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HomeMy WebLinkAbout06-2143 DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant To: Marlena S. Betts 7535 Wertzville Road Carlisle, PA 17013 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. b(o -x142 IN DIVORCE NOTICE 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 tail 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: CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE. PA 17013 (717) 249-3166 IF YOU DO NOT FILE A CLAIM FOR ALIMONY. DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE. GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 w DARRYL E. BETTS Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA V. : NO. C(9 - ?lv"??_ - l MARLENA S. BETTS, IN DIVORCE Defendant COMPLAINT IN DIVORCE 1. The Plaintiff is Darryl E. Betts, an adult individual residing at 7535 Wertzville Road, Carlisle, Cumberland County, Pennsylvania 17013 since December, 1993. 2. The Defendant is Marlena S. Betts, an adult individual residing at 7535 Wertzville Road, Carlisle, Cumberland County. Pennsylvania 17013 since December, 1993. 3. Plaintiff has been a bona tide resident in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on May 18, 1991 in Cumberland County, Pennsylvania. 5. Neither Plaintiff nor Defendant is in the military or naval service of the United States or its allies within the provisions of the Soldiers and Sailors Act of the Congress of 1940 and its amendments. 6. There have been no prior actions of divorce or for annulment between the parties. COUNT 1 - DIVORCE 7. The averments of paragraphs 1 through 6 hereof are incorporated herein by reference. 8. The Defendant has engaged in an adulteress relationship with another man. 9. The Defendant has offered such indignities to the Plaintiff as to render Plaintiff s condition intolerable and life burdensome. 9. Plaintiff is an innocent and injured spouse. 10. The marriage is irretrievably broken. 11. Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the Court require the parties to participate in counseling. 12. There were two (2) children born of the marriage. Cariana (D.O.B. 8/9/93 and Mandi (D.O.B. 1/25/96). COUNT 11 - EQUITABLE DISTRIBUTION 13. The averments of paragraphs 1 through 12 hereof are incorporated herein by reference. 14. During the marriage the parties acquired marital property, assets and debts which Plaintiff requests the Court equitably distribute and assign. WHEREFORE, Plaintiff requests the Court to enter a Decree in Divorce, enter an Order equitably distributing marital property, and enter such other Orders as are appropriate and just. NESTICO, DRUBY & HILDABRAND, LLP By: Grp V (?C?G?,--?' Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Date: -lZ 16 Hershey, PA 17033 (717) 533-5406 Attorney for Plaintiff VERIFICATION I, Darryl E. Betts, verity that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: Darryl E. Betts } a lcj? Cl-I ? V I - It 40 DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-2143 CIVIL TERM IN DIVORCE AFFADAVIT OF SERVICE I, Karl R. Hildabrand, Esquire, counsel for Plaintiff Darryl E. Betts, hereby certify that a true and correct copy of Complaint in Divorce was served upon Defendant Marlena S. Betts by certified mail, return receipt requested on April 19, 2006 at the following address: Marlena S. Betts 7535 Wertzville Road Carlisle, PA 17013 Attached hereto, marked as Exhibit A and incorporated herein by reference is the signed return receipt card for said service. NESTICO, DRUBY & HILDABRAND, LLP By: Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Attorney for Plaintiff Date: Z? D A . r ¦ l.lNl PL-te items 1, c, and 3. Al ompkyte item 4 If Restricted Delivery is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the beck of the mailpiece, or on the front If space permits. 1. Articie Addressed to. "(Iena S- Get s -1535 ? ZVA V- (Z : Cdr lsk IDA 1-7013 O Agent ? Addressee Received by (fin ) C. Date of Delivery D. J' r dress dI ferent from item 11 ? Yes delivery address below: ? No Mail ? Express Mail ? Re*ter ed 'ARetum Receipt for Mwdw)dise ? Insured mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) ? Yes 2.,.ArgdoNwobw 7003 2260 0005 6584 9373 (OwWw ftm lurk - A1ba4 PS Forrn 3811. February 2w4 DomsNb Rsgxn Rsosipt 102505 )a.Wts40 EXHIBIT A 4 . k itl i? DARRYL E. BETTS, Plaintiff VS. MARLENA S. BETTS, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYVANIA NO. 06-2143 CIVIL TERM IN DIVORCE NOTICE TO PLEAD TO: Darryl E. Betts c/o Karl R. Hildabrand, Esquire Nestico, Druby & Hildabrand, LLP 840 East Chocolate Avenue Hershey, PA 17033 You are hereby directed to file a written response to the Answer with New Matter Counterclaims attached hereto within twenty (20) days from service thereof or a judgment may be entered against you. Date: 6114 1 JD V Respectfully submitted, LAW FIRM OF LINDA A. CLOTFELTER Li4da A. Clotfelter, Esquire A orney ID No. 72963 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 (717) 796-1930 telephone (717) 796-1933 facsimile Counsel for Defendant DARRYL E. BETTS, Plaintiff VS. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYVANIA NO. 06-2143 CIVIL TERM : IN DIVORCE DEFENDANT'S ANSWER WITH NEW MATTER COUNTERCLAIMS AND NOW, comes Defendant, Marlena S. Betts, by and through her counsel, Linda A. Clotfelter, Esquire, who files this Answer with New Matter Counterclaims (hereinafter "Answer"), respectfully responding as follows: 1. - 6. Admitted. COUNT I - DIVORCE 7. Denied. No response is required. 8. Admitted in part and denied in part. It is admitted that in the past Defendant had a relationship with a person of the opposite sex, but the implication therein that Defendant's conduct serves as a basis for a fault-based divorce is specifically denied and strict proof thereof is demanded. In further answer, it is Plaintiff's very recent adulterous relationships that have resulted in the need for this divorce proceeding. 9. Denied. It is specifically denied that Defendant has offered indignities to Plaintiff and further denied that Defendant has made Plaintiff's life intolerable and burdensome. In further answer, it was Plaintiff by his recent conduct who offered such indignities to Defendant so as to render Defendant's life intolerable and burdensome. Therefore strict proof of these allegations is demanded. 9. (a) (improperly numbered as 9 in Complaint). Denied. It is specifically denied that Plaintiff is an innocent an injured spouse. In further answer hereof, Plaintiff has had numerous past affairs and very recent affairs such that he has offered such indignities to Defendant as the innocent and injured spouse so as to render Defendant's life intolerable and burdensome. Therefore, strict proof of the allegations of this paragraph is demanded at trial. 10. Admitted. 11. Denied. The allegations of this paragraph are specifically denied by Defendant as Defendant lacks sufficient knowledge or information to determine the truth of the averments and therefore, strict proof thereof is demanded at trial. 12. Admitted. COUNT II - EQUITABLE DISTRIBUTION 13. Denied. No response is required. 14. Admitted. WHEREFORE, Defendant, Marlena S. Betts, respectfully requests that this Court enter a Decree of Divorce, an Order equitably dividing the parties marital property, and awarding Defendant, alimony pendente lite, permanent alimony, counsel fees, costs and expenses, as well as any additional relief the Court deems just and proper. NEW MATTER WITH COUNTERCLAIMS CLAIM III - DEFENDANT'S REQUEST FOR DIVORCE 15. Defendant's responses to Paragraphs 1 through 14 of Plaintiff's Complaint above are incorporated herein as if fully set forth. 16. Plaintiff has engaged in adulterous relationships with other women. 17. Plaintiff has offered such indignities to Defendant, the innocent and injured spouse, so as to make Defendant's condition intolerable and life burdensome. 18. Any claims by Plaintiff that Defendant has committed adultery are barred as Plaintiff has been guilty of such conduct and Plaintiff has admitted Defendant into conjugal society or embraces after Plaintiff knew of such fact thereby condoning Defendant's prior conduct, if any. WHEREFORE, Defendant, Marlena S. Betts, respectfully requests that this Court enter a Decree of Divorce, an Order equitably dividing the parties marital property, and awarding Defendant, alimony pendente lite, permanent alimony, counsel fees, costs and expenses, as well as any additional relief the Court deems just and proper. CLAIM IV - REQUEST FOR ALIMONY 19. Paragraphs 1 through 18 above are incorporated herein as if fully set forth. 20. Defendant lacks sufficient property to provide for her reasonable needs. 21. Defendant is unable to sufficiently support herself through appropriate employment. 22. Plaintiff has sufficient income and assets to provide continuing and indefinite support for the Defendant. WHEREFORE, Defendant, Marlena S. Betts, respectfully requests that this Court enter a Decree of Divorce, an Order equitably dividing the parties marital property, and awarding Defendant, alimony pendente lite, permanent alimony, counsel fees, costs and expenses, as well as any additional relief the Court deems just and proper. CLAIM V - REQUEST FOR ALIMONY PENDENTE LITE, COUNSEL FEES, COSTS AND EXPENSES 23. Paragraphs 1 through 22 above are incorporated herein as if fully set forth. 24. By reason of the institution of the action to the above term and number, Defendant will be and has been put to considerable expense in the preparation of her case, in the employment of counsel, and the payment of costs. 25. Defendant is without sufficient funds to support her and to meet the costs and expenses of this litigation and is unable to appropriately maintain herself during pendency of this action. 26. Defendant's income is not sufficient to provide her reasonable needs to pay her attorney's fees and the costs of this litigation. 27. Plaintiff has adequate earnings to provide support for the Defendant and to pay her counsel fees, costs and expenses. 28. Defendant requires reasonable support to adequately maintain herself in accordance with the standard of living established during the marriage. 29. Due to Defendant's inability to sustain herself during the course of this litigation Defendant requests that this Honorable Court enter an Order of alimony pendente lite, counsel fees, costs and expenses, in the interim and through the final hearing and thereupon award permanent alimony, as deemed appropriate. WHEREFORE, Defendant, Marlena S. Betts, respectfully requests that this Court enter a Decree of Divorce, an Order equitably dividing the parties marital property, and awarding Defendant, alimony pendente lite, permanent alimony, counsel fees, costs and expenses, as well as any additional relief the Court deems just and proper. Respectfully submitted, LAW FIRM OF LINDA A. CLOTFELTER Date: I k D lr Lin a A. Clotfelter, Esquire Atto ney ID No. 72963 §jDA E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 (717) 796-1930 telephone (717) 796-1933 facsimile Counsel for Defendant DARRYL E. BETTS, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYVANIA VS. : NO. 06-2143 CIVIL TERM MARLENA S. BETTS, IN DIVORCE Defendant VERIFICATION I, MARLENA S. BETTS, verify that the statements in the foregoing document 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 unsworn falsification to authorities. Date: A S. BETTS, Defendant DARRYL E. BETTS, Plaintiff VS. MARLENA S. BETTS, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYVANIA NO. 06-2143 CIVIL TERM IN DIVORCE AND CHILD CUSTODY CERTIFICATE OF SERVICE I, the undersigned, hereby certify that on this date, a true and correct copy of the foregoing document was served upon the interested parties by way of United States first class mail, postage prepaid, addressed as follows: Karl R. Hildabrand, Esquire Nestico, Druby & Hildabrand, LLP 840 East Chocolate Avenue Hershey, PA 17033 Dated: A I ei V L, LAW FIRM OF LINDA A. CLOTFELTER A21 East Trindle Road, Suite 100 Mechanicsburg, PA 17050 (717) 796-1930 telephone (717) 796-1933 facsimile N ?- S- i ? y>d 2 y0 '?? i W .: t C7 1. :ern 1 J r DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-2143 CIVIL TERM MARLENA S. BETTS, IN DIVORCE Defendant PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY: Kindly mark the above action discontinued, without prejudice. NESTICO, DRUBY & HILDABRAND, LLP Byc Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Attorney for Plaintiff Date: S ZZ (? ni- tv m 1 - - c -r. ?m ?i N DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-2143 MARLENA S. BETTS, IN DIVORCE Defendant PLAINTIFF'S REPLY TO DEFENDANT'S NEW MATTER AND COUNTERCLAIM 15. The averments of paragraphs l through 14 of Plaintiff's originally filed Complaint are incorporated herein by reference. 16. Denied. The averments of paragraph 16 are specifically denied and proof thereof is demanded at trial. 17. Denied. The averments of paragraph 17 are specifically denied and proof there of is demanded at trial. 18. Denied. The averments of paragraph 18 are specifically denied and proof thereof is demanded at trial. 19. The averments of paragraphs 1 thorough 18 hereof are incorporated herein by reference. 20. Denied. The averments of paragraph 20 are specifically denied and proof there of is demanded at trial. 21. Denied. The averments of paragraph 21 are specifically denied and proof thereof is demanded at trial. 22. Denied. The averments of paragraph 22 are specifically denied and proof thereof is demanded at trial. 23. The averments of paragraphs 1 through 22 hereof are incorporated herein by reference. 24. Denied. The averments of paragraph 24 are specifically denied and proof there is demanded at trial. 25. Denied. The averments of paragraph 25 are specifically denied and proof thereof is demanded at trial. 26. Denied. The averments of paragraph 26 are specifically denied and proof thereof is demanded at trial. 27. Denied. The averments of paragraph 27 are specifically denied and proof thereof is demanded at trial. 28. Denied. The averments of paragraph 28 are specifically denied and proof thereof is demanded at trial. 29. Denied. The averments of paragraph 29 are specifically denied and proof thereof is demanded at trial. NESTICO, DRUBY & HILDABRAND, LLP ?c7 ?t C By: arl R. Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 S ^ y., /' Attorney for Plaintiff Date: VERIFICATION I, Darryl E. Betts, verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: Darryl . Betts CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire of the law firm Nestico, Druby & Hildabrand, LLP, hereby certify that I served a true and exact copy of the foregoing document referenced to the foregoing action by First Class Mail, postage prepaid, this 5 day of June, 2006, on the following: Linda A. Clotfelter, Esquire 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 Karl R. Hildabrand L?.i te.? ? -- ``:-.a r cx-? 7l ?? =r? r?? ' -,-, , . - _?M -,' . .~ .. Pv '?. .1 ( ? -a ?-? r.,? ,. ?? DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-2143 IN DIVORCE PLAINTIFF'S PETITION PURSUANT TO Pa.R.C.P. 1920.15 COUNTERCLAIM The averments of Plaintiff's Complaint filed in the above matter on April 13, 2006, and subsequently discontinued by Praecipe, are hereby restated and reasserted as a counterclaim to Defendant's Answer, New Matter and Counterclaim. NESTICO, DRUBY & HILDABRAND, LLP By: c? Karl . Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Attorney for Plaintiff Date: (Z::, S'" t' ?- VERIFICATION I, Darryl E. Betts, verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: L-. 4 Darryl . Betts CERTIFICATE OF SERVICE 1, Karl R. Hildabrand, Esquire of the law firm Nestico, Druby & Hildabrand, LLP, hereby certify that I served a true and exact copy of the foregoing document referenced to the foregoing action by First Class Mail, postage prepaid, this 'day of .tune, 2006, on the following: Linda A. Clotfelter, Esquire 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 Karl R. Hildabrand - t_ _-. tjl 4 DARRYL E. BETTS, Plaintiff vs. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 06-2143 CIVIL ACTION -LAW DIVORCE PRAECIPE TO WITHDRAW AND ENTER APPEARANCES TO THE PROTHONOTARY: Kindly withdraw the appearance of Linda A. Clotfelter, Esquire, as attorney for Defendant, Marlena S. Betts, in the above captioned matter. Dated: ? 5. I Lld TL*da A.Clotfelter, Esquire preme Court ID No. 72 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 Telephone: (717) 796-1930 Kindly enter the appearance of Jeanne B. Costopoulos, Esquire, as attorney for Defendant, Marlena S. Betts, in the above captioned matter. Dated: 0 /07 Jeanne B. Costopoulos, Esquir PA Supreme Court ID No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone: (717) 221-0900 O DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. c)fo - a--N3 NO. 2,005 CV 3WCU MARLENA S. BETTS, CIVIL ACTION - LAW Defendant IN CUSTODY ORDER OF COURT AND NOW, this/ 7 ay of J*470, 2007, the Stipulation of the parties regarding the custody of Cariana Betts (D.O.B. 8/9/93) and Mandi Betts (D.O.B. 1/25/96) attached hereto, is hereby approved, adopted and made an Order of this Court. BY Edward E. Guido, Judge cc: A-arl R. Hildabrand, Esquire, Attorney for Plaintiff Aeanne' B. Costopoulos, Esquire, Attorney for Defendant 1 Z i't ? i f R^ -t 0Z .8 W, ZZ SPOV LUZ :]Hl -40 DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. 0G- ZI`13 NO.;?O6 -C V .3-5?C U MARLENA S. BETTS, CIVIL ACTION - LAW Defendant IN CUSTODY STIPULATION FOR CUSTODY WHEREAS, Plaintiff Darryl E. Betts filed a complaint seeking custody of Cariana Betts (D.O.B. 8/9/93) and Mandi Betts (D.O.B. 1/25/96) on April 2, 2007; and WHEREAS, an Interim Order was entered by the Court on May 11, 2007, following a custody conference on May 8, 2007; and WHEREAS, this matter has been scheduled by the Court for a hearing on July 16, 2007 at 9:00 a.m.; and WHEREAS, the parties have reached agreement and intend this Stipulation to set forth the terms of that agreement. It is understood by the parties that this agreement will be submitted to the Court for an Order approving same; NOW, THEREFORE, it is hereby stipulated and agreed as follows: I . The parties shall share and have joint legal custody of the two minor children, Cariana Betts and Mandi Betts. The parties shall have an affirmative obligation to consult with one another, in advance, on major decisions affecting the best interest of the children. Father and Mother shall share information relating to the children's physical, intellectual, emotional and spiritual well-being to the fullest extent possible. Father and Mother shall notify each other by telephone immediately, in the event of any 2 illness or other emergency that may arise when the children are in his or her own physical custody. Father and Mother shall not alienate nor attempt to alienate nor destroy the affection of the children for the other parent, but shall instead, exert every reasonable effort to foster a feeling of affection between the children and the other parent. 2. Mother shall have primary physical custody of the children. 3. Father shall have partial custody pursuant to the following schedule: a. Every other weekend during the summer vacation from school beginning Friday after work and ending Monday morning. During school year, every other weekend beginning Friday after work and ending Sunday evening at 6:00 p.m. The parties have agreed that the children will attend church with Mother on Sundays and Father shall drop the children off at Mother's house at 7:30 a.m. on his Sundays and Mother will return them to Father no later than 2:00 p.m. b. Father shall have one evening during the week in which he does not have the children for the weekend from 4:00 p.m. to 8:00 p.m. on a day to be agreed by the parties. If and when Father's business is no longer located at the residence of Mother then Father shall have one evening every week from 4:00 p.m. to 8:00 p.m. on a day to be agreed by the parties. C. Father shall have two non-consecutive weeks in the summer. d. Father will be able to take Cariana hunting for an extended weekend at the time of deer season and an occasional Saturday or 3 other days during other hunting seasons. Father will also enjoy an extended weekend(s) with Mandi at a time to be agreed by the parties. To the extent practicable Father will provide Mother with at least 30 days notice of any hunting trips or extended weekends and the specific times shall be agreed upon by the parties. e. For so long as Mandi desires to bowl in a bowling league with Father, Father will continue bowling leagues with Mandi. Father will have the opportunity to participate with Mandi in other events or activities in place of the bowling league. f. The parties will share time with the girls on their birthdays. g. Mother shall have the girls on Mother's Day and Father shall have the girls on Father's Day. On Father's Day, Father shall be able to take the girls to his church and on Mother's Day, Mother shall be able to take the girls to her church. h. Unless otherwise agreed by the parties, Christmas will be divided into two segments: (i) In odd numbered years, Father will have the children from December 24`h at 12:00 noon until December 25`h at 1:00 p.m.; Mother will have the children from December 25`h at 1:00 p.m. until December 26`h at 8:00 p.m. (ii) In even numbered years, Mother will have the children from December 24`h at 12:00 noon until December 25`h at 4 1:00 p.m., Father will have the children from December 25`' at 1:00 p.m. until December 26'h at 8:00 p.m. (iii) The parties will be reasonably flexible regarding this holiday schedule to accommodate the schedules of extended family members of the parties. i. The parties will alternate the following holidays, New Years Day, Easter, Memorial Day, 4`h of July, Labor Day, and Thanksgiving as follows: (i) In odd numbered years, Father will have New Year's Day, Memorial Day and Labor Day, and Mother will have Easter, 4`h of July and Thanksgiving Day. (ii) In even numbered years, Mother will have New Year's Day, Memorial Day and Labor Day, and Father will have Easter, 4`h of July and Thanksgiving Day. (iii) Unless otherwise agreed by the parties, the time for the holiday shall be 8:00 a.m. until 8:00 p.m. 4. Mother shall notify Father of all school and social events so that he may participate in such events and special occasions including, but not limited to, piano recitals, school programs, graduations, special presentations, etc. 5. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decisions affecting the children's general well- being including, but not limited to, all decisions regarding their health, education and religion. Pursuant to the terms of 23 Pa.C.S. §5309, each parent shall be entitled to all 5 records and information pertaining to the children including, but not limited to medical, dental, religious or school records, the residence address of the children and the other parent. To the extent one parent has possession of any such records or information, that parent is hereby required to share the same, or copies thereof, with the other parent within such reasonable time as to make the records and information of reasonable use to the other parent. Both parents shall be entitled to full participation in all educational and medical/treatment planning meetings and evaluations with regard to the minor children. Each parent shall be entitled to full and complete information from any physician, dentist, teacher or authority and copies of any reports given to them as parents including, but not limited to: medical records, birth certificates, school or educational attendance records or report cards. Additionally, each parent shall be entitled to receive copies of any notices which come from school with regard to school pictures, extracurricular activities, children's parties, musical presentations, back-to-school nights, and the like. 6. Except as otherwise set forth above, transportation shall be shared such that the receiving party shall transport the children. 7. Neither party shall do or say or permit a third party to do so say anything that may estrange the children from the other parent, injure the opinion of the children as to the other parent, or hamper the free and natural development of the children's love and respect for the other parent. 8. The parties may modify the provisions of this agreement by mutual consent. In the absence of mutual consent, the terms of the agreement and Court Order approving same shall control. 6 9. Each party shall keep the other fully apprised in advance of the location of the children and reasonable contact shall be provided to the other parent. Mother and Father shall provide each other with telephone numbers where the children can be reached when they are in his/her physical custody. 10. With regard to any emergency decisions which must be made, the parent having physical custody at the time shall be permitted to make the decision necessitated by the emergency without consulting the other parent in advance. However, the parent making such decisions shall inform the other of the emergency and shall consult with him or her as soon as possible. Day to day decisions of a routine nature will be the responsibility of the parent having physical custody at the time. IL Mother and Father agree that the best interest and permanent welfare of the children shall be their paramount concern. 12. The parties agree that this Stipulation will be submitted to the Court of appropriate jurisdiction for an Order approving and adopting same. 13. This Stipulation is binding upon the parties upon execution by both parties and its validity is not contingent upon Court Approval. WITNESS: F DARRYL E. BETTS r -- MARLENA S. BE TS 7 COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CAvr Le-r2) On this, the 9t, day of 2007, before me a Notary Public in and for said County and State the undersigned officer, personally appeared DARRYL E. BETTS, known to me (or satisfactorily proven) to be the person whose name is described to the within instrument, and acknowledged that they executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. My Commission Expires t?\ 4X,61-- Notary Public NOTAM SEX KAREN A THOMAS SXVERSPRING TOWNSHIP ~ CUMKRLAND COUNTY Conimbsion Ewku Dec 19. 2009 COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF C 1Y) -'(' . On this, the day of Fcr1007, before me a Notary Public in and for said County and State the undersigned officer, personally appeared MARLENA S. BETTS, known to me (or satisfactorily proven) to be the person whose name is described to the within instrument, and acknowledged that they executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. My Commission Expires NOTARIAL SEAL Glenda M. Jones, Notary Public Silver Spring Twp., Cumberland County My commission expires January 14, 2010. Notary Public 9 DARRYL E. BETTS, Plaintiff vs. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 06-2143 CIVIL ACTION - LAW DIVORCE DEFENDANT'S EMERGENCY SPECIAL RELIEF PETITION FOR EXCLUSIVE POSSESSION OF THE MARITAL RESIDENCE Defendant, Marlena S. Betts, by and through her attorney, Jeanne B. Costopoulos, Esquire, avers the following: 1. Petitioner, Defendant above, Marlena S. Betts (hereinafter referred to as Wife), is an adult individual who currently resides at 7535 Wertzville Road, Carlisle, Cumberland County, Pennsylvania, 17015. 2. Respondent, Plaintiff above, Darryl E. Betts (hereinafter referred to as Husband), is an adult individual who currently resides in an apartment in Carlisle, Cumberland County, Pennsylvania, 17013. 3. Husband filed a Complaint in Divorce at the above term and docket number on April 13, 2007. 4. Wife filed an Answer and Counterclaim on May 21, 2007, raising claims of equitable distribution, alimony, alimony pendent lite, and counsel fees. 5. Husband filed a Praecipe to Discontinue on May 24, 2007. 6. Husband filed an Answer to Wife's Counterclaim and a Counterclaim reinstating his original Complaint on June 7, 2007. 7. During their marriage, the parties acquired a home and property located at 7535 Wertzville Road, Carlisle, Cumberland County, Pennsylvania, 17015. 8. The parties have two children, namely Cariana Ruth Betts, born August 9, 1993, and Mandi Sue Betts, born January 25, 1996. 9. Husband vacated the marital residence on August 7, 2006 and has lived separate and apart from Wife and the children since that date. 10. On or about September 14, 2007, Husband informed Wife that he would be moving back into the marital residence at the end of the month. Wife indicated her objection at that time and also subsequently attempted to discuss the issue.with him. 11. It is appropriate that Wife be granted exclusive possession of the marital residence for the following reasons: a. Husband has been living outside of the marital residence for over one year. b. Husband tends to begin arguments with Wife in the presence of the children. C. Husband has physically abused Wife in the past, including grabbing Wife around the neck when she attempted to interfere when he was spanking one of the children out of anger. d. On several occasions, Husband has physically blocked Wife from exiting rooms during arguments with Husband. C. Less than a year ago, Husband has sexually assaulted Wife during the night, which she reported to police but not pursue charges. f. Husband has engaged in a pattern of financially irresponsible behavior. In addition to large amounts of debt associated with his landscaping business, Husband has incurred personal debt estimated at over $30,000.00 for credit cards and classic car restoration. Despite the debt he owes and his constant complaining to Wife that he cannot afford to pay bills, Husband has been working minimal hours and appears to be purposefully decreasing the number of hours worked. g. Husband verbally and emotionally abuses Wife. He has called Wife derogatory names both to her face and to third parties who have informed Wife as the statements being made about her by Husband. h. Husband has a history of pornography addiction and lives a sexually reckless lifestyle. i. Husband recently disclosed to Wife in the presence of his counselor that he had acquired a sexually transmitted disease (STD). j. Both children have expressed that they do not want Husband returning to the marital residence. The children fear anger of Husband, and abuse of Wife by Husband, and arguing of their parents. k. Husband is deceptive, habitually lies to Wife, and refuses to communicate with her about his ongoing problems. 12. Husband has a shed and business related equipment on the same property as the marital residence. Wife does not currently object to Husband's continued use of the shed and access to his equipment provided he does not enter the marital residence without the 13 consent of Wife. On September 27, 2007, undersigned counsel contacted Husband's attorney, who confirmed that Husband does plan to move back into the marital residence against Wife's express wishes. He further indicated that he opposes the relief sought in the instant petition. WHEREFORE, Wife requests this Honorable Court to grant her emergency exclusive possession of the marital residence. Dated: e 7 -1? eanne B. Costopoulos, Esquire PA Supreme Court ID No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone: (717) 221-0900 ATTORNEY FOR DEFENDANT VERIFICATION I, Marlena S. Betts, hereby verify and state that the facts set forth in the foregoing document 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.A. §4904 relating to unsworn verification to authorities. Date: { a b 1 arlena S. Betts CERTIFICATE OF SERVICE I, Jeanne B. Costopoulos, Esquire, hereby certify that this day I served a copy of the foregoing document upon the person, and in the manner, indicated below, which service satisfies the requirements of the PA Rules of Civil Procedure, by depositing a copy of the same with the United States Post Office at Mechanicsburg, Pennsylvania, through first class mail, prepaid, and addressed as follows: Karl Hildabrand, Esquire 840 Chocolate Avenue Hershey, PA 17033 By: JEANNE B. COSTOPOULOS, ESQ Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 l l .?/? 7 Attorney for Defendant Date: 74 - C? v ' SEP 2 8 20071>4 i/ DARRYL E. BETTS, IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : No. 06-2143 MARLENA S. BETTS, CIVIL ACTION -LAW Defendant DIVORCE ORDER OF COURT AND NOW this 1.9 lit day of 2007, a Rule is hereby issued on Plaintiff to show cause why Defendant's Emergency Special Relief Petition for Exclusive Possession of the Marital Residence should not be granted. Rule returnable O OP b t k otLt O d O 1 'ZOO? In the meantime, Defendant shall not enter the marital residence absent the express consent of Wife. However, Plaintiff may continue to use his shed and business equipment located outside of, but on the same property as, the marital residence. BY THE COURT: Distribution: q1_2-P10 , Jeanne B. Costopoulos, Esq., 5000 Ritter Road, Suite 202, Mechanicsburg, PA 17055 - C'o/Y ?UJOkA,l (sy 4 r Karl R. Hildabrand, Esq., 840 E. Chocolate Ave., Hershey, PA 17033 - "Op y '-ftu <<fcc r- ; ^+ e.= ^-'? `n k' - n , ?... ?`'-} ?..__ ?"' , _, • l? ?:.?K r - .-.. ., DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-2143 IN DIVORCE PLAINTIFF'S ANSWER AND NEW MATTER TO DEFENDANT'S EMERGENCY SPECIAL RELIEF PETITION FOR EXCLUSIVE POSSESSION OF THE MARITAL RESIDENCE 1. Admitted. 2. Admitted. 3. It is admitted that Husband filed a Complaint in Divorce at the above term and docket number on April 13, 2006 seeking divorce and equitable distribution of marital property. 4. Denied. On the contrary, Wife filed an Answer with New Matter and Counterclaim on May 23, 2006 raising claims for divorce, equitable distribution, alimony, alimony pendente lite, counsel fees, costs and expenses. 5. Admitted. 6. Denied. On the contrary, on June 7, 2006 Plaintiff filed a Reply to Defendant's New Matter and Counterclaim and also a petition pursuant to Pa.R.C.P. 1920.15 reinstating and reasserting Plaintiff's Compliant. 7. Admitted. 8. Admitted. 9. Denied. The averments of paragraph 9 are specifically denied and proof thereof is demanded. 10. Denied. On the contrary, on or about September 15, 2007 Plaintiff advised Defendant that he intended to move back into the marital residence at the end of September 2007. It is further admitted that Wife raised an objection. 