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HomeMy WebLinkAbout02-1993IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, : PLAINTIFF : NO. O~ -/~ ROBERT E. POTTEIGER, JR. DEFENDANT IN DIVORCE CIVIL TERM COMPLAINT IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divome or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divome is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DMSION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania, 17013 (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, PLAINTIFF : NO. 0,2-/q9_3 ; : IN DIVORCE ROBERT E. POTTEIGER, JR. : DEFENDANT : CIVIL TERM COMPLAINT IN DIVORCE The Plaintiff is Anne T. Potteiger, who presently resides at 1023 Yverdon Drive, Camp Hill, Pennsylvania 17011. She has resided there since 1995. The Defendant is Robert E. Potteiger, Jr., who currently resides at 516 Blue Eagle Avenue, Harrisburg, Pennsylvania 17112. (Prior to that, he resided at 2853 Foxianna Road, Middletown, Pennsylvania 17057). He has resided at his current address since October 5, 2001. The Plaintiffhas been a bona fide resident of the Commonwealth for at least six months immediately previous to the filing of this complaint. The Plaintiff and Defendant were married May 14, 1988 in Warren County, Pennsylvania. The parties have one minor child, Rachel Elizabeth Potteiger, who was bom on December 27, 1994. o The parties to this action separated on October 5, 2001 and have continued to live separate and apart since then. There have been no prior actions of divorce or for annulment between the parties. 8. The marriage is irretrievably broken. o The Plaintiff has been advised that counseling is available and that the plaintiff may have the right to request that the court require the parties to participate in counseling. 10. 11. Neither the Plaintiff nor the Defendant is in the military or naval service or in any branch of the armed forces of the United States of America or its allies or is otherwise within the provisions of the Soldiers' and Sailors' Civil Relief Act of Congress of 1940 and its amendmems. The Plaintiff requests the court to enter a decree of divorce under Section 3301 (c) of the Divorce Code. 12. In the alternative, the Plaintiff requests the court to enter a decree of divorce, under Section 3301 (d) of the Divorce Code. WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter a decree of divorce pursuant to 23 P.S. §3301 (c), or 3301 (d), upon both parties filing affidavits consenting to the divorce after ninety (90) days of service of this complaint. Respectfully Submitted, The Law Offices of Richard C. Gaffney Couth~ey L. Ki~el, Esquire PA Supreme Court ID # 81509 2120 Market Street, Suite 101 Camp Hill, PA 17011 (717) 975-9033 Attorney for Plaintiff VERIFICATION I verify that the statements made in this complaint are tree and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unswom falsification to authorities. Anne T. Potteiger IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, PLAINTIFF ROBERT E. POTTEIGER, JR. : DEFENDANT : NO. CIVIL TERM IN DIVORCE Certificate of Service I, Courtney L. Kishel, hereby certify that on the 18th day of April 2002, I served a tree and correct copy of PlaintitTs Complaint in Divorce, via first class United States Mail, postage prepaid, and via United States Certified Mail, Restricted Delivery, Return Receipt Requested, to the following person: Date: Robert E. Potteiger, Jr. 516 Blue Eagle Avenue Harrisburg, PA 17112 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, PLAINTIFF ROBERT E. POTTEIGER, JR. DEFENDANT NO. 02-1993 CIVIL TERM IN DIVORCE AFFIDAVIT OF SERVICE Courtney L, Kishel, Esquire, being duly sworn according to law, deposes and says that she is the attorney for the Plaintiff in the above-captioned action; that on April 23, 2002 she mailed a tree and correct copy of the Complaint in Divorce, duly endorsed with a Notice to Defend, by certified, restricted U.S. mail delivered to Defendant at the address of 516 Blue Eagle Avenue, Harrisburg, PA 17112; that on April 25, 2002, Defendant did personally receive said Complaint in Divorce as evidenced by the signed Certified U.S. Mail form attached hereto; and that the facts set forth in the within Affidavit are tree and correct to the best of her infomiation and belief. 2002. Sworn to and subscribed before me this '2.~d- day of ~ Notary Public My commission expires: · Complete items 1, 2, and 3. Also complete. item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. r'l Ag~t · Attach this card to the back of the mailpiece, [] or on the front if space permits. D. Isde~-~"¥e~ Item1? []Yes 1. Article Addressed to: If YES, enter deliver/address betow:. [] No t rri's I [] Insured Mail ~ C.O.D. I 4. Restricted Daiive~ (Exba Fes) PS Form ~8"[1, July 1999 ' ~ Ret~m R~::aipt r-~ n THIS MA effective as of thc POTTEIGER, an Cumberland Cott adult individual v Pennsylvania (heJ WHERE) 1988 in Warren C WHERE,4 child, Rachel Eliz WHEREA Separation") and 1 and WHEREA between each othe WHEREA of his or her assets MARITAL SETTLEMENT AGREEMENT RITAL SETTLEMENT AGREEMENT (this "Agreement") is made 30th day of October 2003 by and between ANNE THELIN adult individual who resides at 1023 Yverdon Drive, Camp Hill, lty, Pennsylvania (hereinafter "Wife"), and ROBERT POTTEIGER, an 'ho resides at 516 Blue Eagle Avenue, Harrisburg, Dauphin County, einafter Husband")(collectively, the "Parties"). WITNESSETH S, the Parties hereto were lawfully married to each other on May 14, aunty, Pennsylvania; and S, the Parties hereto are the natural and biological parents of one minor ibeth Potteiger, born December 27, 1994 (the "Child"); and S, the Parties separated on October 5, 2001 (hereinafter, the "Date of he Parties intend to live separate and apart for the rest of their lives; 3, the Parties desire to settle their respective rights and obligations as and each Party has represented to the other and has made full disclosure liabilities, income and expenses to the other Party. Page 1 NOW, T} and conditions he Parties mutually ~ 1. PERSONAL each other. interference fully as if he { with whomev malign each c employees of 2. MARITAL R occupied a le~ interest is a m and exclusive execution of for the said le in the leased 1; occurred after 3. DIVISION Ol a) SEPARA~ by each of separate p~ [EREFORE, in consideration of the premises and the mutual covenants reinafter contained, and intending to be legally bound hereby, the ~gree as follows: ~IGHTS. The Parties intend hereafter to live separate and apart from ach Party shall be free from any direct or indirect control, restraint, authority in his or her personal or business activities in all respects as she were single or unmarried. Each Party may reside wherever and · he or she desires. The Parties shall not interfere with, harass, or ther or the respective families, friends, colleagues, employers or *ach other. :~SIDENCE. Prior to the date of separation, the Parties and the Child sed residence at 1023 Yverdon Drive, Camp Hill, PA. The leasehold >nth-to-month tenancy. The Parties agree that Wife shall retain sole ~ossession of this leasehold interest. Effective as of the date of is Agreement, Husband shall have no further rights to, or obligations tsehold interest, including any right to a refund of the security deposit remises or any obligation for damages to the leased premises that the Date of Separation. 'PERSONAL PROPERTY· 'E PROPERTY. All personal property that was acquired separately the Parties prior to the marriage or after separation shall remain the operty of the Party who acquired that separate property. P~e2 b) VEHICL! marriage ~ Ford Prol~ model yet name. Ht vehicles c further th~ from Citil and Wife retain sok Buick Ce~ presents h and/or titl Century c) MARIT~ and agree satisfactio accounts, mutual fu~ intangible either of ti Party shal ;S. Husband and Wife acknowledge that during the term of the hey acquired and currently own two (2) automobiles: a 1990 model : that is in Wife's possession and is titled in Wife's name and a 1989 ' Buick Century that is in Wife's possession and is titled in Wife's ;band and Wife agree that the aggregate fair market value of both a the Date of Separation was $500.00. Husband and Wife acknowledge I the Wife pledged the title to the Ford Probe in order to obtain a loan .ank, whose current balance due is approximately $4,300.00. Husband igree that, as of the date of execution of this Agreement, Wife will and exclusive title, possession and control of the 1989 model year .tury and the 1990 Model Ford Probe. Husband agrees to and by these :reby does release, remise and relinquish any and all rights, interest ~ that he has, had, might have or may have in and to the said Buick id the said Ford Probe. , PERSONAL PROPERTY. Husband and Wife hereby acknowledge Ihat they have already equitably divided between them to their mutual 2, all of the personal effects, household goods and furnishings, checking ;avings accounts, cash and cash equivalents, investments, stocks, bonds, tds, securities, and all other articles of personal property, tangible or without limitation by specification, owned or acquired by both or rem during their marriage (the "Marital Personal Property"). Each keep and retain sole ownership, control and enjoyment of all the Page 3 Marital P~ execution d) WAIVER and all inl of the Ma Party. W and all M this Agre~ any liabili Personal to sign ar request ot 4. RETIREMEb a) 401(K). the Partie savings pl "Plan"); balance ~ $1.00 per $15,000.0 the loan; ,rsonal Property in his or her possession or control as of the date of of this Agreement. OF INTEREST. Husband and Wife specifically release and waive any ~rest, claim or right that he or she may have as to the whole or any part 'ital Personal Property that is in the control or possession of the other th respect to property held separately, (including any vehicles) and any trital Personal Property held by a Party as of the date of execution of ment, each Party agrees to indemnify and hold the other harmless from ~y, cost or expense associated with the separate property and the Marital 'roperty held by them. Should it become necessary, each Party agrees title or documents necessary to give effect to this paragraph upon :he other Party. T BENEFITS. [usband and Wife acknowledge that, during the term of the marriage, established and maintained a section 401 (k) qualified retirement an through Husband's employer, Ahold, U.S.A. d/b/a Giant Foods (the tat on or about the Date of Separation (October 5, 2001), the vested the Plan was, $25,886.92 (representing 25,886.920 shares valued at ~hare) that on or about October 17, 2000, the Parties obtained ) from the Plan as a loan; that Husband has made periodic payments on ~at on September 30, 2003, the vested balance of the Plan was Page 4 (representing 40,817.140 shares valued at $1.00 per share); and that ~er 30, 2003 the balance due on the loan was $7,161.50. ~UITABLE SHARE. Husband and Wife hereby agree that Wife is and titled to an equitable share of the Plan, which share amount shall be to be sixty percent (60%) of the Vested Balance of the Plan led by any outstanding loan balance, as of the last day of the month ly following the date of separation, plus any interest and investment earnings ~ losses attributable thereon for periods subsequent to the aforesaid date until the rte of total distribution. METHO OF DISTRIBUTION. Contemporaneous withthe execution of this Agreemen :, Husband and Wife shall execute a Qualified Domestic Relations Order ("Q)RO") substantially in the form of the QDRO attached to this 1 Agreement. The method of distribution, commencement date of distribution, and / other terml concerning distribution shall be in accordance with the QDRO Husband s ~all fully cooperate with Wife to effectuate any transfer of funds from the Plan, ; Wife may elect, so that the transfer will qualify as a non-taxable transfer, iusband and Wife will submit the signed QDRO to the Court for its approval, ghould the Court not approve the QDRO, the Parties agree that Wife shall nonel heless be entitled to the share amount set forth hereinabove, and that $40,817.1 on Septen b) WIFE'S shall be et calculated undiminis immediate c) Husband early witt soon as ad~ ill withdraw or cause to be withdrawn from the Plan, by way of a loan, rawal or otherwise, Wife's share amount as set forth hereinabove, as ainistratively practicable. Page 5 d) FURTHE] document: MARITAL D marriage, the3 the Divorce C a) A loan fr outstandi approxim~ b) An unsecu the date ot c) A Citibar~ Husband'. d) A second, balance of e) A Sears cr, $4,391.00. f) A J.C. Pen g) A Boscov' h) An accoun i) Past due 1o approxima' j) A loan fror [ DOCUMENTS. The Parties further agree to execute any and all . that may be required to accomplish the purpose of this Paragraph. :~BTS. Husband and Wife acknowledge that, during the term of the incurred certain debt, which constitutes "marital debt" as defined in >de, to wit: n Citibank that is secured by Wife's 1990 Ford Probe vehicle with an balance as of this date of execution of this Agreement of ~'ly $4,300.00; red loan from Beneficial Finance Co. with an outstanding balance as of execution of this Agreement of approximately $4,500.00.; MasterCard (5424-1802-0730-5126) revolving credit card in ~ossession with a balance of approximately $6,347.00; ~secured loan from Citibank in Husband' s possession an approximate $3,267.00; ~dit card in Husband's possession with an approximate balance of ~ey unsecured account with an approximate balance of $966.00; ; unsecured account with an approximate balance of $420.00; at Hershey Medical Center with an approximate balance of $550.00; :al school taxes in the total amount of $530.00, of which amount, ely $67.00 is marital debt; and the 401 (k) Plan, whose current balance is set out hereinabove. P~e6 BANKRUPT~ Wife filed a Code in the 1 at docket no. notwithstandi of this Agreer Bankruptcy C Discharge in The Parti~ of all of the m Parties recogn debt, they ma~ that portion ot portion of the The Parties re, debt, they ma3 priority debt, The Parti{ discharging al or otherwise agree to allot ~'Y. Prior to the date of execution of this Agreement, Husband and dnt Voluntary Petition under Chapter 7 of the United States Bankruptcy fited States Bankruptcy Court for the Middle District of Pennsylvania (the "Bankruptcy Case"). Husband and Wife agree that, tg the pending Divorce action and notwithstanding any other provision tent to the contrary, they will cooperate and jointly prosecute the tse to conclusion and to obtain, if possible, a Final Decree and ~e Bankruptcy Case. anticipate that a Discharge in the Bankruptcy Case will relieve them ~ecured debt listed in this Agreement in paragraph 5 hereinabove. The [ze, however, that, even if they obtain a Discharge of the unsecured remain jointly and/or severally liable for the secured debt, including the Citibank loan that is secured by Wife's Ford Probe vehicle and that $ears debt that is secured by the washer and dryer in Wife's possession. ',ognize further that, even if they obtain a Discharge of the unsecured remain jointly and/or severally liable for the non-dischargeable acluding the school taxes. ; acknowledge that the Bankruptcy Court may not issue a Decree or part of their debt and/or that the Bankruptcy Case may be dismissed rminated voluntarily or involuntarily. In such an event, the Parties Ie the marital debt as follows: Page 7 Husband: accounts for whic removed Husbam Husband ~ defend the other collection activit hereunder. 7. ALIMO~ rights they may h~ alimony, support, sole responsibilit support from the acknowledge that Wife shall assume and be responsible to pay the balances on the following accounts: the Citibank loan that is secured by her Ford Probe; the school taxes; and the Beneficial Finance Co. loan. Husband shall assume and be responsible to pay the balances on the following accounts: the Citibank Master Card; the Citibank unsecured loan; the Sears account; the J.C. Penney account; the Boscov's account; the Hershey Medical Center account; and the loan from the 401 (k) Plan. hall remove or shall cause to be removed Wife's name from all h Husband assumes liability and Wife shall remove or cause to be ['s name from all accounts for which Wife assumes liability hereunder. nd Wife shall indemnify, hold harmless and, at the other Party's option, 'arty from and against any and all claims, demands, lawsuits, liability or relating to those accounts for which that Party assumes liability ~'. Wife and Husband do hereby waive, release, and surrender any .ye against the other for alimony pendente lite, spousal support, and/or maintenance. From the date of this Agreement, it shall be the of each of the Parties to sustain him or herself without seeking any .ther Party, except as provided in this Agreement. The Parties hereby each has secured and maintains a substantial and adequate fund from Page 8 which to provide comfort, maintem 8. CHILD S1 of Sixty-Five Dol agrees further th. and effect a poli~ amount of no less which names the ~ prevent a Party fr~ of competent juri~ full force and affe provide the maxin and to Wife until ~ shall be deemed the child's reachi whichever occurs 9. CHILD C[ of the Parties' mir Child. Husband Parties on a regu] special events sucl fimself or herself sufficient financial resoumes to provide for his or her rice and support in the station of life to which he or she is accustomed. IPPORT. Husband shall provide child support to Wife in the amount ars ($65.00) per week until the Child becomes emancipated. Husband until the Child is emancipated, Husband will maintain in full force of life insurance from a reputable insurance company, in a face than $100,000.00, which policy names Husband as the insured life, and ~hild and/or a trustee for the benefit of the Child. Nothing herein shall ,m commencing an action for child support or from petitioning a court diction to modify a support obligation. Husband agrees to maintain in :t a plan of health insurance through his employer, which plan shall rum possible coverage, to the parties' Child until she is emancipated, he date that a final Decree in Divorce is granted by the Court. A child nancipated for the purposes of this Agreement upon the occurrence of g the age of eighteen (18) years, or graduation from high school, ater. ~STODY. Husband and Wife agree that they shall share legal custody or Child. Wife will have full physical custody of the Parties' minor ill have periods of partial custody and/or visitation as agreed to by the basis, taking into account the Parties' employment schedules and as holidays, church activities, and other activities Page 9 The Partie greater than 50 m other Party or pri~ The Partie health, safety, edt may estrange the other Party, or wi and affection for 1 Whenever to contact her mo~ the Child requests, custody, Husband this request know: While the under the influenc to consume or be While the anyone else to sm, Whenever times maintain in to furnish to Wife fails or refuses for s agree that neither Husband nor Wife shall relocate to a location that is les from their current residence without the prior written consent of the court approval. shall communicate and cooperate in all matters concerning the Child's cation and general welfare. The Parties shall not do anything which 2hild from the other party, or injure the opinion of the Child as to the ich may hamper the free and natural development of the Child's love he other Party. the Parties' Child is in Husband's custody, the Child shall be permitted her (Wife) at any and all times that the Child requests. In the event that that she be returned to the mother's custody while she is Husband's shall immediately permit the Child to telephone her mother and make hild is in custody of either Party, that Party shall not consume or be e of, nor shall that Party permit any other person in the same household ~nder the influence of alcohol or any controlled substance. 2hild is in custody of either Party, that Party will not smoke, nor permit ~ke, while indoors or in any vehicle. Husband is responsible to transport the Child, Husband shall at all ~tll force and effect a policy of automobile insurance. Husband agrees satisfactory evidence of such insurance. In the event that Husband any reason to maintain such insurance or fails or refuses to furnish Page 10 satisfactory evide~ automobile. 10. FULL DIS that he or she has: nature whatsoever to which such Pax Agreement. 11. WARRAI' course of the marr: represents, covena specifically othem date of this Agreer remain which were Party may be deem threatened against at law or in equity is Husband or Wifi such action, suit or should be determin thereafter, the Part against and hold 1 fees, incurred as a ~ ce of such insurance to Wife, Husband shall not transport the Child by 2LOSURE. Husband and Wife each represent and warrant to the other nade a full and complete disclosure to the other of all assets of any and of all other facts relating to the subject matter of this Agreement 5~ may reasonably require to make an informed decision regarding this rY AS TO EXISTING AND FUTURE OBLIGATIONS. During the age, Husband and Wife incurred certain liabilities. Each Party its and warrants that, to the best of his or her knowledge, and except as ise provided - for by the terms of this Agreement, as of the effective ~ent: a) other than disclosed in this Agreement, no unpaid liabilities incurred by him or her or on his or her behalf for which the other ed liable; b) there are no actions, suits or proceedings pending or tusband and/or Wife or affecting any jointly held properties or fights, >efore any federal, state, municipal or other governmental agency, nor aware of any facts which, to his or her knowledge, might result in ~roceeding; c) if any such liabilities, actions, suits or proceedings d to have existed as of the date of execution of this Agreement or who incurred that debt shall exonerate and indemnify the other Party ~ other Party harmless from any liability or expense, including counsel ~sult of those liabilities; and d) he or she shall not incur any liability Page 11 whatsoever in the liable, and shall harmless from a: counsel fees, inc~ 12. EXECUT execute and deliv desirable to effecl on demand to con costs, and other e: 13. RELEASt each Party to this obligations and c~ Parties. 14. RELEASI~ in this Agreement (a) inherit from th property from the dated subsequent representative of t the other, unless n this Agreement. future for which the other Party or the estate of the other Party may be conerate and indemnify the other Party against and hold the other Party ~ such damages resulting from such liability, including reasonable fred by the other Party. ON OF OTHER DOCUMENTS. Each of the Parties shall on demand ~r any document and do any act or thing that may be necessary or aate the provisions and purposes of this Agreement. If either Party fails tply with this provision that Party shall pay to the other all attorney fees ~enses reasonably incurred as a result of the failure. DF ALL CLAIMS. Except as specifically set forth in this Agreement, ~greement releases the other from all claims, liabilities, debts, uses of action that have been incurred during the marriage between the OF TESTIMENTARY CLAIMS. Except as specifically provided for the Parties hereby mutually waive and release to the other any right to: other any part of the estate of the other at his or her death; (b) receive ..state of the other by bequest or devise, except under a Will or Codicil the effective date of this Agreement; (c) act as a personal estate of the other on intestacy; (d) act as executor under the Will of ~minated by a Will or Codicil dated subsequent to the effective date of Page 12 15. BREACH. one of the Parties include all tamed theories of equity, remedies specific~ If either P* exonerate and ind~ harmless for all 1 fees and costs rel 16. ADVICE have been fully el Esquire and to Hu Each Party confirr of this Agreement The Parties furthe~ voluntarily and th~ influence, collusio 17. INTENTI£ mutual consent, nc Divorce Code of 1 incorporated into Court of Comm, In the event of a breach of any of the provisions of this Agreement by the remedies available to the non-breaching Party are cumulative and ~s at law and in equity, including those for breach of contract, under under the Divorce Code, as amended, and shall not be limited to those lly referred to in this Agreement. rty breaches any provision of this Agreement, the breaching Party shall :mnify the non-breaching Party and hold the non-breaching Party ;ses resulting from the breach, including, but not limited to, counsel :ing to such breach, whether or not litigation is instituted. )F COUNSEL. The provisions of this Agreement and their legal effect ~lained to the Wife by her counsel, Richard C. Gaffney, Jr., MBA, ;band by his legal counsel, Robert B. Maclntyre, Esquire. ; that he or she fully understands the terms, conditions and provisions ad believes them to be fair and reasonable under the circumstances. confirm that each is entering into this Agreement freely and the execution of this Agreement is not the result of any duress, undue ., or improper or illegal agreement or agreements. N WITH RESPECT TO DIVORCE. The Parties intend to secure a -fault divorce pursuant to the provisions of Section 3301(c) of the 780, as amended. The Parties intend that this Agreement shall be ~ut not merged with, any divorce decree which may be entered and the Pleas entering the divorce decree shall retain continuing jurisdiction Page 13 over the Parties ar of enforcement of Agreement shall c the Parties and ex~ remain in full forc 18. WAIVER~ of this Agreement 19. NO WAIV effect unless and [ waiver of any bre~ subsequent defauh other obligations insist upon strict affect the right ot 20. }NTEGRA Parties and supers~ There are no other conditions, agreen' expressly set forth 21. SEVERAB to be void or invali the subject matter of this Agreement and the QDRO for the purpose ny of their provisions. It is the further intention of the Parties that this )ntinue to be effective after entry of a final decree in divorce between :ept as otherwise provided for in this Agreement, this Agreement shall and effect even if no final decree in divome is entered. OR MODIFICATION. No modification or waiver of any of the terms shall be valid unless in writing and signed by both Parties. ER OF DEFAULT. This Agreement shall remain in full force and ntil terminated under and pursuant to the terms of this Agreement. No :h or default of this Agreement shall be deemed a waiver of any of the same or similar nature or a waiver of strict performance of any ursuant to the terms of this Agreement. The failure of either Party to ~rformance of any of the terms of this Agreement shall in no way uch Party to enforce those terms in the future. I'ION. This Agreement constitutes the entire understanding of the des any and all prior agreements and negotiations between them. express or implied, oral or written representations, terms, covenants, ents or warranties, of any nature whatsoever, other than those in this Agreement. [LITY. If any provision of this Agreement shall be finally determined d, then only that provision shall be stricken from this Agreement and Page 14 in all other respec effect. 