HomeMy WebLinkAbout05-2978
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PAUL ADJAN, * NO d$ /
Plaintiff °?97a?' ?! u t t
f 1?
*
VS. * CIVIL ACTION - LAW IN DIVORCE
*
KATHRYN ANN ADJAN,
Defendant
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND AGAINST THE CLAIMS SET FORTH IN THE
FOLLOWING PAGES, YOU MUST TAKE PROMPT ACTION. YOU ARE WARNED THAT IF YOU FAIL TO DO SO, THE
CASE MAY PROCEED WITHOUT YOU AND A DECREE OF DIVORCE OR ANNULMENT MAY BE ENTERED
AGAINST YOU BY THE COURT. A JUDGMENT MAY ALSO BE ENTERED AGAINST YOU FOR ANY OTHER CLAIM
OR RELIEF REQUESTED IN THESE PAPERS BY THE PLAINTIFF. YOU MAY LOSE MONEY OR PROPERTY OR
OTHER RIGHTS IMPORTANT TO YOU, INCLUDING CUSTODY OR VISITATION OF YOUR CHILDREN.
WHEN THE GROUND FOR THE DIVORCE IS INDIGNITIES OR IRRETRIEVABLE BREAKDOWN OF THE
MARRIAGE, YOU MAY REQUEST MARRIAGE COUNSELING. A LIST OF MARRIAGE COUNSELORS IS AVAILABLE
IN THE OFFICE OF THE PROTHONOTARY AT THE CUMBERLAND COUNTY COURTHOUSE, I COURTHOUSE
SQUARE, CARLISLE, PA 17013.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR
EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY
OF THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER
OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE
YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY LAWYER REFERRAL SERVICE
2 LIBERTY AVENUE
CARLISLE, PA 17013
(717) 249-3166
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PAUL ADJAN,
Plaintiff * NO. ?S "Z 9??
VS. * CIVIL ACTION - LAW IN DIVORCE
KATHRYN ANN ADJAN,
Defendant
DIVORCE COMPLAINT
t • The Plaintiff is Paul Adjan, who currently resides at 1109 Granada Lane, Mechanicsburg,
Pennsylvania, 17055.
2. The Defendant is Kathryn Ann Adjan, who currently resides at 1109 Granada Lane,
Mechanicsburg, Pennsylvania, 17055.
3. Plaintiff and Defendant have been bona fide residents in the Commonwealth of Pennsylvania
for at least six months immediately previous to the filing of this Complaint.
4. Plaintiff and Defendant were married on May 11, 1974 in Cumberland County, Pennsylvania.
5. The parties are the parents of one (1) adult child. There are no minor children of this
marriage.
6. There have been no prior actions of divorce or for annulment between the parties.
7. Neither party is presently a member of the Armed Forces on active duty.
8. The parties have not entered into a written agreement as to alimony, counsel fees c
property division. > osts, or
9. Plaintiff has been advised that counseling is available and that he may have the right to
request that the court require the parties to participate in counseling. Being so advised, Plaintiff does not
request that the Court require the parties to participate in counseling prior to a Divorce Decree being issued.
10. The cause of action and sections of the Divorce Code under which Plaintiff is proceeding are:
(a) §3301(c). The marriage of the parties is irretrievably broken; and
(b) §3301(d). The marriage of the parties is irretrievably broken and, at the appropriate time,
Plaintiff will submit an affidavit stating that the parties have been living separate and apart for a period of at
least two (2) years.
11. Plaintiff requests This Honorable Court enter a Decree of Divorce.
WHEREFORE, Plaintiff respectfully requests This Honorable Court enter an Order dissolving the
marriage between Plaintiff and Defendant.
Respectfully submitted,
Dated: G o
Dillsburg, PA 17019
(717) 432-9666
I.D. # 85211
WILEY, LENrX, COLGAN & MARZZACCO, P.C.
Thomas M. Clark, Esquire
130 West Church Street
VERIFICATION
I, Paul Adjan, verify that the statements made in this Complaint are true and correct to the best of
my knowledge, information, and belief. I understand that false statements herein are made subject to the
penalties of 18 Pa. CS. §4904, relating to unswom falsification to authorities.
Date: ()(o- 03- p S
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PAUL ADJAN
Plaintiff
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PAUL ADJAN,
Plaintiff
* NO. 05-2978 CIVIL TERM
*
*
* CIVIL ACTION - LAW IN DIVORCE
*
*
*
*
VS.
KATHRYN ANN ADJAN,
Defendant
RETURN OF SERVICE
On the 0 day of July, 2005, I, David Rudy, Process Server, served
KATHRYN ANN ADJAN, with the Divorce Complaint filed on June 9, 2005 by
Rn40.1.. &AID/AI6 T??ascsrty Y ,t'..,+sreM) (manner of service) at
1104 l?,?wwwn.. hn/ /ngeK Al /?OS? at ,20 00tri. (time
of service).
I verify that the statements in this return of service are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A.
§4904 relating to unsworn falsification to authorities.
Date: / a?G2?`?
DAVID RUDY
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PAUL ADJAN, * NO. 05-2978 CIVIL TERM
Plaintiff
*
VS. * CIVIL ACTION - LAW IN DIVORCE
KATHRYN ANN ADJAN,
Defendant
MOTION FOR APPOINTMENT OF MASTER
Paul Adjan, Plaintiff, moves the court to appoint a Master with respect to the following claims:
(X) Divorce (X) Distribution of Property
( ) Annulment ( ) Support
( ) Alimony ( ) Counsel Fees
( ) Alimony Pendente Lite ( ) Costs and Expenses
and in support of the motion states:
(1) Discovery is complete as to the claims(s) for which the appointment of a Master is requested.
(2) The Defendant has appeared in the action through his attorney, Wayne Shade, Esquire.
(3) The statutory ground(s) for divorce (are) 23 Pa. C.S.A. &§ 3301(c), (d) and (a)(6).
(4) Delete the inapplicable paragraph(s):
(a) The netion is not .
(b) An agreement has been reached with respect to the following claims: None.
(c) The action is contested with respect to the following claim: Distribution of Property.
(5) The action does involve complex issues of law or fact.
(6) The hearing is expected to take one (1) day.
(7) Additional information, if any relevant to the motion: N/A.
Date: /v • ?
Thomas M. Clark, Esquire
WILEY, LENOX, COLGAN & MARZZACCO, P.C.
Attorney for Plaintiff
ORDER APPOINTING MASTER
AND NOW, this day of 12007, ,
Esquire is appointed master with respect to the following claims:
By the Court:
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PAUL ADJAN,
Plaintiff
VS.
KATHRYN ANN ADJAN,
Defendant
NO. 05-2978 CIVIL TERM
* CIVIL ACTION - LAW IN DIVORCE
PETITION FOR RELATED CLAIMS UNDER DIVORCE CODE
AND NOW, comes the Plaintiff, Paul Adjan, by and through her attorney, Thomas M.
Clark, Esquire of Wiley, Lenox, Colgan & Marzzacco, P.C., and files this Petition for Related
Claims Under Divorce Code, respectfully averring as follows:
COUNT I - CLAIM FOR EQUITABLE DIVISION OF MARITAL PROPERTY
UNDER §3502(a) OF THE DIVORCE CODE
A Divorce Complaint was filed on June 9, 2005, under Sections 3301(c) and 3301(d)
of the Divorce Code.
2. Plaintiff and Defendant have individually or jointly acquired property during the
marriage in which they individually or jointly have legal or equitable interest, which marital
property is subject to equitable distribution.
WHEREFORE, Plaintiff respectfully requests This Honorable Court to determine and
equitably distribute, divide or assign said marital property pursuant to §3502(a) of the Divorce
Code.
Dated: /a 3 4?
Resp 1 submitted,
WI EY, NOX, COLGAN & MARZZACCO, P.C.
Thomas M. Clark, Esquire
130 West Church Street
Dillsburg, PA 17019
(717) 432-9666
I.D. # 85211
VERIFICATION
L Paul Adjan, verify that the statements made in the foregoing Petition for Related
Claims are true and correct to the best of.my knowledge, information and belief. I understand
that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904, rrel.abngto
unsworn falsification to authorities.
Date: 9.12.0- l /Paul Aajan U
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CERTIFICATE OF SERVICE
I, Thomas M. Clark, Esquire hereby certify that I am this day serving a copy of the
foregoing document upon the person(s) and in the manner indicated below, which service
satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of
same in the United States mail, first-class, postage prepaid, as follows:
Joanne Harrison Clough, Esquire
24 North 32" Street
Camp Hill, PA 17011
Date: 46° ?L- By. /.
Thomas M. Clark, Esquire
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JOANNE HARRISON CLOUGH, P.C.
3820 MARKET STREET
CAMP HILL, PA 17011
717-737-5890
PA. ID. NO. 36461
Counsel for Defendant
PAUL ADJAN,
Plaintiff
V.
KATHRYN ANN ADJAN,
Defendant
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 05- 2978 CIVIL TERM
CIVIL ACTION -LAW
IN DIVORCE
ANSWER AND COUNTERCLAIM TO COMPLAINT IN DIVORCE
AND NOW, this k4ly of October, 2007 comes the Defendant Kathryn Ann
Adjan, by and through her attorney, Joanne Harrison Clough, Esquire, and respectfully
answers the Complaint in Divorce and files a Counterclaim as follows:
1. Admitted.
2. Admitted.
3. Admitted.
4. Admitted.
5. Admitted.
6. Admitted.
7. Admitted.
8. Admitted.
9. Admitted.
10. Admitted.
11. Admitted in part. It is admitted Plaintiff requests a decree in divorce be
issued. It is denied a decree should be issued until the outstanding issues of property
distribution, Alimony Pendente Lite, Alimony, and Counsel Fees Costs and Expenses are
resolved.
WHEREFORE, Defendant Kathryn Ann Adjan respectfully requests this
Court not enter a Divorce until the issues raised in the Counterclaim set forth below are
resolved by the Court.
COUNTERCLAIM
COUNT II
ALIMONY PENDENTE LITE, INTERIUM COUNSEL FEES, COSH
AND EXPENSES
12. By reason of this action, Defendant has and/or may incur considerable
expense in the preparation of her case and the employment of counsel and the payment of
costs.
13. The Defendant is without sufficient funds to support herself and to meet
the costs and expenses of this litigation.
14. Defendant is disabled an not able to earn sufficient Plaintiff income nor is
she able to engage in full time employment to provide for her reasonable needs and to
pay her attorneys' fees and the cost of this litigation and she is unable to appropriately
maintain herself during the pendency of this action.
15. Plaintiff husband has adequate earnings to provide for the Defendant
wife's support and to pay her counsel fees, costs and expenses.
16. Defendant wife lacks sufficient property to provide for her reasonable
needs.
17. Defendant wife is unable to support herself through appropriate
employment
18. Plaintiff husband has sufficient income and assets to provide continuing
support for the Defendant.
WHEREFORE, Defendant Kathryn Ann Adjan respectfully requests this
Honorable Court to enter an Order granting her Alimony Pendente Lite, and award her ff
interim counsel fees, costs and expenses.
COUNT III
ALIMONY, COUNSEL FEES COSTS AND EXPENSES
19. By reason of this action, Defendant Kathryn Ann Adjan has incurred
considerable expense in the preparation of her case and the employment of counsel and
the payment of costs.
20. The Defendant is without sufficient funds to support herself and to meet the
costs and expenses of this litigation.
21. Defendant is disabled and her income is not sufficient to provide for her
reasonable needs and to pay her attorneys' fees and the cost of this litigation and she is
unable to appropriately maintain herself during the pendency of this action.
22. Plaintiff Paul Adjan has adequate earnings to provide for Defendant's support
and to pay her counsel fees, costs and expenses.
23. Defendant Kathryn Ann Adjan lacks sufficient property to provide for her
reasonable needs after the entry of a Divorce Decree.
24. Defendant is disabled and is unable to support herself through appropriate
employment post divorce.
25. Plaintiff has sufficient income and assets to provide continuing support for
the Defendant post divorce.
WHEREFORE, Defendant Kathy Ann Adjan prays this Honorable Court enter an
Order awarding her permanent alimony, and award her counsel fees, costs and expenses.
Respectfully submitted,
JOANNE HARRISON CLOUGH, P.C.
r
Date: ? ,-
Joanne son Clough, quire
Attorney ID No. 36461
3820 Market Street
Camp Hill, PA 17011
(717) 737-5890
Attorney for Defendant Kathryn Ann Adjan
VERIFICATION
I GCG r `r Y? &A Q hereby verify and state that the facts set forth in the foregoing
pleading are true and correct to the best of my information, knowledge and belief.
I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.
Section 4904 relating to unworn verification to authorities.
DATE: w I ? C) 7 ? q/ -?? J A, ? ) a , -
f U
CERTIFICATE OF SERVICE
I, Joanne Harrison Clough, Esquire, do hereby certify that on this date I served a copy of
the foregoing document by United States First Class Mail to the following individual set forth
below:
Thomas M. Clark, Esquire
130 West Church Street
Dillsburg, PA 17019
Counsel for Plaintiff
Date: L-o ^ it, - 01-7
Joanne Harrison Clough,
Attorney ID No. 36461
3820 Market Steet
Camp Hill, PA 17011
(717) 737-5890
Attorney for Defendant Kathryn Ann Adjan
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OCT 15 200 P?"'
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
PAUL ADJAN, * NO. 05-2978 CIVIL TERM
Plaintiff
VS. * CIVIL ACTION - LAW IN DIVORCE
KATHRYN ANN ADJAN,
Defendant
MOTION FOR APPOINTMENT OF MASTER
Paul Adjan, Plaintiff, moves the court to appoint a Master with respect to the following claims:
(X) Divorce (X) Distribution of Property
( ) Annulment ( ) Support
( ) Alimony ( ) Counsel Fees
( ) Alimony Pendente Lite ( ) Costs and Expenses
and in support of the motion states:
(1) Discovery is complete as to the claims(s) for which the appointment of a Master is requested.
(2) The Defendant has appeared in the action through his attorney, Wayne Shade, Esquire.
(3) The statutory ground(s) for divorce (are) 23 Pa. C.S.A. H 3301(c), (d) and (a)(6).
(4) Delete the inapplicable paragraph(s):
(a) The action is not .
(b) An agreement has been reached with respect to the following claims: None.
(c) The action is contested with respect to the following claim: Distribution of Property.
(5) The action does involve complex issues of law or fact.
(6) The hearing is expected to take one (1) day.
(7) Additional information, if any relevant to the motion: N/A.
-- 1
Date: /v 7 0 ?'
Thomas M. Clark, Esquire
WILEY, LENOX, COLGAN & MARZZACCO, P.C.
Attorney for Plaintiff
ORDER APPOINTING MASTER
AND NOW, this I -Aday of , 2007, C? &464-?j
Esquire is appointed master with respect to the following claims: Azligg?
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PLAINTIFF'S PRE-TRIAL STATEMENT
AND NOW, comes the Plaintiff, Paul Adjan, by and through his counsel,
PAUL ADJAN,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff
* NO. 05-2978 CIVIL TERM
* CIVIL ACTION - LAW IN DIVORCE
VS.
KATHRYN ANN ADJAN,
Defendant
Thomas M. Clark, Esquire of Wiley, Lenox, Colgan & Marzzacco, P.C. and submits the within
Pre-Trial Statement:
1. Plaintiff s Information
Name: Paul Adjan
Address: 118 West Keller Street, Mechanicsburg, PA 17055
Employer: Commnweatlh of Pennsylvania
Occupation: Facility Maintenance Manager
II. Defendant's Information
Name: Kathryn Ann Adjan
Address: 1109 Granada Lane, Mechanicsburg, PA 17055
Employer: Giant Food Store
III. Marital Information
Date of Marriage: May 11, 1974
Place of Marriage: Cumberland County, Pennsylvania
Divorce Complaint: Filed June 5, 2005
Minor Children: No minor children
h
IV. Marital Assets - Plaintiff's Inventory is attached hereto as Exhibit "A."
1. Marital Residence at 1109 Granada Lane, Mechanicsburg, PA 17055
Marital residence has not been appraised.
Plaintiffs Estimated Value: $179,000.00
Mortgage balance: Approximately $160,000.00
2. 1995 Jeep Grand Cherokee - Plaintiff will stipulate to NADA wholesale value (or
other comparable valuation) as of date of separation. There is no loan asscoiated
with this vehicle. Wife is in possession of this vehicle.
3. 1998 Ford F-150 - Plaintiff will stipulate to NADA wholesale value (or other
comparable valuation) as of date of separation. There balance on the loan
asscoiated with this vehicle is less than $500.00 Husband is in possesion of this
vehicle.
4. SERS Retiremnet - (Balance as of February 2008 was approximatly $350,000.00)
Plaintiff can produce the date of separation statement and the most current
statement.
5. Home Depot Future Builder Retirment (Balance as of Summer 2007 was
$2329.64).
6 Mattel Stock (6 shares - Approximatley $23.23/share).
7 Home Depot stock (55.5 shares - Approximateley $36.89/share).
8 Plaintiff has a PSECU Checking/Savings. This account was a day-to-day account
with a very low balance.
9 Plaintiff/Defendnat have M&T Bank Checking/Savings.
V. Non-Marital Assets
Plaintiff is unaware of any non-marital assets that are in his possession.
2. Plaintiff is unaware of any non-marital assets attributable to Wife.
VI. Expert Witnesses
It is not clear at this time what experts, if any, will testify at the time of trial. Expert
testimony could be necessary regarding the values of the marital residence and to determine
Wife's earning potential. If expert testimony is required, appropriate notice will be provided to
opposing counsel and the Master in advance of trial and copies of expert reports will be
provided.
VII. Plaintiff's Witnesses
1. Paul Adjan will testify on his own behalf;
2. Kathryn Ann Adj an, as on cross-examination;
3. Husband reserves the right to call other witnesses to be determined in advance of
trial with appropriate notice to opposing counsel.
VIII. Exhibits
1. Mortgage Statements.
2. Plaintifft's Income and Expense Statement - attached hereto as Exhibit "B".
3. Statement regarding SERS Retiremnet.
4. Statement regarding Mattel Stock.
5. Statement regarding Home Depot stock.
6. Support Calculations - attached hereto as Exhibit "C.".
7. Additional exhibits, if any, to be provided in advance of trial.
IX. Income and Expenses
An Income and Expense Statement has been submitted to the Divorce Master's Office
and has been filed - attached hereto as Exhibit "B".
X. Pension / Retirement
1. Plaintiff has SERS Retiremnet through his employment with the State of
Pennsylvania. This retirment account has an approximate value of $ 350,000.00.
2. Plaintiff has a Home Depot Future Builder Retirment Account. As of the Summer
of 2007 the balance was $2329.64.
XI. Counsel Fees and Costs
Plaintifft makes no claim for counsel fees and costs and proposes that each party pay their
respective attorney's fees and costs.
XII. Personal Property
The personal property (household furnishings) of the parties have been divided.
XIII. Marital Debts
Mortgage on the marital residence 1109 Granada Lane, Mechanicsburg, PA
17055. Plaintiff will produce the current statement.
XIV. Proposed Resolution
1. Husband proposes a 50/50 division of the total marital estate in favor of Wife.
2 Husband understands that given the length of marriage and given disparity in
incomes there will be an alimony payment in this case. The breakdown between
the parties deals with the amount of the alimony. Undersigned counsel believes
that support calculations should be performed with Wife being held to a full-time
earning capacity and that any alimony payment should certainly not be greater
than what Wife would be entitled to as spousal support..
3 Husband proposes that any claim for counsel fees and costs be denied.
XV. Additional Considerations
The parties were married in May of 1974 and separated in June of 2005. No formal
support order has been entered as Husband has been supporting Wife since the date of separation.
Husband's support of Wife included him paying the mortgage on the marital residence since the
date of separation. Since the date of separation, Wife has resided in the martial residence and
wishes to maintain the marital residence.
Husband is willing to agree to a distribution in whcih Wife would retain the martial
residence. However, given the size of the home and given the large mortgage payment, it makes
little finanical sense for either party to remain in this home alone. In the past, Husband had taken
on a second job in addition to his full time position in order to try to make ends meet. However,
due to the enormous workload with Husband's full time employer, Husband will not be able to
maintain any additional employment. Husband and Wife have had financial difficulties in the
past and were forced to go through a bankruptcy. The bankruptcy allowed the parties to
discharge the great majority of their marital debt.
Wife is currently working at the Giant Food Store in Camp Hill, Pennsylvania. In the
recetn past, Wife was performing duties that required heavy lifting, as she was responsible for
washing pots and pans. Wife's attorney has made the argument that Wife has medical issues that
prevent her from working long hours. Although medical documentation was requested, to date
undersigned counsel has received no medical documentation regarding Wife's condition. In the
past, Husband and Wife had been very open about Wife's condition. Husband believes that Wife
can work on a full time basis and should be held to a full time earning capacity. To Husband's
knowledge, Wife has never attempted to request social security due to any type of disability. If a
doctor is affirming that Wife cannot work, certainly Wife could take steps to obtain some type of
disability payment.
Husband does not deny that Wife has medical issues. However, without medical
documenation we cannot agree that she is unable to work. It seems strange that the job Wife
chooses to work is one that requires the lifting of heavy objects. Undersigned counsel is
unaware, if Wife took any steps since the date of separation to find employment that would
require less lifting. In any event the burden should be on Wife to show that she is unable to
work. Husband continues to to assert that Wife can work a full time postition, and, to date, no
proofproof of Wife's inability to work has been provided.
Husband understands that given the length of marriage and given disparity in incomes
there will be an alimony payment in this case. The breakdown between the parties deals with the
amount of the alimony. Undersigned counsel believes that support calculations should be
performed with Wife being held to a full-time earning capacity and that any alimony payment
should certainly not be greater than what Wife would be entitled to as spousal support.
Husband should not be prohibited from having this case moved forward due to Wife's
claim of medical issues. To date Wife has not provided any medical documentation indciating
she is not able to work. Husband believes that a pre-hearing conference date should be set and
that, if Wife does not have medical documentation, this case should move forwrd and this issue
should be waived.
Date: 21,S-16 By:
Resp lly submitted,
Thomas M. Clark, Esquire
WILEY, LENOX, COLGAN
& MARZZACCO, P.C.
130 W. Church Street
Dillsburg, PA 17019
(717) 432-9666
ID# 85211
Attorney for Plaintiff
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PAUL ADJAN, * NO. 05-2978 CIVIL TERM
Plaintiff
*
VS. * CIVIL ACTION - LAW IN DIVORCE
KATHRYN ANN ADJAN,
Defendant
INCOME AND EXPENSE STATEMENT OF PAUL ADJAN
ATTORNEY: Thomas M. Clark, Esquire
130 W. Church Street, Suite 100
Dillsburg, PA 17019
(717) 432-9666
SECTION I : INCOME AND INSURANCE INFORMATION
INSTRUCTIONS: THIS SECTION MUST BE FULLY COMPLETED. IF YOU ARE NOT PRESENTLY EMPLOYED, THE EMPLOYER
INFORMATION SHOULD REFLECT EARNINGS INFORMATION FROM YOUR LAST JOB.
INCOME:
CURRENT OR LAST EMPLOYER: Commonwealth of Pennsylvania
PAYROLL ADDRESS: 400 North Street, 5'h Floor, Harrisburg, PA 17120
POSITION HELD: Facility Maintenance Manager RATE OF PAY/FREQUENCY: $
HOW PAID: (CIRCLE ONE) WEEKLY ./ BIWEEKLY / MONTHLY / SEMI-MONTHLY / OTHER
IF LAST JOB: DATE LEFT JOB REASON FOR LEAVING
GROSS PAY PER PERIOD: $ 2506.65
ITEMIZED PAYROLL DEDUCTIONS: $
FEDERAL WITHHOLDING $ 216.28
SOCIAL SECURITY (& MEDICARE) $ 163.90
LOCAL WAGE TAX $ 42.42
STATE INCOME TAX $ 76.61
MANDATORY RETIREMENT
HEALIHINSURANCE $ 156.66 (REQUIRED MINIMUM % )
$38
33
OTHER (SPECIFY) .
Unemployment $ 2.39
Vehicle Tax $ 24.72
EE Pretax M/H Ret $ 11.35
NET PAY PER PAY PERIOD $ 1794.71
OTHER INCOME: WEEK MONTH YEAR PROPERTY OWNED: OWNERSHIP
(FILL IN APPROPRIATE COLUMN) DESCRIPTION VALUE H W J
INTEREST CHECKING ACCTS $ 250.00 X
DIVIDENDS SAVINGS ACCTS. $ 11.00 X
PENSION CREDIT UNION $
ANNUITY STOCK/BONDS $ _
SOCIAL SECURITY REAL ESTATE $ 3,000 _X
RENTS BUSINESS $
UNEMPLOYMENT COMP. $
WORKMENS COMP.
I $
RA
TIP
TOTAL
$ 3,260.00
ALIMONY (RECOD.)
Home Denot P/T $150.00
TOTAL
150.00
INSURANCE (COVERING DEPENDENTS IN THIS CASE): COVERAGE
COMPANY AND CLAIMS ADDRESS GROUP #
HOSPITAL
BLUE CROSS
OTHER
MEDICAL
BLUE SHIELD
OTHER
HEALTH/ACCIDENT
DISABLITY
DENTAL
OTHER
PEBTF PFP361
POLICY# H W C
x x _
Delta
Vision
x x _
x x
•H=HUSBAND, W=WIFE, J=JOINT, C=CHILD
SECTION II: SUPPLEMENT INCOME STATEMENT
INSTRUCTIONS: IF YOU ARE SELF-EMPLOYED OR IF YOU ARE SALARIED BY A BUSINESS OF WHICH YOU ARE OWNER IN
WHOLE OR IN PART, YOU MUST ALSO FILL OUT THIS SECTION.
THIS FORM IS TO BE FILLED OUT BY A PERSON (CHECK ONE)
(1) WHO OPERATES A BUSINESS OR PRACTICES A PROFESSION, OR
(2) WHO IS A MEMBER OF A PARTNERSHIP OR JOINT VENTURE, OR
(3) WHO IS A SHAREHOLDER IN AND IS SALARIED BY A CLOSED CORPORATION OR SIMILAR ENTITY
B. ATTACH TO THIS STATEMENT A COPY OF THE FOLLOWING DOCUMENTS RELATING TO THE PARTNERSHIP, JOINT
VENTURE, BUSINESS, PROFESSION, CORPORATION OR SIMILAR ENTITY
(1) THE MOST RECENT FEDERAL INCOME TAX RETURN AND
(2) THE MOST RECENT PROFIT AND LOSS STATEMENT.
1. NAME OF BUSINESS
ADDRESS
TELEPHONE NUMBER(S)
2. NATURE OF BUSINESS (CHECK ONE)
(1) PARTNERSHIP
(2) JOINT VENTURE
(3) PROFESSION
_ (4) CLOSED CORPORATION
(5) OTHER
3. NAME OF ACCOUNTANT. CONTROLLER OR OTHER PERSON IN CHARGE OF FINANCIAL RECORDS:
4. ANNUAL INCOME FROM BUSINESS:
(1) HOW OFTEN IS INCOME RECEIVED?
(2) GROSS INCOME PER PAY PERIOD:
(3) NET INCOME PER PERIOD?
(4) SPECIFIED DEDUCTIONS, IF ANY:
SECTION III: EXPENSES
INSTRUCTIONS:
1. ONLY SHOW EXTRAORDINARY EXPENSES IN THIS SECTION, UNLESS 2. APPLIES TO YOU.
2. IF YOU ARE REQUESTING SPOUSAL SUPPORT/APL OR IF YOU ASSERT YOUR CASE CANNOT BE DETERMINED
ACCORDING TO THE GUIDELINE GRIDS OR FORMULA, THIS SECTION MUST BE FULLY COMPLETED.
MONTHLY EXPENSES MONTHLY EXPENSES
SELF CHILDREN SELF CHILDREN
HOME EDUCATION
RENT 750 PRIVATE SCHOOL
MAINTENANCE _
50 PAROCHIAL SCHOOL
UTILITIES _ COLLEGE
ELECTRIC RELIGIOUS
GAS 160 PERSONAL
OIL CLOTHING
TELEPHONE/DSL FOOD 100
WATER/SE W ER BARBER/HAIRDRESSER
CREDIT PAYMENTS
EMPLOYMENT CREDIT CARDS 75
PUBLIC TRANSIT (PARKING)
_40
-
CHARGE ACCOUNT _
LUNCH 156 MEMBERSHIPS
TAXES _ LOANS
REAL ESTATES CREDIT UNION
PERSONAL PROPERTY
INCOME
INSURANCE
HOMEOWNERS MISCELLANEOUS
AUTOMOBILE 122 HOUSEHOLD HELP
LIFE 104 CHILD CARE
ACCIDENT -
-- PAPERS/BOOKS/MAGS
HEALTH ENTERTAINMENT
OTHER PAY TV
AUTOMOBILE VACATION
PAYMENTS 125 GIFTS
FUEL 50 LEGAL FEES
REPAIRS/ MAINTENANCE 50 CHARITABLE CONTRIB.
MEDICAL OTHER CHILD SUPPORT
DOCTOR SUPPORT PAYMENTS 1 5 _
DENTIST
ORTHODONTIST OTHER:
HOSPITAL
MEDICINE
THERAPY
SPECIAL NEEDS
(GLASSES. BRACES,
ORTHOPEDIC DEVICES, ETC.)
EXHIBIT B
ASSETS OF THE PARTIES
Plaintiff marks on the list below, those items applicable to the case at bar and itemizes the
assets on the following pages. If an item has been appraised, a copy of the appraisal report is attached.
(x) 1. Real property
(x) 2. Motor vehicles
(x) 3. Stock, bonds, securities and options
( ) 4. Certificates of deposit
( x) 5. Checking accounts, cash
( x) 6. Savings accounts, money market and savings certificates
( ) 7. Contents of Safe Deposit boxes
( ) 8. Trusts
( x) 9. Life insurance policies (indicate face value, cash surrender
value, and current certification)
( ) 10. Annuities
( ) 11. Gifts
( ) 12. Inheritances
( ) 13. Patents, copyrights, inventions, royalties
( ) 14. Personal property outside the home
( ) 15. Business (list all owners, including percentage (%) of ownership, and
officer/director positions held by a party with the company)
( ) 16. Employment termination benefits; severance pay, Workman's
Compensation (claim/award)
( ) 17. Profit Sharing plans
( x) 18. Pension plans (indicate employee contribution and date plan
vests)
( x) 19. Retirement Plans, Individual Retirement Accounts
( ) 20. Disability Payments
( ) 21. Litigation claims (matured and unmatured)
( ) 22. MilitaryN.A. benefits
( ) 23. Education benefits
( x ) 24. Debts due others, including loans, mortgages held
( x) 25. Household Furnishings and Personalty (Include as a Total
Category and attach an itemized list if distribution of such
assets is in dispute)
() 26. Other
MARITAL PROPERTY
Plaintiff lists all marital property in which either, or both spouses have a legal or equitable interest,
individually, or with any other person as of the date this action was commenced:
ITEM NUMBER 1 2 2
DESCRIPTION OF 3BR Ranch House 1995 Jeep 1998 Ford F150
PROPERTY at 1109 Granada Ln Cherokee Lien w/ PSECU
Mechanicsburg, PA Pymt = 124.55/mo
No Lien Bal 8-1-07=1334.80
NAMES OF ALL Paul Adjan Paul Adjan Paul Adjan
OWNERS Kathyrn adjan
MARITAL PROPERTY
Plaintiff lists all marital property in which either, or both spouses have a legal or equitable interest,
individually, or with any other person as of the date this action was commenced:
ITEM NUMBER 3 3 5
DESCRIPTION OF Mattel Stock Home Depot stock M&T Bank
PROPERTY 6 shares 55.5 shares Checking
8-7-07 $23.23/share 8-1-07 $36.89/share Savings
NAMES OF ALL Paul Adjan Paul Adjan Paul Adjan
OWNERS Kathy Adjan Kathy Adjan
MARITAL PROPERTY
Plaintiff lists all marital property in which either, or both spouses have a legal or equitable interest,
individually, or with any other person as of the date this action was commenced:
ITEM NUMBER 5 6 9
DESCRIPTION OF PSECU See #5 Term Life policy
PROPERTY Checking Face amount
Savings $11.00 250,000
No cash value
NAMES OF ALL Paul Adjan Paul Adjan
OWNERS
MARITAL PROPERTY
Plaintiff lists all marital property in which either, or both spouses have a legal or equitable interest,
individually, or with any other person as of the date this action was commenced:
ITEM NUMBER 9 18 19
DESCRIPTION OF Term Life Policy Home Depot Future State Employees
PROPERTY Face amount Builder Retirement System
100,000 Bal 6-30-07 =
No cash value $2329.64
1 % of pay - varies
100% vested
my cont. = 1346.43
HD match= 983.21
TOTAL= 2329.64
NAMES OF ALL Kathy Adjan Paul Adjan Paul Adjan
OWNERS
J
MARITAL PROPERTY
Plaintiff lists all marital property in which either, or both spouses have a legal or equitable interest,
individually, or with any other person as of the date this action was commenced:
ITEM NUMBER 24 24 25
DESCRIPTION OF 1109 Granada Lane, 1998 Ford F150 See listing on
PROPERTY Mechanicsburg, PA settlement
agreement
NAMES OF ALL Paul Adjan Paul Adjan
OWNERS
LIABILITIES OF THE PARTIES
Plaintiff lists all liabilities of either or both spouses alone or with any person as of the date this action
was commenced:
ITEM NUMBER 24 24 24
DESCRIPTION OF Mortgage on 1109 1998 Ford F150 Washington Mutual
LIABILITY Granada Lane, Visa
Mechanicsburg, PA
Bal as of 8-1-07 Bal as of 8-1-07
Approx.$162,000 $1334.80 Approx $1200.00
NAMES OF ALL Wilshire Financial PSECU Washington Mutual
CREDITORS
NAMES OF ALL Paul Adjan Paul Adjan Paul Adjan
DEBTORS
LIABILITIES OF THE PARTIES
Plaintiff lists all liabilities of either or both spouses alone or with any person as of the date this action
was commenced:
ITEM NUMBER 24
DESCRIPTION OF Capital One
LIABILITY Mastercard
Bal as of 8-1-07
Approx $300.00
NAMES OF ALL CapitalONE
CREDITORS
NAMES OF ALL Paul Adjan
DEBTORS
EXHIBIT C
S. UientslCLARKIADJANTretrial Statement.wpd
In the Court of Common Pleas of Cumberland County, Pennsylvania
Support Guideline Worksheet
Rule 1910.16-1, et se g.
Defendant Name: Paul Adjan Docket Number:
PACSES Case Number:
Plaintiff Name: Kathryn Adjan Other Case ID Number:
Defendant Plaintiff
1. Number of Dependents in this Case
2. Total Gross Monthly Income $5,275.83 $1,666.70
3. Less Monthly Deductions $1,812.72 $304.88
4. Monthly Net Income
Line 2 minus Line 3 $3,463.11 $1,361.82
5. Combined Total Monthly Net Income
Amounts on Line 4 Combined $4,824.93
6. Plus Child's Monthly Soc. Sec. Retirement or Disability Derivative Benefit. -
7. Adjusted Combined Total Monthly Net Income -
8. PRELIMINARY Child Support 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. 112006 _
11. Net Income as a Percentage of Combined Amount 71.78 28.22
12. Each Parent's Monthly Share of the Child Support Obligation
-
-
-
13. Adjustment for Shared Custody Rule 1910.16-4 c # of Overnights:
-
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 Line 8 minus Line 9, plus Lines 10, -
19. Less Split Custody Counterclaim Rule 1910.16-4 d -
20. Obligor's Support Obligation Line 14 minus Line 15 -
Prepared by: Date: 2/15/2008
Summarv Report
S1. PACSES Multiple Family Adjustment -
S2. Spousal Support Award $840.52
S3. Adjustment for Excess Mortgage Payments (If Applicable) -
S4. Custodial Parent Spousal Support Obligation (if Applicable) (-) -
S5. Adjusted Support Obligation
Line 16 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) Monthly:
$840.52 Weekly:
$193.45
TAX INFORMATION Tax Method Filing Status Exemptions
S6. Defendant 1040 ES Single
1
S7. Plaintiff 1040 ES Single
1
S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly:
S9. J
SupportCak 2007
In the Court of Common Pleas of Cumberland County, Pennsylvania
Support Guideline Worksheet
Rule 1910.16-1, et se q
Defendant Name: Paul Adjan Docket Number:
PACSES Case Number:
Plaintiff Name: Kathryn Adjan Other Case ID Number:
Defendant Plaintiff
1. Number of Dependents in this Case
2. Total Gross Month/ Income $5,275.83 $1,250.00
3. Less Months Deductions $1,812.72 $199.71
4. Monthly Net Income
Line 2 minus Line 3 $3,463.11 $1,050.29
5. Combined Total Monthly Net Income
Amounts on Line 4 Combined $4,513.40
6. Pius Child's Month/ Soc. Sec. Retirement or Disability Derivative Benefit. -
7. Adjusted Combined Total Month/ Net Income _
8. PRELIMINARY Child Support Obli ation 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. 112006
-
11. Net Income as a Percentage of Combined Amount 76.73 23.27
12. Each Parent's Month/ Share of the Child Support Obligation
13. Adjustment for Shared Custody Rule 1910.16-4 c # of Overnights:
-
-
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 Line 8 minus Line 9, plus Lines 10, -
19. Less Split Custody Counterclaim Rule 1910.16-4 d -
20. Obligor's Support Obligation Line 14 minus Line 15 _
Prepared by: Date: 2/15/2008
Summary Report
S1. PACSES Multiple Family Adjustment _
S2. Spousal Support Award $965.13
S3. Adjustment for Excess Mortgage Payments (If Applicable) -
S4. Custodial Parent Spousal Support Obligation (if Applicable)
S5. Adjusted Support Obligation
Line 16 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) Monthly:
$965.13 Weekly:
$222.12
TAX INFORMATION Tax Method Filin Status Exemptions
S6. Defendant 1040 ES Sin le 1
S7. Plaintiff 1040 ES Single
1
S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly:
S9. Justification for Deviatin from Guidelines Calculation and/or Other Case Comments:
SupportCak 2007
r?
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.-r? '?!
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r R? ?
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5 -?
?.;? ? ?x
g ?$
...."
..«.?
Q%DOCUMENTS AND SETTINGSIALL USERSIDOCUMENTSUHC FOLDERICLIENT DIRECTORY\ADJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
JOANNE HARRISON CLOUGH, P.C.
3820 MARKET STREET
CAMP HILL, PA 17011
717-737-5890
PA. ID. NO. 36461
Counsel for Defendant
PAUL ADJAN, : IN THE COURT OF COMMON PLEAS
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
V. NO. 05- 2978 CIVIL TERM
KATHRYN ANN ADJAN, : CIVIL ACTION -LAW
Defendant : IN DIVORCE
PRE-TRIAL STATEMENT OF
DEFENDANT KATHRYN ANN ADJAN
Kathryn Ann Adjan, the Defendant, by and through her counsel, Joanne Harrison Clough,
Esquire files the following Pre Trial Statement:
I. BACKGROUND INFORMATION:
PLAINTIFF:
1. Name: Paul Adjan
2. Address: 118 West Kelker Street
Mechanicsburg, PA 17055
3. Age: 55
4. Date of Birth: 9-5-1952
5. Educational Background: High School Graduate and 2 years HACC
6. Health: Good
7. Occupation: Facility Maintenance Manager
8. Employer: Commonwealth of Pennsylvania
Part time: Home Depot
C:%DOCUMENTS AND SETTINGS ALL USERS%DOCUMENTSUHC FOLDER%CLIENT DIRECTORYIADJAN, KATHRYN%PRE-
TRIAL.SHORT.DOC
March 27, 2008
DEFENDANT:
1. Name: Kathryn Ann Adjan
2. Address: 1109 Granada Lane
Mechanicsburg, PA 17055
3. Age: 55
4. Date of Birth: 2-4-1953
5. Educational Background: High School Diploma
6. Health: Fair. Wife suffers from Craniocervical Dystonia. She suffers from
a dystonic head tremor and receives botulinium toxin injections which provide a
minimal improvement.
6. Occupation: unemployed throughout most of marriage. Now working 25 plus hours per week
at Giant Foods in kitchen doing food preparation. .
7. Employer: Giant Foods
CHILDREN OF THIS MARRIAGE:
1. Sara N. Adjan
Date of Birth: 6-10-1981 age 27
MARRIAGE INFORMATION:
1. Date of Marriage: May 11, 1974
2. Place of Marriage: Cumberland County, PA
3. Date of Separation: April, 2006
4. Date Action Commenced: June 5, 2005
5. Issues Raised: Separation date: Husband filed for divorce in June of 2005.
He moved from marital residence. The parties subsequently reconciled and Husband agreed
to move back home if Wife got a job. Wife applied for a job was hired and Husband moved
back home and the parties commenced marriage counseling. He moved out again on April 23, 2006
and moved in with his girlfriend. This is the date of the parties' final separation.
C:ID000MENTS AND SETTINGSIALL USERSIDOCUMENTSUHC FOLDERICLIENT DIRECTORY%ADJAN, KATHRYN%PRE-
TRIAL.SHORT.DOC
March 27, 2008
II. INCOME
1. Husband's total income for 2007 was $ 80,145.84. See attached W-2s
2. Wife's total income for 2007 was $ 9,957.10. See attached W-2 and attached Income
and Expense Statement
III. MARITAL ASSETS:
Real Estate:
1. Marital residence located at 1109 Granada Lane, Mechanicsburg, PA
Estimated value: $ 175,000.00 approx. Mortgage balance $161,000.00. If the parties sold the
home through a realtor they would not have enough money to pay the mortgage off and pay the
real estate commission, transfer taxes, and other seller's costs.
Vehicles:
2. 1995 Jeep Grand Cherokee. Parties can stipulate to Kelly Blue Book value or a NADA
value. There is no lien on this car. Wife currently uses this vehicle.
3. 1998 Ford F-10 Pickup truck: Parties can stipulate to Kelly Blue Book value or a NADA
value. There is no lien on this truck. Husband currently uses this vehicle.
Retirements:
4. Husband's SERS Retirement. The marital portion is believed to be in excess of
$ 350,000.00. The immediate offset method of distribution is not available and this will need to be
distributed via a Q.D.R.O.
5. Husband's Home Depot Future Builder Retirement. It si believed the marital portion of
said retirement in approximately $ 2,300.00.
C:ID000MENTS AND SETTINGSWLL USERSIDOCUMENTSIJHC FOLDERICLIENT DIRECTORYWDJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
6. Wife has no retirement.
Stocks:
7. Home Depot Stock: Husband has approximately 56 shares. Value to be determined if unable
to reach stipulation as to value.
8. Mattel Stocks: 6 shares. Value to to be determined if unable to reach stipulation as to value.
Bank accounts:
9. Husband's PSECU Checking/Savings account: Separation balances to be determined if unable
to reach stipulation as to value.
10. Joint M&T Bank Checking/Savings account.: Separation balances to be determined if unable
to reach stipulation as to value.
Personal Property:
It is anticipated that the parties can reach an agreement re: the personal property. In the
alternative, Wife will submit testimony as to the values and items she wishes to retain in equitable
distribution.
IV. NONMARITAL ASSETS
Neither party is claiming any non marital assets are in possession of the other party.
V. EXPERT WITNESSES
1. Wife may call Terry Leslie as a Vocational Expert to testify regarding wife's earnings
capacity if the parties are not able to stipulate that wife is currently meeting her earnings capacity
through her current employment.
2. Wife may call her treating physician(s) or submit medical records regarding her health if
the parties are not able to stipulate that wife has health issues.
C:ID000MENTS AND SETTINGSIALL USERSIDOCUMENTSUHC FOLDERICLIENT DIRECTORYIADJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
VI. INCOME AND EXPENSES
Husband has previously filed an Income and Expense Statement and Wife is attaching her
Income and Expense Statement to this Pre Trial Statement.
VII. WITNESSES
1. Kathryn Ann Adjan will testify regarding the relevant factors for equitable distribution,
alimony, and counsel fees, costs and expenses.
2. Paul Adjan as on cross examination.
3. Wife reserves the right to call additional witnesses as may be necessary and will provide
advance notice to Plaintiff's counsel
VIII. COUNSEL FFES. COSTS AND EXPENSES
1. Wife is seeking an award of counsel fees, costs and expenses. It has caused Wife great
economic hardship top pay for her counsel fees, costs and expenses in this action and it is
believed she will be forced to incur expert witness fees to substantiate her earnings capacity and
her health related issues when Husband is well aware of said issues but continues to challenge
her earnings potential and her health related issues but has retained no expert to substantiate his
claim.
IX. EXHIBITS
1. 2007 W-2s of Husband
2. 2007 W-2 of Wife
3. Husband's SERS statement closest to separation date 4-23-06
4. Husband's SERS current statement
5. Home Depot retirement statements
6. Mortgage statements
7. Letter of Albert W. Heck, M.D.
8. Support calculations
9. Home Depot stock statements
C:ID000MENTS AND SETTINGSIALL USERSIDOCUMENTSUHC FOLDERICLIENT DIRECTORYIADJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
10. Mattel Inc. stock statements
11. Giant Foods information re: limitations on availability of health insurance for Wife
as employee
12. COBRA cost of health insurance for WIFE post divorce through Husband's insurer.
13. Possible vocational expert report
14. Possible additional expert medical report(s)
X. MARITAL DEBT
1. Mortgage on marital residence.
2. possible other minor debt; the parties had filed bankruptcy prior to Husband filing for
divorce.
XI. PROPOSED RESOLUTION
Wife proposes that she retain the marital residence and the 1995 Jeep Grand Cherokee. Husband
would pay Wife indefinite alimony in the amount of $1,750.00 per month. Husband would also pay the
COBRA or other health insurance for until she is able to get health insurance that covers her pre existing
condition at a reasonable cost. Wife would receive 50% of the marital portion of all of Husband's
retirements via a QDRO for the Commonwealth retirement and a rollover, if possible from the Home
Depot retirement. It should be noted that the marital residence has no net equity. The marital residence
cannot be sold given the current outstanding balance due on the mortgage, the real estate commission
and other transfer taxes and sellers costs. The parties would be "upside-down" on the property and in
fact owe monies at settlement even if they received full value for the property if they listed the property
for sale.
A review of the equitable distribution factors in this case clearly supports such a distribution.
This is a 33 plus year marriage, Wife was not in the work force for more than twenty years immediately
preceding separation, she suffers from a serious neurological disease which causes her to have a head
tremor, husband has a substantial earnings history and earnings capacity compared to Wife's limited
earnings, her lack of work history and earnings capacity. In fact, Husband earns 89% of the parties
combined income. The requested alimony is also appropriate given the length of this marriage, my
Wife's health issue, her limited earnings and earning potential, Husband's earnings and Husband's
marital misconduct. This is a case where maximum indefinite alimony will certainly be awarded.
Husband left Wife to move in with his girlfriend who he helps to support, and he has the benefit of
cohabitating with his paramour who is a wage earner and shares monthly living expenses, whereas his
Wife has no other individual to assist her with her monthly living and medical expenses.
C:ID000MENTS AND SETTINGSIALL USERSIDOCUMENTSUHC FOLDERICLIENT DIRECTORYWDJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
Wife has reentered the work force and is doing all that she can do to provide for herself but it is
unlikely she will ever be able to secure a sufficient annual income to provide for her basic daily needs or
her health insurance and medical expenses.
Respectfully Submitted,
Date: By AlVl?IE HAKRISrH, PC
JO S )N CL
7QH, ES L
Attorney I.D. No. 36461
3820 Market Street
Camp Hill, PA 17011
Telephone No. [717] 737-5890
Attorney for Defendant Kathryn Ann Adjan
C:0000MENTS AND SETTINGSWLL USERSIDOCUMENTSUHC FOLDERICLIENT DIRECTORMDJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
CERTIFICATE OF SERVICE
AND NOW, this day of , 2008, I hereby verify that I have
caused a true and correct copy of the foregoing document, Pre-Trial Statement of Kathryn Ann Adjan
to be placed in the U.S. mail, first class, postage prepaid and addressed as follows:
Robert E. Elicker, II, Esquire
Divorce Master
9 North Hanover Street
Carlisle, PA 17013
Thomas M. Clark, Esquire
130 West Church Street
Dillsburg, PA 17019
Counsel for Plaintiff Paul Adjan
JOANNE HARRISON CLOUGH, P.C.
By:
JOANNE HARRI N CLOD H, E UIRE
Attorney I.D. No. 36461
3820 Market Street
Camp Hill, PA 17011
Telephone No. [717] 737-5890
Attorney for Defendant Kathryn Ann Adjan
CADOCUMENTS AND SETTINGSIALL USERSIDOCUMENTSIJHC FOLDERICLIENT DIRECTORYU?DJAN, KATHRYNIPRE-
TRIAL.SHORT.DOC
March 27, 2008
In the Court of Common Pleas of Cumberland County, Pennsylvania
--
? # 'fw ez
Defendant Name: Paul Adjan Docket Number:
Plaintiff Name: Kathy Adjan PACSES Case Number:
Other Case ID Number:
1. Number of Dependents in this Case
2. Total Gross Month/ Income $6,678.80 $828.90
3. Less Month Deductions $1,995.56 $110.36
4. Monthly Net Income
Line 2 minus Line 3 $4,683.24 $718.54
5. Combined Total Monthly Net Income
Amounts on Line 4 Combined $5,401.78
6. Plus Child's Month/ Soc. Sec. Retirement or Disability Derivative Benefit. -
7. Adjusted Combined Total Month/ Net Income _
8. PRELIMINARY Child Support 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. 112006
-
11. Net Income as a Percentage of Combined Amount 86.70 13.30
12. Each Parent's Month Share of the Child Support Obligation
13. Adjustment for Shared Custody Rule 1910.16-4 c # of Ovemi hts: - -
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 Line 8 minus Line 9, plus Lines 10, -
19. Less Split Custody Counterclaim Rule 1910.16-4 d -
20. Obligor's Support Obligation Line 14 minus Line 15 _
Prepared b : JHC Date: 3/27/2008
S1. PACSES Multiple Family Adjustment _
S2. Spousal Support Award $1,585.88
S3. Adjustment for Excess Mortgage Payments (If Applicable) $229.45
S4. Custodial Parent Spousal Support Obligation (if Applicable)
S5. Adjusted Support Obligation
Line 16 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) Monthly:
$1,815.33 Weekly:
$417.80
TAX INFORMATION Tax Method Filing Status Exemptions
S6. Defendant 1040 ES Single 1
S7. Plaintiff 1040 ES Single 1
S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly:
S9. Justification for Deviating from Guidelines Calculation and/or Other Case Comments:
SupportCalc 2006
In the Court of Common Pleas of County, Pennsylvania
SUPPI*`
Defendant Name: Paul Adjan Docket Number:
PACSES Case Number:
Plaintiff Name: Kathy full time Other Case ID Number
1. Number of Dependents in this Case
2. Total Gross Month Income $6,678.80 $1,195.80
3. Less Month Deductions $1,995.56 $190.39
4. Monthly Net Income
Line 2 minus Line 3
$4,683.24
$1,005.41
5. Combined Total Monthly Net Income
Amounts on Line 4 Combined
6. Plus Child's Month Soc. Sec. Retirement or Disability Derivative Benefit. $5,688.65
-
7. Ad lusted Combined Total Monthly Net Income
8. PRELIMINARY Child Support 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 able Rev. 112006
-
11. Net Income as a Percentage of Combined Amount 82.33 17.67
12. Each Parent's Monthly Share of the Child Support Obligation
-
-
13. Adjustment for Shared Custody Rule 1910.16-4 c # of Overnights: - -
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 Unreimbumed Medical Expenses Rule 1910.16-6 c -
17. Adjustment for Additional Expenses Rule 1910.16-6 d -
18. Total Obligation with Adjustments Line 8 minus Line 9, plus Lines 10, -
19. Less Split Custody Counterclaim Rule 1910.16-4 d -
20. Obligor's Support Obligation Line 14 minus Line 15 -
Prepared b : Date: 3/27/2008
I - Sew Repwt
S1. PACSES Multiple Family Adjustment -
S2. Spousal Support Award $1,471.13
S3. Adjustment for Excess Mortgage Payments (If Applicable) -
S4. Custodial Parent Spousal Support Obligation (if Applicable) (-) -
S5. Adjusted Support Obligation
Line 16 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) Monthly:
$1,471.13 Weekly:
$338.58
TAX INFORMATION Tax Method Filing Status Exem tions
S6. Defendant 1040 ES Single 1
S7. Plaintiff 1040 ES Single 1
S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly:
S9. Justification for Deviatinc from Guidelines Calculation and/or Other Case Comments:
SupportCa/c 2006
PENNSYLVANIA NEUROLOGICAL ASSOCIATES, LTD.
and
SLEEP HEALTH CENTER
Albert W. Heck, M.D. Francis J. Janton, M.D. Liana I. Laza, M.D.
November 12, 2007
Joanne Harrison-Clough, PC
Attorney and Counselor of Law
3820 Market Street
Camp Hill, PA 17011
RE: KATHRYN A.. ADTAN
Dear Ms. Harrison-Clough:
Vivian C. Faircloth, M.D.
I am writing to you on behalf of Kathryn Adjan, a patient of mine who I have known for several years.
She has the diagnosis of a craniocervical dystonia associated with a dystonic head tremor. This is a
chronic condition that causes some degree of head tremor and abnormal head posturing, as well as some
pain in her shoulders. As noted, it is chronic and has been present for many years. i do not anticipate that
it will change in the future, nor do I believe that it will resolve. I have treated it .vith various medications
and botulinum toxin injections with a minimal degree of improvement. To this point, I am unaware that it
has affected any of her regular daily activities, other than the discomfort that it has caused her in her daiiv
activities. My records do not indicate that we have had to discuss any issues surrounding employment to
this point, and I believe that whatever impact that this has had in her work performance to this point in
time will continue to be an issue in the future.
Please let me know if there are any other specific questions.
Sincerely yours,
Albert W. Heck, M.D
AWHiy56
ES#: 51003345 5100 1
PT ID#: 24163
?e
V v'
110 Lowther Street Lemoyne, PA 17043 Phone (717) 774-2202 Fax (717) 774-2634
Commonwealth of Pennsylvania
EMPLOYEE PAY STATEMENT
Paul Adjan Personnel Number..... 00078718
1.118 West Keller Street Transportation Pyrl Area 2
Mechanicsburg PA 17055 Pay Period.. 12/01/2007 - 12/14/2007
Fed Tax Status:
Fed Tax Allowances: Period: 26/2007
IB/U:J3 Group:08 Level:13
Pay Date Payment Amount = Gross + Reim. - Taxes Deds.
12/28/2007 1,644.95 = 2,269.50 + 0.00 - 467.36 - 157.19
I
Payroll Area T2
2 Wage and Tax 2007
Form !¦w$tateCXieYFt
Copy B - To Be Filed With Employee's FEDERAL Tax Return.
This information is being furnshen ;o the intemal Revenue Service.
1cGet`r WT!srPtffCff!eVt7kW,'? LLC
(1149 HARRISBURG PIKE
CARLISLE PA 17013
e Employ e_ &..a 9 _ d r ;c
KATHRYN A ADJAN
1109 GRANADA LN
MECHANICSBURG PA 17055
1 t. ;es. no other c r e ion x .tar e ^a. • 3 70
?d. 10
?rlE nlc 1or>;;
7 Socai secure y Lips O 3 Scca' Security wan 47 . 10 4 72
B fi.i,ca:ed tips . 00 o Medicare :.ages rW7 . 10?t 44. 23
9 Advance EIC payment 00 10 ,Dependent care benetis 001 1'11 00
12a See struc+uons for bcx 12 ,12b ?12c -??
E
12d its ?„rcry je,•-- .,t =16pftms 52.00
b 'J IaO jrjmte, iEft a FflW e53 ,'sffj tuber
?
5 State >tare 16 Sto'_e :•: aq s ur .
D 18 r
17 tat ^corre ter,:
e .:errs' I c ynue i>en; ?e
sA
Wage and Tex
A
f S }?
L7
MB "° 545- "
vk3 i? jr ?r
??F! . 1 O +
i r ?N
. 70
tatement
Form
copy C - For EMPLOYEE'S RECORDS (See Nofice. to 7 SceEet secunbj ps
0
.0 3 ocial secura:y °n
V647. 1 0 I a ?oaar ,e ant. ' x v.6 r
. 7 Z I
lo
y
e
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ee on the back of Copy 0.)
s dre ca
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t
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G l I4ry- 1 {` V tJ L1 1 U J 8 Allocated Itps
. 00 5 ^4edclre nn s ?7
. 10 + 6 Medicare tax wil yield
744.23
t
,
111 9 Advance EIC payment 00 i 10 [Dependent care twnebts 00 11 Nonquatifred plans OQ
? '--
1149 HARRISBURG. PIKE
1 --- e ---
12a See instrttotiuns f? twx 12 12b 12c
ICARLISLE PA 17013 I ;
I
_
Emoloy_e'c ?amo address and Zipowl
e )2d 1 r?? y
r 1 Ya.rte n; ??vavri
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mGe INj a
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ai i1
o,
"
1 KATHRYN A ADJAN 4 30
0
1 p0.7?U 7
Tom
11109 GRANAulk LN` } -
"his infoirn'atton isng.• rm st_d to the intc.nal..EYevc t Serv.c ( are
i MECHANICS601WQ PA 17055 I requtredtotr?eamKreturn aresugeneepe=taayoroter r"??n
.
.... imposed ort a e re.Texalsle and. 4AQ
t
_- _:--- -- --- f - _ --
{
!
{8 S: z'e 117 Stale Incone tax
_o=aMy Pamz
18 wcai v+etgss-lips,. etc.. ' 19 Loal ,nc- ,me tax. t 2O
L Ua arf:r e , ? _9e :. ? C _?e Je . -
VVage and Tax
20
t
St 0 7 f t Wages: ii p er
` ?10
n rvc t;a5-oa,a 2 Fede a .cct n '.ax
70
atemen
Filed With Employee's State, City, or Local
To g
Cppy 2 - e -
7 S,-l sec,oty VD, °oc?af sec t rty v; V647.
00 10 4 Soc,ar security tex *94%. 7
income Tax.strtum.
e s r r}e
G?Ia1F LLC 8 Apocate, hcvs
.00 5 taadce re wages
lVsl. 10 & Mctica 9 - v.6h'ne
144.23
9 Na,1Ce EIS na+{manl 00 10p=e oeneErS 00 f t Noy r o1a 00
-----
1149 HARRISBURG PIKE 2a j t2b 120
CARLISLE PA 17013
e Emp.oyee s nara_.. address. arc ZIP ccae 1l2d +is t, ; e ?eyyrr --t>a > i6PC}y? 1 G*s
R
KATHRYN A ADJAN I.b 1#`2111 ""1 f, ,t?,r,FINi a f??'=??=SFCy(?rx tube ?
1109 GRANADA LN r ---------- j
MECHANICSBURG PA 17055 i
RJR A L LAI -
924710
90 dam- 7 .-10_- 205 40 ses. 016,
t5' State Empoyers state 1) somber 16 Siato wages, tps:.e c 17 State inUxlY. taz 18 iota voe??-. tips.. 19 tcez`, „>:ome tax20 Lr 'ty
e a?+x t rh .-e t`) :.. Iem R c tie Service
/? Wage and Tax
Form *2 Statement 2 ®®? i t wanes ;ins. other urno a, on 2 ed ra come raxwthheld
_ onBrlc•.,sa5-ows 9947. 10 - 759.70'
--t- 0'
'
?
Copy 2 - To Be Filed With Employee's State, City, or Local .ax hreid
3 Social securty na es 4 y
j 7 Social securty tics
616.721
00 947 ' 10
i
Income Tax Return. --
.
c Emplc er's name, address, and ZIP code
LLC
GIANT FOOD STORES 8 Ail aced tips
00 5 Medicare wanes and lips 6 ^: r?dr e - x =+i i
144.23!
01
9947. 1
,
i -
?---
'
8 Actvance EiC payment
00 d= ;'7t rvon -he. pans
10 Dependent care bene
.00 1 .001
1149 HARRISBURG PIKE
CARLISLE PA 17013 12a
1 12b
1 12c ---?
?--
e Employees name, address. and ZIP cone 112d
( 13 ;atuter; R_l r-- Th-rd parly
1 Tc Ian X - , pay 14 Other
52.00
MS
KATHRYN A ADJAN [ypploye ?eIItrfaiaq77 njmber (Elti)
b SS 66 ((11 a 'nb?oye?so?al sgcu8ny$m7er
4 ?3 b
tf
1109 GRANADA LN i- '
MECHANICSBURG PA 17055
-
±
;.AQ
061U., E.
784062 --_
9969.10
-?-9W
rl? 15 State c ,:.o, ers,tate :D number
116 State,ages. tips, etc.
117 State income tax ?18 toes: wagers. tiGS. etc. i 19 '_cca me tae-_i 20 -ai'- y :ame
-
i944-NAB..... •-... .... - .... -: i7F11RiMILefY'6/'ilitl"'TlRaSUryMIRlH41'aeeelpl!''d!¢erCa ""'_ OMe T¢U'--:1eaa'+em ..? ..:OIII ht ft b lilt-?T r _ _____ 1bYrs1ll.:.aaNrtF.
t 'ava._, ES ' LC other c7mpe-saflon 2 Federal !f iccme tax wtnhe c! 1 Wiae_.Ds. c-her compen5atl m 2 rederai 1r,;--me '-ax w '1!1e!c
11563.41 496.72 11563.41 496.7/2
• 3 -c.a`. Securitv Waaes 4 Social security tax wltnneld 9 So-iai Securrfy Wages 4 _ ociai sxur,?y tax r
11619.12 720.39 11619.12 72C.39
5 Medicare wages and tips _
6 ',ied-a-tax withlle;d 5 Medicare wages and tips 6 Meelcire tax wltl-oed
11619.12 168.48 11619.12 168.48
c Employer's lame. address. and ZIP code c Employer's lame. address, and ZIP code
HOME DEPOT U.S.A. 'INC. HOME DEPOT U.S.A. INC-
STORE SUPPORT CENTER STORE SUPPORT CENTER
2455 PACES FERRY RD 2455 PACES FERRY RD
ATLANTA GA 30339 ATLANTA GA 30339
_
7 Social Security Tips 8 Allocated Tips 9 Advance EIC Payment 7 Social Security Tips 8 Allocated Tips 1 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans c 2a See. instructions for box 12 - 1o Dependent care benefits 11 Nonquarfied plans 2a See instructions for box 12
I D 348.60 a D 348.60
o
12b I42c 12d 12b 12c 12d
c
c Ic c o
a ( id I a e a a
It Employer identification number a Employee's social security number b Employer identification number a Employee's social security number
58-1853319 I 194-42-9193 58-1853319 194-42-9193
13 Statuatory Retirement Third-party ?. 14 Other SPP GAI M.89 13Statuatory Retirement Third-party ) 14?Ot erh ESPP GAIN -292.8V
employee plan sick pay PA- DI 10.47 employee plan sick pay PA -DI 10.47
X E I X I
e Employee's name. address, and ZIP code
PAUL ADJAN
118 WEST KELLER STREET
MECHANICSBURG PA 17055
Form 15 State Employer's state ID number
-2 _PA_ 581853319_ _ _ _ _
Wage and Tax 17 State income tax
Statement _ _ __ _ 356.69
I
200 ?19 Local income tax 20 Locality name f 19 Local income tax 20 Localdy name
200.
166.15 HAMPDEN I
I 166.15 HAMPDEN
Copy2
For
Stale, City - - - -
? - ' - - - - - - - - - - - - - -
Copy 2 For Sfax, City ?_ - -
- - - - - - I - - - -- - - -
or
Local
Tax
Department or Local Tax Department
0.9 N. 1545-0008 '6-03]1690 D- rtment br the Treasury-Internal R¢venu¢ Service Nme Nn .54.-COOS Department of the Treasury In-1.1 Revenue Sc
1 Wages. tips, other compensation 2 Federal income tax withheld 1 Wages, tips. other compensation j 2 Federal income tax withheld
This ;nr¢rmanan 11563.41 496. 72 11563.41
?c
e 496.72
s bcin9 rurnishe?
?° m¢ me¢raa, 3 Social Security Waaes
4 Social secuniy tax withheld .r?tc
lreyou
3 Social Security Wages
urr
`'
' I
i 4 Social security tax withheld
Revenue Servi ce
11619.12
720.39 •
n
"e911 cnce
11619.12
I 720.39
'5 Medicare wages and tips _
6 Medicare tax withheld ..:?; 5 Medicare wages and tips j 6 Medicare tax withheld
11619.12 168.48 A 1619. 12 j 168.48
c Employer's name. address, and ZIP code c Employer's name, address, and ZIP code
HOME DEPOT U.S.A. INC. HOME DEPOT U.S.A. INC.
STORE SUPPORT CENTER STORE SUPPORT CENTER
2455 PACES FERRY RD 2455 PACES FERRY RD
ATl AKTA n_A Zngga AT] AAITA r_A gnaara
7 Social Security Tips 8 Allocated Tips 19 Advance EIC payment
10 Dependent care benefits I11 Nonqualified plans t za see instructions tot box t
a D 348.60
12b 12c 2d
0 0 0
4 a a
b Employer identification number a Employee's social security number
. 58-1853319 194-42-9193
13 Statuatory Retirement Third-party 14 Other E S P P GAIN 29:F. 89
employee plan sick pay PA-DI 10.47
I X ?
I e Employee's name, address, and ZIP code
PAUL ADJAN
118 WEST KELLER STREET
MECHANICSBURG PA 17055
Form 15 State Employer's state ID number 16 State wages, tips, etc.
PA _581853319_ _ _ - _ _ - _ _ _ _ 11912.01
Wage and Tax 17 State income tax 18 Local wages, tips, etc.
Statement _ _ _ - _ 356.69 - - _ _ _11912_01_
2007 19 Local income tax 20 Locality name
_ _ _ _ _ 166=15_ _ HAMPDEN
Copy B To Be Filed with
Employee's FEDERAL Tax Return.
e Employee's name, address, and ZIP code
PAUL ADJAN
118 WEST KELLER STREET
MECHANICSBURG PA 17055
16 State wages. tips. etc. T Form 15 State Employer's state ID number ( 16 State wages, tips. etc..
- - _ 119 12. 0 1- _ W-2 - PA 58 1 8533 19 _ - _ _ 11912.01
18 Local wages. tips. etc. Wage and Tax 17 State income tax 18 Local wages; tips, etc.
- _ _ _11912_01 Statement - _ - _ - _ 356.69 - _ _ _ _11912_01-
7 Social Security Tips 8 Allocated Tips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans PaSee instructions for box 12
S D 348.60
12b
0
d 12c
0
a 12
0
e
b Employer identification number a Employee's social security number
58-1853319 194-42-9193
13Statuatory Retirement Third-party 14 Other ESPIP A 292. W
employee plan sick pay PA-DI 10.47
X
1
I
e Employee's name, address. and ZIP code
PAUL ADJAN
118 WEST KELLER STREET
MECHANICSBURG PA 17055
Form 15 State Employer's state ID number
W_ 2? PA 581853319
Wage and Tax 17 State income tax
Statement 356.69
16 State wages, tips. etc.
- _ _ _ _ 11912.01
18 Local wages. tips, etc.
___ 11912_01_
200 19 Local incometax 20 Locality name
166_15 HAMPDEN
Copy C For EMPLOYEE'S RECORDS.
(See Notice to Employee on back of Copy B).
Departrre t o' +ne t-•e y .r; Una aue. c?riice _.._
d Contrci number 1 YJages > { order compensation! 2 Federal income tax withheld d Control number 1 Wages, tips, other compensation 2 Federal inccme tax withheld
00078718 _ 57769.19 5135.81 00078718 _ 57769.19 5135.81
OMB IYG. 1545-ax-8 r 3 S`-;cia= ecur,ty wages 4 Social security tax withheld OMB NO, 1545 0?'Oa 3 Social security wages 4 Social security tax withheld
61612.23 3819.96 micrmaso! tcli,,, 61612.23 3819.96
5 Medina+e ;,ages and Pips 6 Medicare tax withheld fum+shed to the 5 Medicare wages and tips 6 Medicare tax withheld
( 61612.23 893.38 Intern; Revenue Seal,, 61612.23 893.38
c Employer's name. address and ZIP cedi c Employers name, address and ZIP code
Commonwealth of Pennsylvania Commonwealth of Pennsylvania
Exec Off - Bur of Comm Pay Op Exec Off - Bur of Comm Pay Op
Harrisburg PA 17105 Harrisburg PA 17105
7 Social security rips 8 Allocated ties 9 Advance EIC payment 7 Social security tips 8 Allocated tips 9 Advance EIC payment
10 Dependen; care benefits 11 Nonqualified plans 12a See instructiorls for box 10 Dependent care benefits 11 Nonqualified plans 12a See Instructions for box 12
t2b 12c 12d 12b 12c 12d
b Employer identification number (EIN) a Employee's social security number b Employer identification number (EIN) a Employee's social security number
23-2172299 194.42-9193 23-2172299 194-42.9193
13 Statutpry, %ftemer4 Triru-par?y 14 Other 13 stati,tory Retirement Third-Party 14 Other
ern:Jipyee pran std( paY emplpyee titan. 3i& pay Tx Vehicle 395.52 Tx Vehicle 395:52
X X
e Employee's name, address and ZIP code Ti- infotmabon is being a Employees name;; address and ZIP code
t6mished to the Intemai
Paul Add?'an Revenue Servi if you Paul Ad' n
118 West Keller Street are cared to t ie a tax 118 W=Keiler Street
Mechanicsburg PA 17055 rpona ry o a n toy
Mechanicsburg ' PA 17055
may I. xnpoeed:on you
if 1Ms income. is taxable
and you-fail To report it..
15 State Employer's state ID No. 16 State wages, tips, et.. 15 Sate Employers state ID No 16 State wages, bps etc.
2007 PA O
13567078 61216.71 PA 13567078 _ 61216.71
€ e? Wage and Tax 17 State fncome tax 18 Local wages, tips, -eta: E Wage. and Tax 17 state income ? 18 Locsi wages, V% etc
W.
w2 statement 1879.43 54595.05.: W-? Statement
1879.43 _ 54595.05
Copy C-For Copy B-To Be Filed
EMPLOYEE'S RECORDS 19 Local income tax 20 Locality name W@h Employee's 19 Local income tax - 20 Locality name
(See Notice to Employee 928.12 Mechanicsburg FEDERAL Tax Return 928.12 MBChan Csb.yrg
on the back of Copy B.) _ `-Y?-• Depadnrn ti-e".?as+erna!rlever F,.,vr.._
d Control number 1 Wages. tips, other com risation
? 2 Federal income tax withheld
- 00078718 5I
769.19 5135,81
cm NO 1545-oom 3 Social security wages
61
6 4 Social security tax withheld
1
2.23 3819.96
5 Medicare wages and tips 6 Medicare tax withheld
61612.23 893.38
c Employer's name, address and ZIP code
Commonwealth of Pennsylvania
Exec Off
B
f Co
-
ur o
mm Pay Op
Harrisburg PA 17105
7 Social security tips 8 Allocated tips 9 Advance Etc paymen,
10 Dependent care benefits 11 Nonqualified plans 128
12b 12c 12d
tentification number (EIN)
b EYS
1
M a Employee's social security number
-
1
299 194-42-9193
13 Stagier, Reto,e.,en: Tt:ir,:-7y 14 Other
c ? p?oyee „1.sea ray
Tx Vehicle 395.52
x
f L
e Employees name, address and ZIP code
Paul Ad'an
118 West Keller Street
Mechanicsburg PA 17055
?r 15 Stale Employers state ID No. 16 State wages. tips, eta
till! r/ PA 13567078 61216.71
Wage and Tax
W-2 17 Stare income tax - 18 toes! wages. tips. etc.
LL
statement 1879.43 54595.05
Copy 2-To Be Filed With
'
Employee
s state, city, or 79 Lo,.ai •„ccme tax 20 Loaiity name
Local Income Tax Return. 928,12 Mechanicsburg
Deaartmen, of the Treasury-iniemal Revenue Serirce
d Control number 1 Wages, tips, other sa6ort
11 2 Federal income tax withheld
00078718 ` 5 / 91
9 5135.81
OMB NO. 1545-0008 3 Social security wages 4 Social security tax withheld
61612.23 3819.96
5 Medicare wages and tips 6 Medicare tax withheld
61612.23 893.38
c Employers name, address and ZIP code
Commonwealth of Pennsylvania
Exec Off • Bur of Comm Pay Op
Harrisburg PA 1.7105
7 Social security tips. 8 Allocated tips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans 128
12b 12c 12d
b Employer identification number (EIN) a Employee's social security number
23-2172299 194-42-9193
13 Statutory Retiremem TN d-pally 14 Other
employee ptaa sick pay
Tx Vehicle 395.52
I I x
e Employees name. address and ZIP code
Paul Ad'an
l
118 Wes
Keller Street
Mechanicsburg PA 17055
x Employers state tD No 16 State wages, tips, etc.
2 Q O 13567,078
rp 61216.71
E Wage and Tax
1 W-2 St
t
t 17 Sta.e income tax 18 Locei wages. tips.. etc.
emen
a 1879.43 54595.05
Copy 2-To Be Filed With
'
Employee
s State, City, or 19 Local inwme tax 20 Locality name
Local Income Tax Return. 928.12 Mechanicsburg
-')n0ahment of the Treasury-Intema. Revenue Service
Department of i':a tflii-,y-m-al R-v, Bc-?rire
d Control numbe( 1 'u?iages by oti?:?. c mrensa6.on 2 Federal income tax withheld d Control r 1 1Nages. tips, other compensation 2 Federal income tax withheld
00078718 _ 00078718
OMB NO. 1545 6Q08 3 ,octal security %,ages 4 Social security tax withheld OMB NO, 1 45-q<;n8 f 3 Social security wages A Social security tax withheld
This inf:;rmaVOn s he?-g
5 Medica e xiaaes and tics 6 Medcare tax vrithhefd -,-r-sned to t c a 15 Medicare wages and tips 6 Medicare tax withheld
_ le nal Reve e
c Employers name, address and Z.P code c Employers name, address and ZIP code
Commonwealth of Pennsylvania Commonwealth of Pennsylvania
Exec Off - Bur of Comm Pay Op Exec Off - Bur of Comm Pay Op
Harrisburg PA 17105 Harrisburg PA 17105
7 Social security taps 8 Ailecated tips 9 Advance EIC payment 7 Sociai security tips 8 Allocated tips 9 Advance EIC payment
10 Dependent care benefits 11 Norquali ied plans 12a See instructions for box 12 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12
12b 12c 12d 12b 12c 12d
b Employer identification number (E1N) a Employee's social security number b Employer identification number (EIN) Employee'sai security. number
23-2172289 194-42.9193 23-2172299 194-42-9193
13 Statutory Retiriam Third-party 1A Other 13 Statutory itetiremert Third-parry 14 Other -
employee plan . sMk pay employee plan sick pay
e Employee's name, address and ZIP code This imiotmation is being a Employee's name, address and ZIP code
famished {4. the Internal
Paul fwYenue ser," if You
Ad' Pa Ar an
fan ere required n, 111-1 a tez ul j
118 West Keller Street return, a a n?,i?r118W est Keller: Street
Mechanicsburg PA 17055 penally or ether sanction Mechanicsburg PA 17055
may be imposed or you -
It this nxrmms',,, taxable
- '. and you fail 10 report it
15 State Employer's state ID No. 16 State wages *ips etc
20 /? ? 15 state Employer's stale ID No. 16 State wages4 tips, etc 2007
€ 1..11 Wage and Tax 17 State income tax 18 Local wages, tips, etc, Wage and Tax - 17 State MCwne tax 16 Local wages; tips etc.
W-2 Statement 6621.66: W-2 statement 6621:66.
Copy C-For _ Copy 9-To Be Filed
EMPLOYEE'S RECORDS 19 Lxal 6acpn a tax 20 Locality dame With Employees 19 Local income tax 20 Locality nama
(See Notice to Employee 112.57. , Upper Allen. To FEDERAL Tax Return
112.57 Upper llen_T9
on the back of Copy 8.)
Depart--e v e -r._- ::-termReverie Szrd:ce
d Control number 1" Wages, tips, other compensation 2 Federal income tax wfthF;;l
00078718
OMB NO. 1545-0008 3 Social security wages 4.Soclaf security tax withheld
5 Medicare wages and tins 6 Medicare tax withheld
c Employer's name, address and ZIP code
Commonwealth of Pennsylvania
Exec Off - Bur of Comm Pay Op
Harrisburg PA 11105
7 Social security lips 8 Allocated fips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans 12a
12b 12c 12d
b Employer identification number (EiNi a Employee's social security number
23-2172299 194-42-9193
13 - ?e, 14 Other
a,
X
t I
e Employee's name, address and Z!r` code
Paul Ad'an
118 Wesl Keller Street
Mechanicsburg PA 17055
try ®+?
2 ILir Sd 15 `_tars Ernplcyers stale ID No,
_ 16 State wages, tips. etc.
2 Wage and Tax
E W 17 State :....',"ne iaz 18 Lacat wages. tips. etc.
M x Statement
'
6621.66
Copy 2-To Be Filed With
' ..._
Employee
s State, City, or 19 Lnea! !^rcne tax 20 Locality name
Local Income Tax Return. t 112.57 Upper Allen To
d Control number 1 Wages, tips other ccuripeftation 2 Federal income tax withheld
00078718
DIAS NO. 1545-0008 3 Social security wages 4 Sodaf security tax.vAththeld
5 Medicare wages. and bps 6 Medicare tax withheld
o Employer's name. address and ZIP code
Commonwealth of Pennsylvania
ec Off
E
B
of C
P
O
x
ur
-
omm
ay
p
Harrisburg PA 17105
7 Social security tips 8 Allocated tips 9 Advance EIC payment
10 Dependent care benefits 11 Nonqualified plans 12a
125 12C 12d
c
b Employer identification number (EIN) a Employee's social security number
23-2172299 194-42-9193
13 o aUitory R.I;na w T'+ J cartV 14 Other
.. I y- an c p ;
I X
e Employee's name. address and ZIP code
Paul Ad1'an
118 West Keller Street
Mechanicsburg PA 17055
2007' 15 State Employer's state ID No. 16 State wages, tips, etc.
{?? Wage and Tax
=2 17 State incoc,e tax 18 vocal wage;, tips, etc.
s YY
statement 6621.66
Copy 2-To Be Filed With
' -. .._ - _. - _ ,- _ ..._....
Employee
s State, City, or 19 Local Incorne tar. 20 Locality name
Local Income Tax Return. 112.57 Upper Allen To
Department of the reasury--Internal Revenue Service Department of the Treasury-lntemel Revenue Service
Commonwealth of Pennsylvania
EMPLOYEE PAY STATEMENT
Paul Adjan Personnel Number..... 00078718
118 West Keller Street Transportation Pyrl Area 2
Mechanicsburg PA 17055 Pay Period... 12/01/2007 - 12/14/2007
Fed Tax Status: Married
Fed Tax Allowances: 03 Period: 26/2007
IB/U:J3 Group:08 Lev61:13
Pay Date Payment Amount = Gross + Reim. - Taxes Deds.
12/28/2007 1,644.95 = 2,269. 50 + 0.00 - 467.36 - 157.19
Pay na?c ni z rvw ua,? icai To votc
Normal working hours 30.26 67.50 2,042.55 50,815.40
Annual Leave Pay 3,733.86
Paid-Office Closing 226,95
Sick Leave Pay 330.52
Personal Leave Pay 30.26 7.50 226.95 1,245.88
Holiday/Comp lieu Holiday 2,478.90
Signing Bonus Payment 1,250.00
Higher Class Pay-Base
1 1,407.60
1
Total Gross 2,269.50 61,489.11
Taxes Amount Year To Date
Federal Federal
(TX Withholding Tax 182.93 5,135.81
JTX EE Social Security Tax 141.54 3,819.96
JTX EE Medicare Tax 33.10 893.38
State Pennsylvania
JTX Withholding Tax 69.33 1,879.43
JTX EE Unemployment Tax 2.07 55.70
Local Harrisburg
(TX EE Occupation Tax 52.00
Local Mechanicsburg Borough
JTX Withholding Tax 38.39 928.12
Local Upper Allen Township
JTX Withholding Tax 112.57
1
Total Taxes 467.36 12,876.97
Deductions Amount Year To Date
SEE PreTx M/H Pct 11.35 272.40
ISt Emp Comb Appeal (SECA) 4.00 104.00
Full Cov Class AA/Cat 0
1 141.84 3,843.04
1
Total Deductions
1 157.19 4,219.44
Non Cash Compensation Amount Year To Date
Commonwealth of Pennsylvania
EMPLOYEE PAY STATEMENT
TX Veh-Nonctrl EE-no FWT
I 24.72 395.52
I
I
Total Non Cash Compensation
i 24.72 395.52
I
(Reimbursements Amount
Direct Deposit Bank / Check Amount
i
Net Payment
lNet Payment
1 825.00
819.95
1
State Paid Benefits
1 Amount
1
JTX ER Social Security Tax
JTX ER Medicare Tax
JER Basic Life
Annuitant Med Hospital
JER Workers Comp Benefit
JPR Blue Cross PPO
JER-SERS
1 141.54
33.10
5119
240.00
53.24
330.00
74.44
1
Federal Taxable Wages Amount
Current Period Results 2,141.03
Garnishment Type Beg Balance Total To Date Remain Balance
JOANNE HARRISON CLOUGH, P.C.
3820 MARKET STREET
CAMP HILL, PA 17011
717-737-5890
PA. ID. NO. 36461
Counsel for Defendant
PAUL ADJAN,
Plaintiff
V.
KATHRYN ANN ADJAN,
Defendant
: IN THE CO T OF COMMON PLEAS
: CUMBERLANO COUNTY, PENNSYLVANIA
NO. 05- 2978
CIVIL ACTI(
IN DIVORCE
INCOME AND EXPENSE
INCOME
Employer: Giant Food Stores #269
Address: 3301 Trindle Road. Camp Hill, PA
Type of Work: Kitchen-Food Prep (carry out cafe)
Pay Period (weekly, biweekly, etc.): $ 8.20 hr. we
Gross pay per period: 22.5 hrs - $184.50 27.51
TERM
- LAW
ATEMENT
Itemized Payroll Deductions: 22.5 hours 27.5 hrs.
Federal Withholding 13.35 19.00
Social Security FICA-OASDI
FICA 11.44
2.67 13.98
3.27
Local Wage Tax UATUP CU 3.14 3.83
State Income Tax 5.66 6.92
Retirement .16 .21
Savings Bonds
Credit Union
Life Insurance
Health Insurance
Other (specify)
Net pay per period: 1$148.08 1 1$178.29
Other Income:
WEEK MO NTH YEAR
Interest
Dividends
Pension
Annuity
Social Security
Rents
Royalties
Expense Account
Gifts
Unemployment Comp.
Worker's Comp.
Child Support
TOTAL
TOTAL INCOME $ 0.00
Expenses:
WEEK MONTH YEAR
Home
Mortgage/rent 10 6.69
Maintenance Paul does all
maintenance
Utilities
Electric 1
pla .00 budget
ti
Cable 53 .58
Trash 43j5 0 Quarterly
Telephone 65 70.00
Water 26 13
Sewer 10(. 00 Quarterly
Internet 9 95
Public
Transportation
Lunch 15 00
Taxes
Real Estate
Personal
Property 1641.25 school
District
Income paid 487.00
Insurance
Homeowners 45. 96
Automobile 87. )6
Life 40. 73
Accident
Health Ins ce by Paul
Other
Automobile
Payments
Fuel 12 0.00
Repairs Pat
the I takes care of
e
Medical
Doctor (includes counseling) 357.00 so far
2007
Dentist 50.00 deductible
Orthodontist
Hospital
Medicine I I w/taul's
plan
.00
Special Needs
(glasses. braces, orthopedic
Glasses -2 yrs
308.005/06
Education
Private School
Parochial School
College
Religious
Personal
Clothing 500.00
Food 501.00
Barber/Hairdresser 24.00
Credit Payments
Credit Card Pa off Full
Charge Account
Memberships 240.00
0. World 123.00 both
AARP 25.00 both
AARP
Loans
Credit Union
Miscellaneous
Household help
Child care
Papers/books/magazines 235.00
Entertainment
Pay TV
Vacation
Gifts 600.00
Legal fees 900.00 as of
November 18,
2007
Charitable contributions 15.00
Other child support
Alimony payments
Other: Dog expenses as of
November 18, 2007 (2 dogs)
Food 335.00
Vet bills 650.00
Insulin and Syringes 450.00
Groomer 265.00
TOTAL EXPENSES
PROPERTY OWN D
DESCRIPTION VALUE OWNERSHIP
H W J
Marital residence 170,000.00- 180.000.00 X
INSURANCE
COMPANY POLICY NO. COVERAGE
Valley Forge Life Ins VI13Y000297 H W C
V113Y000298 250,000.00 100,000.00
Globe Life & Accident 14F442955 10,000.00
I verify that the statements made in this Incor? a and Expense Statement are true
and correct to the best of my knowledge, information and belief.
I understand that false statements herein are made subject to the penalties of 18
Pa. C.S. § 4904 relating to unworn falsification to
Date: & l? d
- -TI
t: -TI
r.?
JOANNE HARRISON CLOUGH, P.C.
3820 MARKET STREET
CAMP HILL, PA 17011
717-737-5890
PA. ID. NO. 36461
Counsel for Defendant
PAUL ADJAN,
Plaintiff
V.
KATHRYN ANN ADJAN,
Defendant
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
NO. 05- 2978 CIVIL TERM
CIVIL ACTION -LAW
IN DIVORCE
INCOME AND EXPENSE STATEMENT
INCOME
Employer: Giant Food Stores #269
Address: 3301 Trindle Road, Camp Hill, PA 17011
Type of Work: Kitchen-Food Prep (carry out cafe)
Pay Period (weekly, biweekly, etc.): $ 8.20 hr. weekly
Gross pay per period: 22.5 hrs - $184.50 27.5 hrs - $225.50
Itemized Payroll Deductions: 22.5 hours 27.5 hrs.
Federal Withholding 13.35 19.00
Social Security FICA-OASDI
FICA 11.44
2.67 13.98
3.27
Local Wage Tax UATUP CU 3.14 3.83
State Income Tax 5.66 6.92
Retirement .16 .21
Savings Bonds
Credit Union
Life Insurance
Health Insurance
Other (specify)
Net pay per period: $ 148.08 $178.29
Other Income:
WEEK MONTH YEAR
Interest
Dividends
Pension
Annuity
Social Security
Rents
Royalties
Expense Account
Gifts
Unemployment Comp.
Worker's Comp.
Child Support
TOTAL
TOTAL INCOME $ 0.00
Expenses:
WEEK MONTH YEAR
Home
Mortgage/rent 1026.69
Maintenance Paul does all
maintenance
Utilities
Electric 145.00 budget
plan
Cable 53.58
Trash 43.50 Quarterly
Telephone 65-70.00
Water 26.13
Sewer 100.00 Quarterly
Internet 9.95
Public
Transportation
Lunch 15.00
Taxes
Real Estate
Personal
Property 1641.25 school
District
Income paid 487.00
Insurance
Homeowners 45.96
Automobile 87.96
Life 40.73
Accident
Health Insurance by Paul
Other
Automobile
Payments
Fuel 120.00
Repairs Paul takes care of
these
Medical
Doctor (includes counseling) 357.00 so far
2007
Dentist 50.00 deductible
Orthodontist
Hospital
Medicine w/Paul's
Prescription plan
250.00
Special Needs
lasses braces, orthopedic
devices Glasses -2 yrs
308.005/06
Education
Private School
Parochial School
College
Religious
Personal
Clothing 500.00
Food 500.00
Barber/Hairdresser 24.00
Credit Payments
Credit Card Pay off Full
Amounts
Charge Account
Memberships
0. World
AARP
AARP 240.00
123.00 both
25.00 both
Loans
Credit Union
Miscellaneous
Household help
Child care
Papers/books/magazines 235.00
Entertainment
Pay TV
Vacation
Gifts 600.00
Legal fees 900.00 as of
November 18,
2007
Charitable contributions 15.00
Other child support
Alimony payments
Other: Dog expenses as of
November 18, 2007 (2 dogs)
Food 335.00
Vet bills 650.00
Insulin and Syringes 450.00
Groomer 265.00
TOTAL EXPENSES
PROPERTY OWNED
DESCRIPTION VALUE OWNERSHIP
H W J
Marital residence 170,000.00- 180.000.00 X
INSURANCE
COMPANY POLICY NO. COVERAGE
Valley Forge Life Ins VIBY000297 H W C
VIBY000298 250,000.00 100,000.00
Globe Life & Accident 1417442955 10,000.00
VERIFICATION
I verify that the statements made in this Income and Expense Statement are true
and correct to the best of my knowledge, information and belief.
I understand that false statements herein are made subject to the penalties of 18
Pa. C.S. § 4904 relating to unworn falsification to authorities.
Date: A /? 0
(')
C7 C?
co FT;
j [
t
-71
C.II
2010 APR 21 PM 3: 22
MARITAL SETTLEMENT AGREEMENT
Ty.
PFD ,?'JS? ' ? ??A
THIS MARITAL SETTLEMENT AGREEMENT, made this day of
2010, by and between PAUL ADJAN, of Belle Vernon, Fayette County,
Pennsylvania (hereinafter referred to as "HUSBAND") and KATHRYN ANN ADJAN, of
Mechanicsburg, Cumberland County, Pennsylvania (hereinafter referred to as "Wife"):
W ITNESSETH:
WHEREAS, the parties were married on May 11, 1974 in Cumberland County, Pennsylvania.
WHEREAS, HUSBAND and WIFE are the parents of one (1) adult child. There are no minor
children of this marriage.
WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the
parties and it is the intention of WIFE and HUSBAND to live separate and apart, and the parties hereto
are desirous of settling fully and finally their respective financial and property rights and obligations as
between each other, including, without limitation by specification: the settling of all matters between
them in relation to the ownership and equitable distribution of real and personal property; settling of all
matters between them relating to the past, present and future support, alimony and/or maintenance of
WIFE by HUSBAND or of HUSBAND by WIFE; settling of custody matters and in general, the settling
of any and all claims and possible claims by either party against the estate of the other party.
NOW, THEREFORE, in consideration of the premises and of the mutual promises, covenants
and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is
hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally
bound hereby covenant and agree as follows:
1. INTERFERENCE: Each party shall be free from interference, authority, and contact by
the other, as fully as though he or she were single and unmarried, except as may be necessary to carry
out the provisions of this Agreement. Neither party shall molest the other or attempt to endeavor to
molest the other, nor compel the other to cohabitate with the other, or in any way harass or malign the
other, nor in any way interfere with the peaceful existence, separate and apart from the other.
2. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS: This Agreement shall
not affect or bar the right of HUSBAND or WIFE to a divorce on lawful grounds or to any defense as
may be available to either party. This Agreement is not intended to condone and shall not be deemed to
be a condonation on the part of either party hereto of any act or acts on the part of the other party which
have occasioned the disputes or unhappy differences.
3. INCORPORATION OF DIVORCE DECREE: It is further agreed, covenanted and
stipulated that this Agreement or the essential parts hereof, shall be incorporated in any decree
hereinafter entered by any court of competent jurisdiction in any divorce proceedings that have been or
may be instituted by the parties for the purpose of enforcing the contractual obligations of the parties.
This agreement shall not be merged in any such decree but shall in all respects survive the same and be
forever binding and conclusive upon the parties.
4. EFFECTIVE DATE: The effective date of this Agreement shall be the "date of
execution" or "execution date," defined as the date upon which it is executed by the parties if they have
each executed this Agreement on the same date. Otherwise, the "date of execution" or "execution date"
of this Agreement shall be defined as the date of execution by the party last executing this Agreement.
5. DISTRIBUTION DATE: The transfer of property, funds and/or documents provided for
herein, shall only take place on the "distribution" date which shall be defined as the date of execution of
this Agreement unless otherwise specified herein. However, the support and/or alimony payments,
retirement transfers, if any, provided for in this Agreement shall take effect as set forth in this
Agreement.
6. SUBSEQUENT DIVORCE: The parties hereby acknowledge that HUSBAND filed a
Complaint in Divorce in Cumberland County, Pennsylvania, docketed to Civil Action No. 05-2978,
claiming that the marriage is irretrievably broken under Section 3301(c) of the Pennsylvania Divorce
Code and that the parties have lived separately and apart as required under Section 3301(d) of the
Pennsylvania Divorce Code. The parties hereby express their agreement that the marriage is irretrievably
broken and express their intent to execute an Affidavit of Consent and Waiver of Notice under Section
3301(c) of the Divorce Code. Additionally, the parties hereby express their agreement that the marriage
is irretrievably broken and express their intent to execute any Affidavit or other documents necessary for
the parties to obtain an absolute divorce pursuant to Section 3301(d) of the Divorce Code. The parties
hereby waive all rights to request court ordered counseling under the Divorce Code. It is further
2
specifically understood and agreed by the parties that the provisions of this Agreement as to equitable
distribution of property of the parties are accepted by each party as a full and final settlement for all
purposes whatsoever, as contemplated by the Pennsylvania Divorce Code.
Should a decree, judgment or order of divorce be obtained by either of the parties in this or any
other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement
and all of its covenants shall not be affected in any way by such separation or divorce; nothing in any
such decree, judgment, order or further modification or revision thereof shall alter, amend or vary any
term of this Agreement. It is the specific intent of the parties to permit this Agreement to survive any
judgment and to be forever binding and conclusive upon the parties.
7. MUTUAL RELEASE: HUSBAND and WIFE each do hereby mutually remise, release,
quit-claim and forever discharge the other and the estate of such other, for all time to come, and for all
purposes whatsoever, of and from any and all rights, title and interest, or claims in or against the
property (including income and gain fiom property hereafter accruing) of the other or against the estate
of such other, of whatever nature and wheresoever situated, which he or she now has or at any time
hereafter may have against the other, the estate of such other or any part hereof, whether arising out of
any former acts, contracts, engagements or liabilities of such other or by way of dower or courtesy, or
claims in the nature of dower or courtesy or widow's or widower's rights, family exemption or similar
allowance, or under the intestate laws, or the right to take against the spouse's will; or the right to treat a
lifetime conveyance by the other as a testamentary, or all other rights of a surviving spouse to participate
in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State,
Commonwealth or territory of the United States, or (c) any country or any rights which either party may
have or at any time hereafter shall have for past, present or future support or maintenance, alimony,
alimony pendente lite, counsel fees, division of property, costs or expenses, whether arising as a result of
the marital relations or otherwise, except, all rights and agreements and obligations of whatsoever nature
arising or which may arise under this Agreement or for the breach of any provisions thereof. It is the
intention of HUSBAND and WIFE to give each other by the execution of this Agreement a full,
complete and general release with respect to any and all property of any kind or nature, real, personal or
mixed, which the other now owns or may hereafter acquire, except and only except all rights and
agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for
the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full
and final resolution of any and all claims which each of the parties may have against the other for
3
equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other
claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction.
8. REPRESENTATION BY COUNSEL: HUSBAND has been represented by Thomas
M. Clark, Esquire, and HUSBAND acknowledges that he has signed this Agreement freely and
voluntarily after full consultation with his counsel. WIFE has been represented by Joanne Harrison
Clough, Esquire, and WIFE acknowledges that she has signed this Agreement freely and voluntarily
after full consultation with her counsel.
The parties acknowledge that this Agreement is not the result of any duress, undue influence,
coercion, collusion and/or improper or illegal agreement. The parties further acknowledge that they
have each made to the other a full and complete disclosure of their respective assets, estate, liabilities,
and sources of income and that they waive any specific enumeration thereof for the purposes of this
Agreement.
9. WARRANTY AS TO EXISTING OBLIGATIONS: Each party represents that they
have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of
the other party may be responsible or liable except as may be provided for in this Agreement. Each
party agrees to indemnify and hold the other party harmless from and against any and all such debts,
liabilities or obligations of every kind which may have heretofore been incurred by them, including
those for necessities, except for the obligations arising out of this Agreement.
10. PERSONAL PROPERTY: Except as otherwise provided herein, the parties have
divided between them, to their mutual satisfaction, the personal effects, household furniture and
furnishings, and all other articles of personal property which have heretofore been used by them in
common, and neither party will make any claim to any such items which are now in the possession or
under the control of the other.
By these presents, each of the parties hereby specifically waives, releases, renounces and forever
abandons whatever claims he or she may have with respect to any personal property which is in the
possession of the other, and which shall become the sole and separate property of the other from the date
of execution hereof.
11. DIVISION OF REAL PROPERTY: The parties jointly own real estate situate at 1109
Granada Lane, Mechanicsburg, Pennsylvania, 17055. The parties agree that the property has an
approximate value of $175,000.00 and the mortgage held on the property has an approximate pay off
balance of $158,084.00 as of April 15, 2009. HUSBAND agrees to transfer all right, title and interest in
4
said property to WIFE by signing a Special Warranty Deed transferring the property from WIFE and
HUSBAND to WIFE individually at the time of execution of this Agreement. Said Deed shall be held
in escrow by WIFE's Attorney pending WIFE's refinancing of the current mortgage on said residence.
WIFE shall attempt to refinance the mortgage on the property by July 1, 2010. In the event
WIFE is unable to secure a commitment letter from a lender for refinancing on or before July 1, 2010
then the real estate shall be listed for sale by August 1, 2010. WIFE shall remain solely responsible for
any and all payments related to the mortgage, real estate taxes convening 2009 and forward,
homeowners insurance, and maintenance on said property and shall indemnify and hold HUSBAND
harmless against any liability resulting from her failure to make payments.
In the event that WIFE shall default or be late on a mortgage obligation by more than thirty (30)
days, the residence shall be listed for sale. If any of the events occur that would trigger WIFE's
obligation to list the property for sale as set forth in this Agreement, then within forty-eight (48) hours
after receiving HUSBAND's request that WIFE list said property for sale. HUSBAND and WIFE shall
pick John Henry from ReMax as the broker for the sale of the residence if the sale is necessary. If John
Henry is unavailable then the parties shall select a new broker.
The parties agree to each execute a listing agreement within one week of mutually selecting a
broker. The parties further agree to seriously consider any reasonable offer which is tendered on the
property. In the event the parties list the property for sale and no tendered offer is sufficient to clear the
debt and pay the transfer costs and real estate commission, then the parties agree that WIFE shall have
the right to continue to reside in the property provided she continue to timely pay the mortgage payment,
real estate taxes and other expenses associated with the property. In such event, the parties agree that
WIFE shall continue on a semi-annual basis to apply to refinance the debt on the marital residence to her
sole narne (WIFE shall provide proof to HUSBAND of her attempts to refinance this debt upon
Husband's request). WIFE shall keep the property listed for sale until such time as WIFE either
successfully obtains refinancing to remove HUSBAND as an obligor on the mortgage or the parties are
able to sell the property at a price sufficient to pay the mortgage in full, pay the transfer tax and real
estate commissions. The parties further agree that if the property is sold and there are sufficient sales
proceeds to conclude the sale, WIFE shall receive any residual net proceeds generated from the sale as
her sole and separate property.
In preparing for any sale of the residence that may be required under the terms of this
Agreement, WIFE shall execute an authorization to permit Thomas M. Clark, Esquire and HUSBAND
5
to obtain and receive all information regarding the residence including any listing contract, listing price,
showings, offers, or contract for sale. Only offers from bona fide qualified purchasers shall be accepted.
HUSBAND has agreed and shall pay all the 2008 real estate taxes for the real estate situate at
1109 Granada Lane, Mechanicsburg, 17055. Once the 2008 real estate taxes are paid, WIFE shall
remain solely responsible for any and all payments related to real estate taxes for said real estate. WIFE
shall indemnify and hold HUSBAND harmless against any liability result from her failure to pay the real
estate taxes for 2009 forward.
12. BANK ACCOUNTS: The parties have divided between them, to their mutual
satisfaction, bank accounts that have heretofore been used by them in common, and neither party will
make any claim to any bank account under the control of the other.
13. MARITAL DEBT: The parties accumulated debt during their marriage which they
intend to equitably divide between them. Each party shall fully assume the balances on the credit cards
and debts that are currently held in their name alone and shall indemnify and hold the other harmless
against any liability resulting from their failure to make payments as prescribed herein.
14. HEALTH INSURANCE: HUSBAND shall continue to cover WIFE on his health
insurance until such time as the parties are divorced. Once a final Decree in Divorce is granted, each
party shall be responsible for his or her own health insurance coverage. HUSBAND shall notify
WIFE's counsel of the date he files a Petition with the Court requesting a final Divorce Decree.
15. PENSIONS, ANNUITIES AND/OR RETIREMENT BENEFITS: HUSBAND is the
owner of a SERS retirement account through his employment with the Commonwealth of Pennsylvania.
The parties agree that the distribution of HUSBAND's SERS retirement account shall be made pursuant
to the Qualified Domestic Relations Order ("QDRO") that is attached hereto as Exhibit "A". The
QDRO shall be signed by both parties concurrently with this Agreement. The QDRO shall be entered
by Stipulation and filed with the court concurrently with the Praecipe to Transmit or upon entry of the
Divorce Decree. HUSBAND shall provide the SERS administrator with proper notice of the QDRO
within ten (10) days of the issuance of the Order. The parties shall cooperate in executing all documents
required to give effect to this Paragraph.
Additionally, HUSBAND represents to WIFE that he has not participated in any deferred
compensation program through his employment with the Commonwealth of Pennsylvania and that he
has no deferred compensation income or benefits that accrued during the parties' marriage.
6
16. MOTOR VEHICLES: The vehicle in HUSBAND's possession, a 1998 Ford F-150,
shall become his sole and separate property. WIFE waives all right, title and interest in said vehicle.
HUSBAND shall indemnify WIFE and hold her harmless against any liability resulting from this
vehicle. WIFE agrees to sign any and all documents necessary to effectuate the transfer and give effect
to this paragraph within ten (10) days of any request by HUSBAND.
The vehicle in WIFE's possession, a 1995 Jeep Grand Cherokee, shall become her sole and
separate properly. HUSBAND waives all right, title and interest in said vehicle. WIFE shall indemnify
HUSBAND and hold him harmless against any liability resulting from these vehicles. At the time of
this agreement there was no money owed on the Jeep Grand Cherokee. HUSBAND agrees to sign any
and all documents necessary to effectuate the transfer and give effect to this paragraph within ten (10)
days of any request by WIFE.
17. OUTDOOR WORLD MEMBERSHIP: HUSBAND shall continue to pay the
maintenance fees for the Outdoor World Membership. HUSBAND and WIFE agree to try to sell the
Outdoor World Membership and split any proceeds received from the sale 50/50. If the Outdoor World
membership is not sold by July 1, 2010, then the Outdoor World Membership shall become the sole and
separate property of HSUBAND. WIFE shall waive all right, title and interest in said Membership.
18. AFTER-ACQUIRED PROPERTY: Each of the parties shall hereafter own and enjoy,
independently of any claim or right of the other, all items of property, be they real, personal or mixed,
tangible or intangible, which are hereafter acquired by him or her, with full power in him or her to
dispose of the same as fully and effectively, in all respects and for all purposes as though he or she were
unmarried.
19. ALIMONY: In recognition of the criteria set forth in Section 3701 of the Divorce Code
23 Pa.C.S. §3701, commencing on the date of execution of this Agreement and with the final payment
date being on the day of HUSBAND's retirement from his current job with the State of Pennsylvania,
HUSBAND shall pay to WIFE as alimony the monthly sum as follows:
• $1,650.00 to be paid until December 31, 2009.
• $1,550.00 to be paid until December 31, 2011.
• $1,400.00 to be paid until December 31, 2012.
• $1,300.00 to be paid until HUSBAND's retirement from his current job with the
State of Pennsylvania.
7
Said Alimony payments shall be made in two (2) monthly installments based on HUSBAND's
regularly scheduled pay days. The parties specifically agree that said alimony payments shall never
exceed the monthly sums listed above. These amounts shall be non-modifiable except in the event of
one of the following:
(1) WIFE's remarriage or co-habitation, (cohabitation is being defined as WIFE living or
residing with an unrelated adult male that she has a relationship with for more than 30
days within any twelve (12) month period). The alimony shall not stop if WIFE rents a
room to a male boarder/tenant;
(2) the death of WIFE;
(3) the death of HUSBAND;
(4) HUSBAND is unable to work due to a catastrophic illness. If HUSBAND is disabled
as a result of a catastrophic illness, then HUSBAND shall have the right to Petition the
Court to request a pro-rata reduction in the alimony obligation to WIFE and WIFE has
the right to defend against the same; and,
(5) HUSBAND experiences a substantial change in his income such that he cannot
reasonably be expected to pay WIFE in accordance with the Agreement as shall be
determined by a court of competent jurisdiction. It is specifically agreed that if
HUSBAND is experiencing financial problems due to an increase in his debt obligations,
that does not warrant an alimony modification. WIFE agrees that any determination as to
whether HUSBAND can reasonably pay maintenance at the level provided by this
Agreement shall be based on his income or earning capacity and not based on any other
standard.
Following the last payment due (final payment date being on the day of HUSBAND's retirement
from his current job with the State of Pennsylvania), WIFE agrees to release and discharge HUSBAND
absolutely and forever for the rest of their lives for all claims and demands, past, present or future, for
alimony, alimony pendente lite or for any provisions for support and maintenance.
The Alimony payments shall be deductible to HUSBAND and are income to WIFE for
Federal Income Tax purposes.
20. INCOME TAX: The parties have filed separate Federal and State tax returns for the
2009 Tax Year. Both parties agree that in the event any deficiency in Federal, State or Local Income
Tax is proposed, or any assessment of any such tax is made against either of them, each will indemnify
8
and hold harmless the other from and against any loss or liability for any such tax deficiency or
assessment and any interest, penalty and expense incurred in connection therewith. Such tax, interest,
penalty or expense shall be paid solely and entirely by the individual who is finally determined to be the
cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income
on the aforesaid joint returns. Following the 2008 Tax Year, HUSBAND and WIFE shall file separate
tax returns.
21. CEMETERY PLOTS: The parties have four (4) cemetery plots. HUSBAND and
WIFE agree that they shall split these plots so that each party is receiving two (2) of the four (4)
cemetery plots. Each party agrees to sign any and all documents necessary to effectuate the transfer and
give effect to this paragraph. The parties further agree that no paramour or future spouses of either party
shall be interred in either of the parties' cemetery plots.
22. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS: The parties
hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be
within the scope and applicability of the Deficit Reduction Act of 1984 (hereinafter the "Act"),
specifically, the provisions of said Act pertaining to the transfers of property between spouses and
former spouses. The parties agree to sign and cause to be filed any elections or other documents
required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this
Agreement without recognition of gain on such transfer and subject to the carry-over basis provisions of
said Act.
23. EFFECT OF DIVORCE DECREE: The parties agree that, except as otherwise
specifically provided herein, this Agreement shall continue in full force and effect after such time as a
final Decree in Divorce may be entered with respect to the parties.
24. BREACH: If either party breaches any provision of this Agreement, the other party
shall have the right, at his or her election to sue for damages for such breach or seek such other remedies
or relief as may be available to him or her, and the party breaching this contract shall be responsible for
payment of reasonable legal fees and costs incurred by the other in enforcing their rights under this
Agreement regardless of whether a Court proceeding was held to cure said default.
25. WAIVER OF CLAIMS: Except as herein otherwise provided, each party may dispose
of his or her property in any way, and each party hereby waives and relinquishes any and all rights he or
she shall now have or hereafter acquire, under the present and future laws of any jurisdiction, to share in
the property or the estate of the other as a result of the marital relationship, including without limitation,
9
dower, courtesy, statutory allowance, widow's allowance, right to take in intestacy, right to take against
the Will of the other, and the right to act as administrator or executor of the other's estate, and each will,
at the request of the other, execute, acknowledge and deliver any and all instruments which may be
necessary or advisable to carry into effect this mutual waiver and relinquishment of such interests, rights
and claims.
26. ENTIRE AGREEMENT: This Agreement contains the entire understanding of the
parties and there are no representations, warranties, covenants or undertakings other than those expressly
set forth herein.
27. AGREEMENT BINDING ON HEIRS: This Agreement shall be binding on and shall
inure to the benefits of the parties hereto and their respective heirs, executors, administrators, successors
and assigns.
28. ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time, at the
request of the other, execute, acknowledge and deliver to the other any and all further instruments that
may be reasonably required to give full force and effect to the provisions of this Agreement.
29. VOID CLAUSES: If any term, condition, clause or provision of this Agreement shall
be determined or declared to be void or invalid in law or otherwise, then only that term, condition,
clause or provision shall be stricken from this Agreement and in all other respects this Agreement shall
be valid and continue in full force, effect and operation.
30. INDEPENDENT SEPARATE COVENANTS: It is specifically understood and
agreed by and between the parties hereto that each paragraph hereof shall be deemed to be separate and
independent Agreement.
31. FINANCIAL DISCLOSURE: The parties confirm that they have relied on the
completeness and substantial accuracy of the financial disclosure of the other as an inducement to the
execution of this Agreement. The parties acknowledge that there has been no formal discovery
conducted in their pending divorce action and that neither party has filed mi inventory and appraisement
as required by Section 3505(b) of the Pennsylvania Divorce Code. Notwithstanding the foregoing, the
rights of either party to pursue a claim for equitable distribution, pursuant to the Pennsylvania Divorce
Code, of any interest owned by the other party in an asset of any nature at any time prior to the date of
execution of this Agreement that was not disclosed to the other party or his or her counsel prior to the
date of the within Agreement is expressly reserved. In the event that either party, at any time hereafter,
discovers such an undisclosed asset, the party shall have the right to petition the Court of Common Pleas
10
of Cumberland County to make equitable distribution of said asset. The non-disclosing party shall be
responsible for payment of counsel fees, costs or expenses incurred by the other party in seeking
equitable distribution of said asset. Notwithstanding the foregoing this Agreement shall in all other
respects remain in full force and effect.
32. MODIFICATION AND WAIVER: A modification or waiver of any of the provisions
of this Agreement shall be effective only if made in writing and executed with the same formality as this
Agreement. The failure of either party to insist upon strict performance of any of the provisions of this
Agreement shall not be construed as a waiver of any subsequent defaults of the same or similar nature.
33. DESCRIPTIVE HEADINGS: The descriptive headings used herein are for
convenience only. They shall have no affect whatsoever in determining the rights or obligations of the
parties.
34. APPLICABLE LAW: This Agreement shall be construed under the laws of the
Commonwealth of Pennsylvania and more specifically under the Divorce Code of 1980 and any
amendments thereto.
S WHEREOF, the parties hereto have set their hands and seals the date and year
WITNESS
WITN SS
PAUL ADJAN
L A,
KATHRYN ANN ADJA
FLED-0:?F GE
OF THE F C'ri-'?"' OT,RY
PAUL ADJAN,
Plaintiff
IN THE COURT OF COMMON PLEAS 2010 APR 23 PM 3: 62
CUMBERLAND COUNTY, PENNSYLVANIA
PENNSYLVANIA
* NO. 05-2978 CIVIL TERM
KATHRYN ANN ADJAN,
Defendant
*
*
VS. * CIVIL ACTION - LAW IN DIVORCE
*
*
*
*
AFFIDAVIT OF CONSENT
1. A complaint in Divorce under §3301(c) of the Divorce Code was filed on June 9,
2005.
2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days
have elapsed from the date of filing and service of the Complaint.
3. 1 consent to the entry of a final decree of divorce after service of notice of intention to
request entry of the decree.
I verify that the statements made in this affidavit are true and correct. 1 understand that
false statements made herein are subject to the penalties of 18 Pa. C.S. §4904 relating to
unsworn falsification to authorities.
¢ • 1-9. 24>10
Date Paul Adjan
Plaintiff
FILED-O!' ICE
OF THE P21", -
IN THE COURT OF COMMON >JWAVR 23 Pik 3. 52
CUMBERLAND COUNTY, PENNSYLVANIA
CUMBE;1-'L 4w1 "-,"JUNTY
PVFh;I?I4YA'A+t?
PAUL ADJAN, * NO. 05-2978 CI IL
Plaintiff
*
VS. * CIVIL. ACTION - LAW IN DIVORCE
*
*
KATHRYN ANN ADJAN,
Defendant
WAIVER OF NOTICE OF INTENTION TO REQUEST
ENTRY OF A DIVORCE DECREE UNDER
SECTION 3301(c) OF THE DIVORCE CODE
1. 1 consent to the entry of a final decree of divorce without notice.
2. 1 understand that 1 may lose rights concerning alimony, division of property, lawyer's
fees, or expenses if I do not claim them before a divorce is granted.
3. I understand that I will not be divorced until a divorce decree is entered by the Court
and that a copy of the decree will be sent to me immediately after it is filed with the
Prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements made herein are subject to the penalties of 18 Pa. C.S. §4904 relating to
unsworn falsification to authorities.
4-- 19• Zoo Gvn
Date Paul Adjan
Plaintiff U
PAUL ADJAN, IN THE COURT OF COMMON PLEAS
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA C `=
~ °
v. NO. 05- 2978 CIVIL TERM ~.; ...; r
~~, ~.:: ,r -g rn
KATHRYN ANN ADJAN, CIVIL ACTION - LAW
~-` c: `-=~~,-
Defendant IN DIVORCE ~,~ ~ ;'
,
t- tm;s
.m rr~
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~
c
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on
June 9, 2005.
2. The marriage of Plaintiff and Defendant is irretrievably broken, and ninety (90)
days have elapsed from the date of the filing and service of the Complaint..
3. I consent to the entr of a final decree of divorce after service of notice of
intention to request entry of the decree or upon filing of my Waiver of the Notice of Intention to
Request Entry of the Decree.
4. I have been advised of the availability of marriage counseling and understand that
the Court maintains a list of marriage counselors and that I may request the Court to require my
spouse and I to participate in counseling and, being so advised, do not request that the Court
require that my spouse and I participate in counseling prior to the divorce becoming final.
I verify that the statements made in this affidavit are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to
unsworn falsification to authorities.
Date: ~~/ /4
HRYN ADJAN ~/,.
C~ ~ , ~~,
PAUL ADJAN, IN THE COURT OF COMMON PLEAS ~ o ~
Plaintiff :CUMBERLAND COUNTY, PENIYSYLVA I`~~' ~ ~,~
~_.. t. .
v. NO.OS- 2978 CIVIL TERM ~ ~;- ~"
. ~. ..a -~~,__~.
KATHRYN ANN ADJAN, :CIVIL ACTION -LAW ~ %-_ `'~' "'
Defendant IN DIVORCE
v:
c,,:: -c
WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY
OF DIVORCE DECREE UNDER
§ 3301(c) OF THE DIVORCE CODE
1. I consent to the entry of a final Decree of Divorce without notice.
2. I understand that I may lose rights concerning alimony, division of property,
lawyer's fees or expenses if I do not claim them before a divorce is granted.
I understand that I will not be divorced until a Divorce Decree is entered by
the Court and that a copy of the Decree will be sent to me immediately after it is filed
with the Prothonotary.
I verify that the statements made in this affidavit are true and correct. I understand
that false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating
to unsworn falsification to authorities.
DATE: ~/~/~~~
Ka hryn Ann Ad~an
IN THE COURT OF COMMON PLEAS OF
PAUL ADJAN ~ :CUMBERLAND COUNTY, PENNSYLVANIA
V.
KATHRYN ANN ADJAN NO. 05-2978
DIVORCE DECREE
AND NOW, ~~ z t ,ZoiO , it is ordered and decreed that
PAUL ADJAN ,plaintiff, and
KATHRYN ANN ADJAN ,defendant, are divorced from the
bonds of matrimony.
Any existing spousal support order shall hereafter be deemed an order for
alimony pendente lite if any economic claims remain pending.
The court retains jurisdiction of any claims raised by the parties to this action
for which a final order has not yet been entered. Those claims are as follows: (If no
claims remain indicate "None.")
NONE.
By the Court,
c~ .~3 ~ ~ a~~ ~ ~ ~~a
-b~c~k
-~o AF~, (~ou~h
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
Paul Adjan .
Plaintiff
VS.
CIViL TERM - TN DIVORCE
l~athrvn A._ Adjan NO.__ 45-2978
Defendant
STIPULATION FOR. THE ENTRY OF "DOMESTIC RELATIONS ORDER"
AND NOW, this ~~~ day of _ Oe~r~~ ~, ~_, the parties, Paul Adjan,
Plaintiff and Kathryn A. Adjan, Defendant, da hereby Agree and Stipulate as follows:
1. The Plaintiff, Paul Adjan (hereinafter referred to as "Member"} is a member of the
Commonwealth of Pennsylvania, State Employees' Retirement System (hereinafter referred to as
"SERB").
2. SERB, as a creature of statute, is controlled by the State Employees' Retirement Code,
71 Pa. C.S. §§5101-5956 ("Retirement Code").
3. Member's date of birth and Social Security number are contained in the attached
Addendum.
4. The Defendant, Kathryn A. Adjan {hereinafter referred to as "Alternate Payee") is the
farmer spouse of Member. Alternate Payeo's date of birth and Social Security nuznber are
contained in the attached Addendum. ,
5. Member's last l~nown mailing address is:
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724 Edwards Street rt~
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Belle Vernon, PA 15012-2119 ~,
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6. Alternate Payee s current mailing address is: .C ~
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1109 Granada Lane ~
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Mechanicsburg, PA 17055 -< '1 -~~
DRO
Page 2
Zt is the responsibility of Alternate Payee to lxeep a current mailing address on file with
SERS at all tunes.
7. (a) The marital property component of Member's retirement benefit equals (1) the
coverture fraction multiplied by (2) the Member's retirement benefit on the effective date of
Member's retirement.
(b) The covertuxe fraction is a fraction with a value less than or equal to one, The
numerator is the amount of Member's service; as defined by SERS, from May 11, 1974 (the date of
marriage) until December 37., 2006 (the date of separation). The denominator is the total amount
of Member's service, as defined by SERS, as of the effective date of Member's retirement.
(c) 50.00°k of the marital property component of Membex's retirement benefit is to be
allocated to the Alternate Payee as her equitable distribution portion of this marital asset.
8. Member's retirement benefit is defined as all monies paid to or on behalf of Member by
SERS, including any lump sum withdrawals or scheduled or ad hoc increases, but excluding the
disability portion of any disability annuities paid to Member by SERS as a result of a disability
which occurs before Member's marriage to Alternate Payea or after the date of Member's and
Alternate Payee's final separation. Member's retirement benefit does not include any deferred
compensation benefits paid to Member by SERS or any enhancements to the Member's retirement
benefit arising from postseparation monetary contributions made by Member. The equitable
distribution portion of the marital property component of Member's retirement benefit, as sot
forth in Paragraph 7, after the application of the appropriate early retirement actuarial reduction
factor, if any, shall be payable to Alternate payee. Payments to Alternate Payee shall commence
as soon as administratively feasible on or about the date the Member actually enters pay status
and SERS approves a Domestic Relations Order incorporating this Stipulation and Agreement,
whichever is later.
9. Member hereby nominates Alternate Payee as an irrevocable beneficiary to the extent
of Alternate Payee's equitable distribution portion of Member's retirement benefit for any death
benefits payable by SER5. This nomination shall become effective upon approval by the Secretary
DRO
Page 3
of the Retirement $oard, or his authorized representative, of any Domestic Relations Order
incorporating this Stipulation and Agreement. The balance of any death benefit remaining after
the allocation of Alternate Payee's equitable distribution portion ("Balance") shall be paid to the
beneficiaries named by Member on the last Nomination of Beneficiaries Form filed with the
Retirement Baard prior to Member's death.
(a) If the last Nomination of Beneficiaries Form filed by Member prior to Member's
death (a} predates any approved Domestic Relations Order incorporating this Stipulation and
Agreement, and (b) names Alternate Payee as a beneficiary, then: (1) the terms of the Domestic
Relations Order shall alone govern Alternate Payee's share of any death benefit, and (2) for
purposes of paying the Balance via the last Nomination of Beneficiaries Form filed with the
Retirement Board prior to Member's death, Alternate Payee shall be treated as if Alternate Payee
predeceased Member. No portion of the Balance shall be payable to Alternate Payee's estate.
(b) In addition, Member shall execute and deliver to Alternate Payee an
authorization, in a form acceptable to SERS, which will authorize SERS to release to Alternate
Payee ail relevant information concerning Member's retirement account. Alternate Payee shall
deliver the authorization to SERS which will allow the Alternate Payee to cherl~ that she has been
and continues to be properly nominated under this paragraph.
10. The term and amounts of Member's retirement benefits payable after SERS approves a
Domestic Relations Order incorporating this Stipulation and Agreement and after Member files a
retirement application with SERS shall be in accordance with Paragraphs 14(a), 10(b) and 14(c) as
follows:
(a) Member may elect to receive, by lump sum, all or a portion of his accumulated
deductions. The portion of the accumulated deductions to be paid to the Alternate Payee or her
estate shall be determined by multiplying (1) by (2) by (3} where (1), (2) and (3) are as follows:
(1) The accumulated deductions as of December 31, 2046, together with
statutory interest {currently 4% per year) from December 37, 2046, through the Member's date of
retirement.
1~RO
Page 4
(2) 50.0090.
(3) Ratio obtained by dividing amount of accumulated deductions the Member
elects to receive by the total amount of his accumulated deductions on the date payments
commence to the Member.
(b) {i) If the Alternate Payee is living, Member shall elect a joint and survivor
annuity as set forth in 71 PA.C.S. 6705(x){4), or any succeeding statue. The Alternate Payee shall
be the irrevocable survivor annustant. The amount of the annuity shall be the equitable
distribution portion (as defined in Paragraph 7) adjusted actuarially for any accumulated
deductions paid to the Alternate Payee (pursuant to Paragraph 10{a)) and, since the cost of the
survivor annuity is to be paid by the Alternate Payee, further adjusted actuarially so that the
amount of the survivor annuity shall equal the amount of the annuity payable to the Alternate
Payee during the Member's lifetime. The intent of this option selection is to maintain levelized
payments to the Alternate Payee for her life in the event of Member's deatl2 after retirement. The
Alternate Payee shall receive a portion of the annuity which is payable to the Member during his
lifetime, and the same amount, as a survivor annuity, if the Member predeceases the Alternate
Payee after retirement. If the Alternate Payee predeceases the Member after retirement, the
portion of his annuity payable to the Alternate Payee shall be paid to Alternate Payee's estate for
the lifetime of the Membex.
{b) (ii) If the Alternate Payee is not living, the Member shall elect a maximum
single life annuity based upon the equitable distribution portion (as defined in Paragraph 7)
adjusted actuarially fox any accumulated deductions paid to the Alternate Payee's estate
(pursuant to Paragraph 10(a)). Such annuity shall be paid to the Alternate Payee's estate for the
lifetime of the Member.
(c) Member may choose any option with respect to the excess of his entire benefit over
the portion awarded the Alternate Payee or her estate and over any accumulated deductions paid
to the Member under Paragraph 10(x). Any option selected shall not reduce the amount that is to
be paid to the Alternate Payee or her estate under the provisions of this Order.
DRO
Page 5
].].. Alternate Payee may not exercise any right, privilege or option offered by SERS. SERS
shall issue individual tax forms L•o Member and Alternate Payee for amounts paid to each.
12. In the event of the death of Alternate Payee, prior to the receipt of all of hex payments
payable to her from SERS under this Order, then any death benefit or retirement benefit payable
to the Alternate Payee by SERS shall be paid to Alternate Payee's estate to the extent of Alternate
Payee's equitable distribution portion of Member's retirement benefit.
13. In no event shall Alternate Payee have greater benefits or rights other than those
which are available to Member. Alternate Payee is not entitled to any benefit not otherwise
provided by SERS. The Alternate Payee is only entitled to the specific benefits offered by SERS as
provided in this Order. All other rights, privileges and options offered by SERS not granted to
Alternate Payee by this Order are preserved for Member. Member and Alternate Payee
acknowledge that benefits paid pursuant to this Stipulation and Agreement are and shall remain
subject to the Public Employee Pension I~'orfeiture Act, ~3 P.S. §1311, et seq.
lA~. Zt is specifically intended and agreed by the parties hereto that this Order:
(a) Does not require SERS to provide any type or form of benefit, ox any option not
otherwise provided under tlae Retireanent Code;
(b) Does not require SERS to provide increased benefits (determined on the basis of
actuarial value) unless increased benefits are paid to Member based upon cost of living or
increases based on other than actuarial values.
15. The parties intend and agxee that the terms of this Stipulation and Agreement shall be
approved, adopted and entered as a Domestic Relations Order.
16. The Court of Common Pleas of Cumberland County, Pennsylvania, shall retain
jurisdiction to amend any Domestic Relations Order incorporating this Stipulation and
Agreement, but only for the purpose of establishing it or maintaining it as a Domestic Relations
Order; provided, however, that no such amendment shall require SERS to provide any type or
DRo
Page 6
form of benefit, or any option not otherwise provided by SERS, and further provided that no such
amendment or right of the Court to so amend will invalidate this existing Order.
7.7. Upon entry as a Domestic Relations Order, a certified copy of the Domestic Relations
Order and this Stipulation and Agreement and any attendant documents shall be served upon
SERS immediately. The Domestic Relations Ordex shall take effect immediately upon SER.S
approval and SERS approval of any attendant document. and then shall remain in effect until
further Order of the Court.
WHEREI~'ORE, the parties, intending to be legally bound by the terms of this Stipulation
and Agreement, do hereunto place their hands and seals.
G~ ~'' E}~Z' t~
Plaintiff/Member Date
Attorney for >E'laintiff/ ate
Member
~:OI~ ~~~.5 rYt~.1
R-I--i. j `r C~L~...
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