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HomeMy WebLinkAbout02-2989RONALDC. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO: YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by enter'rog a written appearance personally or by Attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgement may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other fights important to you. 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 OFFICES SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA (717) 249-3166 1-800-990-9108 RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORC~ , COMPLAINT IN DIVORCE UNDER SECTIONS 3301(c) OR 3301(d) OF ~ DIVORCE CODE AND NOW, comes the Plalmiff, RONALD EBERTS, SR., by his attorney, Barbara L. Wevodau, Esquire, pursuant to the Pennsylvania Divorce Code, Title 23 Sections 3301(c) and 3301 (d) to petition this Honorable Court for dissolution from the bonds of matrimony. In support of this Complaint, the Plaimiff asserts the following: Plaintiff, RONALD EBERTS, SR., an adult individual, who currently resides at 208 South 19~. street, Camp Hill, Cumberland County, Pennsylvania. Defendant, JERI L. EBERTS, an adult individual, who currently resides at 208 South 19~ Street, Camp Hill, Cumberland County, Pennsylvania. Plaintiff and Defendant have been bona fide residents of the Commonwealth of Pennsylvania for at least six (6) months immediately prior to the filing of this Complaint. 4. Plaintiff and Defendant were married on July 13, 1968. Plaintiff has been advised that counseling is available and that he may have the right to request that the Court require the p~ies to participate in counseling. There has been no prior action of divorce or annulment between the parties in this or any other jurisdiation. 7. This action is not collusive. 8. There are two (2) children bom to this marriage who are both over the age of eighteen. COUNT I EOUITABLE DISTRIBUTION 9. Paragraphs one (1) through nine (9) are incorporated herein. 10. The parties have aecumuiated property, both real and personal, during their marriage as well as debts and liabilities subject to equitable distribution. 11. Pursuant to the Divorce Code, Section 330 l(c) and 3301(d), the Plaintiff avers that the marriage of the parties is irretrievably broken. WHEREFORE, Plaimiff requests that this Honorable Court grant the Plaintiff's request to dissolve the parties' bonds of matrimony. Respectfully Submitted, /Atto~ey for Pla~it~ Barbara L. Wevodau, Esquire Supreme ID# 85673 P.O. Box 459 26 East Main Street New Bloomfield, PA 17068 (717) 582-8883 RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant 1N THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO: PLAINTIFF'S AFFIDAVIT UNDER SECTION 3301(D) OF THE DIVORCE CODE 1. The parties to this action separated on or about March of 2002, and have continued to live separate and apart to the present. 2. The marriage is irretrievably broken. 3. 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. I verify that the statemems made in this affidavit are tree and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unswom falsification to authorities. Date: I[ONALD C. EBERTS, SR. RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO: VERIFICATION I verify that the statements made in the above-referenced Divorce Complaint 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: RONALD C. EBERTS, SR. RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO: COMMONWEALTH OF PENNSYLVANIA COUNTY OF PERRY SS. AFFIDAVIT OF NON-MHJTARY STAT[IS I, RONALD C. EBERTS, SR., being an adult individual, hereby depose and affirm that JERI L. EBERTS, Defendant, is not in the military service of the Armed Forces of the United States of America. Sworn to and subscribed before me this _Z._._~day of~ff/JfJ ,2002. /~'~l~ara ~. Wev~dau My Commission Expires: 1~ NOT~RLAL SEAL BARBA~ L. WEVOOAU, NOTARY PUBLIC/ NEWPORT BORO., PERRY COUNTY ~/Y COMMISSION EXPIRES FEB. ~5. ~006] Ronald C. Eberts, Sr. (SEAL) RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO: NOTICE OF RIGHT TO COUNSELING You are one of the parties in the above-caption action in divorce. By virtue of Section 3302 of the Pennsylvania Divorce Code, it is a duty of the Court to advise both parties of the availability of counseling and, upon request of either, provide both parties a list of qualified professionals who provide such sm'vices. Accordingly, if you desire counseling, please advise in writing promptly by replying to: Prothonotary Cumberland County Courthouse Carlisle, PA. (The above is issued at the direction of the President Judge of the 9~ Judicial District of Pennsylvania) Deputy Prothonotary RONALD C. EBERTS, SR. Plaimiff /ERg L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT, CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO: CERTIFICATE OF