22. AGREEM this Agreement shall be valid and shall continue in full force and NT B1ND1NG ON HEIRS. The terms, provisions and conditions of this Agreement administrators, su. otherwise herein [ 23. APPLICA accordance with ti 24. HEAD1NI any of the paragr~ convenience of r~ shall not affect i~ 25. ADDRESS under this Agreem informed of his or any change of add~ Each Party statements, terms, sl~ all be binding upon and shall insure to all of the heirs, executors, :cessors or assigns of either of the respective Parties hereto, except as rovided. 3LE LAW. This Agreement shall be governed by and construed in laws of the Commonwealth of Pennsylvania. I NOT PART OF AGREEMENT. Any headings preceding the text of ~hs or subparagraphs of this Agreement are inserted solely for erence, shall not constitute a part of this Agreement and, therefore, interpretation. ES OF PARTIES. As long as any obligations remain to be performed ;nt, each Party shall have the affirmative obligation to keep the other her residence address, and shall promptly notify the other in writing of ess. has carefully read and fully considered this Agreement and all of the :onditions and provisions thereof prior to signing below. Page 15 IN WITN hereby, have here Witness: ~SS WHEREOF, the Parties hereto, intending to be legally bound anto executed this Agreement the day and year first written above. ~e T. Potteiger ~ R~be~ E.~Po~tt~ger Page 16 COMMONWEAl COUNTY OF CE On this, th Public for the Cot known to me (or ~, within Agreemenl contained. IN WITNI Notary/Public My Commission I ,TH OF PENNSYLVANIA SS. MBERLAND .~ ~d~ day of ~ ,2003, before me, a Notary unonwealth of Pennsylvania, personally appeared Anne Potteiger, atisfactorily proven) to be the person whose name is subscribed to the and acknowledged that she executed the same for the purposes therein ;SS WHEREOF, I have hereunto set my hand and official seal. Seal Tonya Notary Public Dauphin County ~ Nov. 29, 21304 COUNTY OF~ On this, th Public for the Cm known to me (or ~, within Agreemenl contained. SS. day of ~ C' .:~tx'X~r~,~ 2003, before me, a Notary amonwealth of Pennsylvania, personally appeared Robert Potteiger, atisfactorily proven) to be the person whose name is subscribed to the and acknowledged that he executed the same for the purposes therein ',SS WHEREOF, I have hereunto set my hand and official seal. I NOTARIAl. $l=~,[= ' Carrie Jean Singer, Notary Public Lower Paxton Twp. Dauphin County My Commission Expires September 7, 2006 Page 17 ANNE T. PO IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBERTE. AND NOW, the parties, IT IS Ol FTEIGER, PLAINTIFF ?OTTEIGER, JR. DEFENDANT NO. 02-1993 CIVIL TERM IN DIVORCE 1. Effect and recognizes the ex Participant's benefits Revenue Code (the "~ 2. Partici Security Number oftl NaiTle~ Addre: ~s: DOB: SSN: Altem Social Security Numt QUALIFIED DOMESTIC RELATIONS ORDER DEFINED CONTRIBUTION PLAN ~n this 3 t ~ day of O'c.~ ~ ',DERED AS FOLLOWS: ~fthis Order as a Qualified Domestic Relations Order: This Order creates stence of an Alternate Payee's right to receive a portion of the payable under an arrangement pursuant to Section 403(b) of the Internal :ode"). ~ant Information: The name, last known address, birth date, and Social te plan "Participant" are as follows: Robert E. Potteiger, Jr. ("Participant") 516 Blue Eagle Avenue Harrisburg, PA 17112 March 16, 1965 197-50-8218 rte Payee Information: The name, last known address, birth date, and er of the plan "Alternate Payee" are as follows: ,2003, upon consent of Name: Addre: ;s: DOB: SSN: Anne T. Potteiger ("Alternate Payee") 1023 Yverdon Drive Camp Hill, PA 17011 January 18, 1963 161-60-3437 The Altemate hereunder, if there is address subsequent t( 4. Plan 1' applies is AHOLD, [ for Hourly Associate: number is which assume liabilit subject to the terms c Any changes in Plan Altemate Payee's rig 5. Pursue' authority granted in tJ Payee. 6. This 7. Amo portion of Participant percent of the value c plus any interest and October 5, 2001, unti The Alternate separately maintainer be credited with any i of the total distributk proportionately divid, account(s) is/are allot 8. Comrr Payee so elects, she s date of Order is apprc no Plan Administrato Internal Revenue Coc permissible option off Plan, including, but 9. Alter deemed to be a Quali total distribution und~ Payee shall have the duty to notify the Plan Administrator or the payor ~o Plan Administrator, in writing of any changes in his or her mailing the entry of this Order. ame: The name of the Section 403(b) an:angement to which this Order .A Retirement Savings Plan or AHOLD USA, Inc. 401 (k) Savings Plan 'hereinafter referred to as "Plan"). The Participant's Plan Account Further, any successor plan or arrangement to the Plan or any other plan(s), ? for provision of the Participant's benefits described below, shall also be ~' this Order. ~dministrator, Plan Sponsor, or name of the Plan shall not affect the tts as stipulated under this Order. nt to State Domestic Relations Law: This Order is entered pursuant to the ce applicable domestic relations law of the State of Pennsylvania. rder relates to the provision of martial property rights to the Alternate ~t of Alternate Payee's Benefit: This Order assigns to the Alternate Payee a 's Total Account Balance under the Plan in an amount equal to sixty (60%) fthe Participant's Total Account Balance, effective as of October 5, 2001, nvestment earnings or losses attributable thereon for periods subsequent to the date of total distribution. Payee's share of the benefits described above shall be segregated and in an Account or Accounts established on her behalf and shall additionally aterest and investment income or losses attributable thereon until the date n to the Alternate Payee. The Alternate Payee's portion shall be :d among the investment funds in the sarne manner as the Participant's ated, as of the date the Order becomes qualified. encement Date and Form of Payment to Alternate Payee: If the Altemate ~all be paid her benefits as soon as administratively feasible following the ved as a QDRO by the Plan Administratur (or payor hereunder, if there is · ), or at the earliest date permitted under the Plan or Section 414(p) of the e. If later, benefits will be payable to the Alternate Payee in any form or terwise available to participants and alternate payees under the terms of the ~t limited to, a single lump-sum cash payment. rte Payee's Rights and Privileges: On ancl after the date this Order is led Domestic Relations Order, but before the Alternate Payee receives her r the Plan, the Alternate Payee shall be entitled to all of the rights, and election privileges afl the right to direct Plal 10. Death receiving the full amc chosen by the Altema appropriate form, sha Order. 11. Death one or more separate treated as the survivir the extent of the full ~ Should the Participan established on his or I Payee's right to the pc 12. Savin~ manner as, to require the terms of t? b. actuarial valm C. required to be deemed to be 13. Certifi shall be conditioned c Administrator (or the may reasonably be re~ amounts contained he 14. Contin QDRO under Section )rded to Plan participants; including, but not limited to, the rules regarding investments, only to the extent permitted under the provisions of the Plan. )fAltemate Payee: In the event of the Alternate Payee's death prior to ant of benefits called for under this Order and under the benefit option :e Payee, such Alternate Payee's beneficiary (ies), as designated on the receive the remainder of any unpaid benefits under the terms of this f Participant: In the event the Participant dies prior to the establishment of tcconnts in the name of the Alternate Payee, such Alternate Payee shall be g spouse of the Participant for any death benefits payable under the Plan to mount of his or her benefits as called for under Paragraph 7 of this Order. predecease the Alternate Payee after the new account(s) have been er behalf, such Participant's death shall rio way affect the Altemate xtion of his or her benefits as stipulated herein. s Clause: This Order is not intended, and shall not be construed in such a :he Plan: to provide any type or form of benefit option not otherwise provided under is plan; to require the Plan to provide increased benefits determined on the basis of ; or to require the payment of any benefits to the Alternate Payee which are paid to another altemate payee under another order which was previously , QDRO. :ation of Necessary Information: All payments made pursuant this Order n the certification by the Alternate Payee and the Participant to the Plan payor hereunder, if there is no Plan Administrator) of such information as uired from such parties to make the necessary calculation of the benefit :elm aed Qualified Status of Order: It is the intention of the parties that this 414(p) of the Internal Revenue Code, as it may be amended from time to time, and that the Pla~ Administrator (or the payor hereunder, if there is no Plan Administrator) shall reserve the right ~o reconfirm the qualified status of the Order at the time benefits become payable hereunder. / 15. Tax Treatment of Distribution Made Under this Order: For purposes of Sections 402(a)(1) and 72 oft?" 