11. Denied. It is specifically denied that it is "appropriate" that Wife be granted exclusive possession of the marital residence. a. Admitted. b. Denied. The averments of paragraph 1 I (b) are specifically denied and proof thereof is demanded. On the contrary, both parties have participated in discussions and disagreements, as all married couples do, both in the presence of, and outside the presence, the children. There is nothing unusual or alarming about the nature of these disagreements. Wife has precipitated many of the disagreements. C. Denied. The averments of paragraph I I (c) are specifically denied and proof thereof is demanded. On the contrary, the incident alleged, although not accurately described by Defendant, occurred in the year 2005. At that time. the parties were living together and the parties had a disagreement regarding the nature of discipline for both children. Outside the presence of the children, Plaintiff placed his hand on the Defendant's arm to get her attention. There was no "physical abuse" and the parties simply discussed the nature of their disagreement. The attempt to describe said discussion as "physical abuse" is a gross exaggeration and distortion of the true facts. d. Denied. On the contrary, the parties have had discussions and disagreements s all married couples do, from time to time and while Husband has been standing in the doorway, Wife has attempted to push her way past him. At no time did Husband physically assault Wife and Wife's attempt to create the impression of "physical abuse" in paragraph I I (d) or the attempt to create the impression that Wife was not an equal participant in the events are distortions and misrepresentations of the true facts. e. Denied. The averments of paragraph 11(e) are specifically denied and proof thereof is demanded at trial. On the contrary, subsequent to their physical separation the parties continued to talk about the possibility of reconciliation. The parties shared a consensual evening together in the marital residence and the intimacy between the parties was consensual. Furthermore, the following morning the Defendant disingenuously pretended that she did not recall what had occurred and threatened to call the police and in fact she notified Husband's family members of an alleged incident. These attempts on her part were false, fraudulent and simply designed to manufacture evidence to be used subsequently in the domestic proceeding between the parties. It is admitted that Wife did not pursue charges. f. Denied. The averments of paragraph 11(f) are specifically denied and proof thereof is demanded. g. Denied. The averments of paragraph I I (g) are specifically denied and proof thereof is demanded. On the contrary, the verbal disagreements between the parties are, and have been, mutual. Prior to the parties separation Wife engaged in a lengthy adulterous affair which eventually precipitated the parties separation. Both prior to and subsequent to separation there were numerous disagreements and discussions about Wife's behavior and other related matters. Wife's bold allegation that "Husband verbally and emotionally abuses Wife" ignores the true nature of the facts and the nature of the marital breakdown between the parties. On the contrary, it was Husband who constantly made efforts to maintain the family unit, and watched the children while Wife was out at all hours of the night with her male companion. Wife has been "verbally and emotionally abusive" to Husband although the nature and extent of the verbal disagreements have been civil and well under control. h. Denied. The averments of paragraph 11(h) are specifically denied and proof thereof is demanded at trial. On the contrary, the breakdown of the parties marriage was due to Wife's adulterous affair with a coworker which continued over an extensive period of time. Wife's allegations are simply designed to deflect scrutiny of her destructive behavior. i. Admitted. However, medical the condition cleared up shortly thereafter, is irrelevant to the within proceeding and is simply Wife's attempt to deflect scrutiny of her adulterous affair which brought about the parties separation. j. Denied. The averments of paragraph 110) are specifically denied and proof thereof is demanded. On the contrary, the circumstances that have prompted Husband to express an interest to move back into the marital residence were prompted by Wife's ongoing lack of cooperation in the custody arrangements. Despite a custody order preventing such conduct, Wife has continued to make derogatory comments about Husband to the children, she has discouraged the children from seeing their father, and has distorted and exaggerated circumstances and facts to try and manipulate the girls feelings against their father and spending time with their father. Much the same as Wife has distorted and manipulated the facts set forth in her Petition herein she has attempted to turn the children against their father in subtle ways. The children love their father, do not fear their father, and it is in their best interest that father move back into the residence to exert more influence over the father/daughter relationship and prevent or minimize the harmful and damaging efforts of Wife. k. Denied. The averments of paragraph 11(k) are specifically denied and proof thereof is demanded. On the contrary, Wife is the one who has been "deceptive," and has habitually lied to Husband. Furthermore, the Defendant has set forth lies and misrepresentations set forth by Wife in her Petition are a clear indication of the harmful behavior of Wife that Husband hopes to counteract by returning to the marital residence. 12. Admitted in part and denied in part. It is admitted that Plaintiff has a shed and business related equipment on the marital property. Husband needs access to the property to obtain his equipment and tools for his landscaping business. NEW MATTER 13. As a result of Wife's extra marital affair and the subsequent breakup of the marriage, Husband has sought and been receiving professional family counseling through his church. 14. As part of the sessions with the counselor, the manipulative and destructive actions of Wife towards the children and the father/daughter relationship have been discussed and become a subject of serious concern. 15. At the recommendation of his counselor, Husband made the decision that it would be in the best interest of his relationship with his children to move back into the marital residence to minimize or eliminate the destructive behavior and negative psychological influences of Wife and Wife's lack of full cooperation with the existing custody schedule. 16. At the recommendation of his counselor, and in an attempt to minimize any difficulty to Wife and the girls by a sudden move, Husband provided advance notice to Wife of his intention to move back into the marital residence. 17. At all times it has been Husband's intention to strengthen his relationship with his daughters and not in any way to antagonize or increase difficulties with Wife. 18. Husband believes that the children would welcome his return to the marital residence. 19. Husband believes that his returning to the marital residence is in the best interest of the children. Date: C? NESTICO, DRUBY & HILDABRAND, LLP Y Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Attorney for Plaintiff VERIFICATION t, Darryl E. Betts, verify that the statements made in the foregoing document are true and correct to the best of my knowledge. information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. Date: Betts CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire of the law firm Nestico, Druby & Hildabrand, LLP, hereby certify that I served a true and exact copy of the foregoing document referenced to the foregoing action by First Class Mail, postage prepaid, this -Z- day of October 2007, on the following: Jeanne' B. Costopoulos, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 arl R. Hildabrand DARRYL E. BETTS, Plaintiff vs. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : No. 06-2143 CIVIL ACTION -LAW DIVORCE DEFENDANT'S ANSWER TO PLAINTIFF'S-NEW MATTER Defendant, Marlena S. Betts, by and through her attorney, Jeanne B. Costopoulos, Esquire, provides the following Answer to Plaintiff's New Matter: 13. Admitted in part; denied in part. It is admitted that Husband has sought and been receiving counseling through his church. It is specifically denied that Husband sought said counseling as a result of Wife's extra marital affair and the subsequent breakup of the marriage. By way of further answer, Wife thought that Husband sought counseling to address his personal problems, such as lying, cheating, anger management, and accountability to God and others. 14. Denied. Since Wife is not present at Husband's sessions with his counselor(s), Wife is without sufficient information to admit or deny the allegations contained in paragraph 14 of Plaintiff's New Matter. It is specifically denied that Wife has committed any manipulative or destructive actions towards the children and the father/daughter relationship. By way of further answer, Husband's reckless lifestyle is the cause of any father/daughter issues. 15. Denied. Wife is without sufficient information to comment about Husband's counselor's n recommendations to Husband about returning to the marital residence and strict proof thereof is demanded. By way of further answer, Husband's counselor(s) have only discussed the current situation with Husband, who Wife believes would have presented a distorted picture of the reality of the situation. Said counselor(s) have not discussed the current situation with either Wife or the children and would, therefore, have no knowledge of the tension between Husband and Wife and its effect on the children. 16. Denied. Wife, again, is without sufficient information to comment about Husband's counselor's recommendations to Husband about why to or how to return to the marital residence and strict proof thereof is demanded. It is admitted that Husband provided Wife with advance notice of his intention, which is why" Wife filed a petition for special relief seeking exclusive possession of the marital residence. As averred in her petition, Wife believes the children would be adversely affected if Husband were permitted to return to the marital residence. 17. Denied. Although Husband's true intent is known only to him, Husband's actions and comments have damaged his relationship with his daughters and have increased difficulties with Wife. By way of further answer, Husband's comments to Wife support the fact that Husband's desire to return to the marital residence is more financially motivated than steered by any intent to strengthen his relationship with his children or Wife. 18. Denied. Regardless of whether or not Husband believes that the children would welcome his return to the marital residence, they in fact would not. 19. Denied. By way of further answer, the fact that Husband holds the belief that his returning to the marital residence is in the best interest of the children confirms to Wife that he is either unable to determine, or unwilling to admit, what is in the best interest of the children. Dated: / 0 /'S /e) 7 e B. Costopoulos, Esquire PA Supreme Court ID No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone: (717) 221-0900 ATTORNEY FOR DEFENDANT VERIFICATION I, Marlena S. Betts, hereby verify and state that the facts set forth in the foregoing document 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.A. §4904 relating to unsworn verification to authorities. Date: 0 '7 Marlena S. Betts CERTIFICATE OF SERVICE I, Jeanne B. Costopoulos, Esquire, hereby certify that this day I served a copy of the foregoing document upon the person, and in the manner, indicated below, which service satisfies the requirements of the PA Rules of Civil Procedure, by depositing a copy of the same with the United States Post Office at Mechanicsburg, Pennsylvania, through first class mail, prepaid, and addressed as follows: Karl Hildabrand, Esquire 840 Chocolate Avenue Hershey, PA 17033 By: NE B. COSTOPOULOS, ESQ Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 10 /07 Attorney for Defendant Date: r n R' ?{ Fri ?{n r JEANNE B. COSTOPOULOS, ESQUIRE Attorney I.D. No. 68735 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone No. (717) 221-0900 Attorney for Defendant DARRYL E. BETTS, Plaintiff V. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-2143 CIVIL TERM CIVIL ACTION - LAW DIVORCE PETITION FOR COUNSELING PURSUANT TO SECTION 3302 OF THE DIVORCE CODE AND NOW comes the Defendant, Marlena S. Betts, by and through her attorney, Jeannd B. Costopoulos, Esquire, and respectfully an Order requiring counseling pursuant to Section 3302 of the Divorce Code and in support thereof avers the following: 1. Petitioner is the Defendant in the above-captioned action for divorce. 2. Despite the averments of the Complaint, it is believed and averred that the marital differences are not irreparable. 3. It is averred that there is a reasonable prospect of reconciliation. 4. Section 3302(a) provides that upon the request of either party, the Court must require up to three counseling sessions whenever Section 3301(a)(6), 3301(c) or 3301(d) of the Divorce Code has been alleged as the grounds of divorce. WHEREFORE, Petitioner, Marlena S. Betts, requests this Honorable Court order the parties to participate in a maximum of three counseling sessions with a qualified professional as provided in the Divorce Code. RESPECTFULLY SUBMITTED BY: BY: Jeanne B. Costopoulos, Esquire 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone: (717) 221-0900 PA Supreme Court ID No. 68735 Date: ATTORNEY FOR DEFENDANT j/Z (d f VERIFICATION I, Marlena S. Betts, hereby verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. ;? 1 f a? Date: 511 Signature: Marlena S. Ben CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing document to the person and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of the same with the United States Post Office at Mechanicsburg, Pennsylvania, through first class mail, prepaid, and addressed as follows: Karl Hildabrand, Esquire 840 Chocolate Avenue Hershey, PA 17033 BY: Jeanne B. Costopoulos, E,V ire 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Telephone: (717) 221-0900 PA Supreme Court ID No. 68735 /2L/? ATTORNEY FOR DEFENDANT Date: / ? ra ea C3 7_1 r t co ? ? ss .:? Lrt co -c DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-2143 IN DIVORCE PLAINTIFF'S PETITION TO COMPEL DISCOVERY On or about February 14, 2007 Plaintiff served its First Set of Interrogatories and First Request for Production of Documents directed to Defendant. Attached hereto, marked as Exhibit A and incorporated herein by reference are copies of said discovery requests. 2. Pursuant to Pa.R.C.P. 4006 and 4009.12 Defendant's responses were due on or before March 16, 2007. 3. On or about October 1, 2007, Counsel for Plaintiff sent correspondence to defendant's counsel indicating that the defendant's answers to Plaintiff's First Set of Interrogatories and First Request for Production of documents had not been received and requested that full and complete answers be provided within fifteen (15) days of the letter. Attached hereto, marked as Exhibit B and incorporated herein by reference is a copy of said correspondence. 4. On or about October 10, 2007, Counsel for Plaintiff sent correspondence to defendant's counsel and enclosed an additional copy of Plaintiffs First Set of Interrogatories and First Request for Production of documents to be answered by Defendant. Attached hereto, marked as Exhibit C and incorporated herein by reference is a copy of said correspondence only. 5. On or about April 11, 2008, Counsel for Plaintiff sent correspondence to defendant's counsel indicating that the defendant's answers to Plaintiff's First Set of Interrogatories and First Request for Production of documents had not been received and requested that full and complete answers be provided within twenty (20) days of the letter. Attached hereto, marked as Exhibit D and incorporated herein by reference is a copy of said correspondence. 6. On or about October 10, 2008, Counsel for Plaintiff sent correspondence to defendant's counsel indicating that the defendant's answers to Plaintiff s First Set of Interrogatories and First Request for Production of documents had not been received and requested that full and complete answers be provided within fifteen (15) days of the letter. Attached hereto, marked as Exhibit E and incorporated herein by reference is a copy of said correspondence. 7. To date, no responses have been received based upon the request to provide full and complete responses and records as stated herein. 8. Defendant's responses are overdue. 9. Defendant has not filed any objections to any of the discovery requests, nor has she filed any objection to the requests to provide full and complete answers and documents. WHEREFORE, it is respectfully requested that this Court issue a Rule upon Defendant to show cause, if any she has, why full and complete answers to Plaintiff s First Set of Interrogatories and First Request for Production of Documents should not be served without objection within twenty (20) days from the date of this Court's Order or face sanctions as determined by the Court. Respectfully submitted, Date: NESTICO, DRUBY & HILDABRAND, LLP K YR. Hildabrand, Esquire Attorney I.D. No. 30102 Scott A. Stein, Esquire Attorney I.D. No. 81738 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Attorney for Defendant CERTIFICATE OF SERVICE I, Scott A. Stein, of the law firm of Nestico, Druby & Hildabrand, L.L.P., hereby certify that on the / Q day of December 2008, a copy of the foregoing document was sent via First Class U.S. Mail, postage paid, to the following: Jeanne B. Costopolous, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Scott A. Stein NED NESHCO, DRUBY & MDABM, LLP ATTORNEYS AT LAW 940 East Chocolate Avenue. Hershey. PA 17033 Phone (717) 533-5406 Fax (717) 533-3717 www.hersheypalaw.corn February 14, 2007 Linda A. Clotfelter, Esquire 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 Re: Betts v. Betts, Docket No. 06-2143 Dear Attorney Clotfelter: Enclosed herewith are Plaintiffs First Set of Interrogatories and First Request for Production of Documents directed to Defendant Marlena S. Betts in the above matter. Please have your client respond within the time set forth in the Rules of Civil Procedure. Very truly yours, NESTICO, DRUBY & HILDABRAND, LLP c 'R. Hildabrand KRH/mlp Enclosures cc: Darryl Betts (w/ enc.) DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-2143 : IN DIVORCE PLAINTIFF'S FIRST SET OF INTERROGA TORIES DIRECTED TO DEFENDANT TO: Marlena S. Betts clo Linda A. Clotfelter, Esquire 5021 E. Trindle Road Suite 100 Mechanicsburg, PA 17050 Demand is hereby made by the Defendant of the Plaintiff for answers, under oath or certification, to the following Interrogatories within the time and in the manner prescribed by the rules of this Court. You are required to file answers to the following Interrogatories within thirty (30) days after service upon you pursuant to Pa.R.C.P.1920.22(b), 4005, and 4006. These Interrogatories shall be deemed to be continuing if, between the time of your Answer and the time of trial of this case, you or anyone acting on your behalf, learn of any further information not contained in your Answers, you shall promptly furnish said information to the undersigned by Supplemental Answers. NESTICO, DRUBY & HILDABRAND, L.L.P. Date: Z © By: C M1 1 R. Hildabrand Attorney I.D. No. 30102 840 E. Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Telephone • (717) 533-5717 Fax Attorney for Plaintiff INSTRUCTIONS AND DEFINITIONS Answer every Interrogatory. No question is to be left blank. If the answer to an Interrogatory is "none" or "unknown," such statement must be written in the answer. If the question is inapplicable, "N/A," must be written in the answer. Whenever a date, amount, or other computation or figure is requested, the exact date, amount, computation, or figure is to be given unless it is unknown. If so, give the best estimate or approximation thereof and note that such answer is an estimate or approximation. The term "communication" means not only oral communications, representations, or warranties, but also any documents (as such term is defined below), whether or not such document or the information contained therein was transmitted by its author to any other person. The term "document" means any written, printed, typed, or other graphic matter of any kind or nature, however produced or reproduced, whether sent or received or neither, including drafts and copies bearing notations or marks not found on the original, and includes, but is not limited to: 1. all contracts, agreements, representations, warranties, certificates, opinions; 2. all letters or other forms of correspondence or communications, including envelopes, notes, telegrams, cables, telex messages, messages (including reports, notes, notations, and memoranda of or relating to telephone conversations or conferences); 3. all memoranda, reports, financial statements or reports, notes, transcripts, end tabulations, studies, analyses, evaluations, projections, work papers, corporate records or copies thereof, lists, comparisons, questionnaires, surveys, charts, graphs, summaries, extracts, statistical records, compilations; 4. all desk calendars, appointment books, diaries; 5. all books, articles, press releases, magazines, newspapers, booklets, circulars, bulletins, notices, instructions, manuals; 2 6. all minutes or transcripts of all meetings; and 7. all photographs, microfilms, phonographs, tapes or other records, punch cards, magnetic tapes, disks, datacells, drums, printouts, and other data compilations from which information can be obtained. Whenever the word "identify" or "identity" is used in reference to a person, corporation, or other entity, this means to state, if appropriate, his, hers, or its full name, present address, and business affiliation. When used in reference to a document, the terms "identify," "identity," or "identification" mean to state the following information: I. Identifying features of the document, including its nature, date of preparation, and any other information (i.e., its title, index, or file number) which would facilitate in the identification thereof, 2. Its present location and the identity, as "identity" is defined with regard to a person herein, of its present custodian, or if its present location and custodian are not known, a description of its last known disposition, the reasons therefore, and the identity of all persons responsible therefore; 3. If a copy of the document cannot be attached to these Interrogatories, its subject matter and substance, and the reason why such document cannot be attached including any reason why such document no longer exists if it has been destroyed and the identity of the persons (as defined herein) responsible for the document no longer being in existence and the identity of its last custodian. Whenever the word "identify" or "identity" is used in reference to an account or investment of any nature whatsoever, this means to state: 1. the name, address, and telephone number of the company or companies maintaining such account of investment and of any account or investment executive or representative who services the account or investment; 2. account, investment, or policy numbers; 3 3. the present location of the account or investment and the identity as "identity" is defined with regard to a person herein, of its present custodian, or if its present location and custodian are not known, a description of its last known disposition, the reasons therefore, and the identity of all persons responsible therefore. The term "income" is defined as income benefits, cash and non-cash, from whatever source derived. Income includes, but is not limited to, hourly, average weekly, or annual salary; wages; commissions; overtime pay; bonuses; gratuities; paid holidays; legal services benefits or the like; sick pay; vacation pay; life, medical, dental and/or hospital insurance or insurances; expense or other compensation accounts and allowances for transportation, meals, entertainment, and housing; the provision to you of an automobile; any other accommodations and expenses for which any person or entity reimburses you; payments on a regular or irregular basis from the Social Security Administration, the federal or state government, any insurance company, or any other agency or entity; inheritances; winnings from gambling or lottery prizes; bank interest; dividends; lease and rental earnings; patent, copyright, trademark, or royalty rights; or compensation of any other nature. 4 INTERROGATORIES Personal Information: 1. Please state your full name and address and social security number. ANSWER: 2. Please state your age, and date and place of birth. ANSWER: 5 3. Please describe your education and training, including all institutions and the dates attended, any certificates, awards, licenses, professional or educational degrees received in your lifetime, and all statuses you now hold or have held in the past four (4) years as a result of this education. Include all fon-nal training you have received, the identity of the person, persons, or institutions rendering it to you, and the date(s) you received it, even if no degree, certificate, license, or award was given for completion. ANSWER: 6 Employment and Income: 4. Identify all of your employers and state your job title(s), including any positions which you hold on the board of directors of any organization(s). If there is/are a written agreement(s) or contract(s) of employment to which you are a party, even if you are self- employed or conduct a business or profession as a sole proprietor, partner, or corporation, identify it/them and attach copies. Similarly, if there is/are an oral agreement(s) or contract(s) of employment to which you are a party, please state and describe its/their terms. ANSWER: 7 5. If you are self-employed or conduct a business or profession as a sole proprietor, partner, or corporation, identify the business, the type of business, and your position in said business. ANSWER: 8 6. Regarding your employment or retirement income, state: a. Your gross employment or retirement income per hour, week, month, and/or year, and whether you receive additional pay for overtime; b. The amount of your gross earnings or retirement income resulting from any and all employment of any nature for each of the past five (5) years and the current year, C. List all bonuses earned by you for each of the past four (4) years and to date this year, including the date the bonus was paid or will be paid and the gross and net amount thereof; d. The exact amount of your take-home pay or retirement income each of the past thirteen (13) pay periods. Designate the date of the payment periods involved, Please attach copies of your pay stubs for said payment periods. ANSWER: 9 7. Do you receive, or have you received during the past five (5) years, any gift, stipend, contribution, compensation, gratuities, benefits, services, or goods from any source, business or otherwise, for any of the following personal expenses? If so, identify the source, the dates and amounts of payments of goods or services, the purpose of the payments or goods or services, and the name and address and the relationship to you of the provider of each payment or goods or services. ANSWER: 8. List all of your income, other than employment income, during the preceding five (S) years, from whatever source derived, and identify each source thereof. ANSWER: 10 9. Identify and attach copies of all documents stating, evidencing, or pertaining to your income for the past five (5) years, including, but not limited to, your federal income tax returns for the past five (5) years with all W-2s and related schedules attached, insurance policies and financial statements, including balance sheets and income statements. ANSWER: 10. Except as otherwise described in the preceding Interrogatories, have you deferred your right to receive any income or other consideration to which you are entitled under any contract, employment agreement, or otherwise? If so, describe in detail the circumstances surrounding each such deferral including reason, manner of deferral, amount of deferral, and date you anticipate receiving said deferral. ANSWER: 11 Retirement: 11. If you now own or hold from past or present employment and/or military service, or expect to own or hold at any time within the next ten (10) years if you continue your present employment and/or military service, any interest, whether as a beneficiary, owner, participant, or otherwise in any pension, stock purchase option, retirement, profit sharing, life insurance, deferred compensation, or other employee or employment benefit plan or any Keogh, HR-10, 401(k), individual retirement account, or other benefit plan, provide the following: a. If there is a written contract or description of such plans, attach copies of all such documents and identify them; b. The specific inclusive time periods during which contributions were made to such plan by you or by anyone else for your benefit and the specific dates and amounts of all individual contributions; C. If your benefits and rights in and to such plan have not entirely vested in you, the earliest date on which they will commence to vest, the degree to which they are invested in you at this time, and the date b y which they will be completely vested in you; d. The earliest date on which you could withdraw funds from such plan and the amount or portion of benefits you would be entitled to withdraw at that time; e. State the present cash value of any such plan, identifying the source of your information, and identify and attach copies of any documents in support thereof. AN_. 12 12. Identify all life insurance policies in which you are the owner (by company, policy number, and amount of coverage), insured, and/or beneficiary, and for each please state the present cash surrender value. Attach copies of all identified policies. ANSWER: 13. If you borrowed against any insurance policy described in these Interrogatories, state: the company and policy, date(s), amount borrowed, method of repayment, specify the reduction in cash surrender value as a result thereof and identify the disposition of the money borrowed. ANSWER: 13 _ Real Estae: 14. Identify and describe all real estate in which you have an interest and for each property state its location and description, the deed book reference, the mortgage book reference, and the amount of any mortgage, the date acquired, the purchased price, the current market value, the identity of any and all co-owners, and the nature of the interest each owner, including yourself, has in the property. Please attach copies of any and all appraisals regarding any and all real estate in which you have an interest. ANSWER: 14 15. If any property identified in Interrogatory No. 14 is income-producing, provide: a. identity of tenants, occupants, or source of income; and b. the annual or monthly rental or income paid by each. ANSWER: 15 16. With respect to each mortgage identified in Interrogatory No. 14, provide: a. identity of the mortgagee; b. identity of any co-mortgagors; C. the amount of the original mortgage obligation; d. the amount of the outstanding obligation; e. the amount and frequency of debt service thereon; and f. any and all documents relating to that mortgage. ANSWER: 1.6 17. With respect to any property or interest, whether business or residential, identified in Interrogatory No. 14, itemize operational or maintenance expenses. Such expenses include, but are not limited to taxes, mortgage payments, insurance, heating fuel, water, and other utilities. ANSWER: 1.7' 18. If you have sold or otherwise disposed of any real estate or interest therein within the past three (3) years, provide: a. location of the property; b. type of property; C. the date of sale or other disposition; d. the value at transfer; e. the sale price, if any; f. the net proceeds from any sale; 9. identity of the purchaser or transferee and any relationship you may have thereto; h. the disposition of the proceeds; and i. any and all documents relating thereto. AN_. 19 19. Please list and completely identify (including name and address of entity and account number) all financial accounts and assets and investments of any nature whatsoever which are or have been owned, possessed, or controlled by you individually or jointly with any other person or entity or by another for you in trust or for your benefit or in which you claim or have claimed to have an interest of any nature whatsoever, at this time or an any time during the preceding five (S) years. Your list must include, but is not limited to, the following assets: all checking, savings, and credit union accounts, investment accounts, certificates of deposit, time deposits, or other deposit assets, savings bonds, treasury notes, thrift plans, money market funds and assets held in trust; all accounts, debts, or other receivables which are owing to you; any "bearer bonds" or other debts owed to the holder or bearer of the document evidencing indebtedness any corporate or individual bonds, corporate or other evidences of indebtedness to you from any corporation, business, person, or entity whatsoever, any stock or stock options, limited partnerships, securities, bonds, mutual funds, or other ownership interests in any corporation or business not previously listed; and insurance policies and annuities not previously listed. Identify and attach copies of all documents evidencing or pertaining to the above assets, during the preceding three (3) years, and make available for inspection and copying all bank records, stock certificates, investment summaries and/or statements, money orders, cashier checks, drafts, check stubs, check registers, and check books evidencing transfers, exchanges, or payments of funds. ANSWER: 1.9 20. Since the date of the marriage, have there been accounts at a savings or commercial banking institution on which your name did not appear but in which you were deposited funds? If so, for each account, identify the name and address of the institution, each name under which the account was/is held, the account number, and the approximate date and amount of each deposit made by you. ANSWER: 20 21. Since the date of marriage, have there been any accounts at a savings or commercial institution on which your name does not appear but from which you have withdrawn money by check or other method? If so, for each account state the name and address of the institution, each name under which each account wastis held, the account number, date and amount of each withdrawal by you, and the reason for each withdrawal. ANSWER: Safe Deposit Boxes 22. Do you now or have you at any time since the date of the marriage (either alone or with another) maintained or had access to a safe deposit box? If so, for each box identify the name and address of each co-owner, location, account, or identifying number, complete contents of the box on the date of separation, and identify each item removed or added to the box since the date of separation, by whom, and the number of times it was visited in the last three (3) years. ANSWER: 21 Vehicles and the Like 23. If you have any interest in an automobile, truck, trailer, camper, mobile home, motorcycle, boat, aircraft, or vehicle of any nature, identify each and your interest therein, and provide the following: a. make, model, and year, b. date acquired; C. the purchase price, if any; d. if not purchased, its value at acquisition; e. the present market value; f. its present location; and g. the name and address of any co-owners or interest holders. ANSWER: 22 24. State the nature of any lien or security interest to which any of the items listed by you in your answer to the preceding question are subject, indicating the name and address of the holder thereof, the holder's relationship to you, the amount and frequency of payments you make thereto, and the balance date. AN. . 