SERVICE I, Barbara L. Wevodau, Esquire, hereby certify that, on this date, a true and correct copy of the foregoing Divorce Complaint was served upon/ERg L.EBERTS, Defendant in the above-captioned matter, by mailing a certified copy via first class mail from the United States Post Office in New Bloomfield, Pennsylvania, and mailing a certified copy via certified mail from United States Post Office in New Bloomfield, Pennsylvania to the following address: DATE: 6 //7~/~ t~r'~ /ERg L. EBERTS 208 SOUTH 19TM STREET CAMP HILL, PA 17011 /Attorney for Plaintiff Barbara L Wevodau, Esquire Supreme Court ID# 85673 P.O. Box 459 26 East Main Street New Bloomfield, PA 17068 (717) 582-8883 AMERICANS WITH DISABILITIES ACT OF 1990 The Perry County Branch of the Court of Common Pleas for the 41st Judicial District is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court, please contact my office. All arrangements must be made at least 72 hours prior to any hearing or business before the Court. You must attend the scheduled conference or hearing. RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY CIVIL ACTION - DIVORCE NO: 2002 - 2989 MARIIAL SEIILEMENI AGREEMENI THIS AGREEMENI, made this I~ dayof~_,~ 2003, byand between RONALD C. EBERIS, SR., party of the first pa[t~, n-o.v~f'208 S. 19th Street, Camp Hill, Cumberland County, Pennsylvania, hereinafter referred to as "Husband," -AND- JERI L. EBERIS, party of the second part, now of, Pennsylvania, hereinafter referred to as "Wife." WITNESSETH WHEREAS, the parties hereto are Husband and Wife, having been married in Pennsylvania, on July 13, 1968. WHEREAS, diverse unhappy marital difficulties have arisen between the parties, causing them to believe that their marriage is irretrievably broken, as a result of which they have separated and now live separate and apart from one another, the parties being estranged due to such marital difficulties with no reasonable expectation of reconciliation, and Husband is desirous of settling fully and finally their respective financial and property rights and obligations, including, without limitation by specification: the setting of all matters between them relating to the ownership of real and personal property; the settling of all matters between the. m relating to the past, present, or future support and/or maintenance of Wife by Husband or of Husband by Wife; and in general, the settling of any and all claims and possible claims by one against the other or against their respective estate, particularly those responsibilities and rights growing out of the mamage relationship; and WHEREAS, the parties respectively acknowledge that each has had a full and fair opportumty to obtain independent legal advice from counsel of his or her selection. Husband has been independently represented by counsel, BARBARA WEVODAU, ESQUIRE, and Wife, representing herself, pro-se, and capable of fully reading said document. The parties acknowledge that they fully understand the facts and they acknowledge and accept that this Agreement is fair and equitable. The parties further acknowledge that this Agreement is being entered into free].y and voluntarily, and that execution of this Agreement is not the result of any duress, undue influence, or collusion and that it is not the result of any improper or illegal agreement or agreements. In addition, both parties acknowledge that he or she is fully aware of the impact of the Pennsylvania Divorce Code, whereby the Court has the right and duty to determine all marital rights of the parties, including divorce, alimony, alimony pendent lite, equitable distribution of all marital property owned or possessed jointly or individually by either party, counsel fees, and costs of litigation. Fully knowing the same, each party still desires to execute this Agreement, acknowledging that the l:erms and conditions set forth herein are fair, just, and equitable to each of the parties. The parties further agree that each waives his or her respective right to have the Court of Common Pleas of Cumberland County, or any other court of competent jurisdiction, make any determination or order affecting the respective parties' fights to a divorce, alimony, alimony pendent lite, equitable distribution of all marital property, counsel fees, and costs of litigation. WI-IEREAS, Husband and Wife each covenant and. agree that he or she has made a complete and full disclosure to the other of all income, assets, property, or holdings of any nature that he or she owns individually or jointly with any other parties, and each acknowledges that he or she has had an opportunity to discuss the disclosure of same with an attorney of his or her choice; and WHEREAS, both Husband and Wife fully understa~td all of the terms, conditions, and provisions of this Agreement; and each acknowledges and accepts that this Agreement is fair, just, adequate, reasonable, and equitable; and that it is being entered into freely and voluntarily after having received such advice and with such knowledge. NOW, IHEREFORE, in consideration of the promises, covenants and undertakings hereinafter set forth; and for other good and valuable consideration, the receipt of which is acknowledged by each of the parties; Husband and Wife, each intending to be legally bound, hereby covenant and agree as follows: 1. SEPARATION. 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 or from one another. Neither party shall molest the other or compel or endeavor to compel the other to cohabit or dwell with him or her by any type of proceedings, including legal. Each may hereafter reside at any place anywhere in the world and engage in any employment, occupation, business, or trade, which either party may deem fit, free from any interference or control, direct or indirect, by the other in all resects as if he or she were single and ur~amed. 2. SUBSEQUENT DIVORCE. The parties aclmowledge that Husband has commenced an action in Divorce in the Court of Common ]?leas, Cumberland County, docketed to No. 02-2989, claiming that the marriage is irretrievably broken under the no- fault, mutual consent provision of Section 3301 (c) of the Permsylvania Divorce Code. The parties express their respective agreement that the mamage is irretrievably broken and express their intent to promptly execute any and all affidavits or other documents necessary for the parties to obtain an absolute divorce pursuant to Section 3301 (c) of the Divorce Code. The parties waive all rights to request Court-ordered counseling under the Divorce Code. Neither party to such action shall seek alimony, alimony pendente lite, or support or maintenance of any nature contrary to the.. provisions of this Agreement. It is further specifically understood and agreed by the parties that each party as a final settlement accepts the provisions of this Agreement relating to equitable distribution of property of the parties for all purposes, as contemplated by 'the Pennsylvania Divorce Code. Should either party obtain a decree, judgment, or order of separation or divorce in this or any other state, county, or jurisdiction, each of the paxties consents and agrees that this Agreement and all of its covenants shall not be affected in any way by any such separation or divorce; and that nothing in any such decree, judgment, order or further modification or revision thereof shall alter, amend, or vary any term of this Agreement, whether or not either or both of the parties shall remarry. It is understood by both parties to this Agreement that this Agreement shall survive and shall not be merged into any decree, judgment, or order of divorce or separation. Notwil/hstanding the provisions of the Pennsylvama Divorce Code or of any other laws to the contrary, none of the terms and provisions of this Agreement shall be subject to modification by the court or in any fashion other than as set forth hereinafter. It is specifically agreed, however, that this Agreement shall be subject to enforcement under the provisions of the Pennsylvania Divorce Code or, at the option of the aggrieved party, by a suit against the alleged breaching party either at law or in equity. 3. MUTUAL RELEASES. Husband and Wife mutually remise, release, quit- claim, or forever discharge the other party, and the estate of the other party, for all time to come and for all purposes from any and all rights, title and i'aterest, or claims in or against the estate of the other party, of whatever nature and 'wherever situated, which he or she now has or at any lime hereafter may have against the other party, the state of the other party, or any part thereof, whether arising out of any fbrmer acts, contracts, engagements, or liabilities of the other party or by way of dower or courtesy; or claims in the nature of dower or courtesy, or widow's or widower's rights, family exemption, or similar allowance or under the intestate laws; or the right to take against the sponse's will; or the right to treat a lifetime conveyance by the other party as testamentary; or all other rights ora surviving spouse to participate in a deceased spouse's estate, whether 9. WAIVERS. Once the Marital Settlement Agreement is executed by all parties, Husband releases any claim he had or may have in the future for checks allegedly fraudulently written by wife. 10. SOCIAL SECURITY. Husband and Wife agree that they do waive any rights to the other's Social Security Benefits that might exist now or that might come into existence in the future. 11. INSURANCE. Husband and Wife agree to cmxy sufficient automobile insurance and hold themselves and him or her safe and brainless from any liability for any injury or damages arising from the use of the above-mentioned vehicles. Husband hereby covenants and agrees to become solely responsible for the homeowner's insurance on the marital domicile. 12. ADDITIONAL INSTRUMENTS. Each of the parties shall, from time to tLrne at the request of the other, execute, acknowledge, and deliver to the other party any and all ftnther instruments or documents that may be reasonably required to give full force and effect to the provisions of this Agreement. 13. MODIFICATIONS AND WAIVERS. A modification or waiver of any of the provisions of this Agreement shall be effective only if made in writing and executed with the same formality as this Agreement. The failure of either party to insist upon the strict performance of any of the provisions of this Agreement shall not be construed as a waiver of any subsequent default of the same or similar nature. 14. BREACH. If either party breaches any provision or defaults in the due performance of the terms, conditions, and covenants of this Agreement, the other party shall have the right, at his or her election, to sue for specific performance and for damages for such breach or to seek such other remedies or relief as may be available to him or her, and the party breaching this contract shall be responsible for payment of all legal fees and costs incurred by the non-defaulting party in enforcing his or her rights court, it being understood that the Agreement shall survive the decree in divorce and not be merged into it. The foregoing agreement consists of 10 pages and 21 numbered paragraphs. IN WITNESS WHEREOF, the parties have hereuxtto set their hands and seals the day and year above written. WITNESS: .(SEAL) RONALD C. EBERTS, SR. (SEAL) JERI L. EBERTS COMMONWEALTH OF PENNSYLVANIA COUNTY OF PERRY 'SS. On this day of ~/~, 2003, before me, the undersigned officer, personally appeared RONALD C. EBERTS, SR., known to me (or satisfactorily 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. Notary l NOTARIAL SEAL ' BARBARA L WEVODAU, NOTARY PUBUC NEWPORT BORO., PERRY COUNTY MY COMMISSION EXPIRES FEB. 25. 200J; COMMONWEALTH OF PENNSYLVANIA COUNTY OF PERRY 'SS. On this ~ day of /~J4 , 2003, before ,ne, the undersigned officer' personally appeared JERI L. EBERTS,"-,~own to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that she executed the same for the purpose thereto contained. /'-~--l~otary pUblic NOTARIAL SEAL BARBARA L WEVODAU, NOTARY PUBUC J NEWPORT BORO., PERRY COUNTY MY COMMISSION EXPIRES FEB. 25. 200~ RONALD C. EBERTS, SR. Plaintiff' JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT CUMBERLAND COUNTY CIVIL ACTION - DIVORCE NO. 2002 - 2989 AFFIDAVIT OF CONSENT 1. A complaim in divorce under section 3301(c) of the Divorce Code was filed on June 21, 2002. 2 The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing the Complaim. 3 I consent to the entry of a final decree of divorce; al%r service of notice of intention to request entry of the decree. I verify that the statemems made in this affidavit are tree and correct. I understand that false statements herein are made subject to the penalties of Title 18 Pa.C.S. Section 4904, relating to unswom falsification to authorities. Date: Ronald C. Eberts, Sr. RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS, Defendant 1N THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT CUMBERLAND COUNTY CIVIL ACTION- DIVORCE NO. 2002 - 2'989 AFFH)AVIT OF CONSENT 1. A complaint in divorce under section 3301(c) o£the Divorce Code was filed on June 21, 2002. 2 The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90) days have elapsed fi-om the date of filing the Complaint. 3 I consent to the ent~ ora final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are tree and correct. I understand that false statements herein are made subject to the penalties of Title 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Date: Ronald C. Eberts, Sr. RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS Defendant 1N THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT CUMBERLAND COUNTY CIVIL ACTION - DIVORCE NO. 2002 - 298,9 WAIVER OF NOTICE OF INTENT TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses ifI do not claim them before a divorce is granted. I understand that I wilt not be divorced until a divorce decree is entered by the Court and that a copy of the decree will he sent to me immediately after it is filed with the prothonotary I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of Title 18 Pa.C.S. Section 4904, relating to unswom falsiftcation to anthofities. Ronald C. Eberts, Sr. RONALD C, EBERTS, SR. Plaimiff JERI L. EBERTS, Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT CUMBERLA2ND COUNTY CIVIL ACTION - DIVORCE NO. 2OO2 - 2989 AFFIDAVIT OF CONSENT 1. A complaint in divorce under section 3301(c) of the Divorce Code was filed on June 21, 2002. 2. The marriage of Plalntiffand Defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing the Complaint. 3. I consem 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 statemems made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of Title 18 Pa.C.S. Section 4904, relating to unswom falsification to authorities. J~L. Eberts RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS Defendant IN THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT CUMBERLAND COUNTY CIVIL ACTION - DIVORCE NO. 2002 - 2989 WAIVER OF NOTICE OF INTENT TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of diw)rce without notice· I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses ifI do not claim them before a divorce is granted. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the prothonotary I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of Title 18 Pa.C.S. Section 4904, relating to unswom falsification to authorities. Date: qr'~05 RONALD C. EBERTS, SR. Plaintiff JERI L. EBERTS Defendant IN THE COURT OF COMMON PLEAS OF THE 9T]~ JUDICIAL DISTRICT CUMBERLAND COUNTY CIVIL ACTION - DIVORCE NO. 2002 - 2989 ,,PROOF OF SERVICE OF DIVORCE COMPLAINT Postage · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. I Print your name and address on the reverse so that we can return the card to you. 1.Attach this card to the back of the mailpiece, _o~ on the front if space permits. ArticJe Addressed to: 2. Article Number (Transfer from service ~abel) PS Form 3811, August 2001 [] Agent [] Addressee delivery address different from item 1 ? []Yes If YES, enter deliver~ address below: [] No 3. Service Type ~Certified Mail r3 Express Mail [] Registered E] Return Receipt for Merchandise [] Insured Mai~ ri C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 0510 Domestic Return Receipt 0003 1762 6794 102595-02-M-0835 RONALD C. EBERTS, SR. :: Plaintiff :: L. EBERTS :: Defendam :: 1N THE COURT OF COMMON PLEAS OF THE 9TM JUDICIAL DISTRICT CUMBERLAND COUNTY CIVIL ACTION-DIVORCE NO. 2002-2989 PR ZCn'E TO, tRANsMrr TO THE PROTHONOTARY: Transmit the record, together with the following information, to the Court for emry ora divorce decree. Grounds for Divorce: irretrievable breakdown under Section 3301(c) of the Divorce Code. Date and Manner of service o the Complaam: Complaim filed June 21, 2002 via first class regular mail and certified mail. Both were not returned and Complaim was deemed served on June 24, 2002 via Certified mail. Date of Execution of Affidavit of Consent required by Section 3301(c) of the Divorce Code; by Plaintiffon June 28, 2003 and Defimdant on June 28, 2003. 4. Related claims pending: None. Date:~ Barbara Wevodau, Esq. Supreme ID #85673 26 East lV[ain Street P.O. Box 459 New Bloomfield, PA 17068 (717) 582-8883 IN THE COURT OF RONALD C. EBERTS~ SR. VERSUS JERI L. EBERTS COMMON PLEAS OFCUMBERLANDCOUNTY STATE OF PENNA. NO. 2002 2989 DECREE IN DIVORCE AND NOW, ¢,,.4/ DECREED THAT RONALD C. EBERTS~ SR. AND JERI L. EBERTS ARE DIVORCED FROM THE BONDS OF MATRIMONY. 2003 , IT IS ORDERED AND , PLAINTIFF, DEFENDANT, THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT YET BEEN ENTERED; BY THE COURT: /'" /~ST: j. ~~'~P R CT H O N OTA Ry RONALD C. EBERTS :: Plaintiff :: V. -'~ JERI L. EBERTS :: Defendant :: 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY CIVIL ACTION - DIVORCE NO: 2002 - 2989 AMENDMENT TO QUAI~IFIED DOMESTIC RELATIONS ORDER This Order is intended to be a qualified domestic relations order ("QDRO"), as that term is defined in Section 206(d) of the Employee Retirement Income Security Act of 1974 ("ERISA" and Section 404(p) of the Internal Revenue Code of 1986 ("Code"). Section 1. Identification of Plan This Order applies to benefits under the IBEW Local No. 520 Annuity ("Plan"). Section 2. Identification of Participant and Alternate Payee a. Ronald C. Eberts is hereafter referred to as the "Participant." The Participant's address is 208 S. 19th Street, Camp Hill, PA 17011. The Participant's Social Security number is 182-40-7829. b. Jeri L. Eberts is hereafter referred to as the "Alternate Payee." The Alternate Payee's address is 57 S. 39th Street, Camp Hill, PA 17011. The Alternate Payee's Social Security number is 206-38-9925. The Alternate Payee is the spouse of the Participant. Section 3. Amount of Benefit to be Paid to Alternate Payee The portion of the Participant's Plan benefits payable to the Alternate Payee is the sum of twenty-five thousand ($25,000.00) dollars which shall be paid to the Alternate Payee as soon as administratively possible. The Alternate Payee intends to complete the withdrawal forms of the Plan to effectuate the withdrawal. This amount, less the 20% IRS tax implication, will leave the Alternate Payee with the agreed upon sum of twenty- thousand ($20,000.00) dollars. Dated: IT IS SO ORDERE~: