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HomeMy WebLinkAbout02-2988JANET R. EBERSOLE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, : NO. Ud " ?rj Jb CIVIL TERM Defendant : IN DIVORCE NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case will proceed without you and a decree of divorce or annulment may be entered against you for any claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at Cumberland County Courthouse, Carlisle, Cumberland County, Pennsylvania, 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF MARITAL 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 Two Liberty Avenue Carlisle, Pennsylvania 17013 (717) 249-3166 JUL 1 5 2002 JANET R. EBERSOLE, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, : NO. 02-2988 Defendant : IN DIVORCE AND NOW, this 4 * day of , 2002, upon presentation and consideration of the within Petition, the hearing previously scheduled in this matter for Friday, July 12, 2002 at 9:45 a.m. in Courtroom No. 5 of the Cumberland County Courthouse, Carlisle, Cumberland County, Pennsylvania, is hereby continued generally to be rescheduled at the request of either party or counsel. BY THE C , 010 Edward E. Guido, Judge cc: Bradley L. Griffie, Esquire Attorney for Plaintiff/Petitioner Wayne F. Shade, Esquire' Attorney for Defendant/Respondent 'g o ? : 4l E,??at g } l(?(' Z? t ?, yj? ON, JANET R. EBERSOLE, Plaintiff VS. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 CIVIL TERM IN DIVORCE I confirm that I did this sT day of .TvGY , 2002, hand deliver a certified and true copy of a Petition for Exclusive Possession and resulting Order of Court upon the Defendant, Timothy M. Ebersole, at g /,? PPS n s4 u? v?u+vaACi7Y jjCDG, PA/Nce 97- (Constable) Sworn and subscribe to before me this day of 2002. Notary Pubr Notarial Seal Robin J. Gosirom, Notary PabNc Cadisle Boro, Cumberland Cotmty My Commission ExplPes Apr. 17, `n ?< ` v , JANET R. EBERSOLE, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, : NO. 02-2988 CIVIL TERM Defendant : IN DIVORCE I confirm that I did this I g7- day of J v G Y 2002, hand deliver a certified and true copy of a Complaint in Divorce upon the Defendant, Timothy M. Ebersole, at S//r PPr,?.s 8 K v ti y??cs?TY Q'D G yK/nic e sT (Constable) Sworn and subscribed to before me this day of , 2002. Notary Pu c Notarial Seal Rabin J. Goshom, Notary Public Carlisle eoro, Cumberland County My Conifnission ExpiPes npr.17, 2003 O ?i c N C m mrr'. C r tia? Cf) ,k JANET R. EBERSOLE, Plaintiff/Petitioner JUN 2 1 2002 fjY IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, : NO. Oa - cZ9 $$ CIVIL TERM Defendant/Respondent : IN DIVORCE ORDER OF COURT AND NOW this day of ?J tt K e 2002, upon presentation and consideration of the within Petition, a Rule is hereby issued upon the Defendant/Respondent to show cause, if any he has, as to why the Plaintiff/Petitioner's request for exclusive possession of the marital residence of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, should not be granted to her pending further Order of Court or agreement of the parties. Rule is returnable by filing a written Answer thereto within / 0_ days of service. If a written Answer is filed, a hearing shall be held on & 13 day of - the 2002, at _ 4F•• 1( 5" in. in Courtroom #_s of the Cumberland County Courthouse, Carlisle, Cumberland County, Pennsylvania. 1! n7m% e a so . Service to be made upon Defendant/Respondent by personal service or certified mail, restricted delivery. J. cc: Bradley L. Griffie, Esquire t '.? c Q_ -J (?? Attorney for Plainti/Petitioner Timothy M. Ebersole, Defendant/Respondent, prose ke-Gj JANET R. EBERSOLE, Plaintiff/Petitioner V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TIMOTHY M. EBERSOLE, NO. ©A CIVIL TERM Defendant/Respondent : IN DIVORCE PETITION FOR EXCLUSIVE POSSESSION AND NOW comes Petitioner, Janet R. Ebersole, by and through her counsel of record, Bradley L. Griffie, Esquire, and petitions the Court as follows: I • Your Petitioner is Janet R. Ebersole, the above named Plaintiff and an adult individual currently residing at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania. 2. Your Respondent is Timothy M. Ebersole, the above named Defendant and an adult individual who has been residing at various locations, including, not believed to be limited to, 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania; 916 Bonny Lane, Mechanicsburg, Cumberland County, Pennsylvania; and an undisclosed location in Carlisle, Cumberland County, Pennsylvania. 3. The parties are the natural parents of two children, namely, Joshua T. Ebersole, born May 25, 1987, and Heather D. Ebersole, born August 16, 1984. 4. A Complaint in Divorce was filed in the above captioned action by Petitioner on June 21, 2002. 5. Petitioner is employed by the Cumberland Valley Christian School at 600 Miller Street, Chambersburg, Franklin County, Pennsylvania. 6. Respondent is employed by the State System of Higher Education, at Shippensburg University, Shippensburg, Pennsylvania. 7. The parties have had marital discord for an extended period of time, which resulted in the filing of the Divorce Complaint, as referenced above. 8. Respondent has been involved in at least two extra marital relationships and is involved in such a relationship at the present time, which has become known to the Petitioner and to the Petitioner's teenage children. 9. Respondent moved from the former marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, in August 2001 to an apartment at a location that Respondent has claimed to be in Carlisle, Cumberland County, Pennsylvania, but for which Respondent has refused to provide the address, telephone number or directions to the residence to Petitioner or the parties' teenage children. 10. Respondent's place of employment is located at the Shippensburg University, in Shippensburg, Pennsylvania, a close distance to the parties' former marital residence of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania. 11. Since August 2001, Respondent has stopped by the parties' former marital residence, as he desires, for unannounced, brief periods of time, even though he has principally resided at the alleged undisclosed location in Carlisle, Cumberland County, Pennsylvania, and with his paramour, Ginny Conner at her address of 916 Bonny Lane, Mechanicsburg, Cumberland County, Pennsylvania. 12. Respondent's habit of stopping by the former marital residence at his choosing has been extremely disruptive and is creating emotional turmoil for Petitioner and the parties' teenage children. 13. Upon the demand of Petitioner to Respondent that he either engage in efforts to reconcile the marriage or initiate divorce proceedings, Respondent began sleeping at the former marital residence approximately three or four times per week beginning after Easter 2002, apparently sleeping the other nights at his claimed residence in Carlisle, Cumberland County, Pennsylvania, or at his paramours address in Mechanicsburg, Cumberland County, Pennsylvania. 14. In May 2002, upon Respondent discovering that Petitioner secured the services of a private investigator, who confirmed that he was spending his other nights with his paramour, Ginny Conner at her address set forth above, Respondent began sleeping at the former marital residence every night for a few weeks in early-May to early-June 2002. 15. Since Petitioner personally discovered Respondent sleeping at his paramour's residence in Mechanicsburg, Cumberland County, Pennsylvania, on June 11, 2002, to June 12, 2002, Respondent has spent most of his waking hours away from the marital residence, coming back to the home at midnight or later than midnight and then leaving the residence again in the morning. 16. The parties' teenage children are fully aware of Respondent's extramarital relationship with another individual several years ago and with his current paramour. 17. It is an extreme mental and emotional hardship on Petitioner and her children to allow Respondent to maintain various residences and come and go as he pleases at the former marital residence, thereby not allowing Petitioner and her children to have the quiet enjoyment of their residence. 18. The parties' teenage daughter, Heather, who discovered Respondent's prior paramour's underwear in the parties' home during Respondent's prior extramarital affair, has found it extremely difficult to deal with Respondent coming and going at the former marital residence. 19. Respondent has advised Petitioner and the children directly that he will date and otherwise be involved with anyone he desires, although, he expects that he, likewise, will be able to return to the Petitioner's and the children's home when he desires. 20. On various occasions, Petitioner has threatened Respondent with physical harm, including statements that if he continues to reside with her, he knows he will end up hurting her. 21. Respondent has made threats of physical violence to Petitioner's parents, which has necessitated them providing him with notice that if he makes any additional threats, criminal action will result. 22. Petitioner has witnessed Respondent become involved with a physical confrontation with Respondent's brother. 23. Petitioner has been advised by Respondent that he has a history of being physically violent toward his own mother. 24. Petitioner is extremely fearful for her and her children's safety, should the Respondent be able to maintain a part-time, intermittent residence with Petitioner and the parties' teenage children. 25. Respondent has at least two other residences and has resided in his own residence with the majority of his clothing and personal effects since August 2001, recently claiming that his paramour, Ginny Conner, is also his landlady. 26. Petitioner has total responsibility for providing the care and needs of her teenage children, without any assistance from Respondent, except financial assistance. 27. The stress and pressure that is created by the Respondent's conduct and particularly the inability of the Petitioner to even have the quiet enjoyment of her own home, is becoming extremely detrimental to her and her children, emotionally and otherwise. 28. Respondent's employment takes him out of the area for various meetings, the most recent of which took him to Myrtle Beach for a period from Father's Day, Sunday, June 16, 2002, to Thursday, June 20, 2002, which excursions are believed to routinely involve Respondent's paramour. 29. Petitioner's income is approximately $20,000.00 and Respondent's income is in excess of $60,000.00. 30. Petitioner will be able to maintain the former marital residence, with the financial support that she will receive from Respondent for child support and spousal support. 31. The children prefer to maintain their residence in the Shippensburg Area School District, where the children are going to be entering the 12th and 10th grades and, therefore, Petitioner desires to maintain her residence there. 32. Respondent is not known to have legal counsel at this time. WHEREFORE, Petitioner requests your Honorable Court to enter a Rule upon Respondent to show cause, if any he has, as to why Petitioner should not be granted exclusive possession of the marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, pending final resolution of the divorce case. Respectfully submitted, or Defendant/Petitioner G IE & & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unworn falsifications to authorities. DATE. 2_ JANET R. EBERSOLE T ri_ L.` .... ?- . 1 TI ? l> CJ'I ? JANET R. EBERSOLE, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA V. : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, : NO. O ?' ?? S$ CIVIL TERM Defendant/Respondent : IN DIVORCE n PETITION FOR EXCLUSIVE POSSESSION AND NOW comes Petitioner, Janet R. Ebersole, by and through her counseY record s 5 c; r < Bradley L. Griffie, Esquire, and petitions the Court as follows: 1. Your Petitioner is Janet R. Ebersole, the above named Plaintiff and an adult individual currently residing at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania. 2. Your Respondent is Timothy M. Ebersole, the above named Defendant and an adult individual who has been residing at various locations, including, not believed to be limited to, 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania; 916 Bonny Lane, Mechanicsburg, Cumberland County, Pennsylvania; and an undisclosed location in Carlisle, Cumberland County, Pennsylvania. 3. The parties are the natural parents of two children, namely, Joshua T. Ebersole, born May 25, 1987, and Heather D. Ebersole, born August 16, 1984. 4. A Complaint in Divorce was filed in the above captioned action by Petitioner on June 21, 2002. 5. Petitioner is employed by the Cumberland Valley Christian School at 600 Miller Street, Chambersburg, Franklin County, Pennsylvania. 6. Respondent is employed by the State System of Higher Education, at Shippensburg University, Shippensburg, Pennsylvania. 7. The parties have had marital discord for an extended period of time, which resulted in the filing of the Divorce Complaint, as referenced above. 8. Respondent has been involved in at least two extra marital relationships and is involved in such a relationship at the present time, which has become known to the Petitioner and to the Petitioner's teenage children. 9. Respondent moved from the former marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, in August 2001 to an apartment at a location that Respondent has claimed to be in Carlisle, Cumberland County, Pennsylvania, but for which Respondent has refused to provide the address, telephone number or directions to the residence to Petitioner or the parties' teenage children. 10. Respondent's place of employment is located at the Shippensburg University, in Shippensburg, Pennsylvania, a close distance to the parties' former marital residence of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania. 11. Since August 2001, Respondent has stopped by the parties' former marital residence, as he desires, for unannounced, brief periods of time, even though he has principally resided at the alleged undisclosed location in Carlisle, Cumberland County, Pennsylvania, and with his paramour, Ginny Conner at her address of 916 Bonny Lane, Mechanicsburg, Cumberland County, Pennsylvania. 12. Respondent's habit of stopping by the former marital residence at his choosing has been extremely disruptive and is creating emotional turmoil for Petitioner and the parties' teenage children. 13. Upon the demand of Petitioner to Respondent that he either engage in efforts to reconcile the marriage or initiate divorce proceedings, Respondent began sleeping at the former marital residence approximately three or four times per week beginning after Easter 2002, apparently sleeping the other nights at his claimed residence in Carlisle, Cumberland County, Pennsylvania, or at his paramours address in Mechanicsburg, Cumberland County, Pennsylvania. 14. In May 2002, upon Respondent discovering that Petitioner secured the services of a private investigator, who confirmed that he was spending his other nights with his paramour, Ginny Conner at her address set forth above, Respondent began sleeping at the former marital residence every night for a few weeks in early-May to early-June 2002. 15. Since Petitioner personally discovered Respondent sleeping at his paramour's residence in Mechanicsburg, Cumberland County, Pennsylvania, on June 11, 2002, to June 12, 2002, Respondent has spent most of his waking hours away from the marital residence, coming back to the home at midnight or later than midnight and then leaving the residence again in the morning. 16. The parties' teenage children are fully aware of Respondent's extramarital relationship with another individual several years ago and with his current paramour. 17. It is an extreme mental and emotional hardship on Petitioner and her children to allow Respondent to maintain various residences and come and go as he pleases at the former marital residence, thereby not allowing Petitioner and her children to have the quiet enjoyment of their residence. 18. The parties' teenage daughter, Heather, who discovered Respondent's prior paramour's underwear in the parties' home during Respondent's prior extramarital affair, has found it extremely difficult to deal with Respondent coming and going at the former marital residence. 19. Respondent has advised Petitioner and the children directly that he will date and otherwise be involved with anyone he desires, although, he expects that he, likewise, will be able to return to the Petitioner's and the children's home when he desires. 20. On various occasions, Petitioner has threatened Respondent with physical harm, including statements that if he continues to reside with her, he knows he will end up hurting her. 21. Respondent has made threats of physical violence to Petitioner's parents, which has necessitated them providing him with notice that if he makes any additional threats, criminal action will result. 22. Petitioner has witnessed Respondent become involved with a physical confrontation with Respondent's brother. 23. Petitioner has been advised by Respondent that he has a history of being physically violent toward his own mother. 24. Petitioner is extremely fearful for her and her children's safety, should the Respondent be able to maintain a part-time, intermittent residence with Petitioner and the parties' teenage children. 25. Respondent has at least two other residences and has resided in his own residence with the majority of his clothing and personal effects since August 2001, recently claiming that his paramour, Ginny Conner, is also his landlady. 26. Petitioner has total responsibility for providing the care and needs of her teenage children, without any assistance from Respondent, except financial assistance. 27. The stress and pressure that is created by the Respondent's conduct and particularly the inability of the Petitioner to even have the quiet enjoyment of her own home, is becoming extremely detrimental to her and her children, emotionally and otherwise. 28. Respondent's employment takes him out of the area for various meetings, the most recent of which took him to Myrtle Beach for a period from Father's Day, Sunday, June 16, 2002, to Thursday, June 20, 2002, which excursions are believed to routinely involve Respondent's paramour. 29. Petitioner's income is approximately $20,000.00 and Respondent's income is in excess of $60,000.00. 30. Petitioner will be able to maintain the former marital residence, with the financial support that she will receive from Respondent for child support and spousal support. 31. The children prefer to maintain their residence in the Shippensburg Area School District, where the children are going to be entering the 12th and 10th grades and, therefore, Petitioner desires to maintain her residence there. 32. Respondent is not known to have legal counsel at this time. WHEREFORE, Petitioner requests your Honorable Court to enter a Rule upon Respondent to show cause, if any he has, as to why Petitioner should not be granted exclusive possession of the marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, pending final resolution of the divorce case. Respectfully submitted, or Defendant/Petitioner G IE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unworn falsifications to authorities. DATE: J T R. EBERSOLE JANET R. EBERSOLE, Plaintiff V. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO.tO.z - 29rV' CIVIL TERM IN DIVORCE COMPLAINT IN DIVORCE NO FAULT 1. Plaintiff is Janet R. Ebersole, an adult individual currently residing at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, where she has resided since November 1999. 2. Defendant is Timothy M. Ebersole, an adult individual who has been residing at various locations, including not to believed to be limited to, 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania; 916 Bonny Lane, Mechanicsburg, Cumberland County, Pennsylvania; and an undisclosed location in Carlisle, Cumberland County, Pennsylvania; for various periods since November 1999, Defendant's principal residence has been 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania. 3. Plaintiff is a bonafide resident of the Commonwealth of Pennsylvania and has been so for at least six months immediately previous to the filing of this Complaint. 4. Plaintiff and Defendant were married on May 15, 1983, in York, York County, Pennsylvania. 5. There have been no other prior actions for divorce or annulment between the parties. 6. Neither the Plaintiff nor the Defendant are members of the United States Armed Forces or its Allies. 7. Plaintiff has been advised of the availability of counseling and the right to request that the Court require the parties to participate in counseling. Knowing this, Plaintiff does not desire that the Court require the parties to participate in counseling. 8. Plaintiff and Defendant are citizens of the United States of America. 9. The parties' marriage is irretrievably broken. 10. Plaintiff desires a divorce based upon the belief that the Defendant will, ninety (90) days from the date of the filing of this Complaint, consent to this divorce. WHEREFORE, Plaintiff requests your Honorable Court to enter a divorce pursuant to 23 P.S. Section 3301 (c) of the Domestic Relations Code. COUNT II ADULTERY 11. Paragraphs 1 through 10 are incorporated herein by reference as if set forth in their full text. 12. Defendant has committed adultery by having sexual relations with a woman individual contrary to his wedding vows and the Plaintiff is the innocent and injured spouse. WHEREFORE, Plaintiff requests you Honorable Court to enter a divorce pursuant to 23 P.S. Section 3301 (a) (2). COUNT III ALIMONY, ALIMONY PENDENTE LITE, AND COUNSEL FEES 13. Paragraphs 1 through 12 are incorporated herein by reference as if set forth in their full text. 14. Plaintiff is unable to provide for, or afford her counsel fees, expenses and costs during the pendency of this divorce action, and through its resolution. 15. Despite being employed, Plaintiff is without sufficient property and otherwise unable to financially support herself through appropriate employment. 16. Defendant is presently employed and receiving a substantial income and benefits and is able to pay for counsel fees, expenses, and costs, as well as alimony, and alimony pendente lite for the Plaintiff. WHEREFORE, Plaintiff requests your Honorable Court to enter an Order requiring Defendant to pay for Plaintiffs counsel fees, expenses, and costs as well as providing for payment of an appropriate alimony and alimony pendente lite to Plaintiff. COUNT IV EQUITABLE DISTRIBUTION 17. Paragraphs 1 through 16 are incorporated herein by reference as if set forth in their full text. 18. Plaintiff and Defendant are joint owners of various items of personal property, furniture, and household furnishings acquired during their marriage which are subject to equitable distribution. 19. Plaintiff and Defendant are joint owners of real estate located in Cumberland County, which was acquired during their marriage and which is subject to equitable distribution. 20. Plaintiff and Defendant have incurred debts and obligations during their marriage which are subject to equitable distribution. WHEREFORE, Plaintiff requests your Honorable Court to enter a decree equitably dividing the parties' property and equitable apportioning the debts incurred by the parties. Respectfully submitted, Piffie, squire ey for P ntiff GRIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unworn falsifications to authorities. DATE: G?eLiiC c=GRP/t G ANET R. EBERSOLE, Plaintiff -; `' ' _ g,, m? -- 4 ??_ ?1 N ?m, l ? /V / ``l.. Ir. .? r. } ? ? !V ?? K o ^ T'' QQQ C/'11 ?' d JANET R. EBERSOLE, Plaintiff V. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 CIVIL TERM IN DIVORCE APPEARANCE To the Prothonotary: Please enter the appearance of the undersigned on behalf of Defendant TIMOTHY M. EBERSOLE in the above-captioned matter. Date: July 3, 2002 Wayn . Shade, Esquire Supreme Court No. 15712 53 West Pomfret Street Carlisle, Pennsylvania 17013 Telephone: 717-243-0220 Attorney for Defendant WAYNE F. SHADE Attorney at taw 53 West Pomfret Street Carlisle, Pennsylvania 17013 ? ? .; ? c. ,, «? -- ?i:_, l= m? ,- ?`_ - ? ? p .' -: - r? c_' --c+ '' ;_. ?; Y (^? G .?- 'c, ea =< JANET R. EBERSOLE, Plaintiff vs. TIMOTHY M. EBERSOLE, Defendant : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL ACTION -LAW : NO. 02-2988 : IN DIVORCE AND NOW, comes Petitioner, Bradley L. Griffie, Esquire, and petitions the Court as follows: 1. Your Petitioner is counsel of record for the above named Plaintiff/Petitioner, Janet R. Ebersole. 2. An appearance has been entered by Wayne F. Shade, Esquire on behalf of the Defendant/Respondent, Timothy M. Ebersole. 3. A Petition for Exclusive Possession was filed by Plaintiff/Petitioner, which caused a hearing to be scheduled for Friday, July 12, 2002, at 9:45 a.m. in Courtroom No. 5 of the Cumberland County Courthouse, Carlisle, Pennsylvania. 4. The parties have thoroughly discussed the present situation and are exerting all efforts to reconcile their marriage and the differences that led to the filing of the Complaint in Divorce and the filing of the Petition for Exclusive Possession. 5. It is the desire of both parties, as expressed to their counsel, that the hearing scheduled for Friday, July 12, 2002, at 9:45 a.m. as described above be continued generally to allow the parties to attempt to effectuate a reconciliation. 6. Both parties and both counsel agree to this request for continuance. WHEREFORE, Petitioner requests your Honorable Court to continue the hearing previously scheduled in this matter for Friday, July 12, 2002 at 9:45 a.m., generally, to be rescheduled at the request of either party or counsel. Respectfully submitted, GRIFFIE & ASSOCIATES e, Esquire M B . G rlaintiff/Petiti y for 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 I verify that the statements made in the foregoing document 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: 7/,6J6,)- XAa . Gp fie, Esquire n C; o ?+Irr 70 . CJ r . JANET R. EBERSOLE, THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 02 - 2988 CIVIL TIMOTHY M. EBERSOLE, Defendant IN DIVORCE ORDER OF COURT AND NOW, this day of 2005, the economic claims raised in the proceedings having been resolved in accordance with a separation and property settlement agreement and addendum dated June 13, 2005, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, Ge E. Hoffer, P.J. cc: Xadley 7 orney ne F. Attorney Griffie for Plaintiff Shade for Defendant 0? ZS o1 !'"l IZ"€1ll'SON SEPARATION AND PROPERTY SETTLEMENT AGREEMENT THIS AGREEMENT made this / 3_Mday of J r\G 2005, by and between JANET R. EBERSOLE, of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, 17257, party of the first part, hereinafter referred to as "Wife," AND TIMOTHY M. EBERSOLE, of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, 17257, parry of the second part, hereinafter referred to as "Husband," WITNESSETH: WHEREAS, Husband and Wife were married on May 15, 1983 in York County, Pennsylvania; and WHEREAS, Husband and Wife are residents of the Commonwealth of Pennsylvania and have been so for at least the past six months; WHEREAS, certain differences have arisen between the parties hereto which have made them desirous of living separate and apart from one another; and WHEREAS, Husband and Wife desire to settle and determine certain of their marital rights and obligations, and make an equitable distribution of their marital property, determine their rights to alimony and support and any other matters which may be considered under the Divorce Code; and WHEREAS, it is the intention and purpose of this Agreement to set forth the respective rights and duties of the parties while they continue to live apart from each other and to settle all financial and property rights between them; and --Page 1 of 2 1-- WHEREAS, the parties hereto have mutually entered into an agreement for the division of their jointly owned assets, the provisions for the liabilities they owe, and provisions for the resolution of their mutual differences, after both have had full and ample opportunity to consult with attorneys of their respective choice, the parties now wish to have that agreement reduced to writing. NOW, THEREFORE, the parties hereto in consideration of the mutually made and to be kept promises set forth hereinafter and for other good and valuable consideration, and intending to be legally bound' and to legally bind their heirs, successors, assigns, and personal representatives, do hereby covenant, promise and agree as follows: ARTICLE I SEPARATION 1.1 It shall be lawful for Husband and Wife at all times hereafter to live separate and apart from each other and to reside from time to time at such place or places as they shall respectively deem fit free from any control, restraint, or interference, direct or indirect, by each other. Neither party shall molest the other or compel or endeavor to compel the other to cohabit or dwell with him or her by any legal or other proceedings. The foregoing provisions shall not be taken to be an admission on the part of either Husband or Wife of the lawfulness of the causes leading to them living separate and apart. ARTICLE II DIVORCE 2.1 This Agreement is not predicated on divorce. It is specifically understood and agreed by and between the parties hereto that each of the said parties does hereby warrant and represent to --Page 2 of 21-- the other that the execution and delivery of this Agreement is not predicated upon nor made subject to any agreement for institution, prosecution, defense, or for the non-prosecution or non- defense of any action for divorce; provided, however, that nothing contained in this Agreement shall prevent or preclude either of the parties hereto from commencing, instituting or prosecuting any action or actions for divorce, either absolute or otherwise, upon just, legal and proper grounds; not to prevent either party from defending any such action which has been, may, or shall be instituted by the other party, or from making any just or proper defense thereto. It is warranted, covenanted, and represented by Husband and Wife, each to the other, that this Agreement is lawful and enforceable and this warranty, covenant, and representation is made for the specific purpose of inducing Husband and Wife to execute the Agreement. Husband and Wife each knowingly and understandingly hereby waive any and all possible claims that this Agreement is, for any reason, illegal, or for any reason whatsoever of public policy, unenforceable in whole or in part. Husband and Wife do each hereby warrant, covenant and agree that, in any possible event, he and she are and shall forever be estopped from asserting any illegality or unenforceability as to all or any part of this Agreement. 2.2 It is further specifically understood and agreed that the provision of this Agreement relating to the equitable distribution of property of the parties are accepted by each parry as a final settlement for all purposes whatsoever. Should either of the parties obtain a decree, judgment or order of separation or divorce in any other state, country, or jurisdiction, each of the parties to this Agreement hereby consents and agrees that this Agreement and all its covenants shall not be affected in any way by any such separation and divorce. --Page 3 of 21-- Z3 This Agreement shall survive any decree in divorce and shall be forever binding and conclusive on the parties. It is understood by and between the parties that this Agreement shall be incorporated into any decree, divorce or separation, but it shall not be deemed merged in such decree. ARTICLE III EQUITABLE DISTRIBUTIONOFMARITAL PROPERTY 3.1 The parties have attempted to divide their marital property in a manner which conforms to the criteria set forth in the Pennsylvania Divorce Code, and taking into account the following considerations: the length of the marriage; the prior marriages of the parties; the age, health, station, amount and sources of income, vocational skills, employability; estate, liabilities, and needs for each of the parties; the contribution of one party to the education, training or increased earning power to the other party; the opportunity of each party for future acquisition of capital assets and income; the sources of income of both parties, including but not limited to medical, retirement, insurance or other benefits; the contribution or dissipation of each part in the acquisition, preservation, depreciation, or appreciation of marital property, including the contribution of a party as a homemaker; the value of the property set apart to each party; the standard of living of the parties established during their marriage; the economic circumstances of each party, including federal, state and local tax ramifications, at the time of the division of the property is to become effective; and whether the parties will be serving as the custodian of any dependent minor children. --Page 4 of21-- 3.2 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 rights of equitable distribution of the parties. 3.3 Personal Property. The parties acknowledge that their children, Joshua Ebersole and Heather Ebersole, have items of personal property, including their bedroom furniture and furnishings, which each child shall retain as their personal property and neither party herein shall make claim against those items from this time forward. With respect to the personal property presently located at the residence of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, should Wife retain ownership and possession of that real estate under the terms set forth in paragraph 3.6 hereinafter, Husband shall move with him, when he vacates the residence, the personal property items listed on Exhibit "A", which is attached hereto and incorporated herein by reference. In the event that Husband retains ownership and possession of the real estate, Wife shall remove with her, when she vacates the residence, the items of personal property listed on Exhibit "B", which is attached hereto and incorporated herein by reference. Except for the transfer or removal of items of personal property referenced herein, the parties acknowledge that they have the furniture, appliances, tools, household furnishings, vehicles and other personal property, tangible and intangible, in their possession that they wish to have and retain from this time forward. Neither party shall make any claim whatsoever against the personal property in the other party's possession, or assets in that other party's possession, or -Page 5 of 21-- items listed on Exhibit "A" and "B" described herein, from the time of execution of this Agreement forward. 3.4 Life Insurance. Each party agrees that the other party shall have sole ownership and possession of any life insurance policies owned by the other. Each parry shall have the right to borrow against, cash in policies, change beneficiaries, an exercise any other incidents of ownership of the respective policies free of any right or claim by the other party. Each party agrees to sign any documents necessary to waive, relinquish or transfer any rights in such policies to the respective parry who presently owns such policies. 3.5 Subsequently Acquired Property. Husband and Wife agree to waive and relinquish any and all right that he or she may now have or hereafter acquire in any real or tangible personal property subsequently acquired by the other party. Husband and Wife specifically agree to waive and relinquish any right in such property that may arise as a result of the marriage relationship. 3.6 Real Estate. The parties are the joint owners of real estate located at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, as tenants by the entireties. The aforesaid real estate is encumbered with a mortgage due and owing to Fulton Bank. At the time of execution of this Agreement, both parties continue to reside at this property. In order to determine who shall retain possession and ownership of the aforesaid real estate, the parties shall conduct a private auction at the office of the Divorce Master for Cumberland County at 9 North Hanover Street, Carlisle, Pennsylvania, on Monday, June 13, 2005 at 9:00 a.m. At that time, the Divorce Master shall select a means of providing for one --Page 6 of 21-- parry to make the initial bid on the purchase of the marital residence. The initial offer at the auction must be at least $200,500.00. After the initial bid is made, the opposing party may place a bid and the parties shall then continue to alternate bidding against each other in this manner in any increasing amounts that they desire, until such time as one party determines that they will no longer bid. At that point, the party with the high bid shall be determined to be the party who shall retain ownership and possession of the real estate at the last price bid. In the event Husband is the successful bidder, he shall, within sixty (60) days of the date of the auction, refinance the mortgage on the property, together with securing sufficient funds to pay a cash disbursement to Wife in an amount equal to fifty-eight (58%) percent of the amount that Husband's final bid exceeds $200,500.00. For example, under circumstances where Husband bids a total of $240,500.00 to secure ownership of the property, thereby exceeding the set price of $200,500.00 by $40,000.00, he shall compensate Wife, at the time of his refinancing of the mortgage, an amount of $23,200.00 in a cash disbursement. In the event Wife is the successful bidder, she shall, within sixty (60) days from the date of the auction, refinance the mortgage on the property, together with securing sufficient funds to pay a cash disbursement to Husband in an amount equal to forty-two (42%) percent of the amount that Wife's final bid exceeds $200,500.00. In addition, however, in the event Wife determines that she wishes to use funds from the QDRO rollover from Husband's TIAA-CREF account, referenced in paragraph 3.7 hereinafter, her refinancing of the mortgage and compensation of any nature to Husband may await the final rollover of those funds such that those funds will be available to Wife to assist in the refinancing of the mortgage and compensating Husband. --Page 7 of21-- At the time of the refinancing of the mortgage by either party as described above, the other parry shall provide a signed, witnessed and notarized special warranty, fee simple deed conveying that party's interest in the real estate to the party who is the successful bidder at the auction as described above. Upon completion of the refinancing settlement as described herein, the party who has not retained ownership of the property shall make no claim of any nature whatsoever against the other party for any legal or equitable interest or similar claims in the real estate from the time of refinancing forward. 