'e Internal Revenue Code, any Alternate Payee who is the spouse or former spouse of the particip, mt shall be treated as the distributee of any distribution or payment made to the Alternate Payee t~ tder the terms of this Order, and as such, will be required to pay the appropriate federal in. :omc taxes on such distribution. 16. Const~ the Participant any be this Order, the Partici he/she has received s~ directly to the Alten 17. Conti Order to the extent re. stipulated herein. Th, necessary to enforce including the re-char~ applicable, or to make comply with the prov: 18. Plan T entitled to receive his with the Plan's termir 19. Action otherwise, that circurr or that diminish or ex~ herein. Should the Pat Altemate Payee, he or Payee to the extent ne~ extent of the Alternate Consent: Participant: Alternate Payee: uctive Receipt: In the evenT that the payor hereunder inadvertently pays to nefits which are assigned to the Alternate Payee pursuant to the terms of 3ant shall immediately reimburse the Alternate Payee to the extent that ich benefit payments, and shall forthwith pay such amounts so received te Payee within ten (10) days of receipt. ued Jurisdiction: The Court shall retain jurisdiction with respect to this tuired to maintain its qualified status an the original intent of the parties as Court shall also retain jurisdiction to enter such further orders as are ~e assignment of benefits to the Alternate Payee as set forth herein, :terization thereof as a division of benefits under another plan, as an award of alimony if applicable, in the, event that Participant fails to sions contained above requiring said payments to the Alternate Payee. ~'rmination: In the event of a Plan termination, the Alternate Payee shall be or her portion of Participant's benefits as stipulated herein in accordance ation for participants and beneficiaries. by Participant: The Participant shall not take any actions, affirmative or vent the terms and provisions of this Qualifted Domestic Relation Order, inguish the rights and entitlements of the Alternate Payee as set forth Iicipant take any action or fail to make arty action to the detriment of the she shall be required to make sufficient payments directly to the Alternate :essary to neutralize the effects of his or her actions or inactions and to the Payee's full entitlements hereunder. Court ANNE T. P~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBERTE 1. A complai Code was 2. The mart 3. Defendar Complaint 4. Ninety da 5. I consent intention t I verify that th that false statements h relating to unsworn E TTEIGER, PLAINTIFF POTTEIGER, JR. DEFENDANT : NO. 02-1993 CIVIL TERM IN DIVORCE PLAINTIFF'S AFFIDAVIT OF CONSENT at in divorce under Section 3301(c) and Section 3301 (d) of the Divorce 51ed on April 23, 2002. ge between plaintiff and defendant is irre, trievably broken. Robert E. Potteiger, Jr. was served a true and correct copy of the on April 25, 2002. (90) have elapsed from the date of filing and service of the Complaint. the entry of a final decree of divorce after service of notice of request entry of the decree. statements made in this affidavit are tree and correct. I understand :rein are made subject to the penalties of 18 Pa.C.S. Section 4904 sification to authorities. Anne T. Potteiger (Plaintiff) ANNE T. Pt ROBERT E PLAINTIFF'S DIVORCE 1. I consent 2. I understa attorney' s 3. I understm Court and with the Pi I verify that th~ that false statements h unswom falsification IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 'TTEIGER, : PLAINTIFF : NO. 02-1993 CIVIL TERM : IN DIVORCE POTTEIGER, JR. : DEFENDANT : AIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A ECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE the entry of a final decree of divorce without notice. d that I may lose rights concerning alimc~ny, division of property, ~'ees and expenses if I do not claim them before a divorce is granted. d that I will not be divorced until a divorce decree is entered by the hat a copy of the decree will be sent to me immediately after it is filed othonotary. statements made in this affidavit are true and correct. I understand .~rein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to o authorities. AnnT. Po~eiger (Plaintiff) ANNE T. P£ Ve ROBERTE. 1. A complai Code was 2. The marr 3. Defenda~ Complaint 4. Ninety da 5. I consent intention t, I verify that th that false statements h~ relating to unswom fal IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~TTEIGER, PLAINTIFF POTTEIGER, JR. DEFENDANT .. : NO. 02-1993 CIVIL TERM _. _. IN DIVORCE _. : DEFENDANT'S AFFIDAVIT OF CONSENT at in divorce under Section 3301(c) and Section 3301 (d) of the Divorce 51ed on April 23, 2002. ge between plaintiff and defendant is irretrievably broken. Robert E. Potteiger, Jr. was served a tree and correct copy of the on April 25, 2002. (90) have elapsed from the date of filing and service of the Complaint. the entry of a final decree of divorce after service of notice of request entry of the decree. statements made in this affidavit are tree and correct. I understand :rein are made subject to the penalties of 18 Pa.C.S. Section 4904 ;ification to authorities. Robert E. Potteige~, J'rf(Defendant) ANNE T. Pi ROBERTE DEFENDANT'S~ DIVORCE 1. I consent 2. I understar attorney's 3. I understan Court and 1 with the Pr I verify that the that false statements h, unsworn falsification IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~TTEIGER, PLAINTIFF POTTEIGER, JR. DEFENDANT : NO. 02-1993 CIVIL TERM IN DIVORCE tAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A ECREE UNDER SECTION 3301(C) OF THE DIVORCE CODE the entry of a final decree of divorce without notice. t that I may lose rights concerning alimony, division of property, ~es and expenses ifI do not claim them before a divorce is granted. J that I will not be divorced until a divorce decree is entered by the hat a copy of the decree will be sent to me immediately after it is filed )thonotary. statements made in this affidavit are true and correct. I understand ~rein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to authorities. Robert E. PotteigeritJr. (151aintiff) ANNE T. PC ROBERTE. To the Prothonotary: Please transn the entry of a divorc~ 1. Grounds 2. Date and States Mi 3. Date of e: Code: by 4. Related c distribute Domestic The parti, Agreeme Court sig QDRO tc IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA TTEIGER, PLAINTIFF POTTEIGER, JR. DEFENDANT : NO. 02-1993 CIVIL TERM _. ._ IN DIVORCE : .. PRAECIPE TO TRANSMIT RECORD it the record, together with the following information, to the Court for decree: .r divorce: irretrievable breakdown under §3301 (c) of the Divorce Code. tanner of service of the complaint: April[ 25, 2002, via Certified United il, return receipt requested. :ecution of the affidavit of consent required by § 3301(c) of the Divorce the plaintiff October 30, 2003; by the detbndant on October 30, 2003. aims pending: Property Distribution. The parties have agreed to marital property in accordance with the lvlarital Settlement and Qualified Relations Order ("QDRO") filed in this Docket on October 30, 2003. :s intend that the Court will incorporate t~he Marital Settlement it into a Decree of Divorce and the Parties respectfully request that the ~ the QDRO. Please transmit the Marital Settlement Agreement and the the Court for this purpose. Date plait Prothonot Divorce tiffs Waiver of Notice in §3301(c) Divorce was filed with the try: October 30, 2003. Date defendant's Waiver of Notice in §3301(c) as filed with the Prothonotary: October 30, 2003. chard C. Gaffne'~sq~e Smigel, gJ~derson, & Sacks 4431 North Front Street Harrisburg, PA 17110 (717) 234.2401 Attorney for Plaimiff IN TH A~qE T. POi'i'~IGER PLAINTIFF COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. VERSUS DECREE IN DIVORCE N O. 02-1993 AND NOW DECREED THAT AND ROB~T E. ARE DIVORCED ROM THE BONDS OF MATRIMONY. ,~,ITIS ORDERED AND ,PLAINTIFF, ,DEFENDANT, THE COURT NS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED 0 RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTEI~ED; Property support and custody. The .Marital Sepa=ation Agreement and the Domestic Relations Order executed by the parties hereto on October 30, ]03, are hereby incorporated into but are not merged with this BY THE COURT: ATTES J. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, PLAINTIFF ROBERT E. POTTEIGER, JR. DEFENDANT NO. 02-1993 CIVIL TERM IN DIVORCE AFFIDAVIT OF SERVICE Richard C. Gaffney, MBA, Esquire, being duly sworn according to law, deposes and says that he is the attorney for the Plaintiff in the above-captioned action; that on or about November 11, 2003 he mailed a true and correct copy of the Qualified Domestic Relations Order, by certified, U.S. mail delivered to Plan Administrator, Ahold, USA, Inc. for Fidelity Investments at the following address, PO Box 770003, Cincinnati, OH 45277-0065; that on or about November 15, 2003, Plan Administrator did receive said Qualified Domestic Relations Order as evidenced by the signed Certified U.S. Mail form attached hereto; and that the facts set forth in the within Affidavit are true and correct to the best of his information and belief. Sworn io~_and subscribed before me this I~--day of ~,J~ 2003. Notary P~lic (.