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HomeMy WebLinkAbout06-7330JASON L. DICK, Plaintiff, : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW 2006 ?3? IIVIL TERM MICHELLE E. DICK, Defendant. IN DIVORCE NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary, Cumberland County Courthouse, Carlisle, Pennsylvania 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 717-249-3166 1-800-990-9108 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. JASON L. DICK, Plaintiff, V. MICHELLE E. DICK, Defendant. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 2005- CIVIL TERM IN DIVORCE COMPLAINT IN DIVORCE PURSUANT TO SECTIONS 3301(c) AND (d) OF THE DIVORCE CODE AND NOW, comes the Plaintiff, Jason L. Dick, by and through her attorneys, Irwin, & McKnight, and files this Complaint in Divorce against the Defendant, Michelle E. Dick, representing as follows: 1. The Plaintiff is Jason L. Dick, an adult individual residing at 1856 Walnut Bottom Road, Newville, Cumberland County, Pennsylvania 17241. 2. The Defendant is Michelle E. Dick, an adult individual currently residing at 20 Rays Drive, Newville, Cumberland County, Pennsylvania 17241. 3. The Plaintiff and Defendant have been residents of the Commonwealth of Pennsylvania at least six months prior to the filing of this action in divorce. 4. The Plaintiff and the Defendant were married on May 27, 1994 in Sussex County, Deleware. 5. There have been no prior actions of divorce or for annulment between the parties. 6. Pursuant to the Divorce Code, Sections 3301(c) and 3301(d), the Plaintiff avers as the grounds upon which this action is based that the marriage between the parties is irretrievably broken. 7. The Plaintiff avers that she has been advised of the availability of counseling and that said party has the right to request that the court require the parties to participate in counseling. WHEREFORE, the Plaintiff respectfully requests judgment dissolving the marriage between the two parties. Respectfully submitted, IRWIN & McKNIG By: Supreme Cou I.D. No. 5476 West Pomfret rofessio Building 60 West Pomfret et Carlisle, Pennsylvania 17013-3222 (717) 249-2353 Date: December 29, 2006 VERIFICATION The foregoing Complaint in Divorce is based upon information which has been gathered by counsel and myself in the preparation of this action. I have read the statements made in this document and they are true and correct to the best of my knowledge, information and belief. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification to authorities. ;A?/ LAD CK Date: December 29, 2006 JASON L. DICK, Plaintiff, V. MICHELLE E. DICK, Defendant. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 2006 - '13 310 CIVIL TERM IN DIVORCE PLAINTIFF'S MARRIAGE COUNSELING AFFIDAVIT The plaintiff, being duly sworn according to law, deposes and says: 1. 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. 2. I understand that the court maintains a list of marriage counselors in the Prothonotary's Office, which list is available to me upon request. 3. Being so advised, I do not request that the court require that my spouse and I participate in counseling prior to a divorce decree being handed down. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. jz?w_ A?,/ ,J 16N L. DICK Date: December 29, 2006 c ?,) ? 3 tJ C V ` 4t W W W r, . J •? I ?J -ELI if -4 JASON L. DICK, : IN THE COURT OF COMMON PLEAS OF Plaintiff, : CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW 2006 - 7330 CIVIL TERM MICHELLE E. DICK, Defendant. IN DIVORCE AFFIDAVIT OF SERVICE OF COMPLAINT PURSUANT TO PA. R.C.P. RULE NO. 1920.4 (a)(1)(i) COMMONWEALTH OF PENNSYLVANIA . SS:. COUNTY OF CUMBERLAND NOW, Marcus A. McKnight, III, Esquire, being duly sworn according to law, does depose and state: L That he is a competent adult and attorney for the plaintiff in the captioned action in divorce. 2. That a certified copy of the Complaint in Divorce was served upon the defendant, Michelle E. Dick, on January 3, 2007, by certified, restricted delivery mail, addressed to her at 20 Rays Drive, Newville, Pennsylvania 17241, with Return Receipt Number 7003 3110 0004 5768 1619. 3. That the said receipt for certified mail is signed and attached hereto and made a part hereof. I verify that the statements made in this affidavit are a and correct. I understand that false statements herein made are subject to the penalties of a. C. S. Section 4904, relating to unsworn falsification to authorities. Date: January 5, 2007 MARCJJS A. M9KNIGHT, III, ESQUIRE Attorney for tiff . , rr • (Domestic ra For delivery information visit our webi FJ N Ln POBWP $ 0 CWWW Foe 0 Retum Redept Fee C3 (Endorsement Required) Rea r-q c u e G1 r-a M Total Postage & Fees $ M ro C3 O ISO -? - iti DRIVE ¦ Complats llama 1, 2, and 3. Aieo complete a item 4 N Plestric%d DeNvory Is desired. X '4 PrW your r me.and address on the reverse so that we can retum the card to you. g ¦ Attach this card to the flack of the mailplece, or on the rtont H space permits. I-Ad ,. Article Addressed to: MS MICHELLE E DICK 20 BAYS DRIVE NKWVILLE PA 17241 >oN UN171% O M ; v s9 -n v ?, t O n Q i? I x m; ` r Agent M=,1/1 C. Date of Detlvery )-3-b7 ddwryaddtess Real 11 ? Yes YES, eater deuvery addraes below: 0 No 3. Service Type Ceru ed mom 0 Erpm Mail R"Wered gR*xn FiOCeipk for IM$Wwldise 0 insured Mail (7 C.O.D. DdWwy7 (Data Fee) UYW 2. Article Number .7 0 0 3 3110 0 0 04 5 7 6 8 1619 ftm service P3 Form 3811, February no 11C Rssunr Rsoelpt 1025e6-02-M-1540 3 C ?? f JASON L. DICK, vs. IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA MICHELLE E. DICK, Defendant To the Prothonotary: No. 9 4, *7 3 3 ° Civil Term IN DIVO CE Notice is hereby given that the Plaintiff inl the above matter: _X_ prior to the entry of a Final OR _ after the entry of a Final Date: in divorce. hereby elects to resume the prior surname provisions of 54 P.S. s704. in Divorce E of avowing her intention pursuant to the E. Dick Name E. Clouse of Name being resumed. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBEIAND On this, the DC j day of / r personally appeared MICHELLE E. DICK/ N1IC ICI- satisfactorily proven) to be the person whose nan acknowledged that she executed the same for the ):ss , 2007 before me, the undersigned officer, ELLE E. CLOUSE personally known to me, (or e is subscribed to the within instrument, and purposes therein contained. IN WITNESS WHEREOF, I hereunto set any hand and official seal. COMIIIQIV?yg?QLTH F PENNSYLVANIA N Public No" Seal Jaw Cati?e BM County My Commission Expires Sept. 6, 028 ommiss11 expires: Rv P d ?txa ? Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 lmaclaya4 mmglaw.corn IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff No. 2006-7330 CIVL TERM V. CIVIL ACTION - LAW MICHELLE E. DICK, Defendant (In Divorce) AFFIDAVIT OF CONSENT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on December 29, 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 in Divorce after service of the Notice of Intention to Request Entry of a Divorce Decree. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S., Section 4904 relating to unsworn falsification to authorities. Date: 0 rjoa' -'/- /Oid n L. Dick, Plaintiff °; . "j" ?(µl p; rn Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 lmaclay_Adzmmglaw.corn IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff V. MICHELLE E. DICK, Defendant No. 2006-7330 CIVL TERM CIVIL ACTION - LAW (In Divorce) WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(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 I further understand 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 Waiver are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. Date: 4--&-o7 c ? = ?- -- .._.? - ??F .': ?.4?% ? E"S,? ? f1, l -T ji i F _ -"." . ?? ^" ?% ? Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 1mac lay(&dzmmglaw. corn IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff No. 2006-7330 CIVL TERM V. CIVIL ACTION - LAW MICHELLE E. DICK, Defendant (In Divorce) AFFIDAVIT OF CONSENT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on December 29, 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 in Divorce after service of the Notice of Intention to Request Entry of a Divorce Decree. I verify that the statements made in this Affidavit are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S., Section 4904 relating to unworn falsification to authorities. Date: Michelle Dick, De endant ?-t'1 ? . - - ? ? , ""`a ? ? ? r µA ? °' ? ` Es M f...? '_?: Y? ? ? Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 lmaclgy dzmmglaw.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff V. MICHELLE E. DICK, Defendant No. 2006-7330 CIVL TERM CIVIL ACTION - LAW (In Divorce) WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(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 I further understand 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 Waiver are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. 117) hD 11 /im''I Date: Michell . Dick, Defendant C :7 s f .? ..,1 '?$'t ? ; t'.. . ?.?- •x __ ?f "?.? ? _ V _. f 1 1 N ; - ?4 _.r --? ?._ JASON L. DICK, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. No. 2006-7330 (Civil Term) MICHELLE E. DICK, : IN DIVORCE Defendant MARRIAGE SETTLEMENT AGREEMENT THIS AGREEMENT, made this day of August, 2007, by and between, MICHELLE E. CLOUSE, formerly known as MICH LE E. DICK, of Cumberland County, Pennsylvania, hereinafter referred to as "WIFE", and JASON L. DICK, of Cumberland County, Pennsylvania, WITNESSETH: WHEREAS, Husband and Wife were lawfully married on May 20, 1994; WHEREAS, there were two children born of this marriage; WHEREAS, disputes and difficulties have arisen between the parties and it is the intention of Husband and Wife to live separate and apart, and the parties desire to settle their respective financial property rights and obligations as between each other, including the settling of all matters between them relating to ownership and equitable distribution of real and personal property; the settling of all matters between them relating to the past, present, and future support, alimony, and/or maintenance of Husband or Wife; and in general, the settling of any and all possible claims by one against the other or against their respective estates; WHEREAS, each parry has had an opportunity to verify the financial disclosure of the other. Discovery, if any, has been conducted to the satisfaction of each party. Each party has had the opportunity to investigate further the financial disclosure of the other, and has had an opportunity to do an independent valuation of the assets, liabilities and income of the other party. To the extent either party decided not pursue further discovery and investigation, he or she did so voluntarily and specifically waives the right to challenge this agreement based on the absence of full and fair disclosure; NOW THEREFORE, with the aforegoing recitals being hereinafter incorporated by reference and deemed an essential part hereof, Husband and Wife in consideration of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged, and each intending to be legally bound, Husband and Wife hereby covenant and agree as follows: 1. FULL DISCLOSURE OF ASSETS. Each party warrants that he or she has made a full and fair disclosure of income, assets, and their valuation prior to the execution of this Agreement as well as any other fact relating to this agreement. Further, the parties do hereby warrant, represent, acknowledge and agree that each is fully and completely informed of, and is familiar with, the wealth, real and personal property, estate and assets, earnings and income of the other and has made any inquiry he or she desires into the income or estate of the other and received any such information requested. Each has made a full and complete disclosure to the other of his and her entire assets, liabilities, income and expenses and any further enumeration or statement thereof in this Agreement is specifically waived. These disclosures are part of the consideration made by each party for entering into this agreement. Each party agrees that he or she shall not, at any future time, raise as a defense, or otherwise, the lack of such disclosure in any legal proceedings involving this agreement, with the exception of disclosure that may have been fraudulently withheld. In the event that either party, at any time hereafter, discovers such a fraudulently undisclosed asset, that party shall have the right to petition the Court of Common Pleas of Cumberland County to make equitable distribution of such asset. The non-disclosing party shall be responsible for payment of counsel fees, costs, or expenses incurred by the other party in seeking equitable distribution of such asset. 2. WAIVER OF APPRAISALS. The parties acknowledge that they are aware of their respective rights pursuant to the Pennsylvania Divorce Code to obtain formal valuations or appraisals of all assets, including, but not limited to the real estate, personal property, vehicles, and retirement accounts, if any, some or all of which were acquired during the marriage and therefore constitute marital property. However, the parties have determined that they will not undertake the expense to have these items appraised and/or valuated, and that the division of property as set forth in this Agreement, represents a fair and equitable distribution. 3. ADVICE OF COUNSEL. The Husband has employed and had the benefit or counsel of LINDSAY GINGRICH MACLAY ESQUIRE, as his attorney. The Wife has employed and had the benefit of JANE ADAMS, ESQUIRE as her attorney. Each party has carefully and completely read this agreement and has been advised and is completely aware not only of its contents but of its legal effect. Each parry acknowledges that they fully understand the facts and have been fully informed of their legal rights and obligations and each accepts that this agreement is, under the circumstances, fair and equitable, and that it is being entered into freely and voluntarily after having received such advice and with such knowledge as each has sought from counsel, and the execution of this agreement is not the result of any duress or undue influence, and that it is not the result of any improper or illegal agreement or agreements. 4. SEPARATION. The parties intend to maintain separate and permanent domiciles and to live apart from each other. Neither party shall harass, annoy, injure, threaten, or interfere with the other party in any manner whatsoever. Neither party shall interfere with the uses, ownership, enjoyment, or disposition of any property now owned and not specified herein or property hereafter acquired by the other. 5. SUBSEQUENT DIVORCE. The parties hereby acknowledge that Husband filed has filed a Complaint in Cumberland County, Pennsylvania, claiming that the marriage is irretrievably broken under the no-fault mutual consent provision of Section 3301(c) of the Pennsylvania Divorce Code. Wife expresses her agreement that the marriage is irretrievably broken and expresses her intent to execute any and all affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301(c) of the Divorce Code. The parties hereby waive all rights to request Court Ordered counseling under the Divorce Code. The provisions of this Agreement relating to equitable distribution of property of the parties are accepted by each party as a final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. Simultaneous with the execution of this agreement, the parties shall execute their respective Affidavits of Consent and Waiver of Notice Forms necessary to finalize the Divorce. Said Affidavits and Waivers will immediately thereafter be filed in the Cumberland County Prothonotary's Office. If either party fails or refuses to execute and file the foregoing documents, said failure or refusal shall be considered a material breach of this agreement and shall entitle the other party at his or her option to terminate this agreement. Should a decree, judgment, or order of separation or divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants shall not be affected in any way by any such separation or divorce; and that nothing in any such decree, judgment, order, or further modification or revision thereof shall alter, amend, or vary any term of this Agreement, whether or not either or both of the parties shall remarry. It is specifically agreed that a copy of this Agreement or the substance of the provisions thereof, may be incorporated by reference into any divorce, judgment, or decree. This incorporation shall not be regarded as a merger, it being the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and conclusive upon the parties. 6. 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 date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. All provisions of this agreement shall be effectuated by the parties within thirty (30) days of the execution date of this agreement unless otherwise specified within this agreement. 7. MUTUAL RELEASE OF ALL CLAIMS. Other than as provided in this agreement, each party may dispose his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship, including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other, execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. 8. WARRANTY OF DEBTS AND FUTURE OBLIGATIONS. Each party warrants that they have not contracted any debt or liability for the other or which the estate of the other party may be responsible or liable, and except only for the rights arising out of this agreement, neither party will hereafter incur any liability whatsoever for which the other party or the estate of the other party, will be liable. Each party agrees to indemnify or hold harmless from the other and against all future obligations of every kind incurred by them. The parties acknowledge and agree that any and all joint credit card accounts have been closed or transferred into the name of one party individually. The parties agree as follows regarding the debts: (a) Wife agrees that the following debts are her own personal responsibility and therefore agrees to completely and finally pay on the following debts and obligations. The Capital One Account in her name acquired during the marriage. The Credit Card Account with Cross Country Bank in her name acquired during the marriage. The Credit Card Account with First Premier in her name acquired during the marriage. Any and all back lot rent associated with the trailer since the parties' date of separation. Any and all back school/real estate taxes associated with the trailer, which are not addressed below, incurred since the parties' date of separation. Any and all back insurance premiums on the trailer, which are not addressed below, since the parties' date of separation. Any and all debts in her name alone or incurred by her after separation. (b) Husband agrees that the following debts are his own personal responsibility and therefore agrees to completely and finally pay on the following debts and obligations. The Capital One Account in his name acquired during the marriage. The Credit Card Account with First Premier in his name acquired during the marriage. The Credit Card Account with Providian Visa in his name acquired during the marriage. The Credit Card Account with Sears in his name acquired during the marriage. The Credit Card Account with Cross Country Bank in his name acquired during the marriage. Any and all debts in his name alone or incurred by him after separation. (c) The parties have agreed that the following marital debts have been satisfied by one party receiving credit from the other in equitable distribution. Husband received credit for paying the following items for Wife after separation: - the insurance for the trailer through State Farm for 2006 in the amount of $244.00; and - the 2006-2007 school taxes on the trailer in the amount of $245.96;and - the 2006 -2007 fall and spring real estate taxes on the trailer in the amount of $39.77 each; and -the Princess House debt in the amount of $197.04 Wife received credit for paying the following items for Husband after separation: - federal income tax liability for the tax year 2004 in the amount of $1250; and - 1/2 of the Christmas savings loan with Jackson Hewitt in the amount of $2$7.50 9. EQUITABLE DIVISION OF MARITAL PROPERTY. The parties have attempted to distribute their marital property in a manner which conforms to the criteria set forth in the Divorce Code at 23 Pa.C. S.A. s3501 et. seq. The division of existing marital propertyis not intended by the parties to constitute in any way a sale or exchange of assets, and the division is being effected without the introduction of outside funds or other property not constituting marital property. The division of property under this Agreement shall be in full satisfaction of all the marital rights of the parties. 10. BANKRUPTCY. The parties further warrant that they have not heretofore instituted any proceedings pursuant to the bankruptcy laws nor are there any such proceedings pending with respect to them which have been initiated by others. It is stipulated and agreed by the parties that the terms of this Agreement as they resolve the economic issues between the parties incidental to their divorce and the obligations of the parties to each other resulting therefrom shall not be dischargable in bankruptcy, should either party file for protection under the Bankruptcy Code at any time after the date of execution of this Agreement. Should Husband or Wife pursue an action in bankruptcy and be successful in extinguishing his obligation to pay any debts for which he has assumed sole obligation as set forth herein, he or she shall immediately be obligated to pay alimony to the other party in an amount equal to the monthly obligation on such debts that he or she otherwise had assumed and for which he had taken sole obligation and responsibility, plus an additional fifteen percent (15%) in consideration of the tax consequences associated with receipt of alimony. 11. OTHER PERSONAL PROPERTY. Husband and Wife do hereby acknowledge that they have previously divided all their tangible personal property. Except as may otherwise be provided in this Agreement, Wife agrees that all of the property of Husband or in his possession shall be the sole and separate property of Husband; and Husband agrees that all of the property of Wife or in her possession shall be the sole and separate property of Wife. 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 PROPERTY. Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of property, be they real, personal or mixed, tangible or intangible, which are acquired by him or her after the execution of this agreement, with full power in him or her to dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were unmarried. 13. VEHICLES. With respect to these items, owned by one or both of the parties, they agree as follows: (a) The automobile current in Wife's possession shall be and remain the sole and exclusive property of Wife. The parties acknowledge that Wife used the proceeds from the Blazer, which was marital property, to purchase her current vehicle. (b) The 2 Broncos shall be and remain the sole and exclusive property of Husband. The titles to the said motor vehicles shall be executed by the parties, if appropriate for effecting transfer as herein provided, within five (5) days of a request by the other party to do so, and said executed titles shall be delivered to the proper parties immediately thereafter. Each party agrees to be solely responsible for the amounts presently due and owing against his or her respective automobiles and the party receiving the vehicle(s) agrees to be responsible for any and all costs associated with the transfer of the vehicle titled solely into their name. 14. TRAILER. Husband holds title to a trailer located at 20 Rays Drive, Carlisle, Pennsylvania, which was purchased during the parties' marriage. Regarding this trailer, the parties agree as follows: (a) In exchange for Wife waiving Husband's support arrearage, as well as for other valuable consideration listed herein, Husband hereby waives all his right, title, and interest in and to the trailer and Wife shall have sole and exclusive possession of this property. (b) As of the date of separation, and without regard to when bills for such items are incurred, received or due, Wife shall be solely responsible for all past, present, and future costs or liabilities associated with or attributable to maintaining the residence (except as provided herein), including but not limited to, all real estate taxes, lot rent, water and sewer rents, gas, electric, and telephone service, homeowner's insurance, and gardening expenses and repairs, and Wife shall keep Husband and his successors, assigns, heirs, executors, and administrators indemnified and held harmless from any liability, cost or expense, including attorney's fees, which are incurred in connection with such maintenance, costs, and expense. Within five (5) days of a request by Wife to do so, Husband and Wife shall meet and take all necessary steps to transfer the title to the trailer solely into Wife's name. Wife shall be solely responsible for any and all costs associated with the transfer of the title solely into her name. Said title shall thereafter immediately be delivered to Wife. 15. MUTUAL WAIVER OF EMPLOYMENT BENEFITS. The parties agree to waive any and all rights they have in and to each other's employment benefits, including but not limited to both parties IRA's, 401(k)'s, stock savings plans, pensions, and retirement plans and Incentive Savings Plans. The parties agree never to assume any claim to such benefits of the other at any time in the future. 16. ALIMONY, ALIMONY PENDENTE LITE and LEGAL FEES. Each party hereby waives any right to spousal support, alimony, or alimony pendente lite, counsel fees and costs, and each party agrees to be responsible for his or her own legal fees and expenses. The parties herein acknowledge that by this Agreement, they have respectively secured and maintained a substantial and adequate fund with which to provide for themselves sufficient financial resources to provide for their comfort, maintenance, and support in the station of life to which they are accustomed. 17. TAXES. The parties have previously filed joint State and Federal Tax returns. The parties intend on filing separately from this point forward. The transfers of property pursuant to this Agreement are transfers between Husband and Wife incident to their divorce and as such are non- taxable, with no gain or loss recognized. The transferee's basis in the property shall be the adjusted basis of the transferor immediately before the transfer. The transfers herein are a division of marital pro erty for full and adequate consideration and as such will not result in any gift tax liability. aks ?, ?g. L EPENDENCY EXEMPTIONS. ?1 be entitled to claim Cody as a dependent nd shall be entitled to claim Caleb as a deduction for the dependency exemption for the 1?l parties' children under Section 152(e) of the Internal Revenue Code of 1954, as amended. When Cody is emancipated and neither party is able to claim him as a dependent, the parties hereby agree to alternate claiming Caleb as a dependent with Wife claiming even years and Husband claiming odd. Each party agrees that, if necessary, he or she will sign the Internal Revenue Form 8332 or any other declaration required by the Treasury Department or the Internal Revenue Service to implement this agreement. Each party hereby agrees to provide the other with documentation, if necessary, within ten (10) days of a request to sign such document. 19. BANK ACCOUNTS. The parties hereby acknowledge and agree that any and all joint bank accounts have been closed or divided to their mutual satisfaction. 20. LIFE INSURANCE. To the extent that either of the parties have life insurance policies, simultaneous with the execution of this agreement, those policies shall become the sole and separate property of the individual owning the policy. Nothing in this agreement will prevent either party from designating beneficiaries under or encumbering their respective life insurance policies. 21. RECONCILIATION; 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. Notwithstanding reconciliation between the parties, this agreement shall continue to remain in full force and effect absent a writing signed by the parties stating that this Agreement is null and void. 22. 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. Wife and Husband covenant and agree that within five (5) days of a request by the other parry to do so, they will forthwith execute any and all written instruments, assignments, releases, satisfactions, deeds, notes, or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. 23. RIGHTS AND RESPONSIBILITIES. Husband and Wife acknowledge that each of them has read and understands his and her rights and responsibilities under this agreement and that they have executed this agreement under no compulsion to do so but as a voluntary act. 24. APPLICABLE LAW. The 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. 25. INTEGRATION. This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements or negotiations between them. There are no representations or warranties other than those expressly set forth herein. 26. 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 by construed as a waiver of any subsequent default or breach of the same or similar nature, not shall it be construed as a waiver or strict performance of any other obligations herein. 