3.7 Pension. Retirement. Prof*Sharing. Wife agrees to waive, relinquish or transfer any and all of her right, title and interest she has or may have in Husband's TIAA-CREF retirement account. In consideration of Wife's waiver, relinquishment and transfer of any interest she has in that account, the parties shall execute a Qualified Domestic Relations Order (QDRO), as prepared by Wife's counsel, in order to provide for the rollover from said account of the sum of FIFTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($51,600.00) DOLLARS from said account to an account for Wife. In the event that Husband is the successful bidder on the real estate on the real estate at 71 Diller Drive, Shippensburg, Pennsylvania, under circumstances described in paragraph 3.6 above, the rollover amount shall be increased to SEVENTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($71,600.00) DOLLARS. Preparation of the QDRO and rollover of the required amount shall be done expeditiously, time being of the essence. Except for the disbursement provided for in this paragraph, Wife shall make no claim of any nature whatsoever against Husband's TIAA-CREF retirement account. -Page 9 of21-- Otherwise, Wife hereby waives, relinquishes and transfers any and all right, title and interest she has or may have in any and all retirement accounts of Husband from the time of execution of this Agreement forward, whether those retirement accounts have been secured through prior or current employment or through Husband's individual efforts. Husband agrees to waive, relinquish or transfer any and all of his right, title and interest he has or may have in Wife's American Funds account, Plan ID #241887760, and in Wife's ING USA Annuity and Life Insurance Company Annuity, contract #183211, as well as any other retirement accounts of any nature whatsoever that Wife may have accrued through her present or prior employment or through Wife's individual efforts. 3.8 Vehicles. The parties acknowledge that Wife has and shall retain sole and exclusive ownership and possession of a certain 1999 Ford Escort. Husband shall execute the title of the vehicle and related documents within fifteen (15) days of being requested to do so by Wife or Wife's legal counsel transferring title to Wife's name individually, in the event Husband's name is on the title to that vehicle. Husband shall make no claim whatsoever relative to access to or use of the aforesaid vehicle and shall make no ownership claims of any nature whatsoever against the aforesaid vehicle from the date of execution of this Agreement forward. Wife shall be solely and exclusively responsible for any and all encumbrances of any nature whatsoever against said vehicle and shall indemnify Husband and hold him harmless from and against any and all demands for payment and collection activity of any nature whatsoever on account of any such debts. The parties acknowledge that Husband has and shall retain sole and exclusive ownership and possession of a certain 2001 Honda Civic. Wife shall execute the title of the vehicle within --Page 9 of 21-- fifteen (15) days of being requested to do so by Husband or Husband's legal counsel transferring title to Husband's name individually, in the event Wife's name is on the title to that vehicle. Wife shall make no claim whatsoever relative to access to or use of the aforesaid vehicle and shall make no ownership claims of any nature whatsoever against the aforesaid vehicle from the date of execution of this Agreement forward. Husband shall be solely and exclusively responsible for any and all encumbrances of any nature whatsoever against said vehicle and shall indemnify Wife and hold him harmless from and against any and all demands for payment and collection activity of any nature whatsoever on account of any such debts. The parties further acknowledge that their adult daughter, Heather, has in her possession a certain 1996 Mazda 626 vehicle, which is and shall be her sole asset. The parties shall execute any documents necessary to transfer and convey any interest they may have to the aforesaid vehicle to their daughter in an expedited manner upon daughter's request or, under any circumstances, upon her graduation from college. 3.9 Intangible Personal Property. Wife hereby waives, relinquishes and transfers any and all right, title and interest she has in Husband's account with the Wednesday Club and his Allfirst or M&T checking account. Wife shall make no claim of any nature whatsoever relative to any ownership interest or other claims against said accounts from the time of execution of this Agreement forward. Husband hereby waives, relinquishes and transfers any and all right, title and interest he has in Wife's Patriot Federal Credit Union account. Husband shall make no claim of any nature whatsoever relative to any ownership interest or other claims against said accounts from the time of execution of this Agreement forward. --Page 10 of 21-- The parties further acknowledge that they had previously maintained an account with Merrill Lynch, which account has been closed and the proceeds from that account have been distributed. Neither party will make any claim of any nature whatsoever against the other for any rights or interest in funds that have been or may have been received from the aforesaid Merrill Lynch account. In the event it is necessary for either party to execute any documents to implement the provisions of this Agreement, they shall do so within fifteen (15) days of being requested to do so by the other parry or the other party's legal counsel. ARTICLE IV DEBTS OF THE PARTIES 4.1 The parties acknowledge that they have outstanding debts or obligations. In particular, Husband has an outstanding obligation to American Express, which shall be his sole and exclusive obligation. Husband shall indemnify Wife and hold her harmless from and against any and all demands for payment or collection activity of any nature whatsoever relative to his American Express account. Wife has a loan against her ING USA Annuity, which shall be her sole and exclusive responsibility. Wife shall indemnify Husband and hold him harmless from and against any and all demands for payment or collection activity of any nature whatsoever relative to the loans on Wife's ING USA Annuity. 4.2 Each party represents to the other that except as is otherwise set forth in this Agreement, and more particularly as set forth in subparagraph 4.1 above, the parties do not have any additional joint debt of any nature whatsoever that could create liability for the other party. --Page 11 of21-- Neither parry has created any such joint debts since the time of filing the divorce action in this matter that would create additional liens, encumbrances or obligations of any nature against the other party. Neither parry shall take any action to create additional indebtedness for the other party in any manner from the time of execution of this Agreement forward. ARTICLE V ALIMONY. SPOUSAL SUPPORT. CHILD SUPPORT, HEALTH INSURANCE 5.1 Beginning on the first day of the first month after the parties have physically separated by one of the parties moving from the former marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, pursuant to paragraph 3.6 herein, Husband shall begin compensating Wife in the amount of ONE THOUSAND ONE HUNDRED AND XX/100 ($1,100.00) DOLLARS per month for an indefinite period as alimony to Wife. As long as monthly payments in this amount are received by Wife by no later than the fifth of each month, Husband may make compensation to Wife for the alimony by direct payment. In the event Husband fails to make payment in a timely manner as described herein, Wife shall be entitled to file a Petition with the Court of Common Pleas of Cumberland County to have this sum collected through the Cumberland County Domestic Relations Office by wage attachment. This sum shall be paid for an indefinite period and may only be modified upon showing of a substantial change in the parties' financial circumstances. The parties further acknowledge that their children have graduated from high school and are at least 18 years of age. As such, no child support is due from either party to the other, nor to the children, for their maintenance or support. Any sums that the parties agree to contribute to the benefit of the children for their education or for their personal expenses during their pursuit of a college education shall be purely voluntary. --Page 12 of 2 1-- 5.2 In the event Wife, in her sole discretion, chooses to maintain her health insurance through Husband's employment via COBRA, Husband shall execute any necessary documents to assist Wife in maintaining her insurance in this manner and shall execute such documents within fifteen (15) days of being requested to do so by Wife or her legal counsel. Otherwise, the parties acknowledge that at the time of the entry of a Decree in Divorce, Husband's health insurance carrier, who carries health insurance on Wife at this time, shall, pursuant to their normal procedures, terminate health insurance for Wife and provide appropriate COBRA notices as required by Federal Law shall be provided to her. MISCELLANEOUS PROVISIONS 6.1 Advice of Counsel. The provisions of this Agreement and their legal effect have been fully explained to the parties by their respective counsel, being Bradley L. Griffie, Esquire, for Wife and Wayne F. Shade, Esquire, for Husband. The parties acknowledge that they have received independent legal advice from counsel of their own selection, that they fully understand the facts and have been fully informed as to their legal rights and obligation or otherwise understand those legal rights and obligations. They acknowledge and accept that this Agreement is, in the circumstances, fair and equitable, that it is being entered into freely and voluntarily, after having received such advice and with such knowledge that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements. --Page 13 of21-- 6.2 Mutual Release. Husband and Wife each do hereby mutually remise, release, quitclaim, and forever discharge the other and the estate of such other, for all times to come and for all purposes whatsoever, of and from any and all right, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situate, which he or she now has or at any time hereafter may have against such other, the estate of such other, or any part thereof, whether arising out of any former acts, contracts, engagements, or liabilities of such other as by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption, or similar allowance, or under the intestate laws, or the right to take against the spouse's Will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any state, commonwealth or territory of the United States, or (c) any other country, or any rights which either parry may have or at any time hereafter have for past, present, or future support or maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation or otherwise, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. It is the intention of Husband and Wife to give to each other by execution of this Agreement a full, complete, and general release with respect to any and all property of any kind or nature, real or personal, not mixed, which the other now owns or may hereafter acquire, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. --Page 14 of 21-- 6.3 Warranties. Each parry represents that they have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable, except as may be provided for in this Agreement. Each party agrees to indemnify or hold the other party harmless from and against any and all such debts, liabilities or obligations of every kind, including those for necessities, except for the obligations arising out of this Agreement. Husband and Wife each warrant, covenant, represent and agree that each will, now and at all times hereafter, save harmless and keep the other indemnified from all debts, charges, and liabilities incurred by the other after the execution date of this Agreement, except as is otherwise specifically provided for by the terms of this Agreement and that neither of them hereafter incur any liability whatsoever for which the estate of the other may be liable. 6.4 No waiver or modification of any of the terms of this Agreement 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. 6.5 Husband and Wife covenant and agree that 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 implementation of this Agreement, and as their respective counsel shall mutually agree should be so executed in order to carry fully and effectively the terms of this Agreement. --Page 15 of 21-- 66 This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania which are in effect as of the date of the execution of this Agreement. 6.7 This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 6.8 This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements and negotiations between them. There are no representations or warranties other than those expressly set forth herein. 6.9 Severability. If any term, condition, clause, section, or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement, and in all other respects, this Agreement shall be valid and continue in full force, effect, and operation. Likewise, the failure of any party to meet his or her obligation under any one or more of the articles and sections herein shall in no way void or alter the remaining obligations of the parties. 6.10 It is specifically understood and agreed that this Agreement constitutes the equitable distribution of property, both real and personal, which was legally and beneficially acquired by Husband and Wife, or either of them, during the marriage as contemplated by the Divorce Code of the Commonwealth of Pennsylvania. --Page 16 of 21- 6.11 Disclosure. The parties each warrant and represent to the other that he or she has made a full and complete disclosure to the other of all assets of any nature whatsoever in which party has an interest, of the sources, and amount of the income of such parry of every type whatsoever, and all other facts relating to the subject matter of this Agreement. 6.12 Enforceability and Consideration. This Agreement shall survive any action for divorce and decree of divorce and shall forever be binding and conclusive on the parties; and any independent action may be brought, either at law or in equity, to enforce the terms of the Agreement by either Husband or Wife until it shall have been fully satisfied and performed. The consideration for this contract and agreement is the mutual benefits to be obtained by both of the parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained is stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound hereby. In the event either party breaches the aforesaid Agreement and it is determined through appropriate legal action that the alleged party has so breached the Agreement, the breaching parry shall be responsible for any and all attorney's fees as well as costs and expenses associated with litigation incurred by the non- breaching party to enforce this Agreement against the breaching parry. In the event of breach, the non-breaching party shall have the right, at his or her election, to sue for damages for such breach or to seek such other and additional remedies as may be available to him or her including equitable enforcement of this Agreement. --Page 17 of 21- IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WITNESS BY: 113 Date ANET R. EBERSOLE 3 0?r ?j Date TIMOTHY M. EBERSOLE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this 13* day of , 2005, before me, the undersigned officer, personally appeared f T X EBERSOLE, known to me (or satisfactory proven) to be the person whose name is subscribed to the within Agreement and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal, NOTARIAL SEAL NOISLEB OSHORN,AN COON CARLISLE BORD., CUMBERLAND COUNTY 1IY COMMISSION EXPIRES APRIL 17, 2001 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this /_? 6 day of , 2005, before me, the undersigned officer, personally appeared TI OTHY M. EBERSOLE, known to me (or satisfactory proven) to be the person whose name is subscribed to the within Agreement and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SEAL ' ROBINI.OOSHORN,NOTARYPOBLIC , ! r J CARLISLE BORO., CUMBERLAND COUNTY NIY COMMISSION EXPIRES APRIL 11 2007 --Page 18 of 21-- _. ,.....?_ , . , ?,?ra r'S r PERSONAL PROPERTY OF HUSBAND Blue sofa Blue love seat Washing machine Clothes dryer Patio furniture Telephone in game room Beigelbrown rocking chair Two-tiered end table Big Screen TV and DVD Player 2001 Honda Civic Personal sports items Items given by Husband's family Lawn mower Personal jewelry, clothing, luggage, toiletries and similar personal items Exhibit "A" --Page 19 of 21-- PERSONAL PROPERTY OF WIFE Maytag Gemini stove/oven Refrigerator Rattan style sofa bed Glass/rattan coffee table Brown recliner chair Blue/green slipper chair Blue card table and 4 chairs Dining room table and 5 chairs Dining room hutch Toshiba television TV Cabinet in Master bedroom Symphonic VCR Master bedroom phone Cherry table with 1 drawer Four piece master bedroom matching set RCA TV and Magnavox VCR 6' ladder and step stool Wooden TV trays Antique trunk Brown plaid sleeper couch Wheelbarrow Tree trimmer Household and garden tools Video camera and tapes Camera Wooden set of coffee/end tables 1999 Ford Escort Antique sewing table Word processor and computer Antique black chair Blue snow shovel Sharp microwave oven Sewing table Linens, towels, bedding Grandmother's clock Piano and bench Print picture Doll collection Sconces Christmas and Easter decorations Cookware and Griddle Cookbooks Sound Design stereo/speakers -Page 20 of 21-- Personal photos, books, records Dropleaf & Antique wall tables Antique child's desk and chair Electric mixer Floor lamp Wooden base lamps Red Devil portable grill Propane gas container/cans Any items from first marriage Items purchased by Wife's parents Personal jewelry, clothing, luggage, toiletries and similar personal items Exhibit "B" --Page 21 of 21-- THIS ADDENDUM to the Separation and Property Settlement Agreement of June 13, 2005, by and between JANET R. EBERSOLE (hereinafter referred to as "Wife") and TIMOTHY M. EBERSOLE (hereinafter referred to as "Husband") provides as follows: The provisions of Paragraph 3.6 are deleted and the following is substituted : The marital residence will be transferred to Husband. Husband will pay Wife the sum of $27,000.00 on or before August 1, 2005. Husband will refinance the mortgage against the marital residence on or before September 1, 2005. Wife shall vacate the marital residence on or before August 1, 2005. In the event of the failure of Husband to pay the sum of $27,000.00 on or before August 1, 2005, or to refinance the mortgage on or before September 1, 2005, Wife shall receive ownership and possession of the marital residence, in which event the roll-over to Wife under the provisions of Paragraph 3.7 shall be $51,600.00. 2. The provisions of Paragraph 3.3 are amended to add to Exhibit "A" the microwave oven and the king-size bed. The provisions of Paragraph 5.1 are amended to provide for commencement of alimony on August 1, 2005, and for termination of alimony upon the death of Wife or her remarriage or cohabitation with a person, either male or female, to whom she would not be related within the degrees of consanguinity. 4. In all other respects, the Separation and Property Settlement Agreement of even date herewith is ratified and confirmed. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WITNESSED BY: 6 (Dt O?- Date JANET R. EBERSOLE A KV . EBERSOLE Date JANET R. EBERSOLE, Plaintiff vs. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 IN DIVORCE AFFIDAVIT OF CONSENT 1. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed on June 21, 2002, and served on July 1, 2002. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. I consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the decree. I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO i1I SWORN FALSIFICATION TO AUTHORITIES. DATE: (%.?Lr?Yrt??/h ?,? ,?Cl?` _S?yL?2 E(fr.QAf_?i JANET R. EBERSOLE, Plaintiff JANET R. EBERSOLE, Plaintiff vs. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST THE ENTRY OF A DIVORCE DECREE UNDER &3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I VERIFY THAT THE STATEMENTS MADE INT THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. DATE xl ('E'[%.??2CtF'$ ?T? v?C?LL? a?tc 7' ???/Lall?tiJ J ET R. EBERSOLE, Plaintiff SEPARATION AND PROPERTY SETTLEMENT AGREEMENT Th THIS AGREEMENT made this day of J tTn? 2005, by and between JANET R. EBERSOLE, of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, 17257, parry of the first part, hereinafter referred to as "Wife," AND TIMOTHY M. EBERSOLE, of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, 17257, party of the second part, hereinafter referred to as "Husband," WITNESSETH; WHEREAS, Husband and Wife were married on May 15, 1983 in York County, Pennsylvania; and WHEREAS, Husband and Wife are residents of the Commonwealth of Pennsylvania and have been so for at least the past six months; WHEREAS, certain differences have arisen between the parties hereto which have made them desirous of living separate and apart from one another; and WHEREAS, Husband and Wife desire to settle and determine certain of their marital rights and obligations, and make an equitable distribution of their marital property, determine their rights to alimony and support and any other matters which may be considered under the Divorce Code; and WHEREAS, it is the intention and purpose of this Agreement to set forth the respective rights and duties of the parties while they continue to live apart from each other and to settle all financial and property rights between them; and --Page 1 of21-- WHEREAS, the parties hereto have mutually entered into an agreement for the division of their jointly owned assets, the provisions for the liabilities they owe, and provisions for the resolution of their mutual differences, after both have had full and ample opportunity to consult with attorneys of their respective choice, the parties now wish to have that agreement reduced to writing. NOW, THEREFORE, the parties hereto in consideration of the mutually made and to be kept promises set forth hereinafter and for other good and valuable consideration, and intending to be legally bound and to legally bind their heirs, successors, assigns, and personal representatives, do hereby covenant, promise and agree as follows: ARTICLE I SEPARATION 1.1 It shall be lawful for Husband and Wife at all times hereafter to live separate and apart from each other and to reside from time to time at such place or places as they shall respectively deem fit free from any control, restraint, or interference, direct or indirect, by each other. Neither party shall molest the other or compel or endeavor to compel the other to cohabit or dwell with him or her by any legal or other proceedings. The foregoing provisions shall not be taken to be an admission on the part of either Husband or Wife of the lawfulness of the causes leading to them living separate and apart. ARTICLE II DIVORCE 2.1 This Agreement is not predicated on divorce. It is specifically understood and agreed by and between the parties hereto that each of the said parties does hereby warrant and represent to --Page 2 of 21-- the other that the execution and delivery of this Agreement is not predicated upon nor made subject to any agreement for institution, prosecution, defense, or for the non-prosecution or non- defense of any action for divorce; provided, however, that nothing contained in this Agreement shall prevent or preclude either of the parties hereto from commencing, instituting or prosecuting any action or actions for divorce, either absolute or otherwise, upon just, legal and proper grounds; not to prevent either party from defending any such action which has been, may, or shall be instituted by the other party, or from making any just or proper defense thereto. It is warranted, covenanted, and represented by Husband and Wife, each to the other, that this Agreement is lawful and enforceable and this warranty, covenant, and representation is made for the specific purpose of inducing Husband and Wife to execute the Agreement. Husband and Wife each knowingly and understandingly hereby waive any and all possible claims that this Agreement is, for any reason, illegal, or for any reason whatsoever of public policy, unenforceable in whole or in part. Husband and Wife do each hereby warrant, covenant and agree that, in any possible event, he and she are and shall forever be estopped from asserting any illegality or unenforceability as to all or any part of this Agreement. 2.2 It is further specifically understood and agreed that the provision of this Agreement relating to the equitable distribution of property of the parties are accepted by each party as a final settlement for all purposes whatsoever. Should either of the parties obtain a decree, judgment or order of separation or divorce in any other state, country, or jurisdiction, each of the parties to this Agreement hereby consents and agrees that this Agreement and all its covenants shall not be affected in any way by any such separation and divorce. --Page 3 of 21-- Z3 This Agreement shall survive any decree in divorce and shall be forever binding and conclusive on the parties. It is understood by and between the parties that this Agreement shall be incorporated into any decree, divorce or separation, but it shall not be deemed merged in such decree. ARTICLE III EQUITABLE DISTRIBUTION OF MARITAL PROPERTY 3.1 The parties have attempted to divide their marital property in a manner which conforms to the criteria set forth in the Pennsylvania Divorce Code, and taking into account the following considerations: the length of the marriage; the prior marriages of the parties; the age, health, station, amount and sources of income, vocational skills, employability; estate, liabilities, and needs for each of the parties; the contribution of one party to the education, training or increased earning power to the other party; the opportunity of each party for future acquisition of capital assets and income; the sources of income of both parties, including but not limited to medical, retirement, insurance or other benefits; the contribution or dissipation of each part in the acquisition, preservation, depreciation, or appreciation of marital property, including the contribution of a party as a homemaker; the value of the property set apart to each party; the standard of living of the parties established during their marriage; the economic circumstances of each party, including federal, state and local tax ramifications, at the time of the division of the property is to become effective; and whether the parties will be serving as the custodian of any dependent minor children. --Page 4 of 21-- 3.2 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 rights of equitable distribution of the parties. 3.3 Personal Property. The parties acknowledge that their children, Joshua Ebersole and Heather Ebersole, have items of personal property, including their bedroom furniture and furnishings, which each child shall retain as their personal property and neither party herein shall make claim against those items from this time forward. With respect to the personal property presently located at the residence of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, should Wife retain ownership and possession of that real estate under the terms set forth in paragraph 3.6 hereinafter, Husband shall move with him, when he vacates the residence, the personal property items listed on Exhibit "A", which is attached hereto and incorporated herein by reference. In the event that Husband retains ownership and possession of the real estate, Wife shall remove with her, when she vacates the residence, the items of personal property listed on Exhibit "B", which is attached hereto and incorporated herein by reference. Except for the transfer or removal of items of personal property referenced herein, the parties acknowledge that they have the furniture, appliances, tools, household furnishings, vehicles and other personal property, tangible and intangible, in their possession that they wish to have and retain from this time forward. Neither party shall make any claim whatsoever against the personal property in the other party's possession, or assets in that other party's possession, or --Page 5 of21-- items listed on Exhibit "A" and "B" described herein, from the time of execution of this Agreement forward. 3.4 Life Insurance. Each party agrees that the other party shall have sole ownership and possession of any life insurance policies owned by the other. Each party shall have the right to borrow against, cash in policies, change beneficiaries, an exercise any other incidents of ownership of the respective policies free of any right or claim by the other party. Each party agrees to sign any documents necessary to waive, relinquish or transfer any rights in such policies to the respective party who presently owns such policies. 3.5 Subseauently Acquired Property. Husband and Wife agree to waive and relinquish any and all right that he or she may now have or hereafter acquire in any real or tangible personal property subsequently acquired by the other party. Husband and Wife specifically agree to waive and relinquish any right in such property that may arise as a result of the marriage relationship. 3.6 Real Estate. The parties are the joint owners of real estate located at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, as tenants by the entireties. The aforesaid real estate is encumbered with a mortgage due and owing to Fulton Bank. At the time of execution of this Agreement, both parties continue to reside at this property. In order to determine who shall retain possession and ownership of the aforesaid real estate, the parties shall conduct a private auction at the office of the Divorce Master for Cumberland County at 9 North Hanover Street, Carlisle, Pennsylvania, on Monday, June 13, 2005 at 9:00 a.m. At that time, the Divorce Master shall select a means of providing for one --Page 6 of 21-- parry to make the initial bid on the purchase of the marital residence. The initial offer at the auction must be at least $200,500.00. After the initial bid is made, the opposing party may place a bid and the parties shall then continue to alternate bidding against each other in this manner in any increasing amounts that they desire, until such time as one party determines that they will no longer bid. At that point, the party with the high bid shall be determined to be the party who shall retain ownership and possession of the real estate at the last price bid. In the event Husband is the successful bidder, he shall, within sixty (60) days of the date of the auction, refinance the mortgage on the property, together with securing sufficient funds to pay a cash disbursement to Wife in an amount equal to fifty-eight (58%) percent of the amount that Husband's final bid exceeds $200,500.00. For example, under circumstances where Husband bids a total of $240,500.00 to secure ownership of the property, thereby exceeding the set price of $200,500.00 by $40,000.00, he shall compensate Wife, at the time of his refinancing of the mortgage, an amount of $23,200.00 in a cash disbursement. In the event Wife is the successful bidder, she shall, within sixty (60) days from the date of the auction, refinance the mortgage on the property, together with securing sufficient funds to pay a cash disbursement to Husband in an amount equal to forty-two (42%) percent of the amount that Wife's final bid exceeds $200,500.00. In addition, however, in the event Wife determines that she wishes to use funds from the QDRO rollover from Husband's TIAA-CREF account, referenced in paragraph 3.7 hereinafter, her refinancing of the mortgage and compensation of any nature to Husband may await the final rollover of those funds such that those funds will be available to Wife to assist in the refinancing of the mortgage and compensating Husband. --Page ? of 21-- At the time of the refinancing of the mortgage by either party as described above, the other parry shall provide a signed, witnessed and notarized special warranty, fee simple deed conveying that party's interest in the real estate to the parry who is the successful bidder at the auction as described above. Upon completion of the refinancing settlement as described herein, the party who has not retained ownership of the property shall make no claim of any nature whatsoever against the other parry for any legal or equitable interest or similar claims in the real estate from the time of refinancing forward. 3.7 Pension, Retirement, Prorti-Sharine. Wife agrees to waive, relinquish or transfer any and all of her right, title and interest she has or may have in Husband's TIAA-CREF retirement account. In consideration of Wife's waiver, relinquishment and transfer of any interest she has in that account, the parties shall execute a Qualified Domestic Relations Order (QDRO), as prepared by Wife's counsel, in order to provide for the rollover from said account of the sum of FIFTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($51,600.00) DOLLARS from said account to an account for Wife. In the event that Husband is the successful bidder on the real estate on the real estate at 71 Diller Drive, Shippensburg, Pennsylvania, under circumstances described in paragraph 3.6 above, the rollover amount shall be increased to SEVENTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($71,600.00) DOLLARS. Preparation of the QDRO and rollover of the required amount shall be done expeditiously, time being of the essence. Except for the disbursement provided for in this paragraph, Wife shall make no claim of any nature whatsoever against Husband's TIAA-CREF retirement account. --Page 8 of21-- Otherwise, Wife hereby waives, relinquishes and transfers any and all right, title and interest she has or may have in any and all retirement accounts of Husband from the time of execution of this Agreement forward, whether those retirement accounts have been secured through prior or current employment or through Husband's individual efforts. Husband agrees to waive, relinquish or transfer any and all of his right, title and interest he has or may have in Wife's American Funds account, Plan ID #241887760, and in Wife's ING USA Annuity and Life Insurance Company Annuity, contract #183211, as well as any other retirement accounts of any nature whatsoever that Wife may have accrued through her present or prior employment or through Wife's individual efforts. 3.8 Vehicles. The parties acknowledge that Wife has and shall retain sole and exclusive ownership and possession of a certain 1999 Ford Escort. Husband shall execute the title of the vehicle and related documents within fifteen (15) days of being requested to do so by Wife or Wife's legal counsel transferring title to Wife's name individually, in the event Husband's name is on the title to that vehicle. Husband shall make no claim whatsoever relative to access to or use of the aforesaid vehicle and shall make no ownership claims of any nature whatsoever against the aforesaid vehicle from the date of execution of this Agreement forward. Wife shall be solely and exclusively responsible for any and all encumbrances of any nature whatsoever against said vehicle and shall indemnify Husband and hold him harmless from and against any and all demands for payment and collection activity of any nature whatsoever on account of any such debts. The parties acknowledge that Husband has and shall retain sole and exclusive ownership and possession of a certain 2001 Honda Civic. Wife shall execute the title of the vehicle within --Page 9 of21-- fifteen (15) days of being requested to do so by Husband or Husband's legal counsel transferring title to Husband's name individually, in the event Wife's name is on the title to that vehicle. Wife shall make no claim whatsoever relative to access to or use of the aforesaid vehicle and shall make no ownership claims of any nature whatsoever against the aforesaid vehicle from the date of execution of this Agreement forward. Husband shall be solely and exclusively responsible for any and all encumbrances of any nature whatsoever against said vehicle and shall indemnify Wife and hold him harmless from and against any and all demands for payment and collection activity of any nature whatsoever on account of any such debts. The parties further acknowledge that their adult daughter, Heather, has in her possession a certain 1996 Mazda 626 vehicle, which is and shall be her sole asset. The parties shall execute any documents necessary to transfer and convey any interest they may have to the aforesaid vehicle to their daughter in an expedited manner upon daughter's request or, under any circumstances, upon her graduation from college. 3.9 Intangible Personal Property. Wife hereby waives, relinquishes and transfers any and all right, title and interest she has in Husband's account with the Wednesday Club and his Allfirst or M&T checking account. Wife shall make no claim of any nature whatsoever relative to any ownership interest or other claims against said accounts from the time of execution of this Agreement forward. Husband hereby waives, relinquishes and transfers any and all right, title and interest he has in Wife's Patriot Federal Credit Union account. Husband shall make no claim of any nature whatsoever relative to any ownership interest or other claims against said accounts from the time of execution of this Agreement forward. -Page 10 of 21-- The parties further acknowledge that they had previously maintained an account with Merrill Lynch, which account has been closed and the proceeds from that account have been distributed. Neither party will make any claim of any nature whatsoever against the other for any rights or interest in funds that have been or may have been received from the aforesaid Merrill Lynch account. In the event it is necessary for either party to execute any documents to implement the provisions of this Agreement, they shall do so within fifteen (15) days of being requested to do so by the other parry or the other party's legal counsel. ARTICLE IV DEBTS OF THE PARTIES 4.1 The parties acknowledge that they have outstanding debts or obligations. In particular, Husband has an outstanding obligation to American Express, which shall be his sole and exclusive obligation. Husband shall indemnify Wife and hold her harmless from and against any and all demands for payment or collection activity of any nature whatsoever relative to his American Express account. Wife has a loan against her ING USA Annuity, which shall be her sole and exclusive responsibility. Wife shall indemnify Husband and hold him harmless from and against any and all demands for payment or collection activity of any nature whatsoever relative to the loans on Wife's ING USA Annuity. 4.2 Each party represents to the other that except as is otherwise set forth in this Agreement, and more particularly as set forth in subparagraph 4.1 above, the parties do not have any additional joint debt of any nature whatsoever that could create liability for the other party. --Page 11 of 21-- Neither party has created any such joint debts since the time of filing the divorce action in this matter that would create additional liens, encumbrances or obligations of any nature against the other party. Neither party shall take any action to create additional indebtedness for the other party in any manner from the time of execution of this Agreement forward. ARTICLE V ALIMONY, SPOUSAL SUPPORT, CHILD SUPPORT. HEALTH INSURANCE 5.1 Beginning on the first day of the first month after the parties have physically separated by one of the parties moving from the former marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, pursuant to paragraph 3.6 herein, Husband shall begin compensating Wife in the amount of ONE THOUSAND ONE HUNDRED AND XX/100 ($1,100.00) DOLLARS per month for an indefinite period as alimony to Wife. As long as monthly payments in this amount are received by Wife by no later than the fifth of each month, Husband may make compensation to Wife for the alimony by direct payment. In the event Husband fails to make payment in a timely manner as described herein, Wife shall be entitled to file a Petition with the Court of Common Pleas of Cumberland County to have this sum collected through the Cumberland County Domestic Relations Office by wage attachment. This sum shall be paid for an indefinite period and may only be modified upon showing of a substantial change in the parties' financial circumstances. The parties further acknowledge that their children have graduated from high school and are at least 18 years of age. As such, no child support is due from either party to the other, nor to the children, for their maintenance or support. Any sums that the parties agree to contribute to the benefit of the children for their education or for their personal expenses during their pursuit of a college education shall be purely voluntary. --Page 12 of 21-- 5.2 In the event Wife, in her sole discretion, chooses to maintain her health insurance through Husband's employment via COBRA, Husband shall execute any necessary documents to assist Wife in maintaining her insurance in this manner and shall execute such documents within fifteen (15) days of being requested to do so by Wife or her legal counsel. Otherwise, the parties acknowledge that at the time of the entry of a Decree in Divorce, Husband's health insurance carrier, who carries health insurance on Wife at this time, shall, pursuant to their normal procedures, terminate health insurance for Wife and provide appropriate COBRA notices as required by Federal Law shall be provided to her. MISCELLANEOUS PROVISIONS 6.1 Advice of Counsel. The provisions of this Agreement and their legal effect have been fully explained to the parties by their respective counsel, being Bradley L. Griffie, Esquire, for Wife and Wayne F. Shade, Esquire, for Husband. The parties acknowledge that they have received independent legal advice from counsel of their own selection, that they fully understand the facts and have been fully informed as to their legal rights and obligation or otherwise understand those legal rights and obligations. They acknowledge and accept that this Agreement is, in the circumstances, fair and equitable, that it is being entered into freely and voluntarily, after having received such advice and with such knowledge that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements. --Page 13 of21-- 6.2 Mutual Release. Husband and Wife each do hereby mutually remise, release, quitclaim, and forever discharge the other and the estate of such other, for all times to come and for all purposes whatsoever, of and from any and all right, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situate, which he or she now has or at any time hereafter may have against such other, the estate of such other, or any part thereof, whether arising out of any former acts, contracts, engagements, or liabilities of such other as by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption, or similar allowance, or under the intestate laws, or the right to take against the spouse's Will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any state, commonwealth or territory of the United States, or (c) any other country, or any rights which either parry may have or at any time hereafter have for past, present, or future support or maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation or otherwise, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. It is the intention of Husband and Wife to give to each other by execution of this Agreement a full, complete, and general release with respect to any and all property of any kind or nature, real or personal, not mixed, which the other now owns or may hereafter acquire, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. --Page 14 of21-- 6.3 Warranties. Each party represents that they have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of the other parry may be responsible or liable, except as may be provided for in this Agreement. Each party agrees to indemnify or hold the other party harmless from and against any and all such debts, liabilities or obligations of every kind, including those for necessities, except for the obligations arising out of this Agreement. Husband and Wife each warrant, covenant, represent and agree that each will, now and at all times hereafter, save harmless and keep the other indemnified from all debts, charges, and liabilities incurred by the other after the execution date of this Agreement, except as is otherwise specifically provided for by the terms of this Agreement and that neither of them hereafter incur any liability whatsoever for which the estate of the other may be liable. 6.4 No waiver or modification of any of the terms of this Agreement 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. 6.5 Husband and Wife covenant and agree that 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 implementation of this Agreement, and as their respective counsel shall mutually agree should be so executed in order to carry fully and effectively the terms of this Agreement. --Page 15 of21-- 6.6 This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania which are in effect as of the date of the execution of this Agreement. 6.7 This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 6.8 This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements and negotiations between them. There are no representations or warranties other than those expressly set forth herein. 6.9 Severability. If any term, condition, clause, section, or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement, and in all other respects, this Agreement shall be valid and continue in full force, effect, and operation. Likewise, the failure of any party to meet his or her obligation under any one or more of the articles and sections herein shall in no way void or alter the remaining obligations of the parties. 6.10 It is specifically understood and agreed that this Agreement constitutes the equitable distribution of property, both real and personal, which was legally and beneficially acquired by Husband and Wife, or either of them, during the marriage as contemplated by the Divorce Code of the Commonwealth of Pennsylvania. --Page 16 of21-- 6.11 Disclosure. The parties each warrant and represent to the other that he or she has made a full and complete disclosure to the other of all assets of any nature whatsoever in which party has an interest, of the sources, and amount of the income of such party of every type whatsoever, and all other facts relating to the subject matter of this Agreement. 6.12 Enforceability and Consideration- This Agreement shall survive any action for divorce and decree of divorce and shall forever be binding and conclusive on the parties; and any independent action may be brought, either at law or in equity, to enforce the terms of the Agreement by either Husband or Wife until it shall have been fully satisfied and performed. The consideration for this contract and agreement is the mutual benefits to be obtained by both of the parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained is stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound hereby. In the event either party breaches the aforesaid Agreement and it is determined through appropriate legal action that the alleged party has so breached the Agreement, the breaching party shall be responsible for any and all attorney's fees as well as costs and expenses associated with litigation incurred by the non- breaching party to enforce this Agreement against the breaching party. In the event of breach, the non-breaching party shall have the right, at his or her election, to sue for damages for such breach or to seek such other and additional remedies as may be available to him or her including equitable enforcement of this Agreement. --Page 17 of 21-- IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WITNESSED BY: G° 13 O of 1"1 L ,/- Date ANET R. EBERSOOLLE 61131051/ 4'?z,.? ?,f Date TIMOTH EBERSOLE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this/ 3 6- day of , 2005, before me, the undersigned officer, personally appeared JAN R. EBERSOLE, known to me (or satisfactory proven) to be the person whose name is subscribed to the within Agreement and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SEAL NOTARY COUPUBLIC ROBINI GOSHORN, / NT'? C CARLISLEBORO BORO.,CUMBERLAND 17 2001 MY COMMISSION g1lPIRES APRIL . / COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this ,'_1 day of 2005, before me, the undersigned officer, personally appeared TI THY M. EBERSOLE, known to me (or satisfactory proven) to be the person whose name is subscribed to the within Agreement and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SEA ROBIN J. GOSHORN, BLIC FNOTA ACOMMI BOBO, CUMBERLAND: OU2 07 - --Page 18 of 21-- PERSONAL PROPERTY OF HUSBAND Blue sofa Blue love seat Washing machine Clothes dryer Patio furniture Telephone in game room Beige/brown rocking chair Two-tiered end table Big Screen TV and DVD Player 2001 Honda Civic Personal sports items Items given by Husband's family Lawn mower Personal jewelry, clothing, luggage, toiletries and similar personal items Exhibit "A" --Page 19 of21-- PERSONAL PROPERTY OF WIFE Maytag Gemini stove/oven Refrigerator Rattan style sofa bed Glass/rattan coffee table Brown recliner chair Blue/green slipper chair Blue card table and 4 chairs Dining room table and 5 chairs Dining room hutch Toshiba television TV Cabinet in Master bedroom Symphonic VCR Master bedroom phone Cherry table with 1 drawer Four piece master bedroom matching set RCA TV and Magnavox VCR 6' ladder and step stool Wooden TV trays Antique trunk Brown plaid sleeper couch Wheelbarrow Tree trimmer Household and garden tools Video camera and tapes Camera Wooden set of coffeefend tables 1999 Ford Escort Antique sewing table Word processor and computer Antique black chair Blue snow shovel Sharp microwave oven Sewing table Linens, towels, bedding Grandmother's clock Piano and bench Print picture Doll collection Sconces Christmas and Easter decorations Cookware and Griddle Cookbooks Sound Design stereo/speakers --Page 20 of 21-- Personal photos, books, records Dropleaf & Antique wall tables Antique child's desk and chair Electric mixer Floor lamp Wooden base lamps Red Devil portable grill Propane gas container/cans Any items from first marriage Items purchased by Wife's parents Personal jewelry, clothing, luggage, toiletries and similar personal items Exhibit "B" --Page 21 of 2 1-- THIS ADDENDUM to the Separation and Property Settlement Agreement of June 13, 2005, by and between JANET R. EBERSOLE (hereinafter referred to as "Wife") and TIMOTHY M. EBERSOLE (hereinafter referred to as "Husband") provides as follows: The provisions of Paragraph 3.6 are deleted and the following is substituted : The marital residence will be transferred to Husband. Husband will pay Wife the sum of $27,000.00 on or before August 1, 2005. Husband will refinance the mortgage against the marital residence on or before September 1, 2005. Wife shall vacate the marital residence on or before August 1, 2005. In the event of the failure of Husband to pay the sum of $27,000.00 on or before August 1, 2005, or to refinance the mortgage on or before September 1, 2005, Wife shall receive ownership and possession of the marital residence, in which event the roll-over to Wife under the provisions of Paragraph 3.7 shall be $51,600.00. 2. The provisions of Paragraph 3.3 are amended to add to Exhibit "A" the microwave oven and the king-size bed. 3. The provisions of Paragraph 5.1 are amended to provide for commencement of alimony on August 1, 2005, and for termination of alimony upon the death of Wife or her remarriage or cohabitation with a person, either male or female, to whom she would not be related within the degrees of consanguinity. In all other respects, the Separation and Property Settlement Agreement of even date herewith is ratified and confirmed, IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WITNESSED BY: i Date Z JANET R. EBERSOLE S" 6113o Date TIMOTH EBERSOLE r ? f': L5 ?rl C-' ? 1 FlZ r„, i" P ??. 1 JANET R. EBERSOLE, Plaintiff VS. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 IN DIVORCE PRAECIPE TO TRANSMIT RECORD TO THE PROTHONOTARY: Transmit the record, together with the following information to the court for entry of a divorce decree: 1. Ground for divorce: Irretrievable breakdown under §3301(c) 3301(dv1) e fthe givefee Code (Strike out inapplicable section). 2. Date and manner of service of the Complaint: via hand delivery by Constable on July 1, 2002. 3. Complete either paragraph (a) or (b). (a) Date of execution of the Affidavit of Consent required by §3301 (c) of the Divorce Code: by Plaintiff: 12116/05 by Defendant: 12121105 (b) (1) Date of execution of the affidavit required by §3301 (d) of the Divorce Code: (2) Date of filing and service of the plaintiffs affidavit upon the respondent: 4. Related claims pending: none 5. Complete either (a) or (b). (a) Date and manner of service of the notice of intention to file Praecipe to Transmit record, a copy of which is attached: (b) Date of Waiver of Notice in §3301 (c) Divorce was filed with the Prothonotary: by Plaintiff: December 16, 2005 by Defendant: December 21, 2005 B G i te, ?Esquiire FF ASSOCIATES Attorney ID #34349 200 North Hanover Street Carlisle, PA 17013 (717)243-5551/(800)347-5552 Attorneyfor Plaintiff JANET R. EBERSOLE, Plaintiff VS. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 IN DIVORCE AFFIDAVIT OF CONSENT A Complaint in Divorce under §3301 (c) of the Divorce Code was filed on June 21, 2002, and served on July 1, 2002. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the Complaint. 3. 1 consent to the entry of a final Decree of Divorce after service of notice of intention to request entry of the decree. I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO LTISWORN FALSIFICATION TO AUTHORITIES. DATE: 121 ZOOS ? ? '?(, TIMOTHY VjEBERSOLE, Defendant (.Yt C'J f5j t-- ra -' i'- l? Gf1 :? Gy JANET R. EBERSOLE, Plaintiff vs. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 02-2988 IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST THE ENTRY OF A DIVORCE DECREE UNDER 0301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I VERIFY THAT' THE STATEMENTS MADE IN THF. FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. DATE: TIMOTHY M. ERSOLE, Defendant ? c, ? ca -?, ?., = ? ? r?a;? s,, _ ? . , `r ?.-C ?? {. _ ?. i'(\ +,?. 1?. ??d ? .. f ? . ' ]l ?... _ _t V , ? JANET R. EBERSOLE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, NO. 02-2988 Defendant IN DIVORCE r QUALIFIED DOMESTIC RELATIONS ORDER (QDRO) AND NOW, this day of 2005, it appears to the Court as follows: 1. The parties hereto, who are husband and wife, seek this Order in conjunction with pursuing a final Decree of Dissolution of marriage in this action pending in this Court at the above number. 2. Timothy M. Ebersole, hereinafter referred to as "Participant," is employed with Shippensburg University of Pennsylvania and is a participate in the Teachers Insurance and Annuity Association - College Retirement Equities Fund, hereinafter "TIAA-CREF," and has the following annuities: TIAA Traditional No. B590260-2 CREF Stock No. Q590260-9 Participant's current and last known mailing address is 71 Diller Drive, Shippensburg, PA 17257. Participant's Social Security Number is 179-54-2597, and his date of birth is January 8, 1961. 3. Janet R. Ebersole, hereinafter "Alternate Payee," is Participant's spouse with a current and last known mailing address is 3442 Eagle Drive, Chambersburg, PA 17201. The Alternate Payee's Social Security Number is 28-78-5382, and her date of birth is January 28, 1951. 4. To accommodate the marital property distribution agreed upon between the parties, IT IS ORDERED, ADJUDICATED AND DECREED AS FOLLOWS: A. B. That the TIAA-CREF annuities previously referenced are marital property. Upon finalization of this Order and pursuant to the terms of said annuities, the current values as of the valuation date of the Participant's TIAA-CREF annuity accumulations for the Martial Portion defined below shall be awarded as the Alternate Payee's sole and exclusive property to be applied to TIAA-CREF annuities subject to the terms and limitations of said annuities: i. The Marital Portion to be transferred is SEVENTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($71,600.00) DOLLARS, and TIAA-CREF is to calculate the accumulation to be transferred, as follows: a.) Accumulations are to be valued as of June 13, 2005, the date of the parties' Separation and Property Settlement Agreement distributing this sum to Wife, as follows: TIAA No. B590260-2 $35,800.00 CREF No. Q590260-9 $35,800.00 ii. Transfer Values: The values actually transferred will reflect interim investment experience until the transfer is recorded by TIAA-CREF. The TIAA Traditional accumulation will increase over time, whereas the TIAA Real Estate and CREF accumulations may increase or decrease, reflecting the performance of the underlying investments. C. Conditions on division of annuity contracts: i. All ownership and interest in the balance of the accumulations not transferred in all annuities issued to the Participant by TIAA-CREF will belong to the Participant. ii. All ownership rights in the newly issued annuities will belong to the Alternate Payee. iii. The beneficiary designation of the Alternate Payee's annuities will be her estate, unless a beneficiary designation is submitted pursuant to the provisions of the contracts, and accepted by TIAA-CREF. The Alternate Payee must review the contracts at issuance for accuracy and inform TIAA-CREF of any change of address. iv. The Alternate Payee's annuities will be issued with the same investment allocation as the Participant's, applied pro rata. The Alternate Payee may change the investment allocation once his or her annuities are issued in accordance with the contributing employer's plan. D. Parties Right to Name Beneficiaries: For all annuity contracts or individual life insurance funded through TIAA-CREF on the life: of the Participant, the parties shall retain rights to name beneficiaries with respect to the account or plan benefits they retain. i. The Alternate Payee shall remain as the beneficiary as per existing designations on the Participant's account until such time as the disbursement has been made by TIAA-CREF establishing 4he Alternate Payee's account. Thereafter, the Participant retains all rights to name and change beneficiary designations as he desires. ii. The Alternate Payee shall likewise retain all rights with respect to the naming of beneficiaries on her account once the account has been established. iii. Both parties shall retain rights to name their beneficiaries with respect to any death benefits, any life insurance proceeds or any other distribution to be made by TIAA-CREFF upon death of either party from the following accounts: TIAA Contract CREF Contract B590260-2 Q590260-9 E. TIAA Traditional Retirement Annuities (RAs) do not allow single-sum withdrawals or transfers to alternate carriers. For other TIAA-CREF annuities, the Alternate Payee's right to receive single-sum withdrawals and/or transfer all or a part of the accumulation to an alternate carrier may be limited in accordance with the contributing employer's plan. F. The parties are directed to submit to TIAA-CREF all documents and releases (if required by TIAA-CREF) to finalize this Order within thirty (30) days of the request for same. 5. This Order: A. does not require any plan to provide any type of form of benefit, or any options not otherwise provided under the plan, and B. does not require TIAA-CREF to provide increased benefits, and C. does not require the payment of benefits to an Alternate Payee which are required to be paid to another Alternate Payee under another Order previously determined to be a Qualified Domestic Relations Order. 6. If any portion of this Order is rendered invalid, the balance of the Order will remain fully enforceable. 7. This Court reserves jurisdiction to issue further Orders as needed to execute and enforce this Order. By the Court, J. The parties hereto have read and reviewed the terms of this Qualified Domestic Relations Order (QDRO) and jointly request that the Court of Common Pleas of Cumberland County approve this as a QDRO. WITNESSETH: Wayne . Shade, Esquire Bradley L. Griffie, Esquire Date Timothy M. ersole, Participant Date ?4anet R. Ebersole, Alternate Payee C" J ~?v DEC 3 u 2005 JANET R. EBERSOLE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, NO. 02-2988 Defendant IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER (ODRO) AND NOW, this 1 ?* day of 204 it appears to the Court as follows: 1. The parties hereto, who are husband and wife, seek this Order in conjunction with pursuing a final Decree of Dissolution of marriage in this action pending in this Court at the above number. 2. Timothy M. Ebersole, hereinafter referred to as "Participant," is employed with Shippensburg University of Pennsylvania and is a participate in the Teachers Insurance and Annuity Association - College Retirement Equities Fund, hereinafter "TIAA-CREF," and has the following annuities: TIAA Traditional CREF Stock No. B590260-2 No. Q590260-9 Participant's current and last known mailing address is 71 Diller Drive, Shippensburg, PA 17257. Participant's Social Security Number is 179-54-2597, and his date of birth is January 8, 1961. 3. Janet R. Ebersole, hereinafter "Alternate Payee," is Participant's spouse with a current and last known mailing address is 3442 Eagle Drive, Chambersburg, PA 17201. The Alternate Payee's Social Security Number is 28-78-5382, and her date of birth is January 28, 1951. 4. To accommodate the marital property distribution agreed upon between the parties, IT IS ORDERED, ADJUDICATED AND DECREED AS FOLLOWS: A. That the TIAA-CREF annuities previously referenced are marital property. B. Upon finalization of this Order and pursuant to the terms of said annuities, the current values as of the valuation date of the Participant's TIAA-CREF annuity accumulations for the Martial Portion defined below shall be awarded as the Alternate Payee's sole and exclusive property to be applied to TIAA-CREF annuities subject to the terms and limitations of said annuities: i. The Marital Portion to be transferred is SEVENTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($71,600.00) DOLLARS, and TIAA-CREF is to calculate the accumulation to be transferred, as follows: a.) Accumulations are to be valued as of June 13, 2005, the date of the parties' Separation and Property Settlement Agreement distributing this sum to Wife, as follows: TIAA No. B590260-2 $35,800.00 CREF No. Q590260-9 $35,800.00 ii. Transfer Values: The values actually transferred will reflect interim investment experience until the transfer is recorded by TIAA-CREF. The TIAA Traditional accumulation will increase over time, whereas the TIAA Real Estate and CREF accumulations may increase or decrease, reflecting the performance of the underlying investments. C. Conditions on division of annuity contracts: i. All ownership and interest in the balance of the accumulations not transferred in all annuities issued to the Participant by TIAA-CREF will belong to the Participant. ii. All ownership rights in the newly issued annuities will belong to the Alternate Payee. iii. The beneficiary designation of the Alternate Payee's annuities will be her estate, unless a beneficiary designation is submitted pursuant to the provisions of the contracts, and accepted by TIAA-CREF. The Alternate Payee must review the contracts at issuance for accuracy and inform TIAA-CREF of any change of address. iv. The Alternate Payee's annuities will be issued with the same investment allocation as the Participant's, applied pro rata. The Alternate Payee may change the investment allocation once his or her annuities are issued in accordance with the contributing employer's plan. D. Parties Right to Name Beneficiaries: For all annuity contracts or individual life insurance funded through TIAA-CREF on the life of the Participant, the parties shall retain rights to name beneficiaries with respect to the account or plan benefits they retain. i. The Alternate Payee shall remain as the beneficiary as per existing designations on the Participant's account until such time as the disbursement has been made by TIAA-CREF establishing the Alternate Payee's account. Thereafter, the Participant retains all rights to name and change beneficiary designations as he desires. ii. The Alternate Payee shall likewise retain all rights with respect to the naming of beneficiaries on her account once the account has been established. iii. Both parties shall retain rights to name their beneficiaries with respect to any death benefits, any life insurance proceeds or any other distribution to be made by TIAA-CREFF upon death of either party from the following accounts: TIAA Contract CREF Contract B590260-2 Q590260-9 E. TIAA Traditional Retirement Annuities (RAs) do not allow single-sum withdrawals or transfers to alternate carriers. For other TIAA-CREF annuities, the Alternate Payee's right to receive single-sum withdrawals and/or transfer all or a part of the accumulation to an alternate carrier may be limited in accordance with the contributing employer's plan. F. The parties are directed to submit to TIAA-CREF all documents and releases (if required by TIAA-CREF) to finalize this Order within thirty (30) days of the request for same. 5. This Order: A. does not require any plan to provide any type of form of benefit, or any options not otherwise provided under the plan, and B. does not require TIAA-CREF to provide increased benefits, and I C. does not require the payment of benefits to an Alternate Payee which are required to be paid to another Alternate Payee under another Order previously determined to be a Qualified Domestic Relations Order. 6. If any portion of this Order is rendered invalid, the balance of the Order will remain fully enforceable. 7. This Court reserves jurisdiction to issue further Orders as needed to execute and enforce this Order. J. The parties hereto have read and reviewed the terms of this Qualified Domestic Relations Order (QDRO) and jointly request that the Court of Common Pleas of Cumberland County approve this as a QDRO. WITNESSETH; ` ^ayy ee F. Shade, Esquire Esquire IOU ?n T Date Timothy A .ra 0 /;t /'? 7/aS a", ? ?[?h ear [[%. Date anet R. Ebersole, Alternate Payee ,,.? "?, 'l??J /4 v . ? ??' .' +?.; I' Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 o Fax: 717-975-0697 • Email: dianeradcliff @comcast.net Attorney for Petitioner, Timothy M. Ebersole IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff NO. 02-2988 CIVIL TERM V. CIVIL ACTION - LAW TIMOTHY M. EBERSOLE, IN DIVORCE Defendant PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION AND NOW, this 31 st day of July, 2007, comes the Petitioner, Timothy M. Ebersole, by his attorney, Diane G. Radcliff, Esquire, files the above referenced Petition, and respectfully represents that: 1. Your Petitioner is Timothy M. Ebersole, the Defendant in the above captioned action. Petitioner is hereinafter referred to as "Former Husband". 2. Your Respondent is Janet R. Ebersole, the Plaintiff in the above captioned action. Respondent is hereinafter referred to as "Former Wife". 3. The parties are formerly husband and wife having been married on May 15, 1983 and divorced by Decree entered on January 9, 2006. 4. As part of the dissolution of their marriage the parties entered onto a Separation and Property Settlement Agreement dated June 16, 2005 (hereafter the "6.13.05 PSA"), which was amended by the Addendum signed by the parties on June 13, 2005 (hereinafter the 6.13.05 Addendum"). A true and correct copy of the 6.13.05 PSA is attached hereto, marked Exhibit "A" and made a part hereof. A true and correct copy of the 6.13.05 Addendum is attached hereto, marked Exhibit "B" and made a part hereof. 5. Paragraph 5.1 of the 6.13.05 PSA requires Former husband to pay former wife "$1,100 1 per month for an indefinite period of time as alimony to Wife. **** This sum shall be paid for an indefinite period and mayonly be modified upon ashowing of asubstantial change in parties' financial circumstances". 6. Paragraph 3 of the 6.13.05 Addendum provides for termination of the alimony obligation set for in paragraph 5.1 of the 6.13.05 Addendum "upon death of Wife, or her remarriage or cohabitation with a person, either male of female, to whom she would not be related within the degrees of consanguinity". 7. The $1,100 per month alimony obligation as set forth in paragraph 5.1 of the 6.13.05 PSA as modified by the 6.13.05 Addendum is hereinafter referred to as the "the 6.13.05 Alimony Obligation". 8. Petitioner is requesting that the 6.13.05 Alimony Obligation be modified (decreased) or terminated for the reasons set forth herein. 9. At the time the parties entered into the 6.13.05 PSA, Petitioner was employed by Shippensburg University as an Executive Director, University Relations earning approximately $62,000 from that employment. Petitioner also earned money officiating sports from which he earned approximately $5,891.00 per year. 10. At the time the parties entered into the 6.13.05 PSA, Respondent was employed by Cumberland Valley Christian School as a teacher, earning approximately $20,000 from that employment. 11. Former Husband believes and therefore avers that there has been a substantial change in the parties' financial circumstances since the parties entered into the 6.13.05 PSA, which change warrants a decrease or termination of the 6.13.05 Alimony Obligation in that: A. Former Wife's income from her teaching job has substantially increased; B. Former Wife's has substantial additional income from her part time employment with a nursing home; C. Former Wife's has substantial additional income from her part time employment as a sports officiator; D. Former Wife's has substantial additional income from selling products through Quickstar (Amway). 2 E. Former Wife's has recently inherited over $130,000.00 F. Former Wife's has added an apartment to her residence and is capable of charging and receiving rent therefor in the estimated amount of $600 per month more or less. G. Former Husband's expenses have substantially increased, especially considering the 30 year mortgage he took out to acquire the marital home; H. Former Husband has been forced to work substantially more hours in his self employment sports officiating business just to pay his bills. 12. To verify the necessity or fairness of granting the relief requested, the Petitioner/ Defendant requires that the parties be provided with income and expense information in the form normally requested by the Domestic Relations Office as well as 2005, 2007 and 2008 income information. 13. The only judge assigned to this case is as follows: A. The Honorable Edward E. Guido, who entered the QDRO required to effectuate the division of Husband's TIAA Creff account as provided by the 6.13.05 PSA. 14. Respondent was previously represented by Bradley L. Griffie. 15. On July 28, 2008, Petitioner's Attorney, Diane G. Radcliff, Esquire advised Attorney Griffie of the intended filing of this Petition and no agreement was reached regarding the relief requested herein. WHEREFORE, the Petitioner respectfully requests this Honorable Court to enter an Order: A. To Issue a Rule upon the Respondent, Janet R. Ebersole, to show cause why the 6.13.05 Alimony Obligation should not be modified (decreased) , or in the alternative terminated. B. Requiring the parties to file the following within 30 days of the date of service of the Order upon Respondent: i. An Income and Expense Statement in the form prescribed in Pa.R. C. P. 1910.27(c)(2)(B); ii. His or her pay stubs or other evidence of income for the preceding six (6) months; iii. Complete copies (with all schedules and W-2 statements) of his or her income tax returns for 2007; 3 iv. Complete copies (with all schedules and W-2 statements) of his or her income tax returns for 2005; V. Proof of the amount of any inheritance or other non-taxable income received within the last 12 months or to which the party is currently entitled to but has not yet received. C. After the filing of an Answer to the Rule and filing of the financial information specified above, and upon presentation of proper motion, to schedule a hearing on this Petition ; D. After the hearing on this Petition, to terminate or substantially decrease Petitioner's 6.13.08 Alimony Obligation. Respectfully submitted, MANE G. RADCLIFF, ESIQ? 3448 Tr' dle Road mp Hill, PA 17011 Phone: (717) 737-0100 Supreme Court ID # 32112 Attorney for Petitioner 4 VERIFICATION I, TIMOTHY M. EBERSOLE, verify that the sta' aments made in the foregoing Petition are true and correct. I understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. TIMO M. EBERSOLE Dated: -712Z/ 0,?- 5 CERTIFICATE OF SERVICE I hereby certify that I am this day serving the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure: Service by First Class Mail Aadressed as Follows: Bradley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013 (Counsel for Respondent/ Plaintiff ) FF, ESQUIRE ttorney Regist ation No 32112) .An JI _ n _ J Camp Hill, PA 17011 Email: dianeradcliffCcomcast.net Phone: (717) 737-0100 Fax: (717) 975-0697 Counsel for Petitioner/ Defendant Dated: July 28, 2008 6 EXHIBIT "A" 6.13.45 PSA SEPARATION AND PROPERTY SETTLEMENT AGREEMENT THIS AGREEMENT made this / 3Aday of J v ?L , 2005, by and between JANET R. EBERSOLE, of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, 17257, party of the first part, hereinafter referred to as "Wife," AND TIMOTHY M. EBERSOLE, of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, 17257, party of the second part, hereinafter referred to as "Husband," WITNESSETH: WHEREAS, Husband and Wife were married on May 15, 1983 in York County, Pennsylvania; and WHEREAS, Husband and Wife are residents of the Commonwealth of Pennsylvania and have been so for at least the past six months; WHEREAS, certain differences have arisen between the parties hereto which have made them desirous of living separate and apart from one another; and WHEREAS, Husband and Wife desire to settle and determine certain of their marital rights and obligations, and make an equitable distribution of their marital property, determine their rights to alimony and support and any other matters which may be considered under the Divorce Code; and WHEREAS, it is the intention and purpose of this Agreement to set forth the respective rights and duties of the parties while they continue to live apart from each other and to settle all financial and property rights between them; and --Page 1 of21-- WHEREAS, the parties hereto have mutually entered into an agreement for the division of their jointly owned assets, the provisions for the liabilities they owe, and provisions for the resolution of their mutual differences, after both have had full and ample opportunity to consult with attorneys of their respective choice, the parties now wish to have that agreement reduced to writing. NOW, THEREFORE, the parties hereto in consideration of the mutually made and to be kept promises set forth hereinafter and for other good and valuable consideration, and intending to be legally bound' and to legally bind their heirs, successors, assigns, and personal representatives, do hereby covenant, promise and agree as follows: ARTICLE 1 SEPARATION 1.1 It shall be lawful for Husband and Wife at all times hereafter to live separate and apart from each other and to reside from time to time at such place or places as they shall respectively deem fit free from any control, restraint, or interference, direct or indirect, by each other. Neither party shall molest the other or compel or endeavor to compel the other to cohabit or dwell with him or her by any legal or other proceedings. The foregoing provisions shall not be taken to be an admission on the part of either Husband or Wife of the lawfulness of the causes leading to them living separate and apart. ARTICLE II DIVORCE 2.1 This Agreement is not predicated on divorce. It is specifically understood and agreed by and between the parties hereto that each of the said parties does hereby warrant and represent to --Page 2 of 2 t-- the other that the execution and delivery of this Agreement is not predicated upon nor made subject to any agreement for institution, prosecution, defense, or for the non-prosecution or non- defense of any action for divorce; provided, however, that nothing contained in this Agreement shall prevent or preclude either of the parties hereto from commencing, instituting or prosecuting any action or actions for divorce, either absolute or otherwise, upon just, legal and proper grounds; not to prevent either party from defending any such action which has been, may, or shall be instituted by the other party, or from making any just or proper defense thereto. It is warranted, covenanted, and represented by Husband and Wife, each to the other, that this Agreement is lawful and enforceable and this warranty, covenant, and representation is made for the specific purpose of inducing Husband and Wife to execute the Agreement. Husband and Wife each knowingly and understandingly hereby waive any and all possible claims that this Agreement is, for any reason, illegal, or for any reason whatsoever of public policy, unenforceable in whole or in part. Husband and Wife do each hereby warrant, covenant and agree that, in any possible event, he and she are and shall forever be estopped from asserting any illegality or unenforceability as to all or any part of this Agreement. 2.2 It is further specifically understood and agreed that the provision of this Agreement relating to the equitable distribution of property of the parties are accepted by each party as a final settlement for all purposes whatsoever. Should either of the parties obtain a decree, judgment or order of separation or divorce in any other state, country, or jurisdiction, each of the parties to this Agreement hereby consents and agrees that this Agreement and all its covenants shall not be affected in any way by any such separation and divorce. -Page 3 of 21-- 2.3 This Agreement shall survive any decree in divorce and shall be forever binding and conclusive on the parties. It is understood by and between the parties that this Agreement shall be incorporated into any decree, divorce or separation, but it shall not be deemed merged in such decree. ARTICLE Ill EQUITABLE DISTRIBUTION OF MARITAL PROPERTY 3.1 The parties have attempted to divide their marital property in a manner which conforms to the criteria set forth in the Pennsylvania Divorce Code, and taking into account the following considerations: the length of the marriage; the prior marriages of the parties; the age, health, station, amount and sources of income, vocational skills, employability; estate, liabilities, and needs for each of the parties; the contribution of one party to the education, training or increased earning power to the other party; the opportunity of each party for future acquisition of capital assets and income; the sources of income of both parties, including but not limited to medical, retirement, insurance or other benefits; the contribution or dissipation of each part in the acquisition, preservation, depreciation, or appreciation of marital property, including the contribution of a party as a homemaker; the value of the property set apart to each party; the standard of living of the parties established during their marriage; the economic circumstances of each party, including federal, state and local tax ramifications, at the time of the division of the property is to become effective; and whether the parties will be serving as the custodian of any dependent minor children. --Page 4 of 21-- 3.2 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 rights of equitable distribution of the parties. 3.3 Personal Proaermy The parties acknowledge that their children, Joshua Ebersole and Heather Ebersole, have items of personal property, including their bedroom furniture and furnishings, which each child shall retain as their personal property and neither party herein shall make claim against those items from this time forward. With respect to the personal property presently located at the residence of 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, should Wife retain ownership and possession of that real estate under the terms set forth in paragraph 3.6 hereinafter, Husband shall move with him, when he vacates the residence, the personal property items listed on Exhibit "A", which is attached hereto and incorporated herein by reference. In the event that Husband retains ownership and possession of the real estate, Wife shall remove with her, when she vacates the residence, the items of personal property listed on Exhibit "B", which is attached hereto and incorporated herein by reference. Except for the transfer or removal of items of personal property referenced herein, the parties acknowledge that they have the furniture, appliances, tools, household furnishings, vehicles and other personal property, tangible and intangible, in their possession that they wish to have and retain from this time forward. Neither party shall make any claim whatsoever against the personal property in the other party's possession, or assets in that other party's possession, or --Page 5 of 21-- items listed on Exhibit "A" and "B" described herein, from the time of execution of this Agreement forward. 3.4 Life Insurance: Each party agrees that the other party shall have sole ownership and possession of any life insurance policies owned by the other. Each party shall have the right to borrow against, cash in policies, change beneficiaries, an exercise any other incidents of ownership of the respective policies free of any right or claim by the other party. Each party agrees to sign any documents necessary to waive, relinquish or transfer any rights in such policies to the respective parry who presently owns such policies. 3.5 Subsequently Acquired Property Husband and Wife agree to waive and relinquish any and all right that he or she may now have or hereafter acquire in any real or tangible personal property subsequently acquired by the other party. Husband and Wife specifically agree to waive and relinquish any right in such property that may arise as a result of the marriage relationship. 3.6 Real Estate. The parties are the joint owners of real estate located at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, as tenants by the entireties. The aforesaid real estate is encumbered with a mortgage due and owing to Fulton Bank. At the time of execution of this Agreement, both parties continue to reside at this property. In order to determine who shall retain possession and ownership of the aforesaid real estate, the parties shall conduct a private auction at the office of the Divorce Master for Cumberland County at 9 North Hanover Street, Carlisle, Pennsylvania, on Monday, June 13, 2005 at 9:00 a.m. At that time, the Divorce Master shall select a means of providing for one --Page 6 of 2 1-- party to make the initial bid on the purchase of the marital residence. The initial offer at the auction must be at least $200,500.00. After the initial bid is made, the opposing party may place a bid and the parties shall then continue to alternate bidding against each other in this manner in any increasing amounts that they desire, until such time as one party determines that they will no longer bid. At that point, the party with the high bid shall be determined to be the party who shall retain ownership and possession of the real estate at the last price bid. In the event Husband is the successful bidder, he shall, within sixty (60) days of the date of the auction, refinance the mortgage on the property, together with securing sufficient funds to pay a cash disbursement to Wife in an amount equal to fifty-eight (58%) percent of the amount that Husband's final bid exceeds $200,500.00. For example, under circumstances where Husband bids a total of $240,500.00 to secure ownership of the property, thereby exceeding the set price of $200,500.00 by $40,000.00, he shall compensate Wife, at the time of his refinancing of the mortgage, an amount of $23,200.00 in a cash disbursement. In the event Wife is the successful bidder, she shall, within sixty (60) days from the date of the auction, refinance the mortgage on the property, together with securing sufficient funds to pay a cash disbursement to Husband in an amount equal to forty-two (42%) percent of the amount that Wife's final bid exceeds $200,500.00. In addition, however, in the event Wife determines that she wishes to use funds from the QDRO rollover from Husband's TIAA-CREF account, referenced in paragraph 3.7 hereinafter, her refinancing of the mortgage and compensation of any nature to Husband may await the final rollover of those funds such that those funds will be available to Wife to assist in the refinancing of the mortgage and compensating Husband. --Page 7 of 21-- At the time of the refinancing of the mortgage by either party as described above, the other party shall provide a signed, witnessed and notarized special warranty, fee simple deed conveying that party's interest in the real estate to the party who is the successful bidder at the auction as described above. Upon completion of the refinancing settlement as described herein, the party who has not retained ownership of the property shall make no claim of any nature whatsoever against the other party for any legal or equitable interest or similar claims in the real estate from the time of refinancing forward. 3.7 Pension. Retirement. Praft,SharinF. Wife agrees to waive, relinquish or transfer any and all of her right, title and interest she has or may have in Husband's TIAA-CREF retirement account. In consideration of Wife's waiver, relinquishment and transfer of any interest she has in that account, the parties shall execute a Qualified Domestic Relations Order (QDRO), as prepared by Wife's counsel, in order to provide for the rollover from said account of the sum of FIFTY-ONE THOUSAND SIX HUNDRED AND XX/100 ($51,600.00) DOLLARS from said account to an account for Wife. In the event that Husband is the successful bidder on the real estate on the real estate at 71 Diller Drive, Shippensburg, Pennsylvania, under circumstances described in paragraph 3.6 above, the rollover amount shall be increased to SEVENTY-ONE THOUSAND SIX HUNDRED AND )X/100 ($71,600.00) DOLLARS. Preparation of the QDRO and rollover of the required amount shall be done expeditiously, time being of the essence. Except for the disbursement provided for in this paragraph, Wife shall make no claim of any nature whatsoever against Husband's TIAA-CREF retirement account. --Page 9 of 21-- Otherwise, Wife hereby waives, relinquishes and transfers any and all right, title and interest she has or may have in any and all retirement accounts of Husband from the time of execution of this Agreement forward, whether those retirement accounts have been secured through prior or current employment or through Husband's individual efforts. Husband agrees to waive, relinquish or transfer any and all of his right, title and interest he has or may have in Wife's American Funds account, Plan ID #241887760, and in Wife's ING USA Annuity and Life Insurance Company Annuity, contract #183211, as well as any other retirement accounts of any nature whatsoever that Wife may have accrued through her present or prior employment or through Wife's individual efforts. 3.8 Vehicles. The parties acknowledge that Wife has and shall retain sole and exclusive ownership and possession of a certain 1999 Ford Escort. Husband shall execute the title of the vehicle and related documents within fifteen (15) days of being requested to do so by Wife or Wife's legal counsel transferring title to Wife's name individually, in the event Husband's name is on the title to that vehicle. Husband shall make no claim whatsoever relative to access to or use of the aforesaid vehicle and shall make no ownership claims of any nature whatsoever against the aforesaid vehicle from the date of execution of this Agreement forward. Wife shall be solely and exclusively responsible for any and all encumbrances of any nature whatsoever against said vehicle and shall indemnify Husband and hold him harmless from and against any and all demands for payment and collection activity of any nature whatsoever on account of any such debts. The parties acknowledge that Husband has and shall retain sole and exclusive ownership and possession of a certain 2001 Honda Civic. Wife shall execute the title of the vehicle within --Page 9 of 21-- fifteen (15) days of being requested to do so by Husband or Husband's legal counsel transferring title to Husband's name individually, in the event Wife's name is on the title to that vehicle. Wife shall make no claim whatsoever relative to access to or use of the aforesaid vehicle and shall make no ownership claims of any nature whatsoever against the aforesaid vehicle from the date of execution of this Agreement forward. Husband shall be solely and exclusively responsible for any and all encumbrances of any nature whatsoever against said vehicle and shall indemnify Wife and hold him harmless from and against any and all demands for payment and collection activity of any nature whatsoever on account of any such debts. The parties further acknowledge that their adult daughter, Heather, has in her possession a certain 1996 Mazda 626 vehicle, which is and shall be her sole asset. The parties shall execute any documents necessary to transfer and convey any interest they may have to the aforesaid vehicle to their daughter in an expedited manner upon daughter's request or, under any circumstances, upon her graduation from college. 3.9 Intangible Personal P Wer& Wife hereby waives, relinquishes and transfers any and all right, title and interest she has in Husband's account with the Wednesday Club and his Allfirst or M&T checking account. Wife shall make no claim of any nature whatsoever relative to any ownership interest or other claims against said accounts from the time of execution of this Agreement forward. Husband hereby waives, relinquishes and transfers any and all right, title and interest he has in Wife's Patriot Federal Credit Union account. Husband shall make no claim of any nature whatsoever relative to any ownership interest or other claims against said accounts from the time of execution of this Agreement forward. -Page 10 of 21- The parties further acknowledge that they had previously maintained an account with Merrill Lynch, which account has been closed and the proceeds from that account have been distributed. Neither party will make any claim of any nature whatsoever against the other for any rights or interest in funds that have been or may have been received from the aforesaid Merrill Lynch account. In the event it is necessary for either party to execute any documents to implement the provisions of this Agreement, they shall do so within fifteen (15) days of being requested to do so by the other party or the other party's legal counsel. ARTICLE IV DEBTS OF THE PARTIES 4.1 The parties acknowledge that they have outstanding debts or obligations. In particular, Husband has an outstanding obligation to American Express, which shall be his sole and exclusive obligation. Husband shall indemnify Wife and hold her harmless from and against any and all demands for payment or collection activity of any nature whatsoever relative to his American Express account. Wife has a loan against her ING USA Annuity, which shall be her sole and exclusive responsibility. Wife shall indemnify Husband and hold him harmless from and against any and all demands for payment or collection activity of any nature whatsoever relative to the loans on Wife's ING USA Annuity. 4.2 Each party represents to the other that except as is otherwise set forth in this Agreement, and more particularly as set forth in subparagraph 4.1 above, the parties do not have any additional joint debt of any nature whatsoever that could create liability for the other party. --Page 11 of 21- Neither party has created any such joint debts since the time of filing the divorce action in this matter that would create additional liens, encumbrances or obligations of any nature against the other party. Neither party shall take any action to create additional indebtedness for the other party in any manner from the time of execution of this Agreement forward. ARTICLE Y ALIMONY. SPOUSAL SUPPORT. CHILD SUPPORT. HEALTH INSURANCE 5.1 Beginning on the first day of the first month after the parties have physically separated by one of the parties moving from the former marital residence at 71 Diller Drive, Shippensburg, Cumberland County, Pennsylvania, pursuant to paragraph 3.6 herein, Husband shall begin compensating Wife in the amount of ONE THOUSAND ONE HUNDRED AND XX/100 ($1,100.00) DOLLARS per month for an indefinite period as alimony to Wife. As long as monthly payments in this amount are received by Wife by no later than the fifth of each month, Husband may make compensation to Wife for the alimony by direct payment. In the event Husband fails to make payment in a timely manner as described herein, Wife shall be entitled to file a Petition with the Court of Common Pleas of Cumberland County to have this sum collected through the Cumberland County Domestic Relations Office by wage attachment. This sum shall be paid for an indefinite period and may only be modified upon showing of a substantial change in the parties' financial circumstances. The parties further acknowledge that their children have graduated from high school and are at least 18 years of age. As such, no child support is due from either party to the other, nor to the children, for their maintenance or support. Any sums that the parties agree to contribute to the benefit of the children for their education or for their personal expenses during their pursuit of a college education shall be purely voluntary. -Page 12 of 21-- 5.2 In the event Wife, in her sole discretion, chooses to maintain her health insurance through Husband's employment via COBRA, Husband shall execute any necessary documents to assist Wife in maintaining her insurance in this manner and shall execute such documents within fifteen (15) days of being requested to do so by Wife or her legal counsel. Otherwise, the parties acknowledge that at the time of the entry of a Decree in Divorce, Husband's health insurance carrier, who carries health insurance on Wife at this time, shall, pursuant to their normal procedures, terminate health insurance for Wife and provide appropriate COBRA notices as required by Federal Law shall be provided to her. MI S C E L L A 1 V E O VA PROVISIONS 61 Advice of Counsel. The provisions of this Agreement and their legal effect have been fully explained to the parties by their respective counsel, being Bradley L. Griffie, Esquire, for Wife and Wayne F. Shade, Esquire, for Husband. The parties acknowledge that they have received independent legal advice from counsel of their own selection, that they fully understand the facts and have been fully informed as to their legal rights and obligation or otherwise understand those legal rights and obligations. They acknowledge and accept that this Agreement is, in the circumstances, fair and equitable, that it is being entered into freely and voluntarily, after having received such advice and with such knowledge that execution of this Agreement is not the result of any duress or undue influence and that it is not the result of any collusion or improper or illegal agreement or agreements. --Page 13 of 21-- 6.2 Mutual Release. Husband and Wife each do hereby mutually remise, release, quitclaim, and forever discharge the other and the estate of such other, for all times to come and for all purposes whatsoever, of and from any and all right, title and interest, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature and wheresoever situate, which he or she now has or at any time hereafter may have against such other, the estate of such other, or any part thereof, whether arising out of any former acts, contracts, engagements, or liabilities of such other as by way of dower or curtesy, or claims in the nature of dower or curtesy or widow's or widower's rights, family exemption, or similar allowance, or under the intestate laws, or the right to take against the spouse's Will; or the right to treat a lifetime conveyance by the other as testamentary, or all other rights of a surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of (a) Pennsylvania, (b) any state, commonwealth or territory of the United States, or (c) any other country, or any rights which either party may have or at any time hereafter have for past, present, or future support or maintenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital relation or otherwise, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. It is the intention of Husband and Wife to give to each other by execution of this Agreement a full, complete, and general release with respect to any and all property of any kind or nature, real or personal, not mixed, which the other now owns of may hereafter acquire, except and only except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any thereof. --Page 14 of 21-- 6.3 Warranties. Each parry represents that they have not heretofore incurred or contracted for any debt or liability or obligation for which the estate of the other party may be responsible or liable, except as may be provided for in this Agreement. Each party agrees to indemnify or hold the other party harmless from and against any and all such debts, liabilities or obligations of every kind, including those for necessities, except for the obligations arising out of this Agreement. Husband and Wife each warrant, covenant, represent and agree that each will, now and at all times hereafter, save harmless and keep the other indemnified from all debts, charges, and liabilities incurred by the other after the execution date of this Agreement, except as is otherwise specifically provided for by the terms of this Agreement and that neither of them hereafter incur any liability whatsoever for which the estate of the other may be liable. 6.4 No waiver or modification of any of the terms of this Agreement 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. 6.5 Husband and Wife covenant and agree that 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 implementation of this Agreement, and as their respective counsel shall mutually agree should be so executed in order to carry fully and effectively the terms of this Agreement. -Page 15 of 21-- 6.6 This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania which are in effect as of the date of the execution of this Agreement. 6.7 This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 6.8 This Agreement constitutes the entire understanding of the parties and supersedes any and all prior agreements and negotiations between them. There are no representations or warranties other than those expressly set forth herein. 69 Severabilft if any term, condition, clause, section, or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement, and in all other respects, this Agreement shall be valid and continue in full force, effect, and operation. Likewise, the failure of any party to meet his or her obligation under any one or more of the articles and sections herein shall in no way void or alter the remaining obligations of the parties. 6.10 It is specifically understood and agreed that this Agreement constitutes the equitable distribution of property, both real and personal, which was legally and beneficially acquired by Husband and Wife, or either of them, during the marriage as contemplated by the Divorce Code of the Commonwealth of Pennsylvania. -Page 16 of 21-- 6.11 Disc_^_ losu_rg The parties each warrant and represent to the other that he or she has made a full and complete disclosure to the other of all assets of any nature whatsoever in which party has an interest, of the sources, and amount of the income of such parry of every type whatsoever, and all other facts relating to the subject matter of this Agreement. 6.12 Enforceability and Consideration. This Agreement shall survive any action for divorce and decree of divorce and shall forever be binding and conclusive on the parties; and any independent action may be brought, either at law or in equity, to enforce the terms of the Agreement by either Husband or Wife until it shall have been fully satisfied and performed. The consideration for this contract and agreement is the mutual benefits to be obtained by both of the parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained is stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound hereby. In the event either party breaches the aforesaid Agreement and it is determined through appropriate legal action that the alleged party has so breached the Agreement, the breaching party shall be responsible for any and all attorney's fees as well as costs and expenses associated with litigation incurred by the non- breaching party to enforce this Agreement against the breaching party. In the event of breach, the non-breaching party shall have the right, at his or her election, to sue for damages for such breach or to seek such other and additional remedies as may be available to him or her including equitable enforcement of this Agreement. --Page 17 of 21-- IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WI SS BY: Date ANET R. EBERSOLE 3 0? Date TIMOTHY M. EBERSOLE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this 13-4> day of , 2005, before me, the undersigned officer, personally appeared f TR. EBERSOLE, known to me (or satisfactory proven) to be the person whose name is subscribed to the within Agreement and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. I?TAINILL SEAL ?41N1.AOSHORN,NOTAR1rPUBU6 j . CARIW BONG CUMBER M COUIM ' Nll M RES APR 1 2001 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this /_4 6 day of , 2005, before me, the undersigned officer, personally appeared TR' OTHY M. EBERSOLE, known to me (or satisfactory proven) to be the person whose name is subscribed to the within Agreement and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SEAL ,/ ' ROBIN J. BOSHORR, NOTARY PUBUC CARUSLEBflRO.,CU1t8EJtLAIW COUNTI MY COMIAISSION EXPIRES APRIL 17 2007 :a4 ? --Page 18 of 21-- ,? .? PERSONAL PROPERTY OF HUSBAND Blue sofa Blue love seat Washing machine Clothes dryer Patio furniture Telephone in game room Beige/brown rocking chair Two-tiered end table Big Screen TV and DVD Player 2001 Honda Civic Personal sports items Items given by Husband's family Lawn mower Personal jewelry, clothing, luggage, toiletries and similar personal items Exhibit "A" --Page 19 of21-- PERSONAL PROPERTY OF WIFE Maytag Gemini stove/oven Refrigerator Rattan style sofa bed Glass/rattan coffee table Brown recliner chair Blue/green slipper chair Blue card table and 4 chairs Dining room table and 5 chairs Dining room hutch Toshiba television TV Cabinet in Master bedroom Symphonic VCR Master bedroom phone Cherry table with 1 drawer Four piece master bedroom matching set RCA TV and Magnavox VCR 6' ladder and step stool Wooden TV trays Antique trunk Brown plaid sleeper couch Wheelbarrow Tree trimmer Household and garden tools Video camera and tapes Camera Wooden set of coffee/end tables 1999 Ford Escort Antique sewing table Word processor and computer Antique black chair Blue snow shovel Sharp microwave oven Sewing table Linens, towels, bedding Grandmother's clock Piano and bench Print picture Doll collection Sconces Christmas and Easter decorations Cookware and Griddle Cookbooks Sound Design stereo/speakers -Page 20 of 21-- Personal photos, books, records Dropleaf & Antique wall tables Antique child's desk and chair Electric mixer Floor lamp Wooden base lamps Red Devil portable grill Propane gas container/cans Any items from first marriage Items purchased by Wife's parents Personal jewelry, clothing, luggage, toiletries and similar personal items Exhibit "B" --Page 21 of 21-- EXHIBIT "B" 6.13.05 Addendum to 6.13.05 PSA THIS ADDENDUM to the Separation and Property Settlement Agreement of June 13, 2005, by and between JANET R. EBERSOLE (hereinafter referred to as "Wife") and TIMOTHY M. EBERSOLE (hereinafter referred to as "Husband") provides as follows: The provisions of Paragraph 3.6 are deleted and the following is substituted : The marital residence will be transferred to Husband. Husband will pay Wife the sum of $27,000.00 on or before August 1, 2005. Husband will refinance the mortgage against the marital residence on or before September 1, 2005. Wife shall vacate the marital residence on or before August 1, 2005. In the event of the failure of Husband to pay the sum of $27,000.00 on or before August 1, 2005, or to refinance the mortgage on or before September 1, 2005, Wife shall receive ownership and possession of the marital residence, in which event the roll-over to Wife under the provisions of Paragraph 3.7 shall be $51,600.00. 2. The provisions of Paragraph 3.3 are amended to add to Exhibit "A" the microwave oven and the king-size bed. 3. The provisions of Paragraph 5.1 are amended to provide for commencement of alimony on August 1, 2005, and for termination of alimony upon the death of Wife or her remarriage or cohabitation with a person, either male or female, to whom she would not be related within the degrees of consanguinity. 4. In all other respects, the Separation and Property Settlement Agreement of even date herewith is ratified and confirmed. IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and year first above written. WITNESSED BY: 6 r 3 ?? Date ANET R. EBERSOLE 'yu I c;fie ?l' ?l'??' l • Date TIMOT M. EBERSOLE _., ,-a ?? ?? ?:.: ; :. ? ,_ ? ,. c: ? s 4' ?_. ? . t --?C. R AUG IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff V. TIMOTHY M. EBERSOLE, Defendant NO. 02-2988 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Re: DEFENDANT'S PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION ORDER AND NOW this day of 208 upon on consideration of the within Y ? p Petition, IT IS HEREBY ORDERED that: A Rule is issued upon the Respondent, Janet R. Ebersole, to show cause why the Petitioner, Timothy M. Ebersole, is not entitled to the relief requested in the within Petition to Modify (Decrease) or Terminate Alimony Obligation . The Rule returnable is 36 days after service, by which date Respondent shall file and serve upon Petitioner's counsel an Answer to this Petition. Within 30 days of the date of service of this Order, each of the parties shall file and provide the other party with: 1. An Income and Expense Statement in the form prescribed in Pa.R. C. P. 1910.27(c)(2)(B); 2. His or her pay stubs or other evidence of income for the preceding six (6) months; 3. Complete copies (with all schedules and W-2 statements) of his or her income tax returns for 2007; 4. Complete copies (with all schedules and W-2 statements) of his or her income tax returns for 2005; 5. Proof of the amount of any inheritance or other non-taxable income received within the last 12 months or to which the party is currently entitled to but has not yet received. BY THE COURT: J. Distribution to: Attorney for ,Petitioner, Timothy M. Ebersole pane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Email: dianeradcliff@comcast.net Phone: (717) 737-0100 Fax: 717-975-0697 Attorney for spondent, Janet R. Ebersole radley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013 Email: B?riffieriffielaw.com Phone: 243-5551 Fax: 243-5063 r?-?'?S ?•- -' ?y_ '? ? ?a1 ?? g "" ?i 1'? ??l??Z • , .,?? ?? JANET R. EBERSOLE, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. : NO. 02-2988 CIVIL TERM : CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, Defendant : IN DIVORCE NOTICE TO PLEAD You are hereby notified to file a written response to the within New Matter within twenty days (20) days from service hereof or a judgment may be entered against you. JANET R. EBERSOLE, Plaintiff VS. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-2988 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE ANSWER TO PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION AND NEW MATTER AND NOW, comes Respondent, Janet R. Ebersole, by and through her counsel of record, Bradley L. Griffie, Esquire and the law firm of Griffie & Associates, and answers Petitioner's Petition as follows: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. It is further averred, however, that the document speaks for itself. 6. Admitted. It is further averred, however, that the document speaks for itself. 7. Admitted. 8. Admitted in part and denied in part. It is admitted that Petitioner is making the request set forth in paragraph number 8. It is denied that the request is appropriate. 9. Admitted in part and denied in part. It is admitted that Petitioner was employed by Shippensburg University as Executive Director of University Relations and that he earned in the neighborhood of $62,000.00 from that employment. It is further averred that Petitioner claimed to have made only $5,891.00 per year in his sports officiating. Respondent does not agree that this figure was accurate. 10. Admitted in part and denied in part. It is admitted that at the time the parties executed the 6.13.05 PSA, Respondent was employed at Cumberland Valley Christian School as a teacher. It is denied, however, that her earnings were approximately $20,000.00, as her earnings for the year of 2005, the year in which the Agreement was executed, were $24,238.90. 11. Admitted in part and denied in part. It is admitted that former husband may believe and, therefore, states that a substantial change in the parties' financial circumstances has occurred since the parties entered into the 6.13.05 PSA. It is denied, however, that any such substantial change has occurred. It is denied that there have been any changes that would warrant a decrease or termination of the alimony obligation set forth in the 6.13.05 PSA. (A) Denied. It is denied former Wife's income from her teaching job has substantially increased. (B) Admitted in part and denied in part. It is admitted that former Wife has additional income by securing part-time employment with a nursing home. It is denied that the income is substantial and it is particularly denied that the income is substantially greater than the income she earned in her part-time employment with Lincoln Intermediate Unit No. 12 in 2005, the year in which the 6.13.05 PSA was executed. (C) Denied. It is denied that former Wife has substantial additional income from part-time employment as a sports officiator, although she has earned a few hundred dollars officiating a few athletic events; (D) Denied. It is denied that former Wife has substantial additional income from selling products through Quickstar (Amway). (E) Admitted. (F) Denied. It is denied that former Wife has added an apartment to her residence. It is denied that former Wife is capable of charging and receiving rent for the alleged apartment, as her daughter is residing in the basement portion of the home. It is denied that Wife could receive rent in the amount of $600.00 per month. It is averred, rather, that Wife has modified her home to allow for her daughter, who recently graduated from college and does not yet have full-time employment, to reside with her at her home in a manner that allows for her daughter to have a separate entrance and to otherwise reside in Wife's basement. It is further averred that the basement to Wife's home will be made available to the parties' son for living quarters in the future should he desire to use this space as has the parties' daughter. (G) Denied. It is denied that former Husband's expenses have substantially increased. It is denied that securing a 30 year mortgage, if that in fact is what occurred, has dramatically increased Husband's expenses. It is further averred that at the time Husband entered into the 6.13.05 PSA, he was fully aware of his financial obligations relative to the commitment he made to pay alimony, along with the commitment he made when he chose to maintain the former marital residence and "buy out" former Wife's interest and, therefore, the obligation he may now have to make payment on a 30 year mortgage is irrelevant to the instant Petition. It is further averred that just prior to reaching a final settlement in the parties' divorce case, Husband demanded of Wife that she execute documents to modify the mortgage on the former marital residence to a twenty (20) year mortgage. (H) Denied. It is denied that former Husband has been forced to work substantially more hours in his self-employed sports officiating business to pay his bills. 12. Admitted. 13. Admitted. 14. Admitted. 15. Admitted. WHEREFORE, Respondent requests your Honorable Court to dismiss Petitioner's request to modify alimony or, in the alternative, to review the parties' financial circumstances and determine whether a modification in the alimony obligation is appropriate such that the alimony should be increased. NEW MATTER 16. Respondent's Answers to paragraphs 1 through 15 of Petitioner's Petition are incorporated herein by reference as if set forth in their text. 17. Husband has recently married and his spouse is gainfully employed with a reasonable income that has provided additional income into Husband's household. 18. Husband has made purchases of personal property items, including an engagement ring for his new wife, which easily exceed the amount of alimony paid annually to Respondent under the 6.13.05 PSA. 19. Husband has retained ownership and possession of the former marital residence, which has substantial living space and extra rooms which could be used to secure rental income if Husband so desired. 20. Husband's home is in a college community, which would allow him to use the extra space within his home for rental purposes, particularly for college students, if he so desired and would, therefore, produce additional income for him. 21. Wife believes and, therefore, avers that Husband has combined his income with his new wife's new income such that Husband and his new wife have joint income and joint expenses and that they each contribute to each other's expenses. WHEREFORE, Respondent requests your Honorable Court to dismiss Petitioner's request to modify alimony or, in the alternative, to review the parties' financial circumstances to determine whether a modification in the alimony obligation is appropriate such that the alimony should be increased. Griffie, Esquire ?r e W!eyr Respondent 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 I verify that the statements made in the foregoing document 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: JANET R. EBERSOLE JANET R. EBERSOLE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 02-2988 CIVIL TERM CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Bradley L. Griffie, Esquire hereby certify that I did, the ? day of September, 2008, cause a copy of Respondent's Answer to be served upon the Petitioner, Timothy M. Ebersole, by serving his attorney of record by first class mail, postage prepaid, at the following addresses: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 DATE: / ? ?? ? - ~s `-!l ?? !? -? y _ ? ? -}? t ?l"i T C,e ; ?w _ "? f ?;3 `_1. -? ORIGINAL IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff V. . NO. 02-2988 CIVIL TERM : CIVIL ACTION - LAW TIMOTHY M. EBERSOLE, IN DIVORCE Defendant Re: DEFENDANT'S PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION I NCOME AND EXPENSE STATEMENT OF TIMOTHY M. EBERSOLE Filed pursuant to Order of Court dated 8/8/08 I verify that the facts set forth in the following Income and Expenses Form, including all attachments thereto, 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: lg't TIMOTH M BERSOLE - 1 - PART I. INCOME DESCRIPTION BIWEEKLY MONTHLY YEARLY Gross Income $2,912.00 $6,309.33 $75,712.00 FICA ($177.41) ($384.39) ($4,612.66) Medicare ($41.49) ($89.90) ($1,078.74) Federal Tax ($331.30) ($717.82) ($8,613.80) State Tax ($87.84) ($190.32) ($2,283.84) Local Tax ($40.06) ($86.80) ($1,041.56) PaSUI (Unemployment) ($1.75) ($3.79) ($45.50) Mandatory Retirement - ARP TIAA-Cref ($145.60) ($315.47) ($3,785.60) Ship Univ Foundation ($61.56) ($133.38) ($1,600.56) Local Services Tax ($2.00) ($4.33) ($52.00) Medical Insurance ($50.65) ($109.74) ($1,316.90) NET INCOME $1 ?97L34 DESCRIPTION BIWEEKLY MONTHLY YEARLY Gross Income $3,072.16 $6,656.35 $79,876.16 FICA ($211.16) ($457.51) ($5,490.16) Medicare ($49.38) ($106.99) ($1,283.88) Federal Tax ($454.71) ($985.21) ($11,822.46) State Tax ($104.56) ($226.55) ($2,718.56) Local Tax ($47.68) ($103.31) ($1,239.68) PaSUI (Unemployment) ($2.06) ($4.46) ($53.56) Mandatory Retirement - ARP TIAA-Cref ($172.83) ($374.47) ($4,493.58) Ship Univ Foundation ($61.56) ($133.38) ($1,600.56) Local Services Tax ($2.00) ($4.33) ($52.00) Medical Insurance ($50.66) ($109.76) ($1,317.16) NET INCOME $1,915.56 -2- DESCRIPTION MONTHLY YEARLY Interest Et Dividends $30.58 $367.00 Pensions Et Annuities Social Security Rents Royalties Expense Account Gifts Employer Fringe Benefits Unemployment Or Workman's Compensation Commissions or Tips Basketball Estimated Post Tax net based on 2007 Tax Return Pretax net of 16,712 SE Tax 015.3%; FT @14.8%; ST @3.4%; LT @1.5% = total tax @35% $905.23 $10,862.80 Other TOTAL OTHER INCOME S - 3 - PART II EXPENSES Note: Joint expenses reported at 59.31% to account for Tim's estimated percentage of total household net income HOME EXPENSES: First Mortgage $1,563.96 $927.74 Joint Expense 30 year mortgage; 26 yrs remain Home Renovations /Modifications $300.00 $177.96 Joint Expense Maintenance and Repairs $450.00 $266.94 Joint Expense Electric $200.00 $118.64 Joint Expense 0$2,400/yr oil $107.71 $63.89 Joint Expense C$1,292.46/yr Home Telephone/Internet/Cable $149.29 $88.56 Joint Expense Cell Phone $25.00 $25.00 Tim Only - Overages Water Salt $10.00 $5.93 Joint Expense Sewer $28.00 $16.61 Joint Expense Trash $32.74 $19.42 Joint Expense @$392.88/yr TAXES: Real Estate Taxes Joint Expense Mortgage Escrow Per Capita Tax $1.00 $1.00 $10/yr INSURANCE: Homeowners Insurance Joint Expense Mortgage Escrow Automobile Insurance $77.78 $77.78 Life Insurance $28.69 $28.69 Medical Insurance Paid through employment C 109.74/mo AUTOMOBILE EXPENSES: Payments Tim will need to purchase new car if to continue 2"d job. Current Vehicle C 155,000 mi.; wife's vehicle @ 305,000 mi. Fuel $390.83 $390.83 Maintenance and Repair $300.00 $300.00 Repairs, tires and service to Tim's car License and Registration $4.50 $4.50 -4- MEDICAL EXPENSES NOT REIMBURS ED BY INSURANCE : Doctor $10.00 $10.00 Optical/Vision Dental $48.75 $48.75 Medicine/ Prescriptions Special Needs/Therapy Etc. EDUCATIONAL EXPENSES: College Et Vocational $250.00 $250.00 Doctoral program expenses Josh's LSAT test cost (one time) $50.00 $50.00 One time cost - $600 Josh's College Rent $300.00 $300.00 Josh's College Expenses $100.00 $100.00 Josh's Books, Fees It Supplies $50.00 $50.00 College - Josh's loan $350.00 $350.00 C? $34,450 + interest accruing PERSONAL EXPENSES:' Clothing $166.67 $166.67 Food $650.00 $385.58 Joint Expense Barber Et Hair Dresser $30.00 $30.00 Memberships $30.00 $30.00 Other Personal Expenses $20.00 $20.00 Assign by Web MISCELLANEOUS EXPENSES: Newspapers, Magazines Et Books $20.58 $12.21 Joint Expense 0$247/yr Entertainment $200.00 $200.00 Vacations $100.00 $100.00 Gifts $50.00 $50.00 Legal Fees $150.00 $150.00 Charitable Contributions $133.33 $133.33 TOTAL EXPENSES $6,378.63 $4,950.03 - 5 - Part III SUPPLEMENTAL INCOME STATEMENT [ d ] CHECK HERE IF NOT APPLICABLE (a) This form is to be filled out by a person: (1) Who operates a business or practices a profession, or (2) Who is a member of a partnership or joint venture, or (3) Who is a shareholder in and is salaried by a closed corporation or similar entity. (b) Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity (check block to indicate the document is attached): (1) The most recent Federal Income Tax Return. [ ] attached (2) The most recent Profit and Loss Statement. [ ] attached (c) Name of Business: Business Address: Business Telephone: (d) Nature of Business (check one) [ ] 1. Sole Proprietorship [ ] 2. Partnership [ ] 3. Joint Venture [ ] 4. Professional [ ] 5. Corporation [ ] 6. Other (e) Name of accountant, controller or other person in charge of financial records: (f) Bu! 1. 2. 3. 4. 5. ?iness Income: Annual income from business: How often is income received: Gross income per pay period: Net income per pay period: Specify deductions, if any: SE°-03-nA I ' a L<EU n 1.;n e C3 ; 1;M CUNB CTY DRO I ljfrtr of (1; • l'n'sidt'r:t h pens jClq mversi?, Aug,ua 1. 2008 fair. "I imoilty ]\4.1 bccrsolc 1 wentivc 1.1iroctr.)r of UnNeoly Relations UidvGrsiq Motions CHIN, Slul licashwl; Univorsity De:.rr rllm: FAX NO. 7172407777 'Monk you An ywrr vtah,ralalc• conidbarlim to anollit:r s?acccss(ul year at Shipponsburg l aria ply; ts_cl lc) ialIiarrr1 yc>U tlrat your perrorataallcc Over llac I L9L year has rosuli.cd in a merit pay diureaso. lsllccliw July 1, 2008, your new la weddy salary will be x+3,072.16. Your new salary along vdul TO rViro".1-rtivo hicrease wilt appear nn your August 29, 2008 paycheck. 'Eau con0mcd c064 do WeMion, and support as a rilunber of the LJ311\rCl' i 's xusn,,.gcnwnt team an gre ady ail Iveciated. Thank you. t,c: 1'1wilu21 Rcsoucccs f)cl.);?rtimni William N. Ruud, PhD. l?h•csicle?at 1 03 1871 ()111 AlOirl l)d;'c' Slrip?rr'r?il.%rrr,, PA 17257-M,`9 717.177.1301 Facsili lilt' 712-,177-4(105 A (VOILl ruetrrh i' rr f Nrc' P0111,sylvioria .V(l1,r Sy0rru ?rJlli;Jx?? l:rfirrrrtkur SE°- '?-?8 ' `ED 10 ? 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O '-i '-1 L ? y ru L n of 0 J V V N O Cwfl V cn --09 Department of the Treasury - Internal Revenue Service 0 Form 104 U.S. Individual Income Tax Return 2007 For the year Jan 1 - Dec 31, 2007, or other tax year beginning 2007, endir Label Your first name MI Last name (See instructions.) Use the IRS label. Otherwise, please print or type. Presidential Election Campaign TIMOTHY M EBER: If a joint return, spouse's first name MI Last name Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. Apartment no. You must enter your 71 DILLER DRIVE At social security number(s) above. City, town or post office. If you have a foreign address, see instructions. State ZIP code Checking a box below will not SHIPPENSBURG PA 17257-9709 change your tax or refund. 1 Check here if you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions) ................ ll? n You E ]Spouse A Filing Status 1 Single 4 X Head of household (with qualifying person). (See 2 Married filing jointly (even if only one had income) instructions.) If the qualifying person is a child but not your dependent, enter this child's Check only 3 Married filing separately. Enter spouse's SSN above & full name here, "' one box. name here .. 5 n Qualifying widow(er) with dependent child (see instructions) Exemptions 6a X Yourself. If someone can claim you as a dependent, do not check box 6a ............ Boxes checked b $ ouse ......................................................................... No6ofachil.i- 1 If more than four dependents, see instructions. c Dependents: (1) First name Last name (2) Dependent's social security number (3) Dependent's relationship to you (4) if qualifying child for child tax credit (see instrs) HEATHER D EBERSOLE au hter 1-1 JOSHUA T EBERSOLE Son n on Sc who: • lived with you ..... 2 • did not live with you due to divorce or separation (see mstrs) . . Dependents on 6c not entered above . Add numbers d Total number of exemptions claimed ................... ............................... on hoes ...... above ..... 3 Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ......... ................................ 7 70,884. 8 a Taxable interest. Attach Schedule B if required ......... ................................ L8a 367. Attach Form(s) 9 b Tax-exempt interest. Do not include on line 8a .......... a Ordinary dividends. Attach Schedule B if required ........ .... I 8bl .... ........................... I 9a W-2 here. Also attach Forms W-2G and 1099-R 10 b Qualified dividends (see instrs) .................................. 9bJ Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ......... . ......... 10 if tax was withheld. 11 Alimony received ..................................... ............................... 11 If you did not 12 Business income or (loss). Attach Schedule C or C-EZ ... ..... . ......................... 12 16,712. get a W-2, 13 Capital gain or (loss). Att Sch D if regd. If not reqd, ck here .......... ................ I, n 13 see instructions. 14 Other gains or (losses). Attach Form 4797 .............. ............................... 14 15 a IRA distributions ............ 15a I bTaxable amount (see instrs) .. 15b 16a Pensions and annuities ...... 16a bTaxable amount (see instrs) .. 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 17 Enclose, but do t h tt 18 Farm income or (loss). Attach Schedule F ............... ............................... 18 no a ac , any payment. Also, 19 Unemployment compensation .......................... ............................... 19 please use 20a Social security benefits ........... 120 a I ? b Taxable amount (see instrs) 20b Form 10404. 21 Other income _ _ _ _ _ _ _ _ _ _ _ _ _ 22 Add the amounts in the far right column for lines 7 through 21. This is our total income, 22 87,963. Ad 23 Educator expenses (see instructions) ................... .... 23 justed Gross 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ ................ .... 24 Income 25 Health savings account deduction. Attach Form 8889 .... .... 25 26 Moving expenses. Attach Form 3903 ................... .... 26 27 One-half of self-employment tax. Attach Schedule SE .... .... 27 1 181. j 28 Self-employed SEP, SIMPLE, and qualified plans ........ .... 28 29 Self-employed health insurance deduction (see instructions) ......... .... 29 30 Penalty on early withdrawal of savings ................. .... 30 31 a Alimony paid b Recipient's SSN .... .. 31 a 13,200. 32 IRA deduction (see instructions) ....................... .... 32 33 Student loan interest deduction (see instructions) ......... ... 33 34 Tuition and fees deduction. Attach Form 8917 ............ ... 34 2,000. 35 Domestic production activities deduction. Attach Form 8903 ........... ... 35 36 Add lines 23 - 31a and 32 - 35 .......... .................... .... ...... ..................... 36 16,381. 37 Subtract line 36 from line 22. This is our adjusted gross inco me 01 37 71,582. BAA For Disclosu re, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIAO112 12/06/07 Form 1040 (2007) IRS Use Only - Do not write or staple in this sl 20 OMB No. 1545-0074 Your social security number Form 1040 Tax and Credits TIMOTHY M EBERSOLE 38 Amount from line 37 (adjusted gross income) ...................................... 39a Check You were born before January 2 1943 Blind Standard Deduction for - • People who checked any box on line 39a or 39b or who can be claimed as a dependent, see instructions. • All others Single or Married filing separately, $5,350 Married filing jointly or Qualifying widow(er), $10,700 Head of household, $7,850 If: • Total boxes Spouse was born before January 2, 1943, Blind, checked ? 39a b If your spouse itemizes on a separate return, or you were a dual-status alien, see instrs and ck here ? 39 b 10 Itemized deductions (from Schedule A) or your standard deduction (see left margin) .................... . 11 Subtract line 40 from line 38 .......................................................... 12 If line 38 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed on line SubtIf line ract lie 42 8 frois over m line 41$1 17'300, see the instructions ....................... 13 Taxable income. S If line 42 is more than line 41, enter -0- . .............. . A Tax (see instrs). Check if any tax is from: a B Form(s) 8814 b E]Form 4972 c Form(s) 8889 ......................... 5 Alternative minimum tax (see instructions). Attach Form 6251 .......................... . ,16 Add lines 44 and 45 ................................................................ ? 7 Credit for child and dependent care expenses. Attach Form 2441 .......... 47 9 Education credits. Attach Form 8863 ....................... 49 0 Residential energy credits. Attach Form 5695 50 1 Foreign tax credit. Attach Form 1116 if required ............. 51 2 Child tax credit (see instructions). Attach Form 8901 if required ........... 52 3 Retirement savings contributions credit. Attach Form 8880 ... 53 4 Credits from: a U Form 8396 b [] Form 8859 c F] Form 8839 .. 54 - 8 Credit for the elderly or the disabled. Attach Schedule R . 48 i Other credits: a 3800 b ? 8801 c L_J Form 55 56 Add lines 47 through 55. These are our total credits 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- .................. ? 58 Self-employment tax. Attach Schedule SE ........ . ......................... Other 59 Unreported social security and Medicare tax from: a E]Form 4137 b [] Form 8919 . ..... . Taxes 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ................... 61 Advance earned income credit payments from Form(s) W-2, box 9 ...................... . 62 Household employment taxes. Attach Schedule H ...................................... . 63 Add lines 57-62. This is your total tax . ..... . .................. ?I Payments 64 Federal income tax withheld from Forms W-2 and 1099 ...... 64 8 8 4 8 s Page 2 71,582. 40 21,020. 41 50,562. 42 10,200. 43 40,362. 44 5, 496. 45 46 5,4 9 6 . 56 5,496. 2,361. f you have a 5 2007 estimated tax payments and amount applied from 2006 return ........ 65 [qualifying 66a Earned income credit (EIC) ................................ 66a hild, attach b Nontaxable combat pay election ..... ?I 66bl chedule EIC. 67 Excess social security and tier 1 RRTA tax withheld instructions (see )....... 67 68 Additional child tax credit. Attach Form 8812 ................ 68 69 Amount paid with request for extension to file (see instructions) ........ 69 . 70 Payments from: a E]Form 2439 b 11 Form 4136 c Form 8885 70 71 Refundable credit for prior year minimum tax from Form 8801, line 27 ...... 71 72 Add lines 64, 65, 66a, and 67 through 71. These are your total payments ... Refund ........... ? 7 73 If line 72 is more than line 63, subtract line 63 from line 72. This is the amount you overpaid ... 7 2 3 Direct de o it? 74a Amount of line 73 ou want f d d ........... p s y re un e to ou. If Form 8888 is attached, check here ? [] 7 4a See instructions ? b Routin number .. and fill in 74b g ........ XXXXXXXXX ? c Type: I n Checking Savings , 74, and 74d ? d Account number XXXXXXXXXXX 7,857. 8,848. 991. 991. XXXXXX Form 8888. or 75 Amount of line 73 you want applied to your 2008 estimated tax ........ ? 75 Amount 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see instructions ............... ? 76 You Owe 77 Estimated tax penalty (see instructions) ....................I 77 I I Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? .......... X Yes. Complete the following. No Designee nDamenee's ? Preparer Phone 0. Personal identification no number (PIN) ? Under penalties of perjury I declare that I have examined this return and accompanying schedules and statements, and to the best my knowledge and Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which prepare r has any knowledge. Here Your signature Joint return? Date Your occupation Daytime phone number See instructions. ADMINISTRATOR Keep a copy Spouse's signature. If a joint return, both must sig-i. Date Spouse's occupation for your records. lllll? Preparer's Date Preparer's SSN or PTIN Paid signature / ROBERT N BOWMAN 04/03/2008 Check if self-employed X P00026119 Preparers Firm's name ROBERT N. BOWMAN Use Only (or yours if y self-essayed),/136 MAPLE STREET -2188089 ZPcodeand MANCHESTER PA EIN 23 17345 Phone no. (717) 266-1569 Form 1040 (2007) FDIA0112 12/06/07 9 .1 ?l zlz:m SCHEDULE A Itemized Deductions OMB No. 1545-0074 (Form 1040) Aoo? 1 Department of the Treasury Internal Revenue Service ? Attach to Form 1040. See Instructions for Schedule A (Form 1040) Attachment . Sequence No. 07 Name(s) shown on Form 1040 Your social security number TIMOTHY M EBERSOLE Medical Caution. Do not include expenses reimbursed or paid by others. and Dental 1 Medical and dental expenses (see instructions) .......................... 1 Expenses 2 Enter amount from Form 1040, line 38 ..... 1 2 1 3 Multiply line 2 by 7.5% (.075) ................................. 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- ...... ...................... 4 Taxes You 5 State and local (check only one box): Paid a X8 Income taxes, or ............................... 5 4,016. b General sales taxes. _ . 6 Real estate taxes (see instructions) ............................ 6 3,055. (See 7 Personal property taxes ...................................... 7 instructions.) 8 Other taxes. List type and amount $ 9 Add lines 5 through 8 ......................................... .. .. ...................... 9 7,071. Interest 10 Home mtg interest and points reported to you on Form 1098 ................ 10 11,949. You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person's name, identifying number, and address ? ------ - - - - - - - - - - - - - - - ---------- ------------------------------- - ---------- - - ------- ------------------------------- 11 Note. 12 Points not reported to you on Form 1098. See instrs for spcl rules ............ 12 Personal 13 Qualified mortgage insurance premiums (see instructions) ....... 13 interest is not 14 Investment interest. Attach Form 4952 if required. deductible. (Seeinstrs.) ................................................... 14 15 Add lines 10 through 14 ....................................... ........................... 15 11,949. Gifts to 16 Gifts by cash or check. If you made any gift of $250 or Charity more, see instrs ............. ................................ 16 2, 000. If you made 17 Other than by cash or check. If any gift of $250 or a gift and more, see instructions. You must attach Form 8283 if got a benefit over $500 for it, see ................................................... 7 instructions. 18 Carryover from prior year ..................................... 18 19 Add lines 16 through 18 ....................................... ........................... 19 2,000. Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) ............................. 20 21 Unreimbursed employee expenses - job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ it required. (See instructions.) ---------- ----- ------------------------------- 21 22 Tax preparation fees ................ ......................... 22 (See 23 Other expenses - investment, safe deposit box, etc. List II instructions.) type and amount --------------- - - ------------------------------- 23 24 Add lines 21 through 23 ....................................... 24 25 Enter amount from Form 1040, line 38 ..... 125 1 26 Multiply line 25 by 2% (.02) ................................... 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter - 0.... ..................... 27 Other 28 Other - from list in the instructions. List type and amount Miscellaneous Deductions ------------------------- 28 Total 29 Is Form 1040, line 38, over $156,400 (over $78,200 if Itemized married filing separately)? Deductions FX] No. Your deduction is not limited. Add the amounts in the far right column n for lines 4 through 28. Also, enter this amount on Form 1040, line 40. . 29 21 020 I I Yes. Your deduction may be limited. See instructions for the amount to enter , . 30 If you elect to itemize deductions even thouoh they are less than your standard deduction check here ? I I I BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIA0301 11/07/07 Schedule A (Form 1040) 2007 IIIIIIIE-., L.-I'll, - "I SCHLDULE C Profit or Loss From Business (Form 1040) (Sole Proprietorshi ) OMB No. 1545-0074 Department of the Treasury 'Partnerships, joint ventures, etc, must file p Form 1065 or 1065-13. 2007 Internal Revenue Service (99) 'Attach to Form 1040, 1040NR, or 1041. ?See Instructions for Schedule C (Form 10401 Attachment ]Name or proprietor TIMOTHY M EBERSOLE A Principal business or profession, including product or service (see instructions) BASKETBALL OFFICIAL CORDINATOR esusmess name. it no separate business name, leave blank. Sequence No. Uty Social security number (SSN) B Enter code from instructions ?711300 D Employer ID number (EIN), if any t Business address (including suite or room no.)? 71 DILLER DRIVE City, town or post office, state, and ZIP code ------------------------------------ SHIPPENSBURG , PA 17257-9709 ---- F Accounting method: (1) LXJ Cash (2) 1:1 Accrual (3) L] Other (specify) ? _ G Did you 'materially participate' in the operation of this business during 2007? If 'No,' see instructions for limit on losses . XX Yes No H If you started or acquired this business during 2007, check here Part l Income 1 Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the 'Statutory employee' box on that form was checked s th i , ee e nstructions and check here ............ 11 2 Returns and allowances ............. 1 34,385. ................................................................ 3 Subtract line 2 from line 1 ........ ..... ... 2 .............................................................. 4 Cost of goods sold (from line 42 on page 2) ............ ... 3 34, 385. ............................................... ... 4 5 Gross profit. Subtract line 4 from line 3 ........ ....................................................... 6 Other income, including federal and state gasoline or fuel tax credit or refund ... 5 34,385. (see instructions) ......................... ...................... ..................................... 7 Gross income. Add lines 5 and 6 ..... ... 6 35, 695. ........... . ........... ............................. Part 11 Ex enses. Enter expenses for business use of our home only on line 30. "' 7 70, 080. 8 Advertising ....... ........ 8 18 Office expense ....................... .. 18 9 Car and truck expe19 Pension and profit-sharing plans 19 (see instructions) ......... 9 8, 876. 20 Rent or lease (see instructions): ee40, 10 Commissions and ........ 10 40, 045. a Vehicles, machinery, and equipment ... .. 20a 11 Contract labor b Other business property .............. 20b . (see instructions) ......... 11 21 Repairs and maintenance ..... .. 21 E ........ 12 Depletion ................ 12 22 Supplies (not included in Part III) .. 22 ...... 13 Depreciation and s23 Taxes and licenses 179 expense deduc .. 23 (not included in Pa24 Travel, meals, and entertainment: (see instructions) ......... 13 a Travel 2, 550. 14 Employee benefit ps b Deductible meals and enter tainment (other than on line 14 ........ (see instructions) .................... 15 Insurance (other thalth) . • . 15 25 Utilities .. 24b 442. .......... . 16 Interest: 26 Wages (less employment credits) . 26 ..... a Mortgage (paid to banks, etc) ........ 16a .. b Other .......... 27 Other expenses (from line 48 on ..... 16b ....... page 2) ............................... 17 Legal & professional services ... 17 75. . 27 1,380. 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns 28 ............. 53,368. 29 Tentative profit (loss). Subtract line 28 from line 7 ........ . 30 Expenses for business use of your home. Attach Form 8829 29 16,712. .............................................. 31 Net profit or (loss). Subtract line 30 from line 29. . 30 • If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2 or on Form 1040NR, line 13 (statutory employees see inst ti , ruc ons). Estates and trusts, enter on Form 1041, line 3. • If a loss, you must go to line 32. 31 16,712. 32 If you have a loss, check the box that describes your investment in this activity (see instructions). 0 If y 32a, enter the loss both and line 1040NR l ne 13 (st tutor em l s t ? ' l ? ll inv t , y p oyee see io ) nstrruc Estates an d trusts, enter on Fom 1041 F line 3. es ment is 32 a at risk. • If you checked 32b you must attach Form 6198. Your loss may be limited Some investment 32b n BAA For Paperwork Reduction Act Notice, see Form 1040 Instructions Is not at risk . Schedule C (Form 1040) 2007 FDIZ0112 06/15/07 Schedule C (Form 1040) 2007 TIMOTHY M EBERSOLE Page 2 Part III Cost of Goods Sold (see instructions) 33 Method(s) used to value closing inventory: a 11 Cost b 11 Lower of cost or market c [] Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'Yes,' attach explanation .............................................................................. .......... n Yes F? No 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation ...................................................................................... 35 36 Purchases less cost of items withdrawn for personal use .................................................. 36 37 Cost of labor. Do not include any amounts paid to yourself ................................................. 37 38 Materials and supplies ................................................................ ................. 38 39 Other costs ................................. .......................................................... 39 40 Add lines 35 through 39 ................................................................................. 40 41 Inventory at end of year ......................... ...................................................... 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ................ 42 'art IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) ? 01/01/2001 44 Of the total number of miles you drove your vehicle during 2007, enter the number of miles you used your vehicle for: a Business - - - - - - 18,300 b Commuting (see instructions) - - - - - - - - - - - c Other 8 5 0 0 45 Do you (or your spouse) have another vehicle available for personal use? ...................... ............. F] Yes X? No 46 Was your vehicle available for personal use during off-duty hours? ....................................... .......... FX1 Yes n No 47a Do you have evidence to support your deduction? .................................................................... 0 Yes No b If 'Yes,' is the evidence written? ................................................................. n Yes n No 'art V Other Expenses. List below business expenses not included on lines 8-26 or line 30. TOLLS --------------------------------------------------------- UNIFORMS,-ETC -------------------------------------------------------- DUES --------------------------------------------------------- DRY CLEANING --------------------------------------------------------- 400. 300. 480. 200. 48 Total other expenses. Enter here and on page 1, line 27 ................................................ I 48 I 1,380. Schedule C (Form 1040) 2007 FDIZ0112 06/15/07 ^a CT+ s J ?- tiA 5 JANET R. EBERSOLE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, NO. 02-2988 CIVIL TERM Defendant IN DIVORCE DOCUMENTS FILED BY PLAINTIFF PURSUANT TO ORDER OF COURT DATED AUGUST 8.2008 OTHER INCOME WEEK MONTH YEAR Interest $ $ Dividends Pension Annuity Social Security Rents Royalties Expense Account Gifts Unemployment Compensation Workmen's Compensation IRS Refund Other - Alimony Other TOTAL $ $ $ TOTAL INCOME $ (Fill in Appropriate Column) EXPENSES WEEK MONTH YEAR HOME Mortgage/Rent $1,151.00 1st & 2nd Maintenance $50.00 UTILITIES Electric $154.00 Gas Oil $300.00 Telephone $160.00 Clothing $62.00 Water $36.00 Sewer $33.00 Employment Public Transportation $65.00 Lunch Taxes Real Estate escrowed Personal Property Income Insurance Homeowners escrowed Automobile $168.00 Life $42.00 Accident $22.00 Health Payroll deducted Other Automobile Payments Fuel $150.00 Repairs $50.00 Medical Doctor $25.00 Dentist $13.00 Orthodontist Hospital Medicine $75.00 Special needs (glasses, braces, orthopedic devices $20.00 Education Private School Parochial School Colle e Religious Personal Clothin $100.00 Food $550.00 Barber/Hairdresser $36.00 CREDIT PAYMENTS: Credit Card Charge Account $470.00 balance $11,463.00 Memberships $5.42 Loans Credit Union TV Loan $200.00 balance $1,835.00 Miscellaneous Household Help Child Care Papers/Books/Magazines $5.00 Entertainment $50.00 Pa TV Included in hone Vacation $50.00 Gifts $92.00 Le al Fees $250.00 Charitable Contributions $445.00 Other Child Support Alimony Payments Child Support Other Son's college expenses $140.00 Contribution to children $150.00 on's colle a expenses 161.33 balance $12,700.00 plus interest TOTAL EXPENSES 5,190.74 Cumberland Valley Christian School Teacher Contract For the 2008 2009 School Year Believing that God has led in this decision, the Administration of Cumberland Valley Christian School has appointed Janet R. Ebersole as a Full-time High School Teacher for the 2008-2009 school year. This contract begins September 1, 2008 and ends August 31, 2009, depending upon satisfactory performance of assigned duties. In so doing, we recognize and affirm the ministry of teaching for you as a God-ordained vocation. We rejoice that God has brought you to us as a "fallow-laborer" in this ministry. This contract provides a framework of mutual obligation and responsibility to assure the orderly operation of an exemplary program at Cumberland Valley Christian School. By accepting this appointment, said teacher specifically acknowledges that this contract is for a limited duration and that all rights and privileges herein shall terminate upon the expiration date of this contract, unless voided earlier pursuant to the provisions of Paragraph 22 below. The parties agree that no rights of tenure or presumption of continued employment are conferred or implied by this contract or by a number of consecutive contracts. The parties further agree that no right to notice of renewal or non-renewal of the contract is conferred or implied. Gross salary for this period of employment will bib-3224;$1-0100 payable in 26 installments of $942.69 beginning in the first month of contract. Fringe benefits are listed in the Financial Worksheet Section. toss n? ?? ?g, sa Conditions of Employment 1. The teacher affirms that, as part of the qualifications for this position, he/she is a "Born Again" Christian who knows the Lord Jesus Christ as Savior. (John 3:3, I Pet. 1:23) 2. The teacher gives testimony that he/she has a sense of God's will, that teaching is his/her calling, and that teaching in this Christian school is God's direction. 3. The teacher will manifest by precept and example the highest Christian virtue and personal decorum, serving as a Christian role model (I Tim. 4:12) both in and out of school to pupils (Luke 6:40), and as an example to parents and fellow faculty members in judgment, dignity, respect and Christian living. This includes, but is not limited to, the refraining from such activities as the use of alcohol, tobacco, illicit drugs, and the use of vulgar and profane language. (Col. 3:17, Titus 2:7-8, I Thess. 2:10, 5:18, 22-23, and James 3:17-18). The teacher further agrees that the Bible dictates the standards for sexual behavior. Any promiscuity, homo- sexuality or other deviant sexual behavior is forbidden and as such violates the bona-fide occupational requirement of being a Christian role model. The unique roles of the male and female are clearly defined in Scripture. Romans 1:24-32 states that God recognizes homosexuals and other deviates as perverted. Deviation from Scriptural standards is grounds for termination. (Rom. 12:1-2; I Cor. 6:9-20; Eph. 4:1-11, 5:3-5;1 Thess. 4:3-8; 1 Tim. 4:12; 2 Tim. 2:19-22; 1 Pet. 1:1S-16, 2:15-17; 1 John 3:1-3). 21. Fringe Benefits. The benefits become effective upon contract performance and shall continue in effect for the contract period. It is understood that the school is not liable to reimburse any teacher for any benefit not used in the fringe benefit package. Teachers may not choose to receive cash in lieu of any benefit and the benefits will be terminated upon the last day of employment. A. Personal/Sick Days. Nine personal/sick days with pay may be taken by full-tune teachers (prorated for part-time teachers) with advance coordination and approval of the Principal, when possible. A prorated payroll deduction will be made for each day absent over the allotted days for both full- and part-time teachers. These days do not accumulate from year to year. B. Vacation Davs. The teacher will receive all standard school holidays including Christmas and spring vacations. C. Medical Insurance. The school offers group health insurance to all full-time teachers. The school subsidizes premiums for both individual or family coverage. The teacher's portion for individual or family coverage, when applicable, will be paid through payroll deduction. D. Pogonelan A full-time teacher is eligible to participate in the 403(b) Plan upon contract performance and a minimum monthly salary reduction of N/A. The school contributes $300.00 per year for each eligible participant enrolled in the plan. E. Life Insurance. The school pays the fees for all full-time teachers to be covered by a $20,000.00 group term life insurance policy. F. Tuition Discount. A full-time teacher shall receive a tuition discount during the school year for his/her children. A part-time teacher shall receive a proration of the benefit based on the number of hours per week contracted. 22. The teacher must give the Principal one month's prior written notice of intended resignation unless a different termination date is mutually agreed upon. If the teacher resigns or is terminated during the period of service covered by this contract, payment shall be made of that proportionate part of the annual salary which the number of days of actual duty bears to the number of days covered by the contract. All fringe benefits would end on the last day of employment. All of the employer's property in the teacher's custody must be returned before he/she is entitled to final payment of any amounts due upon separation. Where cause exists, the Administration may terminate this contract, provided that the teacher has been informed in writing of the cause or causes for discharge and has been given an opportunity to respond to them prior to final termination. Failure to request a hearing with the Administration within seven days of delivery of the termination notice shall waive the teacher's right to such a hearing and the termination is final. Dismissal may be immediate or with longer notice depending upon the reason for dismissal. Cause, as used herein includes, but is not limited to, any conduct tending to reflect discredit upon the school or upon the teacher, or tending to seriously impair his/her continued usefulness as a Christian role model for the students. The Teacher's Handbook and the Policy and Procedures Manual give full details regarding termination of contract. 4 / 2008-09 23. Cumberland Valley Christian School has been classified as a 501(c)(3) non-profit, church-related organization and has chosen not to participate in the Federal Unemployment Tax Act. Therefore upon termination of employment, regardless of the reason(s), unemployment benefits are not available. 2008 - 2009 Financial Worksheet Education: Master Equivalency in Health and Physical Education CVCS Experience: 13.0 Other Experience: 12.5 Base Salary: $ 24,510.00 F.I.C.A. Contribution: $ 1,875.02 Health Insurance: $ 3,906.72 TOTAL COST ($2,734.64 - CVCS cost/ $1,172.08 - Employee cost) Pension Plan: $ 300.00 CVCS Tuition Discount: $ 0.00 Group Life Insurance Policy: $ 20,000.00 (Face Value) 1 have read and understand the duties, responsibilities, salary and benefits and will abide with the terms and conditions of this contract. This contract will be valid only if it is signed and returned by June 11, 2008. o & //Z /elf 4Ttget R. Ebersole Date We at Cumberland Valley Christian School extend our warmest welcome to you. We pledge our prayer support and help as you minister to the needs of the students. C kk Signature of Principal Date CCMQ" ? - 070 -o E? 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IC O w O %.O "O J ON V1 - O O z z 0 z ?x n 9SARGUARk LITHOOSA SFSL3 WS08113L Borough Of Chambersburg STATEMENT OF EARNINGS ENDING DATE: 8/12/2008 CHECK NO: -7 EMPLOYEE#:9330 MARITAL STATUS: S NO DEPEND: 0 EXT FED: f HOURLY RATE: 8.85 REG HOURS: 6.0 OT HOURS: CURRENT Y-T-D CURRENT Y-T-D Regular Pay: 53.10 336.30 Gross Pay: 53.10 336.30 Fica Tax: 3.29 20.85 Fica medical: 77 4.87 Federal Tax: 6.62 State Tax: 1.63 10.33 Unemployment Tax: 3 20 Local Tax: 90 5.71 E-M-S or Ocp Prv Tx: 2.00 8.00 Net Pay 44.48 279.72 Borough Of Chambersbu9rg STATEMENT OF EARNINGS ENDING DATE: 8/12/2008 CHECK NO: 160769 EMPLOYEE#:9330 MARITAL STATUS: S NO DEPEND: 0 EXT FED: HOURLY RATE: 8.85 REG HOURS: 6.0 OT HOURS: Comments n ? ro ,ti` NOW SFaCb/9('rT1115a15A R80R{iE-R FACMI YOUR L0-,-AL SAFFGUARD FkSMf5UTLW IF UNKNOWN CAll 80,0-5232422 HNOONS010000 L01SF'044478. L?UWMIJAHU.. LITHO USA SFSL3 CK7SM113L Borough Of Chambersburg STATEMENT OF EARNINGS ENDING DATE: 7/29/2008 CHECK NO: EMPLOYEE#:9130 MARITAL STATUS: S NO DEPEND: 0 EXT FED: 160628 HOURLY RATE: 8.85 REG HOURS: 4.0 OT HOURS: CURRENT Y-T-D CURRENT Y-T-D Regular Pay: 35.40 283.20 Gross Pay: 35.40 283.20 Fica Tax: 2.19 17.56 Fica Medical: 51 4.10 Federal Tax: 6.62 State Tax: 1.09 8.70 Unemployment Tax: 2 17 Local Tax: 60 4.81 E-M-S or Ocp Prv Tx: 2.00 6.00 Net Pay 28.99 235.24 Borough Of Chambersburg STATEMENT OF EARNINGS ENDING DATE: 7/29/2008 CHECK NO: 160628 EMPLOYEE#:9330 MARITAL STATUS: S NO DEPEND: 0 EXT FED: HOURLY RATE: 8.85 REG HOURS: 4.0 OT HOURS: SF40b1SOTTN5-1 SA REORDER,fROMYOURLOCALGAFtGUARUTIISTfi(BUTIR IF UNKNOWN, CALL 800-523-2422 HM36NSOOIBM LOISfO44476 X7 3A1t17UAXU_ LITHO USA SFSL3 WS03113L Borough Of Chambersburg STATEMENT OF EARNINGS ENDING DATE: 7/15/2008 CHECK NO: ^ A 048 EMPLOYEE#:9330 MARITAL STATUS: S NO DEPEND: 0 EXT FED: 16 2 HOURLY RATE: 8.85 REG HOURS: 9.0 OT HOURS: CURRENT Y-T-D CURRENT Y-T-D Regular Pay: 79.65 247.80 Gross Pay: 79.65 247.80 Fica Tax: 4.94 15.37 Fica medical: 1.15 3.59 Federal Tax: 6.62 State Tax: 2.45 7.61 + Unemployment Tax: 5 15 Local Tax: 1.35 4.21 E-M-S or Ocp Prv Tx: 2.00 4.00 Net Pay 67.71 206.25 Borough of Chambersburg STATEMENT OF EARNINGS ENDING DATE: 7/15/2008 CHECK NO: 1 6 0 4 U 2 EMPLOYEE##:9330 MARITAL STATUS: S NO DEPEND: 0 EXT FED: HOURLY RATE: 8.85 REG HOURS: 9.0 OT HOURS: ?i ?: f } k "??'7?•1 ??' =tq >3! ? 4.i?V«r' 'J? is SF4001807NS-1SA REORDER FROM YOUR LOCAL SAFEGUARD DISTRIBIJTDR IFUNKNOWN CALL800-523-2422 HNMONS0010000 L01SFOW76 _- . - -._.--- _ ------------ Gvp CC--Far EN111i' d3Y REGARDS (See ss 2treet3aa Notice trs EmptvyWe tan the back ofiNG OMS No. 1545-©ooe a Employees SSN 1 Wtt s, spa, 011W 2 Federal income tax WMWId 1126.35 985.051 228-78-5382 s Sooiat ssaudty wm9? 4 Soael securityx wkhhs[d 112 6 9.3 5 6 9 8. 6 8 b v ID no. (ON) 5 medicem _ 23-6276101 We and 8 Mgdmm tax wMhold 11269.35 163.381 c E[nptoylla name, address, and ZIP code MENN0 HAVEN INC 2011 Scotland Avenue 1 Chambersburg, PENNSYLVANIA 17201 d carf I number e Employee's name. address, and 7.J' code JANET R EBERSOLE 3442 EAGLE DRIVE CHAMBERSBURG, PENNSYLVANIA 17201 f 7 Soda[ sectstty lips B Aiboated lips 8 Advance EIC payment 19 Dependent care benefits 11 Nor Walified plans 12eC009 See inst. for brut 12 19 statti wy employee 14 Oftw 12b Code Ret?rertt plan ; Chamb e L S T 52,00 12e cow i Tterd•pagy sk:k Pay ? 12dCotte 1 PA; 1 11269.35 345.961 5 State EEiptoy s state ID numw 18 State wages, tips, at. 17 Stale inmtne tax e tonal wages' tips, at, 11269.35 19 Local income tax158.87 2o Lwatty GreenameTP, Chat? orm W-2 Wagc and Tax Statement 2007 Cwt. of the Treasury ^ W5 I" lnlonnatiM to bli t9 fw*w ed to 9e Me. If yrttt ate W 91e a tit ""M. 4 f""*K*'. Malty w other sanMW may be jmVeed on you tt tlrs Inwmr. is f8 01- amd you tali to mptln k. formation is being furnished i Thi to the Internal Revenue Service. If you a Employee's social security number n s are required to file a tax return, a negligence penalty or other sanction 228-78 - 5 3 8 2 OMB No. 154 5-0008 ma be imposed on you if this inc ome is taxable and you fail to report it. b Employer identification number (EIN) 1 Wages, tips, other compensation 23361.08 2 Federal income tax withheld 2734.48 25-1254833 3 Social security wages 4 Social security tax withheld c Employer s name, address, and ZIP code CUMBERLAND VALLEY CHRISTIAN SCHO0 23661.12 1467.04 5 Medicare wages and tips 5 Medicare tax withheld 04 343 23661.12 . 600 MILLER ST 7 Social security tips 8 Allocated tips CHAMBERSBURG PA 17201-1064 9 Advance EIC payment 10 Dependent care benefits d Control number e Employee's name, address, city, and ZIP code Suff. 11 Nonqualified plans 12a See instructions for box 12 'E 300.04 JANET R EBERSOLE 3442 EAGLE DR. 13 employce ?remem Third-party SiCk pay 12b CHAMBERSBURG PA 17202 0 >n ? 14 Other EMST 10.00 12c ; 12d c d 15 State Employer's state ID number 16 State wages, tips, etc. 12 23661 17 State inco 726 me tax ,40 18 LWW wages, tips, etc. 1 23661.12 9 Local income tax 320.67 20 Locality name CHBG PA . _ wage and Tax n Department of the Treasury-Internal Revenue Service t U Safe, accurate, 2 Statemefr Fom? Copy C For EMPLOYEE'S RECORDS. (See Notice to FAST! Use FORM LW2C Employee on back of Copy B) f 029,C I OW CipyB For Barrnnr,WBl75R'/S•,676 f0?8W??Y B? RRrrc?Nn'OMOB /?15?50 ,0 rTax Statement for Forms 1098, 1099, 5498 for Year 2007 1398-A, Copy B, For 80 0a er, ore l15464M +099 Nf C?YBB Fo RaG ?B#5,4W2,5 ,58 38, Copy B, F w. ore?.5-0715 ,054M1S1C opY 1389-C, COpy B,F orwRocDe6tor,0YB t,S51 1{2/ ,W9WD, toP%',F nt N,5/501,7 orR. ,09915 9 For T'.V. .Ww t&BN546-M7 NAME, ADDRESS ANDIEDERAL I.D. NO. CUSTOMER NAME, ADDRESS , ?i ?ns?"is,siis o70 FORD INTEREST ADVANTAGE JANET R EBERSOLE P.O. BOX 1732/MD-7020 3442 EAGLE DR DEARBORN MI 48121-1732 CHAMBERSBURG PA 17202-7419 Payer's Federal ID# 38-1612444 Questions? (800) 462-2614 535D00018636-01 002 FORM 1 OF 1 2007 FORM 1099-INT: INTEREST INCOME Account Type Account Number Decosit ID IRS Description IRS Box* Amount 09071623367 00001 Interest income 1 771.29 TOTALS., interest'iripme 9 771.29 >=arly vdtlOjiwal arty 2 0.0( Interest b lU.S.• wings t3onds and Treasury obligations 3 O.Ot Feder,al.lincome tax withheld 4 0.00 triire a l i3iexpenses 5 0. ac Fri sign #ajc paid 6 0.0c Tax-wiper pt interest 8 0:00 Speafieid.private activity bond interest 9 0.00 TAXPAYER I.D. NO. t8ceey for your ranrde) DEPARTMENT OF THE TREASUR]- INTERNAL REVENUE SERYb Fa Fdm,o938,DN, INT, RISC, 01D, and 0: This tex olhrmetlon uMS NOV furnoWto the Iri mel Ra ue Service. tyou are required b file a rem, a nagFg p.* orotar sanoton may be imposed on you 0 ft inoo-is but L antl tlu lRStlalf hes notbeen mp?vt 010: ft 22'78-J3?2 Fam,0?B8 Cabow rd be Tlnrro m'. back. sho mey nd be NR aldeduchy b?yyw'?LM SWsed onM boe?mwntand he caleM ve ueM ha sew ed POPeM Yepp Y.Nso,You may aNy detlud ins ea b he mtlen it was matured bYYOU edudYDax or after Separ?er 12004, box you may be abk to drum ban F' 1 f -l It 17 `-- Department of the Treasury - Internal Revenue Service Form 1040 U.S. Individual Income Tax Return Label (See instructions.) Use the IRS label. Otherwise, please print or type. Presidential Election Campaign For the year Jan 1 - Dec 31 2007, or other tax year beginning 2007, endi Your first name MI Last name Janet R Ebersole If a joint return, spouse's first name MI Last name IRS Use Only - Do not write or staple in this OMB No. 1545.0074 Your social security number 228-78-5382 Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. Apartment no. You must enter your social security 3442 Eagle Drive number(s) above. City, town or post office. If you have a foreign address, see instructions. State ZIP code Checking a box below will not Chambersbur PA 17201-7419 change your tax or refund. Check here if you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions) ................ 0- E]You ? Spouse 1 Single 4 U Head of household (with qualifying person). (See Filing Status 9 instructions.) If the qualifying person is a child 2 H Married filing jointly (even if only one had income) but not your dependent, enter this child's 3 Married filing separately. Enter spouse's SSN above & full name here. 01 Check only one box. name here .. 01 5 n Qualifying widow(er) with dependent child (see instructions) Exemptions 6a Yourself. If someone can claim you as a dependent, do not check box 6a ......... Boxes checked on 6a and 6b .. 1 b Spouse ............................ ..................................... _ ....... No. of children (2) Dependent's (3) Dependent's (4) if on 6c who: c Dependents: social security relationship qualifying lived number to you child for child wNh you tax credit • did not 1 First name Last name (see instrs) live with you due to divorce or se ration pa (see nstrs) . . Dependents If more than on 6c not four dependents, see instructions. d Total number of exemptions claimed ................... ................................. .... Add numbers on lines above..... 1 7 Wages, salaries, tips, etc. Attach Form(s) W-2 .......... .............................. 7 34,630. Income 8a Taxable interest. Attach Schedule B if required .......... ................. . . . . .......... 8a 771 . b Tax-exempt interest. Do not include on line 8a .......... .... I 8bl Attach Form(s) 9a Ordinary dividends. Attach Schedule B if required ........ ............................... 9a W-2 here. Also attach Forms b Qualified dividends (see instrs) .................................. I 9bl 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ...................... 10 W-213 and 1099-R if tax was withheld 11 Alimony received ..................................... ............................... 11 13,200. . 12 Business income or (loss). Attach Schedule C or C-EZ ... ............................... 12 624. not you did W t 2 13 Capital gain or (loss). Att Sch D if reqd. If not regd, ck here .......... ................ 10. 11 13 ge a - , g see instructions. 14 Other gains or (losses). Attach Form 4797 .............. ............................... 14 15a IRA distributions ............ 15a b Taxable amount (see instrs) .. 15b 16a Pensions and annuities ...... 16a b Taxable amount (see instrs) .. 16b 998. 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 17 Enclose but do 18 Farm income or (loss). Attach Schedule F ............... ............................... 18 , not attach, any ............ 19 Unemployment compensation .............. ............................. . . 19 payment Also, l 20 a Social security benefits ........... 120 a l b Taxable amount (see instrs) .. 20b p ease use Form 10404. 21 Other income -- 21 --------------------------- 22 Add the amounts in the far right column for lines 7 through 21. This -------- is our total income. 22 50,223. 23 Educator expenses (see instructions) ................... .... 23 2150. Adjusted Gross 24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ ................ .... 24 Income 25 Health savings account deduction. Attach Form 8889 .... .... 25 26 Moving expenses. Attach Form 3903 ................... .... 26 27 One-half of self-employment tax. Attach Schedule SE.... .... 27 44. 28 Self-employed SEP, SIMPLE, and qualified plans........ .... 28 29 Self-employed health insurance deduction (see instructions) ......... .... 29 30 Penalty on early withdrawal of savings ................. .... 30 31 a Alimony paid b Recipient's SSN .... le' .. 31 a 32 IRA deduction (see instructions) ........................... 32 33 Student loan interest deduction (see instructions) ........ .... 33 34 Tuition and fees deduction. Attach Form 8917 ........... .... 34 35 Domestic production activities deduction. Attach Form 8903 .......... .... 35 36 Add lines 23.31a and 32 - 35 ............................... ......... ...................... 36 294. 37 Subtract line 36 from line 22. This is our adjusted gross income . .................... ? 37 49,929. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0112 12/06/07 entered above . Form 1040 (2007) , Form 1040 2007 T__ _+- D 228-78-5382 Pace 2 ------ -- ---------- 38 Amount from line 37 (adjusted gross income) .......................................... 38 49,929. Tax and Credits 39a Check r 8 You were born before January 2, 1943, 8 Blind. Total boxes L if: 1 Spouse was born before January 2, 1943, Blind. checked 39a Standard b If your spouse itemizes on a separate return, or you were a dual-status alien, see instrs and ck here ? 39b Deduction 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) ..................... 0 ,352. for - 41 Subtract line 40 from line 38 .......................................................... 41 41,577. -- • People who checked any box on line 39a or 42 If line 38 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed on line 6d. If line 38 is over $117,300, see the instructions ....................... °M 42 3,400. 39b or who can be claimed as a 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41 enter -0 . ....................................................... 43 38,177. dependent, see instructions. , 44 Tax (see instrs). Check if any tax is from: a 8 Form(s) 8814 b E]Form 4972 c Form(s) 8889 ......................... 44 5,968. • All others: 45 Alternative minimum tax (see instructions). Attach Form 6251 ........................... 46 Add lines 44 and 45 ................................................................ ? 5,968. Single or Married filing separately, 47 Credit for child and dependent care expenses. Attach Form 2441 .......... 47 $5,350 48 Credit for the elderly or the disabled. Attach Schedule R ..... 48 Married filing 49 Education credits. Attach Form 8863 ....................... 49 ointly or 50 Residential energy credits. Attach Form 5695 ............... 50 uallfymg widow(er) 51 Foreign tax credit. Attach Form 1116 if required ............. 51 1 , $10,700 52 Child tax credit (see instructions). Attach Form 8901 if required ........... 52 f H d 53 Retirement savings contributions credit. Attach Form 8880 ... 53 ea o household, 54 Credits from: a Form 8396 b [] Form 8859 c [] Form 8839 54 $7,850 55 Other credits: a s8ooo b ? 8801 c ? Form 55 56 Add lines 47 through 55. These are your total credits ........ ..... ...................... ?56 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- ..... ............. ? 57 5,968. 58 Self-employment tax. Attach Schedule SE ...................................................... 58 88. Other 59 Unreported social security and Medicare tax from: a E] Form 4137 b ? Form 8919 .................. 59 Taxes 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ................... 60 61 Advance earned income credit payments from Form(s) W-2, box 9 ....................... 61 62 Household employment taxes. Attach Schedule H ....................................... 62 63 Add lines 57-62. This is our total tax ...................................................... 01 63 6,056. ments 64 Federal income tax withheld from Forms W-2 and 1099 ...... Pa 64 3,719. y 65 2007 estimated tax payments and amount applied from 2006 return ........ 65 1,704. If you have a 66a Earned income credit (EIC) .............................No lif i 66a y qua ng child, attach b Nontaxable combat pay election ..... ?1 66bl Schedule EIC. 67 Excess social security and tier 1 RRTA tax withheld (see instructions) ....... 67 - 68 Additional child tax credit. Attach Form 8812 ................ 68 69 Amount paid with request for extension to file (see instructions 69 70 Payments from: a [] Form 2439 b [] Form 4136 c h Form 8885 70 71 Refundable credit for prior year minimum tax from Form 8801, line 27 ...... 71 72 Add lines 64, 65, 66a, and 67 through 71. These are our total payments ......................................... ................... 72 5,423. nd 73 If line 72 is more than line 63, subtract line 63 from line 72. This is the amount you overpaid ................ Ref 73 u osit? 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here .. ? Direct de 74a p See in structions ? b Routing number ........ xxxxxXX c T e: Checking Savings and fill in 74b,r 1, d Account number ....... XXXXXXXXXXXXXXXXX 74c, and 74d o Form 8888. 75 Amount of line 73 ou want a lied to our 2008 estimated tax ........ 75 1, Amount 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see instructions ............... 01 YOU Owe 77 Estimated tax penalty see instructions 634. Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? .......... XU Yes. Complete the following. U No Designee's Phone Personal identification Designee name ? Pre arer no. ? number (PIN) ? Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return? See instructions. Educator Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your records. Date Preparer's SSN or PTIN Preparer's Paid signature Check if self-employed X 1174-46-7379 Preparer's Firm's name Marrazzo and Associates (or yours if Use Only self.employed) 501 South Arlington Avenue EIN address, and ZIP code Harrisburg PA 17109 Phone no. Form 1040 (2007) FDIA0112 12706!07 OMB No. 1545.0074 SCHEDULE A Itemized Deductions (Form 1040) 2007 Department of the Treasury = ant Service Attach t0 Form 1040. ? ? See instructions for Schedule A (Form 1040). Attach Sequencent me No. 07 Name(s) shown on Form 1040 1 Your social security number Janet R Ebersole 228-78-53B2 Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see instructions) Dental 1 1,429. 4 Expenses 2 Enter amount from Form 1040, line 38 .... 2 49, 929. 3 Multiply line 2 by 7.5% (.075) ................................. 3 3 , 745. 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0 . ............................ 4 0. Taxes You 5 State and local (check only one box): Paid a Income taxes, or ................... 5 1,606. I 8 b General sales taxes. 6 Real estate taxes (see instructions) ............................ 6 i 7 Personal property taxes ...................................... 7 (See instructions.) 8 Other taxes. List type and amount ? 9 Add lines 5 throu ti 8 . . -. . ...... ..................... 9 1,606. Interest 10 Home mtg interest and points reported to you on Form 1098 ................ 10 You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person's name, identifying number, and address ? ------------------------------ - ------------------------------ --------------- f7,. 4 ---------------- 11 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 Points not reported to you on Form 1098. See instrs for spcl rules ............ 12 Note. Personal 13 Qualified mortgage insurance premiums (see instructions) ....... 13 interest 14 Investment interest. Attach Form 4952 if required. is not deductible. (Seeinstrs.) ................................................... 14 15 Add lines 10 through 14 ....................................... ...... ..................... 15 Gifts to 16 Gifts by cash or check. If you made any gift of $250 or Charity more, see instrs ............................................. 16 6,746. If you made 17 Other than by cash or check. If any gift of $250 or a gift and more, see instructions. You must attach Form 8283 if got a benefit over $500 17 for it, see instructions. 18 Carryover from prior year ..................................... 18 19 Add lines 16 through 18 ....................................... ..... ...................... 19 6,746. Casualty and Theft Losses 20 Casual or theft loss(es). Attach Form 4684. See instructions.) ............................. 20 21 Unreimbursed employee expenses - job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) ? --------------- 21 22 Tax preparation fees .......................................... 22 r (See 23 Other expenses - investment, safe deposit box, etc. List q< instructions.) type and amount ? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 878. Expenses _ Miscellaneous 23 878. ------ ---- - 24 Add lines 21 through 23 ....................................... 24 878. ;. 25 Enter amount from Form 1040, line 38 ..... 25 49,929. 011111111111111 11 26 Multiply line 25 by 2% (.02) ................................... 26 999. 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0... ....................... 27 0. Other 28 Other - from list in the instructions. List type and amount ? Miscellaneous -------------- ,; Deductions ---------------------------- 28 Total 29 Is Form 1040, line 38, over $156,400 (over $78,200 if Itemized married filing separately)? Deductions X? No. Your deduction is not limited. Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40. ? 29 8,352. Yes. Your deduction may be limited. See instructions for the amount to enter. 30 If you elect to itemize deductions even though the are less than our standard deduction check here ? BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIA0301 11/07/07 Schedule A (Form 1040) 2007 • SCHEDULE C (Form 1040) Profit or Loss From Business (Sole Proprietorship) Department of the Treasury ? Partnerships, oint ventures, etc, must file Form 1065 or 1065-B. Internal Revenue Service (99) 'Attach to Form 1040,104NR, or 1041. 'See Instructions for Schedule C (Form 1040). OMB No. 1545-0074 2007 Attachment - Name of proprietor Social security number(SSN) Janet R Ebersole 228-78-5382 A Principal business or profession, including product or service (see instructions) B Enter code from instructions Sales '454390 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), If any Ebersole Enterprises E Business address (including suite or room no.)? 3442 Eagle_Drive City, town or post office, state, and ZIP code ---- ------------------------------------ Chambersbur , PA 17201-7419 F Accounting method: 0) % Cash (2) Accrual (3) Other (specify) ? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ G Did you 'materially participate' in the operation of this business during 2007? If 'No,' see instructions for limit on losses. . X?Yes No 1? H If ou started or acquired this business during 2007, check here .............................................................. Income 1 Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the 'Statutory employee' box on that form was checked, see the instructions and check here ............ 11. El 1 2,314. 2 Returns and allowances ................................................................................ 2 3 Subtract line 2 from line 1 .............................................................................. 3 2,314. 4 Cost of goods sold (from line 42 on page 2) .............................................................. 4 5 Gross profit. Subtract line 4 from line 3 .................................................................. 5 2,314. 6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) ....................................................................................... 6 7 Gross income. Add lines 5 and 6 ...................................................................... ? 7 2,314. Expenses. Enter ex enses for business use of our home only on line 30. 8 Advertising.. . ................. 8 18 Office expense ......................... 18 9 Car and truck expenses 19 Pension and profit-sharing plans 19 _ (see instructions) .............. 9 20 Rent or lease (see instructions): 10 Commissions and fees ......... 10 a Vehicles, machinery, and equipment ..... 20a 11 Contract labor b Other business property ................. 20b (see instructions) .............. 11 21 Repairs and maintenance ............... 21 12 Depletion ..................... 12 22 Supplies (not included in Part III) ........ 22 1,757. 13 Depreciation and section 23 Taxes and licenses ..................... 23 179 expense deduction (not included in Part III) 24 Travel, meals, and entertainment: (see instructions) .............. 13 a Travel ................................. 24a 14 Employee benefit programs b Deductible meals and entertainment (other than on line 19) ......... 14 (see instructions) ....................... 24b ...................... . . . . . . . . . . 15 Insurance (other than health) ... 15 25 Utilities 25 16 Interest: 26 Wages (less employment credits) ........ 26 a Mortgage (paid to banks, etc) ........ 16a 27 Other expenses (from line 48 on b Other ......................... 16b page 2) ................................ 27 17 Legal & professional services ... 17 304. 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns ............. ? 28 2,061. 29 Tentative profit (loss). Subtract line 28 from line 7 ........................................................ 29 253. 30 Expenses for business use of your home. Attach Form 8829 ............................................... 30 31 Net profit or (loss Subtract line 30 from line 29. • If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2 or on Form 1040NR, line 13 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 31 253. • If a loss, you must go to line 32. - 32 If you have a loss, check the box that describes your investment in this activity (see instructions). • If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form All investment is 1040NR, line 13 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 32 a © at risk. Some investment • If you checked 32b, you must attach Form 6198. Your loss may be limited. - 32b n is not at risk. BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule C (Form 1040) 2007 FDIZ0112 06/15/07 • Schedule C (Form 104000) 2007 Janet R Ebersole 228-78-5382 Page 2 33 Method(s) used to value closing inventory: a U Cost b U Lower of cost or market c U Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'Yes,' attach explanation ......................................................................................... Yes ? No 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation ...................................................................................... 35 36 Purchases less cost of items withdrawn for personal use .................................................. 36 37 Cost of labor. Do not include any amounts paid to yourself ................................................. 37 38 Materials and supplies .................................................................................. 38 39 Other costs ............................................................................................ 39 40 Add lines 35 through 39 ................................................................................. 40 41 Inventory at end of year ................................................................................ 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ................ 42 Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) 44 Of the total number of miles you drove your vehicle during 2007, enter the number of miles you used your vehicle for: a Business b Commuting (see instructions) _ _ _ _ _ _ _ _ _ _ _ cOther 45 Do you (or your spouse) have another vehicle available for personal use? ............................................. Yes No 46 Was your vehicle available for personal use during off-duty hours? .................................................... Yes No 47a Do you have evidence to support your deduction? .................................................................... E]Yes No b If 'Yes,' is the evidence written? ............................. n Yes n No Other Exoenses. List below business expenses not included on lines 8-26 or line 30. y Total otherexpenses. Enter here and on page 1, line 27 .................................................. 1 48 Schedule C (Form 1040) 2007 FDIZ0112 06/15/07 SCHEDULE C (Fonn 1040) Department of the Treasury Internal Revenue Service I Profit or Loss From Business (Sole Proprietorship) ? Partnerships, oint ventures, etc, must file Form 1065 or 1065-B. ?Attach to Form 1040,104ONR, or 1041. ?See Instructions for Schedule C (Form 1040). OMB No. 1545.0074 2007 achment 09 wence No. Social security number(SSN) Janet R Enerso.l.e 440-10 _).J04 A Principal business or profession, including product or service (see instructions) B Enter code from instructions Referee '999999 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), if any E Business address (including suite or room no.)" 3442 Eagle-Drive - - - - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City, town or post office, state, and ZIP code - - - - Chambersbur , PA 17201-7419 F Accounting method: (1) Cash (2) Accrual (3) Other (specify) ? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ G Did you 'materially participate' in the operation of this business during 2007? If 'No,' see instructions for limit on losses. XTYes No H If ou started or acquired this business during 2007, check here .............................................................. Income 1 Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the 'Statutory employee' box on that form was checked, see the instructions and check here............ ?El 1 2 Returns and allowances ................................................................................ 2 3 Subtract line 2 from line 1 .............................................................................. 3 4 Cost of goods sold (from line 42 on page 2) .............................................................. 4 5 Gross profit. Subtract line 4 from line 3 .................................................................. 5 6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) ....................................................................................... 6 7 Gross income. Add lines 5 and 6 ................ 1? Enter 8 Advertising .................... 9 Car and truck expenses (see instructions) .............. 10 Commissions and fees ......... 11 Contract labor (see instructions) .............. 12 Depletion ..................... 13 Depreciation and section 179 expense deduction (not included in Part III) (see instructions) .............. 14 Employee benefit programs (other than on line 19) ......... 15 Insurance (other than health) . . 16 Interest: a Mortgage (paid to banks, etc) ........ b Other ......................... 17 Legal & professional services .. . for business use of on line 30. 8 18 Office expense ......................... 18 19 Pension and profit-sharing plans 19 9 712. 20 Rent or lease (see instructions): 10 a Vehicles, machinery, and equipment ..... 20a b Other business property ................. 20b 11 21 Repairs and maintenance ............... 21 12 22 Supplies (not included in Part III) ........ 22 23 Taxes and licenses ..................... 23 13 24 Travel, meals, and entertainment: a Travel ................................. 24a 14 b Deductible meals and entertainment (see instructions) ....................... 24b 15 25 Utilities ................................ 25 26 Wages (less employment credits) ........ 26 16a enses (from line 48 on 27 Other ex 16b p page 2) ................................ 27 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns ............. 29 Tentative profit (loss). Subtract line 28 from line 7 ........................................................ 29 30 Expenses for business use of your home. Attach Form 8829 ............................................... 30 31 Net profit or (loss). Subtract line 30 from line 29. • If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2 or on Form 1040NR, line 13 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 31 • If a loss, you must go to line 32. - 32 If you have a loss, check the box that describes your investment in this activity (see instructions). 1,123. 1,123. 1,123. 1,123. 752. 371. 71. • If yyou checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form All investment is 1040NR, line 13 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 32 a © at risk. Some investment e If you checked 32b, you must attach Form 6198. Your loss may be limited. - 32b n is not at risk. BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule C (Form 1040) 2007 FDIZ0112 06/15/07 ' Schedule C Form 1040 2007 Janet R Ebersole 228 2 -78-5382 Page Cost of Goods Sold see instructions 33 34 35 Method(s) used to value closing inventory: a Cost b Lower of cost or market c Other (attach Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'Yes,' attach explanation ............................................................................... Inventory at beginning of year. If different from last year's closing inventory, .................................................................................... attach explanation expla ..... 35 nation) ..... ? Yes ? No 36 .. Purchases less cost of items withdrawn for personal use .................................................. 36 37 Cost of labor. Do not include any amounts paid to yourself ................................................. 37 38 Materials and supplies .................................................................................. 38 39 Other costs ............................................................................................ 39 40 Add lines 35 through 39 ................................................................................. 40 41 Inventory at end of year ................................................................................ 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ................ 42 Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) ? 01 /01/2006- -_ 44 Of the total number of miles you drove your vehicle during 2007, enter the number of miles you used your vehicle for: a Business 1,468 b Commuting (see instructions) _ _ _ _ _ _ _ _ _ _ _ cOther 0 45 Do you (or your spouse) have another vehicle available for personal use? ............................................. ? Yes X? No 46 Was your vehicle available for personal use during off-duty hours? .................................................... X? Yes ? No 47a Do you have evidence to support your deduction? .................................................................... X? Yes E] No bIf'Yes,'is the evidence written? .................................................................................... X Yes No Other Exoenses. List below business expenses not included on lines 8-26 or line 30. 48 Total other expenses. Enter here and on page 1, line 27 .......................................... Schedule C (Form 1040) 2007 FD1z0112 06/15/07 'SCHEDULE SE (Form 1040) Department of the Treasury Infernal Revenue Service Self-Employment Tax ? Attach to Form 1040. ? See Instructions for Schedule SE (Form 1040). Yes Name of person with self-employment income (as shown on Form 1040) Social security number of person Janet R Ebersole with self-employment income ? 228_78_5382 Who Must File Schedule SE You must file Schedule SE if: • You had net earnings from self-employment from other than church employee income (line 4 of Short Schedule SE or line 4c of Long Schedule SE) of $400 or more, or • You had church employee income of $108.28 or more. Income from services you performed as a minister or a member of a religious order is not church employee income (see instructions). Note. Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use either 'optional method' in Part 11 of Long Schedule SE (see instructions). Exception. If your only self-employment income was from earnings as a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not file Schedule SE. Instead, write 'Exempt - Form 4361' on Form 1040, line 58. May I Use Short Schedule SE or Must I Use Long Schedule SE? Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE, above. Did you receive wages or tips in 2007? 1 No Are you a minister, member of a religious order, or Yes Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-emDlovment tax on other earnings? No Are you using one of the optional methods to figure your Yes net earnings (see instructions)? ?No Did you receive church employee income reported on Yes Form W-2 of $108.28 or more? No I You may use Short Schedule SE below I Was the total of your wages and tips subject to social security or railroad retirement tax plus your net earnings from self-employment more than $97,500? No 2007 Whment 7 wence No. Did you receive tips subject to social security or Medicare Yes tax that you did not report to your employer. No Did you report any wages on Form 8919, Uncollected Yes Social Security and Medicare Tax on Wages? I You must use Long Schedule SE on page 2 1 Section A - Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. 1 Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A ......................................................................................... 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code A. Ministers and members of religious orders, see instructions for amounts to report on this line. See instructions for other income to report ......... 3 Combine lines 1 and 2 .................................................................................. 4 Net earnings from self-employment. Multiply line 3 by 92.35% (.9235). If less than $400, do not file this schedule; you do not owe self-employment tax ..................................................... ? 5 Self-employment tax. If the amount on line 4 is: • $97,500 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 58. • More than $97,500, multiply line 4 by 2.9% (.029). Then, add $12,090 to the result. Enter the total here and on Form 1040, line 58. _ 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.5). Enter the result here and on Form 1040, line 27 ...............................I 6 BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. OMB No. 1545.0074 624. 624. 576. Schedule SE (Form 1040) 2007 FDIA1101 11/02/07 Form W-2 Wage and Tax Statement q This information is being furnished to the Internal Revenue Service i j a Control number Safe, accurate, Visit the IRS website OMS No. 1545-0008 FAST! Use at www.irs.govleftle. b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld 25-1254833 23938.86 2981.08 c Employer's name, address, and ZIP code 3 Social security wages 4 Social security tax withheld CUMBERLAND VALLEY CHRISTIAN SCHOOL 24238.90 1502.76 600 MILLER STREET 5 Medicare wages and tips 6 Medicare tax withheld CHAMBERSBURG, PA 17201 24238.90 351.48 7 Social security tips 8 Allocated tips d Employee's social security number 9 Advance EIC payment 10 Dependent care benefits 228-78-5382 e Employee's name, address, and ZIP code 11 Nonqualified plans 12a See instructions for box 12 d E 300.04 JANET R EBERSOLE 13 statutory Retirement Third-parry employee plan sick pay 12b c 3 4 4 2 EAGLE DR 7 201 CHAMBERSBURG, PA 1 14 Other 12c OPT 10 00 d . 12d c d 15 state Employer's state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name PA 24238. 9- 744 08 24238 ---- ----- - 300. 43 ---------------------- CHBG ------- -- ----- ------ ---------- - - - ------------ -- - Wage and Tax Department of the Treasury-Inte Revenue Service Form *2 Statement 2005 ??•y ° /77 Copy B-To Be Filed With Employee's FEDERAL Tax Return. This information is being furnished to the Intemal Revenue Service. FORM LW2B CORRIrM (if eheetmd) Pa?ees Name, Street Address. City, State and ZIP Code 1 Grow Dbirlbutian $ 997.56 Commonwealth of Pennsylvania L Taxable Amount Public School Employees' Retirement System $ 997.56 PO Box 125 Harrisburg, PA 17108-0125 2b Total Distribution Payer's Federal ID number Recipient's ID number 3 Amount ai Box 2i eligible for capital gain election 23-1739115 228-78-5382 Recipient's Name (first, middle, last), Street Address, City, State and ZIP Code JANET R EBERSOLE 3442 EAGLE DR CHAMBERSBURG PA 17201-7419 Form 10"-R OMB NO. 1545-0119 2005 Statements for Recipients of 4 Federal Income Tax Wit $ 0.00 5 Recovered This Year Distribution From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. COPY B 7 Dist. Code 19a Your Total Di: 9b Total Employee Contributions 14 Medical Premium DepwtnzW of the Troamuy - xaterml Revenue Service C0KRMLMW pf d w&*d) Payer's Name, Street Address, City, State and ZIP Code 1 Grow Distribution 997.56 Commonwealth of Pennsylvania Amount 2a Taxable Amaxxtat Public School Employees' Retirement System $ 997.56 PO Box 125 _ Harrisburg, PA 17108-0125 2b Total Distribution CD Payer's Federal ID number I Recipient's ID number 3 Amount in Box 2a eligible for capital gain election 23-1739115 228-78-5882 Recipie» is Name (first, middle, last), Street Address, City, State and ZIP Code JANET R EBERSOLE 3442 EAGLE DR CHAMBERSBURG'G PA 17201-7419 _._,. Form 10",R, OMB NO. 1545-0119 2005 Statements for Recipients of Distribution From Pensions, Annuities, Retirement or profit-sharing Plans, IRAs, Insurance Contracts, etc- I Federal Income Tax wit! $ 0.00 5 l ecovered This Year Report this income on your Federal Tax return. If this form shows Federal Income Tax withheld in Box 4, attach this copy to your return. This information is being 5unished to the internal Revenue Service. COPY C For recipients c`.vr .man. 7 Dist. 2 Code 9a Your Total Dist 9b Total Employee Contributions This information is being furnished to the Internal Revenue - Service. Dew of the Tra muy - roteamd Rev== Service To comply with IRS regulations, the Public School Employees' Retirement System (PSERS) is required to produce separate 1099-R's for each payment type. If you received multiple payment types (example: monthly benefits, partial lump sum withdrawal, death benefits, direct rollovers, etc.), you will receive multiple 1099-R's. Please refer to the number at the bottom of this page which will inform you of the number of 1099-R's you will receive. (Example: 1 of 3 means this is the first of three 1099-R's) I Be sure to include all of your 1099-R's when filing your Federal income tax return. I Iiiill Iil? Nlll III VIII IIIII 1iNl Nhl 1? ICI X11 III III 1111111111 Ilil illl *0153821295* 61119-6-2294-2121 1 of 1 YR496AZ i e Department of the Treasury - Internal Revenue Service 2005 Form 1040 U.S. Individual Income Tax Return For the year Jan 1 - Dec 31, 2005, or other tax year beginning 2005, endi Label Your first name MI Last name (See instructions.) TIMOTHY M EBERSOLE If a joint return, spouse's first name MI Last name Use the IRS label. JANET R EBERSOLE Otherwise, Home address (number and street). If you have a P.O. box, see instructions. please print or type. 71 DILLER DRIVE City, town or post office. If you have a foreign address, see instructions (99) IRS Use Only - Do not write or staple in this space 20 OMB No. 1545-0074 Your social security number 179-54-2597 Spouse's social security number 228-78-5382 Apartment no. You must enter your social security State ZIP code number(s) above. 1 Checking a box below will not Presidential SHIPPENSBURG PA 17257-9709 change your tax or refund. Election Campaign , Check here if you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions) ................ YOU Spouse Filing Status 9 1 Single 4 U Head of household (with qualifying person). (See hild f lif i i 2 X Married filing jointly (even if only one had income) ng person s a c the qua Instructions.) I y but not your dependent, enter this child's Check only 3 Married filing separately. Enter spouse's SSN above & full name here. 01, one box. name here .. 01 5 n Qualifying widow(er) with dependent child (see instructions) Exemptions -? Boxes chocked 2 If more than four dependents, see instructions. 6a box 6a ........ oxen Yourself. If someone can claim ou as a dependent, do not check on 6a and 6 y b X .................................. _ ........ No. of child S Ouse ...................... (2) Dependent's (3) Dependent's (4) if on 6c who: c Dependents: social security relationship qualifying 0 lived number to you child for child with you . . tax credit • did not (1) First name Last name (see instrs) livewitnyor HEATHER D EBERSOLE 197-64-8484 Daughter drseparvor or searatio JOSHUA T EBERSOLE 164-68-4426 Son pen nt de ( Dependents on 6c not entered abo b ren n Add number 2 :e e. s d Total number of exemptions claimed ...................................... above ?.... 0- 4' 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ........................................ 7 91, 998. Income 8a Taxable interest. Attach Schedule B if required ......................................... 8a 34. b Tax-exempt interest. Do not include on line 8a .............. I 8bl Attach form(s) 9a Ordinary dividends. Attach Schedule B if required .......................................) 9al 25. W-2 here: Also b Qualfd divs I 9b? 25 . attach Forms (see instrs) ................... Forms 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ...................... 10 R W-2G and 1099 if tax was withheld. 11 Alimony received .................................................................... 11 12 Business income or (loss). Attach Schedule C or C-EZ .................................. 12 6,798. If you did not 2 13 Capital gain or (loss). Att Sch D if regd. If not regd, ck here .......................... 01 11 t W 13 -16. ge a - , see instructions. 14 Other gains or (losses). Attach Form 4797 ............................................. 14 15a IRA distributions ........... 15a b Taxable amount (see instrs) .. 15b 16a Pensions and annuities .... 16a b Taxable amount (see instrs) .. 16b 998. 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .. 17 but do 18 Farm income or (loss). Attach Schedule F .............................................. Enclose 18 , not attach, any 19 Unemployment compensation ......................................................... 19 payment Also, lease use 20 a Social security benefits ......... 120a l I b Taxable amount (see instrs) .. 20b p Form 10404 21 Other income -------- 21 ------------------------------ 22 Add the amounts in the far right column for lines 7 through 21. This is our total income. 22 99,837. 23 Educator expenses (see instructions) ....................... 23 226. Adjusted 24 Certain business expenses of reservists, performing artists, and fee-basis Gross government officials. Attach Form 2106 or 2106-EZ .................... 24 Income 25 Health savings account deduction. Attach Form 8889 ........ 25 26 Moving expenses. Attach Form 3903 ....................... 26 27 One-half of self-employment tax. Attach Schedule SE ........ 27 4 8 0 2 ?h 28 Self-employed SEP, SIMPLE, and qualified plans ............ 28 (jam t 29 Self-employed health insurance deduction (see instructions) ............. 29 ? 30 Penalty on early withdrawal of savings ..................... 30 31 a Alimony paid b Recipient's SSN .... 31 a 32 IRA deduction (see instructions) ............... 32 33 Student loan interest deduction (see instructions)............ 33 34 Tuition and fees deduction (see instructions) ................ 34 2, 490. I 35 Domestic production activities deduction. Attach Form 8903 .............. 35 36 Add lines 23 - 3] a and 32 - 35 ................................... ..... ...................... 36 3,196. 37 Subtract line 36 from line 22. This is your adjusted gross inco me .. ................... - 137 96, 641. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0112 11/07/05 Form 1040 (2005) 2 Form 1040 (2005 TIMOTHY M & JANET R EBERSOLE 179-54-2597 Page Tax and 38 Amount from line 37 (adjusted gross income) ...................................... 38 96,641. Credits 39a Check _? e You were born before January 2, 1941, 8 Blind. Total boxes if. Spouse was born before January 2, 1941, Blind. checked 39a... Standard b If your spouse itemizes on a separate return, or you were a dual-status Deduction alien, see instructions and check here ...................................... 39b . for - - • People who 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) ..................... 40 20,447. checked any box 41 Subtract line 40 from line 38 .......................................................... 41 76,194. on line 39a or 42 If line 38 is over $109,475, or you provided housing to a person displaced by Hurricane Katrina, see 39b or who can be claimed as a instructions. Otherwise, multiply $3,200 by the total number of exemptions claimed on line 6d ................ 42 12,800. dependent, see 43 Taxable income. Subtract line 42 from line 41. instructions. If line 42 is more than line 41, enter -0 ........................................................ 43 63,394. 44 Tax (see instrs). Check if any tax is from: a n Form(s) 8814 b F] Form 4972 ........................ 44 9,174. • All others: 45 Alternative minimum tax (see instructions). Attach Form 6251 ........................... 45 Single or Married 46 Add lines 44 and 45 ................................................................ ? 46 9,174. filing separately, $5,000 47 Foreign tax credit. Attach Form 1116 if required ............. 47 ' 48 Credit for child and dependent care expenses. Attach Form 2441 .......... 48 Married filing jointly or 49 Credit for the elderly or the disabled. Attach Schedule R ..... 49 Qualifying 50 Education credits. Attach Form 8863 ....................... 50 7 7 7 . widow(er), $10,000 51 Retirement savings contributions credit. Attach Form 8880 ... 51 52 Child tax credit (see instructions). Attach Form 8901 if required ........... 52 Head of household 53 Adoption credit. Attach Form 8839 ......................... 53 , ' $7,300 54 Credits from: a F] Form 8396 b F] Form 8859 ................. 54 55 Other credits. Check applicable box(es): a ? Form 3800 b [] Form c Form 55 8801 56 Add lines 47 through 55. These are your total credits ....................... 56 777. 57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0- .................. 01 57 8,397. 58 Self-employment tax. Attach Schedule SE ...................................................... 58 960. Other 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 .................. 59 Taxes 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ................... 60 61 Advance earned income credit payments from Form(s) W-2 ............................. 61 62 Household employment taxes. Attach Schedule H ....................................... 62 63 Add lines 57-62. This is your total tax ...................................................... ? 63 9,357. Payments 64 Federal income tax withheld from Forms W-2 and 1099 ...... 64 11, 079. If you have a 65 2005 estimated tax payments and amount applied from 2004 return ........ 65 qualifying 66a Earned income credit (EIC) . . . ........................ 66a child, attach pay ?I I ) ...... . Schedule EIC. F b Nontaxable combat a election ..... 66b 67 Excess social security and tier 1 RRTA tax withheld (see instructions 67 68 Additional child tax credit. Attach Form 8812 ................ 68 69 Amount paid with request for extension to file (see instructions) .......... 69 70 Payments from: a [ ] Form 2439 b n Form 4136 c n Form 8885 70 71 Add lines 64, 65, 66a, and 67 through 70. These are your total payments ............................................................ 71 11,079. Refund 72 If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid ................ 72 1,722. Direct deposit? 73a Amount of line 72 you want refunded to you ......................................... 1- 73a 1, 722. See instructions ? b Routing number ........ XXXXXXXXX I ? c Type: n Checking Savings and fill in 73b, ? d Account number ....... XXXXXXXXXXXXXXXXX 73c, and 73d. 74 Amount of line 72 you want applied to your 2006 estimated tax ........ 74 Amount 75 Amount you owe. Subtract line 71 from line 63. For details on how to pay, see instructions ............... 75 You Owe 76 Estimated tax penalty (see instructions) .................... 176 Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? _77-T . Yes. Complete the following. No Designee's Phone Personal identification Designee name ? Pre parer no. ? number (PIN) ? Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return? See instructions. ADMINISTRATOR Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation i{ ; F{ R t r for your records. TEACHER:' Date Preparer's SSN or PTIN Preparer's IP00026119 Paid signature / ROBERT N BOWMAN 03/17/2006 Check if self-employed X Lti Preparer's Firm's name ROBERT N BOWMAN Use Only selfYemplofe 136 MAPLE STREET EIN 23-2188089 zPcodeand MANCHESTER PA 17345 Phoneno. (717) 266-1569 Form 1040 (2005) FDIA0112 11/07/05 *SCHEDULE A (Form 1040) Department of the Treasury Internal Revenue Service (99) Itemized Deductions ? Attach to Form 1040. ? See Instructions for Schedule A (Form 1040). Name(s) shown on Form 1040 Your social security number TIMOTHY M & JANET R EBERSOLE 179-54-2597 Medical Caution. Do not include expenses reimbursed or paid by others. and 1 Medical and dental expenses (see instructions) ............. . Dental Expenses 2 Enter amount from Form 1040, line 38 ..... 1 2 1 3 Multiply line 2 by 7.5% (.075) .................... 3 I 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0 . ........................ . ... 4 OMB No. 1545-0074 2005 achment 07 auence No. o estate anu iocai kcnvuvt vnry Inc livxz. _ a X8 Income taxes, or {- ............ 5 4, 3 41. % Taxes You b General sales taxes (see instructions) _ Paid 6 Real estate taxes (see instructions) ............................ 6 2,716.1 (See 7 Personal property taxes ...................................... 7 instructions.) 8 Other taxes. List type and amount ? ------------------------------- 9 Add lines 5 through 8 ....................................................... 9 7,057. Interest 10 Home mtg interest and points reported to you on Form 1098 10 9 964 . You Paid 11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person's name, identifying number, and address ? (See instructions.) ------------------------------- ------------------------------- --------------- Note. ------------------------------- ............ 12 Personal 12 Points not reported to you on Form 1098. See instrs for spcl rules interest is not 13 Investment interest. Attach Form 4952 if required. deductible. (Seeinstrs.) ................................................... 13 1A Aririlinoc in thrminh 13 .. ...................................................... 14 9,964. Gifts to 15a Total gifts by cash or check. If you made any gift of $250 or Charity more, see instrs ............................................. 15a 3, 426. b Gifts by cash or check after August 27, 2005, If you made that you elect to treat as qualified J a gift and contributions (see instructions) ........... II gt a benefit 16 Other than by cash or check. If any gift of $250 or for it, see more, see instructions. You must attach Form 8283 if instructions. over $500 ...... ......... ............. ....................... ) 16 17 Carryover from prior year ..................................... 17 18 Add lines 15a, 16, & 17 ....................................... ................ ........... 18 3,426. Casualty and Theft Losses 19 Casualty or theft loss(es). Attach Form 4684. See instructions.) .. ................ ........... 19 Job Expenses 20 Unreimbursed employee expenses - job travel, union dues, and Certain job education, etc. Attach Form 2106 or 2106-E7 if Miscellaneous required. (See instructions.) ? Deductions --------------- ------------------------------- 20 21 ------------------------------- Tax preparation fees .......................................... 21 (See 22 Other expenses - investment, safe deposit box, etc. List instructions.) type and amount ? Miscellaneous Expenses 53_ 22 53. 23 Add lines 20 through 22 .................. ...... 23 53. 24 Enter amount from Form 1040, line 38 ..... 1 24 1 96, 641. 25 Multiply line 24 b 2/0 02 ............ 25 1,933. 26 Subtract line 25 from line 23. If line 25 is more than line 23, enter -0.............. ........... 26 0. Other 27 Other - from list in the instructions. List type and amount ? Miscellaneous -------- ------ Deductions ------------------------------- 27 Total 28 Is Form 1040, line 38, over $145,950 (over $72,975 if MFS)? Itemized Deductions X? No. Your deduction is not limited. Add the amounts in the far right column enter this amount on Form 1040, line 40. for lines 4 through 27. Also ? 28 28 20,447. ^` i n " 29 If you elect to itemize deductions even though they are less than your standard deduction, check here ? n °'i BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. FDIA0301 11/18105 Schedule A (Form 1040) 2005 -SCHEDULE C (Form 1040) Department of the Treasury Internal Revenue Service Profit or Loss From Business (Sole Proprietorship) Partnerships, joint ventures, 1, See etc, Istrmust uctiols for Schedule C(Form 1040 Attach to Form 1040 or 1041. ). OMB No. 1545-0074 2005 achment 09 iuence No. Name of proprietor Social security number (SSN) JANET R EBERSOLE 228-78-5382 A Principal business or profession, including product or service (see instructions) B Enter code from instructions SALES ?454390 C Business name. If no separate business name, leave blank. D Employer ID number (EIN), If any E Business address (including suite or room no.)"' 71 DILLER DRIVE - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City, town or post office, state, and ZIP code - - - - - - - - - - - - - - - SHIPPENSBURG PA 17257-9709 F Accounting method: (1) X Cash (2) Accrual (3) Other (specify) ? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ G Did you 'materially participate' in the operation of this business during 2005? If 'No,' see instructions for limit on losses . XTYes No H If you started or acquired this business during 2005, check here .............................................................. Z tl, '' Income 1 Gross receipts or sales. Caution. If this income was reported to you on Form W-2 and the 'Statutory employee' box on that form was checked, see the instructions and check here ............ t.? 1 11,333. 2 Returns and allowances ................................................................................ 2 3 Subtract line 2 from line 1 .............................................................................. 3 11,333. 4 Cost of goods sold (from line 42 on page 2) .............................................................. 4 9,952. 5 Gross profit. Subtract line 4 from line 3 .................................................................. 5 1,381. 6 Other income, including Federal and state gasoline or fuel tax credit or refund .............................. 6 7 Gross income. Add lines 5 and 6 ...................................................................... b- 7 1,381. Rart,11 Expenses. Enter expenses for business use of our home only on line 30. 8 Advertising .................... 8 18 Office expense ......................... 18 9 Car and truck expenses 19 Pension and profit-sharing plans 19 (see instructions) .............. 9 42. 20 Rent or lease (see instructions): 10 Commissions and fees ......... 10 a Vehicles, machinery, and equipment ..... 20a 11 Contract labor b Other business property ................. 20b (see instructions) .............. 11 21 Repairs and maintenance ............... 21 12 Depletion ..................... 12 22 Supplies (not included in Part III) ........ 22 30. 13 Depreciation and section 23 Taxes and licenses ..................... 23 179 expense deduction 24 Travel, meals, and entertainment: (not included in Part III) (see instructions) .............. 13 27. a Travel ................................. 24a 14 Employee benefit programs (other than on line 19) ......... 14 b Deductible meals and entertainment ..... 24b 15 Insurance (other than health) ... 15 25 Utilities ................................ 25 16 Interest: 26 Wages (less employment credits) ........ 26 a Mortgage (paid to banks, etc) ........ 16a 27 Other expenses (from line 48 on page 2) ......... 27 300. b Other ........................ 16b A 17 Legal & professional services ... 17 75.1 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns ............. 0' 28 474. 29 Tentative profit (loss). Subtract line 28 from line 7 ........................................................ 29 907. 30 Expenses for business use of your home. Attach Form 8829 ............................................... 30 31 Net profit or (loss). Subtract line 30 from line 29. • If a profit, enter on Form 1040, line 12, and also on Schedule SE, line 2 (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 31 907. • If a loss, you must go to line 32. - 32 If you have a loss, check the box that describes your investment in this activity (see instructions). • If you checked 32a, enter the loss on Form 1040, line 12, and also on Schedule SE, line 2 All investment is (statutory employees, see instructions). Estates and trusts, enter on Form 1041, line 3. 32 a at risk. Some investment • If you checked 32b, you must attach Form 6198. Your loss may be limited. - 32b n is not at risk. BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule C (Form 1040) 2005 FDIZ0112 11114/05 Schedule C 33 Method(s) used to value closing inventory: a U Cost b U Lower of cost or market c L_j utner rattacn expianation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If 'Yes,' attach explanation ......................................................................................... ? Yes No 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation ...................................................................................... 35 36 Purchases less cost of items withdrawn for personal use .................................................. 36 9,952. 37 Cost of labor. Do not include any amounts paid to yourself ................................................. 37 38 Materials and supplies .................................................................................. 38 39 Other costs ............................................................................................ 39 40 Add lines 35 through 39 ................................................................................. 40 9,952. 41 Inventory at end of year ................................................................................ 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ................ 42 9,952. P?rt:YV"! Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month, day, year) - 44 Of the total number of miles you drove your vehicle during 2005, enter the number of miles you used your vehicle for: a Business b Commuting cOther 45 Do you (or your spouse) have another vehicle available for personal use? ............................................. ? Yes No 46 Was your vehicle available for personal use during off-duty hours? .................................................... E]Yes No 47a Do you have evidence to support your deduction? .................................................................... ? Yes No b If 'Yes,' is the evidence written? .................................................................................... I I Yes I I No :1art?.V Other Expenses. List below business expenses not included on lines 8.26 or line 30. INTERNET 49% 71. CELLPHONE 30 % 189• ---------------------------------------------------------- MEMBERSHIP 40. ---------------------------------------------------------- ---------------------------------------------------------- ---------------------------------------------------------- ---------------------------------------------------------- ---------------------------------------------------------- 48 Total other expenses. Enter here and on page 1, line 27 .................................................. 48 300. Schedule C (Form 1040) 2005 FDIZ0112 11/14105 -SCHEDULE D (Form 1040) Department of the Treasury Internal Revenue Service Capital Gains and Losses ? Attach to Form 1040. ? See Instructions for Schedule D (Form 1040). ? Use Schedule D-1 to list additional transactions for lines 1 and 8. Name(s) shown on Form 1040 TTMr)TNY M S JANET R EBERSOLE OMB No. 1545.0074 2005 Attachment 2 Sequence No. Your social security number 179-54-2597 Part 1 I Short-Term Capital Gains and Losses - Assets Held One Year or Less (a) Description of property (Example: 100 shares XYZ Co) (b) Date acquired (Mo, day, yr) (C) Date sold (Mo, day, yr) (d) Sales price (see instructions) (e) Cost or other basis (see instructions) (f) Gain or (loss) Subtract (e) from (d) 1 2 Enter your short-term totals, if any, from Schedule D-1, line 2 .... 2 3 Total short-term sales price amounts. Add lines 1 and 2 in ............................................... column (d) 3 _ ... 4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 ............. 4 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 .... 5 -42. 6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your Capital Loss Carryover Worksheet in the instructions ........................................................................... 6 7 Net short-term caaital qain or (loss). Combine lines 1 through 6 in column (f) ............................... 7 -42. Part 111 I Long-Term Capital Gains and Losses - Assets Held More Than One Year (a) Description of property (Example: 100 shares XYZ Co) (b) Date acquired (Mo, day, yr) (C) Date sold (Mo, day, yr) (d) Sales price (see instructions) (e) Cost or other basis (see instructions) (f) Gain or (loss) Subtract (e) from (d) 8 9 Enter your long-term totals, if any, from Schedule D-1, line 9 ... 9 10 Total long-term sales price amounts. Add lines 8 and 9 in column (d) ................................................... 10 11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from and 8824 ............................................................................ Forms 4684 6781 11 12 , , Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 ...... 12 26. 13 Capital gain distributions. See instrs ............................................................................ 13 14 Long-term capital loss carryover. Enter the amount, if any, from line 13 of your Capital Loss Carryover Worksheet in the instructions ........................................................................... 14 15 Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to Part III on page 2 ................................................................................................. 15 26. BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule D (Form IU4U)ZUUS FDIA0612 05/18/05 Schedule D (Form 1040) 2005 TIMOTHY M & JANET R EBERSOLE 179-54-2597 Page 2 Part III Summary 16 Combine lines 7 and 15 and enter the result. If line 16 is a loss, skip lines 17 through 20, and go to line 21. If a gain, enter the gain on Form 1040, line 13, and then go to line 17 below ................................ 17 Are lines 15 and 16 both gains? Yes. Go to line 18. ? No. Skip lines 18 through 21, and go to line 22. 18 19 -16. Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet in the instructions .................. "I 18 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet in the instructions ...................................................................................... b-1 19 20 Are lines 18 and 19 both zero or blank? Yes. Complete Form 1040 through line 43, and then complete the Qualified Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040. Do not complete lines 21 and 22 below. 0 No. Complete Form 1040 through line 43, and then complete the Schedule D Tax Worksheet in the Instructions. Do not complete lines 21 and 22 below. 21 If line 16 is a loss, enter here and on Form 1040, line 13, the smaller of: • The loss on line 16 or • ($3,000), or if married filing separately, ($1,500) _ Note. When figuring which amount is smaller, treat both amounts as positive numbers. 22 Do you have qualified dividends on Form 1040, line 9b? XD Yes. Complete Form 1040 through line 43, and then complete the Qualified Dividends and Capital Gain. Tax Worksheet in the Instructions for Form 1040. No. Complete the rest of Form 1040. Schedule D (Form 1040) 2005 FDIA0612 05/18/05 'Schedule E (Form 1040) 2005 Name(s) shown on return. Do not enter name and social security number if shown on Page 1. Your social security number 2 TIMOTHY M & JANET R EBERSOLE 1179-54-2597 Caution: The IRS compares amounts reported on our tax return with amounts shown on Schedules K-1. Part 11 1 Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See instructions. 27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursed partnership expenses? ..... 11 Yes R]No li . eA 'Va nctrnrfinnc hafnra rmmnlafinn fhic sartinn- 28 (a) Name (b) Enter P for partnership; S for S corporation (c) Check if foreign partnership (d) Employer identification number (e) Check if any amount is not at risk A WEDNESDAY CLUB P 23-2299791 B C D Passive Income and Loss N o passi ve Income and Loss (f) Passive loss allowed (attach Form 8582 if required) (g) Passive income from Schedule K-1 (h) Nonpassive loss from Schedule K-1 (i) Section 179 efrom Fo m 4562n a) Nonpassive Schedule K 1 A B C D 29a Totals ............... b Totals ...............? - -- 30 Add columns (g) and 0) of line 29a .......... .......................................... .................. 30 31 Add columns (f), (h), and (i) of line 29b ...... .......................................... .................. 31 32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the result here and include in the total online 41 below ...................................................................... 32 gort IICr Income or Loss From Estates and Trusts 33 (a) Name (b) Employer ID no. A B Passive Income and Loss Non passive Income and Loss (c) Passive deduction or loss allowed (attach Form 8582 if required) (d) Passive income from Schedule K-1 (e) Deduction or loss from Schedule K-1 (f) Other income from Schedule K-1 A B - 34a Totals .................................. .. l - b Totals ..................................... 35 Add columns (d) and (f) of line 34a ...................................................... ................ 35 36 Add columns (c) and (e) of line 34b ...................................................... ................ 36 37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and include in the total on line 41 below ....................................... ................ 37 ParTW "I Ine-nma nr I ncc Frnm Rpal Fctatp Mnrfnanp lnvestmpnt Cnnduits ItREMICM - Residual Holder 38 (a) Name (b) Employer identification number Excess inclusion from Schedules Q, line 2c (see instructions) (d) Taxable income (net loss) from Schedules Q, line 1 b (e) Income from Schedules Q, line 3b 39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below ............. 39 FAUM MI I Summa 40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below .................. ........... 40 41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17 .......................................................................... ....... ' 41 42 Reconciliation of farming and fishing income. Enter your gross farming and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065), ; box 14, code B; Schedule K-1 (Form 1120S), box 17, code N; and Schedule K-1 Y (Form 1041), line 14, code F (see instructions) ............................... 42 x: „r , .:,.. L , •.. 43 Reconciliation for real estate professionals. If you were a real estate professional (see instructions), enter the net income or (loss) you reported anywhere on Form 1040 from all rental real estate activities in which you materially participated under the passive activity loss rules ..................... 43 BAA FDIZ2302 11/14105 Schedule E (Form 1040) 2005 Attachment Sequence No. 13 SCHEDULE SE (Form 1040) Self-Employment Tax IInterr ail Revenue Serviceury (99) I ? Attach to Form 1040. ? See Instructions for Schedule SE (Form 1040). Name of person with self-employment income (as shown on Form 1040) Social security number of person JANET R FRERSOLE with self-employment income Who Must File Schedule SE You must file Schedule SE if: Yes • You had net earnings from self-employment from other than church employee income (line 4 of Short Schedule SE or line 4c of Long Schedule SE) of $400 or more, or • You had church employee income of $108.28 or more. Income from services you performed as a minister or a member of a religious order is not church employee income (see instructions). Note. Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use either 'optional method' in Part II of Long Schedule SE (see instructions). Exception. If your only self-employment income was from earnings as a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not file Schedule SE. Instead, write 'Exempt - Form 4361' on Form 1040, line 58. May I Use Short Schedule SE or Must I Use Long Schedule SE? Did You Receive Wages or Tips in 2005? No Are you a minister, member of a religious order, or Yes Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? No Are you using one of the optional methods to figure your Yes net earnings (see instructions)? No Did you receive church employee income reported on Yes Form W-2 of $108.28 or more? No I You Mav Use Short Schedule SE Below I Was the total of your wages and tips subject to social Yes security or railroad retirement tax plus your net earnings from self-employment more than $90,000? No 2005 achment 7 auence No. 228-78-5382 Did you receive tips subject to social security or Medicare Yes tax that you did not report to your employer? You Must Use Long Schedule SE Section A - Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE. 1 Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A ......................................................................................... 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9. Ministers and members of religious orders, see instructions for amounts to report on this line. See instructions for other income to report ................ 3 Combine lines 1 and 2 .................................................................................. 4 Net earnings from self-employment. Multiply line 3 by 92.35% (.9235). If less than $400, do not file ..................................................... this schedule; you do not owe self-employment tax 5 Self-employment tax. If the amount on line 4 is: _ • $90,000 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 58. • More than $90,000, multiply line 4 by 2.9% (.029). Then, add $11,160.00 to the result. Enter the total here and on Form 1040, line 58. _ 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.5). Fn+ar +ha racy iI+ harp nnr+ nn Fnrm 1 ndn_ line 27 ......... ............ I 6 BAA For Paperwork Reduction Act Notice, see Form 1040 instructions. OMB No. 1545-0074 907. 907. 838. 128. T 4 Schedule SE (Form 1040) 2005 FDIA1101 11/08/05 Form8863 (Rev January 2006) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return TIMOTHY M & J_ Education Credits (Hope and Lifetime Learning Credits) ? See instructions. ? Attach to Form 1040 or Form 1040A. R EBERSOLE OMB No. 1545.0074 2005 achment 50 auence No. Your social security number 179-54-2597 Caution: You cannot take both an education credit and the tuition and fees deduction (Form 1040, line 34, or Form 7040A, line 19) for the same student in the same year. B a r u,...,. /?..e.a:+ r•.....:..... v,,., --f nLec the Pnnc rrarlit fnr mnre than 2 tax vears for the same student 1 (a) Student's name (as shown on page 1 of your tax return) First name - - - - - - - - - - Last t name name (b) Student's social security number (as shown on page 1 of your tax return) (c) Qualified expenses (see instructions). Do not enter more than $2,000" for each student. (d) Enter the smaller of the amount in column (c) or $1,000- (e) Add column (c) and column (d) (f) Enter one-half of the amount in column (e) T J OS H U A _ __________ _ _ _ _ _ EBERSOLE 164-68-4426 2,000. 1,000. 3,000. 1,500. ---------------- ---------------- *For each student who attended an eligible educational institution in the Gulf Opportunity Zone, do not enter more than $4,000. **For each student who attended an eligible educational institution in the Gulf Opportunity Zone, enter the smaller of the amount in column (c) or $2,000. 2 Tentative Hope credit. Add the amounts on line 1, column (f). If you are taking the lifetime learnina credit for another student, go to Part II; otherwise, go to Part III ......................... 1- 2 1,500. Pa'rf III. Lifetime Learning Credit (a) Student's name (as shown on page 1 3 (b) Student's social (c) Qualified Caution: You of your tax return) security number (as expenses cannot take the shown on page 1 of (see instructions) Hope credit and First name Last name your tax return) the lifetime learning credit for the same student in the same year. and enter the total ................................................. column (c) 4 Add the amounts on line 3 4 , , 000 .................................................................... 5a Enter the smaller of line 4 or $10 5a , b For students who attended an eligible educational institution in the Gulf Opportunity Zone, enter the smaller 000 or their qualified expenses included on line 4 (see special rules on page 3) ....................... of $10 5b , c Subtract line 5b from line 5a ............................................................................ 5c 6a Multiply line 5b by 40% (.40) ............................................................................ 6a b Multiply line 5c by 20% (.20) ............................................................................ 6b c Tentative lifetime learning credit. Add lines 6a and 6b and o to Part III ..................................... 6c P" AJ ! Allowable Education Credits 7 Tentative education credits. Add lines 2 and 6c ........................................................... 7 1,500. 8 Enter: $107,000 if married filing jointly; $53,000 if single, head of household, or qualifying widow(er) ...................................................... 8 107,000. 9 Enter the amount from Form 1040, line 38", or Form 1040A, line 22 ............. 9 96,641. 10 Subtract line 9 from line 8. If zero or less, stop; you cannot take any education credits ........................................................ 10 10 , 35 9 . . 000 if married filing jointly; $10,000 if single, head of household, 11 Enter: $20 , or qualifying widow(er) ...................................................... 11 20,000. +' 12 If line 10 is equal to or more than line 11, enter the amount from line 7 on line 13 and go to line 14. I If line 10 is less than line 11, divide line 10 by line 11. Enter the result as a decimal (rounded to at least three places) ..................................................................................... 12 x 0.518 13 Multiply line 7 by line 12 .............................................................................. ? 13 777. 14 Enter the amount from Form 1040, line 46, or Form 1040A, line 28 ......................................... 14 9,174. 15 Enter the total, if any, of your credits from Form 1040, lines 47 through 49, or lines 29 and 30 ............................................................................ Form 1040A 15 , 16 Subtract line 15 from line 14. If zero or less, stop; you cannot take any education credits .................. 16 9,174. 17 Education credits. Enter the smaller of line 13 or line 16 here and on Form 1040, line 50, or Form 1040A, line 31 .............................................................................................. 17 777. * If you are filing Form 2555, 2555-EZ or 4563, or you are excluding income from Puerto Rico, see Pub. 970 fo r the a mount to enter. BAA For Paperwork Reduction Act Notice, see instructions. FDIA3601 01/13106 Form 8863 (Rev 1-2006) OMB No. 1545-0172 4562 F Depreciation and Amortization orm (Rev January 2006) (Including Information on Listed Property) 2005 Department of the Treasury Internal Revenue Service ? See separate instructions. ? Attach to our tax return. Attachment 67 Sequence No. Name(s) shown on return Identifying number TTMOTHY M k JANET R EBERSOLE 179-54-2597 Business or activity to which this form relates Sch C SALES Part 1 ° Election To Expense Certain Property Under Section 179 Note: If you have an listed property, complete Part V before you complete Part 1. 1 Maximum amount. See the instructions for a higher limit for certain businesses 1 $105,000. 2 Total cost of section 179 property placed in service (see instructions) ....................................... 2 3 Threshold cost of section 179 property before reduction in limitation ........................................ 3 $420,000. 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0. ................................. 4 5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing seDarately. see instructions ............................................................................. 5 6 (a) Description of property _ I (b) Cost (business use only) I (c) Elected cost 7 Listed property. Enter the amount from line 29 ......................................1 7 1 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 ......................... 9 Tentative deduction. Enter the smaller of line 5 or line 8 ................................................... 10 Carryover of disallowed deduction from line 13 of your 2004 Form 4562 ..................................... 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instrs) .... 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 ...................... 13 Carryover of disallowed deduction to 2006. Add lines 9 and 10, less line 12 ......... 13 Note: Do not use Part 11 or Part 111 below for listed property. Instead, use Part V. Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) 14 Special allowance for certain aircraft, certain property with a long production period, and qualified New York Liberty or GO Zone property (other than listed property) placed in service during the tax year (see instrs) ...... 15 Property subject to section 168(f)(1) election ............................................................. 16 Other depreciation (including ACRS) ..................................................................... Part 111 MACRS Depreciation (Do not include listed property.) (See instructions) Section A 14 16 p; 17 MACRS deductions for assets placed in service in tax years beginning before 2005 .......................... 117 1 _ 18 If you are electing to group any assets placed in service during the tax year into one or more general n asset accounts check here c....a:.... a A-+- oi-A c., ce.. a n..dnn 9nnc Tnv Ypar I Icinn the Mpnpral r1pnrpeiatinn Svstem (a) Classification of property (b) Month and year placed in service (C) Basis for depreciation (business/investment use only - see instructions) (d) Recovery period (e) Convention (f] Method (g) Depreciation deduction 19a 3-year property .......... b 5-year property .......... c 7-Year property .......... d 10-year property ........ . e 15-year property ........ . f 20-year property ......... g 25-year property ......... 25 rs S/L In Residential rental 27.5 rs MM S/L property ................. 27.5 rs MM S/L i Nonresidential real 39 rs mm S/L property ................. MM S /L Section C - Assets Placed in Service During 2005 Tax Year Using the Alternative Depreciation System 20a Class life ................ S/L b 12-year ................. 12 rs S/L c 40-vear ................. 40 rs MM S /L Mart N.' Summa (see instructions 21 Listed property. Enter amount from line 28 ............................................................. 21 27. 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations - see instructions .................................... 22 2-7. 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs ........................ 23 BAA For Paperwork Reduction Act Notice, see separate instructions. FDIZ0812 12129/05 Form 4562 (2005) (Rev 1-2006) 'Form 4562 2005 (Rev 1-2006) TIMOTHY M & JANET R EBERSOLE 179-54-2597 Page2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Section A - Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) ?An nn umi hava ovidanra to cimnnrt the hucinecc/investment use claimed? X Yes No 24b If 'Yes.' is the evidence written? ...... X Yes No (a) (b) (c) (d) (e) M (g) (h) (i) Type of property (list Date placed Business/ nv ent Cost or Basis for depreciation Recovery Method/ Depreciation Elected vehicles first) in service other basis (business/investment period Convention deduction section 179 use use only) cost percentage 25 Special allowance for certain aircraft, certain property with a long production period, and qualified New York Liberty or GO Zone property placed in service during the tax year and used more than 50% in a qualified business use (see instructions) ......... 25 VAN 04/01/03 1.26 COMPUTER 08/25/05 49.00 551. 270. 5.00 SL/HY 27. R ' i 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 ................... 28 27. 29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 ................................................ 1 29 Section B - Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. (a) (b) (c) (d) (e) (f) 30 Total business/investment miles driven i d l d th t i d Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 ur e year ( o no nc ng u e commuting miles) ......................... 98 31 Total commuting miles driven during the year......... 1,850 32 Total other personal (noncommuting) miles driven ............................... 5,852 33 Total miles driven during the year. Add lines 30 through 32 ........................ 800, Yes No Yes No Yes No Yes No Yes No Yes No 34 Was the vehicle available for personal use during off-duty hours? ...................... X 35 Was the vehicle used primarily by a more than 5% owner or related person? .......... X 36 Is another vehicle available for personal use? ............................. X Section C - Ouestions for Emolovers Who Provide Ve hicles for Use by Their EmDlovees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). 37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, Yes No by your employees? ................................................................................................. 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners .................. 39 Do you treat all use of vehicles by employees as personal use? ......................................................... 40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? ......................................................................... 41 Do you meet the requirements concerning qualified automobile demonstration use. (See instructions) ..................... Note: If your answer to 37, 38, 39, 40, or 41 is 'Yes,' do not complete Section B for the covered vehicles. (a) (b) (c) (d) (e) M Description of costs Date amortization Amortizable Code Amortization Amortization begins amount section period or for this year percentage 42 Amortization of costs that beqins durinq your 2005 tax year (see instructions): 43 Amortization of costs that began before your 2005 tax year ................................................ 43 44 Total. Add amounts in column (f). See instructions for where to report ..................................... 44 FDIZ0812 12/29/05 Form 4562 (2005) (Rev 1-2006) 97 Prnnerty ncarl rmo/ nr IAGC in a nnalifiari himinass use- COURT OF COMMON PLEAS OF CUMBERLAND, PA ORPHANS' COURT DIVISION FIRST AND FINAL ACCOUNTING OF Dianne K. McCullough, Executor For Estate of Frances S. Smith Date of Death: Date of Appointment: Accounting for the Period: August 26, 2007 September 05, 2007 August 26, 2007 to March 31, 2008 Purpose of Account: The above fiduciary offers this account to acquaint interested parties with the transactions that have occurred during his/her administration. It is important that the account be carefully examined. Requests for additional information, or questions, or objections, can be discussed with: Patterson, Kiersz & Murphy, P.C. 239 East Main Street Waynesboro, PA 17268-1681 (717)762-3170 RELEASE TO EXECUTRIX KNOW ALL MEN BY THESE PRESENTS, That we (1) Janet Rae Ebersole of 3442 Eagle Dr., Chambersburg, PA 17201; (2) James Warren Smith of 1928 Penny Royal Avenue, Richland, WA 99352-8509; and (3) Dianne Kay McCullough of 9015 Goods Dam Road, Waynesboro, PA 17268, do hereby acknowledge that we have received and/or will receive from the Executrix of the Estate of Frances S. Smith, late of South Middleton Township, Cumberland County, Pennsylvania, deceased, the following: Janet Rae Ebersole ............. ............................ 137,232.63 James Warren Smith .................................. 137,232.63 Dianne Kay McCullough ............................ 137,232.63 which payment is in full satisfaction of the amount bequeathed to us under Item "SECOND" of the Last Will and Testament of said decedent, and in consideration of the said payment, we do hereby remise, release, quitclaim and forever discharge the Executrix as aforesaid, of and from all liabilities, suits, action, claims and demands for or by reason of any sum or sums of money, share or shares, purparts or dividends, due and payable or belonging to or coming to me by or from the Estate of Frances S. Smith, deceased. We agree that in the event there are additional claims, taxes or beneficial interests determined to be owed by the estate, excepting claims or taxes occurring through the negligence of the Executrix, we agree to indemnify the estate. We agree that we have been furnished with a complete listing of the estate assets, receipts and disbursements as set forth on the Accounting, and it is our desire that final distribution of this estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Franklin County, it being our desire to avoid the expense, delay and publicity of the formal accounting. We agree that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon our heirs, successors, administrators, and assigns. This Agreement shall be governed by the laws of.the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of .2008. Witness: Janet Rae Ebersole COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF FRANKLIN SEAL) On this, the day of , 2008, before me, a Notary Public, the undersigned officer, personally appeared Janet Rae Ebersole known to me (or satisfactorily proven) to be the person, whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. Witness my hand and notan_al seal the day and year aforesaid. Notary Public IN WITNESS WHEREOF, I have hereunto set my hand and seal this , 2008. Witness: James Warren Smith STATE OF WASHINGTON COUNTY OF SS' day of (SEAL) On this, the day of , 2008, before me, a Notary Public, the undersigned officer, personally appeared James Warren Smith known to me (or satisfactorily proven) to be the person, whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. i , 4 IN WITNESS WHEREOF, I have hereunto set my hand and seal this , 2008. Witness: Dianne Kay McCullough COMMONWEALTH OF PENNSYLVANIA COUNTY OF FRANKLIN SS day of .(SEAL) On this, the day of , 2008, before me, a Notary Public, the undersigned officer, personally appeared Dianne Kay McCullough known to me (or satisfactorily proven) to be the person, whose. name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. Witness my hand and notarial seal the day and year aforesaid. Notary Public Estate of Frances S. Smith Summary of Account Principal Principal Receipts Net Loss on Sales or Other Dispositions Less Disbursements: Debts of Decedent Funeral Expenses Administrative Expenses Federal & State Taxes Fees & Commissions Balance Before Distributions Less Amounts to Beneficiaries Total Distributions Principal Balance On Hand Income Receipts Net Gain on Sales or Other Dispositions Less Disbursements: Balance Before Distributions Less Amounts to Beneficiaries Total Distributions Income Balance on Hand For Information: Investments Made Unpaid Expenses Unrealized Gains and Losses Combined Balance on Hand $ 431,286.39 (163.52) $ 431,122.87 $ 473.33 2,829.69 7,716.96 18,050.00 9,242.50 38,312.48 $ 392,810.39 $ 306,582.00 $ 306,582.00 $ 85,939.83 $ 18,887.50 0.00 $ 18,887.50 0.00 $ 18,887.50 0.00 0.00 $ 18,887.50 $ 105,115.89 No. of Shares Stocks 26 MetLife, Investor ID #8067 4649 0975 Tangible Personal Property 1999 Oldsmobile, VIN#1G3WX52H3XF389231; taken in kind by Janet Rae Ebersole, daughter Kenny's Auction - net proceeds sale of household furnishings Personal property taken in kind by Dianne McCullough, James Smith and Janet Ebersole, children and heirs Miscellaneous AFBA Life Insurance, payable to Dianne NPC Investment account #4NR100666 Total.Inventory Total Receipts of Principal Page 1 Estate of Frances S. Smith Principal Receipts Cash and Cash Equivalents Checking account #9840895594, M &TBank Refund, Bank of America Refund, UGI Utilities Refund, USAA Refund, Waynesboro Hospital Refund, Woman's Day magazine Refund, USAA Inventory Value 08/26/2007 $ 22,710.89 1.88 19.29 359.48 40.52 16.99 1,144.58 $ 1,699.36 $ 5,125.00 9,596.12 1,457.00 $ 550.00 388,565.28 $ 431,286.39 $ 431,286.39 (2) Estate of Frances S. Smith Gains and Losses on Sales or Other Dispositions of Principal Net Gain 09/05/2007 Sale 26 Shares MetLife, Investor ID #8067 4649 0975 Inventory Value Net Proceeds Total Gains and Losses Net Loss $ 1,699.36 1,535.84 $ 0.00 $ Net Loss 163.52 163.52 $ 163.52 Page 1 (3) 1 • , Date Paid Debts of Decedent 09/17/2007 AAA Financial Services Estate of Frances S. Smith Disbursements of Principal Payoff account ending 6859 09/10/2007 Diakon Lutheran Social Ministries Payment on account #IL000068 10/11/2007 Embarq Final telephone invoice 09/10/2007 Heather Ebersole Check #290 dated August 8, 2007, cleared 9/10/07 09/10/2007 Joseph M. Bourdon, DDS Medical invoice 09/10/2007 UGI Gas Service Utility invoice 11/06/2007 Waynesboro Hospital Invoice #W00016491375 Total Debts of Decedent Funeral Expenses 09/17/2007 Hollinger Funeral Home & Crematory Funeral expenses Total Funeral Expenses Administration Expenses 09/17/2007 Carl Ocker, Auctioneer Appraise personal property taken in kind 03/19/2008 Clerk of Courts Record Family Settlement Agreement 09/10/2007 Cumberland County Legal Journal Advertise Grant of Letters Page 1 Amount Paid $ 178.03 136.20 21.29 35.00 43.00 19.29 40.52 $ 473.33 $ 2,829.69 $ 2,829.69 $ 125.00 26.50 75.00 (4) Date Paid Disbursements of Principal (Continued) Administration Expenses 03/19/2008 Dianne Kay McCullough Executrix commission 03/10/2008 Lucinda Potter, CPA Preparation of final life period returns 09/11/2007 Met-Ed Electric invoice 03/19/2008 Patterson, Kiersz & Murphy, P.C. Escrow for unforeseen expenses and debts of the estate; to be distributed upon approval of the Pennsylvania Inheritance Tax Return and filing of the fiduciary income tax returns 10/01/2007 The Sentinel Advertise Grant of Letters 09/17/2007 UGI Gas Service Final utility invoice Total Administration Expenses Federal and State Taxes 11/01/2007 Glenda Farner Strasbaugh, Register of Wills Estimated inheritance taxes Total Federal and State Taxes Fees and Commissions 09/17/2007 Glenda Farner Strasbaugh, Register of Wills Probate fees 03/19/2008 Patterson, Kiersz & Murphy, P.C. Attorney fees Total Fees and Commissions Total Disbursements of Principal Page 2 Amount Paid $ 5,000.00 195.00 81.29 2,000.00 182.56 31.61 $ 7,716.96 $ 18,050.00 $ 18,050.00 $ 627.50 8,615.00 V,l4l.,U $ 38,312.48 (5) Estate of Frances S. Smith Receipts of Income Income Collected Checking account #9840895594, M & T Bank 11/19/2007 Interest dod to closeout Estate Checking Account #9844895723, M&TBank 10/10/2007 Interest 11/09/2007 Interest 12/10/2007 Interest 01/10/2008 Interest 02/08/2008 Interest 03/10/2008 Interest MetLife, Investor ID #8067 4649 0975 12/11/2007 Dividend NPC Investment account #4NR100666 11/19/2007 Income dod to closeout Total Income Collected Total Income Received Page 1 $ 0.69 $ 0.69 $ 0.87 1.05 10.46 5.20 4.74 5.13 27.45 $ 19.24 19.24 $ 18,840.12 18,840.12 $ 18,887.50 $ 18,887.50 (6) IN THE COURT OF COMMON PLEAS OF 39TH JUDICIAL DISTRICT OF PENNSYLVANIA - FRANKLN COUNTY BRANCH Re: Estate of Frances S. Smith Deceased Orphans Court Division No. 21-07-0813 RECEIPT AND RELEASE TO THE HONORABLE, THE JUDGES OF SAID COURT: I, Janet R. Ebersole, being beneficially interested in the above titled estate, hereby acknowledge that I will receive from the Estate of Frances S. Smith, a partial advanced cash distribution of inheritance in the sum of $100,000.00. In consideration of this distribution being made without the receipt and audit of the final inventory and Pennsylvania Inheritance Tax Return be filed, I hereby agree to refund on demand, all or any part of this distribution which may be determined to have been improperly made. Dated this 9 3 r$day of f?o-yemr n e_r , 2007. JA'et R. Ebersole IN THE COURT OF COMMON PLEAS OF 39TH JUDICIAL DISTRICT OF PENNSYLVANIA - FRANKLN COUNTY BRANCH Re: Estate of Frances S: Smith Deceased Orphans Court Division : No. 21-07-0813 RECEIPT AND RELEASE TO THE HONORABLE, THE JUDGES OF SAID COURT: I, James W. Smith, being beneficially interested in the above titled estate, hereby acknowledge that I will receive from the Estate of Frances S. Smith, a partial advanced cash distribution of inheritance in the sum of $100,000.00. In consideration of this distribution being made without the receipt and audit of the final inventory and Pennsylvania Inheritance Tax Return be filed, I hereby agree to refund on demand, all or any part of this distribution which may be determined to have been improperly made. Dated this 954kday of VVVQ" bey , 2007. ames W. Smith r. Re IN THE COURT OF COMMON PLEAS OF 39TH JUDICIAL DISTRICT OF PENNSYLVANIA FRANKLN COUNTY BRANCH Estate of Frances S. Smith Deceased Orphans Court Division No. 21-07-0813 RECEIPT AND RELEASE TO THE HONORABLE, THE JUDGES OF SAID COURT: i, Dianne Kay McCuiiough, being beneficially interested in the above titled estate, hereby acknowledge that I will receive from the Estate of Frances S. Smith, a partial advanced cash distribution of inheritance in the sum of $100,000.00. In consideration of this distribution being made without the receipt and audit of the final inventory and Pennsylvania Inheritance Tax Return be filed, I hereby agree to refund on demand, all or any part of this distribution which may be determined to have been improperly made. Dated this •???'? day of 'o ?e-n1 Lac t , 2007. Dianne Kay McCull gh -.0 PROPOSED DISTRIBUTION TO BENEFICIARIES 12/3/07 Advanced Cash Distribution $ 300,000.00 1999 Oldsmobile taken in kind by Janet Rae Ebersole 5,125.00 Household furnishings taken in kind by heirs 1,457.00 Cash available for distribution 105,115.89 $ 411,697.89 In satisfaction of bequest under Item SECOND of Last Will and Testament: To: Janet Rae Ebersole, vehicle taken in kind $ 5,125.00 Household furnishings taken in kind 1,250.00 12/3/07 Advanced cash distribution 100,000.00 Cash 30,857.63 $ 137,232.63 To: James Warren Smith Household furnishings taken in kind 31.00 12/3/07 Advanced cash distribution 100,000.00 Cash 37,201.63 $ 137,232.63 To: Dianne Kay McCullough Household furnishings taken in kind 176.00 12/3/07 Advanced cash distribution 100,000.00 Cash 37,056.63 $ 137,232.63 ....................... .............................. . . Total ............................ ... $ 411,697.89 ........... . . Which exhausts the funds. t~ ? c? ?.' ? ? ? , ?} ?;:. ? a `? 4 - t .? a.. _. .?" A . w ?? Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 • Fax: 717-975-0697 • Email: dianeradcliff @comcast.net Attorney for Petitioner, Timothy M. Ebersole IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff NO. 02-2988 CIVIL TERM V. CIVIL ACTION - LAW TIMOTHY M. EBERSOLE, IN DIVORCE Defendant MOTION FOR HEARING Re: PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION AND NOW, this 24th day of December, 2008, comes Diane G. Radcliff, Esquire, attorney for Petitioner, Timothy M. Ebersole, hereby moves this Honorable Court to schedule a hearing on the above referenced Petition and assigns the following reasons therefor: 1. Your Petitioner is Timothy M. Ebersole, the Defendant in the above captioned action. Petitioner is hereinafter referred to as "Former Husband". 2. Your Respondent is Janet R. Ebersole, the Plaintiff in the above captioned action. Respondent is hereinafter referred to as "Former Wife". 3. On or about August 4, 2008 Petitioner filed a Petition to Modify (Decrease) or Terminate Alimony Obligation. 4. On or about August 8, 2008 this Honorable Court entered a Rule requiring that within 30 days the Respondent was to file an Answer to the Petition and both parties were to file an Income and Expense Statement and other specified documents. 5. Respondent filed her Answer to the Petition on September 5, 2008. 6. Both parties have filed the required financial documents. 1 7. The case is now ready for hearing on the merits. 8. The only judge assigned to this case is as follows: A. The Honorable Edward E. Guido, who entered the QDRO required to effectuate the division of Husband's TIAA Creff account as provided by the 6.13.05 PSA and the Rule entered on this Petition on August 8, 2008. WHEREFORE, Petitioner respectfully requests this Honorable Court to schedule a hearing on his Alimony Termination /Modification Petition. Respectfully submitted, DIA CLIFF, ESQUIRE 448 Trin Road t ll, PA 17011 Phone: (717) 737-0100 Supreme Court ID # 32112 Attorney for Petitioner 2 CERTIFICATE OF SERVICE I hereby certify that I am this day serving the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure: Service by First Class Mail Addressed as Follows: Bradley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013 (Counsel for Respondent/ Plaintiff ) w - . LIFF, ESQUIRE Attorney jeg jstration No 32112) Camp Hill, PA 17011 Email: dianeradcliff( comcast net Phone: (717) 737-0100 Fax: (717) 975-0697 Counsel for Petitioner/ Defendant Dated: December 24. 2008 ? ?,._, ,. _.. ;_,.; _ ? ,.? .? -1 a -, ice.). ? -,. a 6 ok"4146:.: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff V. TIMOTHY M. EBERSOLE, Defendant NO. 02-2988 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Re: DEFENDANT'S PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION ORDER AND NOW, this6?day of , 2001 , upon consideration of the within Motion of Diane G. Radcliff, Esquire, torney for Defendant/ Petitioner, IT IS HEREBY ORDERED that a hearing on the above referenced petition shall be held on the _ 6_ day of , 2001, at 1., 30 o'clock At m. in Courtroom 3 of the Cumberland County Courthouse, One Courthouse Square, Carlisle, PA . BY THE J. Distribution to: Attorney for Petitioner, Timothy M. Ebersole ?Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Email: dianeradcliff@comcast.net Phone: (717) 737-0100 Fax: 717-975-0697 Email: Bgriffie@griffielaw.com Phone: 243-5551 Fax: 243-5063 ?'?? s mac LL Attorney for Respondent, Janet R. Ebersole ,,-t-radley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013 k r ? ? 1 LL `.I? JANET R. EBERSOLE, Plaintiff VS. TIMOTHY M. EBERSOLE, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-2988 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Prior Judge: The Honorable Edward E. Guido PETITION FOR CONTINUANCE AND NOW comes Petitioner, Bradley L. Griffie, Esquire, and petitions the Court as follows: 1. Petitioner is counsel of record for the above named Plaintiff, Janet R. Ebersole. 2. The Respondent's counsel is Diane G. Radcliff, Esquire, of 3449 Trindle Road, Camp Hill, Cumberland County, Pennsylvania, 17011. 3. Upon Motion of the Defendant, through counsel, a hearing was scheduled in this matter for Friday, February 6, 2009 at 9:30 a.m. in Courtroom No. 3 of the Cumberland County Courthouse, Carlisle, Pennsylvania, a copy of said Order being attached hereto and incorporated herein by reference as Exhibit "A". 4. Petitioner herein notified counsel for Defendant that Petitioner has a conflict with two conciliation matters being scheduled the morning of Friday, February 6, 2009. 5. The office of counsel for the Defendant advised Petitioner that, similarly, counsel for Defendant had a court hearing previously scheduled for Friday, February 6, 2009. 6. Both counsel have court conflicts with the scheduled hearing date in this matter. 7. Petitioner, with the concurrence of opposing counsel, requests that the Court continue the hearing in the instant matter from Friday, February 6, 2009 at 9:30 a.m. to a later date. WHEREFORE, Petition requests your Honorable Court to enter an Order continuing the hearing in this matter to a subsequent date. Respectfully Submitted, Esquire, Petitioner L ?Ciriffe AND ASOCIAES rFFIE th Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 VERIFICATION I verify that the statements made in the foregoing document 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 falsifications to authorities. DATE: 1 JANET R. EBERSOLE, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 02-2988 CIVIL TERM CIVIL ACTION -LAW TIMOTHY M. EBERSOLE, : Defendant IN DIVORCE Prior Judge: The Honorable Edward E. Guido CERTIFICATE OF SERVICE I, Bradley L. Griffie, Esquire hereby certify that I did, the Jday of January, 2009, cause a copy of the within Petition for Continuance to be served upon the Defendant, Timothy M. Ebersole, by serving his attorney of record by first class mail, postage prepaid, and facsimile at the following address: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Facsimile: 975-0697 DATE: ) I I 1 L. Gzj?ffie, Esquire A rney for laintiff RIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 G .°s9 .? t 2:2 t JANET R. EBERSOLE, Plaintiff vs. TIMOTHY M. EBERSOLE, Defendant AN 15 20090 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 02-2988 CIVIL TERM CIVIL ACTION -LAW IN DIVORCE :Prior Judge: The Honorable Edward E. Guido PETITION FOR CONTINUANCE A AND NOW this day of , 2009, upon presentation and consideration of the within Petition of Continuance, it is hereby ORDERED AND DIRECTED that the hearing previously scheduled in this matter for February 6, 2009 at 9:30 a.m. in Courtroom No. 3 in the Cumberland County Courthouse, Carlisle, Pennsylvania is hereby continued to /Lt4--4dA? ,the day of p,?ZY 2009 at o'clock /" m. in Courtroom No. 3 of the Cumberland County Courthouse, Carlisle, Pennsylvania. Cc: " Bradle y L. Griffie, Esquire Attorney for Plaintiff Diane G. Radcliff, Esquire Attorney for Defendant DES GzCL Edward E. Guido, Judge 91 :C W8 91 Vf 600Z IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff : NO. 02-2988 CIVIL TERM V. TIMOTHY M. EBERSOLE, Defendant : CIVIL ACTION - LAW : IN DIVORCE STIPULATION FOR ENTRY OF QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this day of 2009, comes the Plaintiff, Janet R. Ebersole, and the Defendant, Timothy M. E rsole , who stipulate and agree that the foregoing Qualified Domestic Relations Order shall be entered by the Court. IN WITNESS WHEREOF, the parties have set their hands and seals the day and year above written. WITNESS: (SEAL) FFIE, ESQUIRE JA R. EBERSOLE .21 191110 SEAL DI DCLIF UIRE iMOTHY . EBERSOLE DATE: ,P - R - I v IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff NO. 02-2988 CIVIL TERM V. CIVIL ACTION - LAW TIMOTHY M. EBERSOLE, IN DIVORCE Defendant DETERMINATION AS TO QUALIFICATION OF DOMESTIC RELATIONS ORDER, NOTICE TO PARTICIPANT AND ALTERNATE PAYEE AND AGREEMENT TO COMPLY WITH ORDER Pursuant to the requirements of the Retirement Equity Act of 1984, TIAA-CREF, as the funding vehicle for a retirement plan in which Timothy M. Ebersole ("Participant") is a participant, hereby states as follows: 1. The attached Order of Court of Common Pleas of Cumberland County, Pennsylvania dated , is a Qualified Domestic Order; and 2. The Participant and Alternate Payee are hereby notified as to the qualification of said Order; and, 3. The undersigned will comply with all of the applicable terms and conditions of said Order upon receipt of the proper documentation. Dated: FOR TIAA-CREF Distribution to: Participant: Alternate Payee: Timothy M. Ebersole Janet R. Ebersole 71 Diller Drive, Shippensburg, PA 17257 1042 Willowbrook Drive, Chambersburg, PA 17202.3005 Participant's Attorney: Alternate Payee's Attorney Diane G. Radcliff, Esquire Bradley L. Griffie, Esquire 3448 Trindle Road, Camp Hill, PA 17011 200 North Hanover Street, Carlisle, PA 17013 -6- co r-. L Prepared By: Diane G. Radcliff, Esquire 3448 Trindle Road, Camp Hill, PA 17011 Supreme Court ID # 32112 Phone: 717-737-0100 • Fax: 717-975-0697 • Email: dianeradcliff ocomcast.net Attorney for Timothy M. Ebersole IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff V. TIMOTHY M. EBERSOLE, Defendant NO. 02-2988 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Re: DEFENDANT'S PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION STIPULATED AGREEMENT AND NOW, this day of February, 2009, the parties, hereby stipulate and agree as follows: WHEREAS, the parties are formerly husband and wife having been married on May 15, 1983 and divorced by Decree entered on January 9, 2006; and WHEREAS, as part of the dissolution of their marriage the parties entered onto a Separation and Property Settlement Agreement dated June 13, 2005 ("6.13.05 PSA"), which was amended by an Addendum signed by the parties on June 13, 2005 ("6.13.05 Addendum"); and WHEREAS, Paragraph 5.1 of the 6.13.05 PSA and paragraph5.1 of the 6.13.05 Addendum requires Former Husband to pay Former Wife $1,100 per month for an indefinite period of time as alimony modifiable upon a showing of a substantial change in parties' financial circumstances, and subject to termination upon death of Wife, or her remarriage or cohabitation with a person, either male of female, to whom she would not be related within the degrees of consanguinity, "the 6.13.05 Alimony Obligation". WHEREAS, on August 4, 2008, Former Husband filed a Petition to Modify (Decrease) or Terminate Alimony Obligation, ("the Petition"), and on September 5, 2008, Former Wife filed an Answer to that Petition ("the Answer"); and on January 16, 2009, the Court has scheduled a hearing on the matter for February 19, 2009 at 1:00 p.m.; and WHEREAS, the parties have reached an agreement regarding the termination of the Alimony Obligation and all issues raised in the Petition and Answer thereto as is more fully hereafter set forth. NOW THEREFORE, in consideration of the premises and mutual promises herein set forth and for other good and valuable consideration the receipt of which is hereby acknowledged, Janet R. Ebersole ("Former Wife") and Timothy M. Ebersole, ("Former Husband") do hereby stipulate and agree as follows: 1. In consideration of and in exchange for Former Wife's agreement to terminate the 6.13.05 Alimony Obligation, Former Husband agrees to pay Former Wife the amount of $84,000.00, payable in the following manner, to wit; a. $30,000.00 to be paid in cash upon Husband's securing of and settlement on a home equity loan in the amount of $30,000.00. Former Husband shalt apply for that home equity loan within fifteen (15) business days of the date of this Stipulated Agreement and shall complete that financing (including any 3 day mandatory recision period) within sixty (60) days of the date of this Stipulated Agreement. The payment shall be due on the completion of the financing even if that date is earlier than the end of the sixty (60) day financing period. b. $59,000.00 to be paid pursuant to a Qualified Domestic Relations Order ("QDRO") to be prepared by Former Husband's attorney to effectuate a tax free roll over of retirement benefits equally from Former Husband's TIAA Traditional Nos. 6590260- 2 and 3544931-3 and to Former Wife's TIAA Traditional No. D774613-6. Said roll over shalt be together with any interim interest and dividend earnings in TIAA from the date of the QpRO until the transfer is recorded by TIAA-CREF. C. The payments aforesaid shall not result in a tax event and none of the payments made by husband shall be tax deductible by him nor shall said payments be reportable as income by Former Wife. Neither party shall take any position with respect to the payments aforesaid which is inconsistent with the terms of this Paragraph on his or her applicable federal or state income tax returns. 2. In consideration of and in exchange for the payment and retirement plan roll over referenced in paragraph 1 above, Former Wife agrees that the 6.13.05 Alimony Obligation shall terminate as of the date she has received the $30,000 cash payment or the date of the entry of the QDRO by the Court in the above captioned action, whichever shall last occur. Pending that termination Former Husband shall be required to continue to make the payment of the 6.13.05 Alimony Obligation, provided however, that 6.13.05 Alimony Obligation shall be prorated for the month of termination as of the date both triggering events have occurred. If as a result Former Wife has received an overpayment of alimony, then she shalt reimburse Former Husband for the overpaid amount resulting from the 2 proration. 3. In as much as this Stipulated Agreement settles all issues raised in the Petition and the Answer, the parties agree that all claims raised in the Petition and the Answer are deemed to be withdrawn and request the Court to cancel the February 19, 2009 hearing. 4. The parties authorize the Court to enter an Order incorporating the terms of this Stipulation. 5. The only Judge(s) assigned to this case is the Honorable Edward E. Guido. IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, have set their hands and seats the day and year below written. DI G. CLIFF, ESQUIR Dated: ' 2- 4 16 C1 RA IFF , ESQUIRE Dated: _-1180 9 aa4__-_ TIMOTHY M. 7ERS7E Dated: G 0 (SEAL) ET R. EBERSOLE Dated: ?? t f 0 q 3 rlit C=s C? r .T FEB 1 9 200: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff NO. 02-2988 CIVIL TERM V. : CIVIL ACTION - LAW TIMOTHY M. EBERSOLE, IN DIVORCE Defendant QUALIFIED DOMESTIC RELATIONS ORDER AND NOW, this d ' may of /,2009, it appears to the Court as 1. The parties hereto were formerly husband and wife, having beon divorced on January 9, 2006 and seek this Order in conjunction with the aforesaid` final Divorce Decree dated January 9, 2006 in that action at the above number. 2. The Defendant, Timothy M. Ebersole, (hereinafter referred to "Participant"), is presently employed by Shippensburg University and is a participant in the Teachers Insurance and Annuity Association-College Retirement Equities Fund, (hereinafter referred to as "TIAA-CREF,") and has the following Retirement Annuity: TIAA Traditional No. 6590260-2 TIAA Traditional No. 3544931-3 3. Participant's date of birth is January 8, 1961; his current and last known mailing address is 71 Diller Drive. ShippensburR, PA 17257 and his Social Security Number is *xxx-XX-xx . 4. The Plaintiff, Janet R. Ebersole, ( hereafter referred to as "Alternate Payee"), is presently employed by the Cumberland Valley Christian School and is a participant in the Teachers Insurance and Annuity Association-College Retirement *At Equities Fund, hereinafter "TIAA-CREF," and has the following Retirement Annuity: TIAA Traditional No. D774613-6. 5. Alternate Payee's date of birth is January 28, 1951; her current. and last known mailing address is 1042 Willowbrook Drive, Chambersburg,PA. 17202-3005;_-and her Social Security Number is *xxx-xx-xxxx. * Social Security Numbers redacted fran original documents. - 1 - 6. To accommodate the marital or community property distribution between the parties IT IS ORDERED, ADJUDICATED AND DECREED AS FOLLOWS: a. Participant's TIAA Traditional No. 8590260-2 and TIAA Traditional No. 3544931-3 referenced above are marital property. b. That subject to the execution of the documents required by TIAA-CREF and the terms of said annuity, The Alternate Payee is hereby awarded and assigned, as her sole and exclusive property, a flat dollar amount of $59,000.00. 50% of that amount or $29,500.00 shall be from the Participant's TIAA Traditional No. 8590260-2 and 50% of that amount or $29,500.00 shalt be from the Participant's TIAA Traditional No. 3544931-3. Each $29,500.00 distribution amount shall be with and subject to investment gains and tosses attributable to the assigned amount from the date of this Order to the date the awarded amount is distributed to the Alternate Payee. C. The $29,500.00 amount awarded to the Alternate Payee from Participant's TIAA Traditional No. B590260-2 and the $29,500.00 amount awarded to the Alternate Payee from Participant's TIAA Traditional No. 3544931-3 shall be transferred to Alternate Payee's TIAA Traditional No. D774613- 6, subject to the terms and limitations of said annuity. d. Transfer Values: The values actually transferred will reflect interim interest and dividend earnings in TIAA and investment experience in CREF from the date of this Order until the transfer is recorded by TIAA-CREF. The TIAA Traditional accumulation will increase over time, whereas the TIAA Real Estate and CREF accumulations may increase or decrease, reflecting the performance of the underlying investments. e. Conditions on division of annuity contracts: i. Alt ownership and interest in the balance of the accumulations in all contracts issued by TIAA-CREF to Participant will belong to the Participant. ii. All ownership rights in the newly issued annuities will belong to the Alternate Payee. iii. The beneficiary designation of the Alternate Payee's annuities wilt .2- 1 be her estate, unless a beneficiary designation is submitted pursuant to the provisions of the contracts, and accepted by TIAA-CREF. The Alternate Payee must review the contracts at issuance for accuracy and inform TIAA-CREF of any change of address. iv. The Alternate Payee's annuities will be issued with the same investment allocations as the Participant's applied pro rata. The Alternate Payee may change the investment allocation once his or her annuities are issued in accordance with the contributing employer's plan. f. Parties' Right to Name Beneficiaries: For all annuity contracts or individual life insurance funded through TIAA-CREF on the life of the Participant, the parties shall retain rights to name beneficiaries with respect to the account or plan benefits they retain. i. Participant retains all rights to name and change beneficiary designations as he desires. ii. Alternate Payee shall likewise retain at[ rights with respect to the naming of beneficiaries on her account once the account has been established. iii. Both parties shall retain rights to name their beneficiaries with respect to any death benefits, any life insurance proceeds or any other distribution to be made by TIAA-CREF upon death of either party regarding his or her share of the following accounts, with Alternate Payee's rights terminating upon distribution to her of her share of the following referenced accounts as set forth above: TIAA Traditional No. 6590260-2 TIAA Traditional No. 3544931-3 g. TIAA Traditional Retirement Annuities (Ras) do not allow single-sum withdrawals or transfer to alternate carriers. For other TIAA-CREF annuities, the Alternate Payee's right to receive single-sum withdrawals and/or transfer all or a part of the accumulation to an alternate carrier may be limited in accordance with the contributing employer's plan. h. The parties are directed to timely submit to TIAA-CREF all documents and releases (if required by TIAA-CREF) to finalize this Order within thirty (30) .3- days of the request for same. 7. This Order: a. Does not require TIAA-CREF to provide any type of form of benefit, or any option, not otherwise provided under the Plan; b. Does not require TIAA-CREF to provide increased benefits; and c. Does not require the payment of benefits to an Alternate Payee which are required to be paid to another Alternate Payee under another Order previously determined to be a Qualified Domestic Relations Order. 8. This Court reserves jurisdiction to issue further orders as needed to effectuate this Order. BY THE Edward E. Guido, Judge Il:.-f r: h•?ti?r? tn• Participant: Alternate Payee: Timothy M. Ebersole Janet R. Ebersole 71 Diller Drive 1042 Willowbrook Drive, Shippensburg, PA 17257 Chambersburg, PA 17202-3005 P rticipant's Attorney: A ternate Payee's Attorney Diane G. Radcliff, Esquire 'Bradley L. Griffie, Esquire 3448 Trindle Road 200 North Hanover Street Camp Hill, PA 17011 Carlisle, PA 17013 ?ES rn? f CZ 43J 60OZ -4- crN L ai.. ? Cna e1-y .? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET R. EBERSOLE, Plaintiff V. TIMOTHY M. EBERSOLE, Defendant NO. 02-2988 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE Re: DEFENDANT'S PETITION TO MODIFY (DECREASE) OR TERMINATE ALIMONY OBLIGATION / _ORDE?R AND NOW, this May of jr&klm , 2009, upon consideration of the within Stipulation, it is hereby ordered that the terms of the parties' within Stipulation dated February 16, 2009 are incorporated hereto the same as of fully set forth at length and are made an order of this Court. BY J. Distribution to: petitioner/Defendant `s Attorney: Diane G. Radcliff, Esquire 3448 Trindle Road Camp Hill, PA 17011 Co?, ?s vn.? L?- ? RRpP°ndent's/Plaintiff's Attorney rB adley L. Griffie, Esquire 200 North Hanover Street Carlisle, PA 17013 8'l :6 14V 8Z 83.E 60OZ ? c? tx? __.. - ! 1411^- 'F __ 1_ 1 .__ -.Y i _. t J ?^.}f..? e _ t ?'