~ - -- My commission expires: q4~"~)¢ Richard C. G~ff~;~s~ire Attorney for the Plaintitt · Complete itlms 1, 2, and 3. Nco coml3~e item 4 if Restricted Deliver7 is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 3. ice Type Cert fled Ma,il r"l Express Mail ~l~istered [] Return Receipt for Mefchandiae _ [] Insured Mair [] C.O.D. 4. Restricted Delivery? ,(,(Ex, re Fee) i-] Yes 7002 0860 0007 8996 4808 Domestic Return Receipt IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, PLAINTIFF ROBERT E. POTTEIGER, JR. DEFENDANT NO. 02-1993 CIVIL TERM IN DIVORCE AMENDED QUALIFIED DOMESTIC RELATIONS ORDER DEFINED CONTRIBUTION PLAN AND NOW, on this f day of the parties, IT IS ORDERED AS FOLLOWS: ,2003, upon consent of I. Effect of this Order as a Qualified Domestic Relations Ordel': This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion of the Participant's benefits payable under an arrangement pursuant to Section 403(b) of the Internal Revenue Code (the "Code"). 2. ~formation: The name, last known address, birth date, and Social Security Number of the plan "Participant" are as follows: Name: Address: DOB: SSN: Robert E. Potteiger, Jr. ("Participant") 516 Blue Eagle Avenue Harrisburg, PA 17112 March 16, 1965 197-50-8218 3. Alternate Payee Information: The name, last known address, birth date, and Social Security Number of the plan "Alternate Payee" are as follows: Name: Anne T. Potteiger ("Alternate Payee") Address: 1023 Yverdon Drive Camp Hill, PA 17011 DOB: January 18, 1963 SSN: 161-60-3437 The Altemate Payee shall have the duty to notify the Plan Administrator or the payor hereunder, if there is no Plan Administrator, in writing of any changes in his or her mailing address subsequent to the entry of this Order. 4. Plan Name: The name of the Section 403(b) arrangement to which this Order applies is AHOLD USA, Inc. 401(k) Savings Plan for Hourly Associates (hereinafter referred to as "Plan"). The Participant's Plan Account number is __ . Further, any successor plan or arrangement to the Plan or any other plan(s), which assume liability for provision of the Participant's benefits described below, shall also be subject to the terms of this Order. Any changes in Plan Administrator, Plan Sponsor, or name of the Plan shall not affect the Alternate Payee's rights as stipulated under this Order. 5. Pursuant to State Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable domestic relations law of the State of Pennsylvania. Payee. This Order relates to the provision of martial property rights to the Alternate 7. Amount of Alternate Payee's Benefit: This Order assigns to the Alternate Payee a portion o Participant s Total Account Balance under the Plan in an amount equal to sixty (60%) percent of the value of the Participant's Total Account Balance. effective as of October 5, 2001, plus any interest and investment earnings or losses attributable ihereon for periods subsequent to October 5, 2001, until the date of total distribution. The Alternate Payee's share of the benefits described above shall be segregated and separately maintained in an Account or Accounts established on her behalf and shall additionally be credited with any interest and investment income or losses attributable thereon until the date of the total distribution to the Alternate Payee. The Alternate Payee's portion shall be proportionately divided among the investment funds in the same manner as the Participant's account(s) is/are allocated, as of the date the Order becomes qualified. 8. Commencement Date and Form of Payment to Alternate Payc¢' If the Alternate Payee so elects, she shall be paid her benefits as soon as administratively feasible following the date of Order is approved as a QDRO by the Plan Administrator (or payor hereunder, if there is no Plan Administrator), or at the earliest date permitted under the Plan or Section 414(p) of the Internal Revenue Code. If later, benefits will be payable to the Alternate Payee in any form or permissible option otherwise available to participants and alternate payees under the terms of the Plan, including, but not limited to, a single lump-sum cash payment. 9. Alternate Payee's Rights and Privileges' On and after the date this Order is deemed to be a Qualified Domestic Relations Order, but before the Alternate Payee receives her total distribution under the Plan, the Alternate Payee shall be entitled to all of the rights, and election privileges afforded to Plan participants; including, but not limited to, the rules regarding the right to direct Plan investments, only to the extent permitted nnder the provisions of the Plan. ! 0. Death of Alternate Payee: In the event of the Alternate Payee's death prior to receiving the full amount of benefits called for under this Order and under the benefit option chosen by the Alternate Payee, such Alternate Payee's beneficiary (les), as designated on the appropriate form, shall receive the remainder of any unpaid benefits under the terms of this Order. 11. Death: In the event the Participant dies prior to the establishment of one or more separate accounts in the name of the Alternate Payee, such Alternate Payee shall be treated as the surviving spouse of the Participant for any death benefits payable under the Plan to the extent of the full amount of his or her benefits as called for under Paragraph 7 of this Order. Should the Participant predecease the Alternate Payee after the new account(s) have been established on his or her behalf, such Participant's death shall no way affect the Alternate Payee's right to the portion of his or her benefits as stipulated herein. 12. Savings Clause: This Order is not intended, and shall not be construed in such a manner as, to require the Plan: a. to provide any type or form of benefit option not otherwise provided under the terms of this plan; b. to require the Plan to provide increased benefits determined on the basis of actuarial value; or c. to require the payment of any benefits to the Alternate Payee which are required to be paid to another alternate payee under another order which was previously deemed to be a QDRO. 13. Certification of Necessary Information: All payments made pursuant this Order shall be conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator (or the payor hereunder, if there is no Plan Administrator) of such information as may reasonably be required from such parties to make the necessary calculation of the benefit amounts contained herein. 14. Continued ~d_Status of Orde~r: It is the intention of the parties that this QDRO under Section 414(p) of the Internal Revenue Code, as it may be amended from time to time, and that the Plan Administrator (or the payor hereunder, if there is no Plan Administrator) shall reserve the right to reconfirm the qualified status of the Order at the time benefits become payable hereunder. 15. Tax Treatment of Distribution Made Under this Ordc~: For purposes of Sections 402(a)(1) and 72 of the Internal Revenue Code, any Alternate Payee who is the spouse or former spouse of the participant shall be treated as the distributee of any distribution or payment made to the Alternate Payee under the terms of this Order, and as such, will be required to pay the appropriate federal income taxes on such distribution. 16. Constructive Receipt: In the evenT that the payor hereunder inadvertently pays to the Participant any benefits which are assigned to the Alternate Payee pursuant to the terms of this Order, the Participant shall immediately reimburse the Alternate Payee to the extent that he/she has received such benefit payments, and shall forthwith pay such amounts so received directly to the Alternate Payee within ten (10) days of receipt. 17. Continued Jurisdiction: The Court shall retain iurisdiction with respect to this Order to the extent required to maintain its qualified status an}he original intent of the parties as stipulated herein. The Court shall also retain jurisdiction to enter such further orders as are necessary to enforce the assignment of benefits to the Alternate Payee as set forth herein, including the re-characterization thereof as a division of benefits under another plan, as applicable, or to make an award of alimony if applicable, in the event that Participant fails to comply with the provisions contained above requiring said payments to the Alternate Payee. 18. Plan Termination: In the event of a Plan termination, the Alternate Payee shall be entitled to receive his or her portion of Participant's benefits as stipulated herein in accordance with the Plan's termination for participants and beneficiaries. 19. Action by Participant: The Participant shall not take any actions, affirmative or otherwise, that circumvent the terms and provisions of this Qualified Domestic Relation Order, or that diminish or extinguish the rights and entitlements of the Alternate Payee as set forth herein. Should the Participant take any action or fail to make any action to the detriment of the Alternate Payee, he or she shall be required to make sufficient payments directly to the Alternate Payee to the extent necessary to neutralize the effects of his or her actions or inactions and to the extent of the Alternate Payee's full entitlements hereunder. Consent: //~ The Court Participant: Alternate Payee: ( Fideli January29,2004 Richard C. Gafthey, Esq. Smigel, Anderson & Sacks, LLP 4431 North From Street Harrisburg, PA 17110-1709 QDRO in connection with Robert E. Potteiger, Jr. ("Participant") Anne T. Potteiger ("Alternate Payee") and Ahold USA, Inc. 401(k) Savings Plan for Hourly Associates ("Plan") Fidelity Reference Number: W002168-21NOV03 Dear Attorney Gaffney: On behalf of the Plan Administrator, Fidelity Employer Services Company LLC ("Fidelity") has determined that the Qualified Domestic Relations Order Defmed Contxibution Plan ("Order") dated October 31, 2003 and submitted for review is not qualified pursuant to Section 206(d)(3) of the Employee Retirement Income Security Act of 1974, as amended, and Section 414(p) of the Internal Revenue Code of 1986, as amended. The document, as presented, is not qualified for the following reason: Section 4 of the Order states that the Plan to which the Order applies is the AHOLD, USA Retirement Savings Plan or Ahold USA, Inc. 401(k) Savings Plan for Hourly Associates~' Please be advised that the Plan in which Mr. Pot~eiger is a participant is theaAhold USA, Inc 401(k~ S_avings Plan for Hourly Associat, es? Please amend the Order accordingly. As the Order is not qualified, the Plan cannot comply with its terms. To be considered a Qualified Domestic Relations Order, the Order must be modified to eliminate the deficiency noted above. Please be advised that in accordance with the enclosed Plan QDRO Guidelines, the disbursement restriction placed on the Participant's Plan account will remain in place throughout the qualification process. During this period, the Participant will be unable to initiate loans or distributions. However, if currently eligible, the Participant will remain eligible to direct the investment of future contributions and existing balances. Please be advised that an amended Order will not receive priority or accelerated review over Orders that are already under review. A true original or court certified copy of an amended Order should be sent to Fidelity at the address listed in the enclosed QDRO Guidelines. Re: Robert E. Pot~eiger, Jr. January 29, 2004 Page 2 If you have any questions regarding the qualification procedures or need additional information, please call our QDRO dedicated telephone line at (800) 489-2363 or me at (508) 787-8922 or send a facsimile to (508) 787-9654. Sincerely, Donna M. Dacey '"" Associate Pension Consultant Enclosure cc: Robert E. Potteiger, Jr. Anne T. Potteiger Robert Maclntyre, Esq. Fidelity Reference Number: W002168-21 NOV03 SMIGEL, ANDERSON & SACKS LLP ATTORNEYS AT LAW RICHARD C. GAFFNEY, MBA, ESQUIRE TELEPHONE: 717.234.2401 TOLL-FREE: 800.822.9757 FACSIMILE: 717.234.3611 E-MAIL: RGaffney@sasl]p.com Web: www.sasllp.com File No. 6845-1-4 February 24, 2004 The Honorable Kevin A. Hess Cumberland County Court of Common Pleas One Courthouse Square Carlisle, Pennsylvania 17013 Anne T. Potteiger v. Robert E. Potteiger, Jr. Cumberland County Court of Common Pleas Docket No. 02-1993-Civil Term - In Divorce Dear Judge Hess: On October 31, 2003 you signed a Qualified Domestic Relations Order in the above- captioned divorce litigation. Unfortunately, the plan administrator for the 401(k) plan in question, Fidelity Investments, informed us that the Order is not qualified pursuant to Section 206(d)(3) of the Employee Retirement Income Security Act of 1974, as amended, and Section 414(p) of the Internal Revenue Code of 1986, as amended. The reason it did not qualify was that the plan name contained in Section 4 of the Order does not exactly match the correct plan name, "AHOLD USA, Inc. 401(k) Saving Plan for Hourly Associates." Accordingly, I amended the QDRO to reflect the correct name of the plan. Other than the change of plan name in paragraph 4 of the QDRO and the addition of the word "AMENDED" in the title line of the QDRO, the provisions and language of the Amended QDRO are identical to the QDRO that you signed on October 31, 2003. I contacted Attorney Maclntyre's office and he has consented to my request that the Court sign the Amended QDRO, which is attached to this letter. I also contacted Fidelity Investments, the plan administrator, which has agreed to accept the Amended QDRO in the form attached to this letter. I represent Anne Potteiger in this matter. Attorney Maclntyre represents Robert E. Potteiger, Jr. Fidelity Investments is the plan administrator for the AHOLD USA, Inc. 401(k) Savings Plan for Hourly Associates. Attached to this letter, please find a copy of Fidelity 4431 North Front Street, Harrisburg, Pennsylvania 17110-1709 A PENNSYLVANIA LIMITED LIABILITY PARTNERSHIP FEBRUARY24,2004 PAGE2 Investments January 29, 2004 letter advising of the non-qualification of the first QDRO. Also attached, please find an Amended QDRO for your signature, should you grant the relief requested herein. Of course, if the Court prefers that this matter proceed by Petition and Rule, we will file the necessary Petition to accomplish this objective. Thank you for your attention and courtesies in this matter. Please feel free to contact me with any questions or concerns. Very truly yours, SMIGEL, ANDERSON & SACKS, LLP Richard C. Gaffney, MBA, Egquire RCG/cnm Enclosure CC: Anne Potteiger Robert Maclntyre, Esquire IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, PLAINTIFF ROBERT E. POTTEIGER, JR. DEFENDANT NO. 02-1993 CIVIL TERM IN DIVORCE AMENDED QUALIFIED DOMESTIC RELATIONS ORDER KEV~N A. HESS ONE COURTHOUSE SQUARE CARLISLtE~ PENNSYLVANIA 17093 Robert MacIntyre, Esquire 5500 Allentown Blvd. ltarrisburg, PA 17112 [] INSUFFICIENT ADDRESS [] ATTEMPTED NOT KNOWN [] OTHER [] ~SUCH NUMBER/STREET IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ANNE T. POTTEIGER, : PLAINTIFF : : V. : : ROBERT E. POTTEIGER, JR. : DEFENDANT : NO. 02-1993 CIVIL TERM IN DIVORCE AMENDED QUALIFIED DOMESTIC RELATIONS ORDER DEFINED CONTRIBUTION PLAN AND NOW, on this ~a ~ day of the parties, IT IS ORDERED AS FOLLOWS: ,2004, upon consent of 1. Effect of this Order as a Qualified Domestic Relations Order: This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion of the Participant's benefits payable under an arrangement pursuant to Section 403(b) of the Internal Revenue Code (the "Code"). 2. Participant Information: The name, last known address, birth date, and Social Security Number of the plan "Participant" are as follows: NalTle: Address: DOB: SSN: Robert E. Potteiger, Jr. ("Participant") 516 Blue Eagle Avenue Harrisburg, PA 17112 March 16, 1965 197-50-8218 3. Alternate Payee Information: The name, last known address, birth date, and Social Security Number of the plan "Alternate Payee" are as follows: Sanle~ Address: DOB: SSN: Anne T. Potteiger ("Alternate Payee") 1023 Yverdon Drive Camp Hill, PA 17011 January 18, 1963 161-60-3437 The Altemate Payee shall have the duty to notify the Plan Administrator or the payor hereunder, if there is no Plan Administrator, in writing of any changes in his or her mailing address subsequent to the entry of this Order. 4. Plan Name: The name of the Section 403(b) arrangement to which this Order applies is AHOLD USA, Inc. 401 (k) Savings Plan for Hourly Associates (hereinafter referred to as "Plan"). The Participant's Plan Account number is . Further, any successor plan or arrangement to the Plan or any other plan(s), which assume liability for provision of the Participant's benefits described below, shall also be subject to the terms of this Order. Any changes in Plan Administrator, Plan Sponsor, or name of the Plan shall not affect the Alternate Payee's rights as stipulated under this Order. 5. Pursuant to State Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable domestic relations law of the State of Pennsylvania. 6. This Order relates to the provision of martial property rights to the Alternate Payee. 7. Amount of Alternate Payee's Benefit: This Order assigns to the Alternate Payee a portion of Participant's Total Account Balance under the Plan in an amount equal to sixty (60%) percent of the value of the Participant's Total Account Balance, effective as of October 5, 2001, plus any interest and investment earnings or losses attributable thereon for periods subsequent to October 5, 2001, until the date of total distribution. The Alternate Payee's share of the benefits described above shall be segregated and separately maintained in an Account or Accounts established on her behalf and shall additionally be credited with any interest and investment income or losses attributable thereon until the date of the total distribution to the Alternate Payee. The Alternate Payee's portion shall be proportionately divided among the investment funds in the same manner as the Participant's account(s) is/are allocated, as of the date the Order becomes qualified. 8. Cnmmencement Date and Form of Pawnent to Alternate Payee: If the Alternate Payee so elects, she shall be paid her benefits as soon as administratively feasible following the date of Order is approved as a QDRO by the Plan Administrator (or payor hereunder, if there is no Plan Administrator), or at the earliest date permitted under the Plan or Section 414(p) of the Internal Revenue Code. If later, benefits will be payable to the Alternate Payee in any form or permissible option othenvise available to participants and alternate payees under the terms of the Plan, including, but not limited to, a single lump-sum cash payment. 9. Alternate Payee's Rights and Privileges: On and after the date this Order is deemed to be a Qualified Domestic Relations Order, but before the Alternate Payee receives her total distribution under the Plan, the Alternate Payee shall be entitled to all of the rights, and election privileges afforded to Plan participants; including, but not limited to, the rules regarding the right to direct Plan investments, only to the extent permitted under the provisions of the Plan. 10. Death of Alternate Payee: In the event of the Alternate Payee's death prior to receiving the full amount of benefits called for under this Order and under the benefit option chosen by the Alternate Payee, such Alternate Payee's beneficiary (ies), as designated on the appropriate form, shall receive the remainder of any unpaid benefits under the terms of this Order. 11. Death of Particivant: In the event the Participant dies prior to the establishment of one or more separate accounts in the name of the Alternate Payee, such Alternate Payee shall be treated as the surviving spouse of the Participant for any death benefits payable under the Plan to the extent of the full amount of his or her benefits as called for under Paragraph 7 of this Order. Should the Participant predecease the Alternate Payee after the new account(s) have been established on his or her behalf, such Participant's death shall no way affect the Altemate Payee's right to the portion of his or her benefits as stipulated herein. 12. Savings Clause: This Order is not intended, and shall not be construed in such a manner as, to require the Plan: a. to provide any type or form of benefit option not otherwise provided under the terms of this plan; b. to require the Plan to provide increased benefits determined on the basis of actuarial value; or c. to require the payment of any benefits to the Alternate Payee which are required to be paid to another alternate payee under another order which was previously deemed to be a QDRO. 13. Certification of Necessary Information: All payments made pursuant this Order shall he conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator (or the payor hereunder, if there is no Plan Administrator) of such information as may reasonably be required from such parties to make the necessary calculation of the benefit amounts contained herein. · 14: Continued Qualified Status of Order: It is the intention of the pa~ies that this QDRO under Section 414(p) of the Internal Revenue Code, as it may be amended from time to time, and that the Plan Administrator (or the payor hereunder, if thore is no Plan Administrator) shall reserve the fight to reconfirm the qualified status of the Order at the time benefits become payable hereunder. 15. Tax Treatment of Distribution Made Under this Order: For purposes of Sections 402(a)(1) and 72 of the Internal Revenue Code, any Alternate Payee who is the spouse or former spouse of the participant shall be treated as the distributee of any distribution or payment made to the Alternate Payee under the terms of this Order, and as such, will be required to pay the appropriate federal income taxes on such distribution. 16. Constructive Receipt: In the evenT that the payor hereunder inadvertently pays to the Participant any benefits which are assigned to the Alternate Payee pursuant to the terms of this Order, the Participant shall immediately reimburse the Alternate Payee to the extent that he/she has received such benefit payments, and shall forthwith pay such amounts so received directly to the Alternate Payee within ten (10) days of receipt. 17. Continued Jurisdiction: The Court shall retain jurisdiction with respect to this Order to the extent required to maintain its qualified status an the original intent of the parties as stipulated herein. The Court shall also retain jurisdiction to enter such further orders as are necessary to enforce the assigxunent of benefits to the Alternate Payee as set forth herein, including the re-characterization thereof as a division of benefits under another plan, as applicable, or to make an award of alimony if applicable, in the event that Participant fails to comply with the provisions contained above requiring said payments to the Alternate Payee. 18. .Plan Termination: In the event of a Plan termination, the Alternate Payee shall be entitled to receive his or her portion of Partmipant's benefits as stipulated herein in accordance with the Plan's termination for participants and beneficiaries. 19. Action by Participant: The Participant shall not take any actions, affirmative or otherwise, that circumvent the terms and provisions of this Qualified Domestic Relation Order, or that diminish or extinguish the rights and entitlements of the Alternate Payee as set forth herein. Should the Participant take any action or fail to make any action to the detriment of the Altemate Payee, he or she shall be required to make sufficient payments directly to the Alternate Payee to the extent necessary to neutralize the effects of his or her actions or inactions and to the extent of the Alternate Payee's full entitlements hereunder. ANNE POTTEIGER, Plaintiff ROBERT E. POTTEIGER, JR., Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 02-1993 CIVIl, TERM : IN DIVORCE/CUSTODY MOTION FOR ENTRY OF CUSTODY STIPULATION AND NOW come the parties hereto, Anne T. Potteiger and Robert E. Potteiger, Jr., and respectfully request this Honorable Court grant the following relief: 1. Plaintiff, Anne T. Potteiger, and Defendant, Robert E. Potteiger, Jr., have voluntarily and otherwise mutually reached agreement regarding the custody of their subject minor child, Rachel Elizabeth Potteiger, bom ]December 27, 1994. 2. A copy of said Agreement/Stipulation is attached hereto and marked Exhibit "A". 3. Pursuant to paragraph six of the Stipulation, the parties respectfully request this Honorable Court incorporate the terms of said Stipulation into an Order of this Honorable Court. Respectfully submitted, THE LAW OFFICES OF SILLIKER & REINHOLD er, Esquire 5922 Linglestown Road Harrisburg, PA 17112 (717) 671-1500 I.D. No. 33671] Attorney for Robert E. Potteiger, Jr. ANNE POTTEIGER, Plaintiff ROBERT E. POTTEIGER, JR., Defendant : 1N THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 02-1993 CIVIL TERM : IN DIVORCE/CUSTODY CUSTODY STIPULATION AND NOW, come the parties herein, Anne T. Potteiger and Robert E. Potteiger, Jr., and hereby agree and otherwise stipulate to the: following: 1. The parties shall have shared legal custody of the subject minor child, Rachel Elizabeth Potteiger, bom December 27, 1994. child. 2. The parties shall have shared physical custody of the subject minor 3. It is agreed between the parties that the subject minor child shall be enrolled in and attend Linglestown Elementary School, which is the appropriate school for Father's residence. 4. Anne T. Potteiger shall have custody of the child whenever her work schedule permits, subject of course to the school schedule of the child. 5. The parties will share all holidays in as equal a manner as possible, with the exact details to be agreed upon between them. Likewise, each of the parties shall be entitled to a minimum of one week during the summer for purposes of summer vacation. 6. It is agreed between the parties that this stipulation shall be filed with the Prothonotary's office of Cumberland County, and shall in tmrn be incorporated as an order of the said Honorable Court of Cumberland County. Witness: .Anne T. Potteiger - RobertJE. Pf>tteiger, Jr. ANNE POTTEIGER, Plaintiff ROBERT E. POTTEIGER, JR., Defendant : 1N THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : : NO. 02-1993 CIVIL TERM : IN DIVORCE/CUSTODY ORDER OF COURT AND NOW, this v~*~ day of /2 'J the terms of the attached Custody Stipulatio~ bet~veen'~Pe ;~rties, ORDERED AND DECREED as follows: ,2004, pursuant to IT IS HEREBY 1. The parties shall have shared legal custody of the subject minor child, Rachel Elizabeth Potteiger, born December 27, 1994. child. 2. The parties shall have shared physical custody of the subject minor 3. It is agreed between the parties that the subject minor child shall be enrolled in and attend Linglestown Elementary School, which is the appropriate school for Father's residence. 4. Anne T. Potteiger shall have custody of the child whenever her work schedule permits, subject of course to the school schedule of the child. 5. The parties will share all holidays in as equal a manner as possible, with the exact details to be agreed upon between them. Likewise, each of the parties shall be entitled to a minimum of one week during the summer for purposes of summer vacation. 6. It is agreed between the ' ' ~' ' ' parties that this ,~tlpulat~on shall be filed with the Prothonotary's Office of Cumberland County, and shall in turn be incorporated as an Order of the said Honorable Court of Cumberland County. BY THE COURT: