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HomeMy WebLinkAbout06-3171DAVID R. WALTZ, : IN THE COURT OF C MMON PLEAS OF Plaintiff : CUMBERLAND COU TY, PENNSYLVANIA VS. NO. 1 C/.. tv ?h c EJLWI CHERYL L. WALTZ, : CIVIL ACTION - LA Defendant : DIVORCE YOU HAVE BEEN SUED IN COURT. If you wish to efend against the claims set forth in the following pages, you must take prompt act on. You are warned that if you fail to do so, the case may proceed without you and a ecree 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 paper by the plaintiff. You may lose money or property or other rights important to you, incl ding custody or visitation or your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of mama a counselors is available in the Office of the Prothonotary at: Office of the Prothonotary Cumberland County Court House One Courthouse Square Carlisle, Pennsylvania 17013 IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DI ISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT O 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 FIN OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIA 2 LIBERTY AVENUE CARLISLE, PENNSYLVANIA 17013 717-249-3166 DAVID R. WALTZ, Plaintiff VS. CHERYL L. WALTZ, Defendant : IN THE COURT OF 1 : CUMBERLAND COI NO. CIVIL ACTION - LA DIVORCE TO CHERYL L. WALTZ, DEFENDANT: LION PLEAS OF ,PENNSYLVANIA You have been named as the Defendant in a Complaint in a divorce proceeding filed in the Court of Common Pleas of Cumberland County. Thi notice is to advise you that in accordance with Section 3302(d) of the Divorce Code, yo may request that the court require you and your spouse to attend marriage counseling rior to a divorce being handed down by the court. A list of professional marriage couns Domestic Relations Office, 13 North Hanover Street, Carlisle, Pe advised that this list is kept as a convenience to you and you are i counselor from this list. All necessary arrangements and the cost are to be home by you and your spouse. If you desire to pursue counseling, you must make your ra within twenty (20) days of the date on which you receive this not will constitute a waiver of your right to request counseling. is available at the You are bound to choose a counseling sessions for counseling Failure to do so Diane S. Baker, Esquire I.D. No. 53200 27 S. Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, V. Plaintiff CHERYL L. WALTZ, Defendant IN THE COURT OF CUMBERLAND CO NO. DL - J1^1t CIVIL ACTION - IN DIVORCE COMPLAINT COUNT 1 - DIVORCE AND NOW comes Plaintiff, David Waltz, by his attorney, files this Complaint, based upon the following: 1. Plaintiff, David Waltz, is an adult individual with a 117, Harrisburg, Dauphin County, Pennsylvania 17108. 2. Defendant, Cheryl Waltz, is an adult individual who MON PLEAS Y, PENNSYLVANIA G S. Baker, Esquire, and address of P.O. Box resides at 820 Sawgrass Lane, Mechanicsburg, Cumberland County, Pennsylvania 3. Plaintiff and Defendant were married on July 12, Pennsylvania. 4. Plaintiff and Defendant separated on or about April 5. Plaintiff has been a bona fide resident of this months immediately prior to the filing of this Complaint. 6. Defendant is not presently a member of the Armed is not presently a member of the Armed Forces on active duty. 7. There are no pending actions in divorce or annulment other jurisdiction brought by either Plaintiff or Defendant 8. Plaintiff has been advised of the availability of have the right to request that the court require the parties to 9. Plaintiff avers that the marriage is irretrievably COUNT 2-CLAIM FOR EQUITABLE DISTRIBUTION 10. Paragraphs 1 through 9 above are herein incorporated 11. The Plaintiff and Defendant are owners of various furniture and household furnishings acquired during the marriage distribution by the Court. 12. The Plaintiff and Defendant are owners of various the marriage which are subject to equitable distribution by the Court. in Lancaster, 2006. for at least six (6) on active duty. Plaintiff this jurisdiction or in any and that Plaintiff may in counseling. reference. of personal property, are subject to equitable vehicles acquired during 13. The Plaintiff and Defendant singly or jointly have in various bank accounts acquired during the marriage which are subject to equitable distribution by the Court. 14. Plaintiff and Defendant own or have an interest in real estate which is subject to equitable distribution by the Court. 15. The Plaintiff and the Defendant have acquired duri g the marriage other marital property which is subject to equitable distribution by the Court. 3- 16. Paragraphs 1 through 15 are incorporated by 17. By reason of this action, Plaintiff will be put to co: preparation of his case, in the employment of counsel and the pay 18. The Plaintiff is without sufficient funds to support and expenses of this litigation, and is unable to appropriately pendency of this action. 19. Defendant has adequate earnings to provide for counsel fees, costs and expenses. COUNT 4 - ALIMONY 20. Paragraphs 1 through 19 are incorporated by reference 21. Plaintiff lacks sufficient property to provide for his rea 22. Plaintiff is unable to currently sufficiently support him employment. herein. ;cable expense in the I of costs. self and to meet the costs i himself during the ff s support and to pay his 23. Defendant has sufficient income and assets to provide c needs. appropriate support for the Plaintiff. WHEREFORE, Plaintiff requests the Court to enter an Plaintiff. WHEREFORE, Plaintiff requests the Court to enter a (a) (b) (c) (d) (e) Dissolving the marriage between Plaintiff Equitably distributing all marital property Ordering the payment of Alimony Pendente Ordering the payment of alimony; and Such further relief as the Court may award in favor of by the parties hereto; costs and expenses; equitable and just. Respectfully DATE: S ?1/rD Dimfe- S. Baker, Supreme Court 27 South Arlene Post Office Box Harrisburg, PA 1 (717) 671-9600 #53200 12-0443 VERIFICATION I, DAVID WALTZ, verify that the statements made in this Complaint in Divorce are true and correct. I understand that false statements herein are made Pa.C.S. Section 4904 relating to unworn falsification to authorities. to the penalties of 18 /• DAVID WAL 0 t c i G, r o ?y P T C L_ T ?z DAVID R. WALTZ, THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-3171 CIVIL TERM CHERYL L. WALTZ, IN DIVORCE Defendant/Respondent PACSES CASE NO: 611108342 ORDER OF COURT AND NOW, this 8th day of June, 2006, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shaddav on Thursday. July 20, 2006 at 1:30 P.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11© (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed on June 8, 2006 to: Petitioner Respondent Diane S. Baker, Esq. Jason Weinstock, Esq. Date of Orde r: June 8.2006 , onference Officer 411? YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 N CJ [- C'? --? Cs? rr?r,, t: S y ? -?. m CU ' t V 7?f? __ _, i?,: ? : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, : PENNSYLVANIA AFFIDAVIT OF SERVICE I, Diane S. Baker, Esquire, hereby certify that a true and correct copy of the Diane S. Baker, Esquire I.D. No. 53200 27 South Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID R. WALTZ, V. NO. 06-3171-CV CHERYL L. WALTZ, CIVIL ACTION - LAW Defendant : IN DIVORCE Complaint for Divorce was served on the Defendant by certified mail, restricted delivery, return receipt requested, on June 8, 2006, at the Defendant's last known address of. Cheryl L. Waltz 820 Sawgrass Lane Mechanicsburg, PA 17050 7 The return receipt card is attached hereto as Diane S. Baker, Esquire Attorney for Plaintiff , • 1 EXHIBIT "A" ¦ Complete items 1, 2, and 3. Also complete A. SI ture item 4 if Restricted Delivery is desired. ? Agent ¦ Print your name and address on the reverse x ? Addressee so that we can return the card to you. B. Recefv (Pnnted Na C. Date of Delivery ¦ Attach this card to the back of the mail place, or on the front if space permits. from ftem 19 ? Yes 1 D, la drdll,,ver . Article ?jddrftssed to If Yatlorgea below: ? No j Ile M6 074 3. Serv' lj?? ?'O 0 / u" c%ert?fled SOMAZIErpress Mail NN ? Registered 0 Return Receipt for Merchandise ? Insured mail ? C.O.D. 4. Restricted Delivery? (Extra Feel ey 2. Article Number (7hens/er from service laba9 PS Form 3811, August 2001 Domestic Return Receipt 102595.01?M-0361 J- • I, r Tl ! _d -S T. 1 71It \ ? 1 DAVID WALTZ, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. Plaintiff, VS. NO. 06-3171 CHERYL L. WALTZ, CIVIL ACTION - LAW Defendant. IN DIVORCE DEFENDANT'S ANSWER AND COUNTERCLAIM TO PLAINTIFF'S COMPLAINT IN DIVORCE AND NOW, comes the Defendant, Cheryl L. Waltz, by and through her attorneys, IRA H. WEINSTOCK, P.C., and respectfully submits this Answer and Counterclaim to Plaintiff's Complaint in Divorce as follows: COUNT 1- DIVORCE 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. Admitted. 8. Admitted. 9. Admitted. COUNT 2 - CLAIM FOR EQUITABLE DISTRIBUTION 10. Paragraphs 1 though 9 of this Answer are incorporated herein by reference as though set forth in full. 11. Admitted. 12. Admitted. 13. Admitted. 14. Admitted. 15. Admitted. WHEREFORE, Defendant respectfully requests that the court enter an Order of equitable distribution of marital property pursuant to Section 3502(a) of the Divorce Code. COUNT 3 - ALIMONY PENDENTE LITE, COUNSEL FEES, COSTS AND EXPENSES 16. Paragraphs 1 though 15 of this Answer are incorporated herein by reference as though set forth in full. 17. Defendant is without knowledge or information sufficient to form a belief as to the truth of this averment. 18. Denied. It is specifically denied that Plaintiff is unable to sustain himself during the pendency of the divorce action. Rather, Plaintiff is able to sustain himself during the pendency of the divorce action. 19. Denied. It is specifically denied that Defendant is able to pay Plaintiff's counsel fees, costs and expenses. Rather, Plaintiff is able to pay his counsel fees, costs and expenses, and Defendant is not able to pay them. 2 WHEREFORE, Defendant respectfully requests that the court deny Plaintiffs request for an award of spousal support and/or of alimony pendente lite. COUNT 4 - ALIMONY 20. Paragraphs 1 though 19 of this Answer are incorporated herein by reference as though set forth in full. 21. Denied. It is specifically denied Plaintiff lacks sufficient property to provide for his reasonable needs. Rather, Plaintiff is able to provide for his reasonable needs. 22. Denied. It is specifically denied that Plaintiff is unable to sustain himself through appropriate employment. Rather, Plaintiff is able to sustain himself through appropriate employment. 23. Denied. It is specifically denied that Defendant has sufficient income and assets to provide continuing support for the Plaintiff. Rather, Plaintiff is able to sustain himself. WHEREFORE, Defendant respectfully requests that the court deny Plaintiff s request for an award of alimony. COUNTERCLAIM 24. The prior paragraphs of this Answer and Counterclaim are incorporated herein by reference as though set forth in full. 25. Plaintiff has offered such indignities to Defendant (who is the innocent and injured spouse) as to render Defendant's condition intolerable and life burdensome. Plaintiffs conduct of dressing as a woman constitutes a course of behavior that is humiliating and degrading to the Defendant's position as a wife and a woman. 26. This action is not collusive as defined by Pa. Cons. Stat. § 3309. 3 WHEREFORE, Defendant respectfully requests the Court to enter a decree of divorce pursuant to Pa. Cons. Stat. § 3301(a)(6). Respectfully Submitted IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657 By: MAGGI I.D.V, 6o 88632 4 VERIFICATION I, Cheryl L. Waltz, verify that the statements made in this ANSWER AND COUNTERCLAIM are true and correct. I understand that false statements herein are subject to the penalties of 18 Pa. Cons. Stat. Ann. § 4904, relating to unsworn falsification to authorities. Date: Q (h, CHER L. LTZ CERTIFICATE OF SERVICE AND NOW, this 13th day of July, 2006, I, Maggi E. Colwell, Esquire, attorney for Defendant, Cheryl L. Waltz, hereby certify that I served the within Defendant's Answer and Counterclaim to Plaintiffs Complaint in Divorce this day by depositing the same in the United States mail, postage prepaid, in the post office at Harrisburg, Pennsylvania, addressed to: By First Class Mail: Diane S. Baker, Esquire 27 South Arlene Street P. O. Box 6443 Harrisburg, PA 17112-0443 DAVID WALTZ, VS. CHERYL L. WALTZ, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 06-3171 CIVIL ACTION - LAW Defendant. IN DIVORCE NOTICE TO PLEAD TO THE WITHIN NAMED PARTIES: You are hereby notified to file a written response to the within Defendant's Amended Answer and Counterclaim to Plaintiff s Complaint in Divorce within twenty (20) days of service hereof, or judgment maybe entered against you. IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657, r By: Dated: July 20, 2006 DAVID WALTZ, vs. CHERYL L. WALTZ, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. Plaintiff, NO. 06-3171 CIVIL ACTION - LAW Defendant. IN DIVORCE AND NOW, comes the Defendant, Cheryl L. Waltz, by and through her attorneys, IRA H. WEINSTOCK, P.C., and respectfully submits this Answer and Counterclaim to Plaintiff's Complaint in Divorce as follows: COUNT 1 - DIVORCE 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. Admitted. 8. Admitted. 9. Admitted. COUNT 2 - CLAIM FOR EQUITABLE DISTRIBUTION 10. Paragraphs 1 though 9 of this Answer are incorporated herein by reference as though set forth in full. 11. Admitted. 12. Admitted. 13. Admitted. 14. Admitted. 15. Admitted. WHEREFORE, Defendant respectfully requests that the court enter an Order of equitable distribution of marital property pursuant to Section 3502(a) of the Divorce Code. COUNT 3 - ALIMONY PENDENTE LITE, COUNSEL FEES, COSTS AND EXPENSES 16. Paragraphs 1 though 15 of this Answer are incorporated herein by reference as though set forth in full. 17. Defendant is without knowledge or information sufficient to form a belief as to the truth of this averment. 18. Denied. It is specifically denied that Plaintiff is unable to sustain himself during the pendency of the divorce action. Rather, Plaintiff is able to sustain himself during the pendency of the divorce action. 19. Denied. It is specifically denied that Defendant is able to pay Plaintiff's counsel fees, costs and expenses. Rather, Plaintiff is able to pay his counsel fees, costs and expenses, and Defendant is not able to pay them. 2 WHEREFORE, Defendant respectfully requests that the court deny Plaintiff's request for an award of spousal support and/or of alimony pendente lite. COUNT 4 - ALIMONY 20. Paragraphs 1 though 19 of this Answer are incorporated herein by reference as though set forth in full. 21. Denied. It is specifically denied Plaintiff lacks sufficient property to provide for his reasonable needs. Rather, Plaintiff is able to provide for his reasonable needs. 22. Denied. It is specifically denied that Plaintiff is unable to sustain himself through appropriate employment. Rather, Plaintiff is able to sustain himself through appropriate employment. 23. Denied. It is specifically denied that Defendant has sufficient income and assets to provide continuing support for the Plaintiff. Rather, Plaintiff is able to sustain himself. WHEREFORE, Defendant respectfully requests that the court deny Plaintiffs request for an award of alimony. COUNTERCLAIM 24. The prior paragraphs of this Answer and Counterclaim are incorporated herein by reference as though set forth in full. 25. Plaintiff has offered such indignities to Defendant (who is the innocent and injured spouse) as to render Defendant's condition intolerable and life burdensome. Plaintiffs conduct of dressing as a woman constitutes a course of behavior that is humiliating and degrading to the Defendant's position as a wife and a woman. 26. This action is not collusive as defined by Pa. Cons. Stat. § 3309. 3 WHEREFORE, Defendant respectfully requests the Court to enter a decree of divorce pursuant to Pa. Cons. Stat. § 3301(a)(6). Respectfully Submitted IRA H. WEINSTOCK, P.C. 800 North Second Street Harrisburg, PA 17102 Phone: 717-238-1657 By: VERIFICATION I, Cheryl L. Waltz, verify that the statements made in this AMENDED ANSWER AND COUNTERCLAIM are true and correct. I understand that false statements herein are subject to the penalties of 18 Pa. Cons. Stat. Ann. § 4904, relating to unsworn falsification to authorities. Date: July 20, 2006 Cwt CHE YL ALTZ CERTIFICATE OF SERVICE AND NOW, this 20th day of July, 2006, I, Maggi E. Colwell, Esquire, attorney for Defendant, Cheryl L. Waltz, hereby certify that I served the within Defendant's Amended Answer and Counterclaim to Plaintiffs Complaint in Divorce this day by depositing the same in the United States mail, postage prepaid, in the post office at Harrisburg, Pennsylvania, addressed to: By Hand Delivery to: Diane S. Baker, Esquire 27 South Arlene Street P. O. Box 6443 Harrisburg, PA 17112-0443 ?> ?, , , _ _? ?..> ; _ ," DAVID R. WALTZ, IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 06-3171 CIVIL TERM CHERYL L. WALTZ, IN DIVORCE Defendant/Respondent PACSES # 611108342 ORDER OF COURT AND NOW, this 20th day of July, 2006, based upon the Court's determination that Petitioner's monthly net income/earning capacity is $2015.50 and Respondent's monthly net income/earning capacity is $4186.16, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $742.00 per month payable as follows: $530.00 for alimony pendente lite and $212.00 on arrears. First payment due next pay date. Arrears set at $1060.00 as of July 20, 2006. The effective date of the order is June 2, 2006. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.§ 3703. Further, if the Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the PA SCDU to: David R. Waltz. Payments must be made by check or money order. All checks and money orders must be made payable to PA SCDU and mailed to: PA SCDU P.O. Box 69110 Harrisburg, PA 17106-9110 Payments must include the Respondent's PACKS Member Number or Social Security Number in order to be processed. Do not send cash by mail. cc360 it Unreimbursed medical expenses that exceed $250.00 annually are to be paid as follows 0% by Respondent and 100% by Petitioner. The Petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. The Respondent is to provide medical insurance coverage. Within thirty (30) days after the entry of this Order, the Respondent shall submit to Petitioner written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at minimum, of. 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order considers that the Respondent has the full obligation of the mortgage payment on the marital home that was purchased in January, 2006. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. Consented: Petitioner Respondent DRO: R. J. Shadday ed copies on: 6 Petitioner Respondent Diane S. Baker, Esq. Maggie Colwell, Esq. Petitioner's Attorney Respondent's Attorney BY THE COURT, ORDERINOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 07/20/06 Case Number (See Addendum for case summary) 611108342 06-3171 CIVIL Q Original OrderlNotice O Amended Order/Notice O Terminate Order/Notice Employer/Withholder's Federal FIN Number XEROX CORPORATION* C/O GARNISHMENT DESK 1350 JEFFERSON RD ROCHESTER NY 14623-3106 184-52-3302 Employee/Obligor's Social Security Number 1039101672 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attadiment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 530. 00 per month in current support $ 212. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 742.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 171.23 per weekly pay period. $ 342.46 per biweekly pay period (every two weeks). $ 371, oo per semimonthly pay period (twice a month). $ 742, oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 00) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information i needed (See #9 on page 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: s_ a-> 6 J. /esley Oler, Judge DRO: R.J. Shadday Form EN-028 Service Type M OMSNo.:097nU15e Worker ID $IATT RE: WALTZ, CHERYL L. Employee/Obligor's Name (Last, First, MI) 1. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? Uheckel you are required, to provi(ie agopy of this form to yourgmdoloyee. If yoyr employee t in a state that is Brent rom the state that issued this o er, a copy must be provi a to your employee even if t e box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employeelobligor. 3.* Repo. ting the Paydatefflate of Withholding. Yoo most report the paydate/date of with iolding vvire. , sendinr the payine. it. TI ie You must comply with the law of the paydateidate of ovithho ding is the date on whid. an.VU1rt Was Withheld ho... the einplcryee4s-wages. state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* EmployeefObligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 1604680200 EMPLOYEE'S/OBLtGOR'SNAME: WALTZ. CHERYL L. EMPLOYEE'S CASE IDENTIFIER: 1039101672 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employeelobligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of. 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. II.Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240.6248 or by internet www.childsupport.state.pa.us Service Type m Page 2 of 2 OMB No, 09700154 Form EN-028 Worker ID $iATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WALTZ, CHERYL L. PACKS Case Number 611108342 Plaintiff Name DAVID R. WALTZ Docket Attachment Amount 06-3171 CIVIL$ 742.00 Child(ren)'s Name(s): DOB ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket AttachmentAmount $ 0.00 Child(ren)'s Name(s): DOB Diane S. Baker, Esquire I.D. No. 53200 27 S. Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, : PENNSYLVANIA V. NO. 06-3171 CHERYL L. WALTZ, : CIVIL ACTION - LAW Defendant : IN DIVORCE PLAINTIFF'S ANSWER TO DEFENDANT'S COUNTERCLAIM AND NOW comes the Plaintiff, David Waltz, by and through his attorney, Diane S. Baker, and responds to Defendant's counterclaim as follows: 24. The averments of paragraphs 1 through 23 of the Complaint are incorporated herein by reference. 25. Denied. It is denied that Plaintiff has offered indignities to the Defendant and it is specifically denied that the Plaintiff has behaved in a manner that was humiliating or degrading to Defendant. Proof to the contrary is demanded at trial. 26. No response required. WHEREFORE, Plaintiff respectively requests this Honorable Court to enter an alimony award in favor of Plaintiff. WHEREFORE, Plaintiff requests the Court to enter a Decree: a. Dissolving the marriage between Plaintiff and Defendant; b. Equitably distributing all marital property owned by the parties hereto; C. Ordering the payment of Alimony Pendente Lite costs and expenses; d. Ordering the payment of alimony; and e. Such further relief as the Court may determine equitable and just. DATE: q,V,D G Supreme Court ID #53200 27 South Arlene Street Post Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 VERIFICATION I verify that the statements made in this are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn falsification to authorities. DAVID WALTZ CERTIFICATE OF SERVICE I hereby certify that on this Z'd?ay of a'( , 2006, a true and correct copy of the foregoing document was served on the following person by United States Mail, postage prepaid, addressed as follows: Maggi E. Colwell, Esquire IRA H. WEINSTOCK, P.C. 800 North 2°d Street Harrisburg, PA 17102 Post Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 a,aaiav u. •.aanva, u..Y...+.. Supreme Court ID 53200 27 South Arlene Street c-, r..> ?-:, o ?- ? - -„ T1 ~ ' n- d . ZT' ?- --, ti-ft f: T c? f m _? to ,Sc? ' cn ? ; ?, .,i r 1 e .r ?-_ "tJ _,. ,__?!j Cr C.' ff1 4, ? •< DAVID WALTZ, * IN THE COURT OF COMMON PLEAS Plaintiff * CUMBERLAND COUNTY, PENNSYLVANIA * VS. * NO. 06-3171 * CHERYL L. WALTZ, Defendant * CIVIL ACTION - LAW IN DIVORCE PRAECIPE FOR WITHDRAW OF APPEARANCE Please withdraw my appearance on behalf of Defendant, Cheryl L. Waltz, in the above captioned matter without prejudice. Date: \ ?' \? \ PRAECIPE TO ENTER APPEARANCE Please enter my appearance on behalf of Plaintiff/Defendant, Cheryl L. Waltz, in the above captioned matter. Date: !/ 2 a G /., ?. Thomas M. Clark, Esquire ?? 4 DAVID WALTZ, Plaintiff VS. CHERYL L. WALTZ, Defendant Dianne Sommers Baker, Esquire Attorney for Plaintiff 27 S. Arlene Street, P.O. Box 6443 Street Address Harrisburg, PA 17112-0443 City - State - Zip Code (717) 671-9601 Phone Number * IN THE COURT OF COMMON PLEAS * CUMBERLAND COUNTY, PENNSYLVANIA * * NO. 06-3171 * * * CIVIL ACTION - LAW IN DIVORCE Thomas M. Clark, Esquire Attorney for Defendant 130 West Church Street Street Address Dillsburg, PA 17019 City - State - Zip Code (717) 432-9666 Phone Number INVENTORY OF CHERYL L. WALTZ Defendant files the following Inventory and Appraisement of all property owned or possessed by either party at the time this action was commenced and all property transferred within the preceding three (3) years. Defendant verifies that the statements made in this Inventory and Appraisement are true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. CheryyWaltz, ASSETS OF THE PARTIES Defendant marks on the list below, those items applicable to the case at bar and itemizes the assets on the following pages. If an item has been appraised, a copy of the appraisal report is attached. (X) 1. Real property (X) 2. Motor vehicles (X) 3. Stock, bonds, securities and options ( ) 4. Certificates of deposit ( X ) 5. Checking accounts, cash (X) 6. Savings accounts, money market and savings certificates ( ) 7. Contents of Safe Deposit boxes ( ) 8. Trusts ( ) 9. Life insurance policies (indicate face value, cash surrender value, and current certification) ( ) 10. Annuities ( ) 11. Gifts ( ) 12. Inheritances ( ) 13. Patents, copyrights, inventions, royalties ( ) 14. Personal property outside the home ( ) 15. Business (list all owners, including percentage (%) of ownership, and officer/director positions held by a party with the company) ( ) 16. Employment termination benefits; severance pay, Workman's Compensation (claim/award) ( ) 17. Profit Sharing plans ( ) 18. Pension plans (indicate employee contribution and date plan vests) ( X) 19. Retirement Plans, Individual Retirement Accounts ( ) 20. Disability Payments ( ) 21. Litigation claims (matured and unmatured) ( ) 22. MilitaryN.A. benefits ( ) 23. Education benefits (X) 24. Debts due others, including loans, mortgages held (X) 25. Household Furnishings and Personalty (Include as a Total Category and attach an itemized list if distribution of such assets is in dispute) () 26. Other MARITAL PROPERTY Defendant lists all marital property in which either, or both spouses have a legal or equitable interest, individually, or with any other person as of the date this action was commenced: ITEM NUMBER 1. 2. 2. DESCRIPTION OF Marital Residence- 2004 Toyota 2001 Toyota PROPERTY 820 Sawgrass Lane, Highlander Tacoma Mechanicsburg, Pennsylvania. NAMES OF ALL Joint Joint Joint OWNERS MARITAL PROPERTY Defendant lists all marital property in which either, or both spouses have a legal or equitable interest, individually, or with any other person as of the date this action was commenced: ITEM NUMBER 3. 3. 6. DESCRIPTION OF Templeton Emloyee Stock PSECU PROPERTY Ownership Plan Savings Account NAMES OF ALL Husband Wife Wife OWNERS MARITAL PROPERTY Defendant lists all marital property in which either, or both spouses have a legal or equitable interest, individually, or with any other person as of the date this action was commenced: ITEM NUMBER 5. 5. 6. DESCRIPTION OF PSECU PSECU PSECU PROPERTY Checking Account Checking Account Savings Account NAMES OF ALL Husband Wife Husband OWNERS MARITAL PROPERTY Defendant lists all marital property in which either, or both spouses have a legal or equitable interest, individually, or with any other person as of the date this action was commenced: ITEM NUMBER 19. 19. 19. DESCRIPTION OF Amp Pennsylvania State Pennsylvania State PROPERTY Retirment Plan Retirment Plan NAMES OF ALL Husband Husband Wife OWNERS MARITAL PROPERTY Defendant lists all marital property in which either, or both spouses have a legal or equitable interest, individually, or with any other person as of the date this action was commenced: ITEM NUMBER 19. DESCRIPTION OF Xerox Retirement PROPERTY Plan and 401(k) NAMES OF ALL Wife OWNERS LIABILITIES OF THE PARTIES Defendant lists all liabilities of either or both spouses alone or with any person as of the date this action was commenced: ITEM NUMBER 24. 24. 24. DESCRIPTION OF Credit Card Credit Card Loan LIABILITY AMES OF ALL Untied Mileage Chase Doris Waltz CREDITORS NAMES OF ALL Joint Joint Joint DEBTORS LIABILITIES OF THE PARTIES Defendant lists all liabilities of either or both spouses alone or with any person as of the date this action was commenced: ITEM NUMBER 24. 24. 24. DESCRIPTION OF Loan Mortgage on Marital Credit Card LIABILITY Residence- 820 Sawgrass Lane, Mechanicsburg, Pennsylvania. NAMES OF ALL Jim Mumper National City PSECU CREDITORS Mortgage NAMES OF ALL Joint Joint Husband DEBTORS LIABILITIES OF THE PARTIES Defendant lists all liabilities of either or both spouses alone or with any person as of the date this action was commenced: ITEM NUMBER 24. 24. DESCRIPTION OF Credit Card 2004 Toyota LIABILITY Highlander AMES OF ALL PSECU Toyota Financial CREDITORS NAMES OF ALL Wife Joint DEBTORS DAVID WALTZ, * IN THE COURT OF COMMON PLEAS Plaintiff * CUMBERLAND COUNTY, PENNSYLVANIA * VS. * NO. 06-3171 CHERYL L. WALTZ, Defendant * CIVIL ACTION - LAW IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Cheryl L. Waltz, Defendant, moves the court to appoint a Master with respect to the following claims: (X) Divorce (X) Distribution of Property ( ) Annulment (X ) Support (X) Alimony (X) Counsel Fees (X) Alimony Pendente Lite (X) Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims(s) for which the appointment of a Master is requested. (2) The Plaintiff has appeared in the action through his attorney, Diane Sommers Baker, Esquire. (3) The statutory ground(s) for divorce (are) 23 Pa. C.S.A. H 3301(c), 3301(d) and 3301(a)(6). (4) Delete the inapplicable paragraph(s): (a) The action is not contested. (b) An agreement has been reached with respect to the following claims: None. (c) The action is contested with respect to the following claim: Alimony, Distribution of Property, Counsel Fees, Costs and Expenses. (5) The action does involve complex issues of law or fact. (6) The hearing is expected to take one (1) day. (7) Additional information, if any relevant to the motion: N/A. Date: I Thomas M. Clark, Esquire WILEY, LENOX, COLGAN & MARZZACCO, P.C. Attorney for Defendant ORDER APPOINTING MASTER AND NOW, this day of , 2006, , Esquire is appointed master with respect to the following claims: By the Court: J. C? t-0 0 J?l DAVID WALTZ, Plaintiff VS. CHERYL L. WALTZ, Defendant * IN THE COURT OF COMMON PLEAS * CUMBERLAND COUNTY, PENNSYLVANIA * * NO. 06-3171 * * * CIVIL ACTION - LAW IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Cheryl L. Waltz, Defendant, moves the court to appoint a Master with respect to the following claims: (X) Divorce (X) Distribution of Property ( ) Annulment (X ) Support (X) Alimony (X) Counsel Fees (X) Alimony Pendente Lite (X) Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims(s) for which the appointment of a Master is requested. (2) The Plaintiff has appeared in the action through his attorney, Diane Sommers Baker, Esquire. (3) The statutory ground(s) for divorce (are) 23 Pa. C.S.A. 3301(c), 3301(d) and 3301 (a)(6). (4) Delete the inapplicable paragraph(s): (a) . (b) An agreement has been reached with respect to the following claims: None. (c) The action is contested with respect to the following claim: Alimony, Distribution of Property, Counsel Fees, Costs and Expenses. (5) The action does involve complex issues of law or fact. (6) The hearing is expected to take one (1) day. (7) Additional information, if any relevant to the motion: N/A. Date: 04 ,- Thomas M. Clark, Esquire WILEY, LENOX, COLGAN & MARZZACCO, P.C. Attorney for Defendant ORDER APPOINTING MASTER AND NOW, this SAday of , 2006, ? Esquire is appointed master with respect to the following claims: the Cou v <f, ? (?" t V S Diane S. Baker, Esquire I.D. No. 53200 27 S. Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-3171 CHERYL L. WALTZ, CIVIL ACTION -LAW Defendant IN DIVORCE PLAINTIFF'S PRE-TRIAL STATEMENT AND NOW, comes the Plaintiff, David Waltz, by and through his attorney, Diane S. Baker, Esquire, and files this Pre-Trial Statement pursuant to Pa. R.C.P. 1920.33 as follows: 1. ASSETS. Plaintiff's Inventory and Appraisement was filed contemporaneously with the filing of this Pre-Trial Statement and sets forth all known marital and non-marital assets. 2. EXPERT TESTIMONY. The marital assets potentially requiring expert testimony include Husband's retirement plan with AMP, Husband's retirement plan with the Commonwealth, Wife's retirement plan with Xerox and the marital residence. Valuations of all retirement accounts are in the process of being completed and information about the expert testimony will be provided as it becomes available. In her Response to Interrogatories, Wife sets forth the value of the marital residence at $420,000.00. Although Husband believes that this is an estimate and is not the results of a formal appraisal, Husband will accept this valuation as accurate. Alternately, Husband will present expert testimony as to the value of the residence. 3. WITNESSES. a. Plaintiff will testify on his own behalf as to all issues before the Court; and, b. Defendant as on cross. C. Plaintiff reserves the right to amend his witness list. 4. EXHIBITS. Plaintiff anticipates the following exhibits: a. Blue-book valuations for both vehicles. b. Statements for Franklin Templeton IRA. C. Statements for Husband's PSECU checking and savings accounts. d. Statements for Wife's PSECU checking account. e. Statements for Wife's Xerox ESOP account. f. Statements for Wife's Xerox 401(k) account. g. Statement for mortgage payoff of marital residence. h. Statements for Husband's PSECU Visa/loan. i. Statements for Wife's Visa/loan. j. Statements for United Mileage Plus Credit Card. k. Statements for Chase Credit Card. 1. Loan documentation and payment records for loan owed to Doris Waltz. m. Statements for debt owed to J. W. Mumper. n. Statements pertaining to Wife's PSERS retirement account. Plaintiff reserves the right to amend his exhibit list. Copies of all exhibits have been exchanged by the parties or will be provided prior to trial. 5. INCOME. Plaintiff's Income and Expense Statement was filed contemporaneously with the filing of this Pre-Trial Statement and sets forth his income from all sources. 6. EXPENSES. Plaintiff's Income and Expense Statement filed contemporaneously with this Pre-Trial Statement sets forth his expenses. 7. RETIREMENT ACCOUNTS. Plaintiff, Husband, is employed by the Commonwealth of Pennsylvania and as such is the title owner of a PSERS retirement account, the value of which is to be determined. Husband began employment with the Commonwealth on October 24, 1999, and remains employed there to date. Husband was previously employed by AMP, Incorporated and as such is the title owner of a retirement account which was appraised by Wife at a value of $27,397.00, if age 65 is assumed as the commencement date. In addition, Husband is the title owner of an IRA with Franklin Templeton with a balance of approximately $108,000.00. This IRA is a rollover account from Husband's 401(k) account with AMP. A portion of the account is non-marital inasmuch as Husband began employment at AMP in February of 1979 and the parties were not married until July 12, 1986, some seven (7) years later. Wife was employed during the marriage by the Commonwealth of Pennsylvania and is the title owner of a PSERS Retirement Account which is in payout status with a monthly benefit of $67.00 per month. The value of this asset is unknown. Wife is currently employed by Xerox Corporation where she is the title owner of a retirement plan, the value of which has not been determined. She is also the title owner of an ESOP account and a 401(k) account, the marital values which are to be determined. 8. COUNSEL FEES. Plaintiff has incurred counsel fees at the hourly rate of $150.00. A copy of itemized billing statements will be provided to opposing counsel prior to trial. 9. PERSONAL PROPERTY. Plaintiff believes and therefore avers that the personal property has been equitably distributed between the parties. 10. LIABILITIES. The marital liabilities are set forth on Plaintiff's Inventory and Appraisement. It is noted that the majority of the marital debts were incurred towards the purchase and furnishing of the marital residence which was custom built by the parties just prior to separation and retained by Wife post-separation. 11. PROPOSED RESOLUTION. The parties to this action were married on July 12, 1986, and separated on April 8, 2006, when Husband moved out due to the constant arguments and disagreements which were occurring between the parties. Both parties are 46 years of age. There were no children born of the marriage. Just prior to separation, the parties purchased a custom-built residence located at 820 Saw Grass Lane, Mechanicsburg. There are an assortment of marital debts, all closely associated with the purchase of this residence. Wife has indicated a desire to retain the residence and refinance the existing mortgage into her individual name. The equity in the residence is believed to be approximately $125,000.00. In addition to the equity in the martial residence, there are an assortment of retirement accounts and retirement plans owned by both parties; the exact values of which need to be determined. Husband was previously employed by AMP; however, his position was eliminated as part of the TYCO transfer in 1999. Since 1999 Husband has been employed the Commonwealth of Pennsylvania as a facility maintenance technician for the Office of the Attorney General. His annual gross income is approximately $35,000.00. Wife has been employed during the marriage by Xerox Corporation as a color systems analyst. Her annual income is approximately $80,000.00. Since separation Husband has been receiving spousal support in the amount of $530.00. This amount was derived by the Domestic Relations Officer after a $300.00 deviation in Wife's favor because she was responsible for the mortgage at the marital residence where she continues to reside. In consideration of the disparity of earnings along with the ability to accumulate retirement assets, Husband proposes a sixty (60%) percent/forty percent (40%) percent distribution in his favor. It is proposed that the value of the various retirement accounts be calculated and there be an offset as necessary to effectuate the distribution scheme. Additionally, the cash assets and liabilities, including the equity in the residence, the vehicles and various bank accounts, should also be calculated and distributed such that Husband receive sixty (60%) percent in his favor. Alternately Husband suggests an equal distribution of marital assets, along with alimony in his favor because of the substantial difference in the party's income and earning opportunities. It is suggested that alimony be set at the statutory amount of $800.00 per month and continue until such time as a significant change in circumstances of either of the parties warrants modification. 27 South Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 BakerLawOffice@aol.com DATE: 1-30 - o 7 LIJ. NO. JJLUU CERTIFICATE OF SERVICE I hereby certify that on this Yo day of 2007, a true and correct copy of the foregoing document was served on the following persons by United States Mail, postage prepaid, addressed as follows: Thomas M. Clark, Esquire 130 West Church Street Suite 100 Dillsburg, PA 17019 Robert Elicker, Esquire One Courthouse Square Carlisle, PA 17013 1.1j. 1VV. JJ6VV 27 South Arlene Street P.O. Box 6443 Harrisburg,'PA 17112-0443 (717) 671-9600 BakerLawOffice@aol.com 0 T .'t s? _ - Co -r- "" i - V I f ' J .. - r?? i G3 j y c .h 01/26/2007 14:41 FAX 7176719601 1a002/015 Diane S. Baker, Esquire Supreme CouTt 1D #53200 27 South Arlene Street POST Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, Plaintiff' VS. CHERYL L. WALTZ, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA :NO. 06-3171 : CIVIL ACTION - DIVORCE INCOME AND EXPENSE STATEMENT OF PLAINTIFF, DAVID WALTZ Plaintiff files the following Income and Expense Statement and verifies that the statements made herein are true and correct. Defendant understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn falsification to authorities. DAVID WALTZ Plaintiff INCOME AND EXPENSE STATEMENT OF DAVID WALTZ INCOME: Employer: Office of Attorney General Address: 14'" Floor, Strawberry Square, Harrisburg, PA 17120 Type of Work: Facility Maintenance Technician Payroll Number: 503221 Pay Period : Biweekly Gross pay per pay period: $1,335.75 Net Pay per pay period: $ 954.48 Monthly net pay: $2,068.04 See attached year-to-date pay stub and tax return. OTHER INCOME: Spousal Support $ 530.00/month MONTHLY NET INCOME $2,598.04 EXPENSES: Monthly Home Rent $ 400 Automobile Fuel 200 Repairs 50 Insurance 50 Medical Doctor 25 Personal Clothing 75 Food 450 Barber 15 Cell phone 60 Misc. personal and household supplies 50 Gym memberships 50 Books/magazines 20 Miscellaneous Vacation 150 Legal fees 400 Charitable contributions 320 Storage 150 Gifts 100 TOTAL EXPENSES 2,565 DATE: 1/1, 0 7 Res a su itted, - Diane S. Baker, Esquire 27 South Arlene Street Post Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 I.D. # 53200 Department of the Treasu ntemal Revenue Service G 4 U.S. Individual In come Tax Return ??0 5 (99) IRS Use Ony--Do not wrtte or staois in this space. For the year Jan. 1Dec. 31, 2005, or other tax year beginning 2005, ending 20 OMB No. 1545-0074 Label Your first name and initial Last name Your social security number v?? ?V o?o? t? 344 (See L instructions A ` on page 16.) a If a joint tum, spouse's first name and initial Last name Spouse's social security number E ?&Ci2 4 L 4011 330 Use the IRS L label. H Home address (numb and street). If you have a P.O. box, see page 16. Apt. no. You must enter Otherwise, E .your SSN(s) above. . please print R or type. E City, town or post office, state, and ZIP code. If you have a foreign address, see page 16. Checking a box below will not Presidential \, - --) change your tax or refund. Election Campaign Poo. Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see page 16) ? ? You ? Spouse 1 ? Single 40 Head of household (with qualifying person). (See page 17.) If Filing Status 2 ? Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter Check only 3 ? Married filing separately. Enter spouse's SSN above this child's name here. ? one box. and full name here. ? 5 ? Qualifying widow(er) with dependent child (see page 17) 6a Exemptions b c If more than four dependents, see page 19. Yourself. If someone can claim you as a dependent, do not check box 6a Spouse .. Dependents: (1) First name Last name (2) Dependent's social security number (3) Dependent's relationship to you (4) I qualifying child for child tax credit see page 19 on 6a and 6b No. of children on 6c who: • lived with you _ • did not live with you due to divorce or separation (see page 20) _ Dependents on 6c not entered above Add numbers onFlines above ? d . . . . . Total number of exemptions claimed . . 7 Attach Form(s) W-2 tips etc salaries Wa es 7 Income 8a . , , g , Taxable interest. Attach Schedule B if required . . . . Be b 8b Do not include on line 8a Tax-exempt interest Attach Form(s) W-2 here. Also 9a . . . Ordinary dividends. Attach Schedule B if required . . . 9a attach Forms W-2G and b 10 Qualified dividends (see page 23) 9b or offsets of state and local income taxes (see page 23) credits Taxable refunds 10 1099-R if tax was withheld. 11 , , received Alimon 11 12 . . . . . . . . . . . . . . . . . . y Attach Schedule C or C-EZ Business income or (loss) 12 13 . . . . . . . . check here ? ? If not required Attach Schedule D if required Capital gain or (loss) 13 If you did not 14 , . . . Attach Form 4797 ains or (losses) Other 14 get a W-2, 15a . g IRA distributions 15a . . . . . . . . . b Taxable amount (see page 25) 15t see page 22. 18a Pensions and annuities 16a b Taxable amount (see page 25) 16t Enclose but do 17 etc. Attach Schedule E trusts S corporations royalties partnerships Rental real estate 17 , not attach, any 18 , , , , , Attach Schedule F Farm income or (loss) 18 payment. Also, 19 . . . . . . . . . . . . . . . ment compensation Unem lo 19 please use Form 10404 20a . . . . . . . . . . p y 120a I I I b Taxable amount (see page 27) benefits Social securit 20L . 21 y . List type and amount (see page 29) Other income 21 22 . Add the amounts in the far right column for lines 7 through 21. This is your total income ? 22 23 Educator expenses (see page 29) GO . . . . . . . Adjusted 24 Certain business expenses of reservists, performing artists, and Attach Form 2106 or 2106-EZ Gross fee-basis government officials 24 . Attach Form 8889 Income 25 Health savings account deduction 25 . . Attach Form 3903 26 Moving expenses 26 . . . Attach Schedule SE 27 One-half of self-employment tax 27 . . and qualified plans SIMPLE 28 Self-employed SEP 28 . . . , , 29 Self-employed health insurance deduction (see page 30) 29 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipient's SSN ? 31a 32 IRA deduction (see page 31) 32 . . . . . . . . 33 Student loan interest deduction (see page 33) . 34 Tuition and fees deduction (see page 34) 34 . . . . . Attach Form 8903 35 Domestic production activities deduction 35 . . . 36 Add lines 23 through 31a and 32 through 35 . . . . . . . . . . . 37 Subtract line 36 from line 22. This is your adjusted gross in come . ? 37 For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78. Cat. No. 113208 Form 1040 (2005) Form 1040 (2005) Page 2 38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . 138 G IG Tax and Credits 39a Check ( ? You were born before January 2, 1941, ? Blind. Total boxes if: Sl ? Spouse was born before January 2, 1941, ? Blind. checked ? 39a Standard b If your spouse itemizes on a separate return or you were a dual-status alien, see page 35 and check here ?39b ? f 40 Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) . for- 41 41 Subtract line 40 from line 38 6-7 -o& i0 a People who checked any box on line Amt? - 42 If line 38 is over $109,475, or you provided housing to a person displaced by Hurricane Katrina, multiply $3,200 by the total number of exemptions claimed on line 6d 42 6 71 see page 37. Otherwise I _ 39a or 39b or who can be , OL I enter -0-43 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41 / claimed a , 44 44 Tax (see page 37). Check if any tax is from: a [I Form(s) 8814 b [I Form 4972 ?/ . . . - , dependent, see page 36. 45 45 Alternative minimum tax (see page 39). Attach Form 6251 • All others: . . . . . . . . . . . . . . . . . ? 46 / I 46 Add lines 44 and 45 "- Sin le or . . . . . . . 47 Foreign tax credit. Attach Form 1116 if required . . . . 47 g filing 48 Credit for child and dependent care expenses. Attach Form 2441 48 Marase $5,000 49 Credit for the elderly or the disabled. Attach Schedule R 49 Marred filin . Attach Form 8863 50 Education credits 5o g jointly or . . . . . . . . 51 Retirement savings contributions credit. Attach Form 8880. 51 Qualifying widow(er) 52 Child tax credit (see page 41). Attach Form 8901 if required 52 , $10,000 Attach Form 8839 53 Adoption credit 53 Head of . . . . . . . . . 54 Credits from: a ? Form 8396 b ? Form 8859 54 household, $7,300 . 55 Other credits. Check applicable box(es): a E3 Form 3800 b ? Form 8801 c ? Form 55 56 Add lines 47 through 55. These are your total credits . . . . . . . . . . . 56 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- . ? 57 / -- 58 Attach Schedule SE 58 Self-employment tax . . . . . . . . . . . . . . . . Other 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 59 Taxes 60 etc. Attach Form 5329 if required other qualified retirement plans 60 Additional tax on IRAs . , , 61 61 Advance earned income credit payments from Form(s) W-2 . . . . . . . 62 Household employment taxes. Attach Schedule H . . . . . . . . . 62 63 Add lines 57 through 62. This is your total tax . ? 63 (p // -- 64 Federal income tax withheld from Forms W-2 and 1099 t P 64 l . . aymen s 65 2005 estimated tax payments and amount applied from 2004 return 65 66a Earned income credit (EIC) 6 6a Eq, . . . . . b Nontaxable combat pay election ? 66b 67 Excess social security and tier 1 RRTA tax withheld (see page 59) 67 . 68 Additional child tax credit. Attach Form 8812 68 . . . . . 69 Amount paid with request for extension to file (see page 59) 69 70 Payments from: a ? Form 2439 b ? Form 4136 c ? Form 8885. 7D 71 Add lines 64, 65, 66a, and 67 through 70. These are your total paym ents ? 71 Al, 31 y L subtract line 63 from line 71. This is the amount you overpaid 72 d 72 If line 71 is more than line 63 R f , e un ? 73a Amount of line 72 you want refunded to you . . . . . . . . . . ? 73a Di d rect eposit See page 59 ? b Routing number ? c Type: ? Checking ? Savings and fill in 73b, ? d Account number 73c, and 73d. 74 Amount of line 72 you want applied to our 2006 estimated tax ? 74 Amount 75 Amount you owe. Subtract line 71 from line 63. For details on how to pay, see page 60 ? 75 y? You OWe 76 Estimated tax penalty (see page 60) . . . . . . . . L76 [ _ Third Party Do you want to allow another person to discuss this return with the IRS (see page 61)? ? Yes. Complete the following. ? No Designee Designee's Phone Personal identification name ? no. ? ( ) number (PIN) ? Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Joint return? Your signature Date Your occupation Daytime phone number See page 17. ( ) Keep copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your records. Paid Preparer's Date Check if Preparer's SSN or PT1N signature ' self-employed ? Preparer's Firm's name (or EIN ; Use Only yours 0 self-employed),' address. and ZIP code Phone no. ( 1 Form 1040 (2005) ® Prinad an recytNd parr SCHEDULES A&B Schedule A-Itemized Deductions OMB No. 1545-0074 (Form 1040) OM (Schedule 8 is on back) Deparmwnt of the Treasury Attachment internal Revenue Service (99) ? Attach to Form 1040. ? See Instructions for Schedules A&8 (Form 1040). Sequence No. 07 Name(s) shown on Form 1040 Your social security number Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see page A-2) 1 Dental 2 Enter amount from Form 1040, line 38 Expenses 3 Multiply line 2 by 7.5% (.075). . . . . . . . . 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, en ter -0 - . 4 Taxes You 5 State and local (check only one box): Paid a ? Income taxes, or 5 r? (See b ? General sales taxes (see page A-3) } page A-2.) 6 Real estate taxes (see page A-5) . . . . 6 O . . . 7 Personal property taxes . . . . . . . 7 8 Other taxes. List type and amount ?_________________•_-_ _ --••-------•-------------•---------••---•-•--------••-•--...... 8 9 Add lines 5 through 8 9 /O ?Sln LG Interest 10 Home mortgage interest and points reported to you on Form 1098 10 1-217 You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid i (See to the person from whom you bought the home, see page A-6 page A-5.) and show that person's name, identifying no., and address ? Note. -------------------------•----•---------_----- 11 Personal 12 Points not reported to you on Form 1098. See page A-6 interest is t for special rules . . . . . . . . . . 12 no deductible. 13 Investment interest. Attach Form 4952 if required. (See page A-6.) . . . . . . . . . . . . . 13 14 Add li 10 h 13 h ? roug nes t . . . . . . . . . . . . . . . . . 14 . Gifts to 15a Total gifts by cash or check. If you made any gift of $250 .Am A Charity or more, see page A-7 . . . . . . . . . . . 15a ;9 X00 GO If you made a b Gifts by cash or check after August gift and got a 27, 2005, that you elect to treat as benefit for it, qualified contributions (see page A-7) 15b see page A-7. 16 Other than by cash or check. If any gift of $250 or more, see page A-7. You must attach Form 8283 if over $500 16 17 Carryover from prior year . . . . . . 17 18 Add lines 15a, 16, and 17 . . . . . . . . . . . . . . . . . . 18 /e Gd Casualty and Theft Losses 19 Casualty or theft loss(es). Attach Form 4684. (See page A-8.) . 19 Job Expenses 20 Unreimbursed employee expenses--=job travel, union and Certain dues, job education, etc. Attach Form 2106 or 2106-EZ Miscellaneous if required. (See page A-8.) ? ............................. 20 Deductions 21 Tax preparation fees. . . . . . . . . . . . 21 (See 22 Other expenses-investment, safe deposit box, etc. List ; page A-8.) type and amount ?------------------•-----••------••••-•--- L w 23 Add lines 20 through 22 . . . . . . . . . . 23 24 Enter amount from Form 1040, line 38 24 25 Multiply line 24 by 2% (.02) . . . . . . . . . 25 26 Subtract line 25 from line 23. If line 25 is more than line 2 3, ent er -0- 26 Other 27 Other-from list on page A-9. List type and amount ? ____________________________ _ Miscellaneous Deductions 27 3 7Z Total 28 Is Form 1040, line 38, over $145,950 (over $72,975 if married filing separately)? Itemized ? No. Your deduction is not limited. Add the amounts in the far right column Deductions for lines 4 through 27. Also, enter this amount on Form 1040, line 40. ? 28 ? Yes. Your deduction may be limited. See page A-9 for the amount to enter. 29 If you elect to itemize deductions even though they are less than your standard deduction, check here ? ? For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 11330x Schedule A (Form 1040) 2005 Schedules A&B (Form 1040) 2005 OMB No. 1545-0074 Page 2 Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side. I Your social security number I Attachment Schedule B-Interest and Ordinary Dividends Seaue ce No. 08 Part 1 1 List name of payer. If any interest is from a seller-financed mortgage and the Interest buyer used the property as a personal residence, see page B-1 and list this ' interest first. Also, show that buyer s social security number and address ? (See page B-1 and the ------------ ?D ---•-•--•• instructions for --• Form 1040, line 8a ) --••••••-- --- ----- S?C?4JCL . ---------- •-•-----•---•••-••--••----•-•••--••••-•-•-•••----•---•---••-•----•...--•-----•-------•-•-•-- Note. If you ----•--•--•-----•--------••---------------•---------------------------------------•--------- -------------------•-••-•-----•-------....------•-•----•-•-•••----•....-••----••-••---•••--- received a Form 1099-INT, Form --•---•----------------------------•--•---•-•-----------------••--•-•------•••------•-•••-_. 1099-0ID, or --••--•••-------•-•-----•--- -----•--------------------------- substitute ---••----------------•-------- statement from -•-----------••----••-••---------•-•--- a brokerage firm, ....--------••-----•-•-••---------•---------•--•-----• .....................•-•••-•-•••-•---- list the firm's name as the payer and enter ••-----------•-••-------------------------------------------------•••-•----•-••-----...•-•-- the total interest .......................................................... ................................. shown on that 2 Add the amounts on line 1 form. 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . 4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a ? Note. If line 4 is over $1,500, you must complete Part III. Part II 5 List name of payer ? ---•---••----•--•••------••-----••---••--••--•----••••-•-•-.--••- Ordinary -•----•-••---------••-- •-•--•---•-----•-•••--••--•-----•-•-•••-••-••••--•-••.•-•-••••-•-•.. ----------- Dividends --•--•• • ............................................. .......... N. ............................................. page B-1 ...---•--•---•---••-•--•--•-••---•---••••-•---•••---•---- and the instructions for Form 1040, ..---•--•------•-•-•----------------•--••-•----....----•--•-•-••..........-•-••-•--••--•.... line 9a.) •-•-•••-•••--•-•••••-••--•-• .................•••-•-•---•--•------•-•••-•-••--•••--•-•--••--. •••--------------••------•--••--...--•-••---•-•-•-•---••----------•---•••--•---••-----••--•- Note. If you ••-•--•-•...-•---•••--•-••--•---••--••--•------••--------•---•-----•••---•--•-••-••-•--•••.. --------•----------••-•---.....---•--•-•---•---••-------------••--•-----•---•----•--•----•-• received a Form •-----•---•--•--•---...•..--•---•-••---•-•------------•--------••••-••-•••--• ............... 1099-DIV or -------•---••---••-••--•-•------•--•---------••-----••-----------•---------•----------••---- substitute statement from -------------------•---------------- --••-------------------•---• .......................... a brokerage firm, ------------•--------------------•-•-•-----------------•----------•••--•--••••---•••-•-----• list the firm's --••-----------•------------•-•----------------------------•---••••----•--•-•---•--•-----_.. name as the payer and enter ------------•------••--------------------------------•••----•••-••---------•- -------------- the ordinary -----------------------------------••-------------•-----•-----•-•- -•------•---••••-----• dividends shown ----------•--•-•---------------•----•--------•------------•---•-•--------•--•----•--••-••_ on that form. .. 6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9a -.-10--- Part III Amount Amount NOW. IT line b is over $1,500, you must complete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; or (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreiqn trust. No Foreign 7a At any time during 2005, did you have an interest in or a signature or other authority over a financial Accounts account in a foreign country, such as a bank account, securities account, or other financial account? and Trusts See page B-2 for exceptions and filing requirements for Form TD F 90-22.1. . . . . . (See b If "Yes," enter the name of the foreign country ? -------------•-•____--._____-.---•_---____---_-___-•-- page B-2.) 8 During 2005, did you receive a distribution from, or were you the grantor of, or transferor to, a foreign trust? If "Yes," you may have to file Form 3520. See page B-2 For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 2005 Commonwealth of Pennsylvania EMPLOYEE PAY STATEMENT {David R Waltz 1820 Sawgrass Lane Mechanicsburg PA 17050 { {B/U:B3 Group:05 Level:05 { Personnel Number..... 00503221 {Attorney General { Pay Period.. 