin 217-56-1790 Note. Figure the amount of your contribution deduction before completing this form. See your tax return instructions. Section A. Donated Property of $5,000 or Less and Publicly Traded Securities—List in this section only items (or groups of similar items) for which you claimed a deduction of $5,000 or less. Also, list publicly traded securities even if the deduction is more than $5,000 (see instructions). Information on Donated Property—lf you need more space, attach a statement. Part I • (a) Name and address of the 1 donee organization (b) If donated property is a vehicle (see instructions), check the box. Also enter the vehicle Identification number (unless Form 1098-C Is attached) (c) Description of donated property (For a vehicle, enter the year, make, model, and mileage. For securities, enter the company name and the number of shares.) A Harrisburg Rotary Foundation HarrisburgnPAB17101 1111 new prom dress A B Toys for Tots 2991 N. Second Street Harrisburg PA 17110 0 new toys C Harrisburg Food Bank 3908 Corey Road Harrisburg PA 17109 • food D Goodwill Carlisle Pike Mechanicsburg PA 17011 • clothes, hammock C E Salvation Army Trindle Road Camp Hill PA 17011 • tables and lamps 110. Note If the amount you claimed as a deduction for an item is $500 or less. you do not have to complete columns (e). M. and (o). entire interest in a property. listed in Part I. Complete lines 3a through 3c if conditions were placed on a contribution listed In Part I; also attach the required statement (see Instructions). 2a Enter the letter from Part I that identifies the property for which you gave less than an entire interest ► If Part ii applies to more than one property, attach a separate statement. b Total amount claimed as a deduction for the property listed in Part I: (1) For this tax year ► (2) For any prior tax years ► c Name and address of each organization to which any such contribution was made in a prior year (complete only if different from the donee organization above): Name of charitable organization (donee) Address (number, street, and room or suite no.) City or town, state, and ZIP code d For tangible property, enter the place where the property is located or kept 110- e e Name of any person, other than the donee organization, having actual possession of the property ► 3a Is there a restriction, either temporary or permanent, on the donee's right to use or dispose of the donated property? b Did you give to anyone (other than the donee organization or another organization participating with the donee organization in cooperative fundraising) the right to the income from the donated property or to the possession of the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or to designate the person having such income, possession, or right to acquire? c Is there a restriction limiting the donated property for a particular use? Yes No For Paperwork Reduction Act Notice, see separate instructions. DAA REV05102/14 TTMae Form 8283 (Rev. 12-2013) (d) Date of the contribution (e) Date acquired by donor (mo., yr.) (f) How acquired by donor (g) Donor's cost or adjusted basis (h) Fair market value (see instructions) (7 Method used to determine the fair market value A 04/02/2013 100. Present value B 11/18/2013 120. Present value C 10/22/2013 110. Present value D 12/15/2013240. Present value E 12/20/2013 210. Appraisal Part II Partial Interests and Restricted Use Property—Complete lines 2a through 2e if you aave less than an entire interest in a property. listed in Part I. Complete lines 3a through 3c if conditions were placed on a contribution listed In Part I; also attach the required statement (see Instructions). 2a Enter the letter from Part I that identifies the property for which you gave less than an entire interest ► If Part ii applies to more than one property, attach a separate statement. b Total amount claimed as a deduction for the property listed in Part I: (1) For this tax year ► (2) For any prior tax years ► c Name and address of each organization to which any such contribution was made in a prior year (complete only if different from the donee organization above): Name of charitable organization (donee) Address (number, street, and room or suite no.) City or town, state, and ZIP code d For tangible property, enter the place where the property is located or kept 110- e e Name of any person, other than the donee organization, having actual possession of the property ► 3a Is there a restriction, either temporary or permanent, on the donee's right to use or dispose of the donated property? b Did you give to anyone (other than the donee organization or another organization participating with the donee organization in cooperative fundraising) the right to the income from the donated property or to the possession of the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, or to designate the person having such income, possession, or right to acquire? c Is there a restriction limiting the donated property for a particular use? Yes No For Paperwork Reduction Act Notice, see separate instructions. DAA REV05102/14 TTMae Form 8283 (Rev. 12-2013) Tax History Report 1. Keep for your records 2013 Name(s) Shown on Return kin, Jr. & Elizabeth G Hoskin *"Tax bracket % is based on Taxable income. Five Year Tax History• 2009 2010 2011 2012 2013 cling status. MFJ MFJ total income 163,625. 157,564. kdjustments to income kdjusted gross income Tax expense interest expense Contributions Miscellaneous deductions Other itemized deductions Total itemized/standard deduction Exemption amount Taxable income Tax Alternative minimum tax Total credits Other taxes Payments Form 2210 penalty Amount owed Applied to next year's estimated tax Refund Effective tax rate % "*Tax bracket % 163,625. 157,564. 16,174. 15,886. 9,664. 9,419. 3,440. 4,685. 2,145. 3,622. 31,423. 33,612. 19,000. 19,500. 113,202. 104,452. 20,283. 17,780. 600. 1,714. 17,527. 16,487. 4. 2,160. 421. 12.03 9.56 25.0 25.0 *"Tax bracket % is based on Taxable income. 10984 Worksheet Tuition Statement ► Keep for your records 2013 Taxpayer's name John T Buskin, Jr. & Elizabeth G Buskin Social Security No. 217-56-1790 1098-T information (Required): A A Form 1096-T was received from this institution Yes B No Q B A Form 1098-T was received from this institution in 2012 with Box 2 filled in and Box 7 checked Yes n No 17j Identify Student (Required): A If student is John or Elizabeth Double-click to link this 1098-T to the applicable Taxpayer or Spouse Student Information Worksheet ► B If student is Katherine, Caroline or John Double-click to link this 1098-T to the applicable Dependent Student Information Worksheet ► Katherine Filer's name Pennsylvania State University 1 Payments received for qualified tuition and related expenses .... $ Street address 103 Shields Building 2 Amounts billed for qualified and related expenses tuition $ 8,496. City State Zip Code University Park PA 16802 Foreign province/county 3 If this box Is checicdd, your educational institution has changed its reporting method for 2013 (-i Foreign postal code Foreign country Filer's Federal identification number 24-6000376 Student's Social Security Number. 