23--- Personal Property 25. Apart from any assets previously disclosed in your answers to these Interrogatories, please list all of your other assets, whether tangible or intangible, which are owned, possessed, or controlled by you individually or jointly with any other person(s) or entities or by another for you in trust or for your benefit, or in which you claim to have an interest of any nature whatsoever, at this time or any time during the preceding five (5) years. Your list must include, but is not limited to, the following assets: any automobile, motor vehicle, trailer, camper, mobile home, motorcycle, boat, aircraft, or vehicle of any nature; household furnishings and appliances; equipment; the contents of any safe deposit boxes; fur coats, jewelry, precious metals or stones; coin collections; sports collectibles or sports card collection; art work; and other tangible personal property assets in total (additionally specifying any particular item or collections of items of personal property with a value exceeding $500.00). Provide a complete description of each asset including identifying features such as account, serial, registration, or policy numbers, locations, names of manufacturers, and product models or brand names, and provide the date of acquisition, purchase price, or acquisition values, values as of the date of separation, and present fair market values for the above assets, and the present location of each identified item. ANSWER: 24 Inheritances and Contract Rights 26. If you have been named as a beneficiary, legatee, or heir in any estate of any decedent at any time during the past five (5) years, or if you have an expectancy to receive an inheritance or any other assets from any estate at this time, provide the identity and date of death of the decedent and your relationship to the decedent, the identity of the personal representative of the estate, the amount of the expectancy or inheritance you have received or expect to receive, and the county and state in which letter of administration or letters testamentary have been issued or will be issued. ANSWER: 25 I I 27. Do you own or have any interest in any property (real or personal), contract right, chose in action, or expectancy of any kind, including an interest or right titled or held in the name of another, not previously identified in your answers to the preceding Interrogatories? If so, describe in detail the property, contract right, chose in action, or expectancy and the present value thereof. ANSWER: 26 28. Do you have any interest under an annuity contract or contracts? If so, identify the name and address of each company, contract/policy number, date of issuance, present value, and maturity date. ANSWER Separate Property 29. Do you claim that there is any property in existence which is your separate property? If so, describe each item, identify its present location, the date and method of acquisition, source of funds to acquire, and facts relied upon to support your claim that the property is separate property. ANSWER: 27' Debts 30. Identify any and all liabilities or obligations of whatever nature, including a list of credit card accounts, that you have in your own name or held jointly with another person. Include the name and address of creditor, account number, balance as of the date of separation, current balance, and source of payments since the date of separation. AN-. 28 Gifts, Transfers, or Disposition of Property 31. If at any time during the three (3) years immediately preceding the filing of this action of divorce, or at any time since the filing of this action, you have made any gifts, sold, transferred, disposed of, or placed any assets of any nature or type whatsoever, into the possession, ownership, care, control, name, title, or custody of any other person, company, or entity, provide a complete description of the items, assets of interests, including a reference to any applicable account or certificate numbers, serial numbers, brand designations or the like, name, address of the purchaser, transferee, or donee, and your relationship to the purchaser, transferee, or donee, its value on the date of transfer, stating the date of transfer and the consideration which was received, if any, and the disposition of the proceeds. ANSWER: 29, Gifts or Loans 32. List the names and addresses of any person(s) to whom you may have given or lent money in excess of $500.00 per gift or loan, within the last five (5) years. ANSWER: Loan Application 33. If you have made formal and written application for a loan or for credit from any person, company, or entity during the past five (5) years, identify the person, company, or entity to whom such application or statements were furnished or supplied, and identify and attach copies of all such financial statements or applications. NCR: 30` Witnesses, Expert Witnesses, Reports 34. Identify and state the nature of your relationship to all persons whom were witnesses to or have knowledge or information of any relevant facts relating to this action, or who possess proof or evidence of the incidents or acts involved, specifying which were eyewitnesses; which have documents in their possession or under their control which relate to this action and which are expert witnesses (stating their area of expertise); and which you intend to offer at trial to support specific contentions. Identify an oral or written report or appraisals rendered to you or prepared by any such witness. Attach copies of any written reports so prepared or rendered. ANSWER: 31: Litiantion 35. Are you involved in any litigation as a party or otherwise? If so, identify by suit, county, docket number, and description of your involvement. ANSWER: Property Removed 36. Please provide a detailed itemization of all items of property removed by you from the marital residence property on or before the date of separation. ANSWER: 31 r r 37. What is the current state of your health, both physical and psychological or emotional? If you are under the care of a physician or other professional for any reason whatsoever, with respect to each such physician or professional, state the following: a. the name and address of the person; b. the purpose for which you are seeing the person; C. the time period during which you have been seeing the person, and the period during which it is anticipated that treatment will continue; d. your diagnosis and prognosis. ANSWER: 31 38. Itemize all income benefits, cash and non-cash, not already included in your Answers to any preceding Interrogatories, such as, but not limited to, pension plans, annuities, inheritances, retirement plans, Social Security benefits, lottery prizes, bank interest, dividends, etc. Provide the following: a. source of the benefit; b. amount and frequency of each; C. the basic terms; d. famish copies of any plans, annuity contracts, inheritance documents, trust documents, pension and retirement plans, as well as all amendments, modifications, and changes; e. for all pension or retirement plans, furnish copies of the most recent Summary Plan Description, individual insurance and annuity contracts, and record of individual account balance as of the last valuation date; and f. for any loans made against any of the above benefits, provide a copy. of any document signed in support of the loan. ANSWER: 3 4 39. What is the date on which you and your spouse separated? ANSWER: Date: NESTICO, DRUBY &. HILDABRAND, L.L.P. By: Karl R. Hildabrand Attorney I.D. No. 30102 840 E. Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Telephone (717) 533-5717 Fax Attorney for Plaintiff 35 CERTIFICATE OF,5ERVICE I, Karl R. Hildabrand, Esquire of the law firm Nestico, Druby & Hildabrand, LLP, hereby certify that I served a true and exact copy of the foregoing document referenced to the foregoing action by First Class Mail, postage prepaid, this day of February 2007, on the following: 7z Linda A. Clotfelter, Esquire 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 1 C 17 6 ICK-O -Z Karl R. Hildabrand 36 DARRYL E. BETTS : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. . : NO. 06-2143 MARLENA S. BETTS, : IN DIVORCE Defendant PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS DIRECTED TO DEFENDANT TO: Marlena S. Betts c% Linda A. Clotfelter, Esquire 5021 E. Trindle Road Suite 100 Mechanicsburg, PA 17050 Pursuant to Pa.R.C.P. 4009, you are hereby requested to produce for inspection and copying at the offices of the Defendant's counsel, Karl R. Hildabrand, Esquire, 840 E. Chocolate Avenue, Hershey, Pennsylvania 17033, or at such other location as may be mutually agreed upon by counsel not later than thirty (30) days after service of these Requests, the following documents. In lieu of the formal scheduled production, copies of all requested documents may be forwarded to Defendant's counsel at the above address within thirty (30) days after service of these Requests. Date: ill K U NESTICO, DRUBY & HILDABRAND, L.L.P. By: L?IIC - Karl R. Hildabrand Attorney I.D. No. 30102 840 E. Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Telephone (717) 533-5717 Fax Attorney for Plaintiff 1. Copies of the certificates of title for all vehicles which you own, have an ownership interest in, or have in your possession and/or control. In addition, if any of these vehicles have been appraised within the last year, a copy of each appraisal, including the name and address of the appraiser, the appraiser's curriculum vitae, and the appraised value. 2. Statements for the past three (3) years to the present showing any stocks, bonds, securities, and mutual funds owned by you, individually, or you, jointly, with any other person. 3. Statements for the past three (3) years to the present showing any pension, 401 K accounts, IRA accounts, profit sharing and/or retirement accounts owned by you, individually, or you, jointly, with any other person. In addition, the most recent description of any pension and/or retirement accounts in your name alone or jointly with any person. In addition, the most recent statement available for each account identified, showing the amount credited to your name, the name of the account, the number of the account, and any personnel or other manual detailing how contributions to the account are made. 4. A copy of all life insurance policies of which you are either the owner, insured, and/or beneficiary, or the premiums for which you are currently paying and a statement showing the current case surrender value of all policies produced. In addition, all statements generated for the last three (3) years showing the cash surrender value for all policies produced. 5. Copies of statements for the past three (3) years for any and all bank, savings and loan, investment, financial, certificates of deposit, or similar accounts showing the amount contained therein, the number of the account, the institution where located, and the account signatories. 6. A copy of your federal and state tax returns, including your W-2 forms, for the past five (5) years. 2 7. A copy of your pay stubs for the last six (6) months to the present. 8. A My-executed Income and Expense Statement pursuant to Pa.R.C.P.1910.26. 9. A fully-executed Inventory Statement pursuant to Pa.R.C.P. 1920.75. 10. Copies of the deeds for each parcel of real estate owned by you either individually or jointly with others at the time of separation and at the present. 11. Copies of all credit card of other debt statements for the past three (3) years for any debts owed individually or jointly by the parties hereto. 12. Copies of all documents identified in your Answers to Interrogatories in this case. 13. Copies of any and all documents reflecting the assets of the parties as of the date of separation. 14. Copies of any and all documents reflecting the debts of the parties as of the date of separation. 15. Copies of statements for the past three (3) years for any retirement, pension, profit sharing, 401Y%., IRA, investment or similar accounts showing the amount contained therein, the number of the account, and the institution where located or maintained. NESTICO, DRUBY & HILDABRAND, L.L.P. By: 44 -4 arl R. Hildabrand Attorney I.D. No. 30102 840 E. Chocolate Avenue ' Hershey, PA 17033 3 CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire of the law firm Nestico, Druby & Hildabrand, LLP, hereby certify that I served a true and exact copy of the foregoing document referenced to the foregoing action by First Class Mail, postage prepaid, this 1 day of February 2007, on the following: Linda A. Clotfelter, Esquire 5021 E. Trindle Road, Suite 100 Mechanicsburg, PA 17050 1 R. Hildabrand 4 ND NESTICO, DRUBY & IRDADUND, LLP 4=ORNEYSATLAW 840 East Chocolate Avenue, Hershey, PA 17033 Phone (717) 533-5406 Fax (717) 533-5717 www.hersheypalaw.com October 1, 2007 Jeanne' B. Costopoulos, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Re: Betts v. Betts, Docket No. 06-2143 Dear Jeanne': On February 14, 2007 I served your client with Plaintiffs First Set of Interrogatories and First Request for Production of Documents. To date I have not received your client's responses. Would you please forward those responses within the next fifteen (15) days. If for some reason you do not have copies of these discovery requests please advise and I will forward additional copies to you. Thank :you. Very truly yours, NESTICO, DRUBY & HILDABRAND, LLP Karl K Hildabrand KRH/mlp cc: Darryl Betts USTIC02 DRUBY & RDABRAND, LLP ATTOItNEYSATLAW 840 East Chocolate Avenue, Hershey, PA 17033 Phone (717) 533-5406 Fax (717) 533-5717 www.hersheypalaw.com October 10, 2007 Jeanne' B. Costopoulos, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Re: Betts v. Betts, Docket No. 06-2143 Dear Jeanne': Pursuant to your recent request, enclosed is another copy of the Plaintiffs discovery requests to Defendant with regard to the above matter. Very truly yours, NESTICO, DRUBY & HILDABRAND, LLP Karl R Hildabrand KRH/mlp Enclosures cc: Darryl Betts (w/out enc.) N D NESTIC0, DP BBY & KDABtW, LLP ATTORNEYSAT LAW W East Chocolate Avenue, Hershey, PA 17033 Phone (717) 533-5406 Fax (717) 533-5717 www.hersheypakw.com April 11, 2008 Jeanne' B. Costopoulos, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Re: Betts v. Betts, Docket No. 06-2143 Dear Jeanne': Mr. Betts has advised me that he wishes to move forward with the divorce. On February 14, 2007 we served Plaintiffs First Set of Interrogatories and First Request for Production of Documents to the Defendant upon Attorney Clotfelter. To date these have not been answered. I am sending additional copies to you with this letter in the chance that you did not receive those. Would you please forward your client's responses within the next twenty (20) days. Thank you. Very truly yours, NESTICO, DRUBY & HILDABRAND, LLP cie?? Karl R. Hildabrand KRH/mlp Enclosures cc: Darryl Betts (w/out enc.) A° 4 NDH NOR DMY & KDABRAND, LLP ATTORNEYS AT LAW 840 Fast Chocolate Avenue, Hershey, PA 17033 Phone (717) 533-5406 Fax (717) 533-5717 www.hersheypalaw.com October 10, 2008 Jeanne' B. Costopoulos, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Re: Betts v. Betts, Docket No. 06-2143 Dear Jeanne' : On February 17, 2007 we served Plaintiff's First Set of Interrogatories and First Request for Production of Documents to the Defendant upon Attorney Clotfelter. On October 19, 2007 I wrote to you and asked that your client respond to our outstanding discovery requests. On April 11, 2008 I wrote to you again and asked that your client respond to the discovery requests within twenty (20) days. I also sent you additional copies of the Interrogatories and Requests for Production. To date we have received no responses. Please be advised that if I do not receive your client's responses within fifteen (15) days of the date of this letter I will be filing a Motion to Compel. Very truly yours, NESTICO, DRUBY & HILDABRAND, LLP A l R Hildabrand KRWmlp cc: Daryl Betts P\ ?. p•, ,.- !. ?_ -. a..., { ,. DARRYL E. BETTS Plaintiff V. MARLENA S. BETTS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-2143 IN DIVORCE PLAINTIFF'S AMENDED PETITION TO COMPEL DISCOVERY On or about February 14, 2007 Plaintiff served its First Set of Interrogatories and First Request for Production of Documents directed to Defendant. Attached hereto, marked as Exhibit A and incorporated herein by reference are copies of said discovery requests. 2. Pursuant to Pa.R.C.P. 4006 and 4009.12 Defendant's responses were due on or before March 16, 2007. 3. On or about October 1, 2007, Counsel for Plaintiff sent correspondence to defendant's counsel indicating that the defendant's answers to Plaintiff s First Set of Interrogatories and First Request for Production of documents had not been received and requested that full and complete answers be provided within fifteen (15) days of the letter. Attached hereto, marked as Exhibit B and incorporated herein by reference is a copy of said correspondence. 4. On or about October 10, 2007, Counsel for Plaintiff sent correspondence to defendant's counsel and enclosed an additional copy of Plaintiff's First Set of Interrogatories and First Request for Production of documents to be answered by Defendant. Attached hereto, marked as Exhibit C and incorporated herein by reference is a copy of said correspondence only. 5. On or about April 11, 2008, Counsel for Plaintiff sent correspondence to defendant's counsel indicating that the defendant's answers to Plaintiffs First Set of Interrogatories and First Request for Production of documents had not been received and requested that full and complete answers be provided within twenty (20) days of the letter. Attached hereto, marked as Exhibit D and incorporated herein by reference is a copy of said correspondence. 6. On or about October 10, 2008, Counsel for Plaintiff sent correspondence to defendant's counsel indicating that the defendant's answers to Plaintiff's First Set of Interrogatories and First Request for Production of documents had not been received and requested that full and complete answers be provided within fifteen (15) days of the letter. Attached hereto, marked as Exhibit E and incorporated herein by reference is a copy of said correspondence. 7. To date, no responses have been received based upon the request to provide full and complete responses and records as stated herein. 8. Defendant's responses are overdue. 9. Defendant has not filed any objections to any of the discovery requests, nor has she filed any objection to the requests to provide full and complete answers and documents. 10. Previous to this motion, the Honorable Judge Edward E. Guido, entered an order on custody and the Honorable Judge M.L. Ebert, Jr. entered an order related to interim possession of the marital home. WHEREFORE, it is respectfully requested that this Court issue a Rule upon Defendant to show cause, if any she has, why full and complete answers to Plaintiff's First Set of Interrogatories and First Request for Production of Documents should not be served without objection within twenty (20) days from the date of this Court's Order or face sanctions as determined by the Court. Respectfully submitted, Date: NESTICO, DRUBY & HILDABRAND, LLP Z rZ6 Karl R. Hildabran , Esquire Attorney I.D. No. 30102 Scott A. Stein, Esquire Attorney I.D. No. 81738 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 Attorney for Defendant CERTIFICATE OF SERVICE I, Scott A. Stein, of the law firm of Nestico, Druby & Hildabrand, L.L.P., hereby certi that on the ? day of December 2008, a copy of the foregoing document was sent via First Class U.S. Mail, postage paid, to the following: Jeanne B. Costopolous, Esquire The Executive Offices at Rossmoyne 5000 Ritter Road, Suite 202 Mechanicsburg, PA 17055 Scott A. Stein ?- exs > cn DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. MARLENA S. BETTS, DEFENDANT NO. 06-2143 CIVIL ORDER OF COURT AND NOW, this 17th day of December, 2008, upon consideration of the Plaintiff's Amended Petition to Compel Discovery, IT IS HEREBY ORDERED AND DIRECTED that the Defendant shall provide the Answers to the First Set of Interrogatories and First Request for Production of Documents to the Defendant on or before January 31, 2009. IT IS FURTHER ORDERED AND DIRECTED that should the Defendant fail to comply with this Order by January 31, 2009, a hearing on this matter shall be scheduled for Tuesday, February 10, 2009, at 9:00 a.m. in Courtroom No. 5 of the Cumberland County Courthouse, Carlisle, Pennsylvania at which time a Rule shall issue upon the Defendant to show cause why she should not be held in contempt. /Scott Stein, Esquire /Attorney for Plaintiff Jeanne Costopoulos, Esquire Attorney for Defendant bas lea ? ES' ?.?-??1? I By the Court, ' -4, M. L. Ebert, Jr., J. ( ! :1 4d 8 P 330 86OZ At3`d± Vi' -;- ?.i jG Karl R. Hildabrand, Esquire Lavery Faherty Patterson N 225 Market Street, Suite 304 M fm =K P.O. Box 1245 xv` --K -a Harrisburg, PA 17108-1245 (717) 233-6633 (telephone) (717) 233-7003 (facsimile) < s,• rr Atty No. PA30102 c kildabrand@laverylaw.com '- Atty for Plaintiff, Darryl E. Betts IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DARRYL E. BETTS, Plaintiff V. MARLENA S. BETTS, Defendant NO. 06-2143 CIVIL ACTION - LAW IN DIVORCE PRAECIPE TO WITHDRAW AND ENTER APPEARANCE PRAECIPE TO WITHDRAW APPEARANCE TO THE PROTHONOTARY: Kindly withdraw the appearance of Karl R. Hildabrand, Esquire and Nestico, Druby & Hildabrand, PC, as counsel for Plaintiff, Darryl E. Betts, in the above matter. Respectfully submitted, NESTICO, DRUBY & HILDABRAND, PC B re??? Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 840 East Chocolate Avenue Hershey, PA 17033 (717) 533-5406 (717) 533-5717 Date: May 10, 2012 Attorney for Plaintiff, Darryl E. Betts PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance on behalf of Plaintiff, Darryl E. Betts, in the above matter. Respectfully submitted, Lavery Faherty Patterson arl R. Hildabrand, Esquire 225 Market Street, Suite 304 P.O. Box 1245 DATE: May 10, 2012 Harrisburg, PA 17108-1245 (717) 233-6633 (telephone) (717) 233-7003 (facsimile) Atty No. PA30102 khildabrand@laverylaw.com Atty for Plaintiff, Darryl E. Betts CERTIFICATE OF SERVICE I, Janice L. Holzer, an employee with the law firm of Lavery Faherty Patterson, do hereby certify that on this 10th day of May, 2012, I served a true and correct copy of the foregoing Praecipe to Withdraw and Praecipe to Enter Appearance, via U.S. First Class mail, postage prepaid, addressed as follows: Jeanne B. Costopoulos, Esquire 130 Gettysburg Pike, Suite C Mechanicsburg, PA 17055 ja'2? ZO-olf a Y' J ce L. Holzer, Legal Secrd(Kry to Karl R. Hildabrand, Esquire M U DARRYL E. BETTS, IN THE COURT OF COMMON PLEAS OF 2 Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V V. No. 06-2143 CIVIL ACTION LAW MARLENA S. BETTS, IN CUSTODY Defendant Prior Judge: Edward E. Guido, J. ORDER OF COURT AND NOW this 7 day of April 2013, upon consideration of the attached Custody Conciliation Report, it is Ordered and Directed as follows: 1. Legal Custody: The Father, Darryl Betts, and the Mother, Marlena Betts, shall have shared legal custody of Mandi Betts,born 01/25/1996. The parties shall have an equal right to make all major non-emergency decisions affecting the Child's general well-being including, but not limited to, all decisions regarding her health, education and religion. Pursuant to the terms of 23 Pa.C.S. §5309, each parent shall be entitled to all records and information pertaining to the Child including,but not limited to,medical, dental, religious or school records, the residence address of the Child and of the other parent. To the extent one parent has possession of any such records or information, that parent shall be required to share the same, or copies thereof, with the other parent within such reasonable time as to make the records and information of reasonable use to the other parent. 2. Physical Custody: Mother shall have primary physical custody of the Child subject to Father's physical custody as follows: a. Commencing Friday 04/19/13, during the school year, Father shall have physical custody of Mandi on alternating weekends from Friday evening until Sunday 10:30 am, whereby Father shall drop Mandi off at the Mechanicsburg Brethren in Christ Church for services with Mother. Mother shall then return Mandi to Father by 2 pm and Mandi shall be returned to Mother by Sunday 6 pm. b. During the summer, his alternating weekends shall be from Friday after work until Sunday 10:30 am dropping Mandi off at the Mechanicsburg Brethren in Christ Church with Mother and then from Sunday 2 pm until Monday morning. C. It is understood that due consideration shall be given to Mandi's desires to spend time with Father after the church service on Sunday at Mechanicsburg Brethren in Christ. d. Father shall also have custodial time at least one evening per week from 4 pm until 8 pm by agreement of the parties. In addition, Father shall have time with Mandi every Thursday at 6:30 pm for bowling at ABC West. e. Each parent shall ensure that Mandi attends her regularly scheduled extra- curricular events. f. Father shall have physical custody of the Child at such other times as the parties may mutually agree. 3. The non-custodial parent shall have liberal telephone/text/email/Skype/Facebook contact with Mandi on a reasonable basis. 4. Holidays: The parents shall arrange the holiday schedule as attached unless otherwise mutually agreed upon. 5. Each parent shall have two non-consecutive weeks of vacation with the Child per year. The requesting parent shall give the other parent 30 days advance notice of the requested time and this vacation week shall supersede the regular physical custody schedule. In the event the parties schedule conflicting vacations, the party first providing written notice shall have the choice of vacation. Prior to departure,the parties will provide each other with information regarding the intended vacation destination and a telephone number at which they can be reached during their vacation. The parties may expand this vacation time by mutual agreement. 6. In the event the custodial parent should take the Child out of state, the custodial parent shall. notify the non-custodial parent within twenty-four hours of departure of the intended destination and a telephone number at which they can be reached. 7. Neither party may say or do anything nor permit a third party to do or say anything that may estrange the Child from the other party, or injure the opinion of the Child as to the other party, or may hamper the free and natural development of the Child's love or affection for the other party. To the extent possible,both parties shall not allow third parties to disparage the other parent in the presence of the Child. 8. In the event of a medical emergency,the custodial party shall notify the other party as soon as possible after the emergency is handled. 9. During any periods of custody or visitation,the parties shall not possess or use illegal substances or consume/be under the influence of alcoholic beverages to the point of intoxication. The parties shall likewise assure, to the extent possible, that other household members and/or house guests comply with this provision. . 10. Relocation. The parties are advised that neither party shall hereafter relocate the child or children if such relocation will significantly impair the ability of a non-relocating party to exercise his or her custodial rights unless (a) every person who has custodial rights to the child/children consents to the proposed relocation or(b) the court approves the proposed relocation. The party seeking relocation must follow the procedures required by 23 Pa,C.S. §5337. 11. This Order is entered pursuant to a Custody Conciliation Conference. The parties may modify the provisions of this Order by mutual consent. In the absence of mutual consent, the terms of this Order shall control. L B e Court rn NrCr CD ..:% �) n Distribution: n /arl Hildabrand, Esquire y r rJ `' Xiarlena Betts, 7535 Wertzville Rd.,Carlisle, PA 17013 ' ca ,8ohn J. Mangan, Esquire A ,\ ` HOLIDAYS AND TIMES EVEN ODD SPECIAL DAYS YEARS YEARS Easter Day From 8 am until 8 pm Father Mother Memorial Day From 8 am until 8 pm Mother Father Independence Day From 8 am until 8 pm Father Mother Labor Day From 8 am until 8 pm Mother Father Thanksgiving From 8 am until 8 pm Father Mother Christmas V Half From noon on 12/24 to 1 pm on Mother Father 12/25 Christmas 2° Half From I pm on 12/25 to 8 pm 12/26 Father Mother New Year's From 8 am until 8 pm Mother Father Mother's Day From 8 am until 8 pm Mother Mother Father's Day From 8 am until 8 pm Father Father DARRYL E. BETTS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. No. 06-2143 CIVIL ACTION LAW MARLENA S. BETTS, IN CUSTODY Defendant Prior Judge: Edward E. Guido, J. CUSTODY CONCILIATION SUMMARY REPORT IN ACCORDANCE WITH CUMBERLAND COUNTY RULE OF CIVIL PROCEDURE 1915.3-8(b), the undersigned Custody Conciliator submits the following report: 1. The pertinent information pertaining to the Child who is the subject of this litigation is as follows: Name Date of Birth Currently in the Custody of Mandi Betts 01/25/1996 Primary Mother 2. A prior Order of Court was issued 08/17/2007. A Conciliation Conference was held with regard to this matter on April 09, 2013 with the following individuals in attendance: The Mother, Marlena Betts, self-represented party. The Father, Darryl Betts, with his counsel, Karl Hildabrand, Esq. 3. The parties agreed to the entry of an Order in the form as attached. Da—ate J angan, Esquire Cus dy Conciliator Karl R. Hildabrand,Esquire Pao (1 /C 7A y z: Lavery Faherty Patterson ��26 P 225 Market Street, Suite 304 '(���� lf 1 7 P.O. Box g PA 17108-1245 'S Y��cou Harrisbur , 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrand@laverylaw.com Attorney for Plaintiff DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-2143 CIVIL ACTION - LAW MARLENA S. BETTS, Defendant IN DIVORCE MOTION FOR APPOINTMENT OF MASTER AND NOW COMES Darryl E. Betts, Plaintiff, in the above captioned matter, by and through his counsel, Lavery Faherty Patterson, and respectfully requests the Court 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 claim(s) for which the appointment of the master is requested. 2. The non-moving party has appeared in the action through her attorney, Peter J. Daley, II, Esquire. 3. The statutory grounds for divorce is/are: 23 Pa. C.S.A. § 3301(c). 4. The action is contested with respect to the following claims: Divorce, Equitable Distribution, Alimony, Alimony Pendente Lite, Support, Counsel Fees, Costs and Expenses. 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take 1-2 days. 7. Additional information relevant to the motion: a. Pursuant to Cumberland County Local Rule 208.3(2), the Plaintiff states that Judge M.L. Ebert, Jr., has previously ruled on discovery issues in the divorce matter, and that Judge Edward E. Guido has signed a stipulated order for custody. b. Pursuant to Cumberland County Local Rule 208.3(9), counsel has sought the concurrence of opposing counsel in the request for appointment of a Master, and counsel does/does not concur in the request. WHEREFORE, it is respectfully requested the Court appoint a Master in Divorce to resolve the aforementioned claims. Respectfully submitted, LAVERY FAHERTY PATTERSON Date: ar R. Hildebrand, Esquire Attorney I.D. No. 30102 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg, PA 17108-1245 (717) 233-6633 (717) 233-7003 khildabrand@laverylaw.com Attorney for Plaintiff 2 CERTIFICATE OF SERVICE 1, Karl R. Hildabrand, Esquire, with the law firm of Lavery Faherty Patterson, do hereby certify that on this ` day of April, 2013, I served a true and correct copy of the foregoing Motion for Appointment of Master, via U.S. First Class mail, postage prepaid, addressed as follows: Peter J. Daley, Esquire Peter J. Daley &Associates, P.C. 242 Wood Street California, PA 15419-1038 Hildabrand, Esquire 3 r p,. Karl R.Hildabrand,Esquire OF !1'Q �� . C f�{� �n �r, Attorney I.D.No.30102 l F�QNO TIAf: l Jessica S.Hosenpud,Esquire 2013 APR Attorney ID.No.307656 2F P ,: Lavery Faherty Patterson f 225 Market Street,Suite 304 PE vS QV cou��rr P. O.Box 1245 CO Harrisburg,PA 17108-1245 +� Tel: 717-233-6633 Fax: 717-233-7003 E-mail:khildabrand @)averylaw.com E-mail:jhosenpud@laverylaw.com Attorneys for Plaintiff DARRYL E. BETTS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO: 06-2143 CIVIL ACTION - LAW MARLENA S. BETTS, Defendant IN DIVORCE INVENTORY OF DARRYL E. BETTS Plaintiff, Darryl E. Betts, files the following inventory of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three years. Plaintiff, Darryl E. Betts, verifies that the statements made in this inventory are true and correct. Darryl E. Betts understands that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification of authority. Date. I ` By: Darryl E. Be s ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets in the following pages. (X) 1. Real Property (X) 2. Motor Vehicles (X) 3. Stocks, bonds, securities and options O 4. Certificates of deposit (X) 5. Checking accounts, cash ( ) 6. Savings accounts, money market and savings certificates O 7. Contents of safe deposit boxes ( ) 8. Trusts (X) 9. Life insurance policies (indicate face value, cash surrender value and current beneficiaries) O 10. Annuities ( ) 11. Gifts ( ) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties (X) 14. Personal property outside the home (X) 15. Business (list all owners, including percentage of ownership and officer/director positions held by a party with company) ( ) 16. Employment termination benefits—severance pay, 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) O 22. MilitaryN.A. benefits ( ) 23. Education benefits (X) 24. Debts due, including loans, mortgages held (X) 25. Household furnishings and personalty (include as a total category and attach itemized list of distribution of such assets in dispute) ( ) 26. Other MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have legal or equitable interest individually or with any other person as of the date this action was commenced. Item Descri tion Names of Number of Property All Owners Value Real Estate 1. 7535 Wertzville Road, Carlisle, PA 17013 Joint $246,500.00 (appraisal 2010) 2. Carlisle Property Husband+ $55,000.00 Wife's Father Vehicles, etc. 3. 2005 Dodge Ram Pick-up Husband $13,000.00 4. 2008 Scion TC Joint $10,500.00 5. 2007 Car Mate Trailer Husband $6,000.00 6. 2011 Sure Trac Trailer Husband $3,000.00 7. 2006 John Deere 110 Backhoe Husband $25,000.00 8. 2007 John Deere 1445 Mower Husband $12,000.00 9. 2011 John Deere 1445 Mower Husband $15,000.00 10. 2001 Dodge Neon Wife $3,800.00 11. 2008 Chevrolet Equinox Wife $10,199.00 Bank Accounts 12. Orrstown Checking 4111900701 Husband $50.62 (9/1) 13. Orrstown Checking #111900278 Husband $898.94 (9/1) 14. Orrstown Account#147000669 Wife $unknown 15. Members First#44844 Joint $265.81 (9/1) 16. Members First.#301080 Husband $5.00 (9/1) 2 17. Members First#265531 Wife $586.11 18. PNC Health Savings Account Wife $973.69 (at least) Stocks, Bonds, etc. 19. Series EE Savings Bonds Wife $unknown 20. Franklin Income, Utilities & Small Cap Funds Joint $unknown Life Insurance 21. Lincoln Financial (Jefferson Pilot)No. 2081022 Wife $1,920.17 22. Lincoln Financial (Chubb)No. 009016194 Wife $unknown Insured: Marlena Beneficiary: Darryl 23, Lincoln Financial (Chubb)No. 009016191 Wife $unknown Insured: Darryl Beneficiary: Marlena 24. Lincoln Financial (Farmington)No. 2083988 Wife $1,127.56 Insured: Cariana (8/2011) 25. Farmington Co. (Chubb)—K56507 Wife $unknown Insured: Mandi 26. Providian Life and Health—Wife &Husband Wife $unknown 27. Unum Life Insurance Policy No. 167588103 Wife $unknown Businesses 28. Betts Lawn Care Service Husband $0.00 (sole proprietorship) (appreciation only) Retirement Plans 29. Holy Spirit 401(k) Wife $79,274.00 30. Fidelity Roth IRA Husband $76.01 31. Roth IRA Wife $unknown 32. Holy Spirit 403(b) Wife $1,201.81 3 Personal Property 33. 2006 Hand Mower (business) Husband $300.00 34. 2011 Snapper Hand Mower(business) Husband $800.00 35. Air Compressor 60 gallon Husband $500.00 36. Miscellaneous Tools Husband $1,000.00 37. Lawn Sprayer Husband $500.00 38. Pressure Washer Husband $500.00 39. Snow Blowers Husband $1,000.00 40. 30 ounces of silver Joint $1,500.00 (amount paid) 41. Guns and Weapons Husband $900.00 (Mossburg 835 12 gauge shotgun, Glock 23 .40 S&W pistol, Hoyt Bow) 42. Jewelry Wife $unknown 43. Gold Shavings Wife $unknown 44. Longaberger Baskets collection (around 30) Wife $unknown 45. Antique Sewing Machines (2) Wife $unknown 46. All household furniture except Wife $10,000.00 kitchen table and dresser 4 NON-MARITAL PROPERTY Plaintiff lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property. Item Description Names of Reason Number of Property All Owners for Exclusion 1. Computer Husband Acquired Post-Separation 2. Computer Desk Husband Acquired Post-Separation 3. Bedroom Set Husband Acquired Post-Separation 4. Drum Set Husband Acquired Post-Separation 5. Bass Guitar, Amp Husband Acquired Post-Separation Speakers 6. 2003 Ford F250 Truck Husband Acquired Post-Separation 7. Members 1" Loan—for#6 Husband Taken Post-Separation 8. Trumpet Husband Pre-Marital 9. Husband's Business Husband Pre-Marital 10. Husband's Equipment/Tools Husband Pre-Marital 11. Misc. Personal Property Husband Acquired Post-Separation 12. Husbands guns and rifles Husband Pre-Marital (Remington 30-06 Springfield, Remington 1100 12 gauge shotgun, Ithaca 31 12 gauge shot gun) 13. 20 Ounces of Silver Husband Acquired Post-Separation 14. MembersFirst Loan 9/23/11 Wife Vehicle Loan Post-Separation 15. Blue Spruce Kitchen Table Husband From Grandfather's Tree and Chairs 16. Stereo System Husband Pre-Marital. 17. Cherry Dropleaf Table Husband . Pre-Marital 5 18. Husband's Childhood Husband Pre-Marital Dresser 19. Home Equity Line Wife's Father Post-Separation with Orrstown Bank . Gift to Wife from her Father 6 PROPERTY TRANSFERRED Person to Item Description Date of Whom Number of Property Transfer Consideration Transferred 3 2005 Dodge Truck October 2011 $12,000.00 Reading Car Dealership 5 2008 Scion TC November 2, 2011 $10,500.00 Willow View 10 2001 Neon August 2012 $3,800.00 unknown (by Wife) 28 30 ounces of silver April 2012 $1,750.00 Various (e-bay) 19 Series E&EE Bonds December 2011 $unknown unknown 44 Longaberger Baskets Unknown $unknown unknown 7 LIABILITIES Item Description Name of Name of Number of Property all Creditors all Debtors Balance Due 1. Mortgage Orrstown Bank Joint $181,768.73 (d/s) 2. Home Equity Line Orrstown Bank Joint $19,612.97 (d/s) 3. Visa *6963 Bank of America Husband $22,713.11 (d/s) 4. Visa *3470 Chase Husband $15,791.98 (d/s) 5. Master Card *9991 Advanta Husband $3,517.29 (d/s) 6. Master Card *9591 Sears Husband $6,303.69 (d/s) 7. Unknown# Members First Wife $7,580.04 (d/s) 8. JD*3125(Backhoe) John Deere Credit Husband $23,711.91 (d/s) 9. JD*3733(Mower '07) John Deere Credit Husband $6,571.32 (d/s) 10. JD *1523(Mower 'I 1)John Deere Credit Husband $19,510.08 (d/s) 11. John Deere *2071 John Deere Account Husband $771.39 (d/s) 12. John Deere *7975 John Deere Account Husband $3,148.27 (d/s) 13. Loan Scion TC Joint $7,505.40 (d/s) (paid off by sale) 14. Used Auto Loan Members First Husband $7,702.73 (d/s) 8 CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire, with the law firm of Lavery Faherty Patterson, do hereby certify that on this day of April, 2013, I served a true and correct copy of the foregoing Inventory of Darryl E. Betts, via U.S. First Class mail, postage prepaid, addressed as follows: Peter J. Daley, Esquire Peter J. Daley &Associates, P.C. 242 Wood Street California, PA 15419-1038 r R. Hildabrand, Esquire 9 LED-OFFICE Karl R. Hildabrand,Esquire OF Ti f� Pj�o�f THONO TAJ�y Lavery Faherty Patterson 225 Market Street, Suite 304 201"J7 APR 26 PM 1: 16 P.O. Box 1245 Harrisburg, PA 17108-1245 CUMBERLAND COUNTY 717-233-6633 (telephone) PE"SYLVANIA 717-233-7003 (facsimile) kliiidabrand@lavealaw.com Attorney for Plaintiff DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO, 06-2143 CIVIL ACTION - LAW MARLENA S. BETTS, Defendant IN DIVORCE INCOME AND EXPENSE STATEMENT OF PLAINTIFF, DARRYL E. BETTS LAVERY FAHERTY PATTERSON By: Y� . Hildabrand, Esquire Attorney I.D.No. 30102 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg, PA 17108-1245 (717) 233-6633 (717) 233-7003 khildabrand@laverylaw.com Attorney for Plaintiff ti INCOME AND EXPENSE STATEMENT OF DARRYL E. BETTS Employer: Betts Lawn and Landscape Address: 7535 Wertzville Road, Carlisle,PA 17013 Type of Work: Self Employed, Landscaping, Seasonal Payroll Number: Pay Period: Weekly See attached Income and Expense Statement for Sole Proprietorship GROSS PAY PER PERIOD: Itemized Payroll Deductions: Federal Withholding Social Security Medicare Allotment, Savings Local Wage Tax State Income Tax Unemployment Tax Retirement(401K) Savings Bonds Vision Dental Health Insurance AD&D Life Insurance Dependent Life LST Stock Purchase Child Support NET PAY PER PERIOD: OTHER INCOME: WEEK MONTH YEAR Interest Dividends Pension Annuity Social Security Rents Royalties Expense Account Unemployment Compensation Workmen's Compensation TOTAL OTHER INCOME: TOTAL MONTHLY NET INCOME: . . ~ WEEKLY MONTHLY YEARLY Mortgage(escrow, ins,taxes incl) $1127.07 Rent $400.00 Repairs $100.00 Electric $22.00 Gas/Propane $109.00 Oil Telephone/Cell Phone $192.00 Water $252.76 Sewer Public Transportation Lunch Real Estate See mortgage Personal Property $600.00 Income $5,234.00 Homeowners See mortgage Automobile $1,200.00 Life Accident Other Payments $720.00 Fuel $150.00 Repairs $200.00 Maintenance Licenses $25.00 Registration $25.00 Auto Club Doctor $200.00 Dentist $100.00 Orthodontist Hospital Medicine Special Needs(eyeglasses,contacts) Private School Parochial School � � College Religious School Lunches Clothing $50.00 Food $50.00 Barber/Hairdresser $15.00 Personal Care $25.00 Laundry/Dry Cleaning $30.00 Hobbies $60.00 Memberships-Gym $50.00 CREDIT PAYMENTS: Credit Card $900.00 Charge Account LOANS OR DEBTS: Credit Union(trailer, mower,truck) $1,400.00 Household Help Child Care Camp Pet Expense $30.00 Entertainment $30.00 Pay TV $70.00 Vacation $1,000.00 Gifts $400.00 LegalFees $1,000.00 Charitable Contributions $1,000.00 Religious Memberships Children's Allowances Other Child Support See mortgage Alimony Payments Lessons for Children Music Study Sports TOTAL XPENSES: $150.00 $5,380.07 11,236.76 4 VERIFICATION I, Darryl E. Betts, do hereby verify the facts set forth in the foregoing document are true and correct to the best of my personal knowledge, inform ' statements here are made subject to the enalti anon and belief. I understand that false p es of 18 Pa. C.s. § 4909, relating to unsworn falsification to authorities. Date: 13 Darryl E. Betts i 5 CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire, with the law firm of Lavery Fahert Patterson, certify that on this Y erson, do hereby day of April, 2013, I served a true and correct copy of the Income and Expense Statement of Darryl E. Betts, via U.S. First Class mail foregoing , postage prepaid, addressed as follows: Peter J. Daley, Esquire Peter J. Daley&Associates, P.C. 242 Wood Street California, PA 15419-1038 --'zx-- 9�rl R. Hildabrand, Esquire 6 Darryl E. Betts, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA C-) c N - V. NO: 06-2143 rnm CIVIL ACTION - LAW f n- Marlena S. Betts, sn� Defendant IN DIVORCE ► `. ORDER APPOINTING MASTER ' co AND NOW this l day of lV , 201, upon consideration of the Motion for Appointment of Master, IT IS HEREBY ORDERED THAT ��� 3 Esq., is appointed master with respect to the following claims: Lu� ZLftt�-t�L It,/,,KX BY THE COURT: J. MOVING PARTY NON-MOVING PAR'T'Y Name:Darryl E.Betts Name:Marlena S.Betts orne 's Name: Karl R.H ildabrand Es . ttorney's Name: Peter J.Daley,Esq. Attorney's Address: 225 Market Street.Suite 304 Attorney's Address: 242 Wood Street Harrisburg,PA 17108 California,PA 15419-1038 Attorney's Telephone#:(717)233-6633 Attorney's Telephone#:(717)221-0900 Attorney's E-Mail: khildabrand@lavealaw.com lavervlaw.com Attorney's E-Mail: Parry's Address and Telephone Party's Address and Telephone #if not represented by counsel: f #if not represented by counsel: Karl R.Hildabrand,EsquireP ILEDI--0 F FICE rn Attoey I.D.No.30102 DF Jessica S.Hosenpud,Esq. 20 13 JUL 12 PH 12: 4 1 Attorney I.D.No.307656 Lavery Faherty Patterson 225 Market Street,Suite 304 CUMBERLAND COLN-1-Y P.O.Box 1245 PENNSYLVANIA Harrisburg,PA 17108-1245 Tel: 717-233-6633 Fax: 717-233-7003 E-mail:kbildabrand@laverylaw.corn E-mail:jhosenpud@laverylaw.com Attorneys for Plaintiff DARRYL E. BETTS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-2143 MARLENA S. BETTS, IN DIVORCE Defendant PLAINTIFF'S PRETRIAL STATEMENT PURSUANT TO PA. R.C.P. 1920.33 1. List of Assets. (i) Marital Assets, Please see Exhibit"A" attached hereto and incorporated herein by reference. (ii) Non-Marital Assets Please see Exhibit"B" attached hereto and incorporated herein by reference. 2. Expert Witnesses. None 3. Witnesses. (i) Darryl E. Betts, Plaintiff (ii) Marlena S. Betts, Defendant, as on cross-examination 4. List of Exhibits. Please see Exhibit"C", attached hereto and incorporated herein by reference. 1M 4. Husband to retain his business and all accounts, vehicles and equipment and assume all business related debt. 5. Wife to retain 2008 Chevrolet Equinox and Honda Civic. 6. Husband will retain his Roth IRA and Wife will retain her retirement through Holy Spirit Hospital. 7. Bank accounts previously divided. 8. Each party retains their life insurance policies. 9. Husband assumes his credit card debt and Wife assumes her credit card debt. Respectfully submitted, LAVERY FAHERTY PATTERSON Date: '7 12- i By: Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 Jessica S. Hosenpud, Esquire Attorney I.D. No. 307656 225 Market Street, Suite 304 P. O. Box 1245 Harrisburg, PA 17108-1245 (717) 233-6633 (717) 233-7003 Attorneys for Plaintiff 3 } 5. Gross Income and Net Income as Reflected on Most Recent State and Federal Income Tax Returns and Pay Stubs. Please see Exhibit"D" attached hereto and incorporated herein by reference. 6. Expenses. Please see Exhibit"E" attached hereto and incorporated herein by reference. 7. Valuation of Pension or Retirement Benefits, Marital Portion Thereof and Supporting Documents. Please see Exhibit"F" attached hereto and incorporated herein by reference. 8. Claim for Counsel Fees. Husband is not requesting that Wife pay his counsel fees or costs, and believes any claim for counsel fees and costs by Wife should be denied. 9. Valuation of Personal Property. Please see Exhibit"A" attached hereto and incorporated herein by reference. 10. Marital Debts. Please see Exhibit"G" attached hereto and incorporated herein by reference. 11. Proposed Resolution of Economic Issues. Plaintiff has proposed the following to resolve the case: 1. Wife receives 7535 Wertzville Road and Wife to pay to Husband one half of the appraisal value less the debt owed (mortgage and home equity loan). Wife to refinance, removing Husband from the debt. 2. Wife to reimburse Husband $9,000 for her portion of mortgage and home equity loan payments made by Husband since separation. 3. Each party to retain personal property in their possession. 2 ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets in the following pages. (X) 1. Real Property (X) 2. Motor Vehicles (X) 3. Stocks,bonds, securities and options ( ) 4. Certificates of deposit (X) 5. Checking accounts, cash ( ) 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 beneficiaries) ( ) 10. Annuities. ( ) 11. Gifts ( ) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties (X) 14. Personal property outside the home (X) 15. Business (list all owners, including percentage of ownership and officer/director positions held by a party with company) ( ) 16. Employment termination benefits— severance pay, 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. Military/V.A. benefits ( ) 23. Education benefits (X) 24. Debts due, including loans,mortgages held (X) 25. Household furnishings and personalty(include as a total category and attach itemized list of distribution of such assets in dispute) ( ) 26. Other EXHIBIT;"' r r MARITAL PROPERTY Plaintiff lists all marital property in which either or both spouses have legal or equitable interest individually or with any other person as of the date this action was commenced. Item Description Names of Number of Property All Owners Value Real Estate 1. 7535 Wertzville Road, Carlisle, PA 17013 Joint $246,500.00 (appraisal 2010) 2. Carlisle Property(Sold September 2011) Husband+ $55,000.00 Wife's Father Vehicles, etc. 3. 2005 Dodge Ram Pick-up Husband $13,000.00 4. 2008 Scion TC Joint $10,500.00 5. 2007 Car Mate Trailer Husband $6,000.00 6. 2011 Sure Trac Trailer Husband $3,000.00 7. 2006 John Deere 110 Backhoe Husband $25,000.00 8. 2007 John Deere 1445 Mower Husband $12,000.00 9. 2011 John Deere 1445 Mower Husband $15,000.00 10. 2001 Dodge Neon Wife $3,800.00 11. 2008 Chevrolet Equinox Wife $10,199.00 Bank Accounts 12. Orrstown Checking#111900701 Husband $50.62 (9/1) 13. Orrstown Checking.#111900278 Husband $898.94 (9/1) 14. Orrstown Account#147000669 Wife $unknown 15. Members First#44844 Joint $265.81 (9/1) 16. Members First#301080 Husband $5.00 (9/1) 2 17. Members First#265531 Wife $586.11 18. PNC Health Savings Account Wife $973.69 (at least) Stocks, Bonds, etc. 19. Series EE Savings Bonds Wife $unknown 20. Franklin Income,Utilities & Small Cap Funds Joint $unknown Life Insurance 21. Lincoln Financial (Jefferson Pilot)No. 2081022 Wife $1,920.17 22. Lincoln Financial (Chubb)No. 009016194 Wife $unknown Insured: Marlena . Beneficiary: Darryl 23. Lincoln Financial (Chubb)No. 009016191 Wife $unknown Insured: Darryl Beneficiary: Marlena 24. Lincoln Financial (Farmington)No. 2083988 Wife $1,127.56 Insured: Cariana (8/2011) 25. Farmington Co. (Chubb)—K56507 Wife $unknown Insured: Mandi 26. Providian Life and Health—Wife &Husband Wife $unknown 27. Unum Life Insurance Policy No. 167588103 Wife $unknown Businesses 28. Betts Lawn Care Service Husband $0.00 (sole proprietorship) (appreciation only) Retirement Plans 29. Holy Spirit 401(k) Wife $79,274.00 30. Fidelity Roth IRA Husband $76.01 31. Roth IRA Wife $unknown 32. Holy Spirit 403(b) Wife $1,201.81 3 Personal Property 33. 2006 Hand Mower(business) Husband $300.00 34. 2011 Snapper Hand Mower(business) Husband $800.00 35. Air Compressor 60 gallon Husband $500.00 36. Miscellaneous Tools Husband $1,000.00 37. Lawn Sprayer Husband $500.00 38. Pressure Washer Husband $500.00 39. Snow Blowers Husband $1,000.00 40. 30 ounces of silver Joint $1,500.00 (amount paid) 41. Guns and Weapons Husband $900.00 (Mossburg 835 12 gauge shotgun, Glock 23 .40 S&W pistol, Hoyt Bow) 42. Jewelry Wife $unknown 43. Gold Shavings Wife $unknown 44. Longaberger Baskets collection (around 30) Wife $unknown 45. Antique Sewing Machines (2) Wife $unknown 46. All household furniture except Wife $10,000.00 kitchen table and dresser 4 NON-MARITAL PROPERTY Plaintiff lists all property in which a spouse has a legal or equitable interest which is claimed to be excluded from marital property. Item Description Names of Reason Number of Propertv All Owners for Exclusion 1. Computer Husband Acquired Post-Separation 2. Computer Desk Husband Acquired Post-Separation 3. Bedroom Set Husband Acquired Post-Separation 4. Drum Set Husband Acquired Post-Separation 5. Bass Guitar, Amp Husband Pre-Marital Speakers 6. 2003 Ford F250 Truck Husband Acquired Post-Separation 7. Members 1St Loan—for#6 Husband Taken Post-Separation 8. Trumpet Husband Pre-Marital 9. Husband's Business Husband Pre-Marital 10. Husband's Equipment/Tools Husband Pre-Marital 11. Misc. Personal Property Husband Acquired Post-Separation 12. Husbands guns and rifles Husband Pre-Marital (Remington 30-06 Springfield, Remington 1100 12 gauge shotgun, Ithaca 31 12 gauge shot gun) 13. 20 Ounces of Silver Husband Acquired Post-Separation 14. MembersFirst Loan 9/23/11 Wife Vehicle Loan Post-Separation 15. Blue Spruce Kitchen Table Husband From Grandfather's Tree and Chairs 16. Stereo System Husband Pre-Marital 17. Cherry Dropleaf Table Husband Pre-Marital EXHIBIT i� � 1 18• Husband's Childhood Husband Pre-Marital Dresser 19. Home Equity Line Wife's Father Post-Separation with Orrstown Bank Gift to Wife from her Father 6 EXHIBIT LIST 1. Real Estate a. Marital home appraisal b. Mortgage Statements — Orrstown Bank C. Home Equity Line — Orrstown Bank 2:. Motor Vehicles a. Blue Book Values b. Vehicle Loan Statements 3. Bank Accounts a. Orrstown Bank Checking Account Statements b. Members First Bank Statements C. PNC Health Savings Statements 4. Life Insurance a. Lincoln Financial Insurance Policy Statements b. Farmington Company Insurance Policy Statements C. Providian Life and Health Insurance Policy Statements d. Unum Life Insurance Policy Statements 5. Retirement a. Holy Spirit 401(k) Statements b. Fidelity Roth IRA Statements C. Holy Spirit 403(b) Statements 6. Liabilities a. Bank of America Visa Statements b. Chase Visa Statements C. Advanta Mastercard Statements d. Sears Mastercard Statements e. John Deere Backhoe Credit Statements f. John Deere 2007 Mower Credit Statements g. John Deere 20011 Mower Credit Statements 7. Stocks and Bonds a. Series EE Savings Bonds b. Franklin Income, Utilities & Small Cap Fund Statements 2 61040 Cielpariment of the Treasury---internal 1,— ue Service (99) 120121 U.S. Individual Income Tax Return OMBNo.154r0074 I IRS Use Only-Do not write o.-staple in this spam, For the year Jam 1-Dec.31,2012,or other tax year beginning 2012,ending 20 See separate instructions, Your first name and initial Last name Your social security number DARRYL E BETTS 206-62-3419 If a joint return,spouse's first name and initial Last name Spouse's social security number 167-58-8104 Home address(number and street).If you have a P.O.box,see instructions. Apt Yoke sure the SSN(s)above 388 BURNT HOUSE RD T no. and on line Sc are correct. City,town or post office,state,and ZIP code.If you have a foreign address,also complete spaces below(see instructions). Presidential Election Campaign Check here r you,or your spouse CARLISLE PA 17015 If filing jointly.want S3 to go to this fund,Checking a box below will Foreign country name Foreign provinceJstatelcounty Foreign postal code not change your tax or refund. I F�You r� Spouse Head of household(with qualifying person).(See instruzbons.)if Filing Status I Single 4 the qualifying person is a child but not your dependent,enter this 2 Married filing jointly(even V only one had income) child's name here.► Check only one 3 Married filing separately.Enter spouse's SSN above 5 Qualifying Md.(.,)with dependent child box. and full name here.► MARLENA S BETTS 6a X Yourself. if someone can claim you as a dependent,do not check box 6a Boxes checked 1 ........ ..• on 68 and 6b Exemptions b Spouse .................................................... ........... ............. ............ ...... 1. No.of children (4) V If on 6C who: c Dependents: child under.• lived with YOU (2)Dependent's (3)Dependents age 17i;lual t6 ,chil social security number relationship to you tax credit did not rive with (1) First.name LasLname (see ins" you due to divorce or-s"on If more than four (see instructions) dependents,see instructions and Dependents on 6c check here o. not entered above Add numbers Total number of exemptions claimed ...... lines above 0.on 7 Wages,salaries,Ups,etc.Attach Form(s)W-2. ....... ......... .......... .................... 7 Income Ba Taxable interest.Attach Schedule B if required........ .................................. Ba Attach Form(s) b Tax-exempt interest.Do not include on line 8a I 8b W-2 here.Also 9a Ordinary dividends.Attach Schedule B if required ...... .......... 9a attach Forms b Qualified dividends W-2G and .I....... ........ ...... 1099-R if tax 10 Taxable refunds,credits,or offsets of state and local income taxes 10 was withheld. 11 Alimony received ,........_... ............. .......... 11 If you did not 12 Business income or(loss).Attach Schedule C or C-EZ ...... 12 10, 114 get a W-2 13 Capital gain or(loss),Attach Schedule D If required,If not required,check here► LJ 13 , see instructions. 14 Other gains or(losses).Attach Form 4797 ...... 14 15a IRA distributions 15a b Taxable amount 151b .............. I I ­­­­­* 16a Pensions and annuities 116a I b Taxable amount .... ....... 16b Enciose,but do 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc.Attach Schedule E 17 not attach,any 18 Farm income or(loss).Attach Schedule F .......... .......... 18 payment.Also, please use . 19 Unemployment compensation .................. Form 11040-V. 20a Social security benefits ­... 20a f b Taxable amount .. 20b 21 Other income.List type and amount ..........I....I—.......1. 21 22 Combine the amounts in the far right column for lines 7 through 21.This is our total income 110- 22 11,265 23 Educator expenses 23 ..... ...... ......... .......... Adjusted 24 Certain business expenses of reservists,performing artists,and Gross fee-basis govemment officials.Attach Form 2106 or 2106-EZ .-...1. 24 Income 25 Health savings account deduction.Attach Form 8889 ....... ...... 25 26 Moving expenses.Attach Form 3903 26 ­.......... .......*­.... 27 Deductible part of self-employment tax,Attach Schedule SE I....... 27 714 28 Self-employed SEP,SIMPLE,and qualified plans ........ 28 29 Self-employed health insurance deduction 29 30 Penalty on early withdrawal of savings. ....... 30 31a Alimony paid b Recipients SSN 110, 31a 32 IRA deduction 32 33 Student loan interest deduction 33 34 Tuition and fees.Attach Form 8917 34 aS Domestic production activities deduct 5 36 Add lines 23 through 35 __ I I��­I­I�...­1. ­.­. 1 36 1 714 37 Subtract fine 36 from line 22.This is yo 37 10 ,551 For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see sea Form 1040(2012) DAA A 8879 IRS 9-file Signature Authorization OMS No.1545-GD74 Department of the Treasury 00- Do not send to the IRS.This is not a tax return. 2012 Internal Revenue Service 10, Keep this form for your records. Declaration Control Number(DON) Taxpayer's name Social security number DARRYL E BETTS 206-62-3419 Spouse's name Spouse's social security number 167-58-8104 - Part I Tax Return information —Tax Year Ending December 31, 2012 (Whole Dollars Only) I Adjusted gross income(Form 1040,line 38;Form 1040A,line 22;Form.1040EZ,line 4) ....... 1 10, 551 2 Total tax(Form 1040,line 61; Form 1040A,line 35;Form 1040F=7,line 10) ........ ........... ........ 2 1, 323 3 Federal income tax withheld (Form 1040,line 62;Form 1040A,line 36;Form 1040EZ,line 7) 3 82 4 Refund(Form I040,line 74a;Form 1040A,line 43a;Form 1040E-Z,line 11a;Form 1040-SS,Part 1,line 12a) 4 5 Amount you owe(Form 1040,line 76;Form 1040A,line 45:Form 1040EZ,line 12)........... ........... ....... 5 1,247 Part 11 Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return) Under penalties of pedury.I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements for the tax year ending December 31,2012,and to the best of my knowledge and belief,ft is true,correct,and complete.I further declare that the amounts in Part I above are the amounts from my electronic income tax return.I consent to allow my intermediate service provider,transmitter,or electronic return originator(ERO)to send my return to the IRS and to-receive from the IRS(a)an acknowledgement of receipt or reason for rejection of the transmission,(b)the reason for any delay in.processing the return or refund,and4c)the_date­.of-any-_refund..if-applicable,I authorize the U.S.Treasury-and its designated Financial Agent to initiate an RCN electronic funds withdrawal(direct debit)entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax,and the financial institution to debit the entry to this account This authorization is to remain in full force and effect until I notify the U.S,Treasury Financial Agent to terminate the authorization.To revoke(cancel)a payment,I must contact the U.S. Treasury Financial Agent at 1-BBB-353-4537.Payment cancellation requests must be received no later than 2 business days prior to the payment(settlement) date,I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment.I further acknowledge that the personal identification number(PIN)below is my signature for my electronic income tax return and,if applicable,my Electronic Funds Withdrawal Consent Taxpayer's PIN:check one box only I authorize HAMILTON & MUSSER, PC, CPAS to enter or generate my PIN F23419 ERO firm name Enterfive numbers,but as my signature on my tax year 2012 electronically filed income tax return. do not enter all zeros I Will enter my PIN as my signature an my tax year 2012 electronically filed income tax return.Check this box only If you are entering your own PIN and your return is filed using the Practitioner PIN method.The ERO must complete Part III below. Your signature► Date Y 03/16/13 Spouse's PIN:check one box only I authorize to enter or generate my PIN ERO firm name Enter five numbers,but as my signature on my tax year 2012 electronically filed income tax return. do not enter all zeros I will enter my PIN as my signature on my tax year 2012 electronically filed income tax return.Check this box only If you are entering your own PIN and your return is filed using the Practitioner PIN method.The ERO must complete Part Ili below, Spouse's signature 10, Date 110- Practitioner PIN Method Returns Onfy—continue below Part.111 Certification and Authentication—Practitioner PIN Method Only ERO'S EFIN/PIN.Enter your six-digit EFIN followed by your five-digit self-selected PIN. 1233199�399 do not enter all zeros I certify that the above numeric entry is my PIN,which'is my signature for the tax year 2012 electronically filed income tax return for the taxpayer(s)indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Publication 1345,-Handboq]k for Authorized IRS e-fil Providers of individual Income Tax Retums. ERO'S signature 0- 41 C Date 1 03/16/13 ERO Must Retain This Form —See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So For Paperwork Reduction Act Notice,see your tax return instructions. Form 9879(2012) DAA Form,1040(2012) ' DARRYL E BETTS 206-62-3419 Page Tax and 38 Amount from line 37(adjusted gross income).........................•......•........ ...... 38 Credits 39a Check r You were born before January 2,1948, Blind Total boxes if. Spouse was bom before January 2,1948, HBIind, I checkad► 39a b If your spouse itemizes on a separate return or you were a dual-status alien,check here 0- 39b Standard — Deduction 40 Itemized deductions(from Schedule A)or your standard deduction(see left margin). ••.•••...••. 40 5 , 950 for— 41 Subtract line 40 from line 38 .­­ ....... ...................... ...... ... 41 4, 601 -People who 42 Exemptions.Multiply$3,800 by the number on line 6d 42 3 ,800 check any ­­....*"­*...... ............. box on line 43 Taxable income.Subtract fine 42 from fine 41.9 line 42 is more than fine 41,enter-0- 43 801 39a or 391d or Form Form c ❑962 who can be 44 Tax(see Fist).Check garryfrom: a 78814(s) b 74972 11 siec." ........ 44 81 ,aimed as a 45 Altsmative minimum tax(see instructions).Attach.Form 6251 45 dependent, ... ....... ....... see 46 Add lines 44 and 45 46 81 instructions. ........ ....... .......... ........ . All others: 47 Foreign tax credit.Attach Form 1116 if required .... ...... 47 Single or 48 Credit for child and dependent care expenses.Attach Form 2441 48 Married filing separately, 49 Education credits from Form 8863,line 19 ....... 49 55,eso 50 Retirement savings contributions credit.Attach Form 8880 50 Married filing jointly or 51 Child tax credit.Attach Schedule 8812,if required 51 Qualifying 52 Residential energy credits.Attach Form 5695 52 widow(er), .......I I $11,900 53 Other credits from Form:a ❑ 3800 b F] 8861 C­[] 53 Head of nousehold, 54 Add lines 47 through 53.These are your total credits 54 $8,700 _J 55 Subtract line 54 from line 46. If line 54 is more than fine' ............... 55 81 -Othe.r 56 Self-employment tax Attach Schedule Si'''' ­...... I............. .11 56 1 ,242 Taxes 57 Unreported social security and Medicare tax from Form: a []'413'7....*b' 8­9*19'' 57 58 Additional tax on IRAs,other qualified retirement plans,etc.Attach Form 5329 if required 58 59a Household employment taxes from Schedule H...... ...... ...... ............... 59a b First-time homebuyer credit repayment.Attach Form 5405 if required .•... ... ...... 59b 60 Other taxes.Enter code(s)from instructions ............... so 61 Add lines 55 through 60.This is your total tax 110- 61 1 , 323 62 Federal income tax withheld from Forms W-2 and 1099 62 82 Payments 63 2012 estimated tax payments and amount applied from 2011 return 63 If you have h a ve a 64a Earned income credit(Etc), ...... . ............... 64a q ua Itt i n g b Nontaxable combat pay election 64b child,attach So,.,ul.E IC_ 65 Additional child tax credit.Attach Schedule 8812 65 66 American opportunity credit from Form 8863,line 8 66 67 Reserved 67 68 Amount paid with request for extension to file .. ....... 68 69 Excess social security and tier I RRTA tax withheld 69 70 Credit for federal tax on fuels.Attach Form 4136 70 71 Credits from Form: a F1 2439 b F1 Reserved cE] ...d L 8885 71 72 Add Fines 62,53,64a,and 65 through 71.These are your total payments ... 00- 72 82 Refund 73 If line 72 is more than line 61,subtract line 61 from line 72-This is the amount you overpaid 73 74a Amount of line 73 you want refunded to you,If Form 8988 is attached,check here.•.... .... llio- L 74a Direct deposit? Op- b Routing number 10. C Type: Checking Savings See 110- d Account number 75 Amount of line 73 you want applied to your 2013 estimated tax 00- 1 75 Amount 76 Amount you owe,Subtract line 72 from line 61.For details on how to pay,see instructions ► 76 1 ,247 You Owe 77 Estimated tax penalty(see instructions)....... ........ ...... 1 77 Third Party Do you want to allow another person to discuss this return with the IRS(see instructions)? X Yes.Complete below. No Designee ossIgnas'l Personal identification number(PIN) 1► 1 331991 name o,. TENNILLE M BURKHART, CPA Phone no. Ili- 717-697-3888 Under penalties of pedury,I declare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge and belief, Sign they are true,correct,and complete.Declaration of preparer(other than taxpayer)is based an all information of which preparer has any tarowledge, Here Your signature Date Your occupation Daytime phone number Join',return? See instr, LANDSCAPER If the IRS PIN,you an identity Keep copy Spouse's signature.If a joint return,both must sign. Date spouses o=pa i n Protection for,your enter it here records. Print Type preparer's name Pr 's sigma (see instr.) heck L if PTIN Paid TENNILLE M BURKRAlitT, CPA ck�N PIC elfampioyed l P00261037 Preparer Rrm'snarne ► HAMILTON & MUSSER PC CAS Firm'sEtN► 23-2213999 Use Only Firm's address 111- 176 CUMBERLAND PARKWAY Phone no. MECHANICSBURG PA 17055 717-697-3888 Form 1040(2012) DAA SCHEDULE C Profit or Loss From Business OMB No,1545-0074 (Form 1040) (Soie Proprietorship) 1 For information on Schedule C and Its instructions,go to www.irs.goviischadulac. 2012 0- Department o`the Treasury Attachment internal Revenue Service (99) 0,Attach to Form 1040,1040NR,or I041;partnerships generally must Me Form 1065. Sequence No. 09 Name of proprietor Social secutity,number(SSN) DARRYL E BETTS 206-62-3419 A Principal business or profession,including product or service(see instructions) B Enter rode from instructions LANDSCAPING ► 238990 C Business name.If no separate business name,leave blank, D Employer ID number(EIN),(see insir.) BETTS LAWN AND LANDSCAPE E Business address(including suite or room no.)00. .......S.A.ME .............. .....................I............ City,town or post office,state,and ZIP code F Accounting method: (1) Xj Cash (2) Accrual (3) Lj Other(specify) ► ....... .... .. G Did you'materially participate'in the operation of this business during 2012? If"No,'see instructions for limit on losses ...... 0 H If you started or acquired this business during 2012,check here............... ......... ....... ............. I Did you make any payments in 2012 that would require you to file Form(s)1099?(see instructions) Yes No J If"Yes,"did you or Will you file all required Forms 1099? ...................... ................ ... Yes No Part I Income I Gross receipts or sales See instructions for line I and check the box If this income was reported to you on Form W-2 and the"Statutory employee"box on that form was checked ......................... 1 116,742 2 Retums-and-allowances(see instructions) 2 3 Subtract line 2 from line 1 3 116,742 4 Cost of goods sold(from line 42) ............*.......*....... ......... 4 73 , 886 5 Gross profit Subtract line 4 from line 3 ........... ...*................................*......*..... .... ....... 5 42 , 856 6 Other income,including federal and state gasoline or fuel tax credit or refund(see instructions) ................ ...... 6 7 Gross income.Add lines 5 and 6 ......... ............. ....I—'....... ........... 7 42 , 856 Part 11 Expenses Enter expenses for business use of your home only on line 30. 8 Advertising 8 397 18 Office expense(see instructions) ........ IS 9 Car and truck expenses(see 19 Pension and profit-sharing plans....... 19 instructions) 9 20 Rent or lease(see instructions): .............................. 10 Commissions and fees 10 a Vehicles,machinery,and equipment 20a 11 Contract labor(see instructions). 11 b Other business property 20b 12 Depletion 12 21 Repairs and maintenance 21 3, 028 13 Depreciation and section 179 22 Supplies not included in Part 111) ...... 22 expense deduction(not 23 Taxes and licenses 23 546 included in Part 111)(see ............**...*...* — instructions)................. ..... i3 10,418 24 Travel,meals,and entertainment 14 Employee benefit programs a Travel –........... ...... 24a (other than on line 19) .. ......... 14 b Deductible meals and 16 Insurance (other than health) is 4, 893 entertainment(see instructions) 24b 16 Interest: 25 Utilities 25 389 a Mortgage(paid to banks,etc.) ... 16a 26 Wages(less employment credits) 26 b Other ISID 2,747 ........................... 27a Other expenses(from line 48) .... .... 27a 8 ,803 17 Legal and professional services... 17 1 r521 b Reserved for future use ............... 27b 28 Total expenses before expenses for business use of home.Add lines 8 through 27a 10, 28 32 ,742 29 Tentative profit or(loss).Subtract line 28 from line 7 ... ....­........*......*.......... ... 29 10,114 30 Expenses for business use of your home.Attach Form 8829.Do not report such expenses elsewhere 30 31 Net profit or(loss).Subtract line 30 from line 29. • If a profit,enter on both Form 1040, line 12(or Form 1040NR, line 13)and on Schedule SE, line 2. (if you checked the box on line 1,see instructions).Estates and trusts,enter on Form 1041,line 3. 31 10 ,114 • if a loss,you must go to line 32. 32 If you have a loss,check the box that describes your investment in this activity(see instructions). • If you checked 32a,enter the loss on both Form 1040, line 12,(or Form 1040NR,line 13)and 32a All investment is at risk. on Schedule SE, line 2.(if you checked the box an line 1,see the line 31 instructions),Estates and 32b Some investment is not trusts,enter on Form 1041, line 3. at risk. * If you checked 32b,you must attach Form 6198,Your loss may be limited. For Paperwork Reduction Act Notice,see your tax return instructions. Schedule C(Form 1040)2012 DAA DARRYL E BETTS 206-62-3419 Schedule C(Form 1040)2012 LANDSCAPING Page 2 -Part[IJ Cost of Goods Sold (see instructions) 33 Method(s)used to value dosing inventory: a D Cost b lower of cost or market c Other(attach explanation) 34 Was there any change in determining quantifies,costs,or valuations between opening and closing inventory? If"Yes,"attach explanation —I............. No Yes 35 Inventory at beginning of year.If different from last year's closing inventory,attach explanation 35 0 ........... ........ ....... ....... 36 Purchases less cost of items withdrawn fof personal use 36 ........................ ....................... 37 Cost of labor.Do not include any amounts paid to yourself... .............. 37 30, 860 38 Materials and supplies,,..... ....... ....... 38 431026 39 Other costs 39 40 Add lines 35 through 39 ......... ...... ....... ....... ...... 40 73, 886 41 Inventory at end of year --41 0. 42 Cost of goods sold.Subtract line 41 from line 40.Enter the result here and on line 4................................... 42 73, 886 Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes?(month,day,year)No- 44 Of the total number of miles you drove your vehicle during 2012,enter the number of miles you used your vehicle for. a Business.. ............... b Commuting(see instructions) c Other 45 Was your vehicle available for personal use during off-duty hours? Yes No 46 Do you(or Your spouse)have another vehicle available for personal use? Yes No .......... 47a Do you have evidence to support your deduction? Yes No .......... ....... ........ ........ ...... b If'Yes,"is the evidence written? ...... I I.... ........................ ...... ........ Yes No Part V- Other Expenses. List below business expenses not included on lines 8-26 or line 30. GASOLINE...& OIL 5 ' 889 . - . ........ TELEPHONE/INTERNET 1.111, .. ... ... ...... . ... ..............*...... ....*. ....... . ............................ 2,228 .........--.. ... ...........POSTAGE 217 ... .— .....I........11....... ....... ...... .............. FUEL: SHOP HEAT (PROPANE) 154 ............----.............. ......... ........ ...... SMALL EQUIPMENT 315 ............... ...... ............. ......I......... ............. ....... ............. ....... ...... ............ ...... ........ ........... .......... ........ ........ .................... ............... .......... ............... ..................... ........................ ....... .............. ........ ................................................. ....... ...... .............. ....... ........ ......................... ............. ......... ........ ....... ....... ................ ....... ......................... ............. ........... ........... ....................... ....... ..........—.-1..I.... ........................ ...... ........................ ....................... ..............................—...... .............. .............. .............................. ................ ...... ...... 48 Total other expenses.Enter here and on line 27a.... ...... ............ ......... .. 48 -8 ,803 DAA Schaduie C(Form 1040)2012 SCHEDULE SE Self-Employment Tax OMS No.1545-0074 (Form I 440) ► Information about Schedule SE and its separate instructions is at WwwJrs.gov1form1040. 2012 Department of the Treasury 10-Attach to Form 1040 or Form 1040NR. Attachment internal Revenue Service (99i Sequence No.17 Name of person with self-employment income(as shown on Form 1040) Social security number of person DARRYL E BETTS I with self-employment income 10- 1206-62-3419 Before you begin:To determine if you must file Schedule SE,see the instructions. May I Use Short Schedule SE or Must I Use Long Schedule SE? Note.Use this flowchart only if you must file Schedule SE.If unsure,see Who Must File Schedule SE in the instructions. Did you receive wages or tips in 2042? No Yes Are you a minister,member of a religious order,or Christian Science practitioner who received IRS approval not to be taxed Yes Was the total of your wages and tips subject to social security Yes on earnings from these sources,but you owe self-employment or railroad retirement(tier 1)tax plus your net earnings from 10 tax on other earnings? self-employment more than$110,1100? No No Are-you using-one of the optional-methods to figure your-nut Yes Did you-receive tips subject to social-security or Medicare tax Yes earnings(see instructions)? that you did not report to your employer? No No Did you receive church employee income(see instructions) Yes No Did you report any wages on Form 8919,Uncollected Social Yes Security and Medicare Tax on Wages? reported on Form"1-2 of$108.28 or more? No You may use Short Schedule SE below You must use Long Schedule SE on page 2 Section A —Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. I a Net farm profit or(loss)from Schedule F,line 34,and farm partnerships,Schedule K-1 (Form 1065), box-14,code A. la b If you received social security retirement or disability benefits,enter the amount of Conservation Reserve Program payments included on Schedule F,line 4b,or listed on Schedule K-1 (Form 1065),box 20,code Y I b 2 Net profit or(loss)from Schedule C,line 31;Schedule C-EZ,line 3;Schedule K-1 (Form 1065), box 14,code A(other than farming);and Schedule K-1 (Form 1065-13),box 9,code J1,- Ministers and members of religious orders,see instructions for types of income to report on this line.See instructions for other income to report.... . ..... ... .. ...... .............. ....... 2 10 , 114 3 Combine lines I a,I b,and 2 0 *.............. ...... 3 1 , 114 4 Multiply line 3 by 9�2.35%(.9235). If less than$400,you do not owe self-employment tax:do not file this schedule unless you have an amount on line I b '*....*.........­*................ ........ 00- 4 9,340 Note. If line 4 is less than$400 due to Conservation Reserve Program payments on line 1 b, see instructions. 5 Self-employment tax.If the amount on line 4 is, • $110,100 or less,multiply line 4 by 133%(.133).Enter the result here and on Form 1040, line 56, or Form 1040NR,line 54 • More than$110,100,multiply line 4 by 2.9%(,029).Then,add$11,450.40 to the result, Enter the total here and on Form 1040,line 56,or Form I D40NR,line 54 5 1 1 ,242 6 Deduction for employer-equivalent portion of self-employment tax. If the amount on line 5 is: • $14,643.30 or less,multiply line 5 by 57.51%(Z751) • More than$14,643.30,multiply line 5 by 50%(.50)and add $1100 to the result. Enter the result here and on Form 1040,line 27,or Form 1040NR,line 27 ................ ....... ...... ........ 714 For Paperwork Reduction Act Notice,see your tax return instructions. Schedule SE(Form 1040)2012 DAA Form 6251 Alternative Minimum Tax—lndivid6ials OMB No.1545-0074 De'partment of,the Treasury 110-110- Information about Form 6251 and its separate instructions is at vP.Vw.irs.gov1formaZ5j. 2012 internal Revenue service 00,Attach to Form 1040 or Form 1040.NR, Attachment Name(s)shown on Form 1040 or Form 104ONR C---M 32 DARRYL E BETTS Your social security number 206-62-3419 -3419 Part I Alternative Minimum Taxable Income (See instructions for how to Complete each line. I If filing Schedule A(Form 1040),enter the amount from Form 1040,line 41, and go to line 2.Otherwise, enter the amount from Form 1040,line 38,and go to line 7.(If less than zero,enter as a negative amount.) 1 10 551 2 Medical and dental,Enter the smaller of Schedule A(Form 1040),line 4,or 2.5%(.025)of Form 1040,fine.... ine..... 38,If zero or less,enter-0- 3 Taxes from Schedule A(Form 1-040)-,fine 9........I....... ....... ............... ...... ................ ............. 2 3 nt,F any,from line 6 of the worksheet in the instructions for this line...... 4 4 Enter the home mortgage interest adjustment, .......... ......... ....... ...... . 5 Miscellaneous deductions from Schedule A(Form 1040),line 27 6 Skip this fine. It is reserved for future use ...... 5 each 2 ,jalch 10 551 7 Tax refund from Form 1040,fine 10 or line 21................. . ..... ......... .......... ................ ....... 6 8 Investment interest expense(difference between regular tax a.no,AMT}. .......... 7 9 Depletion(difference between regular tax and AMT) .............. ...... . 8 10 Net operating loss deduction from Form 1040,line 21'.'Enter'as'a*positive'amount ........ ...... ........ 10 11 Alternative tax net operating loss deduction 12 Interest from specified private activity bonds'exempt,from*the regular,tax...... ................. ............. 13 Qualified small business stock(7%of gain excluded under section 1202) ......*...... .................*.... 1Z 14 Exercise of incentive stock options(excess of AMT income over regular tax inc I. ome)..... ...................... 13 15 Estates and trusts(amount from Schedule K-1 (Form 1041),box 12,code A) .... 14 16 Electing large partnerships(amount from Schedule K-1.(Form 1065-B),box 6).... ........... 15 ........ ...... 17 Disposition of property(difference between AMT and regular tax gain or loss) 16 18 Depreciation on assets placed in service after 1986(difference between regular'tax"and.................. ...... 17 19 Passive activities(difference between AMIT and.regular tax income or loss) AMT) ....I...I... ................ 18 -8 , 782 20 Loss limitations (difference between AMT and regular tax income or loss) ........*....... ......*...*.....*' 19• 21 Circulation costs(difference between regular tax and AMT) —....I I....... ............. 20 0 22 Long-term contracts(difference between AMT and regular t'x­i`hco'me`)..... ....... .......... 21 a ....... 23 Mining costs(difference between regular tax and AMT) 22 23 24 Research and experimental costs(difference between regular'tax'and'AMT} ......... ......... 25 Income from certain installment sales before January 1,1987 .... ............ 24 26 Intangible drilling costs preference .... ........I...... 25 27 Other adjustments,including income-based*related'adjustments...*­......................*.......... ..... 27 26 ...................... ......... 28 Alternative minimum taxable income.Combine lines I through 27.(if married filing separately,'see ­ ...... ....... instructions.) ...... 1, 769 Part 11 Alternative Minimum Tax AMT) 29 Exempfion.'See instructions 30 Subtract line 29 from line 28. If I more t.han I zero,I... go I to.line.31 1.f.zero I or.less,enter.-0-.h.ere,an.d.o.n.fines 31 ...... 29 39 , 375 33,and 35,and go to line 34 2555-EZ,see instructions for the amount to enter. ­*.... 30 0 31 - If you are filing Form 2555 or ........*........*................... • If you reported capital gain distributions directly on Form 1040,line 13;you reported qualified dividends on Form 1040,line 9b;or you had a gain on both lines 15 and 16 of Schedule D(Form 1040)(as refigured for the AMT,If necessary),complete Par III on the back and enter the amount from line 54 here. • All others:If line 30 is$175,000 or less($87,500 or less If mated filing separately), ------• ..... 31 multiply fine 30 by 26%(.26).Otherwise,multiply line 30 by 28%(.28)and subtract $3,500($1,750 If married filing separately)from the result 32 Alternative minimum tax foreign tax credit(see instructions) ....... .................. ......... 32 33 Tentative minimum'tax.Subtract line 32 from line 31 ................ ............*........ 33 0 34 Tax from Form 1040,line 44(minus any tax from Form 4972 and any foreign tax credit from Form 1040,fine 47). If you used Schedule J to figure your tax,the amount from line 44 of Form 1040 must be refigured Without using Schedule J (see instructions) .............. ............ 34 35 AMT.Subtract line 34 from line 33. If zero or less,enter-0-,Enter here and on Form 1040,line 45 ................. 35 0 For Paperwork Reduction Act Notice,see your tax return instructions. Form 6251 (2012) DAA Form 1040 Not Earnings from Self-Employment Worksheet 2012. dame Taxpayer Identification Number DARRYL E BETTS Taxpayer Spouse =arm profit or(loss) ScheduleF .............­.................. ............... Farm Partnerships-Schedule K-1,box 14,code A .�.......... ................_.. Auto expense from farm partnerships ..................................................... Amortization from farm partnerships ................... ........ ............ Depreciation&Section 179 from farm partnerships .... ........ ........... Depletion from farm partnerships .... ............... ........ Other expenses from farm partnerships ..'._�_.......... ....... Home office expenses from farm partnerships ..... ............ ..... ... ........ .. Unreimbursed partnership expenses from farm partnerships ............ Farm adjustment to SE Income ....... ............ ....... ........................... Net farm profit or(loss)-Schedule SE fine 1a 0 0 Conservation Reserve Program payments to social securityJdisabirity benefit recipients, 0 0) included on Sch F,in 4b or listed on Sch K-1 (Form 1065), box 20,code Y-Sch SE line 1b( - Nonfarm profit or(loss) Schedule C(excluding minister Schedule C income reported below) 10, 114 Nonfarm partnerships-Schedule K-1,box 14,Code A , .. ...... ......... Auto expense from nonfarm partnerships .. ....................................... ...... Amortization from nonfarm partnerships ..... ...... ..................................... Depreciation&section 179 from nonfarm partnerships... .......... ........ Depletion from nonfarm partnerships ._�... ..... ........ Other expenses from nonfarm partnerships .�.... ......... Home office expenses from nonfarm partnerships Unreimbursed partnership expenses from nonfarm partnerships ...... Employee business expenses-Form 2106(excluding minister 2105 expenses reported below) Nonfarm adjustment to SE income ... ...... .......... Self-employment income reported as other income ....... ................... ........... Self-employment income from contracts and straddles... ........_...... ............. Minister/clergy Self-employment income(from Clergy Worksheet Page 4,line 8)��....... Net nonfarm profit or(loss)-Schedule SE line 2 10 ,114 0 Other income items subject to and/or exempt from self-employment tax Fees received for services performed as a notary public ..................... ............ C Earnings while debtor in a chapter 11 bankruptcy case ................................... Taxable community property income/-loss . ......... .......... .......... Exempt Community property incomel-loss.... ...... ........... Net adjustment included on Schedule SE,line 3 0 0 Net profit(loss)from self-employment activities-Schedule SE line 3 10 ,114 0 Church employee income-Schedule SE,Page 2 line Sa 206-62-3419 _-- Federal Statements SKI ROUNDTOP OPERATING CORP. Form HIV-2. Box 14 - Other Description Amount STATE ILYNENPLOYMENT FUND CONTRIBUTIONS $ TOTAL $ 1 206-62-3419 Federal Statements i LANDSCAPING Schedule C. Line 15 - Insurance (other than health) Description Amount LIABILITY INSURANCE $ 1, 742 COMMERCIAL AUTO INSURANCE 1, 447 WORKERS COMP INSURANCE 1, 704 TOTAL $ 4, 893 LANDSCAPING Schedule C, Line 16b - Other Interest Description Amount JJOPDJ DEERE FINANCIAL $ 2, 747 TOTAL $ 2 ,747 LANDSCAPING Schedule C, Line 23 - Taxes and Licenses Description Amount REGISTRATIONS/LICENSES $ 546 TOTAL $ 546 i 206-62-3419 Federal Statements LANDSCAPING Schedule C, Line 37 - Cost of Labor Description Amount WAGES $ 26, 501 PAYROLL TAXES 4, 359 TOTAL $ 30, 660 I 206-62-3419 _.__ Federal Statements _- Form 6251, Line 18 - Post-1986 Depreciation Adjustment _ Nonpassive Activity type Amount DEPRECIATION ADJ7JSTIiENT REPORT $ '8782 TOTAL $ -8, 782 I I 206-62=s4�9 Federal Statements LANDSCAPING Legal and professional fees Description Amount PAYROLL SERVICES $ 1, 184 ACCOUNTING SERVICES 337 TOTAL $ 1,521 i 206-62-3419 - Federal Asset Report LANDSCAPING Date Bus Sec Basis Asset Description In Service Cost % 179Bonus for Depr PerConv Meth Prior Current Prior MACRS: I TRUCK 1/01/89 15,351 15,35I 7 HY 20ODB 13,367 0 2 LAWN TRACTOR 7/01/90 6,890 X 0 3 HY 20ODB 6,890 0 3 SNOW PLOW 7/01/90 1,417 X 0 3 HY 20ODB 1;417 0 4 WHEELBARROW 7/01/90 37 X 0 3 HY 20ODB 37 0 5 BROOM 7/01/90 11 X 0 3 HY 20ODB 11 0 6 POWER BLOWER 7/01/90 244 X 0 3 HY 20ODB 244 0 7 EQUIPMENT 7/01/91 1,860 X 0 3 HY 20ODB 1,860 0 8 TRACTOR 10/15/92 9,699 X 0 3 HY 20ODB 9,699 0 9 WEED TRIh0AER 4/15/92 211 X 0 3 HY 20ODB 211 0 10 MORBR 6/15/92 698 X 0 3 HY 20ODB 698 0 11 TOOLS 7/01/92 317 X 0 3 HY 20ODB 317 0 12 CHAIN SAW 4/01/93 737 X 0 3 HY 20ODB 737 0 13 ECHO WEED TRIMMER 6/01/93 215 X 0 3 HY 20ODB 215 0 14 WOOD.SPLITTER 11/06/93 1,1.28 X 0 3 HY 20ODB 1,128 0 15 BENCH VISE 1/02193 42 X 0 3 HY 20ODB 42 0 16 LADDER 8/28/93 91 X 0 3 HY 20ODB 91 0 17 VJEEDWACKER 6/07/94 317 X 0 3 HY 20ODB 317 0 18 PUSHMOWER 8/16/94 794 X 0 3 HY 20ODB 794 0 19 79 FORD DUMP TRUCK 8/31/94 4,500 X 0 3 HY 20ODB 4,500 0 20 SNOW BLOWER 9/14/94 1,642 X 0 3 HY 20ODB 1,642 0 21 WELDER 9/24/94 322 X 0 3 HY 20ODB 322 0 22 2-PLOWS 10/11/94 3,498 X 0 3 HY 20ODB 3,498 0 23 CHAINS 11/26/94 49 X 0 3 HY 20ODB 49 0 24 TOOLS&EQUIPMENT 7/01/95 678 X 0 3 HY 20ODB 678 0 25 TOOLS &EQUIPMENT 7/01/97 2,972 X 0 5 HY 20ODB 2,972 0 26 TOOLS&EQUIPMENT 7/01/96 5,789 X 0 3 HY 20ODB 5,789 0 27 TOOLS&EQUIPMENT 7/01/98 14,204 X 0 7 HY 20ODB 14,204 0 28 TOOLS&EQUIPMENT 7/01/99 15,965 X 0 7 HY 20ODB 15,965 0 29 TOOLS&EQUIPMENT 7/01/00 14,902 X 0 5 HY 20ODB 14,902 0 30 TRUCK 7/01/00 21,020 21,020 5 HY 20ODB 21,020 0 31 TOOLS&EQUIPMENT 7/01/01 1,629 X 0 5 HY 20ODB 1,629 0 32 TOOLS&EQUIPMENT 7/01/02 19,515 X X 0 5 HY 20ODB 19,515 0 35 TOOLS &EQUIPMENT 7/01/04 11,107 11,107 5 MQ20ODB 11,107 0 36 05 DODGE RAM 3500 12/20/04 44,083 44,083 5 MQ20ODB 44,083 0 38 TOOLS&EQUIPMENT 7/01/05 4,306 4,306 5 HY 200DB 4,306 0 39 TOOLS&EQUIPMENT 7/01/06 11,664 X 0 5 HY 20ODB 11,664 0 40 SPREADER&EQUIPMENT 7/01/07 5,010 X 0 5 HY 20ODB 5,010 0 41 JOHN DEERE TRACTOR 3/01/08 25,340 X 12,670 5 HY 20ODB 23,151 1,459 42 STEEL POWER HEAD&TRIMMING Ex 7/01/09 848 X 424 5 HY 20ODB 726 49 43 JOHN DEERE BACKHOE 3/22/10 30,822 X 15,411 5 HY 20ODB 23,425 2,959 45 John Deere Commercial Front Mower 3/01/11 21,488 X 0 5 MQ20ODB 21,488 0 46 2003 Ford F250 11/01/11 11,990 11,990 5 MQ20ODB 600 4,556 47 Pressure Washer 7/01/11 920 920 5 MQ20ODB 138 313 48 Plow&Salt Spreader 10/14/11 6,636 X 0 5 MQ20ODB 6,636 0 49 Salt Spreader for Dodge 3500 Truck 10/31/11 1,797 1,797 5 MQ20ODB 90 683 50 Snapper Hand Mower 12/01/11 1,048 1,048 5 MQ20ODB 52 399 323,803 140,127 297,236 10,418 Grand Totals 323,803 140,127 297,236 10,418 Less: Dispositions and Transfers 0 0 0 0 Less: Start-up/Org Expense 0 0 0 0 Net Grand Totals 323,803 140,127 297,236 10,418 206-52-3419 gnus Depreciation Repot_ Date In Tax Bus Tax Sec Current Prior Tax-Basis Asset Property Description Service Cost Pct 179 Exp Bonus Bonus for Depr Activity; LA_h-DSCAPING 32 TOOLS&EQULPMEN 7/01/02 19,515 19,515 0 0 0 41 JOHN DEERE TRACTOR 3/01/08 25,340 0 0 12,670 12,670 42 STEEL POWER HEAD&TKNOvIING EX'I 7/01/09 848 0 0 424 424 43 JOHN DEERE BACKHOE 3/22/10 30,822 0 0 15,411 15.411 LANDSCAPING 76,525 0 0 28,505 28,505 Grand Total 76.525 0 0 28,505 28,505 i 206-62-3419 AMT Asset Report LANDSCAPING Date Bus Sec Basis Asset Description In Service Cost - % 179Bonus for Depr PerConv Meth Prior Current Prior MACRS: I TRUCK 1/01/89 15,351 15,351 5 HY 150DB 13,789 0 2 LAW-NT TRACTOR 7/01/90 6,990 x 0 3 HY 150DB 6,890 0 3 SNOW PLOW 7/01/90 1,417 x 0 3 HY 150DB 1,417 0 4 WHEELBARROW 7/01/90 37 x 0 3 HY 150DB 37 0 5 BROOM 7/01/90 11 x 0 3 HY 15ODB 11 0 6 POWER BLORIER 7/01/90 244 x 0 3 HY 150DB 244 0 7 EQUIPMENT 7/01/91 1,860 x 0 3 HY 150DB 1,860 0 8 TRACTOR 10/15/92 9,699 x 0 3 HY 150DB 9,699 0 9 WEED TRIMMER 4/15/92 211 x 0 3 HY 15ODB 211 0 10 MOWER 6/15/92 698 x 0 3 HY 150DB 698 0 11 TOOLS 7/01/92 317 x 0 3 HY 150DB 317 0 12 CHAINT SAW 4/01193 737 x 0 3 HY 150DB 737 0 13 ECHO WEED TRIMMER 6/01/93 215 x 0 3 HY 150DB 215 0 14 'WOOD SPLITTER 11/06/93 1,128 x 0 3 HY 15ODB 1,128 0 15 BENCH VISE 1/02/93 42 x 0 3 HY 15ODB 42 0 16 LADDER 8/28/93 91 x 0 3 HY 150DB 91 0 17 'WEEDWACKER 6/07/94 317 x 0 3 HY 15ODB 317 0 18 PUSH10OWER 8/16/94 794 x 0 3 HY 15ODB 794 0 19 79 FORD DUMP TRUCK 8/31/94 4,500 x 0 3 HY 150DB 4,500 0 20 SNOW BLOWER 9/14/94 1,642 x 0 3 HY 15ODB 1,642 0 21 WELDER 9/24/94 322 x 0 3 HY 150DB 322 0 22 2-PLOWS 10/11/94 3,498 x 0 3 HY 150D3 3,498 0 23 CHAINS 11/26/94 49 x 0 3 HY 150DB 49 0 24 TOOLS&EQUIPMENT 7/01/95 678 x 0 3 HY 150DB 678 0 25 TOOLS&EQUIPMENT 7/01/97 2,972 x 0 5 HY 150DB 2,972 0 26 TOOLS&EQUIPMENT 7/01/96 5,789 x 0 3 HY 150DB 5,789 0 27 TOOLS&EQUIPMENT 7/01/98 14,204 x 0 7 HY 15ODB 14,204 0 28 TOOLS&EQUIPMENT 7/01/99 15,965 x 0 7 HY 15ODB 15,*965 0 29 TOOLS&EQUIPMENT 7/01/00 14,902 x 0 5 HY 15ODB 14,902 0 30 TRUCK 7101/00 21,020 21,020 5 HY 15ODB 21,020 0 31 TOOLS&EQUIPMENT 7/01/01 1,629 x 0 5 HY 150DB 1,629 0 32 TOOLS&EQUIPMENT 7/01/02 19,515 x x 0 5 HY 20ODB 19,515 0 35 TOOLS&EQUIPMENT 7/01/04 11,107 11,107 5 MQ 15ODB 11,107 0 36 05 DODGE RAM 3500 12/20/04 44,083 44,083 5 MQ 150DB 44,083 0 38 TOOLS&EQUIPMENT 7/01/05 4,306 4,306 5 HY 150DB 4,306 0 39 TOOLS&EQUIPMENT 7/01/06 11,664 x 0 5 HY 150DB 11,664 0 40 SPREADER&EQUIPMENT 7/01/07 5,010 x 0 5 HY 150DB 5,010 0 41 JOHN DEERE TRACTOR 3/01/08 25,340 x 12,670 5 HY 150DB 22,174 2,111 42 STEEL POWER HEAD&TRIMMING EY 7/01/09 848 x 424 5 HY 150DB 671 71 43 JOHN DEERE BACKHOE 3/22/10 30,822 x 15,411 5 HY 20ODB 23,425 2,959 45 John Deere Commercial Front Mower 3/01/11 21,488 21,488 5 MQ20ODB 7,521 5.587 46 2003 Ford F250 -11/61/11 11,990 11,990 5 MQ200DB 600 4"556 47 Pressure Washer 7/01/11 920 920 5 MQ20ODB 138 313 48 Plow&Salt Spreader 10/14/11 6,636 6,636 5 MQ20ODB 332 2,521 49 Salt Spreader for Dodge 3500 Truck 10131/11 1,797 1,797 5 MQ20ODB 90 683 50 Snapper Hand Mower 12/01/11 1,048 1,048 5 MQ 200DB 52 399 323,803 168,251 276,355 19,200 Grand Totals 323,803 168,251 276,355 19,200 Less-Dispositions and Transfers 0 0 0 0 Net Grand Totals 323,803 168,251 276,355 19,200 2D6-62-3419 De ceciation Adjustment Rer' !-)rt L All Business Activities AMT Adjustments/ Form Unit Asset Description Tax AMT Preferences NLkCRS Adiustments: C I I TRUCK 0 0 0 C 1 2 LAWN TRACTOR 0 0 0 C 1 3 SNOW PLOW 0 0 0 C 1 4 WHEELBARROW 0 0 0 C 1 5 BROOM 0 0 0 C 1 6 POWER BLOWER 0 0 0 C 1 7 EQUIPMENT" 0 0 0 C 1 8 TRACTOR 0 0 0 C 1 9 WEED TRIMMER 0 0 0 C I jo MOWER 0 0 0 C I II TOOLS 0 0 0 C 1 12 CHAIN SAW 0 0 0 C 1 13 ECHO WEED TRIMMER 0 0 0 C 1 14 WOOD SPLITTER 0 0 0 C 1 15 BENCH VISE 0 0 0 C 1 16 LADDER 0 0 0 C 1 1,7 WEEDWACKER 0 0 0 C 1 18 PUSHMOWER 0 0 0 C 1 19 79 FORD DUMP TRUCK 0 0 0 C 1 20 SNOW BLOWER 0 0 0 C 1 21 WELDER 0 0 0 C 1 22 2-PLOWS 0 0 0 C 1 23 CHAINS 0 0 0 C 1 24 TOOLS&EQUIPMENT 0 0 0 C 1 25 TOOLS&EQUIPMENT 0 0 0 C 1 26 TOOLS&EQUIPMENT 0 0 0 C 1 27 TOOLS&EQUIPMENT 0 0 0 C 1 28 TOOLS&EQUIPMENT 0 0 0 C 1 2.9 TOOLS&EQUIPMENT 0 0 0 C 1 30 TRUCK 0 0 0 C 1 31 TOOLS&EQUIPMENT 0 0 0 C 1 32 TOOLS&EQUIPMENT 0 0 0 C 1 35 TOOLS&EQUIPMENT 0 0 0 C 1 36 05 DODGE RAM 3500 0 0 0 C 1 38 TOOLS&EQUIPMENT 0 0 0 C 1 39 TOOLS&EQUIPMENT 0 0 0 C 1 40 SPREADER&EQUIPMENT 0 0 0 C 1 41 JOHN DEERE TRACTOR 1,459 2,111 -652 C 1 42 STEEL POWER HEAD&TRIMMING EXT 49 71 -22 C 1 43 JOHN DEERE BACKHOE 2,959 2,959 0 C 1 45 John Deere Commercial Front Mower 0 5,587 -5,597 C 1 46 2003 Ford F250 4,556 4,556 0 C 1 47 Pressure Washer 313 313 0 C 1 48 Plow&Salt Spreader 01 2,521 -2,521 C 1 49 Salt Spreader for Dodge 3500 Truck 683 683 0 C 1 50 Snapper Hand Mower 399 399 0 10,418 19,200 -8,782 206-62=3419 Future C.I )reciation Report FIDE. 12/31/13 LANDSCAPING Date In Asset Description Service Cost Tax AMT Prior MACRS: I TRUCK 1/01/89 15,351 0 0 2 LAWN TRACTOR 7/01/90 6,890 0 0 3 SNOW PLOW 7/01/90 1,417 0 0 4 WHEELBARROW 7/0i/90 37 0 0 5 BROOM 7/01/90 11 0 0 6 POWER BLOWER 7/01/90 244 0 0 7 EQUIPMENT 7/01/91 1,860 0 0 8 TRACTOR 10/15/92 9,699 0 0 9 WEED TR M1\4ER 4/15/92 211 0 0 10 MOWER 6/15/92 698 0 0 11 TOOLS 7/01/92 317 0 0 12 CHAIN SAW 4/01/93 737 0 0 13 ECHO WEED TRDv2vIER 6/01/93 215 0 0 14 WOOD SPLITTER 11/06/93 1,128 0 0 15 BENCH VISE.' 1/02/93 42 0 0 16 LADDER 8/28/93 91 0 0 17 WEEDWACKER 6/07/94 317 0 0 18 PUSHMOWBR 8/16/94 794 0 0 19 79 FORD DUMP TRUCK 8/31/94 4,500 0 0 20 SNOW BLOWER 9/14/94 1,642 0 0 21 WELDER 9/24/94 322 0 0 22 2-PLOWS 10/11/94 3,498 0 0 23 CHAINS 11/26/94 49 0 0 24 TOOLS&EQUIPMENT 7/01/95 678 0 0 25 TOOLS&EQUIPMENT 7/01/97 2,972 0 0 26 TOOLS&EQUIPMEINTT 7/01/96 5,789 0 0 27 TOOLS&EQUIPMENT 7/01/98 14,204 0 0 28 TOOLS&EQUIPMENT 7/01/99 15,965 0 0 29 TOOLS&EQUIPMENT 7/01/00 14,902 0 0 30 TRUCK 7/01/00 21,020 0 0 31 TOOLS&EQUIPMENT 7/01/01 11629 0 0 32 TOOLS &EQUIPMENT 7/01/02 19,515 0 0 I 35 TOOLS&EQUIPMENT 7/01/04 11,107 0 p 36 05 DODGE RAM 3500 12/20/04 44,083 . 0 0 38 TOOLS&EQUIPMENT 7/01/05 4,306 0 0 39 TOOLS&EQUIPMENT 7/01/06 11,664 0 0 40 SPREADER&EQUIPMENT 7/01/07 5,010 0 0 41 JOHN DEERE TRACTOR 3/01/08 25,340 730 1,055 42 STEEL POWER HEAD&TRIMMING EXT 7/01/09 848 49 71 43 JOHN DEERE BACKHOE 3/22/10 30,822 1,775 1,775 45 John Deere Commercial Front Mower 3/01/11 21,488 0 3,352 46 2003 Ford F250 11/01/11 11,990 2,733 2,733 47 Pressure Washer 7/01/11 920 188 188 48 Plow&Salt Spreader 10/14/11 6,636 0 1,513 49 Salt Spreader for Dodge 3500 Truck 10/31/11 1,797 410 410 50 Snapper Hand Mower I2/01/11 1,048 239 239 323,803 6,124 11,336 Grand Totals 323,803 6,124 11,336 ' ' . . 1040 Salaries & Wages Report ' 2012 Name Identification Number DARRYL E BETTS 2-3419 TIS Employer Federal Wages Fecip ral Withheld Soc Sec Wages A SKI ROUNDTOP OPERATING CORP. 1, 151 82 1, 151 Taxpayer 'Spouse 1 ,151 8-2 1 , 151 ' Totals Soc Sec Withheld Medicare Wages Medicare Withheld Soc Sec Tips Allocated Tips Dep Care Ben Other,Box 14 Taxpayer — Spouse 4 1 , 151 17 Totals State State Wages State Withheld Name of Locality Local Wages Local Withheld A PA 1, 151 35 PSD210302 222 1, 151 222 18 Taxpayer Spouse 1, 151 35 Form 1040 Two Year Comparison Report - Schedule C 2011.&2012 Vame Taxpayer identification number DARRYL E BETTS. 206-62-3419 principal business or profession Unit LANDSCAPING 1 Income 2011 2012 Differences 1. Gross receipts or sales ......... ........ ......... 1. 118 ,822 _116, 742 -2 , 080 2. Returns and allowances 2. .................... .. 3. Cost of goods sold 3. 50, 830 73, 886� _23 , 056 4. Gross profit.............. .. ........... ...................... 4. 67 , 992 42 , 856 -25 , 136 5. Other income 5. 6. Gross income ...... .. ...... .. . . ..... ........ 6. 67, 992 -25, 136 Expenses 7. Advertising.... ..................... .......... 7. 1 , 154 397 -757 9. Car and truck expenses 8. S. Commissions and fees 9. ............ .... ............ M Contract labor 10. 111. Depletion 11. 12. Depreciation and section 179 expense deduction 12. 35,4781 10 , 418 -25, 060 13. Employee benefit programs ...............**''*.......... 13, 14. insurance(other than health) ................'....... .... 14. 3 ,012 4, 893 1, 881 S. Interest-mortgage(paid to banks,etc.) is. 16. Interest-other .... ...........*.. ....*............... M 2 ,444 2 , 747 303 17. Legal and professional services.. ...... ...... 17. 913 1r521 608 S. Office expense 18. ............... ......... ....... .. ......... . 19. Pension and profit-sharing plans 19. 20. Rent or lease-vehicles,machinery,and equipment 20. 21. Rent or lease-other business property 21. 22. Repairs and maintenance .......*...... ........ ...... 22. 9, 120 3 , 028 -6 , 092 23. Supplies(not included in cost of goods sold) 23. 24. Taxes and licenses 24. 297 546 249 .......... 25. Travel 25. ...................... 26. Total meals and entertainment 26, 26a. Nondeductible meals and entertainment 26a. 26b.Deductible meals and entertainment 26b. 27. Utilities 27. 540 389 -151 .............................. 28. Wages(less employment credits) 28. 29. Other expenses......... ................................. ... 29. 12 653 8 , 803 -3,850 30. Total expenses .......11,....11.1..................... 30. 65 , 6111 32 , 742 -32, 869 Profit/(loss) 31. Tentative profit(loss) ........... ......*........ . 131. 2,381 10 , 114 Tr 733 32. Expenses for business use of home 32. 33. Net profit or(loss). ...... 2 , 381 10 ,114 7 ,733 Cost of Goods Sold 34. inventory-Beginning of year 34. ............ 35. Purchases 35. ............. .... ... 36, Labor 36. 24,125 30,860 6, 735 ' '­.......... ......................... 37. Materials '''' '**... .....*.......... 37. 26,705 43 ,026 16 , 321 38. Other costs 38. 29. Goods available for sale(sum of lines 34-38)............ 139. 1 50 , 830 73 ,8867 23 , 056 40. inventory-End of year ...... ....... 40, 1 Form 1040 Tax Return History Report - Page 1 2012 Name DARRYL E BETTS Taxpayer Identification Number 206-62-3419 ' 2008 2009 2010 2011 2012 2013 PROJECTED Filing Status MFS MFS MFS MFS MFS MFS Salaries and wages......... ..... 4 ,252 2 , 120 3L533 2 ,272 1 , 151 1 151 ...... Interest income ........................ Dividend income i ..:..................... Business income/loss ......... -77 -8 33 8 , 571 2 3 81 10 114 10 114 ....... Capital gains/losses .................. Other gains/losses .............. 51000 6 0 0 0 ..... IRA distributions,pensions,annuities Rent,royalty,farm rental income Partnership/S core income Z ........... Estate or trust income 2 ................. Farm income/loss ..................... Other income/loss .................... Total income 4 175 6,287 12 , 104 10 653 11,265 11 ,265 ........................ Total adjustments 606 168 714 715 Adjusted gross income .............. 4 , 175 6,287 11,498 10 485 10 , 551 10 550 Allowable itemized deductions 2 ,263 13, 965 417 13,493 12 889 12 889 Standard deduction 5. 450 6,200 5 700 5, 800 5, 950 6, 100 Itemized or standard deduction taken 5,450 6 2 0 0 51700 5 8 0 0 1 5, 950 6 10 0 Exemptions 3 500 3 650 3 650 3,700 .. 3 ,800 3- 1900 Taxable income....................... 2 , 148 985 801 550 i Combined with Interest Income on the Federal Tax Projection Worksheet 2 Combined with Rent,royalty,farm rental income on the Federal Tax Projection Worksheet as Schedule E income/loss $14,000 $14,000 Total income Adjusted gross income - $10,000 $10,000 -. $6,000 $6,000 $2,000 $2 000 �.. t€ 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 2012 2013 (Projected) (Projected) Itemized or standard deduction taken Taxable income $6,400 _... . .. .... $2,700 $6,000 $1,000 $5,600 $900 $5,200 :r . r t1 , $0 2008 2009 2010 2011 2012 2013 2000 2009 2010 2011 2012 2013 (Projected) (Projected) I Form 1040 Tax Return History Report - Page 2 2012 Name DARRYL E BETTS Taxpayer Identification Number 206-62-3419 2008 2009 2010 2011 2012 2013 PROJECTED Taxable income 2 148 985 801 550 ........................ Tax on taxable income 214 99 81 55 .................. Alternative minimum tax ................. Total credits ............................. Net tax liability 214 99 81 55 Self-employment taxes 1 ,211 292 1 ,242 1 ,429 Othertaxes .............................. Total tax 1 ,425 391 .1 ,323 1 ,484. ................................. income tax withheld 352 255 297 131 82 8. . , Estimated tax payments ................. Other payments 8 0 400 Total payments .................. 