12/30/2006 - 01/12/2007 { {Fed Tax Status: Married {Fed Tax Allowances: 00 Period: 02/2007 { { { Pay Date Payment Amount = 01/26/2007 954.48 = Gross + Reim. - 1,335.75 + 0.00 - Taxes - Deds. 276.11 - 105.16 {Gross Current Pay Rate Hrs/Unt Amount Year To Date { {Normal working hours 17.81 {Holiday/Comp lieu Holiday 17.81 { 67.50 1,202.18 7.50 133.57 2,404.36 267.14 { Total Gross 1 1,335.75 2,671.50 { { {Taxes { Amount Year To Date { Federal Federal ITX Withholding Tax 111.17 {TX EE Social Security Tax 82.40 {TX EE Medicare Tax 19.27 {State Pennsylvania ITX Withholding Tax 40.80 ITX EE Unemployment Tax 1.20 {Local Hampden Township {TX Withholding Tax 21.27 {Local Harrisburg ITX EE Occupation Tax 1 { 222.34 { 164.80 38.54 { { 81.60 { 2.40 { { 42.54 { { 52.00 { { {Total Taxes { 276.11 604.22 { { Deductions Amount Year To Date { {EE PreTx M/H Pct {Emp Supp Life - Hartford {Full Cov Class AA/Cat 0 { 6.68 15.00 83.48 13.36 { 30.00 { 166.96 { { {Total Deductions { 105.16 210.32 { Non Cash Compensation { Amount Year To Date { { {Reimbursements Amount { { { Commonwealth of Pennsylvania EMPLOYEE PAY STATEMENT (Direct Deposit Bank / Check Amount Net Payment I 954.48 State Paid Benefits I Amount ITX ER Social Security Tax ITX ER Medicare Tax IER Basic Life Annuitant Med Hospital IER Workers Comp Benefit IPR Health America HMO IER-SERS I 82.40 19.27 4.40 240.00 22.43 310.00 43.14 (Federal Taxable Wages Amount Current Period Results 1 1,245.59 (Garnishment Type I Beg Balance Total To Date Remain Balance I (Payroll Area Z2 CERTIFICATE OF SERVICE I hereby certify that on this _3° day of January, 2007, a true and correct copy of the foregoing document was served on the following persons by United States Mail, postage prepaid, addressed as follows: Thomas M. Clark, Esquire 130 West Church Street, Suite 100 Dillsburg, PA 17019 Diane S'. Baker Supreme Court ID #53200 27 South Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 01/26/2007 14:42 FAX 7176719601 Diane S. Baker, Esquire Supreme Court I D #53200 27 South Arlene Street Post Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, Plaintiff V3. CHERYL L. WALTZ, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-3171 : CIVIL ACTION - DIVORCE INVENTOR'Y' OF PLAINTIFF DAVID WALTZ Plaintiff 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 verifies that the statements made in this inventory are true and correct. Plaintiff understands that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904 relating to unsworn falsification to authorities. .00&. - ?X*, - DAVID WALTZ [a 005/015 ASSETS OF PARTIES Plaintiff marks on the list below those items applicable to the case at bar and itemizes the assets on the following pages: W (X) (X) (X) (X) (X) 1. Real property 2. Motor vehicles 3. Stocks, bonds, securities and options 4. Certificates of deposit 5. Checking accounts, cash 6. Savings accounts, money market and savings certificates 7. Contents of safe deposit boxes 8. Trusts 9. Life insurance policies 10. Annuities 11. Gifts 12. Inheritances 13. Patents, copyrights, inventions, royalties 14. Personal property outside the home 15. Business 16. Employment termination benefits-severance pay, worker's compensation claim/award 17. Profit sharing plans 18. Pension plans 19. Retirement plans, Individual Retirement Accounts 20. Disability payments 21. Litigation claims 22. MilitaryN.A. benefits 23. Education benefits 24. Debts due, including loans, mortgages held 25. Household furnishings and personalty 26. Other MARITAL ASSETS Item 1 Marital residence, 820 Saw Grass Lane, Mechanicsburg, Pennsylvania. Value: To be determined Titled jointly to Husband and Wife Subject to a first mortgage, balance due to be determined Notes: Occupied by Wife since the date of separation Item 2 2001 Toyota Tacoma Titled jointly No debt Notes: Utilized by Husband post- separation Item 3. 2004 Toyota Highlander Titled jointly Subject to a first lien, balance due to be determined Notes: Utilized by Wife Post- separation Item 4 Franklin Templeton IRA, acct number 0494230 Account balance $108,623.01 (6/30/06) Marital portion to be determined Titled in Husband's individual name Notes: This IRA was a roll-over from Husband's AMP 401(k). The asset is both marital and non-marital as a portion of the 401(k) contained pre-marital contributions. The marital and non-marital component is to be determined Item 5 AMP Retirement Title Owner- Husband Dates of employment: 2/26/79- 6/27/99 Marital value: to be determined Item 6 PSERS Retirement account Title owner: Husband Dates of employment: 10/24/99-present Marital value: to be determined MARITAL ASSETS (Continued) Item 7 PSERS Retirement account Title owner: Wife Dates of employment: To be determined Marital value: to be determined - account is currently in pay-out status. Amount of benefit is approximately $67/month Item 8 PSECU, joint checking account - Husband as primary Value- 1,477.31 (3/31/06 statement) Notes: retained by Husband at the time of separation Item 9 PSECU, joint savings account - Husband as primary Value- $6,067.00 (4/7/06) Net retained by Husband after payment of marital debts: $2119.11 Notes: retained by Husband however $3,947.89 was used at the time of separation to pay an assortment of marital debts- see Items 8-11 of Marital Debt listing. Item 10 PSECU, joint checking account - Wife as primary Value- $2,687.11 (4/7/06) Notes: retained by Wife at the time of separation Item 11 Xerox Retirement plan (RIGP) Title owner- Wife Dates of employment: April, 1993- present Marital Value: to be determined Item 12 Xerox ESOP account Title owner: Wife Dates of employment: April, 1993- present Marital value: To be determined Item 13 Xerox 401(k) account Title owner: Wife Dates of employment: April, 1993- present 4/7/06 balance: $28,548.79 Current Marital value: To be determined MARITAL DEBTS Item 1 Mortgage on marital residence- National City Mortgage Amount owed to be determined Notes: Property utilized solely by Wife, post-separation and she has paid the monthly mortgage payments Item 2 PSECU Visa/Personal Service loan -Husband Balance due $7,284.72 (4/25/06 statement) Notes: Debt is marital however is in Husband's individual name and he has made all payments post separation Item 3 PSECU Visa/Personal Service loan - Wife Balance due: $9,359.06 (3/31/06 statement) Notes: Debt is marital however is in Wife's individual name and she has made all payments post separation Item 4 United Mileage Plus credit card, acct # xxxx1629 Balance due: To be determined Notes: Debt is believed to be marital however is in Wife's individual name and she has made all payments post separation. Item 5 Chase Credit card Balance due: to be determined Notes: Debt is believed to be marital however is in Wife's individual name and she has made all payments post separation. Item 6 Personal loan owed to Doris Waltz Joint debt Balance due: $18,800.00 Item 7 JW Mumper- debt for construction at marital residence $1,128.90 Joint debt Item 8 2006 Real estate taxes for residence $1409.52 Paid by Husband at the time of separation using funds in his PSECU account, (Marital Asset Item 9) Item 9 Wife's individual 2005 state tax $672.77 Paid by Husband at the time of separation using funds in his PSECU account, (Marital Asset Item 9) Item 10 Sod for marital residence $1653.60 Paid by Husband at the time of separation using funds in his PSECU account, (Marital Asset Item 9) Item 11 Water /sewer bill for marital residence $212.00 Paid by Husband at the time of separation using funds in his PSECU account, (Marital Asset Item 9) Respectfully submitted, DATE: iane S. Baker, Esquire 27 South Arlene Street Post Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 I.D. # 53200 CERTIFICATE OF SERVICE I hereby certify that on this 30 day of January, 2007, a true and correct copy of the foregoing document was served on the following persons by United States Mail, postage prepaid, addressed as follows: Thomas M. Clark, Esquire 130 west Church Street, Suite 100 Dillsburg, PA 17019 Respectfully submitted, S. Baker Supreme Court ID #53200 27 South Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 r--> ?'-Y _'? ?? _ .-- t C; . _ ,,,,a.. -ice _ Y,:. ' ?', ; ? ? 1 . ' C:_ `b ^'`? (,?? .. -- IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DAVID WALTZ, Plaintiff NO. 06-3171 Civil Term VS. CHERYL L. WALTZ, Defendant CIVIL ACTION - LAW IN DIVORCE DEFENDANT'S PRE-TRIAL STATEMENT AND NOW this 1 st day of February 2007, comes the Defendant, Cheryl L. Waltz, by and through her attorney, Thomas M. Clark, Esquire, and submits the following Pre- Trial Statement pursuant to Pa.R.C.P. 1920.33 of which the following is a statement: 1. List of Assets: (a) Martial Assets (spreadsheet outlining approximate values of marital assets is attached as Exhibit A): (i) The Parties' marital residence which is located at 820 Sawgrass Lane, Mechanicsburg, PA. (ii) The Parties' 2004 Toyota Highlander (In Wife's possession). (iii) The Parties' 2001 Toyota Tacoma (In Husband's possession). (iv) Husband's Templeton retirement. (v) Husband's AMP retirement. (vi) Husband's PSRS retirement. (vii) Wife's PSRS retirement. (viii) Wife's Xerox retirement. (ix) The Parties' PSECU checking account. (x) The Parties' PSECU savings account. (b) Marital Debt (spreadsheet outlining approximate values of marital debts is attached as Exhibit A): (i) Mortgage held by National City Mortgage on Marital Residence which is located at 820 Sawgrass Lane, Mechanicsburg, PA. (ii) Debt associated with 2004 Toyota Highlander. (iii) The Parties' United Mileage Credit Card. (iv) The Parties' Chase Credit Card. (v) Husband's PSECU Credit Card. (vi) Wife's PSECU Credit Card. (vi) The Parties' loan from Doris Waltz. (c) Non-Marital Assets: None that require involvement by the Court. 2. Expert witnesses: It is not clear at this time what experts, if any, will testify at the time of trial. If expert testimony is required, appropriate notice will be provided to opposing counsel and the Master in advance of trial and copies of expert reports will be provided. 3. Fact witnesses other than the parties: None at this time. To the extent additional fact witnesses are required, appropriate notice will be provided to the Master and opposing counsel in advance of trial. 4. Exhibits: (a) Income and Expense Statement of Cheryl L. Waltz. (A current Income and Expense Statement is being filed and will be submitted to the Divorce Master's Office within one (1) week of the filing of this Pre-Trial Statement). (b) Personal Federal Income Tax Returns of the Defendant for 2005 with associated schedules and supporting documents (attached as Exhibit B ). (c) Account information for the parties' mortgage held by National City Mortgage for marital residence located at 820 Sawgrass Lane, Mechanicsburg, PA (not attached hereto but has been previously provided to opposing counsel). (d) Account information for the Parties' 2004 Toyota Highlander (not attached hereto but has been previously provided to opposing counsel). (e) Account information for Husband's Templeton retirement (not attached hereto but has been previously provided to opposing counsel). (f) Account information for Husband's AMP retirement (not attached hereto but has been previously provided to opposing counsel). (g) Account information for Husband's PSRS retirement (not attached hereto but has been previously provided to opposing counsel). (h) Account information for Wife's PSRS retirement (not attached hereto but has been previously provided to opposing counsel). (i) Account information for Wife's PSRS retirement (not attached hereto but has been previously provided to opposing counsel). (j) Account information for Wife's Xerox retirement (not attached hereto but has been previously provided to opposing counsel). (k) Account information for Debt associated with 2004 Toyota Highlander (not attached hereto but has been previously provided to opposing counsel). (1) Account information for the Parties' United Mileage Credit Card (not attached hereto but has been previously provided to opposing counsel). (m) Account information for the Parties' Chase Credit Card (not attached hereto but has been previously provided to opposing counsel). (n) Account information for Husband's PSECU Credit Card (not attached hereto but has been previously provided to opposing counsel). (o) Account information for Wife's PSECU Credit Card (not attached hereto but has been previously provided to opposing counsel). (p) Information for loan from Doris Waltz (not attached hereto but has been previously provided to opposing counsel). (q) Account information for the Parties' PSECU checking account (not attached hereto but has been previously provided to opposing counsel). (r) Account information for the Parties' PSECU savings account (not attached hereto but has been previously provided to opposing counsel). 5. Statement of Gross Income: A current Income and Expense Statement is being filed and will be submitted to the Divorce Master's Office within one (1) week of the filing of this Pre-Trial Statement. 6. Expense Statement: A current Income and Expense Statement is being filed and will be submitted to the Divorce Master's Office within one (1) week of the filing of this Pre-Trial Statement. 7. Stipulations: The parties have not yet stipulated to anything. 8. Attorney's Fees: Defendant has not raised a claim for Counsel Fees. 9. Tangible personal property: There was no appraisal performed with regard to these items. 10. Marital Debts: (a) Mortgage held by Chase Mortgage on Marital Residence which is located at 820 Sawgrass Lane, Mechanicsburg, PA. (b) The Parties' PSECU checking account. (c) The Parties' United Mileage Credit Card. (d) The Parties' Chase Credit Card. (e) Husband's PSECU Credit Card. (f) Wife's PSECU Credit Card. (g) The Parties' loan from Doris Waltz. 11. Proposed resolution of the economic issues: Wife proposes that the Master should award her the majority of the marital assets available for distribution. The basis for this proposal is as follows: Husband and Wife were married on July 12, 1986. In April 2006, Husband removed himself from the marital residence. There are several reasons for the parties separating however; one of the main reasons was Husband's conduct leading up to the date of separation. Specifically, Husband has dressed as a woman. Husband has admitted to this behavior and has admittedly purchased bras, blouses and skirts. Wife is currently employed by Xerox Corporation. Her job title is that of Color Systems Annalist. Husband is currently employed by the Office of the Attorney General for the Commonwealth of Pennsylvania. His job title is that of Facility Maintenance Technician. Wife is currently paying spousal support in the amount of $530.00. Additionally, since the time of leaving the martial residence Wife has been responsible for paying all the household bills, including the mortgage. Husband's leaving the home was due to his own conduct. While Husband has employment through the State, it is believed that he is not fulfilling his true earning potential. Reasons for Husband leaving his job with AMP will be disputed. Husband is able to provide for his reasonable needs and will be able to sustain himself through appropriate employment. During the parties' marriage, aside from working a full time job, Wife devoted her time to taking care of the majority of the household duties. Again, Wife proposes that the Master should award her the majority of the marital assets available for distribution. Resp lly submitted, Thomas M. Clark, Esquire I.D. #85211 WILEY, LENOX, COLGAN & MARZZACCO, P.C. 130 West Church Street, Suite 100 Dillsburg, PA 17019 (717) 432-9666 Attorney for Defendant EXHIBIT A co c rn L o a ?o ? E N N O u _ OC) ? eU+ m O O O I O L C O O O O i N E 'X M M M E -- M M ~ o 0 0 Q a a w o w 0 0 0 w o w 0 w 0 w 0 0 0 0 o o I - - v o n m m o 0 0 0 0 o It O O O O O O M O O LO W r 0 0 0 0 0 0 M J O O O M r-? M r-? OD O 6 M N 6 O N O O Q O N w N r- r- m Lo to 0 to o w 0 O to o 0 m ?. 'IT Lo w v v_ M to N _ Lo O N O M N M O O ... bq O oo r-: 06 O M O C6 O _ O fR v> N 1 M v _ N e4 tV W,, 0 5q 69 9 6 Ef! fA EA ffl tv m U) I .- In O O O O O O O O 0 C. 6 N 6 O N 6 O wi O o 0 O O J O N O M N M H O N 1-: C6 V7 a? -7 rl: rl cq » M N W 2 J C) 0 3 ° 0 0 r 10 C, } H o 0 0 0 C) y 0 LU C, c, C:i 'n r- 00 w z (o U) o o co r,4 v N - vd o U N Q s ° ?s P-: s N C6 U J s 9 b- 9 6 9 N D r H W ?- Z M W O _ m o a v o? a N U C m L U N U C m ? J d y Q a L N m 3 v ?' U 2 ? w cn m o ? A PE Q N Lm um 0 U ? m o U I- co = y M s Y 4) Y o (D m U 0 v U .. .. U 0) .. v v w o o c m t N d J^ w d d _ = m N % V 2 U a = ? D H w H H J 2 , j w w Z5 a x ° m 2 L) w o o E a x o o . y w a Q w ? U) U) x N N F- d d a x x ? U 0 a a ? E?gIBIT B 1 040 Department of the Treasury-Intemal revenue service %?//I???I U.S. Individual Income Tax Return '!`J 1991 IRS Use Onrv- ro not write or stacie ns scace. C M 6 Nc. 1S =6-CO%= Fcr ;r.e year Jan. 3', 2CC5. cr cue :ax Year cec:nr rg , 20C5. er&.g , 20 Label Ycur firs: name arc initial Las names : Your social security nu tmoeer ins'rdc::c.n.s on pace 1c.) A B If a joint •etulm/, scoussee's firs, name and irttiai Las: name Spouse's social security number 5;z : 33aoZ L /842z i the IRS U L , se label. home actress (numb arc sireet.j. If you have a P.O. box, see pace 16. I Apt. ro. You must enter ® p e E your SSN(s; above. ase l p rint please pri R or type. E City. town or post office. state, arc Z!P cote. If ycu have a `creicr actress. see page 16. Checking a cox beicw will no-, J Presidential change your tax cr reins. I _ ouse 16) ? ? Y r S f d Election Campaign ou p (see pace un ? Check here if you, or your spouse if filing jointly, want $3 to go to this 1 ? Single 4 ? Head of household (with qualifying person). (See cage 17.) if Filing Status 2 ? Married filing jointly (even if only one had income) the qualifying person is a child but not your eependent. enter Check only 3 ? Married filing separately. Enter spouse's SSN above this child's name here. ? widow(er) with dependent child (see Dace 17) in lif 5 ? O y g ua one box. and full name here. ? 111 Boxes checked 6a Yourself. If someone can claim you as a dependent, do not check box 6a : t on 6a and 6b Exemptions b Spouse j No. of children c If more than four dependents, see page 19. Dependents- (2) Dependent's security number (3) relationship Depentlentt's social (1) First name Last name you FaMit d aualltymg ld for child tax Ise.- can 191 i ? ? d Total number of exemptions claimed 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . Income 8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . Attach Form(s) b Tax-exempt interest. Do not include on line 8a . . . 8b W-2 here. Also 9a Ordinary dividends. Attach Schedule B if required . . . . . . . attach W G and Forms b Oualified dividends (see page 23) . . . . . . . 9b 1099-R if tax 10 Taxable refunds, credits, or offsets of state and local income taxes (see page 23) was withheld. 11 Alimony received . . . . . . . . . . . . . . . . . . . . . 12 Business income or (loss). Attach Schedule C or C-EZ ... . . . . . . . . 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ? ? If you did not 14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . get a W-2, 15a IRA distributions 15a 1 -1 b Taxable amount (see page 25) see page 22. 25) 16a Pensions and annuities 16a b Taxable amount (see page Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E not attach, any 18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . payment. Also, please use 19 Unemployment compensation . . . . . . . . . Forth 1040-V. 20a Social security benefits . 120a I I b Taxable amount (see page 27) 21 Other income. List type and amount (see page 29) ------------------------------------ 22 Add the amounts in the far right column for lines 7 through 21. This is your total income ? 23 Educator expenses (see page 29) . . . . . . . 23 I Adjusted 24 Certain business expenses of reservists, performing artists, and GirOSS fee-basis government officials. Attach Forth 2106 or 2106-EZ 24 Income 25 Health savings account deduction. Attach Form 8889. 25 26 Moving expenses. Attach Form 3903 26 27 27 One-half of salt-employment tax. Attach Schedule SE . 28 Self-employed SEP, SIMPLE, and qualified plans . . . 28 29 Self-employed health insurance deduction (see page 30) 29 i 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipients SSN ? 31a 32 IRA deduction (see page 31) . . . . . . . . 32 I 33 Student loan interest deduction (see page 33) . . . . 33 34 Tuition and fees deduction (see page 34) . . . . . 34 i 35 Domestic production activities deduction. Attach Form 8903 35 36 Add lines 23 through 31a and 32 through 35 . . . . . . . . . . . 37 Subtract line 36 from line 22. This is your adjusted gross income . ? For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78. Cat. No. 113208 on 6c who: • lived with you • did not live with you due to divorce or separation (see page 20) Dependents on 6c not entered aboven Add numbers ont t lines above ? 10 luo I 19 1040 (2oos) Fcrm 1040 i2CC5, Paco 2G ax and "n A-cunt frc, lire 37 (adiusted gross income) 1 38 Credits 39, Check 1 You were tom before January 2, 1941, C Eiind. Total boxes if: 'Spouse was bcr^ tefere Jar.uz7y 2, 1941, ? Elird. checked ? 