623-76-7128 4 Adjustments made for a prior year $ 5 Scholarships or grants $ Student's name Katherine 6 Adjustments to scholarships or grants for a prior year $ 7 Checked if the amount in box 1 or 2 includes amounts for an academic period beginning January - Street address Apt. No. 212 Willow Ave. City State Zip Code Camp Hill PA 17011 March 2014.... ►'- Service Provider/ Acct No 8 Check if at least 9 Checked if a graduate student .. ► 10 Ins. contract reimb.ltefund $ half-time student 104 1 Reconciliation of Box 1, Payments Received for Qualified Tuition and Related Expenses A Enter box 1 amount not paid during 2013 B Enter box 1 amount actually paid during 2013 Reconciliation of Box 2, Amounts Billed for Qualified Tuition and Related Expenses A Enter box 2 amount not paid during 2013 B Enter box 2 amount actually paid during 2013 0. 26,594. Reconciliation of Box 5, Veteran- or Employer -Provided Assistance included In Box 5 A Enter portion of box 5 amount from veteran- or tax free employer-provided assistance .. . B Enter portion of box 5 amount from employer-provided assistance included in Income ... C Portion of box 5 amount from scholarships or grants B Box 5 amount includes veteran- or employer-provided educational assistance Form 1099-0 Payments From Qualified Education Programs 2013 (Under Sections 529 and 530) ► Keep for your records Recipient's name Katherine Ruskin Social Security No. 623-76-7128 Designated Beneficiary and Recipient A Who was the designated beneficiary of the distribution reported on this form 1099-Q? . . B Who was the recipient of the distribution reported on this form? (1) (2) (3) (4) (5) Someone Not Taxpayer Spouse Dependent else applicable a a a o ❑ El n El C if the designated beneficiary is a dependent, double-click to link this 1099-Q to the applicable Dependent Student information Worksheet D If the designated beneficiary is someone else, double-click to link this 1099-Q to the applicable Qualified Education Expenses Worksheet ► IN -Katherine PAYER'S!TRUSTEE'S name First Clearing LLC. Street address 2601 Market Street City State ZIP code St. Louis MO 63103 Telephone no. Ext: i Gross Distribution $ 21,536. 2 Earnings $ 0. PAYER'S federal identification number 23-2384840 RECIPIENT'S social security number 623-76-7128 3 Basis $ 0. 4 Trustee -to -trustee transfer RECIPIENT'S name Katherine Ruskin Street address (including apt. no.) 212 Willow Ave. City State ZIP code Camp Hill PA 17011 5 Check one: • Qualified tuition program — Private ... State • Coverdell ESA X 6 Check if the recipient is not the designated beneficiary El Account number 4434-1004 Distribution Code Distribution code, if payer reported code in the box below boxes 5 and 6 . . ► Qualified Tuition Program If State Qualified Tuition Program, enter state ► Distributions Due to Death or Disability 1 Check box if this distribution was due to the disability of the designated beneficiary ► 2 Check box if this distribution was due to the death of the designated beneficiary ► Katherine Buskin 623-76-7128 Page 2 Rollovers and Transfers 1 Was the distribution rolled over and the following conditions met? * Rolled over within 60 days of the distribution * 12 months since a previous rollover (to the same beneficiary for a QTP). See Help a Yes, entire distribution was rolled over meeting above conditions b Yes, a portion of distribution was rolled over meeting above conditions (1) Enter portion rolled over ► c No, no portion of the distribution was rolled over or conditions above not met 2 Amount that was rolled over 3 If a rollover or transfer, check box if the owner of the account receiving the rollover is a The original designated beneficiary b A family member of the original designated beneficiary c Someone who is not a family member of the original designated beneficiary d Not applicable Coverdell Education Savings Account (ESA) Return of Contribution 1 Was this distribution a return of a contribution to a Coverdell ESA? if yes, check one: 2 The contribution was made in 2013 and returned in 2013 3 The contribution was made in 2013 and returned in 2014 (2014 1099-0) . 4 The contribution was made in 2012 and retumed in 2013 5 Amount of return of contribution nYes [ INo ► lWA X 21,536. Coverdell Education Savings Account (ESA) Activity Information Coverdell Education Savings Account (ESA) Computation of Taxable Distribution For Purposes of Regular Tax For Purposes of 10% Additional Tax 1 Enter the amount contributed to this ESA for 2013 2 Enter your basis of this ESA as of December 31, 2012 3 Add lines 1 and 2 4 Enter the total distributions from this ESA during 2013 5 Enter the amount of adjusted qualified education expenses attributable to this ESA 6 Subtract line 5 from line 4 7 Enter the value of this ESA as of December 31, 2013 8 Add lines 4 and 7 9 Basis fraction. Divide line 3 by line 8 10 Multiply line 4 by line 9. 11 Subtract line 10 from tine 4. 12 Tax-free fraction. Divide line 5 by line 4 (but not more than 1.0) 13 Multiply line 11 by line 12. This is the amount of tax-free earnings 14 Subtract line 13 from line 11. This is the taxable amount to the recipient... 15 Basis as of December 31, 2013. Subtract line 10 from line 3. (a) As of 12/31/2012 (b) During 2013 (o) As of 12/31/2013 (d) During 2014 1 Basis 0. 2 Contributions: a For 2012 .... ,.`:.... ._...._ .._....... b For 2013 0. 3 Value 83. 4 Outstanding rollovers Coverdell Education Savings Account (ESA) Computation of Taxable Distribution For Purposes of Regular Tax For Purposes of 10% Additional Tax 1 Enter the amount contributed to this ESA for 2013 2 Enter your basis of this ESA as of December 31, 2012 3 Add lines 1 and 2 4 Enter the total distributions from this ESA during 2013 5 Enter the amount of adjusted qualified education expenses attributable to this ESA 6 Subtract line 5 from line 4 7 Enter the value of this ESA as of December 31, 2013 8 Add lines 4 and 7 9 Basis fraction. Divide line 3 by line 8 10 Multiply line 4 by line 9. 11 Subtract line 10 from tine 4. 12 Tax-free fraction. Divide line 5 by line 4 (but not more than 1.0) 13 Multiply line 11 by line 12. This is the amount of tax-free earnings 14 Subtract line 13 from line 11. This is the taxable amount to the recipient... 15 Basis as of December 31, 2013. Subtract line 10 from line 3. Katherine Huskin 623-76-7128 Page 3 Qualified Tuition Program (QTP) Computation of Taxable Distribution For Purposes of Regular Tax For Purposes of 10% Additional Tax 1 Enter the total distributions from this OW during 2013 2 Enter the amount of adjusted qualified education expenses attributable to this QTP 3 Excess distributions. Subtract line 2 from line 1 4 Total distributed earnings from Form 1099-0 box 2 5 Fraction. DMde line 2 by line 1. 6 Multiply line 4 by tine 5. 7 Subtract line 6 from line 4. This is the taxable amount to the recipient Distributions Not Subject to Additional 10% Tax 1 Distributions included in income 2 Distributions not subject to additional 10% Tax: a Paid to beneficiary on or after the death of the designated beneficiary b Made because the designated beneficiary is disabled o Included in income because beneficiary received tax-free scholarship d Made on account of attendance at U.S. military academy e Included only because qualified expenses were taken into account in determining American Opportunity or lifetime learning credit. f Total. Add lines 2a through 2e Form 1040 Qualified Dividends and Capital Gain Tax Worksheet 2013 Line 44 Keep for your records Name(s) Shown on Return Social Security Number John T Ruskin, Jr. & Elizabeth G Ruskin 217-56-1790 1 Enter the amount from Form 1040, line 43 2 Enter the amount from Form 1040, line 9b Are you filing Schedule D? Yes. Enter the smaller of line 15 or 16 of Schedule D, If either line 15 or 16 is blank or loss, enter -0- 3 No. Enter the amount from Form 1040, line 13. 4 Add lines 2 and 3 .... • . • • . • • • • 4 5 If filing Form 4952 (used to figure Investment Interest expense deduction), enter any amount from line 4g of that form. Otherwise, enter -0•. 5 6 Subtract line 5 from line 4. If zero or less, enter -0- 7 Subtract line 6 from line 1. If zero or less, enter -0- 8 Enter: $36,250 if single or married filing separately, $72,500 if married filing jointly or qualifying widow(er), $48,600 if head of household. 9 Enter the smaller of line 1 or line 8 Ix1 2 238. 1,674. 1,912. 0. 1 104,452. 6 1,912 7 102,540. 72,500. 9 72,500. 10 Enter the smaller of line 7 or line 9 10 72,500. 11 Subtract line 10 from line 9 (this amount taxed at 0%) 11 . 0. 12 Enter the smaller of line 1 or line 8 12 1,912. 13 Enter the amount from line 11 13 0. 14 Subtract line 13 from line 12............... 15 Enter: $400,000 If single, $225,000 if married filing separately, $450,000 if married filing jointly or qualifying widow(er), $425,000 If head of household. 16 Enter the smaller of line 1 or line 15 17 Add lines 7 and 11 18 Subtract line 17 from line 16. If zero or less, enter -0- 19 Enter the smaller of line 14 or Une 18 20 Multiply line 19 by 15% (.15) 1,912. — 15 450,000. 16 104,452. 17 102,540. 18 1,912. 19 1,912. 20 287. 21 Add lines 11 and 19 21 1, 912. 22 Subtract line 21 from line 12 22 0 . 23 Multiply line 22 by 20% (.20) 23 0 24 Figure the tax on the amount on line 7. If the amount on line 7 Is less than $100,000, use the Tax Table to figure the tax. If the amount on line 7 is $100,000 or more, use the Tax Computation Worksheet 24 17,493. 26 Add Tines 20, 23, and 24 25 17,780. 26 Figure the tax on the amount on line 1. If the amount on line 1 Is less than $100,000, use the Tax Table to figure this tax. If the amount On line 1 Is $100,000 or more, use the Tax Computation Worksheet 26 17 , 9 71. 27 Tax on all taxable Income, Enter the smaller of line 25 or line 26 here and on Form 1040, line 44 27 17,780. Tax Payments Worksheet 2013 ► Keep for your records Name(s) Shown on Return John T Ruskin, Jr. & Elizabeth G Buskin Social Security Number 217-56-1790 Estimated Tax Payments for 2013 (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 04/15/13 04/15/13 04/15/13 06/17/13 06/17/13 2 06/17/13 09/16/13 09/16/13 3 09/16/13 01/15/14 01/15/14 4 01/15/14 5 Tot Estimated Payments .. . Tax Payments Other Than Withholding (If multiple states, see Tax Help) Federal State ID Local ID 6 Overpayments applied to 2013... . 7 Credited by estates and trusts ... 8 Totals Lines 1 through 7 9 2013 extensions Taxes Withheld From: Federal State Local 10 Forms W-2 15,487. 5,596. 3,645. 11 Forms W -2G 12 Forms 1099-R . 13 Forms 1099-MISC and 1099-G 14 Schedules K-1 15 Forms 1099 -INT, DIV and OID s 16 Social Security and Railroad Benefits 17 Form 1099-B St Lac 18 a Other withholding ... - St Loc b Other withholding St Loc c Other withholding St Loc d Positive Adjustment St Loc e Negative Adjustment . . St Loc f Additional Medicare Tax 19 Total Withholding Lines 10 through i 8f 15,487. 5,596. 3,645. 20 Total Tax Payments for 2013 15,487. 5,596. 3,645. Prior Year Taxes Paid In 2013 (If multiple states or localities, see Tax Help) State ID Local ID 21 Tax paid with 2012 extensions 22 2012 estimated tax paid after 12/31/2012 .. 23 Balance due paid with 2012 return 24 Other (amended returns, installment payments, etc) . • Schedule A State and Local Tax Deduction Worksheet 2013 Line 5 ► Keep for your records Name(s) Shown on Return John T Ruskin, Jr. & ElizabethG Ruskin Social Security Number 217-56-1790 State and Local Income Taxes State income taxes: 1 State income tax withheld 2 2013 state estimated taxes paid in 2013 3 2012 state_estimated taxes paid in 2013 4 Amount paid Vvith 2012 state application for extension 5 Amount paid with 2012 state income tax return 6 Overpayment on 2012 state income tax return applied to 2013 tax 7 Other amounts paid in 2013 (amended returns, Installment payments, etc.) ... 8 State estimated tax from Schedule(s) K-1 (Form 1041) Local Income taxes: 9 Local Income tax withheld 10 2013 local estimated taxes paid in 2013 11 2012 local estimated taxes paid in 2013 12 Amount paid with 2012 local application for extension 13 Amount paid with 2012 local income tax return 14 Overpayment on 2012 local income tax return applied to 2013 tax ..... . 15 Other amounts paid in 2013 (amended returns, installment payments, etc.) 16 Local estimated tax from Schedule(s) K-1 (Form 1041) Other: 17 State mandatory taxes 18 Total Add lines 1 through 17 19 State and local refund allocated to 2013 20 Nondeductible state income tax from line. 28 21 Total reductions Add lines 19 and 20 22 Total state and local Income tax deduction Line 18 less line 21 Nondeductible State Income Tax (Hawaii Only) 23 Nontaxable federal employee cost of living allowance 24 Adjusted gross Income 25 Add lines 23 and 24 26 Nondeductible percent. Line 23 divided by line 25 27 Hawaii state income tax included in line 18 28 Nondeductible Hawaii state income tax. Multiply line 26 by line 27 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 5,596. 3,645. 236. 9,477. 9,477. Charitable Contributions Summary ► Keep for your records 2013 Name(s) Shown on Return John T Huskin, Jr. & Elizabeth G Huskin Social Security Number 217-56.-1790 !Part it I Cash Contributions Summary Name of Charitable Organization (a)(b)(c Total 50 Umit 30% Limit RESERVED for future use ((Other 5Ub% Limit Harrisburg Rotary Foundation 400. 400. Harrisburg Rotary Foundation I•,: :, ';:.._. i ' ; . ' . Washington and Lee University 200. 200. 'toys for Tots Lion Foundation 94U. 940. Cultural Enrichment Fund 100. 100. 110. WITF 120. 120. Goodwill Charitable mileage expense 29. 29. tmaritanle transportation 4xpense 2 ,1/b. a , 11b. 210. • Totals: 3,905.. 3,905. ' 0. . _ .........__._.._.................. 0 . 0 . Part it I Non -Cash Contributions Summary Name of Charitable Organization Total Property)) Capital((t►Gain Property Total ((Other 5Ub% Limit 30% Limit 30% Limit 20e% Limit Harrisburg Rotary Foundation 100. 100. --- '-- -. - 4, 685. 'toys for Tots 120. 120. 4, 685. 4 685. Harrisburg Food Bank 110. 110. Goodwill 240. 240. Salvation Army 210. 210. 0. . _ .........__._.._.................. 0 . 0 . O. 0 . 0 . 0 . 0. 0. 0 . 0 . Totals: 780 . 780. 0 . 0 . iParC1il1 Contribution Carryovers to 2014 WOW] Special Situations in Your Return for Current Year Donations 1 Was the entire interest given for all property donated to all charities? [ n Yes 2 Were restrictions attached to any charities's right to use or dispose of any property donated to any charity" .. .. .. .. ► 3 Did you give to anyone other than the charity the right to income from any of the donated property or to possession of any of the donated property? ► Yes X No 4 Was any charity other than a 50% charity? Yes X No l r i No Yes rj No Total Cash and Other Non -Capital Gain Gain Property Capital Gain Property Total RESERVEDb 50%(30% Limit Limit 30% Limit 20% Limit 1 2013 contributions. . 2 2013 contributions allowed 3 Carryovers from: a 2012 tax year ... . b2011 tax year . . .. c 2010 tax year ... . d 2009 tax year ... . e2008 tax year ... 4 Carryovers allowed in 2013 5 Carryovers disallowed in 2013 6 Carryovers to 2014: a From 2013 b From 2012 cFrom 2011 d From 2010 e From 2009 .' I From 2008 (expired) 4,685. --- '-- -. - 4, 685. 4, 685. 4 685. 0 . 0. 0. 0. . _ .........__._.._.................. 0 . 0 . O. 0 . 0 . 0 . 0. 0. 0 . 0 . 0 . 0 . 0 . 0 . • WOW] Special Situations in Your Return for Current Year Donations 1 Was the entire interest given for all property donated to all charities? [ n Yes 2 Were restrictions attached to any charities's right to use or dispose of any property donated to any charity" .. .. .. .. ► 3 Did you give to anyone other than the charity the right to income from any of the donated property or to possession of any of the donated property? ► Yes X No 4 Was any charity other than a 50% charity? Yes X No l r i No Yes rj No Education Tuition and Fees Summary 2013 ► Keep for your records Name(s) Shown on Return John T Ruskin, Jr. & Elizabeth Ruskin Your Social Security No. 217-56-1790 Part 1- Qualified Education Expense Summary (a) Student's name First Name MI (b) Qualified Education Expenses (c) Qualified for: Yes No (d) Elected Credit or Deduction if manual (e) Elected Credit or Deduction if automatic Last Name Suffix Social Security Number Katherine L 27, 226. Amer Opp Cr . ► X — X Lifetime Cr... ► X Ruskin 26, 594. Tuition Ded . . ► X 26,594 . 623-76-7128 , :. — — Total Qualified Expenses 27, 226. ,........ .. .: Amer Opp Cr . ► Lifetime Cr... ► Tuition Ded ► ..... ::: Total Qualified Expenses Amer Opp Cr . ► Lifetime Cr... ► Tuition Ded .. ► TotalQualified D Ex eases >..: Total qualified expenses 27, 226. Amer Opp Cr Lifetime Cr Tuition Ded 26,594 . 26, 594. Part II - Optimize Education Expenses for the Lowest Tax Automatic 1 Launch OPTIMIZER - Check to launch Automatic Education Expense Optimizer now 2 Automatic - Check to use the Credit choices calculated in Part I, column (e) above or 3 Manual - Check to use the Credit choices you entered in Part I, column (d) above ►C] Part IIi - Summary of Deduction and Credits Tuition and Fees Deduction Summary 1 Total 2013 tuition and fees paid for purposes of deduction 2 Modified adjusted gross income 3 Maximum deduction allowed 4 Allowable Tuition and Fees Deduction (lesser of line 1 or line 2) American Opportunity, Lifetime Learning Credits Summary 5 Tentative American Opportunity Credit 8 Tentative Lifetime Learning Credit 7 Total Education Credits (after limitations) 1 2 3 4 5 6 7 0. 2,500. 2,500. PLAINTIFF'S EXHIBIT 1 C„opy 2sT +tSKFSICd WA E,tiil0101§. S F G.ftyt�vralEbt et IPIco111tTantPRetum t r a#i1p7q ee 3or4la {, 52ft7fdy nlImDertY "# b#in i i tf- r 1 01{1 tnpldy'e(,�Dnulnber 2`v .J;64r ! c',EmpEbye Gsname 1fWage rbrj.r1.49M5,1' 9:en k r rt "rte ttr2316'3 6 T�]�4n; 3S6aa3 ewind - f�SEMed carawag&sc -0,0,:sulatZ�IP bode s.� 2F OMB, ND ..',(19°I5.f talMM1 r3*T9i 4k 5e:41#1 sairun 'rtai.`a il}xetdr' `d,7 r;k�i in � 0EMe001.: itar4w,ttl 0. xxr e,ttp i y John T Huskin Jr. 212 Willow Aven . e Camp Hill, PA i7011 - Employee's address. and ZIP code 7 Social security lips • 110 Dependent care benefits 113 Statutory employee Retirement plan X •i '3rd party sick pay 8 Allocated tips 9 11 Nanqualified plans • • 12a Code C 234.60 14 Other PA-HAR 52.00 PASUI 112.20 5125 2799.94 2b Code D 14048.54 12c Code 2d Code PAI 17870742 15 State Emplr.'s state I.D. # 18 Local wages, lips, etc. 137450.08 form W-2 Wage and Tax Statement 137450.08 16 State wages, tips, etc. 4219.82 17 State income tax 19 Local income tax 2748.96 20 Locality name 22 -Dauphin Tax C I --k7.7 - Dept. of the Treasury - IRS I (See Notice to Employee on back of CoCopy C For EMPLOYEE'S RECORDS B.IAO / A 0 48 py ) L I' L a Employee's social security number 1 Wages, tips, other comp. 123636.14 2 Federal income tax withheld 13790.45 217-56-1790 3 Social security wages 4 Social security tax withheld b Emplbyer ID number 11010 0. 0 0 424 .20 t 28-1643634 5 Medicare wages and tips 137684.68 6 Medicare tax withheld 1996.43 • c Employer's name, address, and ZIP code Thomas, Thomas, & Hafer LLP 305 N Front Street 6th Floor Harrisburg, PA 17101 . d Control Number ' 7865. 4344 Huskin Jr. John T 43 ' e Employee's first name and • J tan �r 1%skia H F"'^[- its ' ",fit Ave 4Ft '°#M1.4-1,4 Ett J6&;44:.4ei+i+ initial Last name . 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'+ifir�� tJ5 w4+.`� Y�r...b re- T'.iv,ti`f;' 2 : ; ..€4.+t€,'.'°::1 _, j,f• 1.._'^ John T Huskin Jr. ;212 Willow Avenue Camp Hill, PA 170.11- ' f Employee'saddress, and ZIP code ` 7 Social security tips • 8 Allocated tips 9 .10 Dependent care benefits • 11 Nonqualifed plans 12a Code C 234.60 13 Statutory employee 14 Other PA-HAR 52.00 PASUI 112.20 5125 2799.94 12b Code D 14048.54 1 • Retirement plan X 12c Code 3rd parry sick pay 12d Code iPAI 17870792 15 State Emplr.'s state 1.0: # 137450.08 16 State wages, tips etc. 4219.82 17 State income tax 18 Local wages, tips, etc. 137450.08 19 Local income tax 2748.96 20 Locality name 22 -Dauphin Tax C Form W-2 Wage and Tax Statement 1 - Dept. of the Treasury - IRS ^fit ELIZABETH G. HUSKIN, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA • v. : DOCKET NO. 00120 S 2014 : PACSES CASE NO. 896114471 JOHN T. HUSKIN, : CIVIL ACTION - LAW Defendant IN DIVORCE EXPENSE STATEMENT OF ELIZABETH G. HUSKIN: I, Elizabeth G. Huskin, 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 unswom falsification to authorities. Date: Monthly Monthly Monthly Total Children Parent EXPENSES Home Mortgage $1.860.00 Maintenance $50.00 Lawn Care/Snow Removal $100,001 211(1 Mortgage UTILITIES Electric $87.00 Gas $33.00 Oil $233.00 Telephone Cell Phone $118.00 $59.00 $59.00 Water $48.00 Sewer $58.00 Cable TV (Internet is included) $177.00 Internet Trash/Recycling $14.00 TAXES Real Estate2 Personal Property ' This expense represents the amount paid by Plaintiff to have someone mow the lawn once a week, perform leaf pick- up in the Fall, and snow removal in the winter. 2 The real estate taxes and insurance are included in the monthly mortgage payment of $1860.00. INSURANCE Homeowners Automobile Life Accident/Disability Excess Coverage Long -Term Care Monthly Monthly Monthly Total Children Parent $194.00 $128.00 $66.00 AUTOMOBILE Lease or Loan Payments $350.003 Fuel $250.00 $50.00 $200.00 Repairs $250.00 $125.00 $125.00 Memberships MEDICAL4 $55.00 Medical Insurance $268.485 $130.00 +$85.00 (Jack) Doctor $20.00 $15.00 $5.00 Dentist $30.00 $20.00 $10.00 Hospital Medication Counseling/Therapy Orthodontist Special Needs (glasses, $60.00 .$35.00 $25.00 contact lenses, etc.) 3 Wife currently possess a 13 year old vehicle with 80,000 miles, and it is anticipated she will require a new vehicle. 4 Wife provides health insurance for Husband and the parties' 3 children. s The amount of $350.00 represents an estimated monthly payment for a new vehicle. Monthly -Monthly Monthly Total Children Parent EDUCATION To be incurred, unknown Tuition at this time Tutoring Lessons Other — Jake's college fund $50.00 PERSONAL Debt Service Clothing $300.00 $100.00 $200.00 Groceries $600.00 $400.00 $200.00 Haircare $160.00 $80.00 $80.00 Memberships $60.00 MISCELLANEOUS Child Care Household Help Summer Camp Papers/Books/Magazines $20.00 $15.00 $5.00 Entertainment $200.00 $100.00 $100.00 Pet Expenses $55.00 Vacations $300.00 Gifts $160.00 Legal Fees/Prof. Fees $1,045.00 Charitable contributions $50.00 Children's Parties Children's Allowances $400.00 Other Child Support Alimony payments TOTAL MONTHLY EXPENSES $7,600.48 $1,257.00 $1,215.00 Thomas, Thomas, & Hafer LLP 305 N Front Street 6th Floor Harrisburg, PA 17101 (717) 237-7136 7865 4344 02/14/14 26637 John T. Ruskin Jr. 212 Willow Avenue Camp Hill, PA 17011- ♦ P1_82Ui(IN192OI2) .F 2001-2012 MPAN Emp Id SSN 4344 XXX -XX -1790 Loc Hire Date Status 100-4 Period Begin 04/23/01. Period End A Check Type Total Gross Pay Hours Medical Reimbursement 0.00 Salary 80.00 Rate Current Amt Ytd Amt 9.62 38.48 3,846.15 15,384.60 Benefits • Employer Contribution 80.00 3,855.77 15,423.08 Current Amt Ytd Amt 115.67 462.68 0 0.00 0.00 Taxes Status Taxable Current Amt Ytd Amt Federal Income Tax M-1 I 3,362.50 170.05 680.20 OASDI 3,748.08 232.38 929.52 Medicare 3,748.08 54.35 217.39 Pennsylvania SITW M-11 3,748.08 115.07 460.28 PA SUI - EE 3,855.77 2.70 10.80 Dauphin Tax Collection District (YTD) 299.84 Camp Hill B. • 3,748.08 74.96 0 Harrisburg C.(Dauphin)( 3,748.08 2.00 8.00 651.51 2,606.03 Other Deductions from Pay. Current Amt Ytd Amt 401(k) 385.58 1,542.32 Pre MESA 57.69 230.76 Pre Tax Parking 132 -Harrisburg 50.00 200.00 493.27 1,973.08 Bank Account Current Amt Checking Account Ends with ***0610 2,710.99 01/26/14 02/08/14 Reg Net Pay Dir Dep 2,710.99 2,710.99 Total Gross Pay Federal Taxes State and Local Taxes Other Deductions Net Pay Direct Deposits Net Check 3,855.77 - 456.78 - 194.73 -493.27 -2,710.99 Time Off Balances Dollars Hours Accrual as of 2,710.99 O This code is shown for information only. It has no effect on your net pay. O This code is not included in your Federal taxable wages. O Current PSD tax amounts are included in the YTD amount of their associated Tax Collection District hi the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 ELIZABETH a HUSKIN VS. JOHN T. HUSKIN Plaintiff Defendant FEBRUARY 12, 2014 Fax: (717) 240-6248 ) Docket Number: 00120 S 2014 , ) PACSES Case Number: 896114471 1 ) Other State ID Number: Please note: All correspondence must include the PACSES Case Number. income Statement THIS FORM MUST BE FILLED OUT AND YOU MUST PROVIDE DOCUMENTS TO SUPPORT ALL AMOUNTS PROVIDED IN THIS INCOME STATEMENT (If you are self-employed or if you are salaried by a business of which you are owner in whole or in part, you must also fill out the Supplemental Income Statement which appears below.) INCOME STATEMENT OF 0 Lt/L:717 (Name) I verify that the statements made in this Income Statement are true and correct, understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. § 4904 relating to unsworn falsification to authorities. Date: (PACSES Number) INCOME Employer: Address: Type of Work: Payroll Number: -14-a A 1-1-6 rvuaL uct Pay Period (weekly, biweekly, etc): Gross Pay per Pay Period $ Itemized Payroll Deductions: Federal Withholding $ FICA Local Wage Tax State Income Tax Mandatory Retirement Union Dues Health Insurance tithFS.I\ Other (specify) (pet4i* =450,00 ci4c7/ -c-7.&210 Net Pay per Pay Period: Service Type M b'* ix,/4),7 DEFENDANT'S EXHIBIT Form IN -008 12/13 Worker ID 21209 Income Statement (Continued) PACSES Case Number: 89611447/ Other Income: Week Month Year (Fill in Appropriate Column) Interest $ $ $ Dividends Pension Distributions Annuity Social Security Rents Royalties Unemployment Comp. Workers Comp. Employer Fringe Benefits Other $ $ TOTAL INCOME $ PROPERTY OWNED Checking accounts Savings accounts �Credat--hien _.. • -,- Stocks/bonds Real Estate Other INSURANCE Hospital Blue Cross Other Medical Blue Shield Other Health/Accident Disability Income Dental Other Ownership* Description Value H W J GJd11 Fa✓V-o $ WAS F Total $ Coverage* Company Policy No. H W C �tE poSvozeo *H=Husband; W=Wife; J=Joint; C=Child Service Type M Page 2 of 3 Form iN-008 12/13 Worker ID 21209 Income Statement (Continued) PACSES Case Number: 896114471 SUPPLEMENTAL INCOME STATEMENT (You only need to complete the below portion if you are self- employed or if you are salaried by a business of which you are owner in whole dr in part) (a) This form is to be filled out by a person (check one): O (1) who operates a business or practices a profession, or Q (2) who is a member of a partnership or joint venture, or Q (3) who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement. (c) Name of business: Address and telephone number: (d) Nature of business (check one) O (1) partnership O (2) joint venture O (3) profession O (4) closed corporation O (5) other (e) Name of accountant, controller or other person in charge of financial records: (f) Annual income from business: (1) How often is income received? (2) Gross income per pay period: (3) Net income per pay period: (4) Specific deductions, if any: Service Type M Page 3 of 3 Form IN -008 12/13 Worker ID 21209 n the Court of Common Peas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320CARLISLE, PA. 17013 Phone: (717) 240-6225 ELIZABETH 0. HUSKIN vs. JOHN T. HUSKIN Plaintiff FEBRUARY 12 2014 ) Docket Number: ) PACSES Case Number: 896114471/ Fax: (717) 240-6248 00120 S 2014 ) ' Defendant ) Other State ID Number: Please note: All correspondence must inciude the PACSES Case Number. Guidelines Expense Statement EXPENSE STATEMENT OF DEFENDANT'S EXHIBIT (Name) frjacses Number) I verify that the statements made in this Expense Statement are true and correcI understand that false statements herein are made subjectothe penalties of1@Pa. C3.A. § 4904 relating to unsworn falsification to authorities. Date: —I —3\-~| ' =^ Plaintiff ndant~~ instructions: Guidelines Expense Statement - This form should only be completed when: 1) You are requesting an adjustment to the amount of support pursuant to Rule 1910.16-5 because of unusual needs and unusual fixed ob|igabonn, other support vbUgahone, medical expenses not covered by insurance, or any other relevant factors, or 2) You are requesting that the other party share in the following expenses pursuant to Rule 1910.16-6: child care expenses, health insurance premiums, unreimbursed medical expenses, private school tuition, summer Camp, or other needs, or mortgage payment. You must provide documents to support all amounts provided in this Expense Statement Service Type M Form IN -008 12/13 Worker ID 21209 Weekly | Monthly | Yearly (Fill in Appropriate Column) Mortgage (including real estate taxes and homeowners insurance) or Rent ` 3<~° . Q{] . 00 Health Insurance Premiums s, Unreimbursed Medical Expenses: Doctor (0, GO Gyt ri ).(:), 00 Dentist Orthodontist Hospital Medicine Special Needs (glasses, braces, orthopedic devices, therapy) Service Type M Form IN -008 12/13 Worker ID 21209 Guidelines Expense Statement (Continued) PACSES Case Number: 896114471 Form IN -008 12/13 Service Type M Page 2 of 2 Weekly Monthly Yearly Child Care Private School Parochial school Loans/Debts Support of Other Dependents: Other child support Alimony payments * . Other: (Specify) . Total $ $ Form IN -008 12/13 Service Type M Page 2 of 2 Payroll Register Thomas, Thomas, & Hafer LLP Company (7865) Buskin Jr., John T Emp Id 4344 Salary 3846.15 Ruskin .Jr., John T Emp Id 4344 Salary 3846.15 Ruskin Jr., John T Emp Td 4344 Salary 3846.15 Huskin Jr., John T Emp Id 4344 Salary 3846.15 Code Earning 401KER Employer Contrit GTL GEL MedReim Medical Reimbur Sal Salary Hours Rate Amount Code Tax Status 123.13 FITW Federal Income"[ M-1 I 248.40 MED Medicare 9.62 PA Pennsylvania SIT M-11 80.00 3846.15 PA -D022 Dauphin Tax Col PA-HARI EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Taxable 3591.83 4002.25 3753.85 3753.85 3753.85 3855.77 4002.25 Amount 209.06 58.03 115.24 75.08 2.00 2.70 248.14 Check Date: 12/06/2013 to 06/06/2014 Process: 2013120601 to 2014060601 Period: 11/17/2013 to 05/31/2014 leinmeat Code Deduction 401K 401(k) GTL GTL PreFSA Pre MESA PrePark Pre Tax Parking Amount Type 410.42 Chk Date 248.40 Batch 51.92 Net 50.00 Dir Dep Chk Amt Chk/Ver Total Earnings Code Earning 401 KER Employer Contril MedReim Medical Reimbut Sal Salary 80.00 Hours 80.00 4104.17 Total Taxes Rate Amount 115.67 9.62. 3846.15 Total Earnings Code Earning 40IKER Employer Contril Bonus Bonus 80.00 Hours 3855.77 Rate Amount 960.06 32002.00 Total Earnings. Code Earning 401 KER Employer Contril MedReim Medical Reimbut Sal Salary Code Tax Status FITW Federal Income T M-11 MED Medicare PA Pennsylvania SIT M-11 PA -D022 Dauphin Tax Col PA-HARI EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Total Taxes Taxable 3368.27 3753.85 3753.85 3753.85 3753.85 3855.77 3753.85 710.25 Total Deductions Amount Code Deduction 175.53 401K 401(k) 54.43 PreFSA Pre MESA 115.24 PrePark Pre Tax Parking : 75.08 2.00 2.70 232.74 Code Tax Status FITW Federal Income '1 M-11 MED Medicare PA Pennsylvania SIT M-11 PA -D022 Dauphin Tax Cot PA-HARI EMS Harrisburg PASUI=E PASUI-EE SS OASD1 760.74 Amount 385.58 51.92 50.00 657:72 Total Deductions Taxable Amount 28801.80 32002.00 32002.00 32002.00 32002.00 32002.00 15851.50 0.00 32002.00 Total Taxes Hours Rate Amount Code Tax Status 115,67 FITW Federal Income T M -I I 9.62 MED Medicare 80.00 3846.15 PA Pennsylvania SIT M-11 PA -D022 Dauphin Tax Col PA-HARI EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Taxable 3362.50 3748.08 3748.08 3748.08 3748.08 3855.77 3748.08 Code Deduction 7200.45 401K 401(k) 464.03 982.46 640.04 22.40 982.79 10292.17 Total Earnings 80.00 3855.77 Total Taxes Amount 170.05 54.35 115.07 74.96 2.00 2.70 232.38 651.51 487.50 Type Chk Date Batch Net Dir Dep Chk Amt Chk/Vcr Reg 1210612013 B 2633.18 2633.18 0.00 25799 Reg 12/20/2013 B 2710.55 2710.55 0.00 25976 Amount Type 401kDNoDD 3200.20 Chk Date 12/30/2013 Batch Bonus Net 18509.63 Dir Dep 0.00 Chk Amt 18509.63 Chk/Vcr # 9148 Total Deductions Code Deduction 401K 401(k) PreFSA Pre MESA PrePark Pre Tax Parking ' Total Deductions 3200.20 Amount 385.58 57.69 50.00 493.27 Type Reg Chk. Date 01/03/2014 Batch B Net 2710.99 Dir Dcp 2710.99 Chk Amt 0.00 Chic/Vet- # 26141 DEFENDANT'S EXHIBIT 6labv 3 Jib Paytime Filing status and exemptions display current data, not data at the time of the payroll. V.,i.c0 I 99,B114 FIYAS Run Date: 06/04/I4 Dept Run Time: 12:39 PM JCode Employee (100) 100 Harrisburg (4) 4 Income Partner Huskin Jr. [roIl Register Thomas, Thomas, & Hafer LLP Company (7865) Check Date: 12/06/2013 to 06/06/2014 Process: 2013120601 to 2014060601 Period: 11/17/2013 to 05/31/2014 Page 2 Huskin Jr., Code Earning Hours John T 401 KER Employer Contrit Emp Id 4344 MedReim Medical Reimbur Salary 3846.15 Sal Salary 80.00 Hoskin Jr., John T Emp Id 4344 Salary 3846.15 Huskin Jr., John T Emp Id 4344 Salary 3846.15 Huskin Jr., John T Emp Id 4344 Salary 3846.15 Huskin Jr., John T Emp Id 4344 Salary 3846.15 Rate Amount 115.67 9.62 3846.15 Code Tax Status FITW Federal Income T M-11 MED Medicare PA Pennsylvania SIT M-11 PA -D022 Dauphin Tax Col PA -HART EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Taxable Amount Total Earnings Code Earning 401 KER Employer Contri1 MedReini Medical Reimbur Sal Salary 80.00 3855.77 Total Taxes Hours Rate Amount 115.67 9.62 80.00 3846.15 Total Earnings Code Earning 40IKER Employer Contrit MedReirri Medical Reimbur Sal Salary 80.00 Hours Rate 3855.77 80.00 Amount 115.67 9.62 3846.15 Code Tax FITW Federal Income T MED Medicare PA Pennsylvania SIT M-11 PA -D022 Dauphin Tax Col PA -HART EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Total Taxes Status M -1I 3362.50 170.05 3748.08 54.34 3748.08 115.07 3748.08 74.96 3748.08 2.00 3855.77 2.70 3748.08 232.38 651.50 Code Tax Status Code 401K PreFSA. PrePark Deduction Amount Type Reg 401(k) Pre MFSA Pre Tax Parking 385.58 Chk Date 01/17/2014 57.69 Batch B 50.00 Net 2711.00 Dir Dep 2711.00 Chk Amt 0.00 Chk'Vcr 4 26302 Taxable Amount 3362.50 170.05 3748.08 54.35 3748.08 115.07 3748.08 74.96 3748.08 2.00 3855.77 2.70 3748.08 232.38 651.51 Taxable Amount FITW Federal Income T M-11 MED Medicare PA Pennsylvania SIT M-11 PA -D022 Dauphin Tax Col PA-HARI EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Total Earnings Code Earning 401 KER Employer Contrit MedReim' Medical Reimbur Sal Salary 80.00 Hours 80.00 3855.77 Total Taxes Rate Amount 115.67 9.62 3846.15 Code Tax FITW Federal income T MED Medicare PA Pennsylvania SIT PA -D022 Dauphin Tax Col PA -HART EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Status M-11 M- II 3362.50 170.05 3748.08 54.35 3748.08 115.07 3748.08 74.96 3748.08 2.00 3855.77 2.70 3748.08 232.38 651.51 Total Deductions Code 401K PreFSA PrePark Deduction 401(k) Pre MFSA Pre Tax Parking 493.27 Amount 385.58 57.69 50.00 Total Deductions Code 401K PreFSA PrePark Deduction 401(k) Pre MFSA Pre Tax Parking • Type Reg Chk Date 01/31/2014 Batch B Net 2710.99 Dir Dep 2710.99 Chk Amt 0.00 Chk/VcrII 26472 493.27 Amount Type Reg 385.58 Chk Date 02/14/2014 57.69 Batch B 50.00 Net 2710.99 Dir Dep 2710.99 Chk Arnt 0.00 Chk/Vcr 4 26637 Taxable Amount 3362.50 170.05 3748.08 54.35 3748.08 115.07 3748.08 74.96 3748.08 2.00 3855.77 2.70 3748.08 232.38 Total Deductions Code Deduction 401K 401(k) PreFSA Pre MESA PrePark Pre Tax Parking 493.27 Amount 385.:8 57.69 50.00 Total Earnings Code Earning 401KER Employer Contrit MedReirri Medical Reimbur Sal Salary 80.00 3855.77 Total Taxes Hours Rate Amount Code Tax 115.67 FITW Federal Income T 9.62 MED Medicare 80.00 3846.15 PA Pennsylvania SIT M-11 Status M- I 1 PA -D022 Dauphin Tax Col PA-HARI EMS Harrisburg PASUI-E PA SUI - EE SS OASDI Total Earnings 80.00 3855.77 Total Taxes 651.51 Taxable Amount 3362.50 170.05 3748.08 54.34 3748.08 115.07 3748.08 74.96 3748.08 2.00 3855.77 2.69 3748.08 232.39 651.50 Type Reg Chk Date 02/28/2014 Batch 6 Net 2710.99 Dir Dep 2710.99 Chk Amt 0.00 Chk/Vcr 8 26798 Total Deductions 493.27 Code Deduction Amount Type Reg 401K 401(k) 385.58 Chk Date 03/14/2014 PreFSA Pre MFSA 57.69 Batch B PrePark Pre Tax Parking : 50.00 Net 2711.00 Dir Dep 2711.00 Chk Amt 0.00 Chk/Vcr 4 26956 Total Deductions 493.27 Paytirne Filing status and exemptions display current data, not data at the time of the payroll. Ace.k. 01995.ala WAY Run Date: 06/04/14 Dept Run Time: 12:39 PM JCode Employee (100) 100 Harrisburg (4) 4 Income Partner Ruskin Jr. Payroll Register Thomas, Thomas, & Hafer LLP Company (7865) Check Date: 12/06/2013 to 06/06/2014 Process: 2013120601 to 2014060601 Period: 11/17/2013 to 05/31/2014 Page 3 Ruskin Jr., Code Earning Hours Rate Amount Code Tax Status Taxable Amount Code Deduction John T 40IKER Employer Contrit 115.67. FITW Federal Income T M-1 I 3362.50 170.05 401K. 401(k) Emp Id 4344 MedReim Medical Reimbur 9.62 MED Medicare 3748.08 54.35 PreFSA Pre MFSA Salary 3846.15 Sal Salary 80.00 3846.15 PA Pennsylvania SIT M-1 I 3748.08 115.07 PrePark Pm Tax Parking : . PA -D022 Dauphin Tax Col 3748.08 74.96 PA-HARI EMS Harrisburg ' 3748.08 2.00 PASUI-E PA SUI - EE 3855.77 2.70 SS OASDI 3748.08 232.38 Total Earnings 80.00 3855.77 Total Taxes 651.51 Total Deductions Amount Type Reg 385.58 Chk Date 03/28/2014 57.69 Batch B 50.00 Net 2711.99 Dir Dep 2710.99 Chk Amt 0.00 Chk/Vcr# 27112 493.27 Ruskin Jr., Code Earning Hours Rate Amount Code Tax Status Taxable Amount Code Deduction Amount Type Reg John T 401KER Employer Conti' 115.67 FITW Federal Income T M-11 3362.50 170.05 401K 401(k) 385.58 Chk Date 04/1I20.14 Emp Id 4344 MedReim Medical Reimbut 9.62 MED Medicare 3748.08 54.35 DomRe! Domestic Relatio 1011.23 Batch B Salary 3846.15 Sal Salary 80.00 3846.15 PA Pennsylvania SIT M-11 3748.08 115.07 PreFSA Pre MESA 57.69 Net 1699.76 PA -D022 Dauphin Tax Col 3748.08 74.96 PrePark Pre Tax Parking • 50.00 Dir Dep 1699.76 PA-HARI EMS Harrisburg ' 3748.08 2.00 Chk Ann 0..00 PASUI-E PA SUI - EE 3855.77 2.70 Chk/Ver # 27270 SS OASDI 3748.08 232.38 Total Earnings 80.00 3855.77 Total Taxes 651.51 Total Deductions 1504.50 Huskin Jr., Code Earning Hours Rate Amount Code Tax Status Taxable Amount Code Deduction Amount Type Reg John T 401KER Employer Contrit 115.67 FITW Federal Income T M -I 1 3362.50 170.05 401K 401(k) 385.58 Chk Date 04/25/201.4 Emp Id 4344 MedReim Medical Reimbur 9.62 MED Medicare 3748.08 54.34 DomRel Domestic Relatio 1011.23 Batch B Salary 3846.15 Sal Salary 80.00 3846.15 PA Pennsylvania SIT M-11 3748.08 115.07 PreFSA Pm MESA 57.69 Net 1699.77 PA -D022 Dauphin Tax Col 3748.08 74.96 PrePark Pre Tax Parking : 50.00 Dir Dep 1699.77 PA -HART EMS Harrisburg • 3748.08 2.00 Chk Amt 0.00 PASUI-E PA SUI - EE 3855.77 2.70 ChkNcr # 27426 SS OASDI 3748.08 232.38 Total Earnings 80.00 3855.77 Total Taxes 651.50 Total Deductions 1504.50 Huskin Jr., Code Earning Hours Rate Amount Code Tax Status Taxable Amount Code Deduction Amount Type Reg John T 401KER Employer Contril 115.67 FITW Federal Income I M-11 3362.50 170.05 40IK 401(k) 385.58 Chk Date 05/09/2014 Emp Id 4344 MedReim' Medical Reimbur 9.62 MED Medicare 3748.08 54.35 DornRel Domestic Relatio 1011.23 Batch B Salary 3846.15 Sal Salary 80.00 3846.15 PA Pennsylvania SIT M-11 3748.08 115.07 PreFSA Pm MESA 57.69 Net 1699.76 PA -D022 Dauphin Tax Col 3748.08 74.96 PrePark Pre Tax Parking : 50.00 Dir Dep 1699.76 PA-HARI. EMS Harrisburg' 3748.08 2.00 Chk Amt 0.00 PASUI-E PA SUI - ED 3855.77 2.70 ChkNcr # 27579 SS OASDI 3748.08 232.38 Total Earnings 80.00 3855.77 Total Taxes 651.51 Total Deductions 1504.50 Huskin Jr., Code Earning Hours Rate Amount Code Tax Status Taxable Amount Code Deduction Amount Type NoDD2 John T 401KER Employer Contrit 115.67 FITW Federal Income T M-11 3362.50 170.05 401K 401(k) 385.58 Chk Date 05/23!2014 Emp Id 4344 MedReim Medical Reimbur 9.62 MED Medicare 3748.08 54.35 DomRel Domestic Relatio 1011.23 Batch B Salary 3846.15 Sal Salary 80.00 3846.15 PA Pennsylvania SIT M -I1 3748.08 115.07 PreFSA Pre MESA 57.69 Net 1699.76 PA -D022 Dauphin Tax Col 3748.08 74.96 PrePark Pre Tax Parking : 50.00 Dir Dep 0.00 PA -HART. EMS Harrisburg. 3748.08 2.00 Chk Amt 1699.76 PASUI-E PA SUI - EE 3855.77 2.70 Chk/Ver # 9290 SS OASDI 3748.08 232.38 Total Earnings 80.00 3855.77 Total Taxes 651.51 Total Deductions 1504.50 Paytime Filing status and exemptions display current data, not data at the time of the payroll. luolro refrlin4>a.,r Run Date: 06/04/14 Dept (100) 100 Harrisburg Run Time: 12:39 PM JCode (4) 4 Income Partner Employee Hoskin Jr. Payroll Register Thomas, Thomas, & Hafer LLP Company (7865) Check Date: 12/06/2013 to 06/06/2014 Process: 2013120601 to 2014060601 Period: 11/17)2013 to 05/31/2014 Huskin Jr., Code Earning Hours Rate . Amount Code Tax 115.67 FITW Federal Income T M-1 1 3362.50 170,05 401K 401(k) 385.58 Chk Date 06/06/2014 9.62 MED Medicare 3748.08 54.35 DomRe1 Domestic Relatio 1011.23 Batch B 80.00 3846.15 PA Pennsylvania SIT M-11 3748.08 115.07 PreFSA • Pre MFSA 57.69 Net 1699.76 PA -D022 Dauphin Tax Col 3748.08 74.96 PrePark Pre Tax Parking 50.00 Dir Dep 1699.76 PA-HARI EMS Harrisburg : 3748.08 2.00 Chk Amt 0.00 PASUI-E PA SUI - EE 3855.77 2.70 Chk/Ver 4 27705 John T 401 KER Employer Contril Emp Id 4344 MedReim Medical Reimbur Salary 3846.15 Sal Salary Page 4 Status Taxable Amount Code Deduction Amount Type Reg SS OASD1 3748.08 232.38 Total Earnings 80.00 3855.77 Total Taxes 651.51 Total Deductions 1504.50 Dept: (100) 100 Harr... JCode: (4) 4 Inconne•:Partner Total Employees 1 Code Earning Hours Rate Amount Code Tax Taxable Amount Code Deduction Amount Checks 2 Female 0 401KER Employer Contra 2586.90 FITW Federal Income T 76111.90 9625.64 401K 401(k) 8623.16 Vouchers 13 Male 1 Bonus Bonus 32002.00 MED Medicare 84735.06 1228.66 DornRel Domestic Relatio 5056.15 Net 51329.12 Chks & Vehrs 15 GTL GTL 248.40 PA Pennsylvania SIT 84486.66 2593.78 GTL GTL 248.40 Dir Dep 31119.73 Female 0 MedReimi Medical Reimbur 134.68 PA -D022 Dauphin Tax Col 84486.66 1689.72 PreFSA Pre MFSA 796.12 Chk Amt 20209.39 Male 15 Sal Salary 1120.00 53846.10 PA-HARI. EMS Harrisburg • 84486.66 28.00 PrePark Pre Tax Parking 700.00 PASUI-E PA SUI - EE 85982.78 60.19 SS OASD1 68584.56 4252.24 Total Earnings 1120.00 86231.18 Total Taxes 19478.23 Total Deductions 15423.83 Dept: (100) 100 Harrisburg Total Employees 1 Code Earning Hours Rate Amount Code Tax Taxable Amount Code Deduction Amount Checks 2 Female 0 401KER Employer Contrit 2586.90 FITW Federal Income 1 76111.90 9625.64 401K 401(k) 8623.16 Vouchers 13 Male 1 Bonus Bonus 32002.00 MED Medicare 84735.06 1228.66 DornRel Domestic Relatio 5056.15 Net 51329.12 Chks & Vehrs 35 GTL GTL 248.40 PA Pennsylvania SIT 84486.66 2593.78 0Th GTI 248.40 Dir Dep 31119.73 Female 0 MedReimi Medical Reimbur 134.68 PA -D022 Dauphin Tax Col 84486.66 1689.72 PreFSA Pre MFSA 796.12 Chk Amt 20209.39 Male 15 Sal Salary 1120.00 53846.10 PA -HART EMS Harrisburg • 84486.66 28.00 PrePark. Pre Tax Parking ' 700.00 PASUI-E PA SUI - EE 85982.78 60.19 SS OASDI 68584.56 4252.24 Total Earnings 1120.00 86231.18 Total Taxes 19478.23 Total Deductions 15423.83 Re: port To,;tai Employees 1 Code Earning Hours Rate Amount Code Tax Taxable Amount Code Deduction Amount Checks 2 Female 0 401KER Employer Contrit 2586.90 FITW Federal Income T 76111.90 9625.64 401K 401(k) 8623.16 Vouchers 13 Male 1 Bonus Bonus 32002.00 MED Medicare 84735.06 1228.66 DornRel Domestic Relatio 5056.15 Net 51329.12 Chks & Vehrs 15 GTL GTL 248.40 PA Pennsylvania. SIT 84486.66 2593.78 GTL GTL 248.40 Dir Dep 31119.73 Female 0 MedReimi Medical Reimbur 134.68 PA -D022 Dauphin Tax Col 84486.66 1689.72 PreFSA Pre MFSA 796.12 Chk Amt 20209.39 Male 15 Sal Salary 1120.00 53846.10 PA-HARt EMS Harrisburg' 84486.66 28.00 PrePark Pre Tax Parking ' 700.00 PASUI-E PA SUI - EE 85982.78 60.19 SS OASDI 68584.56 4252.24 Total Earnings 1120.00 86231.18 Total Taxes 19478.23 Total Deductions 15423.83 Paytime Filing status and exemptions display current data, not data at the time of the payroll. Rgeb819,213111MPAT Run Date: 06/04/14 Run Time: I2:39 PM Dept (100)100 Harrisburg JCode (4)4, Income Partner Employee Huskin .fr. /It (seeNdtiC°er tEOMEPrni-p°i07.4:t.^%.,_ cO:Rb6-frSC:Yi-- S---- /:-iov I a sEe'cnuPrli°tytTbe-c-71 :::::: 5-1,6136-347 217-56-17901-- 113700.00 i 84. om No i 6-';'.,3Ittleeticere .wages-gn7:-1 Trps - --770:i-C.--ttcare •-t i .11777-78° — , 129850. CYer adciri:7sio-cZG-----50 -- — ------ -------------- 8-:- 81--:-----2-/ / Thomas, Tho.z m.s, & Hafer - 305 N Pont Street 61:1-1 F7o0.1.- i , RarrirT.Psburq, PA 17.107 Controti_286.5 4344 ., i ow :.Hu-S2-;ckT-e."i-ll 212WHuskJr' Avenue Camp :gill, PA 17011_ 1/ 1_2",,adcfr!;35. and ZIP ii 7 Social securrIty tips - code I 10 Dependent care benefits I 11 Nonqualifte,27a-C-T-tde- --.1-_---------_-_. i I . / 13 '''t-atutory--71—.„.-34. Other i C 246.401 1 . f-,--Ta-ier-ii7-1,---1 PASI)." • ,, ,y. , 9125 I PI-S.-.RiAR. .. 92.5&s2ID 3rd oe.,--:;`7, ' ' -°49 92 112c Cod -p - I 17-----AJ----F77-87674fI ' • ,29602.7397-8-7-7-51 • , I R..F.-co-E-6----- _I I • I . t ,:1.15:2!ate Eftle!CS state f.D. # I 16 Stat.c wLes ti s, oto. /17 State incdme iax _41 Copy 2 To Be Fiied With Er-4.,,rovee.c *--.:j-T-r--.-'"--T—T---er,,,-,'N /18 Local wages, tips, etc. 119 Locei iticoR-3; :dx - 120 Loed/iY naMe ------ ' /29607.10 I I 2592.12 I 2.2 -Dauphin T:-: Form W-2 Wage and Tax Statement --.----......._ This information is being furnisNd to the IRS. fr you drq required to file fax return, a negligende -------------Dept. o` the TrE.,asury ••• IRS i___------------ penattvloth.ar sanction may be imposed or) VCU if This CO Is taxable and you fait tc recorI a_ t r C. !ty,,or Local Income Tax Return 'a'e' 1410 i a 154s-oaDel 0, ., rrip.---'-i2.!---aoirat ...- -.-:-,--,10,,,,..e 2.17 -- 56 1 7 9 01---F-§,------------- ' . 216600.38 / , 1806.121 !(--E-5-r,-;---'----' I___— / , L I. .30Curuy wages . :4 Social security' tax witioeld i 113700 OD 1 1543634 I 5 Me-diTer., irv-i-d7-------16 Medicare tax withheld I _,,,_ 7049.401 c-t7i,"I'g-jtoyens na.rf-Inc..1-flP code • -----L ' • . . 129850 SO I 1882 831 . r.r.”--,....T., ...,.cas• r ,, 305'....NT,ProntStreet 6th' 14aziisbUrg, . , 1 7,8.65 4 3 4 4 - 6-17q3176,-,------'------.--. e .E.n't.-s-'st ,-,-a-r,--ied inkjet .' t.alist'Insatnk'ean jr j°h" T. ---1'.---------; ------------j John T 1.-Tuskin Jr. .0 Dependent care bonefits -1 11 NonqUd'j-Driens — I 212 Willow Avenue . Camp Iiill, PA 17011- f:t'n.2Eloy2___.ae,!...t" clqr.f...... and Z7P cOde . 7 Socia!securtty tips - .--- I 8 Aitocatedtips ----- ' . ! i 13 Statutory erakiloye4-14 OL-- th------ ---. 712Cb Of:me 73:_a:1 -i PAS"II x , S.:25 i PA-TLAR ' :..9sg ;p _2_273,350.12( 2,48:401 ,rd party s,ck pay f 2 s 4 , 22 ;12c Code - I III L3:41- ---T--_7070 rif-2----- I----- - - -1,9- -602 1-6-'1111.1j-"CcE; - - 1.- :17. 10,111 1 '1 I __ __ __. _.... ....... „..1 ,s_state_t a 5 _____11,9 St -tie w_ag,ts, lips. etc. 177 State in-ome °cat wages, trqs. etc. —,-", 7-9 Local ocome tax —me ' ' -1 129602.70/ 'rat W-2 Waoe an. i 2592 , 22/22- r) a. up h i n T:: of .. . . De—qt7 Of the Treasury - IRS .5--7.--..i''' • It