27. SEVERABILITY. If any term, condition, clause, or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause, or provisions shall be stricken from this Agreement; and in all other respects, this Agreement shall be valid and continue in full force, effect, and operation. Likewise, the failure of any party to meet his or her obligations under any one or more of the paragraphs herein, with the exception of the satisfaction of the conditions precedent, shall in no way avoid or alter the remaining obligations of the parties. 28. BREACH. If either party breaches any provisions of this agreement, the other party shall have the right, at his or her election, to sue for damages for such breach, or seek other remedies or relief as may be available to him or her, and the party breaching this contract should be responsible for payment of legal fees and costs incurred by the other in enforcing their rights under this agreement. 29. INFORMED AND VOLUNTARY EXECUTION. Each party to this agreement acknowledges that he or she is fully informed as to the facts relating to the subject matter of this agreement, is entering into this agreement voluntarily, free from fraud, undue influence, coercion or duress of any kind, has given careful thought to the making of this agreement, has carefully read each provision of this agreement, and fully and completely understands each provision of this agreement. 30. AGREEMENT BINDING ON PARTIES AND HEIRS. It is understood and agreed that not only the parties hereto, but also their heirs, administrators, executors and assigns, shall be bound by all the terms, conditions and clauses of this agreement. 31. PRESERVATION OF RECORDS. Each party will keep and preserve for a period of four (4) years from the date of their Divorce Decree, all financial records relating to the marital estate, and each party will allow the other party reasonable access to those records in the event of tax audits. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written: WITNESS: J Adams, Esquire 7ar rney f or Mother . Pitt St. isle, Pa. 17013 (717) 245-8508 Attorney for Wife WITNESS: Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, Pa. 17109 (717) 657-4795 Attorney for Husband Michelle E. Clouse, Mother rn Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 lmaclay_(a)dzmmglaw. corn IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff V. MICHELLE E. DICK, Defendant No. 2006-7330 CIVL TERM CIVIL ACTION - LAW (In Divorce) PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Please transmit the Record, together with the following information, to the Court for entry of a Decree in Divorce: Ground for Divorce: irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and manner of service of the Complaint: Defendant was served via Certified Mail, Return Receipt Requested, Restricted Delivery, by signing the domestic return receipt on January 3, 2007. An Affidavit of Service was docketed on January 5, 2007. As required by Section 3301(c) of the Divorce Code, Plaintiff and Defendant executed their respective Affidavits of Consent on August 8, 2007, which Affidavits are being filed simultaneously herewith. 4. Related claims pending: None. 5. As required by Section 3301(c) of the Divorce Code, Plaintiff and Defendant executed their respective Waiver of Notice forms on August 8, 2007, which Waivers are being filed simultaneous herewith. jA LEY ZUCKER MEIL N MINER & GINGRIC LLC Date: f By: n say Gi h lay, Esqu ttorn ey I. No. 8 954 1029 Scenery Drive Harrisburg, Pennsylvania 17109 (717) 657-4795 Attorney for Plaintiff .. c,. ' ?? ...-? ? ?_: ' ?"j t IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. JASON L. DICK, ri Plaintiff No. 2006 VERSUS MICHELLE E. DICK, DECREE IN DIVORCE - 7330 AND NOW, 2007 IT IS ORDERED AND DECREED THAT JASON L. DICK PLAINTIFF, AND MICHELLE E. DICK DEFENDANT, 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; None. The parties' Marriage Settlement Agreement dated August 17, 2007 is incorporated herein but not merged. ATTEST: ,J PROTHONOTARY f?,,,?,,,, ?? ca.o?- ? `? . .? . } r a ? ?.,? .., y?,,, .i Lindsay Gingrich Maclay, Esquire DALEY ZUCKER MEILTON MINER & GINGRICH, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 Imaclaya,,dzmmglaw.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Docket No. 2006-7330 (Civil Term) Plaintiff/Petitioner V. MICHELLE E. DICK, Defendant/Respondent (In Divorce) PETITION TO ENFORCE PROPERTY SETTLEMENT AND SEPARATION AGREEMENT AND FOR ATTORNEY'S FEES AND NOW, this ? day of AdVtj4, 2008, comes Plaintiff/Petitioner, Jason L. Dick, by and through his attorneys, Lindsay Gingrich Maclay, Esquire of the firm of Daley Zucker Meilton Miner & Gingrich, LLC, and avers as follows: 1. Jason L. Dick, an adult individual who resides at 1860 Walnut Bottom Road, Newville, Pennsylvania, Cumberland County, Pennsylvania, is the Plaintiff/Petitioner in the above-captioned matter (hereinafter referred to as "Husband"). 2. Michelle E. Dick, an adult individual who, upon information and belief presently resides at 20 Rays Drive, Newville, Cumberland County, Pennsylvania, is the Defendant/Respondent in the above-captioned matter (hereinafter referred to as "Wife"). 3. The Parties were married on May 20, 1994, in Sussex County, Delaware. 4. The Parties were divorced on August 28, 2007. A copy of the Divorce Decree is attached hereto and incorporated by reference as Exhibit "A". 5. The Parties' division of all marital property and debts occurred through a Property Settlement and Separation Agreement executed by the Parties on August 17, 2007 (hereinafter referred to as "PSSA"). A copy of said agreement is attached hereto and incorporated by reference as Exhibit "B". 6. The provisions of Paragraph Eighteen (18) of the PSSA, regarding the tax dependency exemptions for the parties' children is as follows: For so long as Husband is timely with his child support payments, Husband shall be entitled to claim Cody as a dependent and Wife shall be entitled to claim Caleb as a deduction for the dependency exemption for the parties' children under Section 152 (e) of the Internal Revenue Code of 1954, as amended. When Cody is emancipated and neither parry is able to claim him as a dependent, the parties hereby agree to alternate claiming Caleb as a dependent with Wife claiming even years and Husband claiming odd. Each party agrees that, if necessary, he or she will sign the Internal Revenue Form 8332, or any other declaration required by the Treasury Department or the Internal Revenue Service to implement this agreement. Each party hereby agrees to provide the other with documentation, if necessary, within ten (10) days of a request to sign such document. 7. Pursuant to Paragraph Eighteen (18) of the PS SA, Husband was entitled to claim Cody as long as his child support payments were timely made to wife on a monthly basis. 8. Since the parties executed their PSSA, Husband timely made his support payments to Wife through Domestic Relations and therefore, when Husband prepared his taxes, Husband attempted to claim Cody as a dependent pursuant to the parties' agreement. 9. When Husband filed his 2007 taxes, Husband attempted to file his 2007 federal and state tax returns with Cody as his dependency exemption (hereinafter referred to as "Proposed Returns") and would have received a federal tax refund of one thousand sixty-one ($1,061.00) dollars and would have owed nothing to the state. A redacted copy of the Proposed Returns with Cody listed as a dependent are attached hereto as Exhibit "C" and are incorporated herein by reference. 10. When Husband attempted to file his Proposed Returns, he received a rejection notice that Cody's Social Security Number had been entered twice. A redacted copy of the notice from Jackson Hewitt- IRS Reject Corrective Action Sheet is attached hereto as Exhibit "D" and is incorporated herein by reference. 11. As a result, Husband had to file amended 2007 federal and state tax returns without Cody listed as a Dependent, (hereinafter referred to as "Amended Returns"). Said Amended Returns make Husband responsible for a federal tax liability in the amount of two thousand one hundred seventy ($2,170.00) dollars and a state tax liability of four hundred eighty-six ($486) dollars. A redacted copy of the Amended Returns are attached hereto as Exhibit "B" and are incorporated herein by reference. 12. As a result of the fact that Husband now has a federal tax liability of two thousand one hundred seventy ($2,170.00) dollars, he can not pay said amount in one lump sum and had to set up a payment plan with the IRS; however, this payment plan includes interest and other penalties. 13. As a result of Wife refusing to honor the parties' agreement under Paragraph 18 of the PSSA, Husband has lost the benefit of a tax refund in the amount of $1,061.00 and instead, now has to pay to the IRS $2,170.00, plus interest and penalties, and to the state $486.00. Moreover, since Wife claimed both children on her tax return, Husband will not receive the benefit of the $300 tax refund check scheduled to be issued by the federal government Therefore, the total of Husband's loss as a result of Wife's alleged breach of their agreement is four thousand seventeen ($4,017.00) dollars. 14. On February 26, 2008, the undersigned's assistant was in contact with Tim Correll, Cumberland County Domestic Relations Conference Officer, who advised that Husband has been not in arrears on his support obligation since the entry of the August 17, 2007 PSSA. 15. On February 28, 2008, the undersigned's assistant was in contact with Attorney Jane Adams, counsel for Wife, advising that Wife was in breach of the August 17, 2007 by claiming both children as exemptions on her tax returns. 16. The undersigned, via letter dated February 26, 2008, requested that Wife pay to Husband $4,017.00 on or before March 10, 2008; however, the undersigned received no response to said letter. A copy of the February 26, 2008 letter is attached hereto as Exhibit "F" and is incorporated herein by reference. 16. As of the date of this Petition, Counsel for Husband has received no response from counsel for Wife. 17. The provisions of Paragraph Twenty-Eight (28) of the PSSA provide as follows: If either party breaches any provisions of this agreement, the other party shall have the right, at his or her election, to sue for damages for such breach, or seek other remedies of relief as may be available to him or her, and the party breaching this contract should be responsible for payment of legal fees and costs incurred by the other in enforcing their rights under this agreement. 18. The provisions of Paragraph Twenty-Nine (29) of the PSSA are as follows: Each party to this agreement acknowledges that he or she is fully informed as to the facts relating to the subject matter of this agreement, is entering into this agreement voluntarily, free from fraud, undue influence, coercion or duress of any kind, has given careful thought to the making of this agreement, has carefully read each provision of this agreement, and fully and completely understands each provision of this agreement. 19. Under Paragraph Twenty-Eight (28) of the PSSA, Wife should compensate Husband for all filing fees, costs, expenses, and attorney fees paid to enforce the provisions of the August 17, 2007 PSSA. 20. Pursuant to Sections 3105(a) and 3502(e) of the divorce Code, Wife should be found in contempt of court for failure to abide by the provisions of Paragraph Eighteen (18) of the Parties' August 17, 2007 PSSA. 21. Husband also seeks reimbursement of attorney fees from Wife, pursuant to the authority found at 3502(e)(7), for fees incurred by Husband in enforcing the provisions of the PSSA. WHEREFORE, Husband respectfully requests this Honorable Court find Wife in contempt of court for failure to abide by the provisions set forth in the PSSA, dated August 17, 2007. Husband further requests this Honorable Court order Wife to immediately pay Husband the difference between what he should have received in a tax refund verses what he now has to pay in tax liability, which amounts to four thousand seventeen ($4,017.00) dollars, plus any amount that the Husband has had to pay in interest and penalties, in satisfaction of the provisions set forth in Paragraph Eighteen (18) of the Property Settlement and Separation Agreement entered into by the Parties on August 17, 2007. In the alternative, Husband requests that this Honorable Court order Husband and Wife to file amended federal and state tax returns allowing the Husband to claim Cody. Additionally, Husband further requests this Honorable Court to order Wife to pay to Husband any and all costs, expenses, and attorney fees expended to enforce the provisions of the Property Settlement and Separation Agreement. Respectfully submitted, DALEY ZUCKER MEILTON MINER & GINGRICH, LLC Date: Dob By: AW, d, ay Ging c Ma ay, Esqu e preme Co I.D. #87954 1029 Scenery Drive Harrisburg, Pennsylvania 17109 (717) 657-4795 Attorney for Plaintiff/Petitioner Mar.18. 2008 2:16PM DALEY ZUCKER GINGRICH LLC No-3445 P. 11 VE=CA'f ON I, Jason L. Dick, PlaintiMetitioner, verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Date: 0c3 - old - d? CERTIFICATE OF SERVICE AND NOW, this ? day of Y h , 2008, I, Amanda M. Shull, Legal Assistant, for the firm of Daley Zucker Meilton Miner & Gingrich, LLC, hereby certify that I have this day served a copy of the Petition to Enforce Property Settlement and Separation Agreement and Attorney Fees, by mailing same by first class mail, postage prepaid, addressed as follows: Jane Adams, Esquire 17 West South Street Carlisle, PA 17013-3220 Attorney for Defendant DALEY ZUCKER MEILTON MINER & GINGRICH, LLC By: 5 Q M, AZ Amanda M. Shull, Legal Assistant 1029 Scenery Drive Harrisburg, Pennsylvania 17109 (717) 657-4795 Exhibit "A" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNA. JASON L. DICK, Plaintiff VERSUS MICHELLE E. DICK, Defendant AND NOW, August 28 DECREED THAT JASON L. DICK , PLAINTIFF, AND MICHELLE E. DICK DEFENDANT, ARE DIVORCED FROM THE BONDS OF MATRIMONY. I. 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; None. The parties' Marriage Settlement.Agreement dated August 17, 2007 is incorporated herein but not merged. BY THE COURT: Edgar B. Bayley ATTEST: J. Certified Copy Issued: ust 2 7 PROTHONOTARY 7330 DECREE IN DIVORCE NO. 2006 ,2007 , IT IS ORDERED AND Exhibit "B" JASON L. DICK, : IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA No. 2006-7330 (Civil Term) vs . : IN DIVORCE MICHELLE E. DICK , Defendant MARRIAGE SETTLEMENT AGREEMENT = c BETWEEN NUCHELLE E. CLOUSE AND JASON L. DICK THIS AGREEMENT, made this /7 day of August, 2007, by and between, MICHELLE E. CLOUSE, formerly known as MICHELLE E. DICK, of Cumberland County, Pennsylvania, hereinafter referred to as "WIFE", and JASON L. DICK, of Cumberland County, Pennsylvania, WITNESSETH: WHEREAS, Husband and Wife were lawfully married on May 20, 1994; WHEREAS, there were two children born of this marriage; WHEREAS, disputes and difficulties have arisen between the parties and it is the intention of Husband and Wife to live separate and apart, and the parties desire to settle their respective financial property rights and obligations as between each other, including the settling of all matters between them relating to ownership and equitable distribution of real and personal property; the settling of all matters between them relating to the past, present, and future support, alimony, and/or maintenance of Husband or Wife; and in general, the settling of any and all possible claims by one against the other or against their respective estates; WHEREAS, each party has had an opportunity to verify the financial disclosure of the other. Discovery, if any, has been conducted to the satisfaction of each party. Each party has had the opportunity to investigate further the financial disclosure of the other, and has had an opportunity to do an independent valuation of the assets, liabilities and income of the other parry. To the extent either parry decided not pursue further discovery and investigation, he or she did so voluntarily and specifically waives the right to challenge this agreement based on the absence of full and fair disclosure; NOW THEREFORE, with the aforegoing recitals being hereinafter incorporated by reference and deemed an essential part hereof, Husband and Wife in consideration of the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged, and each intending to be legally bound, Husband and Wife hereby covenant and agree as follows: 1. FULL DISCLOSURE OF ASSETS. Each party warrants that he or she has made a full and fair disclosure of income, assets, and their valuation prior to the execution of this Agreement as well as any other fact relating to this agreement. Further, the parties do hereby warrant, represent, acknowledge and agree that each is fully and completely informed of, and is familiar with, the wealth, real and personal property, estate and assets, earnings and income of the other and has made any inquiry he or she desires into the income or estate of the other and received any such information requested. Each has made a full and complete disclosure to the other of his and her entire assets, liabilities, income and expenses and any further enumeration or statement thereof in this Agreement is specifically waived. These disclosures are part of the consideration made by each party for entering into this agreement. Each party agrees that he or she shall not, at any future time, raise as a defense, or otherwise, the lack of such disclosure in any legal proceedings involving this agreement, with the exception of disclosure that may have been fraudulently withheld. In the event that either party, at any time hereafter, discovers such a fraudulently undisclosed asset, that party shall have the right to petition the Court of Common Pleas of Cumberland County to make equitable distribution of such asset. The non-disclosing party shall be responsible for payment of counsel fees, costs, or expenses incurred by the other party in seeking equitable distribution of such asset. 2. WAIVER OF APPRAISALS. The parties acknowledge that they are aware of their respective rights pursuant to the Pennsylvania Divorce Code to obtain formal valuations or appraisals of all assets, including, but not limited to the real estate, personal property, vehicles, and retirement accounts, if any, some or all of which were acquired during the marriage and therefore constitute marital property. However, the parties have determined that they will not undertake the expense to have these items appraised and/or valuated, and that the division of property as set forth in this Agreement, represents a fair and equitable distribution. 3. ADVICE OF COUNSEL. The Husband has employed and had the benefit or counsel of LINDSAY GINGRICH MACLAY ESQUIRE, as his attorney. The Wife has employed and had the benefit of JANE ADAMS, ESQUIRE as her attorney. Each party has carefully and completely read this agreement and has been advised and is completely aware not only of its contents but of its legal effect. Each party acknowledges that they fully understand the facts and have been fully informed of their legal rights and obligations and each accepts that this agreement is, under the circumstances, fair and equitable, and that it is being entered into freely and voluntarily after having received such advice and with such knowledge as each has sought from counsel, and the execution of this agreement is not the result of any duress or undue influence, and that it is not the result of any improper or illegal agreement or agreements. 4. SEPARATION. The parties intend to maintain separate and permanent domiciles and to live apart from each other. Neither party shall harass, annoy, injure, threaten, or interfere with the other party in any manner whatsoever. Neither party shall interfere with the uses, ownership, enjoyment, or disposition of any property now owned and not specified herein or property hereafter acquired by the other. 5. SUBSEQUENT DIVORCE. The parties hereby acknowledge that Husband filed has filed a Complaint in Cumberland County, Pennsylvania, claiming that the marriage is irretrievably broken under the no-fault mutual consent provision of Section 3301(c) of the Pennsylvania Divorce Code. Wife expresses her agreement that the marriage is irretrievably broken and expresses her intent to execute any and all affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301(c) of the Divorce Code. The parties hereby waive all rights to request Court Ordered counseling under the Divorce Code. The provisions of this Agreement relating to equitable distribution of property of the parties are accepted by each parry as a final settlement for all purposes whatsoever, as contemplated by the Pennsylvania Divorce Code. Simultaneous with the execution of this agreement, the parties shall execute their respective Affidavits of Consent and Waiver of Notice Forms necessary to finalize the Divorce. Said Affidavits and Waivers will immediately thereafter be filed in the Cumberland County Prothonotary's Office. If either party fails or refuses to execute and file the foregoing documents, said failure or refusal shall be considered a material breach of this agreement and shall entitle the other parry at his or her option to terminate this agreement. Should a decree, judgment, or order of separation or divorce be obtained by either of the parties in this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants shall not be affected in any way by any such separation or divorce; and that nothing in any such decree, judgment, order, or further modification or revision thereof shall alter, amend, or vary any term of this Agreement, whether or not either or both of the parties shall remarry. It is specifically agreed that a copy of this Agreement or the substance of the provisions thereof, may be incorporated by reference into any divorce, judgment, or decree. This incorporation shall not be regarded as a merger, it being the specific intent of the parties to permit this Agreement to survive any judgment and to be forever binding and conclusive upon the parties. 6. 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 date" of this Agreement shall be defined as the date of execution by the party last executing this Agreement. All provisions of this agreement shall be effectuated by the parties within thirty (30) days of the execution date of this agreement unless otherwise specified within this agreement. 7. MUTUAL RELEASE OF ALL CLAIMS. Other than as provided in this agreement, each party may dispose his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship, including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other, execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. 8. WARRANTY OF DEBTS AND FUTURE OBLIGATIONS. Each party warrants that they have not contracted any debt or liability for the other or which the estate of the other party may be responsible or liable, and except only for the rights arising out of this agreement, neither party will hereafter incur any liability whatsoever for which the other party or the estate of the other party, will be liable. Each party agrees to indemnify or hold harmless from the other and against all future obligations of every kind incurred by them. The parties acknowledge and agree that any and all joint credit card accounts have been closed or transferred into the name of one party individually. The parties agree as follows regarding the debts: (a) Wife agrees that the following debts are her own personal responsibility and therefore agrees to completely and finally pay on the following debts and obligations. The Capital One Account in her name acquired during the marriage. The Credit Card Account with Cross Country Bank in her name acquired during the marriage. The Credit Card Account with First Premier in her name acquired during the marriage. Any and all back lot rent associated with the trailer since the parties' date of separation. Any and all back school/real estate taxes associated with the trailer, which are not addressed below, incurred since the parties' date of separation. Any and all back insurance premiums on the trailer, which are not addressed below, since the parties' date of separation. Any and all debts in her name alone or incurred by her after separation. (b) Husband agrees that the following debts are his own personal responsibility and therefore agrees to completely and finally pay on the following debts and obligations. The Capital One Account in his name acquired during the marriage. The Credit Card Account with First Premier in his name acquired during the marriage. The Credit Card Account with Providian Visa in his name acquired during the marriage. The Credit Card Account with Sears in his name acquired during the marriage. The Credit Card Account with Cross Country Bank in his name acquired during the marriage. Any and all debts in his name alone or incurred by him after separation. (c) The parties have agreed that the following marital debts have been satisfied by one parry receiving credit from the other in equitable distribution. Husband received credit for paying the following items for Wife after separation: - the insurance for the trailer through State Farm for 2006 in the amount of $244.00; and - the 2006-2007 school taxes on the trailer in the amount of $245.96;and - the 2006 -2007 fall and spring real estate taxes on the trailer in the amount of $39.77 each; and -the Princess House debt in the amount of $197.04 Wife received credit for paying the following items for Husband after separation: - federal income tax liability for the tax year 2004 in the amount of $1250; and - 1/2 of the Christmas savings loan with Jackson Hewitt in the amount of $287.50 9. EQUITABLE DIVISION OF MARITAL PROPERTY. The parties have attempted to distribute their marital property in a manner which conforms to the criteria set forth in the Divorce Code at 23 Pa.C. S.A. s3501 et. seq. The division of existing marital property is not intended by the parties to constitute in any way a sale or exchange of assets, and the division is being effected without the introduction of outside funds or other property not constituting marital property. The division of property under this Agreement shall be in full satisfaction of all the marital rights of the parties. 10. BANKRUPTCY. The parties further warrant that they have not heretofore instituted any proceedings pursuant to the bankruptcy laws nor are there any such proceedings pending with respect to them which have been initiated by others. It is stipulated and agreed by the parties that the terms of this Agreement as they resolve the economic issues between the parties incidental to their divorce and the obligations of the parties to each other resulting therefrom shall not be dischargable in bankruptcy, should either party file for protection under the Bankruptcy Code at any time after the date of execution of this Agreement. Should Husband or Wife pursue an action in bankruptcy and be successful in extinguishing his obligation to pay any debts for which he has assumed sole obligation as set forth herein, he or she shall immediately be obligated to pay alimony to the other party in an amount equal to the monthly obligation on such debts that he or she otherwise had assumed and for which he had taken sole obligation and responsibility, plus an additional fifteen percent (15%) in consideration of the tax consequences associated with receipt of alimony. 11. OTHER PERSONAL PROPERTY. Husband and Wife do hereby acknowledge that they have previously divided all their tangible personal property. Except as may otherwise be provided in this Agreement, Wife agrees that all of the property of Husband or in his possession shall be the sole and separate property of Husband; and Husband agrees that all of the property of Wife or in her possession shall be the sole and separate property of Wife. 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 PROPERTY. Each of the parties shall hereafter own and enjoy, independently of any claim or right of the other, all items of property, be they real, personal or mixed, tangible or intangible, which are acquired by him or her after the execution of this agreement, with full power in him or her to dispose of the same as fully and effectively, in all respects and for all purposes, as though he or she were unmarried. 13. VEHICLES. With respect to these items, owned by one or both of the parties, they agree as follows: (a) The automobile current in Wife's possession shall be and remain the sole and exclusive property of Wife. The parties acknowledge that Wife used the proceeds from the Blazer, which was marital property, to purchase her current vehicle. (b) The 2 Broncos shall be and remain the sole and exclusive property of Husband. The titles to the said motor vehicles shall be executed by the parties, if appropriate for effecting transfer as herein provided, within five (5) days of a request by the other party to do so, and said executed titles shall be delivered to the proper parties immediately thereafter. Each party agrees to be solely responsible for the amounts presently due and owing against his or her respective automobiles and the party receiving the vehicle(s) agrees to be responsible for any and all costs associated with the transfer of the vehicle titled solely into their name. 14. TRAILER. Husband holds title to a trailer located at 20 Rays Drive, Carlisle, Pennsylvania, which was purchased during the parties' marriage. Regarding this trailer, the parties agree as follows: (a) In exchange for Wife waiving Husband's support arrearage, as well as for other valuable consideration listed herein, Husband hereby waives all his right, title, and interest in and to the trailer and Wife shall have sole and exclusive possession of this property. (b) As of the date of separation, and without regard to when bills for such items are incurred, received or due, Wife shall be solely responsible for all past, present, and future costs or liabilities associated with or attributable to maintaining the residence (except as provided herein), including but not limited to, all real estate taxes, lot rent, water and sewer rents, gas, electric, and telephone service, homeowner's insurance, and gardening expenses and repairs, and Wife shall keep Husband and his successors, assigns, heirs, executors, and administrators indemnified and held harmless from any liability, cost or expense, including attorney's fees, which are incurred in connection with such maintenance, costs, and expense. Within five (5) days of a request by Wife to do so, Husband and Wife shall meet and take all necessary steps to transfer the title to the trailer solely into Wife's name. Wife shall be solely responsible for any and all costs associated with the transfer of the title solely into her name. Said title shall thereafter immediately be delivered to Wife. 15. MUTUAL WAIVER OF EMPLOYMENT BENEFITS. The parties agree to waive any and all rights they have in and to each other's employment benefits, including but not limited to both parties IRA's, 401(k)'s, stock savings plans, pensions, and retirement plans and Incentive Savings Plans. The parties agree never to assume any claim to such benefits of the other at anytime in the future. 16. ALIMONY, ALIMONY PENDENTE LITE and LEGAL FEES. Each party hereby waives any right to spousal support, alimony, or alimony pendente lite, counsel fees and costs, and each party agrees to be responsible for his or her own legal fees and expenses. The parties herein acknowledge that by this Agreement, they have respectively secured and maintained a substantial and adequate fund with which to provide for themselves sufficient financial resources to provide for their comfort, maintenance, and support in the station of life to which they are accustomed. 17. TAXES. The parties have previously filed joint State and Federal Tax returns. The parties intend on filing separately from this point forward. The transfers of property pursuant to this Agreement are transfers between Husband and Wife incident to their divorce and as such are non- taxable, with no gain or loss recognized. The transferee's basis in the property shall be the adjusted basis of the transferor immediately before the transfer. The transfers herein are a division of marital property fo 11 and adequate consideration and as such will not result in any gift tax liability. K IS PENDENCY EXEMPTIONS. Wsa 1 be entitled to claim Cody as a dependent ?andw shall be entitled to claim Caleb as a deduction for the dependency exemption for the parties' children under Section 152(e) of the Internal Revenue Code of 1954, as amended. When Cody is emancipated and neither party is able to claim him as a dependent, the parties hereby agree to alternate claiming Caleb as a dependent with Wife claiming even years and Husband claiming odd. Each party agrees that, if necessary, he or she will sign the Internal Revenue Form 8332 or any other declaration required by the Treasury Department or the Internal Revenue Service to implement this agreement. Each party hereby agrees to provide the other with documentation, if necessary, within ten (10) days of a request to sign such document. 19. BANK ACCOUNTS. The parties hereby acknowledge and agree that any and all joint bank accounts have been closed or divided to their mutual satisfaction. 20. LIFE INSURANCE. To the extent that either of the parties have life insurance policies, simultaneous with the execution of this agreement, those policies shall become the sole and separate property of the individual owning the policy. Nothing in this agreement will prevent either party from designating beneficiaries under or encumbering their respective life insurance policies. 21. RECONCILIATION; 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. Notwithstanding reconciliation between the parties, this agreement shall continue to remain in full force and effect absent a writing signed by the parties stating that this Agreement is null and void. 22. -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. Wife and Husband covenant and agree that within five (5) days of a request by the other party to do so, they will forthwith execute any and all written instruments, assignments, releases, satisfactions, deeds, notes, or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. 23. RIGHTS AND RESPONSIBILITIES. Husband and Wife acknowledge that each of them has read and understands his and her rights and responsibilities under this agreement and that they have executed this agreement under no compulsion to do so but as a voluntary act. 24. APPLICABLE LAW. The 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. 25. INTEGRATION. This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements or negotiations between them. There are no representations or warranties other than those expressly set forth herein. 26. 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 parry hereafter to enforce the same, nor shall the waiver of any default or breach of any provision hereof by construed as a waiver of any subsequent default or breach of the same or similar nature, not shall it be construed as a waiver or strict performance of any other obligations herein. 27. SEVERABILITY. If any term, condition, clause, or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause, or provisions shall be stricken from this Agreement; and in all other respects, this Agreement shall be valid and continue in full force, effect, and operation. Likewise, the failure of any party to meet his or her obligations under any one or more of the paragraphs herein, with the exception of the satisfaction of the conditions precedent, shall in no way avoid or alter the remaining obligations of the parties. 28. BREACH. If either parry breaches any provisions of this agreement, the other party shall have the right, at his or her election, to sue for damages for such breach, or seek other remedies or relief as may be available to him or her, and the party breaching this contract should be responsible for payment of legal fees and costs incurred by the other in enforcing their rights under this agreement. 29. INFORMED AND VOLUNTARY EXECUTION. Each party to this agreement acknowledges that he or she is fully informed as to the facts relating to the subject matter of this agreement, is entering into this agreement voluntarily, free from fraud, undue influence, coercion or duress of any kind, has given careful thought to the making of this agreement, has carefully read each provision of this agreement, and fully and completely understands each provision of this agreement. 30. AGREEMENT BINDING ON PARTIES AND HEIRS. It is understood and agreed that not only the parties hereto, but also their heirs, administrators, executors and assigns, shall be bound by all the terms, conditions and clauses of this agreement. 31. PRESERVATION OF RECORDS. Each party will keep and preserve for a period of four (4) years from the date of their Divorce Decree, all financial records relating to the marital estate, and each party will allow the other parry reasonable access to those records in the event of tax audits. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written: WITNESS: 4ale Adams, Esquire A orney for Mother S. Pitt St. Carlisle, Pa. 17013 (717) 245-8508 Attorney for Wife WITNESS: A 1k, )Attorneyfi say Gin a y, squir rthey Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, Pa. 17109 (717) 657-4795 Attorney for Husband Miche e E. Clouse, Mother Exhibit "C" 02/27/2008 04:00 17177764583 JD'S FLOOR COWERING 0 9epwlp..Tnt of the Treasury - Intemeii Revenge Service w 1049 turn ! I g a I- U.S. v1 I From Tax M L ett)el E r the c 31 or n r And (50B y6i r {(rat nano and Wetal Leek nam0 . instVons.) I. JASON L DICK use the IRS if a joint return, Speuss's first name an0 inltlei Las) Herne label. lab a itie, L L Hnmg ecldrass (number and street), if you have a P.O. Oar. see n32ruclicna. Apt. no. c,tease print R 4860 WALNUT BOTTOM ROAD or type. ctown or poet orrice, stale, and ZIP code. If you hoc: a foreign address, soa instructiOne. Presidential PA 47241 PAGE 02/13 ..,?.; .. M EG t C Hoclal.secur(ty nUrnrw spouse's scolal security A, You must enter A Checking a box below will not change your tax or refund, Filing Status 1 El Single 4 ® Head of household (with qualitying person). (see Instr.) Check only 2 ? Married filing Jointly (even if only one had income) If the qu2Jify)ng person is a child but not your dependent, one box. 3 ? Married filing separately. Enter spouse's SSN above and enter this child's name here_? a F1 n„-t;f Arin wldnwfPA with deoendent chiid_fsee inatr) Exemptions If more than four dependents, see instructions. Ba Yourself. If someone oan claim you as a dependent, do•not check box 6a .. .. . . . . D 6ej a use . c Dependents: 1 F'r n m n e . . (2) Depondent's soclel Security number - - - - - (3) oepentient-a relationship to (a) if clualifyinq child for child tax r r See irwr CODY A DICK SON TINA SMITH NONE JAMES SMITH. NNE LEE.ANN SM I TN NX Income 7 Wages: salaries, tips. etl:, Attach Form(s) W-2 .. ... .... ..... . ... • . • . • . 8a Taxable interest. Attach Schedule B if required . ..... . . . .. .. • ' . • L8b I 8 l d li Attach Form(s) W-2 b a .. .. . .. . . . ne u e on Tax-exempt interest, Do not inc here. Also attach 9 a Ordinary dividends. Attach Schedule B if required ... .. .. .. • - .. • . . . • . . I 9b Forms W-2G and b Qualified dividends (see instructions) ........... . . . . • 1099-•R if tax 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) .. ... . wag withheld. 11 Alimony received . . .. . . . . ... . . . .. .. . . • . . ..... . . .. . . . .. ... . 12 Business income or (toss). Attach Schedule C or C-EZ ......... ......... ... . 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ... 10, ? if you did not 14 Other gains or (losses). Attach Farm 4797 . • get a W-21 see i6 a IRA distributions . . .... • . . . , 15a ..,, b Taxable amount (see insir). instructions, 16 a Pensions and annuities ...... 18 b Taxable amount fees Instr). 17 Rental real estate, royalties, partnerships, S corporations, trusts, eto. Attach Schedule E ... . Enclose, but do 18 Farm Income or (loss). Attach Schedule F ..... .. . . . . ..... ...... . .. • . • . not attach, any 19 Unemployment compensation . • . • .. • . payment. Also, 20 a Social security benefits .... . . 120a I b Ta mble amount (aee insr). please use 21 Other income. List type and amount (see instructions) .. .. ...... . 23 Educator expenses (see instructions) . ... Adjusted 24 Certain business expenses of reservists, perforating artists, and Attach Form 2106 or 21ofl-EZ . . Gross fee-basis government officials . Attach Form 8889.. ... . . Income 25 Health savings account deduction 25 . ........... . . . Attach Form 3903 expenses 26 Movin 28 . . . g 27 One-half of self-employment tax. Attach Schedule SE ... . . . 27 IAN and qualified piton ... . . . .. SIMPLE e4 SEP 28 Self-emplo 2e . , y 29 Self-employed health insurance deduction (see instructions) . . 29 ........ . 30 Penalty on early withdrawal of savings . .. . . aid b Recipient's SSN ? 31 a Alimon 31a yp ..... . . .. . . 32 IRA deduction (see instructions) ? .. .. . . . dent ban Interestdeduotion (see instructions)....... .. 33 St 3 u Attach Form 8917 ......... 34 Tuition and fees deduction 4 . Attach Form 8903. roduction activities deduction 35 Domestic 36 . p 36 Add lines 23 through 31a and 32 through 35 .. ... .. .. .. . ... . • • . • • • • • • on 69 and 60 No, of Children on 60 wno: 4 • lived with you 9 did not live Win yoV dive to divorce or aeporatlon (see instrudions) 0ependents on ac 3 not entered above Add number s privacy Act, and Paperwork Reduction Act Notice, sec Instntatilorts. MxA F 11;5107 F:wm 1040 (2007) 02!27/2008 04:00 17177764583 JW S FLOOR COVERING PAGE 03/13 C EF _ IAQrW I nIs,if R1:kLU1%')a afT AM 91AW A7 ? 0-1 TeX end 38 Amount from line 37 (fidiusted gross income).. , . • ... . . ... . ... . . . .. .. . .... 3 3 C dits 39 a Check J ? You were born before January 2, 1943, ? Blind. ? Total boxes Standard if: ? Spouse was born before January 2, 1943. ? Blind. checked 0-392 . b v your spout.. itemizes On a separate retum or you ware. a dwat-status alion., see imir and check hore 10-39b Deduction L for • 40 itemized deductions (from Schedule A) or your standard deduction (see left margin) . .. , . 0 ,650 o Peco!a who 41 Subtract line 40 from line 38 ... .. . ....... . . .... ...... . ... .. . ... 4 2,423 checked any acx on iina . . 42 If litre 38 is $1171300 or less, fnuitiply $3,400 by ft total number of exemp8ons claimed on llne 6d. If line 38 Is over $117,300, see the worksheet in the instructions ..... , , ..... "?, .a, 4 17 000 ?? °,jv c r ai 0-b or 43 Taxable income, Subtract line 42 from line 41, if lime 42 is more than line 41, enter -0-.. ... , 0-4 ©1\E wno pan ba o;air eo as a 44 Tax (see inevi, check iiamy tax is Rom: a El Form(s) 8814 b 0-J Pam, 4972 c ? FuCnt(3) $$l39 Wit dependert. 45 Ahernativo minimum tax (see )nstructions). Attach Form 62.511 . . . . . . . . . . .. . . . . . . . 45 .ee Inatructiors. 46 Add fines 44 and 45 ? 46 W Ail Othsra: gip nr 47 Credit for child and dependent care expenses, Attach Form 2441 47 e Monied rung 48 Credit for the elderly or the disabled, Attach 50nedule R . ..... F seoaraitly. 49 education credits. Attach Form 8883 . . . . . . . . . . . . . . .. . 49 ss,3eo 50 Residential energy credits. Attach Form 5695 .. . , .. ..... . 51 Foreign tax credit Attach Fong 1116 sf re uired 50 5 = );;tnt!v or Auaiiryino . q . , . .. • .... 52 Child tax creditt (see instructions), Attach Form 8901 if required 52 ' w do1wier), $10,700 53 Retirement saAngs contributions credit, Attach Form 8880 . ... . 54 Credits from: a ? Form 8396 b ? Form 8859 a ? Form 8839 53 ?' kcad o5 heusencld, $73-50 65 Other rred1t9: a ? Form 3800 b ? Form 8801 c ? Form 5 56 Add lines 47 through 55, These are your total crodit9 . . . . .. .. .... . .. . . . . .. .. . 57 Subtract line 56 Lgrin line 46. If lie 6 ' r line ? 57 NONE Other 58 Self-employment tax, Attach Schedule SE . . . . . .. ........ .. 58 2.170 Taxes 59 Unreported social security ana Iuleatcare tax from: a ? Fount 4137 b ? Form 8919 59 60 Additional tax on IRAs: other qualified retirement plans, etc. Attach Form 5329 if required . . .. . 61 Advance earnod Income credit payments from Form(s) W-2: box 9 . .... . . . . ...... . . 62 Household employment taxes, Attach Soheduie H . . . . .. .. . . . . .. . . . . . ..... . 2 A 'a lines 57 th ou • i our total to ? 8 2,170 Payments 64 Federal income tax withheld from Forms W-2 and 1099 . .. , .. 64 65 2007 estimated tax payments and amount applied from 2006 return 66 If you have a Boo Earned income credit (IF)C) .. , . , . . . .. .... . 662 2,053 , quallfylflg b Nontaxaibie combat pay election 0-- 664 child, attach 67 Excess social security and tier 1 RRTA tax withheld (see instructions) 67 = w. ' 0-11 ! . 68 Additional child tax credit Attach Farm 8612. .. , .. .. - 37$ t 68 Amount paid with request for extension to file (see (nsmic;tfons) . 70 Peym®,,0-a from: a ? form 2438 b ? I:orm e,38 C ? r`orm 8885 70 71 Refundable credit for prior year minimum tax from Form 8801, In 27 1 72 A lines 65, 662 and 57 r h 71. ere are your to a nt% . ? 72 3,231 Refund 73 If line 72 is more then tine 63, sulAract line 63 from line 72. This Is the amount you overpaid • , . 73 1 061 Direct daposi1? 74 a Amount of line 73 you want refunded to you. If Form 8868 is attached, check here . .. ? ? See instructions ? b RoUdrig number ?c Type; ? Checking ? Savings and 511 in 74b, 74c, and 74d. ? d Account number r Farr, 8$& 75 Amount of ilne 73 tied to our 20091 1 tad tax 10-F75 74a tut ?• Amount 76 Amount you owe. Subtract line 72, from line 63. For details on how to pay see instructions . ? O OW Estimated tax penalty Instructions) 77 NONE 76 i ntrd Party Do you want to allow another person to dlsouss this return with the IRS (fee Instructions)? ® Yes. Complete the following. ? No Designee Desiynea'a Pt ono Personal Identification sM ? Rosanna M C i i ire Do. ? 301 739-1528 nuinkm N ?59919 Sign Under oenatties of perjury. I dada,& that I hqua nxamfnad this return avd accompanying senedufes and 5iaEem4nts. SW to the best of my knowledge and bafief, [Mey are uue. correct, ono comp!ew Declaration of preparer (other than: iarp;yarl Is based on all information of whim preparer has Dny knowledge. Here Yvu, signature ciot¢ tour odzupetian Di hane numger Joint return? $ EMPLOYED JClP. instructions. 01i SDOUZs'S signal Z If a yoint return, both must sign.. Date spouse's occuDattan & Keep a copy for vo-ur ` PaEd Preparer'a Date Cneck 0-t Preparer's 5SN or MN Pt•eparees Am Appleby arn t P00415701 Use Only Firm's n&me (or youm Jackson Hewitt Tax Service EiN52-2066592 :f ploy ): eel' ?m 50 F King St -, Pncaa nn. rw,. r 11 rfii47 Fora 1040 ;2ocrj 02/27/2008 04:00 17177764583 R J JD'S FLOOR COVERING 07CO113196 PA-40 - 2007 Pennsylvania Income Tait Retum ENTER ON5 LETTER OR NUMBER IN EACH BOX Do Not Use Your Praprtntod Label DICK JASON L Occupation SELF EMPLO Occupation 1860 WALNUT BOTTOM ROAD NEWVILLE PA 17241 717 386 1384 21050 PAGE 04/13 C EF L. N Extension. N Amended Return. R Residency Status. PA ResidenVNonresident/Part-Year Resident from to Single/Married. Filing Jointly/Married: Filing SeparatelydFlnal Return/Deceased Date of death N Fetmers. la Gross Compensation. Do not include exempt income. such as combat tone pay and qualifying retirement benefits. See the instructions. 1b Unreimbursed Employed Business Expenses.. 1c Net Compensation. Subttact Line 1t? from I-lne la. 2 Interest Income. Complete PA SchoduteA if required. 3 Dividend and Capital Gains DistribuUons Income, Complete PA Saedulo B if required. 4 Net Income or Loss from the Operation of a Business, Profession, or Farm. 5 Net Gain or Loss from the Sate, Exchange, or Disposition of Property. e Net income or Logs from Rents, Royalties, Patents, or Copyrights. 7 Estate or Trust Income. Complete and aubmit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 9 ToWPA Taxable Income. Add only the positTee income amounts from Lines 1c, 2, 3, 4: 5, 5, 7, and a. DO Nor ADD any losses reported on Lines 4, y• or S. 10 Other Deductions. Enter the appropriate code for the type of deduction. N See the instructions for additional information. 11 Adjusted PA Taxable Imoms. Subtract Line 10 from Line 9. 1a 0 1b 0 1C n 2 0 3 0 4 15836 5 Q 6 0 7 0 8 n 9 35836 10 Q 15836 EC Page 1 of 3 FC 0700113196 ? 1 1 1 r= ? 0700113196 02/27/2008 04;00 17177764583 PA'-40 - 2007 Soclai Security Number JD'S FLOOR COVERING 0700213200 PAGE 05/13 C fF L. Name(s) JASON L DICK 12 PA Tax Liability. Mulfiply Line 11 by 3.07 percent (0.0307). 13 Tutat PA lax Withhcid. Sacs the Instrvc0on5, 14 Credit.from your 2006 PA Income Tax return. 15 2007 Esfimated )natatiment Payments, 16 2007 Extension Payment. 17 Nonresident Tax Wtthheld from your PA Schedule(s) NRK-1, (Nooresidenta only) 18 Total Estimated Payments and Credits, Add Lines 14, 15, 16, and 17. Tax Forgiveness Credit. 19a Fiiing Status: $ 01 unmarried or Separated 02 Married 03 Deceased 19b Dependents, Part B, Llrte 2,. PA Schedule SP 20 Total Eligibility Income from Part C, Line 11. PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schadctle SP. 22 fttiderit Credit. Submit your PA Schedule(s) G-5/0-L and/or RK-1. 23 Total Other Credits. Submit your PA Schedule CC. 24 TOTAL PAYMENTS and CREDITS. Add Lines 13 and 16, 21, 22, and 23. 25 TAX DUE. If Line 12 is more than Line 24, enter the difference here. 26 Penalties and Interest. See the instructions. Enter Code. If attaching form REV-1630, mark the box. N 27 TOTAL PAYMENT. Add Lines 25 and 26. 28 OVERPAYMENT. If mine 24 is more than the total of Line 12 and Line.26, enter the difference here. The total of Lines 29 through 35 must equal Line 28. 29 Refund - Amount of Line 28 you want as a ohaok mailed to you. Refund 30 Credit . Amount of Line 28 you want as a credit to your 20(28 estimated account- 31 Amount of Line 28 you went to donate to the 1Wld Resource. Conservation Fund. 32 Amount of Line 28 you want to donate to the Witary Family Regal' Assistance Program. 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenite (Typo 1) Diabetes Cure Research Fund. 35 Amount of Line 28 you want to donate to the Breast and Cervical Cancer Research Fund. Signgture(s), finder penalties of perjury, I ?'wej cleciar that I (we) have examinW thiS return, including 811 Your Signature Preperer'S Name eno TeEeahone Number 12 486 13 0 14 a y5 0 16 0 17 0 18 0 19A 01 190 01 20 15836 21 486 2R fl 23 fl 24 486 25 0 26 0 27 E3 28 a 29 30 31 D 32 33 a 34 p 35 0 l E C IPTIN Date 522066592 XXXXXXXXX Page 2 of 2 Spoo"% Signature, F Fling jWnily .....,, 0700213200 0700213200 02/27/2008 04:00 17177764583 PA SCHEDULE SP Special Tax Forgiveness JD'S FLOOR COVERING 9701110025 PAGE 06/13 C EF Nsrre of taxpovtr dai-ing Tex Forgiveness fif filar.„ a FA-40 ioiruy' enter the narne shown 5octal security Number {shown ffrat JASON L DICK spouse's NB-9 (6vBn If filing ?Opa:alaiyl °auuae'a 3oalal Security r?vmb¢r i E tigibllitY questions 1. Are you a dependent on another taxpayer's (paren(, guardian, step-parent, etc-) r8dera} tayc return? 2 if you answered "Yes" above does the taxpayer on whose return you area dependent qualify for tax forgiveness? Yes ? No M Yes ? No ? IMPORTANT: if you answered "No" to Queetion 1, please proceed with completing Schedule SP. If you answered "Yet" to Question 1: you must also have answered "Yea" to Question 2 to be eligible for tax forgiveness and complete fine 1b, or Line 3o, from Part A•betow. Part A. Filing Status for Tax Forgiveness. 1. Z Unmarried - Use Column A to calculate your Eligibility Income. Check the unmeroad box an Las 19a of your PA-40. Check Me ban that deacroas your situation: a. Single. Unmarried/divorced on December 31; 9007 b. ? Single and claimed as a dependent on another person's PA Schedule SP. Enter the other person's' SSN; Name: 2. ? Separated - Use Column A to cakt;ulate your Eligibility Income. Check this box only if (a) you are separated pursuant to a written agreement or (b) you were married, but separated and lived apart for the last six months of the year. Check the Unmarried box on Line 19a of your PA-40. 3. ? Married " Check the Married box on Line 19& of your PA-40. Enter your spouse's name and SSN above, crieck the box that descrion your situation: a. ? Married and claiming TAx Forgivenesa "ether with my spout;e. lase Column A to calculate Eligibility Income. ' b. ? Married and filing separate PA tax returns. ? Certification. Check this box certifying that you and your spouse are submitting the same information on each PA Schedule SP. Use Columns B and C to-calculate your Eligibility Income. c. ? Married with a spouse who i5 a dependent on another person's PA Schedule SP or federal -income tax return. Use Columns B and C to calculate Eligibility Income. Enter the other person's: SSN: Name: d. ? Separated and lived apart from my spouse but for less than the last six months of the year. Use Columns Band C to calculate Eligibility Income. Enter your spouse's name and SSN above. 4. ? Deceased - use CoWmn A to calculate your Eligibility Income. ghee: the, Deceased box on Line 195 of the PA-40. You must annualize the decedent's income (see the instructions) and briefly desaibe your method: Pe B. n nt C dren Pr d Ir he ntor:nsoon for c n(sw a c . if more than lour de a ohiidren, submit atldilional sheets in this €ormai. _ I Onty claim the child or children no.,a.,ae nt?n,a Anr_ Rnimfianshio Social S ri No. i that you claimed as your dependent(s) on your 2007 Federal income Tax recur 2. Number of dependent children. part i ibil" Inc me Married taxpayers filing jointly use Column A and Eligibility Income Married taxpayers filing separately, and taxpayers separated but not for the last Table 2. Single filers. qualifyin separated tilers, ana It nhng for C lu A AnTalloiblifty Income Table 1. 114 nfhs oft ar use C ! and and Eli ibill InOP_rUg 'Cable 2- coiumn A Income Tal?I are in the PA-40 booklet Eli ibilit T Marrial Fill IQ atet Unmarried or Married Filin ointl . y g he Column B TAVMIL_ Column C sDO 1. 15 PA le income, f z, n I interest. dividends, annualized 'noo a 2. 4 Insurance proceeds an inheritances 4. 5- oft, awaws, a tze5 6• G, n 1 nt in o art ar resident t 13- 7. Nontaxable military, ing2me - Q9 not inclUde o b t a Gain xcl d ruWencer 9. Nontaxable educational _a$Eistaricy 10 h ryoelygd f o f py[posea m outside Your h=A ,. 15, Total Eligibility ! f C:olympi A Total Eligibili ty Income F Columns 8 and C - add Lines 1 through use and enter total 111- 1 at t D. Calculating Your a Po ivaneas Credit 12. your P Lin 2 i mended re i s 12. 1 Le5a a from o r PA Line 2 13. 14 48 N ? Tax Liability. Subtract Lin 13 from 1 12 1 151 .00 Percentage of Tax Forgiveness Born the Eligibility income Table dependents 0ing your o Part B and vqur Total Eli ib•i Inoome from Ling 11 Pja 1 Hass Credit Muni I 'fns t im I on Llne 15. En(oro;i P -40 Line 2 16. Exhibit "D" 02/27/2008 04:00 17177764583 JD'S FLOOR COVERING PAGE 07/13 aACKSDN HEWITT TAX SERVICE IRS Reject Corrective Acton Sheet (B..ZM0540028.1)CR) Processing Center. ; BEM Date; 02/24/2008 Time: 12:59:25 PM Return IRS EF FFIN-Rere:ipc TBW Cycle SSN Typo Code Date ST Octant office DI 252037-34529 17629 ACR Rejeot 02/23/2008 AN 15078 JASON DICK I-) IRS Reject: 0506 Form: SCHEIC occur: 01 Field: 0025 )n schedule SIC, the SSN for child 1 was previously used for the same purpose. This means that Jac child waCa previously identified as a qualifying child on another return, or the SST was rteviously used (in error) on another return, or the SSN on this return is in error. First ;heck any pxepa.rer documentation (SSN copy, etc) to verity correct entry. Next contact customer verify SSN with personal documents and to ask about any other filers who might have .daritifcied the child as qualifying for EIC, Finally have customer verify records with the 'ocial.Security Administration (SSA), (If there 3s a IRS/BSA mismatch it may take two weeks to :orrect.) If there is no error in the S$N as transmitted, then the child has already been identified for EIC (or the SSN used), and the only recovrses are to either file a paper return with the child, (and preferably an explanatory statement), or to retransmit without the child as qualifying for SIC. NOTE: PxoFiler automatically sel;'ects anatural, child before any foster ;hild' as a qualifying child as Child I on Schedule EIC. To remove this child from Schedule UC_, disqualify him/her using the "claim.ed as E7C qualifying person on another return" question. Ln the EIC section, This will shift the next available natural, child (it any) into a lualifying child slot. 2.) IRS Reject: 0507 Form: 1040 OCCUr: 01 Field: 0175 >i Form 1040, the SSN for dependent #1 was previously used for the same purpose. This means "hat the dependent was previously claimed on another return, or the SSN was previously used (in. 3rro7r) on another re(.urn, or the SSN on this return is in orror. First check any preparer locumentation (S5N card copy, etc) to verity correct entry_ Next contact customer to verify SON aith personal documents and to ask about any other filers who might have claimed the dependent. Finally have customer verity records with the social Security Administration (SSA). (if theme iz a XAS/SSA mismatch, it may take two weeks to correct.) If there is no error in the SSN as transmitted, then the dependent has already been claimed (or the SSN used), and.the only recourses are to either file a paper return with the dependent (axed preferably an explanatory statement), or to retransmit w:.thout the dependent. Exhibit "E" 02/27/2008 04:00 17177764583 JD'S FLOOR COVERING ntomarnent of the Treasury - Int&Cnat Revenue Service m 1 040 U.S. indivi sa gigm, I I- D Qme Tax N R Label Fat the ar J. 1- Dec 1 2007. or lijor to t (See YourrQr8t Herne and IrJtla Last r!0me instructions.) L JASON L DICK use the IRS a it a join( return, spouses ttrat name Intl initiai Last name E iflbal, L Utheru;ge, Fr Home address (numbar grid stfest). It you have a P.O. Lox, See instructions. Apt. tlo. E plec188 print R or type.. I~ 1860 WALNUT BOTTOM ROAD PAGE 08/13 C EF MA o; staple in thi3 a C - onsa M1to. 1?aa-00y4 Your social seeurny nustlber spouse's social se4urlty nut loor A, You must enter A City, Sown or port oft:re, Mete, and sir codb, tf you havo a fwaigA address. ACa !ncrructlon3. Checking a box below will PrQgidential NPA 117241 not change your tax or refund. Et o' Cam at n? Ch2ck_hrMify if r ro r fi jointly. i ? You 8 o se Filing Status 1 Single 4 (1 tread of household (Hllth qualifying person). (See instr.) Check only 2 C? Married feting jointly (even if only one had income) If the qualifying person is a child but not your dependent, one box. 3 Married -filing separately. Enter spouse's SSN above and enter this chlid's name here.? Exemptions if rrlorc than four dependents, see instructions. 6 a Z Yourself. If someone can claim you as a dependent, do not o hec)c box r2a . .... , a n e.. c Dependents: 1 First n a i t c, (2) Dependenre soclar security number (3) Depandenrs relationship to (a) Vif qualifying child for child %ox r d a TINA SMITH NODE JAMES SMITH NONE LEEANN SMITH NONE Income 7 Wages, salaries, tips, etc. Attach Form(s) W2 ... , , . .. .. • . . .. .... . . ... .. . . Attach Form(s)1W-Z 8 a b Taxable Interest. Attach Schedule J3 If required .. , , . ... t . , .. , .... . Tax-exempt interest. 0o not include on line 8a ... , , .. , , . 18b. t here. Alao attach 9 a Ordinary dividends. Attach Schedule B if required .......... ........ . Forms W-20 and b I Qualified dividends (see Instrucilons) .... . . ...... . . ! .. sb I 1099-R if tax 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ... . wets 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 . . , . 11 0 If you did not 14 Ot ter gains or (losses), Attach Form 4797 ....... . , . .... . , . get a W-2, see 15a IRA distributions . ......... 15a b Tsxabie amount taee insv). instrutdorg, 16a Pensions and annuities ...... 164 b Taxable amount (see ir,ato 17 Rental real estate, roolties. partnerships, S corporations, trusts, etc. Attach Schedule E ... , Enclose, but do 18 Farm income or (lose). Attach Schedule F . . . . . . . . .. .. . .. . . . . . . . ... .. . nat attach, any Al 19 ilnemplcWent compensation , , .. . ..... ... . . . . . . . i S l I pay'rent. so. 20 a ocia secur ty benefits , ..... 20e1 b Taxable amount (sae metr). please use 21 Other Income, Ust type and aimount: (see: instructions) 23 Educator expenses (see instructions) ........ . ..... . 23 Adjusted 24 Certain business expenses of reservists, performing artists, and Gross fee-pasis government officials. Attach Form 2106 or 2106-EZ . 4 Incornie W Health savings account deductlorl. Attach Form 8569... . 2 26 Moving expenses. Attach Form 3903. , .. . , , .. . , • . , , , 28 27 One-haif of serf-amp(cyment tax. Attach Schedule SE . .. 27 1 a8 Self-employed SEP, SiMFUE, and qualified plans ... , 29 Self-employed health Insurance deduction (see instrucdons) . . 30 Penalty on early withdrawal of savings . ... . . . .... .. . . . 30 31 a Attrnony paid b Recipiertf s SSN ? AIM_ 32 IRA deduction (see instructions) .. ..... .. . . ... . . .. 32 33 - Student loan interest deduction (see inatluctions) ......... 3 34 Tuition and fees deduction. Attach Form 8917 . ......... 34 4 35 Domestic production actlvitles deduction, Attach Form 8903 . . . 39 36 Add lines 23 through 31a and 32 through 35 .. ... .. . , , .. .. .. ... , . .. . Soxto checked on 6e and eb No, or children on 60 who; 6 ilved with you a did not live with you due 10 divorce or sgpara1lon (ass instructions) Dependents or, 6c 3 not entered at)ove Add numbers For Disclosure, Privacy Ack and Paperwork Reduction Act Notice, w o instrtsetWinis, h4XA F 11/5/07 Form 1040 (2007) 02/27/2008 04:00 17177764583 ,._IA.Si1N I RICK' JD'S FLOOR COVERING RMA . FTR MA 91'1117 (17 PAGE 09/13 C EF Tax and 38 amount from line 37 (adjusted gross income) . . .. . ........ . . , ..... , dits of 39a Check ? You were born before January 2, 184.3, © Bhnd. Total poxes Standard if: l ? Spouse was born before January 2, 1043, ? Blind, checked 0.399 Deduction b if your spouse itemizes on a :aparat2 retort Or you were edual-stalu3 8fi@n, sae Ina r and CrSpck hCre ?38b for - 40 Itemised dedoctions ((roar Schedule A) or your standard daductiori (see left margin) . .... `" 40 50 7 fd NAOO!rs :vhg • 41 Subtract line 40 from line 38 . . . .. . .. . ... . . . . . . . . . .. . . . . .. . . . . . ... . 4 4,923 o0ac-Lew qny sir cn nr,a 42 If tine 38 is $117,300 or less, multiply $3,400 by the total number of exem0one claimed on line 6d. if line 33 is over $117:300. see the worksheet in the instructions ..... . .. . .. , 42 600 399 or 'sn of whc con ne 43 Taxable Income. Subtract line 42 from 1100 41. If line 42 is more than tine 41, enter -0-..... , OE cla!nteo ea a 44 Tax isee Instr). ci%ack if any tax is Horn: a 1? Form(s) 8814 b D Form 4972 a ? Form(a) 8689 E 1 depandeni. 45 Alternative minimum tax (see instructions). Attach Form 6251 . .... . ...... . . . . . . a5 • soe insgva,ions• 46 Add lines 44 and 46 • , ...... . . , .. .. .. , , ? 46 Q Ail otharc: le or So 47 Credit for child and dependent care expenses. Attach Form 2441. 4 g Married filing 48 Credit for the elderly or the disabled" Attach Schedule R . . .. . . ssparately 49 Education credits. A'%qh Form 6863 .. . . . ....... . . . . . 49 .0,150 50 Residential energy credits. Attach Form 5695 .. .. .. 5 N:arrkld filing io;nt+y or 51 Foreign tax credit, Atfadi Form 1116 if required .. . . .. .. .. . 54 aum;:ryi,:g 52 Child tax credit (see instructions). Attach Form 8301 if required 52 y<;dow(ar), 5.3 Retirement savings contributions credit. Attach Form 11880 .. .. 53 110,700 54 Credits from: a ? Form 8396 b ? Form 8859 c 0 Form 8839 5 cuaehotd, L_?_r860 55 Other credits: a El Farm 3300 b F Form 8801 c ? Form 9 56 Add lines 47 through 55. These are your total credits . .. . .. .. . . . . . .. ..... . . 56 37 Sub act ' fr2M n 46. If tine 56 is mQrg Than line 46, ter ? 57 Other 56 Self-employment tax. Attach Schedule SE - , .... ... .. . .... ....... , . 58 2 170 Taxes 59 Unreported social security ant! Medicare tax from; . a ? Form 4137 b ? Form 8919 59 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Fot"m 5329 9 required ..... 6 61 Advance earned income credit payments from Form(s) W-2, box 9. • . . .. .. . . . .. . .. . 6.1 62 Household employment taxes. Attach Sohedule N ... .. . . .. .. .. . , 62 6 A lines 7 rou n 62 This is your t . ? 2,170 Payments 64 Federal lnocme tax withheld from Formes W-2 and 1099 .. , , , . 64 65 2407 estimated WX payments and amount applied from 2006 return 135 It you have a 66 a Earned income credit (EIC) . , .. . , , . . , , , . MIR qualifying b Nontaxable combat pay election ? child, attach 67 Excess social security and tier 1 RRTA tax withheld (see instructions) . 67 •Y Schedule I 68 Additional child tax credit. Attach Form 8812 . ..... .. . . . .. 68 69 Amount paid with request for extension to file (see instructione) , , 69 70 payments irorrt; a ? Farm 24sq b ? Farm 4135 c ? Pplm 8985 70 71 Refundable credit for prior year minimum tax from Form 8801, In 27 71 72 Add lines 64, 6§gS1nJ 07 h 71. These or wi a nts ? 72 E Refund 73 If lino 72 Is more than line 63, subtract line 63 from line 72, This is the amount you overpaid , , . 73 Oirtfot deposit? 74 a Amount of line 73 you want refunded to you. If Form 6888 is attached, check here , ? ? 4a Sea instructions ? b Routing number ? c "type: ? Checking ? Savings and `NI in 74b, ` 74c, and 74d. d Account cumber . or Form $865,_ _ 76 AMoul' t of line 73 youw2nl applied to our 2 08 o d II 75 -tax A!'r'toUnt 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see instructions . ? You QW9 7 m tad iax I s r 77 N 2 1TO l Clara, warty Do you want to allow another person to discuss this return with the IRS (see ins-ttuctions)? L& Yes. Complete the fotlowing. LJ No D®Sig1116e Dac-igano's Phone Per5or,al idivilflealio(, narne .Rosanna M Cline no. ? 301 739-9528 n umper pu) 0.59919 Sign Undrr penalties of penury, I declara that I he" examinsd this return and acco nppany)ng SeMdolea and alat&mantg, and to the beat of my knowleoee and oat a<• they arV tryp, eorrecl. and coniR ate Dacisrevon of aroparer tther then fexRayer) is hosed on gill information of whioh praparer has any knowledge. Here 1 avr algnatura Male Four occupation iii Joint return? SELF EMPLOYED 50® instructions. Spouse'a n1gr+a(vre, If a joint rtturn, both must sign. Date Spouse's occupation leftp a cOPY !k, • r Paid Prey6reCS Date Checlr if t'raparais 33N or PTIN Pr'eparer's ?jgnatyr2. tAmy Apple b 1520-amnloyrdO P00415701 Use Only Firm's riaatt (or yowls Jackson Hewitt Tax Service 5IN 52-2065592" if sot(-employed), 50 E King St A-- chow no. I _ .'. .. ... - wnnw r: i ti5107 Form 1040 i2oo?) 02/27/2008 04:00 ft 'A 17177764583 How To Prepare Your Payment JD'S FLOOR COVERING PAGE 10/13 • Make your check or money order payable to the "United States Treasury." Do not send cash. • Make sure your name and address appear on your check or money order. • Enter "2007 Form 1040," your daytime phone number, and your 83N on your check or motley order. If you are filing a joint return, enter the 58N shown first on your return. • To help process your payment, enter the amount on the right side of your check like this: S XXXXX. Do not use clashes or lines {for example, do not enter "$ )(XX-" or "$ XXX " ). How To Send In Your 2007 Tax Return, Payment, and Form 1040-V • Detach Form 1040?V along the dotted line. • Do not staple or otherwise attach your payment or Form 1040-Y to your return 'or to each other. Instead, just put them loose in the envelope. • Matt your 2007 flax return, payment, and Form 1040-V In the envelope that came with your 2007 Form 1040 instruction booklet. MAIL YOUR CHECK OR MONEY ORDER ALONG WITH FORM 1040V TO: INTERNAL REVENUE SERVICE CENTER P . O , BOX 370008 HARTFORD, CT 06176-0006 <'1C.' St------------------.. ...........,..- --------DETACH HERE -,,..... --------------.- -- --. ------- Oiparlmanc of thin Trea;wy tn;rrnai Revenue Se; 2007 Form 1040-V Payment Voucher Amount you are Donere Cents paying by chock Money order ? ,17 0 - 0 Q -or 1031 uASON L DICK 1860 WALNUT BOTTOM ROAD P.O. BOX 37008 NEWVILLE, PA 17241 HARTFORD, CT 06176-0008 PL DICK 30 0 200712 610 F 02/27/2002 04:00 17177764533 JD'S FLOOR COVERING PAGE 11/13 C EF 0700113146 PA-40 - 2007 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER. IN EACH ROX. Do Not Use Your Preprinted Label a??r DICK JASON L occupation SELF E M P L O Occupation 1860 WALNUT BOTTOM ROAD NEWVILLE PA 17241 717 386 1384 21050 L-0. N Extension. N Amended Return. R Residency Status, PA Resident/Nonr"denHPart-Year Resident fro,n to S SingleiMam ed, )tiling Join9yNarr?ed. Piling Separately/Final RetumMeoeased Date of death N Fanners, la Gross Compensation. Do not include exempt income, such as eombst zone pay and qualifying retirement benwlts. See the instructions. 1p Unroirrburs6d Employee gusinses Expanses. 1c Net Compensation. Subtract Line 1b from Lima la. 2 interest Income. Complete PA Schedule A if required. 3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 4 Net Income or Loss from the Operation of a Bushels, Profession, or Farm. 6 Net Gain or Loss from the Sale, Exchange, or Disposition of Property. G Net Income or toss from gents, Royaltles, Patents, or copyrights. 7 estate or Trust Income. Comp!ate and submit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 8 'focal PA Taxable Inane. Add only the positive income amounts from Lines 1c, 2, 3. 4, 5, 6. t, and 8. DO NOT ADD any losses reported on. Lines 4, 5, or 6. iG Other Deductions. Enter the appro-priale code for the type of deduction. N See the Instruotions for additional information. 11 Ad}listed PA Taxabie Income, Subtract Line 10 from Line 9. 1a 0 lb D 1C 2 a 3 a 4 15836 5 0 6 a 7 Q 8 1 9 1,5836 10 0 11 15836 EC Page 4 of 2 FC lp- 070011311'6 02/27/2008 04:00 17177764583 JD'S FLOOR COVERING PAGE 12/13 a C EF PA-40 .2007 Social Security Number a? Narrte(sy JASON L ?ICK 12 MBA Tax Liability. Multiply Line 11 by 3.07 percent (0,0307). 13 Totei PA Tax Withheld. Seethe instructions, 14 Credit from your 2006 PA Income Tax return. 15 2007 Estimated Installment Payments- 16 2007 Eytenrsiore Payment. 17 NonresidetltTax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 18 Total Estimated Payments and Credits. Add Lines 144, 15,18; and 17, Tex Forgiveness Credit. 19a Filing Statue: 41 Unmarried or Separated 02 Married o3 Deceased 19b Dependents. Part 8, Line 2; PA Schedule SP 20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 22 Resident Credit. Submit your PA Schedule(s) G-?slG-l and/or RK-1. 23 Total Other Credits- Submit your PA Schedule OC. 24 TOTAL PAYMENTS and CREDITS, Add Lines 13 and 18, 21, 22, and 23. 25 TAX DUE. If Line 12 is more than Line 24. enter the difference here. 25 Ponaitiee and Interest. Seethe instructions. Enter Code. If attaching form REVA630, mark the box. N 27 TOTAL. PAYMENT, Add Lines 25 al id 28- 28 OVERPAYMENT, if Line 24 is more than the total of Line 12 and Line 26. enter the dlfferance here. The total of Lines 29 through 35 must equal Line 2&. 29 Refund - Amount of Line 28 you want as a check mailed to you. Refund 30 Credit - Amount of Line 28 you want as a credit to your 2008 estimated account. 31 Amount of Line 28 you want to donate to the Wild Resource Conservation Fund. 32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Prograim. 33 /Amount of Line 26 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure R.assarch Fund, 35 Amount of Lire 28 you want to donate to the Breast and Cervical Cancer Research Fund. $Ign(qurn(le). UnJer Dvn91tie0 Of ooriV'Y• I fwo) dsoler V%zj I (wo) hava oxo e6m44 thle rotorm indudlnq Oil Your Slgnatxe spouw'a Slgnslurb, if filiq )Olntly Preparers Name and Telephone Number 12 486 13 0 14 a 15 0 16 Q ?,7 Q 18 fl 19A QQ 199 GO 20 0 21, 22 a 23 a 24 0 251 486 26 0 ,.rte 27 486 26 - rr 29 0 30 31 a 32 0 33 0 34 0 35 0 RI EI P S Date [::522066592 XXXXXXXXX Page 2 of 2 ?.?.,. 0700213200 0700213200 02/27/2008 04:00 17177764583 JD'S FLOOR COVERING AAail to: Pannsyivenia Departmant of Revenue Payment Enclosed 1 Revenue Place Harrisburg, PA 17129-0001 PAGE 13/13 8-PA .NTr v ' ''?' 97 Cut Ate potted line 2007 PA-V PA PAYMENT VOUCHER Dz DICK MASON L 1860 WALNUT BOTTOM ROAD NEW.VILLE PA 17241 I- 717 386 1384 DEPARTMENT USE ONLY F_ I 0700`18115 PAYMENT AMOUNT 486.00 Make check or moray order payable-to the PenneyhFanla Department of Revenue I A Exhibit "F" February 26, 2008 PATRICIA CAREY ZUCKER SANDRA L. MEILTON STEVEN P. MINER KATHLEEN MISTURAK-GINGRICH LINDSAY GINGRICH MACLAY QUINTINA M. LAUDERMILCH PATRICIA A. PATTON OFFICE ADMINISTRATOR REPLY TO: EAST SHORE OFFICE: 1029 SCENERY DRIVE HARRISBURG, PA 17109 717-657-4795 717-657-4996 FAX WEST SHORE OFFICE: 1035 MUMMA ROAD SUITE 101 WORMLEYSBURG, PA 17043 717-724-9821 717-724-9826 FAX VIA FACSEMnE (717) 243-9200 & U.S. MAIL Jane Adams, Esquire 17 West South Street Carlisle, PA 17013-3220 Re: Dick v. Dick (In Divorce) Docket No. 2006-7330 PACSES No. 111107613 Dear Jane: I am writing as a follow-up to your telephone conversation with my assistant, Amanda, on Tuesday, February 26, 2008. As discussed, Ms. Dick claimed both children contrary to Paragraph 18 of the parties' August 17, 2007 Property Settlement Separation Agreement (PSSA) which states if Mr. Dick paid his child support on time since-August 17, 2007, he would be entitled to claim Cody on his taxes for that year. I was in contact with Tim Correll, conference officer, and he stated that Mr. Dick was not in the arrears since the entry of the last Order. Therefore Ms. Dick should not have claimed both children on her tax returns. Unless Ms. Dick will make Mr. Dick whole by providing him with the difference between what he received verses what he would have received in a tax refund which is $4017.00, we will be filing a petition to enforce the Property Settlement & Separation Agreement in which we will be seeking attorney's fees and costs. Please advise no later than Monday March 10, 2008, if your client will voluntarily agree or whether we will need to file the appropriate documents with the court. Thank you for your attention to this matter. Very truly yours, DALEY ZUCKER MEILTON jay ER & LING ICH, LLC L Gin ch clay LGMIams cc: Mr. Jason Dick DALEY ZUCKER MEILTON MINER & GINGRICH, LLC A Pennsylvania Certified Woman Business Enterprise #. . .o ?i •ILi ?„y . MAR S 5 2008 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Docket No. 2006-7330 (Civil Term) Plaintiff/Petitioner V. MICHELLE E. DICK, Defendant/Respondent (In Divorce) ORDER AND NOW, this Io day of daid , 2008, upon consideration of the attached Petition to Enforce Property Settlement and Separation Agreement, IT IS HEREBY ORDERED AND DECREED that a conference/hearing concerning the Petition shall be held on the nd day of , 2008, at o'clock CA m. in Courtroom No. of the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. Distribution: Lindsay Gingrich Maclay, Esquire, Daley Zucker Meilton Miner & Gingrich, LLC, 1029 Scenery Drive, Harrisburg, Pennsylvania 17109, At orneys for Plaintiff/Petitioner Jane Adams, Esquire, l7 South West Street, Carlisle, Pennsylvania 17013, Attorneys for Defendant/Respondent ?/? dos r c? ?`? ? - . - _ ? ????- ?. ? ?.: >;, ?''^4 C..1... ' _ ?.F (??. Ll. ? ? t.?. c° a Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 6574795 lmaclayna,dzmmglaw.com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff No. 2006-7330 CIVL TERM V. CIVIL ACTION - LAW MICHELLE E. DICK, : Defendant (In Divorce) PETITION FOR LEAVE TO WITHDRAW AS COUNSEL This Motion of Lindsay Gingrich Maclay, Esquire, and Daley Zucker Meilton Miner & Gingrich, LLC, respectfully represents: 1. The Movants are Lindsay Gingrich Maclay, Esquire, and Daley Zucker Meilton Miner & Gingrich, LLC, who are presently counsel of record for Defendant, Jason L. Dick, in the above-captioned matter. 2. The Respondent is Jason L. Dick, Defendant in the above-captioned matter. 3. Respondent, Jason L. Dick's address is 1860 Walnut Bottom Road, Newville, PA 17241. 4. Movants have been counsel of record in this matter since in or around May 2007. 5. Over the course of the Movants' representation of Respondent, certain issues have arisen which make it impossible for Movants to continue to represent Respondent. 6. Respondent entered into a Fee Agreement with Petitioners on May 11, 2007, when at that time Respondent paid for legal services and was fully aware that payment must be made in the future for other services rendered; however, Respondent has not met his financial obligations to Daley Zucker Meilton Miner & Gingrich, LLC. A copy of the Fee Agreement is attached hereto and incorporated by reference as Exhibit «A„ 7. Respondent has been given reasonable warning that Petitioners will ' withdraw as counsel of record unless his financial obligation is fulfilled. 8. After numerous requests by Petitioners, Respondent has yet to pay significant outstanding counsel fees in this matter. 9. Despite repeated promises by Respondents to pay Petitioner, Respondent has failed to pay his significant outstanding balance. 10. There is currently nothing pending in this matter with the Court. 11. Therefore, under Rule 1.16(b)(5) and Rule 1.16(b)(6) of the Pennsylvania Rules of Professional Conduct, good cause exists for Petitioners' withdrawal of appearance in this case. 12. As a result of the above, Petitioners accordingly request permission to withdraw as counsel for Respondent. WHEREFORE, Movants, Lindsay Gingrich Maclay, Esquire, and Daley Zucker Meilton Miner and Gingrich, LLC, respectfully request this Honorable Court grant Movants leave to Withdraw as Counsel for Respondent, Jason L. Dick, in the above- referenced Divorce matter. Respectfully Submitted, DALEY ZUCKER MEILTON MINER AND GINGRICH, LLC Date: min 9 4. 20 By: Harrisburg, PA 17109 (717) 657-4795 VERIFICATION Upon my personal knowledge, information and belief, I, Lindsay Gingrich Maclay, Esquire, do hereby verify that the facts averred and statements made in the foregoing petition are true and correct. I understand that false statements or averments therein made will subject me to the criminal penalties of 18 Pa C.S.A. §4904 relating to unsworn falsification to authorities. Date: 0 /1 11, IM By: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff No. 2006-7330 CIVL TERM V. CIVIL ACTION - LAW MICHELLE E. DICK, ; Defendant (In Divorce) CERTIFICATE OF SERVICE I, Amanda M. Shull, Paralegal, hereby certify that on this +h day of March 2009, a copy of the Motion for Leave to Withdraw as Counsel was placed in the United States Mail, Postage pre-paid, addressed as follows: Jane Adams, Esquire 17 West South Street Carlisle, PA 17013-3220 Attorney for Plaintiff Mr. Jason L. Dick 1860 Walnut Bottom Road Newville, PA 17241 DALEY ZUCKER MEILTON MINER AND GINGRICH, LLC BY: Amanda M. Shull, Paralegal 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 Exhibit "A" (14- 15 2) DOD, 0 -1`-074 KATHLEEN CAREY DALEY, ESQ. PATRICIA CAREY ZUCKER, ESQ. SANDRA L. MEILTON, ESQ. STEVEN P. MINER, ESQ. KATHLEEN MISTURAK-GINGRICH, ESQ. LINDSAY GINGRICH MACLAY, ESQ. QUINTINA M. LAUDERMILCH, ESQ. May 7, 2007 Jason Lloyd Dick 770 Conodoquinet Avenue Carlisle, PA 17015 Re: Retainer Agreement Dear Jason: Thank you for selecting Daley Zucker Meilton Miner & Gingrich, LLC ("DZMMG"), to represent you. This letter is a fee agreement which sets forth the financial arrangements under which your case will be handled by our office. Please read this letter carefully and if you wish to have DZMMG serve as your attorney, please sign your name, date this letter, and return it, along with the required retainer, to our office at your earliest possible convenience. This letter then becomes an effective agreement between us as to our representation of you. PATRICIA A. PATTON Services are charged on the basis of attorney and paralegal time expended. This OFFICE ADMINISTRATOR time is charged for in-person conferences, long distance telephone calls, copies and faxes, attendance at hearings, meetings or conferences, research and preparation time, preparation of legal documents and letters, and any and all REPLYTO: other services rendered on your behalf. The office bills in units of 1/10'1 of an EAST SHORE OFFICE hour. You will be charged at the rate of $175.00 per hour for the time I spend on your behalf and $250.00 per hour for the time a partner of the firm spends-oz your behalf. Our paralegals bill at the rate of $125.00 per hour. The,§;,fees are for calendar year 2007. This fee does not include any out-of-pocket expenses which must also be paid. These out-of-pocket expenses include, but are not limited to, court filing fees, accounting and appraisal fees, sheriff fees, excess postage fees, and the fees and expenses of expert witnesses or consultants. For DZMMG to continue representation in this matter, a One Thousand Dollar ($1,000.00), non-refundable retainer is required. These funds will be used to open your file and to begin your case. As work is performed by our office on your case, a regular, itemized billing statement will be mailed to you, which will indicate to you the amount due to this office. When bills are mailed, payment is expected upon receipt. If payment cannot be made upon receipt, contact should be made with our office. Interest will accrue on any unpaid balances at the rate of one percent (1%) per month which is an annual percentage rate of twelve percent (12%) per year which will be added to all unpaid balances over thirty (30) days. In the event that you do not contact this office and you do not pay your fees in a timely manner, representation from this office will cease. EAST SHORE: 1029 SCENERY DRIVE, HARRISBURG, PA 17109 • 717-657-4795 • 717-657-4996 FAX WEST SHORE: 1035 MUMMA ROAD, SUITE 101, WORMLEYSBURG, PA 17043 • 717-724-9821 • 717-724-9826 FAX Jason Lloyd Dick May 7, 2007 Page 2 In the event legal action is necessary to collect unpaid fees, expenses or costs, this office will request your unpaid balance and reasonable attorneys' fees and costs which were incurred to bring the action against you. This office reserves the right to notify you of increases in the billing rates, and you, by signing this agreement, hereby agree to pay the increased hourly rate. One of the absolute necessities in any matter of legal representation is good communication between the attorney and client. Because the attorneys' schedules often involve court appearances and client interviews, it is often impossible for the attorneys to speak with you. Our staff is trained and experienced in listening and evaluating your questions to be able to provide you with information that you may need on a moment's notice. Although they cannot provide legal advice, they have been trained to check with one of the attorneys as to any issues which may require immediate legal intervention. Please do not hesitate to talk to any member of our staff about your concerns because we all work together as a team to help our clients to the best of our abilities. We will do our best to represent your interests in this matter. A lawsuit is almost always a very difficult time for the parties involved. Please be assured that we will try to keep you informed and provide you with the best advice that we can. In exchange, the following is expected from you: Complete candor and truthfulness in any information you provide to this office; 2. Cooperation with this office in furnishing any documents and information that is requested of you in a reasonable manner; and 3. Payment of all fees and costs that you are charged by this office for services rendered in a prompt manner. Your failure to comply with any provisions of this agreement may be a basis for this office' to cease representation of you and withdraw from your case. Some of our clients use electronic mail ("Email") to conduct communications between them and the firm. During 1999, the Ethics Committee of the American Bar Association issued a Formal Opinion in which it concluded that an attorney could transmit information relating to the representation of a client by use of unencrypted Email sent over the Internet without violating the attorney's responsibilities under the Rules of Professional Conduct because such a mode of information transmission afforded a reasonable expectation of privacy form a technological and legal standpoint. However, if you do not want the firm to use Email for some, or all, of its Jason Lloyd Dick May 7, 2007 Page 3 communications with you, please advise us promptly to that effect. We will follow your instructions as to the manner in which you want to communicate with the firm. For your information, I am enclosing with this engagement letter a copy of the "Daley Zucker Meilton Miner & Gingrich, LLC Privacy Policy Statement," which explains our firm's duty to keep confidential the information communicated between us, as well as other information relating to this legal representation. Again, please make sure that you have reviewed this letter carefully and that you understand every aspect of the letter. If you have any questions about the content of this letter, please contact our office prior to your signing of the agreement. By signing and returning this letter with your initial retainer of One Thousand Dollars ($1,000.00), you indicate that you are requesting our office to represent you and you are authorizing us to proceed on your behalf. Unfortunately, as with life, there are no guarantees in the law. We will do our best to represent you in a fair and aggressive manner, always keeping in mind that this is not just another lawsuit but a very important event which may have a profound impact upon your life. Very truly yours, DALEY ZUCKER MEILTON MINER & GINGRI H, LLC in say Gin h Mac fay, Esquire F LGM/jlc Intending to be legally bound by my signature below, I acknowledge receipt of an original of this letter of agreement and my acceptance of the terms of representation set forth in the letter. Accepted this day of _1'n et (4 2007 Loyd Dick J . 00 ?'°'? ( 1 t .;3 -... 3 ? °".? {'?? :7 . . ?a ? `-? -=; ?:.a z }n? ` Y t,. `"C a Lindsay Gingrich Maclay, Esquire Daley Zucker Meilton Miner & Gingrich, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 lmac lay(&dzmmglaw. com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff V. MICHELLE E. DICK, Defendant No. 2006-7330 CIVL TERM CIVIL ACTION - LAW (In Divorce) ADDENDUM TO THE PETITION FOR LEAVE TO WITHDRAW AS COUNSEL This Motion of Lindsay Gingrich Maclay, Esquire, and Daley Zucker Meilton Miner & Gingrich, LLC, respectfully represents: 1. Paragraphs 1- 13 of the March 27, 2009 Petition for Leave to Withdraw as Counsel are incorporated herein by reference thereto as is set forth at length. 2. According to Local Rule 208.3(a)(2), the Honorable Edgar B. Bayley has been assigned to the above-captioned matter. 3. According to Local Rule 208.3(a)(9), on April 1, 2009 Plaintiff's attorney, Jane Adams, Esquire, was contacted by telephone and has no objection to filing of this Petition. WHEREFORE, Movants, Lindsay Gingrich Maclay, Esquire, and Daley Zucker Meilton Miner and Gingrich, LLC, respectfully request this Honorable Court grant Movants Leave to Withdraw as Counsel for Respondent, Jason L. Dick, in the above- referenced Divorce matter. Date: &0 1 1 - 1 By: Respectfully Submitted, DALEY ZUCKER MEILTON MINER AND GINGRICH, LLC 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 VERIFICATION Upon my personal knowledge, information and belief, I, Lindsay Gingrich Maclay, Esquire, do hereby verify that the facts averred and statements made in the foregoing petition are true and correct. I understand that false statements or averments therein made will subject me to the criminal penalties of 18 Pa C.S.A. §4904 relating to unsworn falsification to authorities. Date: 2db By: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JASON L. DICK, Plaintiff No. 2006-7330 CIVL TERM V. CIVIL ACTION - LAW MICHELLE E. DICK, Defendant (In Divorce) CERTIFICATE OF SERVICE ST I, Amanda M. Shull, Paralegal, hereby certify that on this I day of April, 2009, a copy of the Addendum to the Motion for Leave to Withdraw as Counsel was placed in the United States Mail, Postage pre-paid, addressed as follows: Jane Adams, Esquire 17 West South Street Carlisle, PA 17013-3220 Attorney for Plaintiff Mr. Jason L. Dick 1860 Walnut Bottom Road Newville, PA 17241 DALEY ZUCKER MEILTON MINER AND GINGRICH, LLC By: 9 A?' Amanda M. Shull, Paralegal 1029 Scenery Drive Harrisburg, PA 17109 (717) 657-4795 RLED-OffiCE OF THE MTKINTARY 2009 APR -2 PH t: 4b pE,IId1SYyll.VANIA JASON L. DICK, IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA V. MICHELLE E. DICK, DEFENDANT 06-7330 CIVIL TERM ORDER OF COURT AND NOW, this day of April, 2009, the motion of Lindsay Gingrich Maclay, Esquire, and Daley Zucker Meilton Miner & Gingrich, LLC, to withdrawn as counsel for Jason L. Dick, IS GRANTED. By the Court, Edgar B.'Bayley, J ?Jane Adams Esquire For Michelle E. Dick ZJason L. Dick 1860 Walnut Bottom Road Newville, PA 17241 Lindsay Gingrich Maclay, Esquire sal uo r cn C7% N