394 Standard L r b If ycur spouse emms cn a seca2:e re-%:m crrcu',yere 2 C7Pi = 2° J:e^.:e ca a 2E arc -.ecx r.62 ? is a, 1 fo Deducti Lip - on 40 Itemized deductions (from Schedule A) or your standard dedu&..ion (see lei, marcin) . ?? for- - F41 Subtract lire 40 from tine 38 . . . . . . . . . . . 1 41 { -7 r^ , / o Feccle whc ;v checked any 42 If line 38 is over S109,-75, er yeu presided hcus:r.c to z pcrscn displaced by r•iurrzar.e Ka:rna, --`?` box on line i 394 or 39b or see pace 37. Other.vise, multiply 53.200 by the total number of exemptions clained on lire 6d 42 who can be 43 Taxable income. Subtract lire 42 from !ire 41. If line 42 is more than line 41, enter -0- 43 ( 41 06, 1 dda - 44 dependent. 44 Tax ( ? see Pace 37• Check if any •ax is from: a ! I Form(s) 8814 b 71 Form 4972 I & // see page 300 45 Alternative minimum tax (see page 39). Attach Form 6251 . . . . . . . . . _ 45 { • All others: 46 Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . ? 46 ( r Single or 47 Foreign tax credit. Attach Form 1116 if required . . . { 47 1 I ='. Married filing w?: 48 Credit for child and dependent care expenses. Attach Form 2441 49 separately, 'r r 'a7d? 55,000 49 Credit for the elderly or the disabled. Attach Schedule R . 49 { Maimed filing 50 Education credits. Attach Form 8863 . . . . . . . 50 { 'r jointly or 51 Retirement savings contributions credit. Attach Form 8880. 51 Qualifying 52i widow(er), 52 Child tax credit (see page 41). Attach Farm 8901 if required 9i „? ,11 $10.000 53 Adoption credit. Attach Form 8839 . . . . . . . . 53 x*r"t Head of 54 Credits from: a ? Form 8396 b El Form 8859. 54 household, $7,300 55 Other credits. Check applicable box(es): a ? Form 3800 •.r+5`;, b ? Form 6801 c ? Form 55 56 Add lines 47 through 55. These are your total credits . . . . . . . . . 1 56 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- . . . . . ? 57 1(„ Other 58 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 58 Taxes 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 59 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . 60 61 Advance earned income credit payments from Form(s) W-2 . . . . . . . . . . 61 62 Household employment taxes. Attach Schedule H . . . . . . , , . • • 62 63 Add lines 57 through 62. This is your total tax . . . . ? 63 Payments 64 Federal income tax withheld from Forms W-2 and 1099. sa J 65 2005 estimated tax payments and amount applied from 20174 return 65 Fq'ya have a 66a Earned income credit (EIC) . . . . . 66a ?at ah b Nontaxable combat pay election ? dule EIC. 67 Excess social security and tier 1 RRTA tax withheld (see page 59) 67 68 Additional child tax credit. Attach Form 8812 . . . . , 68 69 Amount paid with request for extension to file (see page 59) 69 70 Payments from: a ? Form 2439 b ? Form 4136 c ? Form 8885 70 ? 71 Add lines 64, 65, 66a, and 67 through 70. These are your total payments . . . . ? 71 Refund Direct deposit? See page 59 and fill in 73b, 73c, and 73d. 72 If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid 73a Amount of line 72 you want refunded to you . . . . . . . . . . ? ? b Routing number ? c Type: ? Checking ? Savings ? of Account number f I I ) 74 oust 75 I Owe 76 Amount of line 72 you want applied to your 2006 estimated tax ? { 74 { { Amount you owe. Subtract line 71 from line 63. For details on how to pay, see page 60 ? Estimated tax penalty (see page 60) . . 1 76 1 1 Third Party Do you want to allow another person to discuss this return with the IRS (see page 61)? ? Yes. Complete the following. ? No Designee Designee's Phone Personal identification name ? no. ? ( ) number (PIN) ? 1 I 1 1 { Sign Under penalties of perlury, I declare that I have examined this return and accomcanying schedules and statements, and to the best of my knowledge and Here belief, they are true. correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of wnich preparer has any knowledge. Joint return? Your signature Date Your occupation i Daytime pnone number See page 17, ( ) Keep a copy Spouse's signature. If a joint return, both must sign. Date + Spouse's occupation - -Y for your records. [?-i M-1 Paid Preparer's I Date I Check if Preparer's SSN or PTIN signature self-employed ? Preparerrs Firm's name (or ; EN Use Only yours it self-emowyed), address. and ZIP code Phone no. f ) Form 1 040 (2005) ® Printed on recYcied pmer SCHEDULES A&B Schedule A-Itemized Deductions (Form 1040) (Schedule B is on back) Coca ?•r?er:t ct •rz 'real:, internal Revenue Sen:ce (S9) ? Attach to Form 1040. 1 See Instruclions for Schedules Aac (rcr-,n 1040 Name(s) shown cn Fcrn 1040 Cms Nc. 1Sd5-v0.3 %-, 01 t At-ac---=-• Secuerc Nc. 07 Your social security number j Medical Caution. Do rot include expenses reimbursed or paid by others. •.-,. I J 1 and 1 Medical and dental expenses (see pace A-2) - Dental 2 ' Enter amount from Form .10,0, line 38 12 1 1 •` ? ? i < ;?z.r_ Expenses 3 Multiply line 2 by 7.5% (.075). . . . . . . . 1 3 I 4 Subtract line 3 from line 1. If fine 3 is more than fine 1, enter -0- . . J 4 Taxes You 5 State and local (check only one box): I Paid a ? Income taxes, or 5 ?D ItiO I%s> . . J (See b ? General sales taxes (see pace A-3) I page A-2.) 6 Real estate taxes (see page A-5) . . . . . . 6 lv O r? r 7 Personal property taxes . . . . . . 7 . . . . 8 Other taxes. List type and amount ?._...-•__-,•...,-_.-- _ - s / I 9 Add lines 5 through 8 9 /O ?s? b 3 Interest 10 Home mortgage interest and points reported to you on Form 1098 10 I I r You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid r=;, (See to the person from whom you bought the home, see page A-6 pa ) e A-5 d h th ' i f ,f;>• g . an ow at person s s name, denti ying no., and address ? ? ,. . ; Personal rater st is 12 Points not reported to you on Form 1098. See page A-6 not for special rules . . . . . . . . . . . . . 12 y^ deductible. 13 Investment interest. Attach Form 4952 if required. (See page A-6.) . . . . . . . . . . . . . . 13 r 14 Add lines 10 through 13 14 '/L. 5 Gifts to 15a Total gifts by cash or check. If you made any gift of $250 Charity or more, see page A-7 . . . . . . . . . 15 a /UU Gp *''4?r ?: If you made a b Gifts by cash or check after August gift and got a 27, 2005, that you elect to treat as benefit for it, ! ¢ try x "• •. r ?. yMt qualified contributions (see page A-7) see a e A 7 15b p g . 16 Other than by cash or check. If any gift of $250 or more, N+ `: see page A-7. You must attach Form 8283 if over $500 16 17 Carryover from prior year . . . . . . . . , . 17 ?;. r 18 Add lines 15a, 16, and 17 . . 18 ?G,rJ Gv Casualty and Theft Losses 19 Casualty or theft loss(es). Attach Form 4684. (See page A-8.) . 19 Job Expenses 20 Unreimbursed employee expenses-job travel, union and Certain dues, job education, etc. Attach Form 2106 or 2106-EZ ' , r r •,. Miscellaneous if required. (See page A-8.) ? ............................. 20 Deductions 21 Tax preparation fees. . . . . . . . . . . . 21 I t . (See 22 Other expenses-investment, safe deposit box, etc. List page A-8.) type and amount ?----------------------------------------- ---------------------------------------•----•- 22 =v 23 Add lines 20 through 22 . . . . . . . 23 24 Enter amount from Form 1040, line 38 24 ! I ' 25 Multiply line 24 by 2% (.02) r . ; 25 26 Subtract line 25 from line 23. If line 25 is more than line 23 , enter -0- 1 26 Other 27 Other-from list on page A-9. List type and amount ? = = Miscellaneous Deductions ---------------------------------------------------- J Total 28 Is Form 1040, line 38, over $145,950 (over $72,975 if married filing separately)? Itemized ? No. Your deduction is not limited. Add the amounts in the far right column Deductions for lines 4 through 27. Also, enter this amount on Form 1040, line 40. ? 28 ? Yes. Your deduction may be limited. See page A-9 for the amount to enter. 29 If you elect to itemize deductions even though they are less than your standard deduction, check here ? ? For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 1133ox Schedule A (Form 1040) 2005 Scnecales A,-,E (Fcrn 1 C-C) 2CC5 Name si srown cn Fcr-n 1040. Cc nct enter name ar.c scc:ai secJR,, number if srown cn ctrer sice. CM2 No. 1545-CC74 Face d- j Your social security number Schedule B-Interest and Ordinary Dividends Se ence 08 1 Lis: name of payer. If any interest is from a seller-financed mortgage and the I Amount Part I buyer used the property as a personal residence, see page B-1 and list this I i Interest interest first. Also, sh ,•:i that buver's social security number and address ? i (See page E-1 ---------- . ----------••----------------------- and the --------...??SF ?--------•------•--------------------------- j 7?3 76, instructions for Form 1040. -•---------_:?.... -•----.....- I line 8a.) I.,r?•--C..CI'C)..... / -------------------------------------------------------------------------------------------- •---•-------••-•-•--•---------------------•----•-•-------••-•----........_.._.........------ 1 i • ...............................................................................•........... Note. If you received a Form • ..............................................•---•----•-----••--------------------_._.._.. 1099-INT, Form ----------•-----------------------------------•----••---•------------------••--------.------ 1099-OID, or substitute statement from •--•-•-• ............................•-------•---.....-----------•--•-•-----•----------...._. a brokerage firm, -----------------------------• list the firm's name as the payer and enter the total interest --------- -------------------------------------•----•-•--•--•-••----•------------------------ shown on that 2 Add the amounts on line 1 . . . . . . . . . . . . . . 2 j form. 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a ? 4 Note. If line 4 is over $1,500, you must complete Part III. Amount Part II 5 List name of payer ? ........................................ j Ordinary .......... Dividends ------•--- -X==??z-----.L?'l'J?S--------------------------------------------- S? (See page B-1 •-• .........................•--•--•---•-- and the instructions for Form 1040, line 9a.) -------------------•------•-•----------------••--------•---•-•••••-------•-•--•-•••-•. •--------------•---•---...-------••--••--•-•---•----•----•---••---•-------•••-•••---•---••-- ....--------•------.....-•------------------•--------------....----•-----•-•------•----•-•-- Note. If you 5 received a Form --•--•-------•------•-----------------------------------------------•---•••------••----•---• 1099-OIV or ------••-•-••---------------•--• ........................................................... substitute •-•---•-•-----••---•------•-• ................................•--•••----•-••-----•-----.----• statement from a brokerage firm, ------------------•--••----------•-----•------------------•------••--•-------•-•-•••-------• list the firm's ---------------•----•--------------------------------------------------------------••--_.-- name as the payer and enter the ordinary ....-•-----------•----------------------•-•--••----•_...._ dividends shown --------------------------------------------------------------•----------------------------- on that form. j 6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9a . ? 6 1 Note. If line 6 is over $1,500, you must complete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; or (b) had I Yes No Part III a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Foreign 7a At any time during 2005, did you have an interest in or a signature or other authority over a financial /accounts account in a foreign country, such as a bank account, securities account, or other financial account? , and Trusts See page B-2 for exceptions and filing requirements for Form TD F 90-22.1. . . . . . ------------------------------------------------------- b If "Yes," enter the name of the foreign country ? ----•_----_•--------------•---------•---••--•--------- (See page a-2.) 8 During 2005, did you receive a distribution from, or were you the grantor of, or transferor to, a page trust? If "Yes," you may have to file Form 3520. See page B-2 . . . . . . . . . For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 2005 Commonwealth of Pennsylvania EMPLOYEE PAY STATEMENT ;,David R Walt.. 1820 Sawgrass Lane ;Mechanicsburg PA 17050 j B/U:B3 Group:05 Level:05 I j?ersonnel Number ..... 00503221 jAttorney General j?ay Period.. 12/301'2006 - 01/12/2007 j jFed Tax Status: Married j jFed Tax Allowances: 00 Period: 02/2007 ; j I I Pay Date Payment Amount = j 01/26/2007 954.48 = 1, j Gross Reim. 335.75 + 0.00 - Taxes - Deds. j 276.11 - 105.16 j Gross Current Pay Rate Hrs/Unt Amount Year To Date j jNormal working hours 17.81 67. jHoliday/Comp lieu Holiday 17.81 7. j 50 50 1,202.18 133.57 2,404.36 j 267.14 j jTotal Gross 1 1,335.75 2,671.50 j j jTaxes j Amount Year To Date j j jFederal Federal jTX Withholding Tax jTX EE Social Security Tax jTX EE Medicare Tax jState Pennsylvania jTX Withholding Tax jTX EE Unemployment Tax jLocal Hampden Township jTX withholding Tax Local Harrisburg jTX EE Occupation Tax j 111.17 82.40 19.27 40.80 1.20 21.27 j 222.34 j 164.80 j 38.54 j j 81.60 j 2.40 j j 42.54 j j 52.00 j j jTotal Taxes j 276.11 604.22 j j jDeductions j Amount Year To Date j j jEE PreTx M/H Pct jEmp Supp Life - Hartford jFull Cov Class AA/Cat 0 j 6.68 15.00 83.48 13.36 j 30.00 j 166.96 j j jTotal Deductions j 105.16 210.32 j j jNon cash compensation I Amount Year To Date j j I j I j jReimbursements j Amount j j I - j Commonwealth of Pennsylvania EMPLOYEE PAY STATEMENT ;Direct Deposit Bank / Check Amount Net Pavment 954.48 State Paid Benefits j Amount jTX ER Social Security Tax jTX ER Medicare Tax jER Basic Life Annuitant Med Hospital JER Workers Comp Benefit APR Health America HMO jER-SERS j 82.40 19.27 4.40 240.00 22.43 310.00 43.14 jFederal Taxable Wages j Amount jCurrent Period Results I 1,245.59 jGarnishment Type j Beg Balance Total To Date Remain Balance I Payroll Area Z2 I CERTIFICATE OF SERVICE I hereby certify that on this day of January, 2007, a true and correct copy of the foregoing document was served on the following persons by United States Mail, postage prepaid, addressed as follows: Thomas M. Clark, Esquire 130 West Church Street, Suite 100 Dillsburg, PA 17019 Respectfull ( ?D'ane S'. Baker Supreme Court ID #53200 27 South Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DAVID WALTZ, Plaintiff VS. CHERYL L. WALTZ, Defendant NO. 06-3171 Civil Term CIVIL ACTION - LAW IN DIVORCE CERTIFICATE OF SERVICE I, Thomas M. Clark, Esquire, hereby certify that on this date, I served a copy of Defendant's Pre-Trial Statement upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure as follows: Regular U.S. Mail and Facsimile E. Robert Elicker, II Divorce Master 9 North Hanover Street Carlisle, PA 17013 and Diane S. Baker, Esquire 27 S. Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 Date: o Thomas M. Clark, Esquire I.D. #85211 WILEY, LENOX, COLGAN & MARZZACCO, P.C. 130 West Church Street, Suite 100 Dillsburg, PA 17019 (717) 432-9666 IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA David Waltz v. Cheryl L. Waltz DOCKET NO. 06-3171 Civil Term INCOME AND EXPENSE STATEMENT OF CHERYL L. WALTZ ADDRESS: Cheryl Waltz ATTORNEY: Thomas M. Clark, Esquire 820 Sawgrass Lane 130 W. Church Street, Suite 100 Mechanicsburg, PA 17050 Dillsburg, PA 17019 (717) 432-9666 PHONE (717) 737-5696 SECTION 1: INCOME AND INSURANCE INFORMATION INSTRUCTIONS: THIS SECTION MOST BE FULLY COMPLETED. IF YOU ARE NOT PRESENTLY EMPLOYED, THE EMPLOYER INFORMATION SHOULD REFLECT EARNINGS INFORMATION FROM YOUR LAST JOB. INCOME: CURRENT OR LAST EMPLOYER: XEROX CORPORATION PAYROLL ADDRESS- 1350 Jefferson Road Rochester NY 14623 POSITION HELD: stems analyst RATE OF PAY/FREQUENCY: $ HOW PAID: (CIRCLE ONE) WEEKLY ./ BIWEEKLY / MONTHLY / SEMI-MONTHLY / OTHER IF LAST JOB: DATE LEFT JOB REASON FOR LEAVING GROSS PAY PER PERIOD: $ 3,041.59 ITEMIZED PAYROLL DEDUCTIONS: $ FEDERAL WITHHOLDING $ 341.05 SOCIAL SECURITY (& MEDICARE) $ 186.14 LOCAL WAGE TAX $ 29.95 STATE INCOME TAX $ 91.95 MANDATORY RETIREMENT $ HEALTH INSURANCE $ 39.34 OTHER (SPECIFY) $ Medicare Tax $ 43.54 SDI Tax $ 2.73 401 k $ 182.07 HOME Maintannance - $ 24.00/month TAXES Poperty - $ 959.61 LOANS Mortgage - $ 1730.00/month Vehicle - $ 405.00/month INSURANCE Homeowners - $ 317.00/yearr MISCELLANEOUS (REQUIRED MINIMUM % ) SECTION II: EXPENSES Alimony Payments - $ 742.00/month MF? CO L„ .1 IP 1110 34-2 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT N . 3 r I cid 1 L- State Commonwealth of Pennsylvania 0Original Order/Notice Co./City/Dist. of CUMBERLAND . O Amended Order/Notice Date of Order/Notice 02/20/07 O Terminate Order/Notice Case Number (See Addendum for case summary) RE: WALTZ, CHERYL L. E m ployer/With holder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) XEROX CORPORATION* C/O GARNISHMENT DESK 1350 JEFFERSON RD ROCHESTER NY 14623-3106 184-52-3302 Employee/Obligor's Social Security Number 1039101672 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 530. 00 per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Oyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 530.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 122.31 per weekly pay period. $ 244.62 per biweekly pay period (every two weeks). $ 265. oo per semimonthly pay period (twice a month). $ 530.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: ;, Service Type M OMB No.: 0970-0154 LEY 'k- .JUDE E Form EN-028 Rev. Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke l you are required. top vhde agopy of this form to yourgmployee. If your employee works in a state that is di Brent rom the state that issu t is o er, a copy must be prowl to your emplogee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydatel0ate of Witi iolding. You must repurt tire paydate/date of withholding when sending the payment. The You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 1604680200 EMPLOYEE'S/OBLIGOR'S NAME: WALTZ CHERYL L. EMPLOYEE'S CASE IDENTIFIER: 1039101672 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. i i. Submitted By: DOMESTIC RELATIONS SECTION 13 N. ANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970.0154 Form EN-028 Rev. 1 Worker I D $ zATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WALTZ, CHERYL L. PACSES Case Number 611108342 Plaintiff Name DAVID R. WALTZ Docket Attachment Amount 06-3171 CIVIL$ 530.00 Child(ren)'s Name(s): DOB ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 1 Service Type M Worker ID OMB No.: 0970-0154 $ IATT - - -n ?? C.r? DAVID WALTZ, * IN THE COURT OF COMMON PLEAS Plaintiff * CUMBERLAND COUNTY, PENNSYLVANIA * VS. * NO. 06-3171 * CHERYL L. WALTZ, Defendant * CIVIL ACTION - LAW IN DIVORCE AFFIDAVIT OF CONSENT 1. A complaint in Divorce under § 3301(c) of the Divorce Code was filed on June 2, 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 made herein are subject to the penalties of 18 Pa.C.S. § 4904 relating to unswom falsification to authorities. C4 -ate- 07 Date 777 X ! DAVID WALTZ, Plaintiff VS. CHERYL L. WALTZ, Defendant * IN THE COURT OF COMMON PLEAS * CUMBERLAND COUNTY, PENNSYLVANIA * * NO. 06-3171 * * * CIVIL ACTION - LAW IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 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 made herein are subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Date . -j-g S ...... r i COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA David Waltz Plaintiff VS. : Chervl L. Waltz Defendant CIVIL ACTION - LAW IN DIVORCE f _t NO. 06-3171 11 F AND NOW, this «1 day of ec7 , the parties, David Waltz, Plaintiff and Cheryl L. Waltz, Defendant, do hereby Agree and Stipulate as follows: 1. The Defendant, Cheryl L. Waltz (hereinafter referred to as "Member") is a member of the Commonwealth of Pennsylvania, State Employees' Retirement System (hereinafter referred to as "SERS"). 2. SERS, as a creature of statue, is controlled by the State Employees' Retirement Code, 71 Pa. C.S. §§5101-5956 ("Retirement Code"). 3. Member's date of birth is September 4, 1958, and her Social Security number is 184-52- 3302. 4. The Plaintiff, David Waltz (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alternate Payee's date of birth is July 19, 1958, and his Social Security number is 208-42-3414. 5. Member's last known mailing address is: 820 Sawgrass Lane Mechanicsburg, PA 17050 6. Alternate Payee's current mailing address is: P.O. Box 117 Harrisburg, PA 17108 6Z :? IJJ 9 1 S_ PI, 1101 LE0Z D-4i 20 DRO Page 2 It is the responsibility of the Alternate Payee to keep a current mailing address on file with SERS at all times. 7. The Alternate Payee is entitled to a portion of the Member's benefits under the Plan as set forth below. The Plan is hereby directed to pay Alternate Payee's share directly to Alternate Payee. 8. The Member is currently receiving a monthly annuity for her lifetime pursuant to the terms of Option 1. Member waives her right to change her option selection by virtue of her divorce. 9. The Alternate Payee is awarded 100% of the Member's gross monthly annuity together with 100% of any death benefit payable under Option 1. The Alternate Payee shall receive 100% of any scheduled or ad hoc increase that is applied to Member's gross monthly annuity. 10. Payments to the Alternate Payee shall commence as soon as administratively feasible on or about the date SERS approves the Domestic Relations Order incorporating this Stipulation and Agreement. 11. Payments shall continue to Alternate Payee for the remainder of the Member's lifetime. 12. If the Member dies before the Alternate Payee, the Alternate Payee shall be paid 100% of any death benefit payable under Option 1. 13. If the Alternate Payee dies before the Member, the Alternate Payee's share of the member's pension and any death benefit payable under Option 1 shall be paid to his estate. 14. Member shall execute and deliver to Alternate Payee an authorization, in a form acceptable to SERS, which will authorize SERS to release to Alternate Payee all relevant information concerning Member's retirement account. Alternate Payee shall deliver the authorization to SERS which will allow the Alternate Payee to check that he has been and continues to be named as the beneficiary for 100% of any death benefit payable under Option 1. DRO Page 3 15. Alternate Payee may not exercise any right, privilege or option offered by SERS. SERS shall issue individual tax forms to Member and Alternate Payee for amounts paid to each. 16. In no event shall Alternate Payee have greater benefits or rights other than those which are available to Member. Alternate Payee is not entitled to any benefits not otherwise provided by SERS. The Alternate Payee is only entitled to the specific benefits offered by SERS as provided in this Order. All other rights, privileges and options offered by SERS not granted to Alternate Payee by this Order are preserved for Member. 17. It is specifically intended and agreed by the parties hereto that this Order: (a) Does not require SERS to provide any type or form of benefit, or any option not otherwise provided under the Retirement Code; (b) Does not require SERS to provide increased benefits (determined on the basis of actuarial value) unless increased benefits are paid to Member based upon cost of living or increases based on other than actuarial values. 18. The parties intend and agree that the terms of this Stipulation and Agreement shall be approved, adopted and entered as a Domestic Relations Order. 19. The Court of Common Pleas of Cumberland County, Pennsylvania, shall retain jurisdiction to amend any Domestic Relations Order incorporating this Stipulation and Agreement, but only for the purpose of establishing it or maintaining it as a Domestic Relations Order; provided, however, that no such amendment shall require SERS to provide any type or form of benefit, or any option not otherwise provided by SERS, and further provided that no such amendment or right of the Court to so amend will invalidate this existing Order. 20. Upon entry as a Domestic Relations Order, a certified copy of the Domestic Relations Order and this Stipulation and Agreement and any attendant documents shall be served upon SERS immediately. The Domestic Relations Order shall take effect immediately upon SERS approval and SERS approval of any attendant documents and then shall remain in effect until further Order of the Court. r DRO Page 4 WHEREFORE, the parties, intending to be legally bound by the terms of this Stipulation and Agreement, do hereunto place their hands and seals. Plaintiff/Alt e Payee Plaintiff/Alternate Payee Defend a ber v <.- - Attorney for Defendant/Member BY THE COURT /(A?? wI DAVID WALTZ, VS. Plaintiff CHERYL L. WALTZ, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 06 - 3171 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this J day of 2007, the economic claims raised in the proceedings having been resolved in accordance with a marital settlement agreement dated July 6, 2007, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, Q !I 12? Edgar B. Bayley, P.J. cc: ?"'1ane S. Baker Attorney for Plaintiff /homas M. Clark C Attorney for Defendant kR 6 C: f . t r.? J au r ` ? f ? C"i MARITAL SETTLEMENT AGREEMENT AGREEMENT, made this 0A day of , 2007, by and between CHERYL L. WALTZ, hereinafter referred to as "Wife", and DAVID R. WALTZ, hereinafter referred to as "Husband". WITNESSETH: WHEREAS, the parties hereto are Husband and Wife, having been married on July 12, 1486, and there were no children born of the marriage; WHEREAS, diverse unhappy differences, disputes and difficulties have arisen between the parties, and it is the intention of Wife and Husband to live separate and apart for the rest of their natural lives, and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them relating to the ownership of real and personal property, the equitable distribution of such property; the settling of all matters between them relating to the past, present and future support and/or maintenance of Wife by Husband or of Husband by Wife; and, in general, the settling of any and all claims and possible claims by one against the other or against their respective estates. NOW, THEREFORE, in consideration of the premises and of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable considerations, receipt of which is hereby ackno«ledged by each of the parties hereto, Wife and Husband, each intending to be legally bound hereby, covenant and agree as follows: 1. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS. This Agreement shall not be considered to affect or bar the right of Wife or Husband to a divorce on lawful grounds if such grounds now exist or shall hereafter exist or to such defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed a condonation on the part of either party hereto of any act or acts on the part of the other party which have occurred prior to or which may occur subsequent to the date hereof. 2. EFFECT OF DIVORCE DECREE. The parties agree that, unless otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final decree in divorce may be entered with respect to the parties. It is the intent of the parties hereto that this Agreement shall create contractual rights and obligations entirely independent of any Court Order and that this Agreement may be enforced by contract remedies in addition to any other remedies which may be available pursuant to the terms of this Agreement or otherwise under law or equity. 3. AGREEMENT TO BE INCORPORATED IN DIVORCE DECREE. The parties agree that the terms of this Agreement shall be incorporated, but not merged, into any divorce decree which may be entered with respect to them. The parties further agree that the Court of Common Pleas which may enter such divorce decree shall retain continuing jurisdiction over the parties and the subject matter of the Agreement for the sole purpose of enforcement of any of the provisions thereof and not for modification of the Agreement. 4. DATE OF EXECUTION. The "date of execution" or "execution date" of this Agreement shall be defined as the date upon which it is executed by the parties if they have each executed the Agreement on the same date. Othen%ise, the "date of execution" or "execution 1) date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 5. ADVICE OF COUNSEL. The provisions of this Agreement and their legal effect have been fully explained to Husband by his attorney, Diane S. Baker, Esquire, and to Wife by her attorney, Thomas M. Clark, Esquire. The parties acknowledge that they fully understand the facts and they acknowledge and accept that this Agreement is, in the circumstance, fair and equitable and that it is being entered into freely and voluntarily and that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements. The parties further acknowledge that they have each made to the other a full and complete disclosure of their respective assets, estate, liabilities, and sources of income and that they waive any specific enumeration thereof for the purposes of this Agreement. Each party agrees that he and she shall not, at any future time, raise as a defense or otherwise the lack of such disclosure in any legal proceeding involving this Agreement, with the exception of disclosure that may have been fraudulently withheld. 6. PERSONAL RIGHTS. Wife and Husband, at all times hereafter, may and shall live separate and apart. They shall be free from any control, restraint, interference or authority, direct or indirect, by the other in all respects as fully as if they were unmarried. Each may, for his or her separate use or benefit, conduct, carry on and engage in any business, occupation, profession or employment Nvhich to him or her may seem advisable. Agreement shall not be affected by their subsequent co-habitation or resumption of marital relations, unless the parties otherwise specifically agree in writing. 8. MUTUAL RELEASES. Husband and Wife each do hereby mutually remise, release, quitclaim and forever discharge the other and the estate of the other, for all time to come, and for all purposes whatsoever, of and from any and all rights, title and interests, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature or wheresoever situate, which he or she now has or at any time hereafter may have against the other, the estate of the other or any part thereof, whether arising out of any former acts, contracts, engagements or liabilities of the other or by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any other country, or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, property division, costs or expenses, whether arising as a result of the marital relation or otherwise, except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is the intention of Husband and Wife to give to each other by the execution of this Agreement a full, complete and general release with respect to any and all property of an), kind or 4 nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction. 9. DATE OF SEPARATION. The parties agree that for the purpose of equitable distribution the date of separation of the parties was April 8, 2006. 10. RETIREMENT ACCOUNTS AND PENSION PLANS. Wife has been employed during the marriage by Xerox Corporation and as a result of said employment is the title owner of a pension, 401 (k) and stock account, the values of which been disclosed during discovery. Wife was previously employed during the marriage by the Commonwealth of Pennsylvania and as a result of said employment is the title owner of a SERS retirement currently in payout status. Husband has been employed during the marriage by the Commonwealth of Pennsylvania and as a result of his employment is the title owner of a SERS retirement account, the value of which has been disclosed during discovery. Husband was previously employed during the marriage by AMP Incorporated and as a result of said employment is the title owner of a pension account, the value of which has been disclosed during discovery. The parties agree that Wife shall retain her Xerox Corporation retirement accounts and Husband shall retain his Commonwealth of Pennsylvania and AMP retirement accounts. NN17ife further agrees that she shall transfer to Husband her monthly SERS retirement benefit in its entirety and it shall become { V the sole and separate property of Husband. It is intended by the parties that this provision for transfer of retirement benefits shall be approved by the court as a separate order, which shall constitute a Qualified Domestic Relations Order ("QDRO") under Section 414(p) of the I.R.C. Said QDRO shall be prepared by Husband at Husband's expense. Both parties agree to execute all documents necessary to effectuate the transfer upon request including the QDRO and any documents pursuant to the Retirement Equity Act or any similar Act that may be required from time to time to accomplish the purpose of this Paragraph. Except as specifically provided for in this Agreement, Wife and Husband hereby release and waive any and all interest, claim, or right that she or he may have to any and all retirement benefits (including pension or profit sharing benefits) or other similar benefits of the other party. 11. PERSONAL PROPERTY. Husband and Wife do hereby acknowledge that they have divided their tangible personal property, including, but without limitation, jewelry, clothes, furniture, furnishings, rugs, carpets, household equipment and appliances, pictures, books, works of art and other personal property in as equitable a manner as possible. All such property currently in possession of Wife shall become the sole and exclusive property of Wife. All such property currently in possession of Husband shall become the sole and exclusive property of Husband. The parties do hereby specifically waive, release, renounce and forever abandon whatever claim, if any, he or she may have with respect to the above items which shall become the sole and separate property of the other. 12. AFTER-aCOUIRED PERSONAL PROPERTY. Each of the parties shall hereafter o«n and enjoy, independently of any claim or right of the other, all items of personal property, tangible or intangible, hereafter acquired by him or her, with full power in him or her to 6 dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were unmarried. 13. AUTOMOBILES. The parties are the owners of a 2001 Toyota Tacoma and a 2004 Toyota Highlander. The 2001 Toyota Tacoma shall become the sole and separate property of Husband. There is no debt owed on this vehicle. The 2004 Toyota Highlander shall become the sole and separate property of Wife and she shall be solely responsible for the debt owed on said vehicle to Toyota Finance Company and shall indemnify and hold Husband harmless therefrom. Both parties agree that they shall cooperate and sign any necessary titles to effectuate this paragraph. 14. BANK ACCOUNTS. The parties agree that they have no remaining joint bank accounts. Any individual accounts owned by the parties shall become the sole and separate property of the party in whose name the account is currently titled and both parties waive any rights they may have to the bank account(s) of the other. 15. CURRENT LIABILITIES. In addition to the debts and loans set forth elsewhere in this Agreement, the parties agree that as of the date of separation there was an assortment of unsecured marital debt. Husband agrees that he shall be solely responsible for the following debt and shall indemnify and hold Wife harmless therefrom: a. PSECU Personal Service Loan/credit card debt in his individual name. Wife agrees that she shall be solely responsible for the following debts and shall indemnify and hold Husband harmless therefrom: a. PSECU Personal Service Loan/credit card debt in her individual name; b. United Mileage Visa credit card, account number ending in 1629. 7 r C. Chase Visa credit card, account number ending in 1474; and, d. Debt owed to Jim Mumper related to construction of the residence. Except as may be set forth above and elsewhere in this Agreement, the parties agree that they have no joint liabilities. All remaining debts accumulated during the marriage are in the sole and separate name of the individual parties and shall become the sole and separate responsibility of the named party. 16. DEBT OWED TO DORIS WALTZ. During the course of the marriage the parties acknowledge that they borrowed approximately $20,000 from Husband's mother, Doris Waltz. Said funds were used for various marital purposes. The parties also agree that during the course of the marriage some payments were made to Doris Waltz as partial repayment of this debt such that the remaining balance owed to Doris Waltz is $17,200. Husband and Wife agree that they shall divide this debt equally and they shall each be responsible to make payment in the amount of $8,600 to Doris Waltz. Payment to Doris Waltz shall be made within ninety (90) days of the date of execution of this Agreement. 17. FRANKLIN TEMPLETON ROLLOVER IRA. Husband is the title owner of an Individual Retirement Account (IRA) managed by Franklin Templeton that contains funds rolled over from Husband's AMP retirement account. The value of this account has been disclosed in discovery. The parties agree that said Individual Retirement Account shall become the sole and separate property of Husband and Wife «,aives any rights she may have to this account. 18. WARRANTY AS TO EXISTING OBLIGATIONS. Each party represents that the), have not heretofore incurred or contracted for any debt or liability or obligations for which 8 A' tr the estate of the other parry may be responsible or liable, except as may be provided for in this Agreement. Each parry agrees to indemnify and hold the other party harmless for and against any and all such debts, liabilities or obligations of every kind which may have heretofore been incurred by them, including those for necessities, except for the obligations arising out of this Agreement. 19. WARRANTY AS TO FUTURE OBLIGATIONS. Wife and Husband each covenant, warrant, represent and agree that, with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnify and hold harmless the other party for and against any and all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement. 20. LIFE INSURANCE. All life insurance policies owned by the parties shall become the sole and separate property of the party in whose name the policy is in and both parties specifically waive any rights which they may have to said policies by virtue of having been a named beneficiary thereon. 21. REAL ESTATE. The parties are the owners of a residence located at 820 Sawgrass Lane, Mechanicsburg, Cumberland County, Pennsylvania. Husband agrees that he shall transfer his interest in this residence to Wife and it shall become her sole and separate property. Wife agrees that she shall be solely responsible for the mortgage owed on said residence to :National City Mortgage and shall indemnify and hold Husband harmless therefrom. Wife further agrees that within ninety (90) days of the date of execution of this Agreement she 9 e r ?J shall refinances id mortgage into her individual name, re mo ' g Husband from responsibility ?? thereon. In the event that Wife is unable to refinance the mortgage she shall immediately list the property for sale at a listing price suggested by the listing real estate agent. Wife shall also be solely responsible for all expenses related to the residence including but not limited to taxes, utilities and insurance and shall become the sole and separate owner of any mortgage company escrow account set up for the purpose of paying the taxes and insurance on the property. Husband agrees to sign all documents necessary to implement this paragraph upon request including execution of the deed upon proof of refinancing and receipt of the payment set forth is Paragraph 22 of this Agreement 22. PAYMENT TO HUSBAND. In partial consideration of Husband's share of the equity in the marital residence and Wife's retirement accounts, Wife agrees to pay to Husband the sum of Fifteen thousand six hundred forty-nine dollars ($15,649). Payment shall be made to Husband upon refinancing of the marital residence or within ninety (90) days of the date of execution of this Agreement, whichever occurs first. 23. HEALTHCARE COVER4GE. Both parties acknowledge that, effective the date of entry of a Decree in Divorce, it shall be their individual responsibility to provide their own medical insurance coverage. To the extent medical insurance coverage is affected by marital status, it shall be the individual responsibility of Husband and Wife to immediately notify his or her employer of the change in marital status. 24. PAST DUE TAXES. The parties have heretofore filed joint Federal and state tax returns. Both parties a;ree that in the event an}, deficiency in Federal, state or local income tax is proposed, or any assessment of any such tax is made against either of them, each 10 I « _ will indemnify and hold harmless the other from and against any loss or liability for any such tax deficiency or assessment and any interest, penalty and expense incurred in connection therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individual who is finally determined to be the cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns. 25. BANKRUPTCY. It is hereby understood and agreed by and between the parties that their obligations pursuant to this agreement shall not be affected by any bankruptcy proceeding and shall not be deemed to constitute or be a dischargeable debt of a bankruptcy. Both parties warrant that he/she has not heretofore instituted any proceedings pursuant to the bankruptcy laws nor are there any such proceedings pending with respect to him/her that have been initiated by others. 26. PAYMENT OF LEGAL FEES. Wife shall be responsible for payment of her legal fees and Husband shall be responsible for payment of his legal fees. 27. ALIMONY, ALIMONY PENDENTE LITE AND SPOUSAL SUPPORT. Includina the benefits provided for in this Agreement, Husband and Wife each have sufficient property and/or income to provide for his or her reasonable needs. Therefore, notwithstanding any provision in the Divorce Code to the contrary, and except as otherwise specifically set forth in this Agreement, Wife and Husband expressly waive, discharge and release any and all rights or claims which he or she may have, now or hereafter, by reason of the parties' marriage, to alimony, alimony pendente lite, support, maintenance and/or any other such benefits resulting from the parties' status as husband and wife. It shall be, from the execution of this Agreement, the sole responsibility of each of the respective parties to sustain themselves without seeking any 11 additional support from the other party, except as provided herein. The parties agree that the spousal support/alimony pendente lite order docketed to Cumberland County Domestic Relations PACSES No. 611108342 shall terminate effective the date of entry of a decree in divorce or the date Wife makes payment to both Husband and Doris Waltz, as set forth in this Agreement in Paragraphs 16 and 22, whichever occurs first. All arrearages, if any, shall remain payable at the rate of $500 per month until paid in full. 28. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS. The parties hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be within the scope and applicability of the Deficit Reduction Act of 1984 hereinafter the "Act"), specifically, the provisions of said Act pertaining to the transfers of property between spouses and former spouses. The parties agree to sign and cause to be filed any elections or other documents required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement without recognition of gain on such transfers and subject to the carry-over basis provisions of the said Act. In the event that there is a transfer tax or income tax on gain assessed then said tax shall be the responsibility of the party receiving the property. 29. MUTUAL CONSENT DIVORCE. The parties agree and acknowledge that their marria?e is irretrievably broken, that they do not desire additional marital counseling, and that they both consent to the entry of a decree in divorce pursuant to Section 3301(c) of the Pennsylvania Divorce Code, Act 26 of 1980, as may be amended (herein referred to as the Code). Upon entry of the QDRO described in Paragraph 10 of this Agreement, both parties agree to execute such consents, affidavits, or other documents and to direct their respective attorneys to 12 a file such consents, affidavits, or other documents as may be necessary to promptly proceed to obtain a divorce pursuant to said Section 3301(c) of The Code. Upon request, to the extent permitted by the law and the applicable Rules of Civil Procedure, the named defendant in such divorce action shall execute any waivers of notice or other waivers necessary to expedite such divorce. 30. WAIVER OR MODIFICATION TO BE IN WRITING. No modification or waiver of any of the terms hereof shall be valid unless in writing and signed by both parties, and no waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the same or similar nature. 31. MUTUAL COOPERATION. Each party shall, at any time and from time to time hereafter, take any and all steps and execute, acknowledge and deliver to the other party any and all further instruments and/or documents that the other party may reasonably require for the purpose of giving full force and effect to the provisions of this Agreement. 32. LAWS OF PENNSYLVANIA APPLICABLE. This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania which are in effect as of the date of execution of this Agreement. 33. AGREEMENT BINDING HEIRS. This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 34. OTHER DOCUMENTATION. NN'ife and Husband covenant and agree that they \Nill forthwith (and «-ithin at least ten (10) days after demand therefor) execute any and all 13 e written instruments, assignments, releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. 35. NO WAIVER OF DEFAULT. This Agreement shall remain in full force and effect unless and until terminated under and pursuant to the terms of this Agreement, The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall in no way affect the right of such party hereafter to enforce the same, nor shall the waiver of any default or breach of any provision hereof be construed as a waiver of any subsequent default or breach of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein. 36. ENTIRE AGREEMENT. This Agreement contains the entire understanding of the parties, and there are no representations, warranties, covenants or undertakings other that those expressly set forth herein. The parties further acknowledge that any previous agreements between them are incorporated herein. 37. ENFORCEMENT OF AGREEMENT. If either party breaches any provision of this Agreement, the other party shall have the right, at his or her selection, to sue for damages for such breach or to require specific performance. The party breaching this Agreement shall be responsible for payment of legal fees and costs incurred by the other party in enforcing their rights under this Agreement or for seeking such other remedies of relief as may be available to him or her. 38 SEVERaBILITY. If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement and, in all other respects, 14 l J ? v this Agreement shall be valid and continue in full force, effect and operation. Likewise, the failure of any party to meet her or his obligations under any one or more of the paragraphs herein, with the exception of the satisfaction of the conditions precedent, shall, in no way, void or alter the remaining obligations of the parties. 39. HEADINGS NOT PART OF AGREEMENT. Any headings preceding the text of the several paragraphs and subparagraphs hereof are inserted solely for convenience of reference and shall not constitute a part of this Agreement, nor shall they affect its meaning, construction or effect. IN WITNESS WHEREOF, the parties hereto have set their hands and seal the day and year first above written. WITNESS NK'I SS CHERYL U/ WALTZ DAVID R. WALTZ 15 f f I t O L COMMONWEALTH OF PENNSYLVANIA :ss. COUNTY OF Yolk On this, the day of Titt4 2007, before me a Notary Public of the Commonwealth of Pennsylvania personally appeared CHERYL L. WALTZ known to me to be the person whose name is subscribed to the within Agreement and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public COMMONWEALTH OF PENNSYLVANIA Note W Seal TkYWW J. CoO n, Noteryr Public DffmbM BM York Coo^ * CM"I1 M EVkW Oct. a 2010 Member, Psnnsylvanla AssodoWn of ii-mries 16 COMMONWEALTH OF PENNSYLVANIA :ss. COUNTY OF On this, the ? day of Joe--( 2007, before me, a Notary Public for the Commonwealth of Pennsylvania, personally appeared DAVID R. WALTZ known to me to be the person whose name is subscribed to the within Agreement and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public iENNSYLVANiA C0MWNWE.AL7H OF Nom Saw Dlane S. Baker. NoWY Public EjJiRy 13 2011 ? of Notaries Pennsylvania Assoc'o'on 17 Diane S. Baker, Esquire I.D. No. 53200 27 S. Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 06-3171 CHERYL L. WALTZ, CIVIL ACTION -LAW Defendant IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed on June 2, 2006. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. 4. I have been advised of the availability of marriage counseling and understand that I may request that the Court require that my spouse and I participate in counseling. I further understand that the Court maintains a list of marriage counselors in the Prothonotary's Office, which list is available to me upon request. Being so advised, I do not request that the Court require that my spouse and I participate in counseling prior to a decree being handed down by the Court. 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. DATED: DAVID WALTZ PLAINTIFF _ . -> c ; _? ?.. .„.-- ---a ..__ __L _....-, i?-? ' " G ??? _? ?__ _. ....._. r?? Diane S. Baker, Esquire I.D. No. 53200 27 S. Arlene Street P.O. Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 DAVID WALTZ, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA V. CHERYL L. WALTZ, Defendant NO. 06-3171 CIVIL ACTION -LAW 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. DATED: )?Ilani?c 91laky D AVID WALTZ PLAINTIFF l .. r v ?`3 i MARITAL SETTLEMENT AGREEMENT AGREEMENT, made this 6 Nay of V , 2007, by and between CHERYL L. WALTZ, hereinafter referred to as "Wife", and DAVID R. WALTZ, hereinafter referred to as "Husband". WITNESSETH: WHEREAS, the parties hereto are Husband and Wife, having been married on July 12, 1986, and there were no children born of the marriage; WHEREAS, diverse unhappy differences, disputes and difficulties have arisen between the parties, and it is the intention of Wife and Husband to live separate and apart for the rest of their natural lives, and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them relating to the ownership of real and personal property, the equitable distribution of such property; the settling of all matters between them relating to the past, present and future support and/or maintenance of Wife by Husband or of Husband by Wife; and, in general, the settling of any and all claims and possible claims by one against the other or against their respective estates. NOW, THEREFORE, in consideration of the premises and of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable considerations, receipt of which is hereby acknowledged by each of the parties hereto, Wife and Husband, each intending to be legally bound hereby, covenant and agree as follows: r 1. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS. This Agreement shall not be considered to affect or bar the right of Wife or Husband to a divorce on lawful grounds if such grounds now exist or shall hereafter exist or to such defense as may be available to either party. This Agreement is not intended to condone and shall not be deemed a condonation on the part of either party hereto of any act or acts on the part of the other party which have occurred prior to or which may occur subsequent to the date hereof. 2. EFFECT OF DIVORCE DECREE. The parties agree that, unless otherwise specifically provided herein, this Agreement shall continue in full force and effect after such time as a final decree in divorce may be entered with respect to the parties. It is the intent of the parties hereto that this Agreement shall create contractual rights and obligations entirely independent of any Court Order and that this Agreement may be enforced by contract remedies in addition to any other remedies which may be available pursuant to the terms of this Agreement or otherwise under law or equity. 3. AGREEMENT TO BE INCORPORATED IN DIVORCE DECREE. The parties agree that the terms of this Agreement shall be incorporated, but not merged, into any divorce decree which may be entered with respect to them. The parties further agree that the Court of Common Pleas which may enter such divorce decree shall retain continuing jurisdiction over the parties and the subject matter of the Agreement for the sole purpose of enforcement of any of the provisions thereof and not for modification of the Agreement. 4. DATE OF EXECUTION. The "date of execution" or "execution date" of this Agreement shall be defined as the date upon which it is executed by the parties if they have each executed the Agreement on the same date. Otherwise, the "date of execution" or "execution 2 r date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. 5. ADVICE OF COUNSEL. The provisions of this Agreement and their legal effect have been fully explained to Husband by his attorney, Diane S. Baker, Esquire, and to Wife by her attorney, Thomas M. Clark, Esquire. The parties acknowledge that they fully understand the facts and they acknowledge and accept that this Agreement is, in the circumstance, fair and equitable and that it is being entered into freely and voluntarily and that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements. The parties further acknowledge that they have each made to the other a full and complete disclosure of their respective assets, estate, liabilities, and sources of income and that they waive any specific enumeration thereof for the purposes of this Agreement. Each party agrees that he and she shall not, at any future time, raise as a defense or otherwise the lack of such disclosure in any legal proceeding involving this Agreement, with the exception of disclosure that may have been fraudulently withheld. 6. PERSONAL RIGHTS. Wife and Husband, at all times hereafter, may and shall live separate and apart. They shall be free from any control, restraint, interference or authority, direct or indirect, by the other in all respects as fully as if they were unmarried. Each may, for his or her separate use or benefit, conduct, carry on and engage in any business, occupation, profession or employment which to him or her may seem advisable. 3 r 7. SUBSEQUENT RECONCILIATION. The parties agree that the terms of this Agreement shall not be affected by their subsequent co-habitation or resumption of marital relations, unless the parties otherwise specifically agree in writing. 8. MUTUAL RELEASES. Husband and Wife each do hereby mutually remise, release, quitclaim and forever discharge the other and the estate of the other, for all time to come, and for all purposes whatsoever, of and from any and all rights, title and interests, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature or wheresoever situate, which he or she now has or at any time hereafter may have against the other, the estate of the other or any part thereof, whether arising out of any former acts, contracts, engagements or liabilities of the other or by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption or similar allowance, or under the intestate laws, or the right to take against the spouse's will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any State, Commonwealth or territory of the United States, or (c) any other country, or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, property division, costs or expenses, whether arising as a result of the marital relation or otherwise, except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is the intention of Husband and Wife to give to each other by the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or 4 nature, real, personal or mixed, which the other now owns or may hereafter acquire, except and only except all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction. 9. DATE OF SEPARATION. The parties agree that for the purpose of equitable distribution the date of separation of the parties was April 8, 2006. 10. RETIREMENT ACCOUNTS AND PENSION PLANS. Wife has been employed during the marriage by Xerox Corporation and as a result of said employment is the title owner of a pension, 401 (k) and stock account, the values of which been disclosed during discovery. Wife was previously employed during the marriage by the Commonwealth of Pennsylvania and as a result of said employment is the title owner of a SERS retirement currently in payout status. Husband has been employed during the marriage by the Commonwealth of Pennsylvania and as a result of his employment is the title owner of a SERS retirement account, the value of which has been disclosed during discovery. Husband was previously employed during the marriage by AMP Incorporated and as a result of said employment is the title owner of a pension account, the value of which has been disclosed during discovery. The parties agree that Wife shall retain her Xerox Corporation retirement accounts and Husband shall retain his Commonwealth of Pennsylvania and AMP retirement accounts. Wife further agrees that she shall transfer to Husband her monthly SERS retirement benefit in its entirety and it shall become 5 the sole and separate property of Husband. It is intended by the parties that this provision for transfer of retirement benefits shall be approved by the court as a separate order, which shall constitute a Qualified Domestic Relations Order ("QDRO") under Section 414(p) of the I.R.C. Said QDRO shall be prepared by Husband at Husband's expense. Both parties agree to execute all documents necessary to effectuate the transfer upon request including the QDRO and any documents pursuant to the Retirement Equity Act or any similar Act that may be required from time to time to accomplish the purpose of this Paragraph. Except as specifically provided for in this Agreement, Wife and Husband hereby release and waive any and all interest, claim, or right that she or he may have to any and all retirement benefits (including pension or profit sharing benefits) or other similar benefits of the other party. 11. PERSONAL PROPERTY. Husband and Wife do hereby acknowledge that they have divided their tangible personal property, including, but without limitation, jewelry, clothes, furniture, furnishings, rugs, carpets, household equipment and appliances, pictures, books, works of art and other personal property in as equitable a manner as possible. All such property currently in possession of Wife shall become the sole and exclusive property of Wife. All such property currently in possession of Husband shall become the sole and exclusive property of Husband. The parties do hereby specifically waive, release, renounce and forever abandon whatever claim, if any, he or she may have with respect to the above items which shall become the sole and separate property of the other. 12. AFTER-ACQUIRED PERSONAL PROPERTY Each of the parties shall hereafter ovum and enjoy, independently of any claim or right of the other, all items of personal property, tangible or intangible, hereafter acquired by him or her, with full power in him or her to 6 dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were unmarried. 13. AUTOMOBILES. The parties are the owners of a 2001 Toyota Tacoma and a 2004 Toyota Highlander. The 2001 Toyota Tacoma shall become the sole and separate property of Husband. There is no debt owed on this vehicle. The 2004 Toyota Highlander shall become the sole and separate property of Wife and she shall be solely responsible for the debt owed on said vehicle to Toyota Finance Company and shall indemnify and hold Husband harmless therefrom. Both parties agree that they shall cooperate and sign any necessary titles to effectuate this paragraph. 14. BANK ACCOUNTS. The parties agree that they have no remaining joint bank accounts. Any individual accounts owned by the parties shall become the sole and separate property of the party in whose name the account is currently titled and both parties waive any rights they may have to the bank account(s) of the other. 15. CURRENT LIABILITIES. In addition to the debts and loans set forth elsewhere in this Agreement, the parties agree that as of the date of separation there was an assortment of unsecured marital debt. Husband agrees that he shall be solely responsible for the following debt and shall indemnify and hold Wife harmless therefrom: a. PSECU Personal Service Loan/credit card debt in his individual name. Wife agrees that she shall be solely responsible for the following debts and shall indemnify and hold Husband harmless therefrom: a. PSECU Personal Service Loan/credit card debt in her individual name; b. United Mileage Visa credit card, account number ending in 1629. 7 C. Chase Visa credit card, account number ending in 1474; and, d. Debt owed to Jim Mumper related to construction of the residence. Except as may be set forth above and elsewhere in this Agreement, the parties agree that they have no joint liabilities. All remaining debts accumulated during the marriage are in the sole and separate name of the individual parties and shall become the sole and separate responsibility of the named party. 16. DEBT OWED TO DORIS WALTZ. During the course of the marriage the parties acknowledge that they borrowed approximately $20,000 from Husband's mother, Doris Waltz. Said funds were used for various marital purposes. The parties also agree that during the course of the marriage some payments were made to Doris Waltz as partial repayment of this debt such that the remaining balance owed to Doris Waltz is $17,200. Husband and Wife agree that they shall divide this debt equally and they shall each be responsible to make payment in the amount of $8,600 to Doris Waltz. Payment to Doris Waltz shall be made within ninety (90) days of the date of execution of this Agreement. 17. FRANKLIN TEMPLETON ROLLOVER IRA. Husband is the title owner of an Individual Retirement Account (IRA) managed by Franklin Templeton that contains funds rolled over from Husband's AMP retirement account. The value of this account has been disclosed in discovery. The parties agree that said Individual Retirement Account shall become the sole and separate property of Husband and Wife waives any rights she may have to this account. 18. WARRANTY AS TO EXISTING OBLIGATIONS. Each party represents that they have not heretofore incurred or contracted for any debt or liability or obligations for which 8 the estate of the other parry may be responsible or liable, except as may be provided for in this Agreement. Each parry agrees to indemnify and hold the other party harmless for and against any and all such debts, liabilities or obligations of every kind which may have heretofore been incurred by them, including those for necessities, except for the obligations arising out of this Agreement. 19. WARRANTY AS TO FUTURE OBLIGATIONS. Wife and Husband each covenant, warrant, represent and agree that, with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnify and hold harmless the other party for and against any and all debts, charges and liabilities incurred by the other after the execution date of this Agreement, except as may be otherwise specifically provided for by the terms of this Agreement. 20. LIFE INSURANCE. All life insurance policies owned by the parties shall become the sole and separate property of the party in whose name the policy is in and both parties specifically waive any rights which they may have to said policies by virtue of having been a named beneficiary thereon. 21. REAL ESTATE. The parties are the owners of a residence located at 820 Sawgrass Lane, Mechanicsburg, Cumberland County, Pennsylvania. Husband agrees that he shall transfer his interest in this residence to Wife and it shall become her sole and separate property. Wife agrees that she shall be solely responsible for the mortgage owed on said residence to National City Mortgage and shall indemnify and hold Husband harmless therefrom. Wife further agrees that within ninety (90) days of the date of execution of this Agreement she 9 a shall refinance said mortgage into her individual name, remov' g Husband from responsibility thereon. In the event that Wife is unable to refinandthe mortgage she shall immediately list the property for sale at a listing price suggested by the listing real estate agent. Wife shall also be solely responsible for all expenses related to the residence including but not limited to taxes, utilities and insurance and shall become the sole and separate owner of any mortgage company escrow account set up for the purpose of paying the taxes and insurance on the property. Husband agrees to sign all documents necessary to implement this paragraph upon request including execution of the deed upon proof of refinancing and receipt of the payment set forth is Paragraph 22 of this Agreement 22. PAYMENT TO HUSBAND. In partial consideration of Husband's share of the equity in the marital residence and Wife's retirement accounts, Wife agrees to pay to Husband the sum of Fifteen thousand six hundred forty-nine dollars ($15,649). Payment shall be made to Husband upon refinancing of the marital residence or within ninety (90) days of the date of execution of this Agreement, whichever occurs first. 23. HEALTHCARE COVERAGE. Both parties acknowledge that, effective the date of entry of a Decree in Divorce, it shall be their individual responsibility to provide their own medical insurance coverage. To the extent medical insurance coverage is affected by marital status, it shall be the individual responsibility of Husband and Wife to immediately notify his or her employer of the change in marital status. 24. PAST DUE TAXES. The parties have heretofore filed joint Federal and state tax returns. Both parties agree that in the event any deficiency in Federal, state or local income tax is proposed, or any assessment of any such tax is made against either of them, each 10 i t , will indemnify and hold harmless the other from and against any loss or liability for any such tax deficiency or assessment and any interest, penalty and expense incurred in connection therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individual who is finally determined to be the cause of the misrepresentations or failures to disclose the nature and extent of his or her separate income on the aforesaid joint returns. 25. BANKRUPTCY. It is hereby understood and agreed by and between the parties that their obligations pursuant to this agreement shall not be affected by any bankruptcy proceeding and shall not be deemed to constitute or be a dischargeable debt of a bankruptcy. Both parties warrant that he/she has not heretofore instituted any proceedings pursuant to the bankruptcy laws nor are there any such proceedings pending with respect to him/her that have been initiated by others. 26. PAYMENT OF LEGAL FEES. Wife shall be responsible for payment of her legal fees and Husband shall be responsible for payment of his legal fees. 27. ALIMONY, ALIMONY PENDENTE LITE AND SPOUSAL SUPPORT. Including the benefits provided for in this Agreement, Husband and Wife each have sufficient property and/or income to provide for his or her reasonable needs. Therefore, notwithstanding any provision in the Divorce Code to the contrary, and except as otherwise specifically set forth in this Agreement, Wife and Husband expressly waive, discharge and release any and all rights or - claims which he or she may have, now or hereafter, by reason of the parties' marriage, to alimony, alimony pendente lite, support, maintenance and/or any other such benefits resulting from the parties' status as husband and wife. It shall be, from the execution of this Agreement, the sole responsibility of each of the respective parties to sustain themselves without seeking any 11 additional support from the other party, except as provided herein. The parties agree that the spousal support/alimony pendente lite order docketed to Cumberland County Domestic Relations PACSES No. 611108342 shall terminate effective the date of entry of a decree in divorce or the date Wife makes payment to both Husband and Doris Waltz, as set forth in this Agreement in Paragraphs 16 and 22, whichever occurs first. All arrearages, if any, shall remain payable at the rate of $500 per month until paid in full. 28. APPLICABILITY OF TAX LAW TO PROPERTY TRANSFERS. The parties hereby agree and express their intent that any transfer of property pursuant to this Agreement shall be within the scope and applicability of the Deficit Reduction Act of 1984 hereinafter the "Act"), specifically, the provisions of said Act pertaining to the transfers of property between spouses and former spouses. The parties agree to sign and cause to be filed any elections or other documents required by the Internal Revenue Service to render the Act applicable to the transfers set forth in this Agreement without recognition of gain on such transfers and subject to the carry-over basis provisions of the said Act. In the event that there is a transfer tax or income tax on gain assessed then said tax shall be the responsibility of the party receiving the property. 29. MUTUAL CONSENT DIVORCE. The parties agree and acknowledge that their marriage is irretrievably broken, that they do not desire additional marital counseling, and that they both consent to the entry of a decree in divorce pursuant to Section 3301(c) of the Pennsylvania Divorce Code, Act 26 of 1980, as may be amended (herein referred to as the Code). Upon entry of the QDRO described in Paragraph 10 of this Agreement, both parties agree to execute such consents, affidavits, or other documents and to direct their respective attorneys to 12 a •L ? file such consents, affidavits, or other documents as may be necessary to promptly proceed to obtain a divorce pursuant to said Section 3301(c) of The Code. Upon request, to the extent permitted by the law and the applicable Rules of Civil Procedure, the named defendant in such divorce action shall execute any waivers of notice or other waivers necessary to expedite such divorce. 30. WAIVER OR MODIFICATION TO BE IN WRITING. No modification or waiver of any of the terms hereof shall be valid unless in writing and signed by both parties, and no waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the same or similar nature. 31. MUTUAL COOPERATION. Each party shall, at any time and from time to time hereafter, take any and all steps and execute, acknowledge and deliver to the other party any and all further instruments and/or documents that the other party may reasonably require for the purpose of giving full force and effect to the provisions of this Agreement. 32. LAWS OF PENNSYLVANIA APPLICABLE. This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania which are in effect as of the date of execution of this Agreement. 33. AGREEMENT BINDING HEIRS. This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 34. OTHER DOCUMENTATION. Wife and Husband covenant and agree that they will forthwith (and within at least ten (10) days after demand therefor) execute any and all 13 r written instruments, assignments, releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. 35. NO WAIVER OF DEFAULT. This Agreement shall remain in full force and effect unless and until terminated under and pursuant to the terms of this Agreement. The failure of either party to insist upon strict performance of any of the provisions of this Agreement shall in no way affect the right of such party hereafter to enforce the same, nor shall the waiver of any default or breach of any provision hereof be construed as a waiver of any subsequent default or breach of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein. 36. ENTIRE AGREEMENT. This Agreement contains the entire understanding of the parties, and there are no representations, warranties, covenants or undertakings other that those expressly set forth herein. The parties further acknowledge that any previous agreements between them are incorporated herein. 37. ENFORCEMENT OF AGREEMENT. If either party breaches any provision of this Agreement, the other party shall have the right, at his or her selection, to sue for damages for such breach or to require specific performance. The party breaching this Agreement shall be responsible for payment of legal fees and costs incurred by the other party in enforcing their rights under this Agreement or for seeking such other remedies of relief as may be available to him or her. 38 SEVERABILITY. If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement and, in all other respects, 14 this Agreement shall be valid and continue in full force, effect and operation. Likewise, the failure of any party to meet her or his obligations under any one or more of the paragraphs herein, with the exception of the satisfaction of the conditions precedent, shall, in no way, void or alter the remaining obligations of the parties. 39. HEADINGS NOT PART OF AGREEMENT. Any headings preceding the text of the several paragraphs and subparagraphs hereof are inserted solely for convenience of reference and shall not constitute a part of this Agreement, nor shall they affect its meaning, construction or effect. IN WITNESS WHEREOF, the parties hereto have set their hands and seal the day and year first above written. WITNESS IT'NESS CHERYI./L."WALTZ DAVID R. WALTZ 15 r r 4 COMMONWEALTH OF PENNSYLVANIA :ss. COUNTY OF Vol(? On this, the day of JU , 2007, before me a Notary Public of the Commonwealth of Pennsylvania personally appeared CHERYL L. WALTZ known to me to be the person whose name is subscribed to the within Agreement and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. w- Notary Public COMMONWEALTH OF PENNSYLVANIA Notarlai Seal Thy I Colgan, Notary Public Di 9KM Bono, York County W Omvrdeeion E*ku Oot. 3, 2010 Member, Penneylvenla Assooiatlon of Notsrles 16 COMMONWEALTH OF PENNSYLVANIA :ss. COUNTY OF ba Jf l'/J 94 On this, the a day of PJAC , 2007, before me, a Notary Public for the Commonwealth of Pennsylvania, personally appeared DAVID R. WALTZ known to me to be the person whose name is subscribed to the within Agreement and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. r' J f Notary Public 17 ?? RJ ?- C-.J DAVID WALTZ, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 06-3171 CHERYL L. WALTZ, : CIVIL ACTION -LAW Defendant : 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: First class mail pursuant to an Affidavit of Service signed by Defendant dated June 8, 2006, and filed with the Court June 16, 2006. 3. (a) Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce Code: by the Plaintiff on August 21, 2007, and filed herewith; by the Defendant on June 25, 2007 and filed with the Court July 17, 2007. 4. Related claims pending: Marital Settlement Agreement dated July 6, 2007, resolved all claims. 5. (b) Date Plaintiff's Waiver of Notice in Section 3301(c) Divorce was filed with the Prothonotary: same as this Praecipe. Date Defendant's Waiver of Notice in Section 3301(c) Divorce was filed with the Prothonotary on July 17, 2007. /' DATE: ane S. Baker, Esquire c g Supreme Court ID #53200 4 27 South Arlene Street Post Office Box 6443 Harrisburg, PA 17112-0443 (717) 671-9600 Leis %aa ? ?"? -gyp IN THE COURT OF COMMON PLEAS VERSUS CHERYL L. WALTZ DAVID WALTZ OF CUMBERLAND COUNTY STATE OF PENNA. No. 06-3171 DECREE IN DIVORCE DECREED THAT AND AND NOW, 1.. a 2007, IT IS ORDERED AND CHERYL L. WALTZ DAVID WALTZ ,DEFENDANT, , PLAINTIFF, ARE DIVORCED FROM THE BONDS OF MATRIMONY. THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; The Marital Settlement Agreement dated July 6, 2007, is incorporated but not merged into this Decree. BY THE COURT: '? '/ ATT E J. ROTHONOTARY ;?O,w *? 40, P I 61 DAVID WALTZ, Plaintiff/Petitioner VS. CHERYL L. WALTZ, Defendant/Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 06-3171 CIVIL TERM IN DIVORCE PACSES Case No: 611108342 ORDER OF COURT AND NOW to wit, this 16th day of October 2007, it is hereby Ordered that the Alimony Pendente Lite order is terminated, effective September 18, 2007, pursuant to the parties' Decree in Divorce and the Marital Settlement Agreement of June 27, 2007. The APL account is closed with a credit of $665.04. BY THE COURT: [WC- sley Oler J. DRO: R.J. Shadday xc: Petitioner Respondent Diane Baker, Esq. Maggi E. Colwell, Esq. Form 0E-001 Service Type: M Worker: 21005 c [ ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 10/16/07 Case Number (See Addendum for case summary) 611108342 Q Original Order/Notice 06-3171 CIVIL Q Amended Order/Notice O Terminate Order/Notice Employer/Withholder's Federal EIN Number XEROX CORPORATION* C/O GARNISHMENTS 0801-55B 1350 JEFFERSON RD ROCHESTER NY 14623-3106 RE: WALTZ, CHERYL L. Employee/Obligor's Name (Last, First, MI) 184-52-3302 Employee/Obligor's Social Security Number 1039101672 Employee/Obligor's Case Identifier (See Addendum far plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0 . o0 per month in current support $ o. oo per month in past-due support Arrears 12 weeks or greater? Dyes ® no $ 0.00 per month in current and past-due medical support $ 0.00 per month for genetic test costs $ 0.00 per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ o. oo per weekly pay period. $ 0. o0 per biweekly pay period (every two weeks). $ o. 0o per semimonthly pay period (twice a month). $ 0 . oo per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. § 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAMEAND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Date of Order: d0? J. rjEy OLER, J JUDGE DROo R.J. SHADDAY Form EN-028 Rev. 1 Service Type M OMB No.: 0970-0154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ? If hecke? you are required to provide a opy of this form to your m loyee. If yor employee works in a state that is di Brent from the state that issued this order, a copy must be provi?, to your empYoyee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydat&Date of Withholding. You niust report the paydate/date of wit' iholding, when sendillig, t! le paymelit. T! le paydate/date of withholding is the date on WhiCh arriount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 1604680200 EMPLOYEE'S/OBLIGOR'S NAME: WALTZ, CHERYL L. EMPLOYEE'S CASE IDENTIFIER: 1039101672 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.C. §1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more than the amounts allowed under the law of the state that issued the order. 10. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Submitted By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker ID $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: WALTZ, CHERYL L. PACSES Case Number 611108342 Plaintiff Name DAVID R. WALTZ Docket Attachment Amount 06-3171 CIVIL$ 0.00 Child(ren)'s Name(s): DOB ?If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ?if checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Addendum OMB No.: 0970-0154 Form EN-028 Rev. 1 Worker I D $ zATT 0 -n --: r- c - r? %JO 6 r t_. 4 c