352 687 1 384 131 82 1, 682 Total due!-refund —352 —687 41 260 1 241 —198 Penalties and interest 6 .................... Net tax due/-refund —352 —68 7 41 260 1,247 —198 Refund applied to estimated tax payments 352 687 Refund received ........................ Marginal tax rate 10 . 0% 10 . 0% 10 . 0% 10 . 0% 10 . 0%--IQ . 0% Effective tax rate.............. ...... .. % % 6 6% 40%, 10 0% 100% Total credits Total tax $30 $1,800 $20 $1,200 $10 $600 $0 $0 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 2012 2013 (Projected) (Projected) Total payments Marginal tax rate $2,100 40% $1,400 30' 70 Y {t 'nY $0 10% 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 .2012 2013 (Projected) (Projected) Form 1040 Two Year Comparison Report - Page I 201:t&2012 Name Taxpayer identification Number DARRYL E BETTS 206-62-3419 2011 2012 Differences Filing Status MFS MFS Dependents claimed 0 0 1, Salaries and wages 2 ,272 1, 151 -1, 121 Z. Interest income .......... 3- Tax exempt interest income ............ ......... ....... 3. 4. Dividend income 4. 5. Qualified dividend income 5. 6. Taxable state/local refunds 6. 7. Alimony received ......... ......... ............... 7. 1 9, Business income/loss ................... 8. 2 ,381 10, 114 7 ,733 n 9. Capital gain/loss .... 9. c 10. Other gains/losses..... 10. 6 , 000 -6,000 0 11. Taxable IRA distributions m 12. Taxable pensions ....... 12. a 13. Rent-and royalty-income in-cludingJarrn rental ..... 13. 14, P a*mTshiplS corp,Income ....... 14. 15. Estate or trust income .............. is. 16. Farm income/loss 16. 17. Unemployment compensation . 17. 18. Taxable social security ......... 18• 19. Other income 19. 20. Total income ...... 20. 10 653 11 , 265 612 A 21, Moving expenses.... .. .............. ............ 21. - 168 714 546 7-2. Self-employment tax adjustment,.._.. .......... 22• 21 SEPISIMPLE/Qualified plans deductions 23, u ­'­....... S 24. SE health insurance ........ .. 24. t 25. Forfeited interest ............... 25. m 26. Alimony paid .......... 2S. a n 27. IRA deductions 27.- t 28. Student loan interest 28. s 29. 29. Other adjustments ........ . .. .. 30. Adjusted gross income, 30. 10 , 485 10, 5511 66 31. Medical ........... ......... 31.321. 3 ,989 3, 131 -858 D 32. Taxes e 33. Interest... .......... .............. 33, 9 ,504 9, 758 254 '­*..........*........*...... ............. d 34. Contributions ... 34. u 35. Casualty losses ... ....................... 35. c 36. Miscellaneous expenses......... .......... ...... 36. t 37. Allowable itemized deductions. ....... 37, 12 , 889 ..-604 1 38. Standard deduction 38, 54 800 5 , 950 . 1-50 0 STANDARD STANDARD n 39. Deduction taken 39. 5 ,800 5, 950 150 S 40. Subtract line 39 from,li ne 30 ......... 40. 4 , 685 4 , 601 -84 41. Exemptions _ 3L70 0 3, 800 100 142. Taxable Inc..ome..... 985 801 -184 Form 1040 I Two Year Comparison Report - Page 2 2011:&.2012 (Jame D_ARRYL E BETTS Taxpayer Identification Number 206-62-3419 2011 2012 Differences 43. Taxable income from 2YR page 1,line 42 43. 985 801 -184 .................... 44. Tax on taxable income 44. 99 81 -18 ........................................ 45. Altemative minimum tax ................................... 45. 46. Child care credit 46 47. Education credits 47 ............................................. 48. Retirement savings credit - T 49. Child tax credit a 50. General business credit x 51. Other credits 52. Total credits ............................................... 52. C 53. Net tax liability 53 99 81 -18 0 54. Self-employment taxes 292 1 ,242 950 m 55. Other taxes p 56. Total tax 56. 391 1 323 9 3 2 ..................................................... u 57, income-tax withheld 57_. 131 82 -49 . .. ....58. Estimated tax payments 58. ...................................... a 59. Earned income credit ......................................... 59. t 60. Additional Child tax credit 6o. ........I............................ 61. i 61. Other refundable tax credits ............................... 0 62. Other payments 62 n 63. Total payments 63 131 82 -49 ................................ .. .... .... 64. Tax due/-refund 64. 260 1 2 41 981 ............................................. 65. Penalties and interest 65 6 6 . ss. Net tax due/-refund ........................................ 66. 2 6 0 1 247 9 8 7 67. Refund applied to estimated tax payments 67. .................... 68. Refund received 69. Marginal tax rate ............................................ ss. 10 . 0° 10 . 0° 70. Effective tax rate............................................ 70. HAMILTON & M-UTSSERPCCPAs 176 Cumberland Parkway Mechanicsburg, PA 17055 717-697-3888 March 16, 2013 CO-NMENTLkL DARRYL E BETTS 388 BURNT HOUSE RD CARLISLE, PA 17015 Dear Darryl: We have prepared the following returns from information provided by you without verification or audit: U.S. Individual Income Tax Return (Form 1040) Pennsylvania Income Tax Return (Form PA-40) Local Earned Income Tax Return- DICKINSON TWP, CARLISLE AREA Sl� We suggest that you examine these returns carefully to fully acquaint yourself with all items contained therein to ensure that there are no omissions or misstatements. Attached are instructions for signing and filing each return. Please follow those instructions carefully. Also enclosed is any material you famished for use in preparing the returns. If the returns are examined, requests may be made for supporting documentation. Therefore,we recommend that you retain all pertinent records for at least seven years. In order that we may properly advise you of tax considerations, please keep us informed of any significant changes in your financial affairs or of any correspondence received from taxing authorities. If you have any questions or if we can be of assistance in any way, please do not hesitate to call. Sincerely, HAMILTON &MUSSER, PC, CPAs 1040 Federal Return Summa � rY 2012. Name Taxpayer Identification Number DARRYL E BETTS 206-62-3419 Tax Form ................ ........... .......... 1040 Filing Status MFS Dependents Income Tax Computation Salaries&wages 1 ,151 Regular tax 81 Taxable interest income . ... ... . ............................ .. .......... Altemative minimum tax .. ........ ..... Tax exempt interest Total tax before credits ..... ...... 81 Dividend income ................................. Child and dependent care credit Qualified dividends .... . . Education credits Taxable state/local refunds Other credits ............................... ......... ................... Alimony received Total credits ... .................................... Business income/-foss 10 , 114 Tax after credits 81 .............................. ................................ Capital gain!-loss Self-employment tax 1 ,242 . . ............. Other gain/-loss(Form . . ......... .. 47-97) Additional tax on IRAs,etc. ............. Taxable IRA distributions Othertaxes ..................... .................... .. . Taxable pension distributions Total tax ... ...... ..... 1 , 323 ................... Rental,royalty,partnership,etc.income/-loss .............. Farm income/-loss Payments ...compensation Federal income tax withheld S2 . ....... Taxable social security benefits Estimated payments ...... ...... Other income ' its.... ........' .....­ Total .................................. Other payments/cred Total income 11 ,265 Total payments ' . Adjustments Refund/Amount Due Moving expenses Amount overpaid . . ......... ................ ....... ............. Self-employment tax adjustment 714 Overpayment applie.d ......... . SEP,SIMPLE,and qualified plan deduction Form 2210 penalty 6 .. ......... . .... Self-employed health insurance deduction Amount duel-refund.. . .......... 1 ,247 Alimony paid Failure to file penalty IRA deduction .................................... Failure to pay penalty ... .. Student loan interest d...eduction.................. Late filing'interest ...................... .............................. Other adjustments Net amount duel-refund 1 ,247 . ...................... Total adjustments 714 Adjusted gross income 10 ,551 2013 Estimates Deductions 1st quarter ...:................................. 400 2nd quarter..................................... 400 Medical and Dental expenses 3rd quarter 400 Taxes paid •• ..••' ......................... . paid '­............................ 4th quarter 400 ..................................... Interest paid Total 1 , 600 ...................................... ........................................... Charitable contributions Other itemized deductions Tax Rates Total allowable itemized deductions Marginal tax rate 10 . 0 % or,Standard deduction ............... 5 , 950 Effective tax rate 100 ° /° Exemption amount 3 , 800 Rate of Long-term............. g term capital gain Taxable income ........................... 801 .................. Pennsylvania Individual Return Summary Tax Year 2012 DARRYL E BETTS Income, Adjustments, and Deductions Gross compensation 1 151 Schedule UE expenses ............................................................................................................ Schedule A ......................................................................................................................... Schedule B Schedule CI'F'" 1 , 179 ...................................................................................................................... Schedule D ....................................................................................................................... Schedule E ......................................................................................................................... Schedule J ......................................................................................................................... Other income ...................................................................................................................... Total taxable income 2 , 330 ............................................................................................................. Other deductions ...................................................... .............................................................. Adjusted taxable income .......... ............... .. .......... ............... .... ............... ......... ... ....... .. 2 ,330 . . .. . . .. . .. . . Tax, Payments, and Credits Income tax ......................................................................................................................... 72 Income tax withheld 35 ................................................................................................................ Estimated tax paid ................................................................................................................. Other payments and credits Usetax ........................................................................... ...................................................................I............................. 0 Contributions ....................................................................................................................... Overpayment applied ............................ Subtotal Refund/Amount Due Underpayment of estimates penalty ................................................................................................ Late filing interest .................................................................................................................. Failure to file penalty ............................................................................................................... Failure to pay penalty .............................................................................................................. Net amount due/-Refund ......................................................................................................... 37 Negative amounts do not display on the Return Summary. Per PADOR,these amounts are not included in total taxable income. Miscellaneous Information 2013 Estimates Residency type RESIDENT 1st quarter .......................................... Filing status MARRIED FILING SEPARATE 2nd quarter ......................................... Amended return 3rd quarter ............ .............................I.......... Direct debit withdrawal date 4th quarter Marginal tax rate 3 . 070% Effective tax rate 3 . 070% Total estimates Form PA-40 Pennsylvania Two Year Comparison Worksheet 201' 01.1 & 2012 Name Taxpayer Identification Number DARRYL E BETTS 206-62-3419 F 2011 2012 Differences 1. Gross compensation R 2 ,272 1 151 (1 121) .................................... 2. Unreimbursed employee expenses 3. Net taxable compensation 2 2 72 1 151 (1 I21) ............................ 4. Taxable interest 4. ........................................ 5. Taxable dividends ..................................... Fg5M2 U0 6. Net income(loss)from bus,profession,or farm 6,297 (5 118) ....... 7. Net gain(loss)from the sale of property ................ B. Net income(loss)from rents,royalties,etc 9. Estate and trust income 10. Gambling and lottery winnings 11. Other deductions .............................12. Total taxable income (6 239) 13. Tax 13. 263 72 (191) .................................................... 14. Income tax withheld 35 (35) 15. Credit from prior year return 15. ............................ 16. Estimated payments 17. Other payments 17. c 18. Total payments........................................ 18. 70 35 (3 5) Tax forgiveness credit from Schedule SP 19, ............... n 20. Credit for taxes paid to other states 20, v 21. Other non-refundable tax credits ........................ 21. @ 22. Total payments and credits 23. Use tax 2z. 7 0 .......................... 35 (3 5) 24. Tax due 23 0 0 .............................I................... ................................................ 24. 19 3 37 - (156) 25. Overpayment 25. .......................................... 26. Penalties and interest 26. ................................... 27. Estimated tax penalty 27. ............................ 28. Donations 29. Net tax duel-refund 29. 193 371 (15 6) pennsylvania DEPARTMENT OF REVENUE Form PA-8879 Pennsylvania e-file Signature Authorization 2012 Submission ID Taxpayer's Name Social Security Number DARRYL E BETTS 206-62-3419 Spouse's Name Spouse's Social Security Number PART I Tax Return Information—Tax Year Ending Dec. 31, 2012 (Whole dollars only) 1. Adjusted PA Taxable Income(Form PA-40,Line 11) .......... .................... ........... 1 2 ,330 2. PA Tax Liability(Form PA-40,Line 12) ....... ....................--........... ...11—......... 2. 72 3. Total PA Tax Withheld(Form PA-40,Line 13) ........ ............ ......... ....... ............. 3, 35 4. Refund(Form PA-40,Line 30) .... ...... ....... 4. 5. Total Payment(Tax Due)(Form PA-40,Line 28) ................ .............. ........................... 5. 37 PART 11 Declaration-acrd Signature Authorization of Taxpayer Under penalties of perjury,I declare I have examined a copy of my electronic individual income tax return and accompanying schedules and statements of my 2012 PA Tax Return(Form PA-40),and to the best of my knowledge and belief,it is true,correct and complete.I further declare that the amounts in Part I above are the amounts shown on the copy of my electronic income tax return.If applicable,I authorize the PA Department of Revenue and its designated financial agents to initiate an electronic funds withdrawal(direct debit)entry to my designated account for Pennsylvania taxes owed.I also authorize my financial institution to debit the entry to my account and the financial institutions involved in the processing of my electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to payment.I certify the funds for this withdraw are originating from an account within the United States or one of its territories. I have selected a personal identification number as my signature for my electronic income tax return and,if applicable,my electronic funds withdrawal consent. Taxpayer's Personal Identification Number(PIN): (check one box only) F&I HAMILTON & MUSSER, PC, CPAS 23419 I�J I authorize to enter my PIN as my signature on my tax year 2012 electronically filed income tax return. ❑ I will enter my PIN as my signature on my tax year 2012 electronically filed income tax return. Your signature Date 03/16/13 Spouse's PIN: (check one box only) ❑ ]authorize to enter my PIN as my signature on my tax year 2012 electronically filed income tax return. ❑ I will enter my PIN as my signature on my tax year 2012 electronically filed income tax return. Spouse's signature Date Practitioner PIN Program Participants Only—Continue Below PART III Certification and Authentication ERO's EFINIPIN,Enter your six-digit EFIN followed by your five-digit self-selected PIN 23319913999 As a participant in the Practitioner PIN Program, I certify the above numeric entry is my PIN,which is my signature on the tax year 2012 electronically filed income tax return for the taxpayer(s) indicated above. I confirm I am participating in the Practitioner PIN Pro� m in pccordance with the requi. m nts established for this program. ERO's signature Jtty,� A Date 03/16/13 ERO must retain this form and the supporting documents for three years. DO NOT SUBMIT THIS FORM TO THE PENNSYLVANIA DEPARTMENT OF REVENUE. [ 1200116042 PA-40 - 2012 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label 206623419 N Extension. BETTS N Amended Return. D A R R Y L E occupation LANDSCAPER R Residency Status. PA Resident/Nonresident/Part-Year Resident Occupation from to M Single/Married,Filing Jointly/Married, Filing Separately/Final Return/Deceased Date of death 388 BURNT HOUSE RD N Farmers. CARLISLE PA 17015 School District Name CARLISLE AREA 21110 1 a Gross Compensation. Do not include exempt income,such as combat zone pay and la 1151 qualifying retirement benefits.See the instructions. 1b Unreimbursed Employee Business Expenses. 1 b 0 1c Net Compensation. Subtract Line 1b from Line 1a. 1 C 1151 2 Interest Income.Complete PA Schedule A if required. 2 0 3 Dividend and Capital Gains Distributions Income.Complete PA Schedule B if required. 3 0 4 Net Income or Loss from the Operation of a Business,Profession or Farm. 4 1179 5 Net Gain or Loss from the Sale,Exchange or Disposition of Property. 5 0 6 Net Income or Loss from Rents,Royalties,Patents or Copyrights. 6 0 7 Estate or Trust Income.Complete and submit PA Schedule J. 7 0 8 Gambling and Lottery Winnings.Complete and submit PA Schedule T. 8 0 9 Total PA Taxable Income.Add only the positive income amounts from Lines 1 c, 9 2330 2,3,4,5,6,7 and 8. DO NOT ADD any losses reported on Lines 4,5 or 6. 10 Other Deductions. Enter the appropriate code for the type of deduction. N 10 0 See the instructions for additional information. 11 Adjusted PA Taxable Income.Subtract Line 10 from Line 9. 11 2330 EC Page 1 of 2 FFCC L 1200116042 ! ! I 1200116042 i .� PA-40-2012 1200216057 Social Security Number 206623419 Name(s) DARRYL E BETTS 12 PA Tax Liability. Multiply Line 11 by 3.07 percent(0.0307). 12 72 13 Total PA Tax Withheld.See the instructions. 13 35 114 Credit from your 2011 PA Income Tax return. 14 0 15 2012 Estimated Installment Payments.. REV-4596 included. N 15 0 16 2012 Extension Payment. 16 0 17 Nonresident Tax Withheld from your PA Schedule(s)NRK-1.(Nonresidents only) 17 0 18 Total Estimated Payments and Credits.Add Lines 14, 15, 16 and 17. 18 0 Tax Forgiveness Credit.Submit PA Schedule•SP. 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19a 00 19b Dependents,Part B,Line 2, PA Schedule SP 19b 00 20 Total Eligibility Income from Part C,Line 11, PA Schedule SP. 20 0 21 Tax Forgiveness Credit from Part D,Line 16,PA Schedule SP. 21 0 22 Resident Credit.Submit your PA Schedule(s)G-R with your PA Schedule(s)GS,G-L and/or RK-1. 22 0 23 Total Other Credits.Submit your PA Schedule OC. 23 0 24 TOTAL PAYMENTS and CREDITS.Add Lines 13, 18,21,22 and 23. 2 4 35 25 USE TAX.Add amount.See instructions. 25 0 26 TAX DUE.If the total of Line 12 and Line 25 is more than line 24,enter the difference here. 26 37 27 Penalties and Interest. See the instructions. Enter Code: 27 0 If including form REV-1630/REV-1630A,mark the box. N 28 TOTAL PAYMENT DUE.See the instructions. 28 37 29 OVERPAYMENT. If Line 24 is more than the total of Line 12,Line 25 and Line 27,enter 29 0 the difference here. The total of Lines 30 through 36 must equal Line 29. 30 Refund—Amount of Line 29 you want as a check mailed to you. Refund 30 0 31 Credit—Amount of Line 29 you want as a credit to your 2013 estimated account. 31 0 32 Amount of Line 29 you want to donate to the Wild Resource Conservation Fund. 32 0 33 Amount of Line 29 you want to donate to the Military Family Relief Assistance Program. 33 0 34 Amount of Line 29 you want to donate to the Governor Robert P.Casey Memorial Organ 34 0 and Tissue Donation Awareness Trust Fund. 35 Amount of Line 29 you want to donate to the Juvenile(Type 1)Diabetes Cure Research Fund, 35 0 36 Amount of Line 29 you want to donate to the PA Breast Cancer Coalition's Breast and Cervical Cancer Research Fund. 36 0 Signature(s).Under penalties of perjury,I(we)declare that I(we)have examined this return,including all accompanying schedules and statements,and to the best of my(our)belief,they are true,correct,and complete. Your Signature Spouse's Signature,if filing jointly Preparer's Name and Telephone Number Date ii //� E-File Opt Out (tt� 5 717-697-3888 Firm FEIN 232213999 HAMILTON 8 MUSSER, PC, CPAS Preparer'sPTIN P00261037 Page 2 of 2 1200216057 1200216057 PA .SCHEDULE W-2S 1201910021 Wage Statement Summary PA-40 Schedule W-2S (06-12) 2012 OFFICIAL USE ONLY Summary of PA—Taxable Employee, Non-employee and Miscellaneous Compensation Name shown first on the PA-40(if filing jointly) I Social Security Number(shown first) DARRYL E BETTS . 1206-62-3419 Use this schedule to list and calculate your total PA-taxable compensation and PA tax withheld from all sources. Part A Instructions:List each federal Form W-2 for you and your spouse,if married,received from your empioyer(s).In the first column enter T for the taxpayers Social Social Security Number that appears first on the PA tax return and enter S for the second or spouse SSN.From the Forms W-2,enter each employer's federal identification num- ber.Enter the amounts from the Forms W-2 in each column.IMPORTANT:You do not have to submit a copy of your Form W-2 If you earned all your income in Pennsylvania and your employer reported your PA wages correctly and withheld the correct amount of PA income tax.You must submit a copy of your Form W-2 in cer- tain circumstances.See the PA Schedule W-2S instructions for a list of when a ropy of a W-2 is required, Part B Instructions:List each source of income received during the taxable year on a form or statement other than a federal Form W-2,Enter each payers name.List the payment type that most closely describes the source of your non-employee compensation.Enter the amount of other compensation that you earned.9 the form or statement does not have separately stated amounts,enter the amount shown in both federal and PA columns. IMPORTANT:You must submit a copy of each form and statement that you list in Part B,whether or not the payer withheld any PA income tax and regardless of whether or not the income was taxable in PA CAUTION:The federal and Pennsylvania(state)wages may be different in Part A and Part S. If you need more space,you may photocopy this schedule or make your own schedules in this format. Part A-Federal Forms W-2 SEE THE INSTRUCTIONS FOR WHEN TO SUBMIT FORM(S)W-2 TIS Employeirs identification number from Box b Federal wages Medicare wages PA compensation PA income tax from Box I from Box 5 from Box 16 withheld from Box 17 T 23-2423904 1 t 153 1 ,151 1,151 35 Total Part A-Add the Pennsylvania columns 1, 1511 35 Part B-Miscellaneous and Non-employee Compensation from federal Forms 1099-R, 1099-MISC and other statements YOU MUST SUBMIT COPIES OF EACH FORM OR STATEMENT LISTED IN THIS PART A. B. C. D. E. F. G. H. T/S Type Payer name 1099R code Total federal amount Adjusted plan basis PA compensation PA tax withheld Total Part B-Add the Pennsylvania columns r TOTAL-Add the totals from Parts A and B 1 1,1511 35 Enter the TOTALS on your PA tax return on: Line I a Line 13 Payment type: A. Executor fee B. Jury duty pay C. Director's fee D. Expert witness fee E. Honorarium F. Covenant not to compete G. Damages or settlement for lost wages,other than personal injury H. Other nonemployee compensation. Describe: 1. Distribution from employer sponsored retirement,pension or qualified deferred compensation plan J. Distribution from IRA(Traditional or Roth) K. Distribution from Life Insurance,Annuity or Endowment Contracts L. Distribution from Charitable Gift Annuities 1201910021 1201910021 1203115272 PA-40 Schedule C -2012 (08-12) Profit or Loss From Business or Profession(Sole Proprietorship) 206623419 D A R R Y L E BETTS Method of Inventory:C=Cost,L=Lower of cost or market,O=Other LANDSCAPING SERVICE Accounting Method:A=Accrual,C=Cash,O=Other C BETTS LAWN AND LANDSCAPE Home office N expenses deducted 238990 Business out of existence N 388 BURNT HOUSE R D Any change in determining N quantities,costs or valuations CARLISLE PA 17015 1 a. Gross receipts or sales 1 A 116742 2. Cost of goods.sold/operations 2 73886 1 b. Returns and allowances 1B 0 3. Gross profit 3 42856 1 c. Balance 1 C 116742 4. Other Income(submit statement) 4 0 5. Total income 5 42856 6, Advertising 6 397 28. Supplies(not included on Schedule C-1) 28 0 7. Amortization 7 0 29. Taxes 29 546 8. Bad debts from sales or services 8 0 30, Telephone 30 0 9. Bank charges 9 0 31. Travel and entertainment 31 0 10. Car and truck expenses 10 0 32. Utilities 32 389 11. Commissions 11 0 33. Wages 33 0 12. Cost depletion not%depletion 12 0 34. Other expenses(specify): 13a.Regular depreciation 13A 19353 13b.Section 179 expense 13B 0 A GASOLINE & OIL A 5889 14. Dues and publications 14 0 B TELEPHONE/INTERNE B 2228 15. Other employee benefit programs 15 0 C POSTAGE C 217 16. Freight(not on Schedule C-1) 1-6 0 D FUEL : SHOP HEAT ( D 154 17. Insurance 17 4893 E SMALL EQUIPMENT E 315 18. Interest on business indebtedness 18 2747 F F 0 G G 0 H H 0 19. Laundry and cleaning 19 0 I I 0 20. Legal and professional services 20 1521 J J 0 21. Management fees 21 0 K K 0 22. Office supplies 22 0 23. Pension and profit-sharing plans 23 0 24. Postage 24 0 34. Total other expenses 34 8803 25. Rent on business property 25 0 35. Total expenses 35 41677 26. Repairs 26 3028 36. Reduce expenses by total business credits 36 0 27. Subcontractor fees 27 0 37. Total adjusted expenses 37 41677 38. Net profit or loss 38 1179 Page 1 of 2 1203115272 1203115272 PA-40 Schedule C -2012 1203215288 Social Security Number 206623419 Name of owner DARRYL E BETTS SCHEDULE C-1 - Cost of Goods Sold and/or Operations 1. Inventory at beginning of year(if different from last year's closing inventory,include explanation) 1 0 2a. Purchases 2A 0 2b. Cost of items withdrawn for personal use 2B 0 2c. Balance(subtract Line 2b from Line 2a) 2 C 0 3. Cost of labor(do not include salary paid to yourself or subcontractor fees) 3 30860 4. Materials and supplies 4 43026 5. Other costs(include schedule) 5 0 6. Add Lines 1,2c,3,4 and 5 6 73886 7. Inventory at end of year 7 0 B. Cost of goods sold and/or operations(subtract Line 7 from Line 6)Enter here and on Part 1, Line 2 8 73886 SCHEDULE C-2 - Depreciation (See Instructions) 1. Total Section 179 depreciation(do not include in items below) 1 0 2. Less:Section 179 depreciation included in Schedule C-1 2 0 3. Balance(subtract Line 2 from Line 1).Enter here and on Part II,Line 13b 3 0 4. Other depreciation: Description of property Date acquired Cost or other basis Depreciation allowed or Method of computing Life or rate Depreciation for allowable in prior years depreciation this year (a) (b) (c) (d) (e) (f) (g) Buildings 4 A _ 0 0 0 Fumitureffixtures 4 B 0 0 0 Trans.equipment 4 C 0 0 0 Machinery 4 D 0 0 0 Other (specify) JOHN D 4E 03012008 25340 20961 MACRS 5 2919 STEEL 4F 07012009 848 604 MACRS 5 97 JOHN D 4G 03222010 30822 16027 MACRS 5 5918 JOHN D 4H 03012011 21488 16621 MACRS 5 1947 2003 F 4I 11012011 11990 600 MACRS 5 4556 PRESSU 4J 07012011 920 138 MACRS 5 313 PLOW & 4K 10142011 6636 332 MACRS 5 2521 SALT S 4L 10312011 1797 90 MACRS 5 683 SNAPPE 4M 12012011 1048 52 MACRS 5 399 4N 0 0 0 40 0 0 0 4P 0 0 0 5. Totals 100889 5 19353 6. Depreciation included in Schedule C-1 6 0 7. Balance(subtract Line 6 from Line 5)Enter here and on Part II,Line 13a 7 19353 Page 2 of 2 1203225288 1203215288 __j Form PA-40 Pennsylvania Income/Loss 201Z " from the Operation of a Business/Farm Worksheet Name Taxpayer Identification Number DARRYL E BETTS 206-62-3419 PA SCHEDULE C INCOME/LOSS LANDSCAPING 1 ,179 TOTAL 1 ,179 Form PA-40 Pennsylvania Income Worksheet - 2012 Name Taxpayer Identification Number DARRYL E BETTS 206-62-3419 Taxpayer Spouse 1a. Gross compensation ....................................................... 1a. 1 ,151 1 b. Unreimbursed employee business expenses............................... 1b. 2. Taxable interest............................................................ 2. 3. Taxable dividends.......................................................... 3. 4. Net income or(loss)from a business or farm .....SEE STMT 4. 1 , 179 5. Net gain or(loss)from the sale,exchange or disposition of property ....... 5. 6. Net income or(loss)from rents.,royalties,patents and copyrights.......... 6. 7. Estate and trust income.................................................... 7. 8. Gambling and lottery winnings ............................................. 8. 9. Gross Pennsylvania taxable income.................................... 9. 2 ,330 10, Other Deductions .......................................................... 10. 11. Net.Pennsy-lvania taxable income....................................... 11. 2 ,330 206-6z-3419 "lennsylvania Statement! LANDSCAPING Form PA-40C - Gross receipts or Sales Description Amount SCH C GROSS SALES $ 116, 742 TOTAL $ 116, 742 LANDSCAPING Form PA-40-C - Taxes Description Amount REGISTRATIONS/LICENSES $ 546 TOTAL $ 546 206-62.3419 Pennsylvania Statements i Income Worksheet - Business Income Description Taxpayer Spouse BUSINESS/FARM INCOME $ 1, 179 $ TOTAL $ 1, 179 $ 0 i { �I t 206-62=3419 PA Asset Report LANDSCAPING Date Basis PA PA Federal Difference Asset Description In Service Cost for Depr Prior Current Current Fed- PA Prior MACRS: 1 TRUCK 1/01/89 15,351 15,351 13,367 0 0 0 2 LAWN TRACTOR 7/01/90 6,890 0 6,890 0 0 0 3 SNOW PLOW 7/01/90 1,417 0 1,417 0 0 0 4 WHEELBARROW 7/01/90 37 0 37 0 0 0 5 BROOM 7/01/90 11 0 11 0 0 0 6 POWER BLOWER 7/01/90 244 0 244 0 0 0 7 EQUIPMENT 7/01/91 1,860 0 1,860 0 0 0 8 TRACTOR 10/15/92 9,699 0 91699 0 0 0 9 WEED TRIMMER 4/15/92 211 0 211 0 0 0 10 MOWER 6/15/92 698 0 698 0 0 0 11 TOOLS 7/01/92 317 0 317 0 0 0 12 CHAIN SAW 4/01/93 737 0 737 0 0 0 I13 ECHO WEED TRIMMER 6/01/93 215 0 215 0 0 0 14 WOOD SPLITTER 11/06/93 1,128 0 1,128 0 0 0 VISE 15 BENCH 1/02/93 42 0 42 0 0 0 16 LADDER 8/28/93 91 0 91 0 0 0 17 WEEDWACKER 6/07/94 317 0 317 0 0 0 18 PUSHMOWER 8/16/94 794 0 794 0 0 0 19 79 FORD DUMP TRUCK 8/31/94 4,500 0 4,500 0 0 0 20 SNOW BLOWER 9/14/94 1,642 0 1,642 0 0 0 21 WELDER 9/24/94 322 0 322 0 0 0 22 2-PLOWS 10/11/94 3,498 0 3,498 0 0 0 23 CHAINS 11/26/94 49 0 49 0 0 0 24 TOOLS&EQUIPMENT 7/01/95 678 0 678 0 0 0 25 TOOLS&EQUIPMENT 7/01/97 2,972 0 2,972 0 0 0 26 TOOLS&EQUIPMENT 7/01/96 5,789 0 5,789 0 0 0 27 TOOLS&EQUIPMENT 7/01/98 14,204 0 14,204 0 0 0 28 TOOLS&EQUIPMENT 7/01/99 15,965 0 15,965 0 0 0 29 TOOLS&EQUIPMENT 7/01/00 14,902 0 14,902 0 0 0 30 TRUCK 7/01/00 21,020 21,020 21,020 0 0 0 31 TOOLS&EQUIPMENT 7/01/01 1 1,629 0 1,629 0 0 0 32 TOOLS&EQUIPMENT 7/01/02 19,515 0 19,515 0 0 0 35 TOOLS&EQUIPMENT 7/01/04 11,107 11,107 11,107 0 0 0 36 05 DODGE RAM 3500 12/20/04 44,083 44,083 44,083 0 0 0 38 TOOLS&EQUIPMENT 7/01/05 4,306 4,306 4,306 0 0 0 39 TOOLS&EQUIPMENT 7/01/06 11,664 0 11,664 0 0 0 40 SPREADER&EQUIPMENT 7/01/07 5,010 0 5,010 0 0 0 41 JOHN DEERE TRACTOR 3/01/08 25,340 25,340 20,961 2,919 1,459 -1,460 42 STEEL POWER HEAD&TRIMMING Ex 7/01/09 848 848 604 97 49 -48 43 JOHN DEERE BACKHOE 3/22/10 30,822 30,822 16,027 5,918 2,959 -2,959 45 John Deere Commercial Front Mower 3/01/11 21,488 7,488 16,621 1,947 0 -1,947 46 2003 Ford F250 11/01/11 11,990 11,990 600 4,556 4,556 0 47 Pressure Washer - 7/01/11 920 920 138 313 313 0 48 Plow&Salt Spreader 10/14/11 6,636 6,636 332 2,521 0 -2,521 49 Salt Spreader for Dodge 3500 Truck 10/31/11 1,797 1,797 90 683 683 0 50 Snapper Hand Mower 12/01/11 1,048 1,048 52 399 399 0 323,803 182,756 276,355 19,353 10,418 -8,935 Grand Totals 323,803 182,756 276,355 19,353 10,418 -8,935 Less:Dispositions 0 0 0 0 0 0 Less: Start-up/Org Expense 0 0 0 0 0 0 Net Grand Totals 323,803 182,756 276,355 19,353 10,418 -8,935 206-62=3419 RA Future "-'epreciation Report FY_- , 12/31/13 LANDSCAPING Date In Asset Description Service Cost PA Prior MACRS: 1 TRUCK 1/01/89 15,351 0 2 LAWN TRACTOR 7/01/90 6;890 0 3 SNOW PLOW 7/01/90 11417 0 4 WHEELBARROW 7/01/90 37 0 5 BROOM 7/01/90 11 0 6 POWER BLOWER 7/01/90 244 0 7 EQUIPMENT 7/01/91 1,860 0 8 TRACTOR 10/15/92 9,699 0 9 ABED TRIMMER 4/15/92 211 0 10 MOWER 6/15/92 698 0 11 TOOLS 7/01/92 317 0 12 CHAIN SAW 4/01/93 737 0 13 ECHO WEED TRIMMER 6/01/93 215 0 14 WOOD SPLITTER 11/06/93 1,128 0 15 BENCH VISE 1/02/93 42 0 16 LADDER. 8/28/93 91 0 17 WEEDWACKER 6/07/94 317 0 18 PUSHMOWER .8/16/94 794 0 19 79 FORD DUMP TRUCK 8/31/94 4,500 0 20 SNOW BLOWER 9/14/94 1,642 0 21 WELDER 9/24/94 322 0 22 2-PLOWS 10/11/94 3,498 0 23 CHAINS 11/26/94 49 0 24 TOOLS&EQUIPMENT 7/01/95 678 0 2.5 TOOLS&EQUIPMENT 7/01/97 2,972 0 26 TOOLS&EQUIPMENT 7/01/96 5,789 0 27 TOOLS&EQUIPMENTT 7/01/98 14,204 0 28 TOOLS&EQUIPMENT 7/01/99 15,965 0 29 TOOLS&EQUIPMENT 7/01/00 14,902 0 30 TRUCK 7/01/00 21,020 0 31 TOOLS&EQUIPMENT 7/01/01 1,629 0 32 TOOLS&EQUIPMENT 7/01/02 19,515 0 35 TOOLS&EQUIPMENT 7/01/04 11,107 0 36 05 DODGE RAM 3500 12/20/04 44,083 0 38 TOOLS&EQUIPMENT 7/01/05 4,306 0 39 TOOLS&EQUIPMENT 7/01/06 11,664 0 40 SPREADER&EQUIPMENT 7/01/07 5,010 0 41 JOHN DEERE TRACTOR 3/01/08 25,340 1,460 42 STEEL POWER HEAD&TRIMMING EXT 7/01/09 848 98 43 JOHN DEERE BACKHOE 3/22/10 30,822 3,551 45 John Deere Commercial Front Mower 3/01/11 21,488 1,168 46 2003 Ford F250 11/01/11 11,990 2,733 47 Pressure Washer 7/01/11 920 188 48 Plow&Salt Spreader 10/14/11 6,636 1,513 49 Salt Spreader for Dodge 3500 Truck 10/31/11 1,797 410 50 Snapper Hand Mower 12/01/11 1,048 239 323,803 11,360 Grand Totals 323,803 11,360 I F Department of the Tmasu�nternai Revenue Seeivice ( ) m 1 040 U.S . Individual Income Tax Return 201 1 oMenta.1545-0074 IRS Use Only—Do not write or staple in this space. For the year den.L ec.31,2011,o.other tax year beginning 011,endi 4 separate Instructions. Your first name and initial Last name our social security number Narlena 5 Betts b 167-58-8104 If a joint return,spouses first name and initial Last name spouse's social security number Home address(number and street).If you have a P.Q.box,see instructions. Apt.no. Make sure the SSN(s)above 7535 Wertzville Road and on line 6c are correct City,town or post office,state,and ZIP code.if you have a foreign address,also complete spaces below(see instructions). Presidential Election Campaign Carlisle PA 17 015 Chic here if you,or your spouse if fling jointly,want$i to go to this fund.Checking Foreign country name Foreign province/country Foreign postal code a box below will not change urtax-7 or refund ❑You r]Spouse Filing Status 1 ❑ Single 4 F Head of household(with qualifying person).(See instr.)If the 9 qualifying person is a child but not your dependent,enter this 2 ❑ Married filing jointly(even If only one had income) child's name here. Check only one 3 ❑ Married filing separately.Enter spouse's SSN above ► box. and full name here. 10.. 5 ❑Qualifying widow(er)with dependent child Exemptions ❑ Y p . . . . . Boxes checked 6a X Yourself. If someone can claim you as a dependent,do not check box 6a 1 on 6a and 6b b 'Spouse . No.of children c Dependents: 2 Dependents '3 Dependent's .(4) trchild� der-ageV �nve who: 2 p ( 1 Pe_ ( }. �' quardyfwfar chi Wtax rrrveedwitttyou {t}First name Last name soda!seventy number retaf�onshrp t4 you (, -buctions) • did not live with Cariana Betts 189-74-5483 Daughter you due ��°''� If more than four Nandi Betts 184-76-0679 Daughter X dependents,see (see Instructions) Dependents on 6c instructions and not entered above check here►L Add numbers on d Total number of exemptions claimed Imes above ► . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Income 7 Wages,salaries,tips,etc. Attach Form(s)W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . 7 48, 464 $a Taxable interest.Attach Schedule B if required . . . . .. . . . . . . . . . . . . . . . . . . . . Be 0 b Tax-exempt interest.Do not include on line 8a . . . . . . . . . . . . . . I 8b 1 0 E=- Attach Form(s) 9a Ordinary dividends.Attach Schedule B if required . . . . . . . . . . . . . . . . . 9a 0 W-2 here.Also b Qualified dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 9b 0 attach Forms 0 W-2G W-2G and 10 Taxable refunds,credits,or offsets of state and local income taxes . . . . . . . . . . . . . . . . 10 if tax 11 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 was withheld. 12 Business income or(loss).Attach Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . 12 0 13 Capital gain or(loss).Attach schedute D if required if not required,Eck here . . . . . . . . . . ► ❑ 13 81 If you did not 14 Other gains or(fosses).Attach Form 4797 . . . . . . . . . . . . . . . . . . . . . . 14 get a W-2, 150 IRA distributions . . : : 150! � b Taxable amount . ' 15b 0 see instructions. 16a Pensions and annuities . . 160 b Taxable amount 16b 0 17 Rental real estate,royalties,partnerships,S corporations,trusts,etc.Attach Schedule E . . . . . 17 Enclose,but do 18 Farm income or(loss).Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 0 not attach,arty 19 Unemployment compensation . . . . . . . . . . . . . . . 19 payment.Also, please use 20a Social security benefits 120al b Taxable amount . . . . 20b Form 1040-V. 21 Other income.list type and amount____________R_S_A__ _____________ _ 21 974 22 Combine the amounts in the far right column for lines 7 through 21.-This is yourtotal income op._ 22 4 9,519 23 Educator expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 U-RiiF: Adjusted 24 Certain business expenses of reservists,performing artists, and Gross fee-basis government officials"Attach Form 2106 or 2106-F7 . . . 24 0 Income 25 health savings account deduction.Attach Form 8889 . . . . . . . . . . . 25 780== 26 Moving expenses.Attach Form 3903 . . . . . . . . . . 26 0 Y : 0 ? ZT Deductible part of self-employment tax.Attach Schedule SE . . . . 27 28 Self-employed SEP,SIMPLE,and qualified plans . . . . . . . . . . . . . 28 0 29 Self-employed health insurance deduction . . . . . . . . . . . . . . 29 0 30 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . 30 0 Kw„f. 31a Alimony paid b Recipient's SSN ► 31a ;ti•'?f+ 32 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 0 -`= 33 Student loan interest deduction . . . . . . . . . . . . . . . . . . . . . . 33 `_ 34 Tuition and fees.Attach Form 8917 . . . . . . . . . . . . . . . . . . 34 35 Domestic production activities deduction.Attach Form 8903 35 0� n 36 Add lines 23 through 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 780 37 Subtract line 36 from line 22.This is your adjusted gross income . . . ► 37 46,739 KIA For Disclosure,Privacy Act,and Paperwork Reduction Act Notice,see separate instructions. Form 1040 (2011) i Form 1040(2011) Marlena S Betts 167-58-8104 Page 2 38 Amount from line 37(adjusted gross income) . . . . . . . . . . . . . . . . . 38 46,739 Tax and 39a Check You were born before January 2,1947, �Blind. Total boxes 10::Credits if: {❑Spouse was bom before January 2, 1947, �Blind. } checked ► 39a Standard b If your spouse itemizes on a separate return,or you were a dual-status alien,check here► 39b ; Deduction 40 Itemized deductions(from Schedule A)or your standard deduction(see left margin) _ . . . . 40 81500 for— 40,239 •People who 41 Subtract fine 40 from line 38 41 check any 42 Exemptions.MuIfSply$3,700 by the number on line 6d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 11,10 0 box on line 29, 139 39a or 39b or 43 Taxable income.Subtract line 42 from line 41.If line 42 is more than line 41,enter-0- . . . . . . . . . . . . . . . 43 who can be 44 Tax(see instructions).Check if arty from: claimed as a 3,754 dependent, a❑Forrn(s)6614 b❑ Form 4972 c❑962 election 44 see 45 instructions. 45 Altemative minimum tax(see instructions).Attach Form 6251 . . . . . . . . . . . . . . . . . . . . . . . . . . ► •All others: 46 Add fines 44 and 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 3, 754 Single or 47 Foreign tax credit.Attach Form 1116 if required . . . . . . . . . . . 47 0 - Married filing 48 separately, 48 Credit for child and dependent care expenses.Attach Form 2441 $5,800 49 Married filing 49 Education credits from Form 8863, line 23 jointly or 50 Retirement savings contributions credit.Attach Form 8880 50 0 = Qualifying 51 11000 - widow(er), 51 Child tax credit(see instructions) Head 0 52 Residential energy credits.Attach Form 5695 . . . . . . . . . 52 0 household, 53 Other credits from Form: a 0 3600 b❑6601 c 53 $8,500 54 Add lines 47 through 53.These are your total credits . . . . . . . . . . . . . . . . . . . . . . . 54 1, 000 55 Subtract fine 54 from line 46.If line 54 is more than line 46,enter-0- . 0. 55 2, 754 Other 56 Self-employment tax.Attach Schedule SE 56 0 Taxes 57 Unreported social security and Medicare tax from Form: a ❑4137 b❑8919 . . . . . . . 57 _ 0 58 Additional tax on IRAs,other qualified retirement plans,etc.Attach Form 5329 if required . . . . . 58 0 59a Household employment taxes from Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . 59a 0 b First-time homebuyer credit repayment.Attach Form 5405 if required . . . . . . . . . . . . . . . . 59b 0 60 Other taxes Enter code(s)from instructions HSA 60 195 61 Add lines 55 through 60.This is your total tax ► 61 2, 949 . . . . . . . . . . . . . . . . . . . . . . . Payments 62 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . 62 7, 846 _ 63 2011 estimated tax payments and amount applied from 2010 return 63 0 ff you have a 64a Earned income credit(EIC) . . . . . . . . . . . . . . . . . . . . . . 64a LSchedui�e�EIC.ualifing b Nontaxable combat pay election . . . . 64b = 65 Additional child tax credit.Attach Form 8812 65 = 66 American opportunity credit from Four 8863,line 14 . . . . . . . . . . . 66 =_ 67 First-time homebuyer credit from Form 5405,line 10 . . . . . . . . . . 67 0 68 Amount paid with request for extension to file . . . . . . . . . . . . . . 68 _ 69 Excess social security and tier 1 RRTA tax withheld . . . . . . . . . . . 69 0 70 Credit for federal tax on fuels.Attach Form 4136 . . . . . . . . . . . . 70 71 Credits from Form: a 0 2439 b 7 8839 cF� 8801 dF-] 8885 1 71 1 0 72 Add fines 62,63,64a,and 65 through 71.These are yourtotal payments . 0- 72 ' 7,846 Refund 73 If line 72 is more than line 61,subtract line 61 from line 72.This is the amount you overpaid ►. 73 4, 897 74a Amount of line 73 you want refunded to you.If Form 8888 is attached,check here 0 74a 4,897 Direct deposit? ► b Routing number 12 31382241 ► c Type: Checking El Savings See instructions. ► d Account numberl 2182655312 75 Amount of line 73 you want applied to your 2012 estimated tax ► 75 0 Amount 76 Amount you owe.Subtract line 72 from line 61.For details on how to pay,see instructions ► 76~ You Owe 77 Estimated tax penal see instructions) 77 = 7; `:'. :`:` Third Party Do you want to allow another person to discuss this return with the IRS(see instructions)? Yes-Complete below X No Designee Designee's Phone Personal indentification g name ► no.► number(PIN) ► Si n Under penalties of perjury,I dedare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge and belief, g they are true,correct,and complete.Declaration of preparer(other than taxpayer)is based on all information of which preparer has any knovedge_ Here Your signature Date Your occupation Daytime phone number Joird retum?See Manager 717-856-4184 instrua co,s. a you an Protection keep a copy for Spouse's signature.If a joint return,both must sign. Date Spouse's occupation PIN,enter it your records. here(see inst) Printrrype preparers name Preparers signature Date Check if PTIN Paid self�mployed Preparer Firm's name Iii- Firm`s EIN Do- Use Only Finn's address► I Phone no. KLA Form 1040(2011) SCHEDULE D Capital Gains and Losses OMB No.l oo74 (Form 1040) 2011 Department of the Treasury 0- Attach to Form 1040 or Form 1040NR. ► See instructions for Schedule D(Form 1040). Attachment Internal Revenue Service (99) ► Use Form 8949 to list your transactions for fines 1,2,3,8,9,and 10. Seouence No. 12 Name(s)shown on return Your socia)security number Narlena S Betts I 167-58-8104 Part f: Short-Term Capital Gains and Losses—Assets Held One Year or Less Complete Form 8949 before completing line 1,2,or 3. (e)sales price from (f)Cost or other basis (9)Adjustments to (h)Gain or Ooss) gain or loss from This form may be easier to complete if you round off cents to Fonn(c 6949,) 2 from Form(s)8949, Form(s)8949, Combine columns(e), whole dollars. ralraru (e) line 2,column(f) (f),and(9) tine z,column(g) 1 Short-term totals from all Forms 8949 with box A checked in Part I 0 ( 0) 0 0 . . . . . . . . . . . . . . . . . . . 2 Short-term totals from all Forms 8949 with box B checked in Part I 0 ( 0) 0 0 3 Short-term totals from all Forms 8949 with box C checked in Part[ 0 ( 0) 0 0 4 Short-term gain from Form 6252 and short-term gain or(loss)from Forms 4684,6781, and 8824 . . . 4 0 5 Net short-term gain or(loss)from partnerships, S corporations, estates,and trusts from Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Short-term capital loss carryover. Enter the amount, if any,from line 8 of your Capital Loss Carryover Worksheet in the instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0 7 Net short-term capital gain or(loss). Combine lines 1 through 6 in column(h).if you have any long-term capital gains or losses, go to Part If below.Otherwise, go to Part III on next page . . 7 0 ;Part!f. Long-Term Capital Gains and Losses—Assets Held More Than One Year Complete Form 8949 before completing line 8,9,or 10. (e)Sales price from (f)Cost or other basis (g)Adjustments to (h)Gain or(loss) gain or loss from Form(s) 8949,fine 4, from Form(s)8949, Form(s)6949, Combine columns(e), This form may be easier to complete if you round off cents to column(e) fine 4,column( (�and(s) whole dollars. fine 4,column,(g) 8 Long-term totals from all Forms 8949 with box A checked in Part 11 0 ( 0) 0 0 . . . . . . . . . . . . . . . . . . 9 Long-term totals from all Forms 8949 with box B checked in Part II 0 ( 0) 0 0 10 Long-term totals from all Forms 8949 with box C checked in Part 11 . . . . . . . . . . . . . . . . . . . 81 ( O) 0 81 11 Gain from Form 4797, Part l; long-term gain from Forms 2439 and 6252;and long-term gain or(loss) 0 from Forms 4684,6781, and 8824 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Net long-term gain or(loss)from partnerships, S corporations,estates,and trusts from Schedule(s)K-1 12 13 Capital gain distributions. See the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 0 14 Long-term capital loss carryover. Enter the amount,if any,from line 13 of your Capital Loss 0 Carryover Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 ( ) 15 Net long-term capital gain or(loss).Combine fines 8 through 14 in column(h).Then go to Part III on 81 page 2 15 KIA For Paperwork Reduction Act Notice,see your tax return instructions. Schedule D(Form 1040)2011 Schedule D(Form 1 D40)2011 Marlena S Betts 167-58-8104 Pace Part.l.I. Summary 16 Combine lines 7 and 15 and enter the result . . . . . . . . . . . . . . . . . . . . . . . . 16 81 • If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13,or Form 1040NR, line 14.Then go to line 17 below. =_ • If line 16 is a loss, skip lines 17 through 20 below.Then go to line 21.Also be sure to complete line 22. • If line 16 is zero,skip fines 17 through 21 below and enter-0-on Form 1040, line 13,or Form 1040NR,line 14.Then go to line 22. 17 Are lines 15 and 16 both gains? _ 0 Yes. Go to line 18. ❑ No. Skip lines 18 through 21, and go to line 22. 18 Enter the amount, if any,from line 7 of the 28%Rate Gain Worksheet in the instructions . . . . ► 18 0 19 Enter the amount, if any,from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the =' instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 9 0 20 Are lines 18 and 19 both zero or blank? ❑ x Yes.Complete Form 1040 through line 43,or Form 104ONR through line 41.Then complete - the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44(or in the instructions for Form 1040NR, line 42). Do not complete lines 21 and 22 _ below. =- ❑ No. Complete Form 1040 through line 43,or Form 1040NR through line 41.Then complete the Schedule D Tax Worksheet in the instructions. Do not complete lines 21 and 22 below. 21 If line 16 is a loss, enter here and on Form 1040,line 13,or Form 1040NR,tine 14,the smaller of_ • The loss on line 16 or `2 • ($3,000),or if married filing separately, ($1,500)1 . . . . . . . . . . . . . . . . . . . . . . . . . . . Note.When figuring which amount is smaller,treat both amounts as positive numbers. 22 Do you have qualified dividends on Form 1040, line 9b,or Form 1040NR, tine 10b? _ ❑ Yes.Complete Form 1040 through line 43, or Form 1040NR through line 41.Then complete the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44(or in the instructions for Form 1040NR, line 42). ❑ No. Complete the rest of Form 1040 and Form 1040NR. KIA Schedule D(Form 1040)2011 Sales and Other Dispositions of Capital Assets OMB No,1545-0074 Form8949 ►See instructions for Schedule D(Form 1040). 2011 Departnent of the Treasury I,-For more information about Form 8949,see wwwJrs.gov1fbrm8949 Attachment Internal Revenue Service (99) Attach to Schedule D to list your transactions for lines 1,2,3,8,9,and 10. Sequence No. 12A Name(s)shown on return social security number Marlena S Betts 1 167-58-8104 F'a t,S Short-Term Capital Gains and Lasses--Assets Held One Year or Less Note.You must check one of the boxes below.Complete a separate Form 8949,page 1,for each box that is checked. *Caution. Do not complete column(b)or(g)until you have read the instructions for those columns(see the instructions for Schedule D(Form 1040)).Columns(b)and(g)do not apply for most transactions and should generally be left blank. (A)Short-term transactions reported on (B)Short-term transactions reported on Form ❑ (C)Short-term transactions for which you Form 1099-B with basis reported to the IRS 1099-6 but basis not reported to the IRS cannot check box A or B la) (b) (c) (d) (a) M Description of property Code,if arty, Date acquired Date sold Sales price Cost or other basis Adjustrrierriz to (Example:100 sh.XYZ Co.) for column(g)* (Mo.,day,yr.) (Mo.,day,yr.) (see instructions) (see instructions) gain or loss,if any* 2 Totals.Add the amounts in columns(e)and().Also,combine the amounts in column(g). Enter here and include on Schedule D,line I Cif box A above is checked),line 2 (if box B above is checked), or line 3 Cif box C above is checked) . ► 2 KIA For Paperwork Reduction Act Notice,see your tax return instructions. Form 8949(2011) i Form 8949(2011) Attachment Sequence No. 12A Page 2 Name(s)shown on return.Do not enter name and social security number if shown on other side. Your social security number Na=lena S Betts 167-58-8104 i?art'1f Long-Term Capital Gains and Losses—Assets Held More Than One Year Note.You must check one of the boxes below. Complete a separate Form 8949, page 2,for each box that is checked. *Caution.Do not complete column (b)or(g) until you have read the instructions for those columns (see the instructions for Schedule D (Form 1040)). Columns(b)and(g)do not apply for most transactions and should generally be left blank. (A)Long-term transactions reported on (B) Long-term transactions reported on Form (C)Long-term transactions for which Form 1099-B with basis reported to the IRS 1099-B but basis not reported to the IRS you cannot check box A or B (a) (b) (C) (d) (e) M (g) 3 Description of property Code,if any, Date acquired Date sold Sales price Cost or other basis Adjustments to (Example:10D sh XYZ Ca) for column(g)` Mo.,day,yr. (Mo.,day,yr.) (see instructions) see instructions in or loss,r any' SER E&EE BONDS 01/01/05 12/31/11 81 0 0 4 Totals.Add the amounts in columns(e)and(f).Also, combine the amounts in column (g). Enter here and include on Schedule D, line 8(if box A above is checked), line 9 Cif box B above is checked), or line 10 if box C above is checked . ► 4 81 0 0 Form 8949(2011) OMB No.1545--0074 Farm 8889 Health Savings Account (HSAs) 2011 Department of the Treasury Attachment Internal Revenue service 00- Attach to Form I040 or Form 1040NPL ► See separate instructions. Sequence No. 53 Name(s)shown on Form 1040 or Form 104ONR Social security number of HSA beneficiary.If both spouses have 167-58-8104 Marlena. S Betts HSAs,see in 0- Before you begin: Complete Form 8853,Archer MSAs and Long-Term Care Insurance Contracts, if required. HSA Contributions and Deduction. See the instructions before completing this part If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse. 1 Check the box to indicate your coverage under a high-deductible health plan(HDHP)during 2011 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Self-only M Family. 2 HSA contributions you made for 2011 (or those made on your behalf),including those made from January 1,2012,through April 17,2012,that were for 2011. Do not include employer 2 780 contributions,contributions through a cafeteria plan,or rollovers(see instructions) . . . . . . . . . — 3 If you were under age 55 at the end of 2011,and on the first day of every month during 2011, you were, or were considered,an eligible individual with the same coverage,enter$3,050 ($6,150 for family coverage).All others,see the instructions for the amount to enter . . . . . . . . 3 6,150 4 Enter the amount you and your employer contributed to your Archer MSAs,for 2011 from Form 8853,lines I and.2. If you or your spouse had family coverage under an HDHP at any time 0 during 2011, also include any amount-contributed to your spouse's Archer MSA_s . . . . . . . . . . 4 6 150 5 Subtract line 4 from line 3. If zero or less,enter-0- . . . . . . . . . . . . . . . . . . . . . . . . . 5 ,r 6 Enter the amount from fine 5. But if you and your spouse each have separate HSAs and had family coverage under an HDHP at any time during 2011,see the instructions for the amount to enter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6,150 7 If you were age 55 or older at the end of 2011,married,and you or your spouse had family coverage under an HDHP at any time during 2011,enter your additional contribution amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 6, 150 8 Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 8 9 Employer contributions made to your HSAs for 2011 . . . . . . . . . . 1 9 1,030 10 Qualified HSA funding distributions . . . . . . . . . . . . . . . . . . . Lk 0 t—_ 11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1, 030 12 5,120 12 Subtract line 11 from line 8.If zero or less,enter-0- . . . . . . . . . . . . . . . . . . . . . . . . . 13 HSA deduction. Enter the smaller of line 2 or line 12 here and on Form 1040, line 25,or Form 104ONR,line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 780 Caution:If line 2 is more than fine 13,you may have to pay an additional tax(see instructions}. HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part 11 for each spouse. 14a Total distributions you received in 2011 from all HSAs(see instructions) . . . . . . . . . . . . . . 14a 974 b Distributions included on line 14a that you rolled over to another HSA.Also include any excess contributions(and the earnings on those excess contributions)included on line 14a that were withdrawn by the due date of your return(see instructions) . . . . .. . . . . . . . . . . . .. . . . . .14b c Subtract line 14b from line 14a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14c 974 15 Unreimbursed qualified medical expenses(see instructions) . . . . . . . . . . . . . . . . . . . . 15 16 Taxable HSA distributions. Subtract fine 15 from line 14c. If zero or less,enter-G-.Also, include this amount in the total on Form 1040, line 21,or Form 1040NR,line 21.On the dotted 16 974 line next to line 21,enter'HSA"and the amount . . . . . . . . . . . . . . . . . . . . . . . . . . . 17a If any of the distributions included on line 16 meet any of the Exceptions to the Additional 20%Tax(see instructions),check here . . . . . . . . . . . . . . . . . . . . . . . . . . . b Additional 20%tax(see instructions). Enter 20%(.20) of the distributions included on line 16 that are subject to the additional 20%tax.Also include this amount in the total on Form 1040, line 60,or Form 1040NR,line 59.On the dotted line next to Form 1040,line 60,or Form 1040NR, line 59,enter"HSA"and the amount . . . . ... . . . . . . . . . . . . . . . . . . . . . 17b 195 KIA For Paperwork Reduction Act Notice,see your tax return instructions. Form 8889 (2011) Form 8889(2011) Paw 2 income and Additional Tax for Failure To Maintain HDHP Coverage. See the instructions before completing this part If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part III for each spouse. 18 Qualified HSA distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 19 Last-month rule . . . . 20 .Qualified HSA funding distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 21 Total income.Add lines 18, 19, and 20. include this amount on Form 1040, line 21,or Form 1040NR, fine 21. On the dotted line next to Form 1040,line 21,or Form 1040NR,line 21,enter „HSA"and the amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 0 22 Additional tax. Multiply line 21 by 10%(.10)_ Include this amount in the total on Form 1040, line 60,or Form 1040NR, line 59.On the dotted line next to Form 1040, line 60,or Fort 1040NR, fine 59, enter"HDHP°and the amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 0 KIA Form 8889 (201 1) 1099-INT(OMB No. 1545-0112) 1099-A (OMB No. 1545-0577) 1099-DIV(OM6 No. 1545-0110) 1099-B (OMB No. 1545-07 115) 1099-OID (OMB No. 1545-0117) 1099-C (OMB No. 15450424) 1099 MISC (OMB No. 1545-0115) 1099-S (OMB No. 1545-0997) MANUFACTURERS AND TRADERS O423482L 1098 (OMB No. 1545-0901) TRUST COMPANY P . O . BOX 767 BUFFALO , NY 14240 E . I . N . 16-0538020 1-800-724-2440 PAGE 1 OF 1 FOR TAX YEAR MARLENA SUE BETTS 423482 7535 WERTZVILLE RD 4350 2011 CARLISLE PA 17015 TAXPAYER ID NUMBER XXX-XX-8104 2011 - 1099- INT, INTEREST INCOME ACCOUNT NUMBER SER E&EE BONDS 004350223354001 BOX 3 INTEREST ON U .S. SAVINGS BONDS AND TREAS. OBLIGATIONS 81 .20 TOTAL U . S. TREASURY NOTES 81 .20 *Form 1099-OID:This may not be the correct figure to report on your income tax return. See instructions on back. LOOP (11/05) 1099-INT 1099-OID 1099-B 1099-A 1099-c 109 8-MORTGAGE 1099-DtV 1099-MISC The informationnextto boxesl,2,and 3 is importarttax infor- This is importanttax information and is being furnished to oration and is being fumishedto the Internal Revenue Service. This is importanttax informationand is being furnished to the the internal Revenue Service.If you are required to File a If you am required to file a return,a negligence penattyor other Internal Revenue Service.IF you are required to file a return,a return,a negligence penalty or other sanction may be sanction may be imposed on you if the IRS determines that an negligence penalty or other sanction may be imposed on you if imposed on you if taxable income results from this trans- underpayment of tax results because you overstated deduction this income is taxable and IRS determinesthat h has not been actionand the IRS determinesthat it has not been reported. for this mortgage interest or for these points or because you did ....•.e..�n rbic mGmd of irrt-tan vow return. OMB NO. 1545-1517 Page I of 1 PNC HEALTH SAVINGS ACCOUNT SERVICES PO BOX 9776 PROVIDENCE RI 02940-9776 BNY MELLON ❑ CORRECTED (if checked) For additional information,please call.: 1-866-622-3946 2011 FORM 1099-SA Recipient's Name and Address: Distributions From an HSA,Archer -31081-PHS1p-I MSA,or Medicare Advantage MSA BNYM I S TRUST CO HSA FBO Copy B for Recipient NIARLENA BETTS 7535WTRTZVILLE ROAD RECIP=S IDENTIFICATION NUMBER CARLISLE PA 17015 ***-**-8104 Trustee's I Payees Name Payer's Federal ID Number Fund&Account Number FDIC-Insured Interest Bearing Bank Port 51-0385754 CHSAXX-3010970725-001 1. Gross Distribution 2.Earnings on Excess 3.Distribution Code 4.Fair Market Value 5. Contributions on Date of Death MA $973.69 0 C> v. C C O Fhu information is being furnished to the Internal Revenue Service. Form 1099-SA is a summary of all distributions from HSA,Archer MSA,and Medicare Advantage MSA account(s)in which you owned shares in 2011. FORM 1099-SA (Keep for your records) Department of the Treasury-Intemal Revenue Service PITS 3010870725 PCSSY80R JOB49676 011920120928 Package Page 1 of 1 INCOME AND EXPENSE STATEMENT OF DARRYL E. BETTS Employer: Betts Lawn and Landscape Address: 7535 Wertzville Road, Carlisle, PA 17013 Type of Work: Self Employed, Landscaping, Seasonal Payroll Number: Pay Period: Weekly See attached Income and Expense Statement for Sole Proprietorship GROSS PAY PER PERIOD: Itemized Payroll Deductions: Federal Withholding Social Security Medicare Allotment, Savings Local Wage Tax State Income Tax Unemployment Tax Retirement (401 K) Savings Bonds Vision Dental Health Insurance AD&D Life Insurance Dependent Life EA1iIBIT a 9 LST Stock Purchase Child Support NET PAY PER PERIOD: OTHER INCOME: WEEK MONTH YEAR Interest Dividends Pension Annuity Social Security Rents Royalties Expense Account Unemployment Compensation Workmen's Compensation TOTAL OTHER INCOME: TOTAL MONTHLY NET INCOME: WEEKLY MONTHLY YEARLY HOME: Mortgage(escrow, ins,taxes incl) $1127.07 Rent $400.00 Repairs $100.00 UTILITIES: Electric $22.00 Gas/Propane $109.00 Oil Telephone/Cell Phone $19100 Water $252.76 Sewer EMPLOYMENT: Public Transportation Lunch TAXES: Real Estate See mortgage Personal Property $600.00 Income $5,234.00 INSURANCE: Homeowners See mortgage Automobile $1,200.00 Life Accident HEALTH: Other AUTOMOBILE: Payments $720.00 Fuel $150.00 Repairs $200.00 Maintenance Licenses $25.00 Registration $25.00 Auto Club MEDICAL: Doctor $200.00 Dentist $100,00 Orthodontist Hospital Medicine Special Needs (eyeglasses, contacts) EDUCATION: Private School Parochial School College Religious School Lunches Books/Misc. PERSONAL: Clothing $50.00 Food $50.00 Barber/Hairdresser $15.00 Personal Care $25.00 Laundry/Dry Cleaning $30.00 Hobbies $60.00 Memberships-Gym $50.00 CREDIT PAYMENTS: Credit Card $900.00 Charge Account LOANS OR DEBTS: Credit Union(trailer,mower,truck) $1,400.00 MISCELLANEOUS: Household Help Child Care Camp Pet Expense $30.00 Papers/Books/Magazines Entertainment $30.00 Pay TV $70.00 Vacation $1,000.00 Gifts $400.00 Legal Fees $1,000.00 Charitable Contributions $1,000.00 Religious Memberships Children's Allowances Other Child Support See mortgage Alimony Payments Lessons for Children OTHER: Music Study Sports TOTAL EXPENSES: $150,00 $5,380.07 11,23 4 876 COl. Lincoln 7 al Group PO Box 7876 Financial Group- Fort Wayne,IN 46801-7876L� WIth You Few Life . Your Retirement Account 07/01/2012-0913012012 . PyUncolnMliance@ Program MARLENA S BETTS Account Information 7835 W IL1 ROAD CARLISLE LE PA PA 17 015 Name: MARLENA S BETTS 7 Company HOLY SPIRIT HEALTH SYSTEM Name: Plan Name: HOLY SPIRIT 401(ln PLAN Plan ID: HSHS-001 Total.Accvunf Vallue (as ofa9i3or2o9zj Curren# Contr>fbutron Afnounts�` $�9 27 .29 u (as of fDlD2/2012)' � r 5 Pretax .00% Account Summary Balance(as of 0710112012) $72,859.75 FSt[filla eC� R4ttrefl78nf ttIGOF1]e Contributions Total Employee This estimate umizDs savings amounts based on prior mordh totals from the $1,318.90 date the statement %t ma was created and years to retirement This mate may not Total Employer $117.09 mustrate a comprehensive analysis of your situation.visit Investment Earnings 2,658 44 www.l.incolnFiinanciaL°om and crick on Tools for a more In-depth analysis. Dividends 135.13 Loan Payments $2,184.98 Estimated Monthly Income at Retirement Balance(as of 0913012012) $79,27429 $2,101.93 Total Account Value $79,274.29 Vested Balance Potential Account Value at Retirement .$79,274.29 $346,865.29 Contact I nfOr)f nat�O� _ Your Potential Account Value at Retirement is based only on savings =_ employer plan.Assumptions for potential account value:You/your employer continue contributing at the same rate as per the previous 12 months until age - Customer Service: 65:your savings grow at 6%annually during the pre-retirement period. Assumptions for potential monthly income:Your retirement begins at age 65 Our customer service representatives are available at and ands of age 85,your savings grow at 4%annually during this 20 year 800 234-3500;Monday-Friday,from 8:00 am to 8:00 pm ET, income u estimated amounts es- and the potential mores Online service: Your Personal Rate of.Return* (as of 0913012012) u: For your updated account values,fund performance 3-Month YTD .;':; 1-Year 3-Year 5-Year information, and to access education/planning tools, visit LincolnFinancial.com. 3.73 % 8.08% N/A N/A N/A Representative: Personalized rat@ of return represents the individual perfomnance of the Lincoln Customer Service Rep investment(s)y6*.fiave selected for your portfolio. The calculation includes 800.234.3500 activity in your account(such as contributions,exchanges among investment options,etc.)using dally share price in effect when the activity occurred.Other For more information, please consult with the Lincoln representative perbanance calculations shown on this statement are different. Because the listed above. timing of your investments and withdrawals will vary,your personal investment results will generally not be the same as the investment returns quoted for the individual funds you have selected.Quoted performance data represents past performance.Past Performance does not guarantee nor predict future performance.Current performance may be lower or higher than the Pertornmce data quoted. MEXHIBIT Lincoin Financial Group is the marketing name for Uncoin Nation a obligations. �� I are separately responsible for their own financial and contractual PAD1201-0008 EMBC0112-3239 Statement Period : 07101111 to 09130/11 1 fmv oes T 19 ifgye I wEpjr�s STATEMENT Env # S 088025135 D Account#00700335466 FMTC CUSTODIAN ROTH IRA - FBO DARRYL E BETTS AMERICAN PORTFOLIOS FINANCIAL SERVICES I 7798 WERTZVlI I E RD 74 W POMFRET ST CARLISLE, PA 17013-7201 CARLISLE, PA 17013-3216 Rep.Name:LANDIS Dealer Number.4515 Rep.Number.C68 Branch Number. 111 PORTFOLIO ALLOCATION BY ASSET CLASS PORTFOLIO SUMMARY 100.00%Growth Portfolio Value as of 06/30/11 $ 110.74 Additions $ 0.00 Withdrawals $ 0.00 Change In Investment Value $ (34.73) Ending Value as of 09130/11 Is 76.01 Change in investinentvaiue represents any appreciation or depreciation of your portfolio as well as any sales load paid. MUTUAL FUND ACCOUNT SUMMARY Market Value Shares Held NAV %of Fund Name Fund-Account# 06t30111 09/30f11 09130/11 09130/11 Total ------------------------------------------------------------------------------------------------------------------- IDELITY ADV STOCK SELECTOR ALL CAP-CL A 0721-00700335466 110.74 76.01 4.643 16.37 100.00 TOTAL $110.74 $76.01 100.09 'FMTC CUSTODIAN ROTH IRA MUTUAL FUND ACTIVITY F96 iDARRYLEBETTS FIDELITY ADV STOCK SELECTOR ALL CAP-CL A Fund#0721 Account#00700336466 CUSIP#315805580 --------------------------------------------------------------------------------------------------------------------------------- Transaction Front-End Confirm Trade Dollar Share Share Share Description Sales Charge Date Date Amount Price Amount Balance Beonning Balance 5.559 2011 Retirement Custodial Fee 09130/11 09/30111 $(15.00) $16.37 (0.916) 4.643 Ending Balance 4-643 PAGE 1 of I M#093011 1300 088025135 Web Address:adylsor-ficiality.cam Fidelity Distributors Corporation(General Distribution Agent) Regular Mail:Fidelity investments Institutional Operations Company,Inc.,PO Box 770002,Cincinnati,OH 45277-0083 Overniaht Deliverv:Fidelity investments Institutional Operations Company,Inc.,100 Crosby Parkway Mail Zone KCI G,Covington,KY 41015-4325 LIABILITIES Item Description Name of Name of Number of Property all Creditors all Debtors Balance Due 1. Mortgage Orrstown Bank Joint $181,768.73 (d/s) 2. Home Equity Line Orrstown Bank Joint $19,612.97 (d/s) 3. Visa *6963 Bank of America Husband $22,713.11 (d/s) 4. Visa *3470 Chase Husband $15,791.98 (d/s) 5. Master Card *9991 Advanta Husband $3,517.29 (d/s) 6. Master Card *9591 Sears Husband $6,303.69 (d/s) 7. Unknown# Members First Wife $7,580.04 (d/s) 8. JD*3125(Backhoe) John Deere Credit Husband $23,711.91 (d/s) 9. JD*3733(Mower '07) John Deere Credit Husband $6,571.32 (d/s) 10. JD *1523(Mower 'I I)John Deere Credit Husband $19,510.08 (d/s) 11. John Deere *2071 John Deere Account Husband $771.39 (d/s) 12. John Deere *7975 John Deere Account Husband $3,148.27 (d/s) 13. Loan Scion TC Joint $7,505.40 (d/s) (paid off by sale) 14. Used Auto Loan Members First Husband $7,702.73 (d/s) EXHIBIT CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire, with the law firm of Lavery Faherty Patterson, do hereby certify that on this 1'L-d-ay of July, 2013, I served a true and correct copy of the foregoing Pretrial Statement, via U.S. First Class mail, postage prepaid, addressed as follows: Peter J. Daley II, Esquire Peter J. Daley&Associates, P.C. 242 Wood Street California, PA 4K . ildabrand, Esquire " OV . 4 tU: 2 ati Karl R. Hildabrand, Esquire ,! Lavery Faherty Patterson 225 Market Street, Suite 304 �Ir�+ P.O.Box 1245 �-VA1 Harrisburg,PA 17108-1245 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrand(cOaverylaw.com Attorney for Plaintiff DARRYL E. BETTS : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 06-2143 : CIVIL ACTION - LAW MARLENA S. BETTS, Defendant : IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in divorce under Section 3301(c) of the Divorce Code was filed on April 13, 2006. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of Notice of Intention to Request Entry of the Decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made su43ject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: C Y C3 � <,�41.- Darryl E. Betts, Plaintiff FRO Karl R. Hildabrand, Esquire N13 HO'Y -4 MI 11: 28 Lavery Faherty Patterson 225 Market Street, Suite 304 IWBERLAHO COUNT': P.O.Box 1245 PENNSYLVANIA Harrisburg,PA 17108-1245 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrand(ci laverylaw.com Attorney for Plaintiff DARRYL E. BETTS : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 06-2143 : CIVIL ACTION - LAW MARLENA S. BETTS, Defendant : N DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A 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. 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 herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: J Darryl E. Bet s, Plaintiff Of t" TH'E P 0T H0 N 0 TARP 2014 FF8 2n AM x 1.: . Karl R.Hildabrand,Esquire CUMBERLAND CGUNTY Lavery Faherty Patterson PENNSYLVANIA 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg,PA 17108-1245 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrand()laverylaw.com Attorney for Plaintiff DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 06-2143 CIVIL ACTION - LAW MARLENA S. BETTS, Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in divorce under Section 3301(c) of the Divorce Code was filed on April 13, 2006. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety 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. 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: IX0 Marlena S. Be s,. efendant t:"LED-,,'-"IF J THE PR0TH0N10 TA R i Karl R.Hildabrand,Esquire 7.014 FEB 20 AM 1.11.; 41, Lavery Faherty Patterson CUMBERLAND COUNTY 225 Market Street, Suite 304 PENNSYLVANIA P.O.Box 1245 Harrisburg,PA 17108-1245 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrand(a]averylaw.com Attorney for Plaintiff DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-2143 CIVIL ACTION - LAW MARLENA S. BETTS, Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A 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. 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 herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Date: 'a 0 /� # Marlena S. Bet s, Defendant i'li �'il� C i i_ L �J THE PRO I.10HO ; 2014 MAR -6 AM 11: 314 CUMBE) LANG COUNTY PENNSYLVANIA In the Court of Common Pleas of Cumberland County, Pennsylvania DARRYL E. BETTS CIVIL ACTION - LAW vs. MARLENA S. BETTS Plaintiff, Defendant. No. 06 -2143 MOTION FOR LEAVE TO WITHDRAW AS LEGAL COUNSEL Filed on behalf of Peter J. Daley & Associates, P.C. Counsel of record for this party: Peter J. Daley and Associates, P.C. 242 Wood Street California, Pennsylvania 15419 Phone: (724) 938 -8953 Peter J. Daley II, Esquire Atty. I.D. #70244 DARRYLE E. BETTS vs. MARLENA S. BETTS Plaintiff, : Defendant. . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 06 -2143 Motion to for Leave to Withdraw as Legal Counsel to Defendant, Marlena S. Betts AND NOW, comes Peter J. Daley & Associates, P.C., by Peter J. Daley II, Esquire, and hereby moves for leave to withdraw as counsel to Defendant, Marlena S. Betts, and states as reasons therefore the following: 1. Movant believes and therefore avers there has been a breakdown of communications between counsel and Defendant, Marlena S. Betts. 2. Movant was informed by Defendant, Marlena S. Betts that she is pursuing other Counsel in regards to this matter and wishes for current Counsel to withdraw his appearance on her behalf. WHEREFORE, Movant, Peter J. Daley II, Esquire, of Peter J. Daley and Associates, P.C. respectfully requests this Honorable Court grant him leave to withdraw his appearance in this matter. Resp ubmitted, LEY & A SOCIATES,P.C. • aley II Certificate of Service I, Peter J. Daley II Esquire, of Peter J. Daley & Associates, P.C. certify that I have served the foregoing Motion to Withdraw upon Defendant and upon Plaintiff's Counsel by First Class US mail on the ay of March 2014. Date: Karl R. Hildabrand, Esquire LAVERY FAHERTY PATTERSON 225 Market Street, Suite .304 P.O. Box 1245 Harrisburg, PA 17108 -1245 Attorney for Plaintiff, Darryl E. Betts Marlena Betts 7535 Wertzville Road Carlisle, PA 17015 , Esquire DARRYL E. BETTS, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. MARLENA S. BETTS, : 2006 — 2143 CIVIL TERM Defendant ORDER OF COURT AND NOW, this 1811--1 day of MARCH, 2014, there being insufficient facts in the petition to allow us to make an informed decision, counsel's request for leave to withdraw is DENIED without prejudice. Karl R. Hildabrand, Esquire •/‹.--)eter J. Daley, II, Esquire :sld tirtculzua 1:4 s koL 3/19//v Edward E. Guido, J. DARRYL E. BETTS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2006 -2143 MARLENA S. BETTS, CIVIL ACTION - LAW Defendant : IN DIVORCE PRAECIPE TO WITHDRAW AND ENTER APPEARANCES TO THE PROTHONOTARY: Kindly withdraw the appearance of Peter John Daley I, Esquire, as attorney for the Defendant, Marlena S. Betts, in the above capt Dated: By: II, Esquire 24 C- iforn'a, P= :nnsyly: nia 15419 (72 8 -89 Kindly enter the appearance of Michael A. Scherer, Esquire, as attorney for the Defendant, Marlena S. Betts, in the above captioned matter. Dated: 3 2 5 J i L I By: Mic1 el A. Scherer, Esquire I.D. No.: 61974 Baric Scherer LLC 19 West South Street Carlisle, Pennsylvania 17013 (717) 249 -6873 Karl R. Hildabrand, Esquire Lavery Faherty Patterson 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg, PA 17108 -1245 717-233-6633 (telephone) 717 - 233 -7003 (facsimile) khildabrand@a,laverylaw.com Attorney for Plaintiff 2814 APR 21 1311 2: 50 PE1;'S YL V N IAr'�' )" DARRYL E. BETTS Plaintiff v. MARLENA S. BETTS, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06 -2143 .: CIVIL ACTION _ LAW IN DIVORCE 1. STIPULATION OF THE PARTIES The parties in the above matter were married on May 11, 1991, and finally separated on September 15, 2011. 2. The above divorce case involves claims for equitable distribution which are presently pending before the Divorce Master, Robert Elicker, Esquire. 3. The first day of testimony at the Divorce Master's hearing was held on February 20, 2014, and an additional day of testimony is scheduled for May 6, 2014. 4. The parties, at the hearing on February 20, 2014, stipulated to the entry of a bifurcated divorce at this time. 5. Both parties request that the court permit the entry of a bifurcated divorce in this matter. Mic ae A. Scherer, Esquire Bane Scherer, LLC 19 West South Street Carlisle, PA 17013 (717) 249-6873 Telephone (717) 249-5755 Facsimile mscherer @baricscherer. corn Attorney for Defendant, Marlena S. Betts 14. 1614 Date: 2 Respectfully submitted, af1 R. Hildabrand, Esquire LA VERY FAHERTY PATTERSON 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg, PA 17108-1245 Attorney I.D. No. 30102 (717) 233-6633 Telephone (717) 233-7003 Facsimile khildabrandPJaverylaw.com Attorney for Plaintiff, Darryl E. Betts Date: V17—/V DARRYL E. BETTS : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. MARLENA S. BETTS, Defendant : NO. 06-2143 c =. -03 IN DIVORCE cal r- ry , --or- 1 r—z > , ORDER z .- --i (..) --.< co AND NOW, this day of N , 2014, upon consideration of the Stipulation of the parties, it is hereby ordered that the parties may file for the Entry of a Bifurcated Divorce at this time with the financial issues to be resolved subsequently. BY THE COURT, Distribution: Karl R. Hildabrand, Esquire, Lavery Faherty Patterson, 225 Market Street, Suite 304, P.O ox 1245, Harrisburg, PA 17108-1245, as attorney for Plaintiff --.'"-Michael A. Scherer, Esquire, Baric Scherer LLC, 19 West South Street, Carlisle, PA 17013, as attorney for Defendant Ccepl'es AiljEdAY DARRYL E. BETTS, Plaintiff vs. MARLENA S. BETTS, Defendant .• IN THE COURT OF COMMON PLEAS OF .• CUMBERLAND COUNTY, PENNSYLVANIA C) r--) -`; NO. 06 - 2143 CIVIL ma -3 m =) to r` IN DIVORCE r--t- <.-.c", >c) ao ORDER OF COURT AND NOW, this 0 day of rrl _ r- -de rrt c —4G -1z 2014, the parties and counsel having entered into an agreement and stipulation resolving the economic issues on May 6, 2014, the date set for a Master's hearing, the agreement and stipulation having been transcribed and signed by the parties and counsel, the appointment of the Master is vacated and counsel can conclude the divorce by completing the petition to bifurcate previously filed so that a final decree in divorce can be entered. THE COURT, 9.44. in A. Hess, P.J. cc: Karl R. Hildabrand Attorney for Plaintiff ..4lichael A. Scherer Attorney for Defendant Ce=re CP.s /2.ifEL- slad/4/5( DARRYL E. BETTS, Plaintiff vs. MARLENA S. BETTS, Defendant .• IN THE COURT OF COMMON PLEAS OF .• CUMBERLAND COUNTY, PENNSY,VA iIA 733 -L— . NO. 06 - 2143 CIVIL x rn mr --< cot f IN DIVORCE <c-.) • >(3 3r Z 5;C: Today is Tuesday, May 6,-42014. THE MASTER: This is the date set for a Master's hearing in the above -captioned divorce proceedings. Present in the hearing room are the Plaintiff, Darryl E. Betts, and his attorney Karl R. Hildabrand, and the Defendant, Marlena S. Betts, and her counsel Michael A. Scherer. Mrs. Betts was previously represented by attorney Peter Daley who has withdrawn from the case and Mr. Scherer has entered his appearance. The Master made opening remarks at the time of the hearing in this case on February 20, 2014, which will be incorporated within this statement. Therefore, the Master is suggesting that we copy Page 3 of the remarks made at the prior hearing, which outlines the circumstances regarding the affidavits and grounds and claims and counterclaims. (Opening remarks of hearing held on February 20, 2014, are attached.) Mr. Hildabrand, do you want to bring us up-to-date, please, on the status of the divorce action? 1 MR. HILDABRAND: Yes, I will. Thank you. As far as the divorce itself goes, I filed a petition for a bifurcated divorce. It was a stipulation of the parties to do so. The Court, just within the last several days, has entered an order permitting the bifurcated divorce. I will be filing tomorrow the praecipe to transmit and requesting that the divorce decree be entered immediately. As far as the property issues, we have reached a settlement and I'll be happy to put that on the record, when you are ready. THE MASTER: With regard to the settlement agreement, which is going to be placed on the record, the agreement that is going to be placed on the record will be binding on the parties when they leave the hearing room today. The only corrections or changes that can be made will be with respect to correction of typographical errors which may be made during the transcription. Any substantive changes will not be addressed after the statement of the agreement is on the record in the presence of the parties, who will acknowledge that they have understood and heard the statement of the agreement. The parties and counsel are going to return later today to review the agreement for typographical errors, make corrections as necessary, and then sign the agreement affirming the terms of settlement as stated on the record. 2 Upon receipt of the completed agreement, the Master will prepare an order vacating his appointment. As indicated, the divorce itself is being processed through the bifurcation petition that has been filed. Counsel can indicate on the proposed divorce decree that all claims in this matter have been resolved in accordance with the agreement which is going to be entered on the record today. The parties were married on May 18, 1991, and finally separated in September of 2011. The parties are the natural parents of two children. The older child is currently in college and the younger child is going to graduate from high school in May 2014, and will be considered an emancipated person upon graduation. Mr. Hildabrand. MR. HILDABRAND: Thank you. 1. Mr. Betts operates a sole proprietor business known as Betts Lawn and Landscape. Wife hereby waives and relinquishes any right, title and interest in the business, and the business assets and equipment shall be solely the property of Mr. Betts. The liabilities of the business shall be the responsibility of husband. 2. Mrs. Betts has a 401(k) account through her employment with Holy Spirt Health System. The account is with Lincoln Financial Group. The balance in the account, as of March 31, 2014, was $57,581.67. That amount shall be transferred from wife to husband by a QDRO and the QDRO expense will be paid by Mr. Betts, and that transfer shall take place as soon as practical. The parties have confirmed today by a phone call with Lincoln Financial Group that the balance in the account is at least the amount that I stated. It is my understanding that wife has made or is making arrangements to transfer 3 that amount, $57,581.67, immediately into a "safe account" which would either be a money market or something to that effect, so that the value will be maintained as opposed to being a stock account which could go up or down in value. To the extent that there are any funds left in that retirement account after the transfer of the $57,581.67, those funds shall be retained by wife, and upon receipt of the funds designated to go to husband, husband shall waive any and all further claims against that Lincoln Financial Group account. 3. During the marriage the parties acquired real estate located at 7535 Wertzville Road, Carlisle, Pennsylvania. The home is encumbered by a first mortgage with Orrstown Bank and a home equity loan with Orrstown Bank. Wife is presently residing in the marital residence. Wife shall have 90 days from today's date, May 6, 2014, in which to refinance should she choose to do so. In the event that she chooses not to do so or is unable to do so, after that 90 day period, the property shall be listed for sale. Should the property be listed for sale, the parties will corporate and use their best efforts with due diligence to sell the property as soon as possible and to remove husband from any obligation on the mortgage or the home equity loan. Effective immediately today, wife assumes sole liability for the mortgage, home equity loan, taxes, insurance and any other property related expenses. In addition, both parties agree that there shall be no additional advances on the home equity loan by either party. In the event that wife refinances the marital residence, husband agrees to transfer a deed to wife transferring any and all interest in the property to her, in conjunction with and contemporaneous with, his removal from the mortgage and home equity loan. In the event that the property is subsequently sold, husband will cooperate to sign a deed and, again, that would be contemporaneous with his removal from and satisfaction of the mortgage and home equity loan. Any net proceeds from the sale of the home shall be solely for wife and husband would waive any claim therein. 4. Husband shall retain the 2008 Scion motor vehicle or any successor vehicle and shall be solely responsible to satisfy the Member's 1st loan on the Scion. Wife shall retain the 2008 Chevrolet Equinox and husband hereby waives and relinquishes any interest therein. 4 There is no loan outstanding on the Equinox. Both vehicles are presently titled in the name of either husband or wife but in the event that they are not and one of the titles needs to be changed, both parties agree that within twenty (20) days from today's date, they will cooperate to sign the necessary titles to transfer ownership as stated above. 5. All personal property presently in husband's possession shall be the sole property of husband and all personal property presently in wife's possession shall be the sole property of wife. 6. Each party shall retain their individual bank accounts and the other waives any interest therein. It is my understanding that there are no joint bank accounts remaining with the exception of the Member's 1st account which, as I understand it, has no money in it. With respect to the Member's 1st account, wife agrees to take those necessary steps to remove her name from the account within twenty (20) days from today's date. 7. Husband presently has a Roth IRA. Husband shall retain the Roth IRA and wife relinquishes any interest therein. 8. Wife presently has a life insurance account with Lincoln CSV. Wife shall retain the account and husband waives any interest therein. 9. With respect to the liabilities, husband shall be solely responsible for the Bank of America Visa and the Sears MasterCard and wife shall be solely responsible for the Member's 1st credit card. Each party shall indemnify the other with respect to the obligation to satisfy these debts. 10. Except for any cause of action for divorce and the obligations set forth previously in my remarks today, each party gives to the other an absolute and unconditional release and discharge from all causes of action, claims, rights or demands whatsoever in law or in equity which either party ever had or now has against the other. This release also includes any claims for alimony or counsel fees and costs. 11. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital 5 relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. MR. HILDABRAND: Darryl, you heard me describe on the record in detail the terms of settlement that you and Marlena have reached today; is that correct? MR. BETTS: Correct. MR. HILDABRAND: Are you in agreement with those terms? MR. BETTS: Yes. MR. HILDABRAND: Do you have any questions or issues that you want to raise at this time? MR. BETTS: No. MR. HILDABRAND: So you're willing to accept those terms as a full and final settlement of all issues between you and Marlena? MR. BETTS: Yes. MR. SCHERER: Marlena, did you hear the agreement dictated by Mr. Hildabrand? MS. BETTS: Yes. MR. SCHERER: Did you understand the agreement? 6 MS. BETTS: Yes. MR. SCHERER: Do you have any questions about the agreement? MS. BETTS: No. MR. SCHERER: Do you accept the agreement as a full and final compromise of the economic claims in this case? MS. BETTS: Yes. THE MASTER: Thank you. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: Irl R. Hildabrand Attorney for Plaintiff Attorney for Defendant s--/6//‘ 7 Darryl E. B tts 1 THE MASTER: Today is Thursday, February 20, 2 2014. This is the date set for hearing in the 3 above -captioned divorce proceedings. Present in the hearing 4 room are the Plaintiff, Darryl Betts, and his attorney Karl 5 R. Hildabrand, and the Defendant, Marlena S. Betts, and her 6 counsel Peter J. Daley. 7 This action was commenced by the filing of a 8 complaint in divorce on April 3, 2006, raising grounds for 9 divorce of irretrievable breakdown of the marriage. With 10 respect to grounds for divorce, the parties have signed 11 affidavits of consent and waivers of notice of intention to 12 request entry of divorce decree which have been filed with 13 the Prothonotary. The affidavits and waivers will allow 14 the case to proceed under Section 3301(c) of the Domestic 15 Relations Code. The complaint also raised grounds for 16 divorce of adultery and indignities. We will not be, 17 however, dealing with those grounds inasmuch as we have the 18 consents of the parties under Section 3301(c). 19 The complaint raised a claim for equitable 20 distribution. On May 23, 2006, a counterclaim was filed 21 raising claims for alimony, alimony pendente lite, and 22 counsel fees and costs. 23 Mr. Daley, with respect to the counterclaim, 24 I understand you were not counsel at the time that those 25 claims were raised. 3 Karl R. Hildabrand, Esquire Lavery Faherty Patterson 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg, PA 17108-1245 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrand(1averylaw.com Attorney for Plaintiff I �• ! I-./ _ felt J T D-Crt 1 20 i NAY 8 PH 14 6 CUMBERL PENNS Y/V N,COUNTY' DARRYL E. BETTS Plaintiff v. MARLENA S. BETTS, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-2143 : IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Transmit the record, together with the following information, to the Court for entry of a Divorce Decree: 1. Ground for divorce: Irretrievable breakdown under §3301(c) of the Divorce Code. 2. Date and manner of service of the complaint: The Defendant accepted Service personally on April 19, 2006. Acceptance of Service was filed on April 27, 2006. 3. Date of execution of the Affidavit of Consent required by §3301(c) of the Divorce Code: By Plaintiff October 24, 2013 and filed November 4, 2013; by Defendant February 20, 2014 and filed February 20, 2014. 4. Related Claims pending: All claims have been resolved in accordance with a Settlement Agreement entered on the record before Master Robert Elicker on May 6, 2014. 5. Date Plaintiff's Waiver of Notice in §3301(c) Divorce was filed with the Prothonotary: November 4, 2013. Date Defendant's Waiver of Notice in §3301(c) Divorce was filed with the Prothonotary: February 20, 2014. Date: Respectfully submitted, LAVERY FAHERTY PATTERSON Karl R. Hildabrand, Esquire Attorney I.D. No. 30102 225 Market Street, Suite 304 P.O. Box 1245 Harrisburg, PA 17108-1245 (717) 233-6633 (717) 233-7003 khildabrand@laverylaw.com Attorney for Plaintiff *.• CERTIFICATE OF SERVICE I, Karl R. Hildabrand, Esquire with the law firm of Lavery Faherty Patterson, do hereby certify that on this 7 day of May, 2014, I served a true and correct copy of the foregoing Praecipe to Transmit Record, via U.S. First Class Mail, postage prepaid, addressed as follows: Michael A. Scherer, Esquire Baric Scherer LLC 19 West South Street Carlisle, PA 17013 . Hildabrand IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DARRYL E. BETTS V. MARLENA S. BETTS NO. 06-2143 DIVORCE DECREE 50fm AND NOW, M L4 t� . 4� it is ordered and decreed that DARRYL E. BETTS , plaintiff, and MARLENA S. BETTS , 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 The above is consistent with this Court's previous Order of April 28, 2014, permitting the entry of a Bifurcated Divorce. All claims in this matter have been resolved in accordance with a Settlement Agreement reached by the parties and placed on the record before Master Robert Elicker on May 6, 2014. By the Court, �%A Ly- Attest: J. Prothonot ry p�Copy marled -M A� s' erer 4 f . Karl R.Hildabrand,Esquire (;) ,�, Lavery Faherty Patterson v 225 Market Street, Suite 304 - 3 i F" r. P.O.Box 1245 �,'� E ' '=9 Harrisburg,PA 17108-1245 PEVA �� �7� C Uy r Attorney ID#PA30102 Y( ►� � �� 717-233-6633 (telephone) 717-233-7003 (facsimile) khildabrandnu,laverylaw.com Attorney for Plaintiff DARRYL E. BETTS : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLA.ND COUNTY, PENNSYLVANIA v. : NO. 06-2143 : CIVIL ACTION- LAW MARLENA S. BETTS, Defendant : IN DIVORCE STIPULATION FOR APPROVAL OF QUALIFIED DOMESTIC RELATIONS ORDER 1. The parties to the above captioned divorce case were divorced by Order of this Honorable Court dated May 14, 2014. 2. Under the terms of the parties marital settlement agreement a Qualified Domestic Relations Order was to be drafted transferring $57,581.67 as of March 31, 2014, from the Lincoln Financial 40 1(k) of Defendant Marlena S. Betts to Plaintiff Darryl Betts. 3. Attached hereto as Exhibit"A" is the prepared Qualified Domestic Relations Order for approval by the Court. 4. The parties jointly request that the Court enter an Order approving and adopting the Qualified Domestic Relations Order as drafted. Respectfully submitted, LAVERY FAHERTY PATTERSON BARIC SCHERER off z. iik- --4 /4-f--7° - - ' . Hildabrand, Esquire Mic el A. Scherer, Esquire 225 Market Street, Suite 304 19 West South Street Harrisburg, PA 17108-1245 Carlisle, PA 17013 (717) 233-6633 (telephone) (717) 249-6873 (telephone) (717) 233-7003 (facsimile) (717) 249-5755 (facsimile) khildabrand@laverylaw.com mscherer@baricscherer.corn Attorney for Plaintiff Attorney for Defendant 2 Darryl E. Betts : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : NO. 06-2143 Marlena S. Betts : CIVIL ACTION — LAW — IN DIVORCE Defendant QUALIFIED DOMESTIC RELATIONS ORDER The parties intend that this Agreement, when approved by the Court with appropriate jurisdiction over the parties and the matter and the Plan Administrator (defined below), shall constitute a Qualified Domestic Relations Order ("QDRO") as established and defined by Section 414(p) of the Internal Revenue Code of 1986 and Section 206(d)(3) of the Employee Retirement Income Security Act of 1974 ("ERISA"). (a) This Order shall apply to the Holy Spirit 401(k) Plan, which is administered by Lincoln Financial Group in which Marlena S. Betts is the "Participant." (b) Darryl E. Betts shall be the "Alternate Payee" under this Order, as defined in Section 414(p)(8) of the Code and Section 206(d)(3)(K) of ERISA. (c) The parties hereby create and/or recognized the Alternate Payee's right to receive all or a portion of the benefits payable under the Plan to the Participant, as provided for herein. (d) This Order relates to the provision of marital property rights to a spouse or other dependent of the Participant and is made pursuant to the applicable state domestic relation law. (e) The following information relates to the Participant: Marlena S. Betts 7535 Wertzville Road Carlisle, PA 17015 Social Security No.: See Addendum Date of Birth: See Addendum (f) The following information relates to the Alternate Payee: Darryl E. Betts 388 Burnt House Road Carlisle, PA 17015 Social Security No.: See Addendum Date of Birth: See Addendum (g) The Plan Administrator of the Plan shall transfer to the Alternate Payee the sum of $57,581.67 of the Participant's vested account balance as of March 31, 2014. At no time will any portion of any outstanding loan balance be transferred or assigned to the Alternate Payee. Payment to the Alternate Payee shall be made in any of the forms below, if provided for by the Plan document: Option One: Segregated from the Participant's annuity into a separate Lincoln annuity in the name of the Alternate Payee. Option Two: Paid in the form of a lump sum rollover to the Alternate Payee's own IRA or other retirement plan at the Alternate Payee's carrier. Option Three: Paid in the form of a lump sum cash distribution directly to the Alternate Payee. Lincoln requires the enclosed Distribution Request Form be completed by the Alternate Payee. Any Lincoln surrender charges would be applicable per the contractual agreement. (h) The distribution described in paragraph (g) above shall not be adjusted by earnings or losses to the account as of March 31, 2014. (i) The parties stipulate that any judgment, decree, or order approving or incorporating the provisions of this Order (1) does not require the plan to provide increased benefits (determined on the basis of actuarial value), (2) does not require the payment of benefits to the Alternate Payee which are required to be paid to any other alternate payee under any other order previously determined to be a QDRO and (3) shall not provide any type or form of benefit, or any option, not otherwise provided under the plan. (j) The Court approving this Order shall retain jurisdiction to amend this Order, but only for the purpose of establishing or maintaining its qualifications as a QDRO under the Retirement Equity Act, provided that no such amendment shall require the Plan to provide any type or form of benefit, or any option, not otherwise provided for under said Plan, and further provided that no such amendment or the right of the Court to so amend will invalidate this Order as "qualified" under said Act. (k) Upon approval by the Plan Administrator, this Order shall take effect immediately and remain in effect until further order of the Court or until it expires by its terms. (I) Each of the parties request that the Plan Administrator of the Plan determine and acknowledge that this Order is a Qualified Domestic Relations Order and further request that the Plan Administrator honor and agree to comply with the same. (m) If the Alternate Payee is the spouse or former spouse of the Participant, the Alternate Payee shall be responsible for all income taxes, penalties and or withdrawal charges associated with the distribution to the Alternate Payee. 2 (n) Both the Participant and the Alternate Payee consent to the distribution described in paragraph (g). Accepted and ordered this day of BY THE COURT Judge CONSENT TO ORDER: 36by Ja7AD Plaintiff/Alternate Payee Date Defendant/Partici.:nt Date Attoyiey for Plaintiff/ Date Attor - . Defendant/ Date Alternate Payee Participant 3 Darryl E. Betts : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : NO. 06-2143 Marlena S. Betts : CIVIL ACTION — LAW — IN DIVORCE Defendant QUALIFIED DOMESTIC RELATIONS ORDER The parties intend that this Agreement, when approved by the Court with appropriate jurisdiction over the parties and the matter and the Plan Administrator (defined below), shall constitute a Qualified Domestic Relations Order ("QDRO") as established and defined by Section 414(p) of the Internal Revenue Code of 1986 and Section 206(d)(3) of the Employee Retirement Income Security Act of 1974 ("ERISA"). (a) This Order shall apply to the Holy Spirit 401(k) Plan, which is administered by Lincoln Financial Group in which Marlena S. Betts is the "Participant." (b) Darryl E. Betts shall be the "Alternate Payee" under this Order, as defined in Section 414(p)(8) of the Code and Section 206(d)(3)(K) of ERISA. (c) The parties hereby create and/or recognized the Alternate Payee's right to receive all or a portion of the benefits payable under the Plan to the Participant, as provided for herein. (d) This Order relates to the provision of marital property rights to a spouse or other dependent of the Participant and is made pursuant to the applicable state domestic relation law. (e) The following information relates to the Participant: (f) Marlena S. Betts 7535 Wertzville Road Carlisle, PA 17015 Social Security No.: See Addendum Date of Birth: See Addendum The following information relates to the Alternate Payee: Darryl E. Betts 388 Burnt House Road Carlisle, PA 17015 Social Security No.: See Addendum Date of Birth: See Addendum (g) The Plan Administrator of the Plan shall transfer to the Alternate Payee the sum of $57,581.67 of the Participant's vested account balance as of March 31, 2014. At no time will any portion of any outstanding loan balance be transferred or assigned to the Alternate Payee. EXHIBIT i A Payment to the Alternate Payee shall be made in any of the forms below, if provided for by the Plan document: Option One: Segregated from the Participant's annuity into a separate Lincoln annuity in the name of the Alternate Payee. Option Two: Paid in the form of a lump sum rollover to the Alternate Payee's own IRA or other retirement plan at the Alternate Payee's carrier. Option Three: Paid in the form of a lump sum cash distribution directly to the Alternate Payee. Lincoln requires the enclosed Distribution Request Form be completed by the Alternate Payee. Any Lincoln surrender charges would be applicable per the contractual agreement. (h) The distribution described in paragraph (g) above shall not be adjusted by earnings or losses to the account as of March 31, 2014. (i) The parties stipulate that any judgment, decree, or order approving or incorporating the provisions of this Order (1) does not require the plan to provide increased benefits (determined on the basis of actuarial value), (2) does not require the payment of benefits to the Alternate Payee which are required to be paid to any other alternate payee under any other order previously determined to be a QDRO and (3) shall not provide any type or form of benefit, or any option, not otherwise provided under the plan. (j) The Court approving this Order shall retain jurisdiction to amend this Order, but only for the purpose of establishing or maintaining its qualifications as a QDRO under the Retirement Equity Act, provided that no such amendment shall require the Plan to provide any type or form of benefit, or any option, not otherwise provided for under said Plan, and further provided that no such amendment or the right of the Court to so amend will invalidate this Order as "qualified" under said Act. (k) Upon approval by the Plan Administrator, this Order shall take effect immediately and remain in effect until further order of the Court or until it expires by its terms. (I) Each of the parties request that the Plan Administrator of the Plan determine and acknowledge that this Order is a Qualified Domestic Relations Order and further request that the Plan Administrator honor and agree to comply with the same. (m) If the Alternate Payee is the spouse or former spouse of the Participant, the Alternate Payee shall be responsible for all income taxes, penalties and or withdrawal charges associated with the distribution to the Alternate Payee. 2 (n) Both the Participant and the Alternate Payee consent to the distribution described in paragraph (g). Accepted and ordered this Si day of I'\V q �j tr� , . CONSENT TO ORDER: Plaintiff/Alternate Payee -71361)y Date Attor ey for Plaintiff/ ernate Payee fiLi-L R -1 y ,( . R rt. Sick.e — s/ytly Date 3 BY THE COURT Defendant/Partici Attor a Defendant/ Participant -vim rn co rn c-7. -4 Date jai Date r r m CD o -T: