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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF * PENNA.
... .DE~~~.. ~.'.. .~!!!lL.LI!.N.BE.~GER 1.
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DECREE IN
DIVORCE
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AND NOW, .. ..~.tl',\',d.. ~.-?..,....... " 19 .~L" It Is ordered and
decreed that".., ". ~~~~~.~:. ~~~~~~~~~~~~~..,.,.".,.. .,.,,'. plaintiff,
and. ., ,.. . .. .... . . ",~~~~'r:'r:1\ .~Ij~~~~~~~~q~~" , . ., , .., , ." . ,." defendant,
are divorced from the bonds of matrlrnony.
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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;
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DENNIS R. SHELLENBERGER.
Plaintiff
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vs.
LORETTA 8HELLENBERGER,
Defendant
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY.
PENNSYLVANIA
CIVIL ACTION - LAW
NO. 94-930
IN DIVORCE
ORDRR FOR AT.TMONY
AND NOW this 3 O~ day of
~ tH"(
, 1996, upon the agreement
of the parties and the joint motion of their counsel. we hereby direct
that the Plaintiff. Dennis R. Shellenberger. shall pay alimony to the
Defendant. Loretta Shellenberger, as follows:
l. The amount of alimony shall be $575.00 per month unless and
2.
The alimony shall commence on the first day of the first month
3. Payments under this order shall
liRelations Office of this Court, which is
be made through the Domestic
hereby directed to open and
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I administer an account fo, the collection of the monies due hereunder and
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the payment over of those monies to the Defendant. The Domestic
.
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Relations Office shall issue a wage attachment to insure the timely
payment of this order.
4. Upon Husband's retirement from his employment with the
Commonwealth of Pennsylvania, if the incomes of the parties are at that
time such that a further order of alimony is not appropriate, this Court
shall suspend, but not terminate. the alimony order, which this Court may
thereafter reinstate if the incomes of the parties change and justify the
payment of alimony from the Plaintiff to the Defendant.
5. Payments made pursuant to this order shall be treated by both
parties as alimony. The Plaintiff shall be entitled to a tax deduction
for such payments and the Defendant will include such payments in her
income for purposes of income taxation.
BY THE COURT
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DENNI8 R. SHELLENBERGER,
Plaintiff
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IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
vs.
CIVIL ACTION - LAW
NO. 94-930
LORETTA SHELLENBERGER,
Defendant
IN DIVORCE
JOINT MOTION
AND HOW come the above-named parties. by their attorneys signed
below, and jointly move the Court to enter the attached Order to provide
for the payment of alimony from the Plaintiff to the Defendant pursuant
to the terms of a property settlement agreement reached by the parties
before the Master in this matter on March 7, 1996.
!Ipe"~~~
IAttorney for Plaintiff
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Dennis' . She lenb er
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' lllJlel L. Ail es
I Attorney for Defendant
Jr,t:tL.J ~k~
oretta Shellenberger
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JDENNIS
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R. SHELLENBERGER,
Plaintiff
IN THE COURT OF COMMON PLEAS
: CUMBERLANCCOUNTY , PENNSYLVANIA
v,
NO. 94-930
LORETTA SHELLENBERGER,
Defendant
CIVIL ACTION- LAW
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 Section (X) 3301 (c)
( ) 3301 (d) (1) of the Divorce Code. (check applicable section).
2. Date and manner of service of the complaint:
Certified Mail March 7, 1994
3. ,Complete either paragraph: (a) or (b),
(a) Date of execution of the affidavit of consent required by Section
3301 (c) of the Divorce Code: by Plaintiff
March 13. 1996
; by
Defendant
April 10, 1996
(b) (1) Date of execution of the Plaintiff's affidavit required by
Section 3301 (d) of the Divorce Code:
N/A
; (2) date of
service of the Plaintiff's affidavit upon the Defendant: N/A
4. Related claims pending: None
5, Date and manner of service of the notice of intention to file Praecipe
to transmit record, a copy of which is attached
waivers signed March 13, 1996
by Plaintiff and April 10, 1996 by Defendant
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DENNIS R. SHELLENBERGER, : IN THE COURT OF COMMON PLEAS
Plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
.
. '130 (99,/
vs. . NO. Cr'vd
.
.
.
. CIVIL ACTION - LAW
LORETTA SHELLE~E~GEIl:r t .
" e en an . IN DIVORCE
.
..
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. If you wish to defend
against the claims set forth in the following pages, you
must take prompt action. You are warned that if you fail to
do so, the case may proceed without you and a decree of
divorce or annulment may be entered against you by the
Court. A judgment may also be entered against you for any
other claim or relief requested in these papers by the
Plaintiff. You may lose money or property or other rights
important to you, including custody or visitation of your
children. .
When the ground for 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, Cumberland
County Courhouse, 1 Courthouse square, Carlisle,
Pennsylvania.
IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF
PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR
ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF
THEM.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF
YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR
TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU
CAN GET LEGAL HELP.
COURT ADMINISTRATOR
Cumberland County Courthouse
4th Floor, Cumberland County Courthouse
1 Courthouse square
Carlisle, PA 17013
(717) 240-6200
to"-."''''
DENNIS R. SHELLENBERGER, . IN THE COURT OF COMMON PLEAS
.
plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
.
. Q30
v. . NO. c /99LI
.
.
.
LORETTA SHELLENBERGER, . CIVIL ACTION - LAW
.
Defendant . IN DIVORCE
.
COMPLAINT IN DIVORCE
COUNT NO. 1
l. The Plaintiff is Dennis R. Shellenberger who currently
resides at 623 State Street, Lemoyne, CUmberland County,
Pennsylvania.
2. The Defendant is Loretta Shellenberger who currently
resides at 113 Sharon Road, Enola, Cumberland County,
Pennsylvania.
3. Plaintiff has been a bona fide resident of the
Commonwealth of Pennsylvania for at least six (6) months
immediately previous to the filing of this Complaint.
4. The Plaintiff and Defendant are both citizens of the
United States of America.
5. The Defendant is not a member of the Armed Services
of the United States or any of its allies.
6. The Plaintiff and Defendant were married on
September 23, 1967, in Dauphin County, Pennsylvania.
7. There have been no prior actions of divorce or
annulment between the parties.
8. The marriage is irretrievably broken.
......
.,,-
9. Plaintiff has been advised of the availability of
counseling and that the Plaintiff may have the right to request
that the Court require the parties to participate in counseling.
10. plaintiff requests the Court to enter a Decree of
Divorce.
COUNT NO. 2
23 Pa. C.S.A. 3301(a) (6)
ll. Averments one (l) through (9) above are herein
incorporated by reference thereto and made a part of this Count.
12. The Defendant has offered such indignities to the
Plaintiff, the innocent and injured spouse, as to render his
condition intolerable and his life burdensome.
13. Plaintiff requests the Court to enter a Decree of
Divorce.
WHEREFORE, the Plaintiff requests the Court to enter a
Decree dissolving the marriage between Plaintiff and Defendant.
Dated:
~/~'/!f;1J
PANNEBAKER AND JONES, P.C.
Attorneys for Plaintiff
BY:pe~~r.,
I.D. #44873
4000 Vine Street
Middletown, PA l7057
Telephone: (717) 944-l333
Esq.
PRH:slw (DSHELL.DIV)
#13514
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VERIFICATION
I verify that the statements made in this Complaint are true
and correct. I understand that false statements herein are made
subject to the penalty of l8 Pa. C.S. 4904, relating to unsworn
falsification to authorities.
DENNIS R. SHELLENBERGER,
Plaintiff
)
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IN DIVORCE
vs.
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL ACTION - LAW
NO. 94-930
LORETTA SHELLENBERGER,
Defendant
PRARCIPR
TO THE PROTHONOTARY:
Please withdraw the Praecipe for a Rule for a Bill of Particulars
previously filed by the Defendant in the above matter and please withdraw
the Rule issued on that Praecipe.
~Qik
Samuel L. Andes
Attorney for Defendant
Supreme Court ID l7225
525 North l2th Street
Lemoyne, PA l7043
(717) 761-536l
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DENNIS R. SHELLENBERGER,
plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 930 CIVIL 1994
v.
LORETTA SHELLENBERGER,
Defendant
: IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under section 3301(C) of the
Divorce Code was filed on February 28, 1994.
2. The marriage of plaintiff and Defendant is
irretrievably broken and ninety (90) days have elapsed from the
date of filing of the Complaint.
3. I consent to the entry of a final Decree in Divorce
after service of notice of intention to request entry of the
decree.
I verify that the statements made in this Affidavit are true
and correct. I understand that false statements herein are made
subject to the penalties of 18 Pa. C.S. S4904 relating to unsworn
falsification to authorities.
Date: 5 -13 -9(.-
4 f. &...~Plaintiff
PRH:jmp DS-AFFC
#13514
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DENNIS R. SHELLENBERGER,
plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 930 CIVIL 1994
v.
LORETTA SHELLENBERGER,
Defendant
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REOUEST
ENTRY OF A DIVORCE DECREE UNDER
~3301(cl 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 this Affidavit are true
and correct. I understand that false statements herein are made
subject to the penalties of 18 Pa.C.S. 54904 relating to unsworn
falsification to authorities.
Date: 3-1~-9(.
PRH: jmp DS-WAIV
#13514
DENNIS R. SHELLENBERGER,
Plaintiff
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IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL ACTION - LAW
NO. 94-930
vs.
LORETTA SHELLENBERGER,
Defendant
IN DIVORCE
AFFIDAVTT OF CONSENT
l. A Complaint in Divorce under Section 3301(c) of the Divorce Code
was filed on 28 February 1994 and was served upon the Defendant on or
about 2 March 1994.
2. The marriage of Plaintiff and Defendant is irretrievably broken
and ninety (90) days have elapsed from the date of filing of the
complaint and the date of service of the complaint on the Defendant.
3. I consent to the entry of a final decree in divorce either after
service of a Notice of
Waiver of
Intention to Request Entry
the Notice of Intention to
of the Decree or upon
Request Entry of the
I filing of my
Decree.
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4. I have been advised of the availability of marriage counseling
understand that the Court maintains a list of marriage counselors and
that I may request the Court to require my spouse and I to participate in
'Icounseling and. being so advised, do not request that the Court require
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Ilthat my spouse and I participate in counseling prior to the divorce
I becoming final.
I verify that the statements made in this Affidavit are true and
correct and I understand that false statements herein are made sUbject to
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;the penalties of 18 Pa. C.S. Section 4904 relating to unsworn
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falsification to authorities.
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DENNIS R. SHELLENBERGER,
Plaintiff
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vs.
LORETTA SHELLENBERGER,
Defendant
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
CIVIL ACTION - LAW
NO. 94-930
IN DIVORCE
WAIVRR OP NOTICR OP TNTRNTTON TO RpntJRBT RNTRY
OF A OTVORCR OBeRRR tJNDRR 8ECTION ~~Ol Ie) OP THE nIVORCR CODE
l. 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 this Affidavit are true and
correct. I understand that false statements herein are made sUbject to
the penalties of l8 Pa. C.S. Section 4904 relating to unsworn
falsification to authorities.
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Dated:
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LORETTA SHELL
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DENNIS R. SHELLENBERGER, : IN THE COURT OF COMMON PLEAS
plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
.
.
v. . NO. 930 CIVIL 1994
.
LORETTA SHELLENBERGER, . CIVIL ACTION - LAW
.
Defendant . IN DIVORCE
.
PROOF OF SERVICE
I, Peter R. Henninger, Jr., Esquire, of the law firm of
Pannebaker and Jones, P. C., being duly sworn according to law,
deposes and says that I did serve a copy of the Complaint in
Divorce in the above-captioned matter, filed on behalf of
Plaintiff to the above term and number on the 7th day of March,
1994, by mailing a copy of said Complaint by certified Mail,
Return Receipt Requested, to the last known address, that being:
113 Sharon Road, Enola, PA 17025. The original Return Receipt,
as well as the receipt for certified Mail No. P 261 700 568 are
attached evidencing the delivery of the above referred
Complaint.
Date: May 26, 1995.
PANNEBAKER & JONES, P.C.
Attorneys for plaintiff
By fJF~//~M~
Peter R.~ng~ Jr., Esq.
I.D.#24415
4000 Vine Street
Middletown, PA 17057-3596
Telephone: (717) 944-1333
SWORN and subscribed to
before me this .JGVJ day
of YI/...~ ' 1995.
(/lM'dtf:r~ t!p/~ ~
:cmz SHELLPROOF
SHELLENBERGER 113514
NOTARIAL SEAL I
I CIIRISTINE M. ZONGILLA, Nllary PUllc
i MI.d1rllwn. Da~n ClUllly I
:,~r ~.r"''';.~'ln Zrplrts Srpltmbfl' 15. 1997
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P 261 700 568
RECEIPT FOR CERTIFIED MAIL
NO I~SURA"CE COVERAGE PfIOvlOEO
NOT FOR 1'tl{AN4TIOltAl MAil
(See Re~'erse)
Sent 10
MRS LORETTA SHELLENBERGE
Street and No
PO. Slate .lnd ZIP Code
Post,lge
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C..rM>t.'<J Fee
Specl.ll Oel.",t..,v Fee
ReslFlctl'd Deh...etV Fee
Return A('Ct!"f)! ~howtng
10 whom .1M D.lle Oehvl'rPd
Relurn Rcc.....PI St\OWIfl9 to _nom
Ddlt>. and AI1fJ!es$ 01 Oelllott,,,
TOT Al Poslaqe and 'etls
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DENNIS R. SHELLENBERGER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY. PENNSYLVANIA
CIVIL ACTION LAW
NO. 930
1994
CIVIL
VS.
LORETTA SHELLENBERGER,
Defendant
DATE:
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IN DIVORCE
STATUS SHEET
ACTIVITIES:
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OFFICE OF DIVORCE MASTER
CUM8ERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanover Street
Carlisle. PA 17013
(717) 240.6535
E. Robert Elicker, II
Divorce Masler
Tracl.lo Colyer June 27, 1995
Office Manager/Reporter
Peter R. Henninger, Jr., Esquire
PANNEBAKER & JONES, P.C.
4000 Vine Street
Middletown, PA 17057
West Shore
697-0371 Ext. 6535
Samuel L. Andes, Esquire
ANDES, VAUGHN & BANGS
525 North Twelfth Street
P.O. Box 168
Lemoyne, PA 17043
RE: Dennis R. Shellenberger vs. Loretta Shellenberger
No. 930 civil 1994
In Divorce
Dear Mr. Henninger and Mr. Andes
By order of Court of President Judge Harold E. Sheely
dated June 22, 1995, the full-time Master has been appointed in
the above referenced divorce proceedings.
A divorce complaint was filed on February 28, 1994,
raising grounds for divorce of irretrievable breakdown of the
marriage and indignities. No economic claims were raised in the
divorce complaint.
On March 21, 1994, wife filed a praecipe for a bill of
particulars. The rule was signed by the prothonotary on March
21, 1994. No bill of particulars has been filed and I ask that
counsel for Defendant file a praecipe withdrawing his request
for a bill of particulars.
On September 30, 1994, a petition for economic relief was
filed on behalf of the Defendant raising the economic claims of
equitable distribution, alimony, alimony pendente lite, and
counsel fees and expenses.
I assume grounds for divorce are not at issue.
Based on the assumption that grounds for divorce are not at
issue, I am directing each counsel to file a pre-trial statement
in accordance with P.R.C.P. 1920.33(b) on or before Monday, July
24, 1995. Upon receipt of the pre-trial statements I will
~
.
Mr. Henninger and Mr. Andes, Attorneys at Law
27 June 1995
Page 2
immediately schedule a pre-hearing conference with counsel to
discuss the issues and, if necessary, schedule a hearing.
Very truly yours,
E. Robert Elicker, II
Divorce Master
NOTE: Sanctions for failure to file the pre-trial statements
are set forth in subdivision (c) and (d) of Rule 1920.33.
THE ORIGINAL PRE-TRIAL STATEMENT SHOULD BE FILED IN THE
MASTER'S OFFICE AND A COPY SENT DIRECTLY TO OPPOSING
COUNSEL.
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DENNIS R. SHELLENBERGER,
Plaintiff
.
.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
.
.
VS.
: CIVIL ACTION - LAW
.
.
: NO. 930 CIVIL 1994
LORETTA SHELLENBERGER,
Defendant
.
.
IN DIVORCE
NOTICE OF PRE-HEARING CONFERENCE
TO: Peter R. Henninger
Samuel L. Andes
, Counsel for Plaintiff
, Counsel for Defendant
A pre-hearing conference has been scheduled at the
Office of the Divorce Master, 9 North Hanover Street, Carlisle,
Pennsylvania, on the
8th day of November, 1995, at 2:00 p.m.,
at which time we will review the pre-trial statements previously
filed by counsel, define issues, identify witnesses, explore the
possibility of settlement and, if necessary, schedule a hearing.
Very truly yours,
Date of Notice: 8/8/95
E. Robert Elicker, II
Divorce Master
ORDER AND NOTICE SETfING HEARING
To: Dennis R. Shellenberger
Peter R. Henninger. Jr.
. Plain tiff
, Counsel for Plaintiff
. Defendant
, Counsel for Defendant
Loretta Shellenberger
Samuel L. Andes
You are directed to appear for a hearing to take
testimony on the outstanding issues in the above captioned
divorce proceedings at the Office of the Divorce Master. 9 North
Hanover Street. Carlisle. Pennsylvania. on the 7th day
of March , 1996, at 9:00 a.m.. at which place
and time you will be given tile opportunity to present witnesses
anrl exhibitG in support of your case.
By the Court.
~~\~
Harold E. Sheely,
.Jud9~
Date of Order and
Notice: 11/9/95
By:
Divorce Master
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.
Court Administrator
Fourth Floor. East Wing
Cumberland County Courthouse
Carlisle. PA 17013
Telephone (717) 240-6200
vs.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 930 CIVIL 1994
DENNIS R. SHELLENBERGER,
Plaintiff
.
.
LORETTA SHELLENBERGER,
Defendant
IN DIVORCE
RE: Pre-Hearing Conference Memorandum
DATE: Wednesday, November 8, 1995
Present for the plaintiff, Dennis R. Shellenberger
was attorney Peter R. Henninger, Jr., and present for the
Defendant, Loretta Shellenberger was attorney Samuel L. Andes.
A divorce complaint was filed on February 20, 1994,
raising grounds for divorce of irretrievable breakdown of the
marriage. The complaint also raised grounds for divorce of
indignities. Counsel have ~dvised, however, that the parties
have been separated since MaL~h 1993 so that the divorce can
proceed under Section 3301(d) of the Domestic Relations Code and
counsel for husband indicated he is going to file an affidavit
under that section averring the two year separation. On
September 30, 1994, wife filed a petition raising economic
claims of equitable distribution, alimony, alimony pendente
lite, and counsel fees and expenses.
The parties were married on September 23, 1967, and
are the natural parents of four children, all of whom are
emancipated. With respect to wife's alimony claim, counsel
indicated they may offer some testimony on husband's alleged
relationship with a female friend prior to the parties'
separation. Counsel for wife recalls that husband may have
admitted that he did have an ongoing relationship prior to the
separation and husband's counsel is going to inquire of Mr.
Shellenberger as to whether or not that information is correct.
Therefore, we may be able to stipulate regarding the extra
marital relationship and not need to take any testimony
specifically about that issue.
Husband is 55 years of age and resides at 623 State
street, Lemoyne, Pennsylvania, in an apartment with a female
companion. He is a correctional officer working for the
Commonwealth of Pennsylvania. He has a high school education.
His gross biweekly income is $1,608.00. At present, he is
paying wife $145.00 per week in spousal support. Husband has
not raised any health issues.
.
.
.
Wife is 53 years of age and resides in the marital
home at 113 Sharon Road, Enola, Pennsylvania. She is a high
school graduate and has a clerical position at UPS and has a
gross annual income of around $21,000.00. Mr. Andes is going to
provide information regarding wife's income based on a pay stub
or appropriate documents verifying her present income. Wife has
not raised any health issues.
The marital real estate where wife resides at 113
Sharon Road, Enola, Pennsylvania, has not yet been appraised but
counsel have indicated that they think that they will have to
have an appraisal accomplished. Husband has a placed a value on
the property at $140,000.00 and wife has placed a value on the
property at $100,000.00. The home is subject to a first
mortgage in favor of First Federal with an approximate payoff of
$1,800.00 and a second mortgage which is a home equity loan in
favor of Hershey Bank-PNC with a principal balance of around
$13,000.00.
Husband has a pension with the Commonwealth of
Pennsylvania and counsel have had a valuation prepared by Harry
Leister. Depending on the assumptions regarding date of
retirement, the pension has a value between $120,000.00 and
$160,000.00.
Wife has a pension with UPS and Mr. Andes indicated
that he does not believe it will have a significant value
because of her short time employment with that company.
However, we will need to establish a value for her pension.
Also, wife has a thrift plan with UPS and as of December 31,
1992, the thrift plan had a value of $732.00. Mr. Henninger has
inquired of Mr. Andes as to whether or not wife had a pension
with Gannett where she was employed prior to the parties'
separation. Mr. Andes is not aware of any pension but will
inquire of his client. The inquiry is based on whether or not,
if there was a pension, did the pension remain with Gannett or
was the money removed and utilized in the marital estate.
The pre-trial statements list the following
vehicles:
1988 cougar
1988 Cougar
1970 Oldsmobile Cutlass
1992 Harley-Davidson motorcycle
"'.'
Yamaha motorcycle
We have no values established for any of the vehicles and they
will have to be appraised. with respect to the 1970 Oldsmobile
cutlass, wife has placed a value on that vehicle at $500.00 and
husband has a placed a value on the vehicle of $700.00.
The household tangible personal property remained
in wife's possession when the parties separated. Husband has
placed a value on that property at $5,000.00 and wife has placed
a value on the property at $2,500.00. Counsel are going to try
to arrive at a stipulated value or in the alternative will have
to have the property appraised.
Wife's pre-trial statement lists various accounts
held, she claims, by the parties at Dauphin Deposit Bank and
Trust company at the time the parties separated. The Super Now
account she has listed at $20,000.00 and has also listed a
savings account, a club account, a certificate of deposit, and a
Prime of Life account. Mr. Andes has a statement showing
certain account numbers but has no values on those accounts nor
do we know if those accounts existed and what happened to the
money that may have been in those accounts. counsel need to
make the inquiry of the bank in order to try to establish
whether the accounts existed and then try to track the funds.
The parties had a joint PSECU savings and checking
account at the time of separation. Mr. Andes has a statement
which around January 31, 1993, shows the total of the two
accounts had a value $7,810.00.
Mr. Henninger is going to inquire of Metropolitan
Life Insurance Company as to whether or not there is any cash
value in that policy and if there is, what the value was at the
date of separation and what the value is today. We will have
to, of course, reduce the value today by any contribution made
by either of the parties following the date of separation.
The marital debts are the two mortgages which have
previously been identified. Otherwise, the parties are free of
joint debt.
Because the parties do not have a lot of cash
assets, counsel are going to try to fashion a distribution of
assets utilizing the fact that wife wants the home awarded to
her. The pension, which is the largest valued asset, will not
be able to be reduced to a cash account for an immediate
distribution. Therefore, we may try to deal with a QDRO or a
partial QDRO in a distribution scheme in this case.
.-......-'"'"
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Mr. Andes also indicated that wife is continuing
her claim for alimony and is not interested in taking a larger
percentage of the assets in a distribution in lieu of alimony
payments. The Master has indicated that in the event of an
alimony award, the alimony would be indefinite subject to
modification on petition of either party based on a showing of
changed circumstances.
A hearing is scheduled for Thursday, March 7, 1996,
at 9:00 a.m. Notices will be sent to counsel and the parties.
E. Robert Elicker, II
Divorce Master
cc: Peter R. Henninger, Jr.
Attorney for Plaintiff
Samuel L. Andes
Attorney for Defendant
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17 April 1996
E. Robert Elicker. II. Esquire
Office of the Divorce Master
9 N. Hanover Street
Carlisle, PA 17013
RE: Shellenberger
No. 94-930
Dear Mr. Elicker:
Enclosed you will find the transcript of the Settlement Agreement reached by the
parties in your office in early March, which has now been signed by both parties and their
attorneys. All parties have retained copies.
Please take whatever action is necessary to have your appointment vacated so that
we can conclude the divorce. We will be filing our consents directly with the
prothonotary in order to conclude the divorce.
If you need anything further, please call Peter Henninger or myself. Thank you for
your cooperation.
Sincerely,
rq
Enclosure
cc: Peter R. Henninger, Jr., Esquire
SAM UBI. ....""D..
oJ. DAHT O.LONB
SAMUEL L. ANDES
ATTOlfNEY AT LAW
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LBMOYNE, PENNSYLVANIA 17043
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E. Robert Elicker, II, Esquire
Office of the Divorce Master
9 North Hanover Street
Carlisle, PA 17013
RE: Dennis R. Shellenberger vs. Loretta Shellenberger
No. 94-930
Dear Mr. Elicker:
I reviewed the transcript of the agreement the parties
reached before you on 7 March 1996 and I request one change. I
would like to see the last three lines of the first paragraph of
Paragraph 7 changed to read as follows:
remarriage: wife's death: husband's death: or
a subsequent order of this court.
I think that makes the intention a little more clear and the
language a lot more simple. It does not change the substance of
the agreement.
I have sent a copy of this letter to Pete Henninger and I
expect he will reply directly to you as to whether he will agree
to this change or not.
Otherwise, the agreement as it has been typed is fine.
Thank you for your cooperation.
Sincerely,
8-
Samuel L. Andes
Ie
cc: Peter R. Henninger, Esquire
Mrs. Loretta Shellenberger
OFFICE OF DIVORCE MASTER
CUMBERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanover Slreel
Carlisle. PA 17013
(717) 240.6535
E. Robert Elicker, II
Divorce Mesler
Trecl Jo Colver
Office Maneger/Reporter
West Shore
697-0371 Ex!. 6535
March 19, 1996
Peter R. Henninger, Jr., Esquire
PANNEBAKER & JONES, P.C.
4000 Vine Street
Middletown, PA 17057
Samuel L. Andes, Esquire
525 North Twelfth Street
P.O. Box 168
Lemoyne, PA 17043
Re: Dennis R. Shellenberger vs. Loretta Shellenberger
No. 94 - 930
In Divorce
Dear Mr. Henninger and Mr. Andes:
Since both counsel have apparently approved the
agreement with a minor change, I am sending the original
document to Mr. Henninger's office for Mr. Henninger to affix
his signature and his client's signature and the date. Mr.
Henninger should then forward the original document to Mr. Andes
so that his signature and his client's signature can be affixed
and the document dated. Mr. Andes should then send a copy of
the fully executed document to me and to Mr. Henninger at which
time I will prepare an order vacating my appointment as Master.
Thank your for your continuing cooperation in bringing
this matter to conclusion.
Very truly yours,
E. Robert Elicker, II
Divorce Master
OFFICE OF DIVORCE MASTER
CUM8ERLAND COUNTY
COURT OF COMMON PLEAS
9 North Hanover Street
Carlisle. PA 17013
(717) 240.6535
E. Robert Elicker, II
Divorce Masler
Trecl JoColyer March 8, 1996
Ofllce Maneger/Reporter
Peter R. Henninger, Esquire
PANNEBAKER & JONES, P.C.
4000 Vine street
Middletown, PA 17057
We.' Shore
697-0371 Ext.6535
Samuel L. Andes, Esquire
525 North Twelfth street
P.O. Box 168
Lemoyne, PA 17043
Re: Dennis R. shellenberger vs. Loretta Shellenberger
No. 94 - 930
In Divorce
Dear Mr. Henninger and Mr. Andes:
Enclosed is a draft of the agreement which you put on the
record on March 7, 1996. Please review the draft for any
corrections with the understanding that no substantive changes
can be made.
When you have reviewed the draft give us a call and let
us know if you want us to send the original to the Plaintiff's
attorney for signature who then can transmit the original to the
Defendant's attorney for signature. When I receive a signed
copy of the document I will then obtain a Court order vacating
my appointment.
Thank you for your continuing cooperation in bringing
this matter to settlement.
Very truly yours,
E. Robert Elicker, II
Divorce Master
DENNIS R. SHELLENBERGER, . IN THE COURT OF COMMON PLEAS OF
.
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
.
.
vs. : NO. 94 - 930
LORETTA SHELLENBERGER, .
.
Defendant . IN DIVORCE
.
..
THE MASTER: Today is Thursday, March 7, 1996.
Present for a Master's hearing are the Plaintiff, Dennis R.
Shellenberger and his counsel Peter R. Henninger, and the
Defendant, Loretta Shellenberger, and her counsel Samuel L.
Andes.
A divorce complaint was filed on February 28, 1994,
raising grounds for divorce of irretrievable breakdown of the
marriage and indignities.
Counsel have advised that the
parties, within a week of today's date, will sign and file
affidavits of consent so that the divorce can be concluded under
Section 3301(C) of the Domestic Relations Code.
On September 30, 1994, the Defendant filed a
petition for economic relief raising the economic issues of
equitable distribution, alimony, alimony pendente lite, and
counsel fees and expenses.
On March 21, 1994, the prothonotary issued a rule
for Bill of Particulars. Counsel indicated they are going to
address that matter in the statement of the agreement.
The Master has been advised that after negotiations
this morning the parties and counsel have reached an agreement
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with respect to the outstanding economic issues.
The agreement
is going to be placed on the record in the presence of the
parties. The agreement as stated on the record will be
considered the substantive agreement of the parties and not
subject to any modifications except for correction of
typographical errors which may be made in the transcription.
After the agreement has been prepared in draft form by our
office, it will be sent to counsel for review for typographical
errors. After any corrections have been made, we will send the
original around to counsel and the parties for signature. The
signing of the agreement by the parties and counsel is
considered an affirmation of the agreement which is placed on
the record today which will be the final and substantive
agreement of the parties.
After the signed document has been returned to the
Master's office, the Master will prepare an order vacating his
appointment and counsel can then prepare a praecipe transmitting
the record to the Court requesting a final decree in divorce.
Mr. Andes.
MR. ANDES: Thank you. The parties have agreed
upon the following items:
1. The Defendant will, by praecipe, withdraw the rule for
Bill of Particulars in this matter. The parties will
both execute and file with the Court, within one week,
affidavits of consent and waivers of further notice so
that a divorce can be concluded in the near future.
2. The marital residence at 113 Sharon Road, East Pennsboro
Township, Enola, Pennsylvania, will be transferred to
wife and husband will execute a deed and any other
necessary documents to make that conveyance.
Wife will be responsible to pay and satisfy, in
accordance with their existing terms, the mortgage
against the property owed to First Federal Mortgage
Company with an approximate balance of $840.00 at this
time and the home equity loan owed to PNC Bank with an
approximate balance of $8,000.00.
Wife will indemnify and save harmless husband from any
loss or costs caused to him by her failure to pay those
obligations.
Wife waives any claim to husband's retirement with the
Commonwealth of Pennsylvania with the exception of the
following:
3.
a) Husband agrees that if he retires prior to
attaining full retirement benefits at his age 65,
he will pay to wife the sum of $18,000.00 promptly
upon his retirement. That sum represents
approximately 1/2 of the difference between the
value of his pension benefits, if he continues to
work to age 65, and those benefits if he retires at
age 62 as determined by the appraiser used by the
parties.
b) Husband will designate wife, irrevocably, to
receive $18,000.00 of the death benefits payable
upon his death under the pension plan and continue
that designation until his age 65.
4. Husband waives all claims to any pension benefits wife
has with Gannett Fleming or her present employer, UPS,
and any claim he has to an interest in or claim against
her thrift plan with UPS.
5. Husband shall pay to wife within sixty (60) days of the
entry of a final decree in divorce the sum of $20,000.00.
That sum shall, among other things, represent the
equitable distribution of the following assets:
Any bank accounts held by the parties at the time
of their separation.
b) Husband's Harley-Davidson motorcycle.
a)
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Any other motorcycle or automobile owned by the
parties at the time of separation and the proceeds
of any vehicles of which they have made any
disposition.
6. The current support order shall continue in effect
and be managed by the Domestic Relations Office of
Cumberland County until the last day of the month in
which the final decree in divorce is entered in this
action. Husband acknowledges that he will be liable to
make all payments due under that order through the
final day of the month in which the final decree in
divorce is entered even though the parties may be
divorced for a portion of that month.
c)
Wife agrees that, upon termination of the support order,
any arrearages existing as of today will be cancelled
and remitted. Any arrearages which arise under the
support order after this date shall not be cancelled and
husband will be obligated to pay those at the time the
support order is terminated.
7. Husband shall pay alimony to wife at the rate of $575.00
per month, commencing on the first day of the first month
following the entry of a decree in divorce in this
action. The alimony will be paid through the Domestic
Relations Office with a formal attachment of husband's
wages. The alimony will continue until terminated by
wife's co-habitation with a man, not her spouse; wife'S
remarriage; wife's death; husband's death; or the
termination by an order of order court based upon the
incomes and assets of the parties at that time.
The parties agree, however, that if the incomes of the
parties are such at the time of and after husband's
retirement, that an alimony order is not appropriate on
the then existing income of the parties, that the alimony
order will be suspended and not be terminated, so it can
be reinstated if the financial circumstances of the
parties change significantly thereafter.
Nothing herein shall be interpretated to prevent either
party from petitioning the Court to request a
modification of the alimony based upon a change in
economic circumstances. The only limitation is that, if
husband's income decreases significantly because of his
retirement, the Court may not absolutely terminate
his alimony obligation at that time, but may only suspend
it so that alimony can be reinstated if his income
significantly increases after his retirement because of
other employment or other income.
8. Husband shall retrieve from the family home his pool
table, a craftmatic bed, a 42 inch television, and his
personal tools from the garage within sixty (60) days of
the entry of the final decree in divorce.
Wife shall retain the other items of furniture and
household furnishings in the family home and each party
waives any further claim to such items in the possession
of the other.
9. Wife waives any further claim to counsel fees or alimony
pendente lite, as does husband.
10. Except as herein otherwise provided, each party may
dispose of his or her property in any way and each
party hereby waives and relinquishes any and all rights
he or she may now have or hereafter acq~ire under the
present or future laws of any jurisdiction to share in
the property or the estate of the other as a result of
the marital relationship including without limitation,
statutory allowance, widow's allowance, right of
intestacy, right to take against the will of the other,
and right to act as administrator or executor in the
other's estate. Each will at the request of the other
execute, acknowledge, and deliver any and all instruments
which may be necessary or advisable to carry into effect
this mutual waiver and relinquishment of all such
interests, rights, and claims.
MR. ANDES: Mrs. Shellenberger, you've heard
everything that I've dictated?
MRS. SHELLENBERGER: Yes.
MR. ANDES: Do you understand it?
MRS. SHELLENBERGER: Yes.
MR. ANDES: Do you understand that by making this
agreement today we are making a final agreement and that if this
afternoon or tomorrow morning we have misgivings, we can't
t.~_.-...",_.,..-...
change the agreement?
MRS. SHELLENBERGER: Yes.
MR. ANDES: You've had a chance to meet with me and
we've had a chance to review the assets. We haven't had
everything formally appraised, but are you satisfied that you
have enough information to intelligently reach this agreement?
MRS. SHELLENBERGER: Yes.
MR. ANDES: And are you satisfied with the terms of
the agreement as satisfying your claims in this divorce action?
MRS. SHELLENBERGER: Yes.
MR. ANDES: And is this your agreement that you are
willing to stand by?
MRS. SHELLENBERGER: Yes.
MR. HENNINGER: Mr. Shellenberger, you've heard Mr.
Andes set forth, quite eloquently -- and I don't even have any
comments, which is surprising in these matters -- with regards
to distribution of property, with regards to your responsibility
as far as alimony is concerned, and specifically with regards to
how your pension would work upon your retirement? Do you
understand that by saying, yes, that you understand and agree to
these things and that you are not going to be able to come and
change your mind in the future unless we can show some fraud or
major misrepresentation on your wife's behalf? You understand
that?
MR. SHELLENBERGER: Yes.
".~.:
MR. HENNINGER: And you understand and are willing
to agree that the terms as set forth by Mr. Andes as per our
discussions are correct?
MR. SHELLENBERGER: Yes.
I acknowledge that I have read the above
stipulation and agreement, that I understand the terms of
settlement as set forth herein, and that by signing below I
ratify and affirm the agreement previously made and intend to
bind myself to the settlement as a contract obligating myself to
the terms of settlement and subjecting myself to the methods and
procedures of enforcement which may be imposed by law and in
particular Section 3105 of the Domestic Relations Code.
WITNESS:
DATE:
Peter R. Henninger
Attorney for Plaintiff
Dennis R. shellenberger
Samuel L. Andes
Attorney for Defendant
Loretta Shellenberger
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DENNIS R. SHELLENBERGER, I IN THE COURT OF COMMON
plaintiff ) PLEAS OF CUMBERLAND
) COUNTY, PENNSYLVANIA
vs )
) NO. 930 CIVIL 1994
LORETTA SHELLENBERGER, I
Defendant ) CIVIL ACTION - LAW
) IN DIVORCE
PRAECIPE FOR RULE FOR A BILL OF PARTICULARS
Please issue a Rule upon the plaintiff to file a Bill of
Particulars in support of his claim for divorce on the grounds
of Indignities, or suffer a non pros, all in accordance with Pa.
R.C.P. 1920.2L
AND
By
S 1 L. Andes
Attorney for Defendant
RULE FOR A BILL OF PARTICULARS
AND NOW, this .:21..,j day of -r>l~ , 1994, a Rule is
hereby issued upon the Plaintiff above named, to file a Bill of
particulars in support of his claims for divorce on the grounds
of indignities or suffer a non pros in accordance with Pa. R.C.P.
1920.21.
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. .
. .
DBNNIS R. SHBLLBNBBRGBR,
Plaintiff
IN THB COURT OF COMMON PLBAS
OF CUHBBRLAND COUNTY,
PBNNSYLVANIA
CIVIL ACTION - LAW
NO. 94-Cf~O CIVIL TBRH
IN DIVORCB
vs.
LORETTA SHBLLBNBBRGBR,
Defendant
PETITION POR BCONOHIC RBLIBP
AND NOW comes the above-named Defendant, LORETTA SHBLLENBERGBR, by her
attorneys, Andes, Vaughn & Bangs, and petitions the Court for economic relief,
based upon the following:
COUNT I - BOUlTABLB DISTRIBUTION
1. During the course of the marriage, the parties have acquired numerous
items of property, both real and personal, which are held in joint names and in
the individual names of each of the parties hereto.
WHBRBFORB, Defendant prays this Honorable Court, after requiring full
disclosure by the Plaintiff, to equitably divide the property, both real and
personal, owned by the parties hereto as marital property.
COUNT II - ALIItONY
2. Although the Defendant was employed outside of the home during the
marriage, her pursuit of a career was always secondary to her primary career of
rearing the children of the parties and making a good home for the Plaintiff
and the family.
1
r+
-.-.-.
3. The Defendant is unable to support herself and is dependent upon the
Plaintiff for financial support and maintenance.
4. The Plaintiff is employed and enjoys a substantial income and is well
able to contribute to the support of the Defendant.
WHBRBPORB, Defendant prays this Honorable Court to enter its Order
awarding Defendant from Plaintiff permanent alimony in such sums as are
reasonable and adequate to support and maintain Defendant in the station of
life to which she is accustomed.
COUNT III
ALIIIONY PBNDIlNTIl LITE AND COUHSBL PBBS AND BXPBNSBS
5. Defendant is without sufficient funds to retain counsel to represent
her in this matter.
6. Without competent counsel, Defendant cannot adequately prosecute her
claims against Plaintiff and cannot adequately litigate her rights in this
matter.
7. Defendant is without sufficient income to support and maintain herself
during the pendency of this action.
8. Plaintiff enjoys a substantial income and is well able to contribute
to the support and maintenance of Defendant during the course of this action
and to bear the expense of Defendant's attorney and the expenses of this
litigation.
2
.....,
VRBRBFORB, Defendant prays this Honorable Court to order plaintiff to pay
her reasonable alimony pendente lite during the pendency of this action and to
order Plaintiff to pay the legal fees and expenses incurred by Defendant in the
litigation of this action.
I verify that the statements made in this Petition are true and correct. I
understand that any false statements in this Petition are subject to the
penalties of 18 Pa. C.S. 4901 (unsworn falsification to authorities).
c:r - '2.'2-9 'i
Date
~
.. & .Ift uu
R A SHBL~BRGE;~
:~~~~
el L. A es
Attorney for Defendant
3
Department oltha Treasury ...- Internal Revenue Servlco
Form 1040 U.S. Individual Income Tax Return
Use L
the A
IRS .
label. E
Oth.r-
W1se, H
please E
print R
or typ.. E
Presidential ...
Elecdon C;tmpalgn ,
1
2
3
4
.11 OMB No. 15.;:.
Vour .oclal .ecurlty nu".
186-30-6875
Spouse's socIal security i
204-30-9264.
.,U...ndina
1994 (gg) IRS Un Only -- Ca nat wnt. ar staal. in nllS sail:':.
r:at nl. v...r Jan. '-O.c. 3'.119". or alh.r lill v...r bt lnnl"
DENNIS R SHELLENBERGER
623 STATE ST APT.
LEYMONE, PA 17043
2
Allng Status
(5.. p.g. 12,)
Check only
one box,
Exemptions
(S.. page 13,)
If more than six
dependents.
see page 14.
Income
Attach
Copy a 01 your
Forms W"'2,
W-2G. and
1099-R here.
II you did not
g.t . W-2, .e.
p.g. 15,
Enclo.., but do
not anach, any
p.ymenlwlth
your return.
Adjustments
to Income
C;tllllon: 5..
In.1IIlcUon. , .. ~
Adl, Gr. Income
"'7:1] 104012
Note: Checking
Ve. No "Ye.' will nOI co,:
Do you w.nt $3 to go 10 this lund? . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . X yourlax orr.~u='
your r.lund.
II. Intr.Mn. do.. our spou.. w.nl $3 10 010 Ihl. lund? . . . . . . .. . .. . . . . . . . . . . ..
Singl. For Prtvacy Act and Paperwork Reduction Act NoUce, .ee pt:. . .
Msrrt.d filing joint r.lUrn (.v.n II only on. h.d Income)
X Mltnld tiling ,,,pilrat. ttlurn. Enltr ,paul"" SSN abav. &. fullnilm. htt..... LORETTA H SHELLENBERGE?
H.ad 01 household (with qualifying p.rson). (Se. page 13.) II qualifying p.r..,n Is . child but not your d.p.nd",..
enter child's name here. ...
Qualilyln widow(.r) with d.p.nd.nt child (yr. spouse dl.d~19 ). (5.. p. .13.)
X Yourselr. II your parent (or someone else) can claim you as a dependent on his/her lax} No. of ba...
rcwrn. do not check box 6a. BUI be sure to check box on line 33b on page 2 :~:~ll:d an II.
b S ou.e.................................,...........................
C Oependents: (2) Cn1l.. (3) If agl t or oleW, (4) Qtot"lunt'. (5) Na. or
It und" d,plnd.nt'. SOCl..1 ucurlty t.~llonsn'o ta O,Mv.d In
(1) Nilm.!flt.t,I",t1i1I. ilndl...1 nillll'l ilg. t numbtt yOU ~~r1~'~'
5
6a
d If yout ChIld dlCn't IIv. Wltl'l you but'. C~lm.d'" your dto.nd.nt und,ta 1:1,.-1915 .gr..",."" C:"'t:II'I'" ..
e Total number 01 exemDlions claimed. . , . . . , . . . . . . . . , . . . . . . , . . . , . , . . . . , . . . . , . . , . . . . . ,
7 Wilg... saliltlU. tiPS. at:. Altac:" Fotml.tW-2
8a Taxablelnl.r.sl income (se. p.g.15). Anach Schedul. B il ov.r $400. ...... ........ .
b Tax-exempt Inler..t (... pg, 16). DON'T includ. on IIn. 6a 8b
9 Dividend income. An.ch Sch.dul. B II ov.r $400 . , . , .. . .. .. .. . .. . .. .. .. .. , .. . .. . ,
10 Taxabl. r.lund.. cr.dits, or ons.ts of .Ial. end locailncome t...s (s.. p.g. 16) ........
11 A1imonyrec.lved..........................................................
12 Business Income or (10"). An.ch Sch.dul. Cor C-EZ....................,........
13 Capital gain or Qo.s). II r.qulr.d. anach Sch.dul. 0 (s.. page 16) .... . . . . . . . . . . . . . . .
14 Olh.rgalnsor{lo....). Anach Form 4797. ......................................
15a TolallRA dlstrlbuUons .. ~ I b Tax.bl. emounl (see pg. 17)
168 Totalp.nlionund"nnuitilS. 168 b Taxable amount (see pg, 17)
17 R.ntal realesl.I.. royalti... p.nn.rshlp.. S corparaUons,1IIlsts, .tc. A1t.ch Sch.dul. E ...
18 Farm Income or (loss). Anach Sch.dul. F.......................................
19 Un.mploymenl comp.ns.Uon (se. page 16).... ... . ......... .. .. .............. ..
20a Social security ben.lIts . ~ I b Taxabl. emount (se. pg. 16)
21 Olh.r Income.
22 Add the emounts In Ih. ler ri ht column lar lines 7 throu h 21. This Is vaur total Income. ~
238 Vour IRA d.ductlon (... page 19). .. ... . .. .. .. .. . .... 238
b Spous.'.IRA d.ductlon (s.. page 19) . . . . . . . . . . . . . . .. 23b
24 Moving .xp.ns... An.ch Form 3903 or 3903-F . . . . . . . . , 24
25 On.-hall 01 sell-.mplayment lax. ....,............... 25
26 S.II-.mploy.d h.alth In.uranc. d.ducUon (s.. page 21).. 26
27 Keogh r.Ur.men! plan & s.Il-.mploy.d SEP d.ducUan .. , 27
28 P.nalty on .arly withdrawal 01 savings. . . , . . . . . . . . . . . . , 28
29 Alimony paid. ROClpi.nrs SSN ~ 204 - 3 0 - 9264 29
7,250
No. of yaur
Cl'llldr'nonlc
wha:
. lived wit" you
. dldn'ttiv.",,'"
yau du.to dlvorc.
ar ,.p.tatlon(".
pig' 1.)
O.und,nlsonlC
n~t.ntl"dlbOv,
AdCnumb"tS
,"I,t,dan
tln"ilDov' ~ ..'
: >1
'"7'
8a
52,0:'
?- ~
:.:'j"
9
10
11
12
13
14
15b
16b
17
18
19
20b
;iimtiHl:!
21
22
52, :~.~
30 Add line. 2:la throuah 29. Thos. are vour total adjustments. . . . . . . . . . . . . . . . . . . . . . ~ 30
31 SUbtracllino 30 from IIno 22. Thl!llS vour adJusted gross Income. ' . . ,.... I 31 I
NT'~ 87'0 r"reoarers Eamon
7,'::
45,:
I"'orm 1040 C';.
Form'0401,994) DENNIS R SHELLENBERGER 186-30-6875
32 Amounllrom Uno 3' (adjustod gro'S1ncomo) . .. . . , .. .. . .. , .. .. . .. .. , . , .. . . .. . .. . , .. I 32
33a Chock II: 0 Vou wora 6.5/oldor. 0 Blind; 0 Spou.e wu 6.5/oldor. 0 Blind,
Add tho number 01 be'O' chockod abevo and ont.r Ih. 10lal h.ro . . . . . . . . . . .. ~ 33a
b II your par.nl (or samoono .1..) can claim you as a d.p.nd.nl. check h.ro. . . .. ~ 33b
c: II you aro mamod filing ..paraloly and your .pou.. ,t.miz.. d.duClion. or you ~ 33c
aro a dual-.lalu. all.n. .ee pago 23 and chock h.r.. . . . . . . . . . . . . . . . . . . . . . .
34 E I {Itemized daducUon. ham Sch.dulo A. Uno 29. OR }
Ihn or Standard deducUon .hown below lor your 1ilI(l9 .IIIU.. But II you checked
I 0 any box on line 33a or b. go to page 23 10 find your .tandard doduCbon.
arger II you checkod box 33C. your .Ianaard d.duclion Is z.ro.
01 . Slnglo __ $3.800 . H.ad 01 hou..hold -- 55.600
your. . Marr10d filing jolnlly or Ouallfying widow(.r) -- $8.350
. Marr10d filing ..paraloly -- $3.175 ".".
35 SubltaCI Un. 341rom Uno 32. ,. ,. . . ,. ,. ,. ,. ,. ,. . ,. ,. . ,. ,. .. ,. . .. ,. . ,. . . ,. ,. ,. ,. ,. 35
36 IIl1n. 321. $83.850 or I.... multiply 52.450 by IholOlal number ol...mption. c1almod on
Iln. 88. II Uno 32 Is ov.r $83,850. .ee Ih. work.h..1 on pag. 24 lor Ih. amount to .nl.r . . . . . .
37 Tanble Income. SubltaCllln. 381rom lin. 35. IIl1n. 381. mar.lhan Un. 35. .nl.r -0-. . . . . . .
38 Tax. Check illrom a 181 Tax Tabl.. b 0 Tax Rat. Sch.dul... C 0 Capllal Gain Tax Work-
.h..I. or dO Form 88'5\... .g. ,.~ Amounllrom Form(') 88'4 ~ e
39 Addillonal lax.'. Check illrom aD Form 4970 bO Form 4972 ................,..
40 Add IIn.. 38 and 39,.,.,.,....,....,...,..,.,.,..,.,.,..,...,....,....,..... ~
41 Cr.dlllor child & d.p.nd.nl car. .'p, Anach Form 244' .. .., 41
42 er.dillor Ih. etd.~y or Ih. dl.ablad. Anach Schadul. R . . . . . . 42
43 For.ign lax cr.dil. Anach Form "'8 , ,.. .. , . ... ,.. .. ,. ,.. 43
44 Olh.r cr.d'l' (.ee page 25). Chock .llrom a 0 Form 3800
b 0 Form 8398 C 0 Form 880' dO Form 44
45 Add lin.. 4' Ihrough 44. , . , . ,. .. ..,. ,. , . , ,. ,. , ,. ,. ,.. . . ,. ,. . . ,. . . . . . , . ,. .. . , . ,.
46 Subtract line 4S Irom line 40. If line 4S is more than Iino 40. enter -0-. . . . . . . . . . . . . . . . . . . ..
47 S.Il-.mploymenllax. Anach Sch.dul. SE. , . , .. ,. , . , ,. . ,.. ,.. . ,. . ,. . .. ,. , . .. ,. . .. ..
48 An.rnabV. ,",nimum lax. Anach Form 6251 . . ,. .. ,. . .. ,. ,. ,. . .. . . ,. ,. ,. . . ,. .. . . , . .. .
49 Rocaplur. lax... Check illrom a 0 Form 4255 b 0 Form 881' C 0 Form 8828. . . . . , .
50 Social secunly and M.dic"'.lax on bp income nol r.pon.d 10 .mploy.r. An.ch Form 4'37 ...
51 Tax on qualified retirement plans. including lRAs. If required. anaen Form ~29 ... . .. . . . .. . .
52 Advance earned income credit payments from Form W-2.. .. .. . ... . ......... .. .. .. . ...
Tax
Compu-
tation
(See page
23.)
II you wanl
Ih. IRS 10
figure your
lax, see
page 24.
Credits
(5.. pag.
24.)
Other
Taxes
(5.. page
25.)
Payments
Mach
Forms W-2.
W-2G. and
'099-R on
pag. ,.
Refund or
Amount
You Owe
SIgn
Here
Ka.p a copy
0' this return
for your
records.
Paid
Preparer's
Use Only
"an
53 Add lin.. 481hrouch 52. Thl.ls vour total tax... ,. ,. .. . ,.. ,. . . ,. . . . , . . . . , , . . ,. . , . . ~
54 F.d,'.lIII'ICOlll, UI Wl11lIltlCl.lh"YII Irolll FO,IIlI1110Il,C".Ck ... ... 54 10,661
55 '994 ..timal.d lax paymenlS & amI. appllbd Irom '993 r.lUrn. 55
56 Earned Income credllll r.qulr.d. anach Sch. EIC (see pg. 27).
Nonlaxabl. .arn.d Income: amt ~ I I
and lyp. ~ 56
.,
57 Amounl pald WIth Form 4888 (.Xl.n.ion r.qu.'I) ...... . . . . . 57 !!",
~: ~~~~ymecialn~::~~h~:AalaxOv::~::~~.(s:Opa;:,~~:,~: ~: ,::}j:;.,:,
",,1.1;..1.
60 Add IIn.. 54 throuqh 59. Th... are ur total pa ments ,.,.,.,.,..,. . ,. . ,. ,. ,. ,. .,. ~ 60
61 IIl1n. 60 Is mar. than IIn. 53. subua., line 53 ham Un. 60. This Is th. amounl you OVERPAID~ 61
62 Amounl olllno 8' you wanl REFUNDED TO VOU,. ,...,.. ,..,.. ,.... ,. . ...,.. ,..,. ~ 62
63 Amount 01 Un. 8' you want APPLIED TO 1995 EST. TAX... ~ 63 ,'. H"',
64 IIl1n.53 Is mar.lhan IIn. SO. .ubltaCllin. 80 from IIn. 53, Thi. Is Ih. AMOUNT YOU OWE. ;!J, ,:,
For dalail. on how to pay. including whal to WIll. on your payment..ee page 32, . .. .. .... . . 64
65 Estimal.d lax p.nallV (see pa .33), A1.0 Includ. on Un. 84. .. I 65 ,,';', ,: ;'1,,':::: !,: ': ;':.,
Und.r penalti.. 01 p.rIUIV. I dedar.IhatI have .xamln.d lhis ,.lUrn and accOl1)panYlng bcn.dul.. and .lal.menlS. end 10 Ih. best
01 my ~nowi.dg..and balI.,.they are trUe. correct and compl.I.. Dedaralion 01 pr.par.r (olh.r Ihen laxpayer) Is bu.d on all
inlonnabon 01 which pr.par.r has any knowl.dg..
~ Your signature Date Your occupation
, CORRECT OFFICER
~ Spou.... slgnalUr.. II a jolnl r.lurn, BOTH musl .ign. Oal. Spou..'s occupation
Pr.par.".... Dal.
s'gnalUr.' See Attestation 1/27/95
Firm's nama (or yours... H AND R BLOCK EASTERN TAX
,I s.Il-.mploy.d) , 5 072 A JONESTOWN RD
and addr... !'.A..RRISBURG. PA
104012 NTF 1711
Chock II
..II-.mplov.d
E.I. No.
ZIP cod.
.o,.U'.4::
"
Paq. 2
45,281
.,:!J:
1,,1,..,.
34
3,175
42.106
36
37
2,450
39,656
38
39
40
8 639
8.639
',"t
45
461
47
48
49
50
51
521
53\
8.639
8,639
';'.:','
10,661
2,022
2,022
Preparer's social secunty no.
173-34-3533
43-1632899
17112-0000
Preparers EdItIon
PREPARER ATTESTATION
(For Computer Completed Returns)
TAXPAYER 1)~~NI <: R S'I4WEJ~~~ SSN /S!t 1.30 1 (,,8'705-
FIRST NAME AND INlTlAL UST NAME
SPOUSE
SSN
1
1
FIRST NAME AIID INITIAL
UST NAME
Tax Year: 1994
I ATTEST THAT ALL INFORMATION
CONTAINED IN THIS INCOME TAX RETURN
WAS OBTAINED FROM
"DENN tS R. SttE.u...E.N BE. R~R
Namelsl of individuallsl who provided tax rclUm infonnation
AND IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE.
PREPARER'S SIGNATURE: ~./' ~.~~
SSN /73/ .3</ /3.J-:k~
Date: 1/:11.(9"-
TIDS ATTESTATION MUST REMAIN
ATTACHED TO TIDS RETURN WHEN FILED
COMMONWEALTH OF PENNSYLVANIA
1994 Resident Individual Income Tax Return
PA
1994 40R
1995 PA....OAt9..~'
OFFICIAL USE
OCCUPATION:
Vour Occupation
FILING STATUS: (Check Ono)
~ ~ ~::d, liIing a join! r.lUrn
M Marriod, filing ..paral.ly
T Joinl Claim for Till Forgiv.n...
F O".....d. Dlf.
P.""It.tu'" of
0'1111
RESIDENCV STATUS: (Check Only II A pan-V.ar R..ld.nl)
P '.rtVr. A"id, Itorn 11.4 to '114
NAME/ADDRESS LABEL OPTION
Chttll ,,.,,It )'OU p&ld. pr.pa", .nd yO\l onlJ' "'Int to ,.ulv..
nl,",'addr.nlab.ln,.t"..."
o FI.cal Vaar FUer B.ginning
Endlno
VOUR SOCIAL SECURllY NUMBER
186-30-6875
SPOUSE'S !:!IN (Iv,n it filing "PltatllYI
204-30-9264
First Name. Initial & Spou.o'.
R
CORRECT OFFICE
Spou..'. Occupation
La., Name
SHELLENBERGER, DENNIS
Homo Addr...
623 STATE ST APT 2
City or Po" Offlc. SIal. Zip Codo
LEYMONE PA 17043
Check herellthlal. a change 01 DAYTIME TELEPHONE NUMBER
address lrom la.t year's return. ( 71 7 ) 761- 7 3 78
SCHOOL DISTRICT NAME Iw'", '" .... 0... >t. ''''1 SCHOOL CODE
WEST SHORE 21900
OFFICIAl. USE
INDICATE HOW MANY OF
EACH FOAM/5CH.IS ATT.
1.. GROSS COMPENSATION........................... 1. 54,714
~ 1b. UN REIMBURSED EMPLOVE BUSINESS EXPENSES...... 1b 609
o lc. NET PA TAXABLE COMPENSATION....................................... 1c
A R 2. TAXABLE INTEREST...... ... .. .... .... . , . ............... .... .. .... . ... 2
T
T M 3. TAXABLE DIVIDENDS.. .. . .. . . .. .. . .. .. . .. .. .. . .. , .. . .. .. .. .. .. .. .. .... 3
~ ~ 4. NET INCOME OR (LOSS) FROM OPERATION OF BUSN.. PROFESSION OR FARM.. 4
H E 5. NET GAIN OR [LOSS] FROM SALE, EXCHANGE OR DISPOSmON OF PROPERlY,. 5
V
Co
~ R 50. AMOUNT OF EXCLUSION FROM UNE 20 OF PA
C 0 SCHEDULE PA-19 .. , .. .. .. , . .. . .. .. .. . .. .. .. . .... 5.
KElDa NotllU:lIlO' In Lln. 5 aooll.1
R 6. NET INCOME OR [LOSS) FROM RENTS. ROVALTlES. PATENTS & COPYRIGHTS... 6
~ 7. ESTATE AND TRUST INCOME.. ...... ... . .. ........ ... ........ .. .... . .., 7
8. GAMBLING AND LOTTERV WINNINGS. . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . ... 8
9. TOTAL PA TAXABLE INCOME (ToUIL,nu 1c, Z. 3,., 5.1. 7 &1--00 NOT DEOUCT(LOSSESU. 9
TAX 10. TAXLIABIUTY MultiolyUn.9 bY2.8\'o(.02Bl ................................ 10
11. TOTAL PA INCOME TAXES WiTHHELD.................................... 11
12. ESTIMATED PAVMENTS AND CREDITS
12. Cr.dit From 1993 PA R.turn .. .. .. .. .. .. .. .. . .... 12a
12b 1994In"allmonl PaymonlS...................... 12b
12c P.ymont with 1994 Roquosl for Ext.nsion.. .. ... .... 12c
Pl.... U..
Vour Correcl , of Forms W-2
School District Cod. , of Schod(.) UE 1
54,105, 01 Sch.d(.) A
, 01 Sch.d(s) B
, 01 Sch.d(.) C
. of SCllldll) AK-l
, 01 SCh.d(.) F
, 01 SCh.d(.) C-F
An.ch All R.qulr.d
DocumonlS , 01 Schod{s) 0
.oISClltdl.)D-71
, 01 Sch.d(s) 19
, 01 Sch.d(.) E
54,105, 01 Schod(.)J
1.515
1,532
This R.Mn Must B.
Fil.d On Or B.lor.
Apnl 17. 1995
A
P N
AD
~ C 12d TOTAL PAVMENTS AND CREDITS..... .. ........... .... .. ............
E ~ 13. TAX FORGIVENESS FROM PA SCHEDULE SP
~? 131 O.p.nd."tsCllim.dfromLln.t.p.nllloIPAsCh.dul.SP.... 13a
5 T 13b Eligiblktylncom,ftomLln,:I,PlnIVofPASe",.aultSP ...... 13b
S
13c Ftd.,.IAdjullla araIJlncomt from Lln, Z. Pan III 01 PA Sell. SP 13c
12d
See Instructions For
R.poning E.timat.d
TalC Cr.dlt And Claiming
Till Forgiv.ness
13d TAX FORGIVENESS FROM UNE 8. pan IV of PA Sch.dul. SP . . . . . . . . . . . . . .
14. TOTAL CREDIT FOR TAXES PAID TO OTHER STATES OR COUNTRIES ....... . . .
15. EMPLOYMENT INCENTIVE PAYMENTS CREDIT. . . . . . . .. . . . . . . . . . . . . . . .. . . ..
18. TOTAL PAYMENTS AND CREDITS (Total Un.. 11. 12d, 13d. 14 and 151. .... ... ...
o
TV
AE
X R
o P
U A
EV
M
oE
R N
T
13d
14
15
18
, of Sch.d(.) SP
. of Sch.d(.) G
. of Sch.d(.) W
1 532
17. TAX DUE See Instructions lor paying yourtlll dU..llles.'h.n $1.00. no p.ymonll. r.qulr.d.. .. , , ..... ... .. 17
18. OVERPAVMENT...................................................... 18 17 Doubl. Check Vour M.th
190. Amount of Un. 1810 be REFUNDED..... , .. ........ .... .. .. .. ..... .., .. ..... ... ...... ..... 19. 17
19b. Amounl 01 Un. 1810 be CREDITED 10 VOUR 1995 ESTIMATED TAX ACCOUNT.. ..... ... ...... ..... 19b
19c. Amounl of Un. 1810 b. DONATED 10 the WILD RESOURCE CONSERVATION FUND... ......... ... .. 19c
19d. Amount 01 Un. 1810 be DONATED to tho U.S. OLYMPIC COMMITTEE. PA DIVISION. .. ... ...... ..... 19d
~;,~:~r:~:~~'~:,~f:.fIUrY.1 O'CWll"a' I nl"" "lm,n'1I1"" rltur", ,nCIUOlnVaCComDAn)'lnv Icnlawlll &/'10 .tal,mll"', '''11 U' 1"' Dill ot my lnGwllagt ano 0....,.('. UUI,
S.gft&tur. at prlll&"'. Diner 1I'lln '..al.,." OUIO on .1I,n'ormltlon Of wnlen
'h. orlDl'" "II .ny IInowlIOQ'
X H AND R BLOCK EASTERN TAX
Preparer's Telephone Number Date
(717) 652-1202 /27/1995
PA12 NTF7519
Sign ..
here
Your Signature
X
0.,.
..
Spouse's signature lllla'nt. BOTH mUI'llon .".n ,t anly an. "Ad ,ncam.)
X
ClIO'l''';l't ~1I'1!l1 SllU.....'. On,y. 1994 N.lco. Inc. Ng4PA I
PA-40 UE-l (9-94)
SCHEDULE UE-1
PA DEPARTMENT OF REVENUE
Employe~. Telephone No.
(717) 737-4531
17120
Employe(. Identillc.tion No. (EIN)
23-2172299
1.
609
2.
3. PART C: SMALL TOOLS AND SUPPUES
3.
609
c.
d.
e.
l.
g.
Ve.
Ve.
Ve.
Ve.
No
No
No
No
I.
I.
k.
I.
Enllr dlor.datlon ",.thod unCI and PlfClftug'.IFrom Form 2101 or othl' g,,,.,atlyaa:'Pl.d lII.thod ,lIowAbl, for PA p~,po''')
Enter deprecl.tion expense (Mulliply Une) by Une k). (Include on Une E4 .bove) . . . . . . . . . . . . . . . . . . . . . .
Actual Expenses
Gasoline, all, repairs. maintenance, Ite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. m.
Vehicle Insurance. ....................................................................... n.
Total vehlel. r.nlal. (whenowncaroremploy.~scarnot .v..l.bl.)................................. o.
Valu. ol.mploy.r-provld.d v.hlc1. (only" l00"k ol.nnual 1....1. Includ.d In your W-2) . . . . . . . . . . . . . .. p.
Total Un..m, n.o .ndp....... ........................................................... q.
Mulliply Un. q by tho bualn... p.re.nt.g.'rom Uno d................................ ........... r.
(Includ. on Un. E4 .bov..)
PART F: OFFICE OR WORK AREA EXPENSES Allach AddlUonal Sheets II Needed
F1. Do.. your .mploy.rf.quirt you to ",,,ntain..uitabl, work I,...part from I'll, or II If pr.mln.1 ...... Yes
F2. Is this work ar.. the principal pl.e. wher. you perform the duU.. 01 your employment? . V..
F3, Is this work oro. used regularly end excluslvely to perform the duUes 01 your employment? Ve.
II you answered YES to ALL three que.Uon., conUnue. tl you an.wered NO to any
quesUon, you may not claim wo", afea !fXPense..
F4. Enler here tho total valu. 01 office suppll.. which you purchased e.cluslvely lor use In your office. . . . . . . . .. F4.
Descrtbo In tho sp.ee bolow the supplies you purchased .nd the costs.
SP.Cify:
m.
n.
o.
p.
q.
r.
No
No
No
F5. Otllc. or work are. e.p.ns... Enter your total yearly amounts.
.. Deprecl.tion Is (homoowne" only) . ... .... .. .. .., ........ .... .. . ... ..... .. .. . ... . ... .. . . .... ..
b. Real est.t. t..es .. .. . .. .. .. .. .. .. . . .. .. .. .. . , .. . . , .. .. .. . . .. .. .. .. . .. .. .. . .. . .. . , .. .. . .. b.
c. Mo"g.gelnterest (homoowne" only) ... . .. . .. .. .. .. . .. .. .. .. .. . . . .. . . . .. . . .. . , . .. . .. .. . .. . .. c,
CONTINUE PART F ON PAGE 2 OF nils SCHEDULE.
PAUE11 NTF 7523
C::IllyIID"t ~o,~s SOftwI" Only. 'U. N,ICO, into N',f,PAUE 1
mles
miles
%
%
186-30-6875
d.
PA Schedule UE-1(9-94) SHELLENBERGER. DENNIS R
d. Utilities, . . , . . . . . . . . . . . , . . . . . . . . . , , . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . , . . . . , . . . . , , .
e. Property Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . .. e.
I. Propeny Malnlenence (describelhe costs Incurred In melnlainlng Ihe propeny below end 101aJ) . , . . . . . . . . . ., f.
Specdy:
Pege 2
g. Olher Apportioneble Expenses (describe Ihe costs Incurred below end 10Iel)....... ..... ... ....... ... ... g.
Specily:
Ren1(only renlers mey claim 'his e.pense) . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. h.
Tolel (edd Unes elhrough h) . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. I.
Business percentege 0' propeny. Divide tOlal squere foolege of propeny used OS omce or work eree by the
10lel squere foolege ofthe entire propeny (round to 2 digits) . .... ...... ........ .. ... .., ............. I.
F5. Apponloneble Expenses. Multiply Unel by Ihe percenlege from Une).. .. . .. ..... ... ... .... ..... ...... F5.
7. TOTAL OFFICE OR WORK AREA EXPENSES. ADD LINES F4 AND F5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 7.
PART G: MOVING EXPENSES Attach AddlUonal Sheets If Needed
Gl. Old you work for 'he same employer before end ener your move? . . . . . . . . . . . . . . . . . . . . . .. lJYeSD No
G2. Were you required by your employer 10 move Irom one olfocleJ workpiece 10 enolher omclal
wOrleplace os e condition 01 employmen17.. ...................... ... ....... .. ......
G3, Did you move ellhe request of your employer? .. .. .. .. .. . .. . .. .. . .. .. . .. . .. . .. .. .. .
If you answered YES to all three quesUons, please canUnue.
G4, Enler Ihe number 01 miles:
a. From your old hOIT18 to your new workpiece.. ... .. ... .. ......... . .. .. ., .. .. . .. ... ..... ........ a.
b. From your old home 10 your old workplace ................................................... b.
c. Subtract Uno b from Una a and enter here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. c.
Only It Una c Is 35 miles or more, conUnue. If not, you may not claim moving expenses.
G5, Transponation e.penses in moving household goods and personal enects . . . . . . . . . . . . . . . . . . . . . . . . . . . .. GS.
G6. Travel. meals and k>>dging expenses in actual move lrom previous residence 10 your new residence. . . . . . . . .. GS.
B, TOTAL MOVING EXPENSES. ADD LINES G5Ind G6 ... ...... .... . . . , . ... . , .. . ... .. . .. ... ....... B.
PART H: EDUCATION EXPENSES Attach AddlUonal Sheets II Needed
H1. Was this education required either by law or by your employer 10 retain your presenl position
or job? .. . .. . .. .. .. . .. .. . .. .. .. . .. . . .. .. .. . .. , .. . . .. .. . .. . . .. .. , . . . .. .. . ... 0 Yas 0 No
It you answer YES, conUnue.
H2. Did you need Ihis education 10 meet entry level or minimum requirements 10 obtain your job?
H:J. Wil! thiS course 01 study or program. II continued, quaJify you lor a new business or prolession?
If you answered NO to quesUons H2 and H3, pleiise conUnue.
H4. Name 01 educationel Institution:
H5. Course 01 study:
HB. Tuilionor'..s:........................................................................... H6.
H7. Coursa malarials: .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. H?
He. Travel expenses: ......................................................................... He.
9. TOTAL EDUCATION EXPENSES. ADD LINES H6. H7 AND HB. . . . . . . . . . . . .. . . . . . . . . . , . . . . .. . . .. . .. . B.
PART I: DEPRECIATION OlllER THAN FOR VEHICLES AND OFFICE OR WORK AREA) Attach AddlUonal Sheets II Needed
Description 01 (e) Cost or Olher (b) DepreclaUon (c) Depreciation (d) Section 179
Propeny Basis Mathod Deduction Expense
h.
I.
I.
Byas BNO
Yas No
Byas BNO
Yes No
(e)
Add (c) . (d)
10. TOTAL DEPRECIATION EXPENSES. ADD COLUMN (e). ENTER HERE. . . . . . . . . . . . . . . . . . . , . . . . . . . . .. 10.
PART J: MISCEllANEOUS EXPENSES Attach AddlUonal Sheets II Needed
Describe In dalailln Ihe spece provldad below or on a seperala .heet your e.panse. lrom Une 4 01 your Faderel Fonn 2108 & othar ..pansa.
allowable 10 cenain employes receiving nonemploye compensaUon for PA Personellncome Tex purposes. Describe eeeh e.pan.e & your cosL
11. TOTAL MISCELlANEOUS EXPENSES. ADO All EXPENSES AND ENTER HERE. . .. . . ... ., ... .. .. ,... 11.
PART K: TOTAL ALlOWABLE BUSINESS EXPENSES .
12. ADD THE EXPENSES FROM UNE 5. PAGE 1 AND PARTS E llIROUGH J . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12. 609
13. ENTER REIMBURSEMENTS FROM YOUR EMPLOYER. INCLUDING REIMBURSEMENTS FOR EXP, CLAIMED
ON UNE 12. WHICH YOUR EMPLOYER DID NOT INCLUDE AS INCOME IN "STATE BLOCK" OF YOUR W-2. 13.
14. SUBTRACT LINE 13 FROM UNE 12... .. , , .. , .. . .. .. , .. ... , . , . . . .... .. . . .. . . , . .. , . , .. , . ... .... 14. 609
IF UNE 13 IS GREATER THAN UNE 12. ADD DIFFERENCE TO YOUR i1<BL COMPENSATION ON LINE la OF YOUR TAX RTRN. IF LINE 12
IS GREATER THAN LINE 13, ENTER DIFFERENCE AS DEDUCTIBLE EMPLOYE BUSN. EXPENSES ON LINE lb OF YOUR PA TAX RETURN.
PAUE12 N'fF 752.
C:'Y'IlJI'II c=....s Setl......'. 01'11'1'. UU ~.'ICO. 1"(. N9.PAUEz
,~
miles
miles
I Employ.,', Id.ntiflullon Numb.,
23-2172288
Employ.,'s lI.m., .dd"... .nd ZIP cod.
COMMONWEALTH OF PENNSYLVANIA
CORRECTIONS
HARRISBURG PA 17120
.:1. ~'~"_"lpaf ~'''''':~o~~~.~'i!~._:f->~-'
: :';\~~_~ ~.~.~ ~:.~8 ?;r~~r :.:j;;:.>.:<{t}.ih~~:71~
~ $ocl,1 ucuIUy W'O"
54,713.64
.2, ',d,,.,, Inco.... :.11X ::w1~"".IG
.;-:;:~:::]~~,~ ~~<>..~.~._:'Y::;:\t),:~:'
" Social lIeufl1., taw: wl,,,,,.ld
3,382.25
$ M,dlca,. wlgu .nd tip.
54,713.64
. M.dln,. t.. withheld
783.45
Employ.... Socl.1 SICUflty Numb.,
I 188-30-8875
'.'~d".nC8 ~ICP.ym.nt
10 Cap,nd.nl car. bln,flu
I Emplon,', ".m, Ifi,... middl.. lutl
OENNIS R SHELLENBERGER
11 NonQUlliflld plt"s
12 D'n."" Included In Bow
13 SII Inlln. for BOM 13 15 O.c....d ',nlion D.f,uld
623 STATE S1 PI.n COmotnUllon
LEMOYNE 0 ~ 0
PA 17043
Employ.... ICd'U' ,nd ZIP cadi
10,5111'1 Employe,', 1111. ID No. 17 Sf'" WlglI. '10. lie. 11 Slate Incom. IIX 19 Loc.lilV nlm. 20 Loul Wlges, liP', IIC. 21 Loc.1 .ncom. IIX
...-..p.i.............2j":il..j722sS...-........... ._......_.5.4~".3. 64.-.... .....--;-...531...9'..-. [:E'M'OVNE"B'iiiii:j--" -....-........s.ji;"fi:i'764.... .............54.7":'.1'3.........
:crm W"2 Wage and Tax
Statement
1994COPY 1 - TO 8E FILED WITH EMPLOYEE'S CITY
INCOME TAX RETURN
o","_,'U .1 ,.. h.nll'''' . "'1.,..1 "....lI.. h'..,n
OR LOCAL 0'" N,. IUS'OODI
,..., ,.1.,."... it ".tII, I.'........ I" 1...,.,1 R.....II... s.rvtu
Form 1040
Usa L
th. A
IRS .
lab.l. f
OthBr-
wise. H
pl.... E
prtnt ~
or typ..
Pr..ld.nUal ..
El.cUon Campaign ,
1
2
3
4
Flllng Status
(S.. p.g. 12.)
Chsclc only
one box.
exemptions
(S.. p.g. 13.)
If more than six
d.p.nd.nts.
... p.g. 14.
Income
Attach
Copy B 01 your
Forms W-2,
W-2G, and
t099-R here.
II you did not
g.t a W-2. s..
pag. 15.
Enclos.. but do
nOlanach, any
payment wilh
your return.
Adjustments
to Income
Caution: See
Instructions. .. ..
O.partrnBnl 01 th. Treasury -- Inl.rnal R.venu. Service
U.S. Individual Income Tax Return
.1. OMB No. 1545-0074
Vour .oclal .ecurlty number
186-30-6875
Spou.... .oclal .ecurlty no.
204-30-9264
For'''I"I.,.un.'-Oec. 3t. tI,., "rath.rtlw...,..' bl
. ,n..lnd'"
1994 (99) IRS U'I Only.... Do "01 wnt. 01 Itlal,ln trUI'D'U,
Not.: Chsclclng
Ves Ho "Vas' will not ch.nge
Do you want $3 to go to this fund? .. .. .. . . .. .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . X you"ax o...duc.
your refund.
If e Inlr.hlrn. do.. ur soouse w.nt $3 10 0 10 this fund?.. .. .. .. .. . .. .. .. .. .. .
Slngl. For Privacy Act and Paperwork ReducUon Act HoUc., ... pag. 4.
Marri.d nllng joint r.hlrn (ev.n II only one h.d Incame)
X Mamld filing upuat. return. Entlt Ipall..', SSN abavI' rulln.me ".".... LORETTA H SHELLENBERGER
H..d of hous.hold (wilh qualllylng p.rson). (S.e page 13.) If qualllylng p.rson Is . child bUI not your d.p.nd.nl.
enter chlld's name her.. ~
Quail n widow(.,) with d.o.nd.nl child ( r. .oouse dl.d~19 ). (S.. o. e 13.)
X Vou..ell. II your par.nt (or .omeone .I.e) can claim you as . d.p.nd.nt on hls/h.r tax} N.. .......
return. do not check bolc Sa. But be sure to check box on Une :J3b on page 2 ~:~~'d on'.
b Sou...............................................................
C Dependents: (2)Chlc. (3) IhV" 0101011. (4) Cap,no,nt, (NO.Or No. or yO'"
If und" oapendants sOCIal ucunty llla(l,on,nlll to O'~l.U In elllld"n on Ie
(1)Nall'l,I'ltSt.inlbal. and l...tn'II'II' av, t numtler you t~ 1.1:' who:
nnln
DENNIS R SHELLENBERGER
623 STATE ST APT. 2
LEYMONE, PA 17043
5
6a
d If your cntld dIdn't !Iv, ...,It/\ you but" cl&lI'1'1'd... your o,p,,,d,"t ,,"o,r,pre-1U5 avr"m,"I. cn'tlc her, ~
e TOlal number 01 exemptions claimed. . . . , . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 w,vn. ulann. tIP'. ,I~ AU.atl'l Forrnt'IW-Z
8a Taxabl. Inl.,.Sllncome (..e pag. 15). M.ch Schedule B II ov.' $400 . . . . . , . . . . . . . . . .
b Tax-.xempt Inler.st (.ee pg. 16). DON'T Include on line 8a 8b
9 Dlvld.nd Income. Anach Sch.dule Bilov.'$4OO.................................
10 Taxabl. ,.Iunds, a.dilS. or on..ts 01 slot. and local Income tax.s (... p.ge 16) ........
11 A1lmonyrec.iv.d...................................,......................
12 Busln.s.lncome or(lo.s). Anach Schedul. C or C-EZ. ................ ........... .
13 Capital gain or (Ios.), II ,.qulr.d. anach Schedule 0 (... page 16) ..... . . . . . . . . . . . . . .
14 Olher gains 0' (Ioss.s). An.ch Form 4797. ......................................
15a TOlallRA dlstribudon. .. ~ I b Taxable amounl (s.e pg. 17)
16a Toul p,n,io", and ,,,,,,,ibn. 168 b Taxable amounl (see pg. 17)
17 R.ntal realastal.. royaltie.. partn.,.hlp.. S corpor.don'.lI\lsts. elc. Anach Schedul. e ...
18 Farm Incame or Ooss). Anach Sch.dule F.. . .... ... ....... ...... ... ........... .,
19 Un.mployment camp.ns.lien (se. pag. 18). .... ... ....... ......... .............
20a SOclal.ecurity b.nellts . ~ I b Tax.ble amount (s.. pg. 19)
21 Olher Income,
22 Add Ihe amounts In Ihe lar ri hI column lor IIn.. 7 throu h 21. Thl. i. your total Income. ~
23a Vour IRA d.duc1ion (s.e p.ge 19). . . . . . . . . . . . . . . . . ... 23a
b Spouse'. IRA d.duclien (.ee pag. 19) . . . . . . . . . . . . . . .. 23b
24 Moving .xp.nsa., Anach Form 3903 or 3903-F ... . . . . . , 24
25 On.-hall 01 ..II-omploymenllax.... , ...... .. .. . .. . .. 25
26 Sel'-.mployed h.a1lh Insu,ance d.duc.on (.ee page 21).. 26
27 Keogh ,.d'ement plan & sell-.mploy.d SEP deduction. .. 27
28 P.nalty on .1U1y withdrawal 01 .avlngs. . . . . . . . . . . . . . . . . 28
29 Alimony paid. Reclpl.nl's SSN~ 204-30- 9264 29 7,250
30 Add lines 2:liJ Ihrouch 29. These are your tobl adJustments, , . . . . . . . . . , .
Adl. Gr. Income 31 SubtrOlcllino 30 trom line~. ThIS IS vcur 3dlusted gross Income.
J'01)J 104012 ....= 0:11'0
1
. Iiv.d with you
. didn't Iiv. With
you due to divorce
01 upata(l,on lu,
p'v""1
O.o,nd."tJonIC
"01 '"I,r.d 'bov.
Addnumtl."
,,,I,,,don
linn ,Ulov. ...
"'.,,,i',
7
8a
52,058
473
F':;'"
t,:',:_,:
9
10
11
12
13
14
15b
16b
17
18
19
20b
;:a~ti!!U:
21
22
52,531
....... ~ 30
... ~ 131
';reC.1rcrs EQltJon
7,250
45.281
t'orm 1040 (19901)
Farm 1040 (1994) DENNIS R SHELLEN3ERGER 186 -30-6875
32 Amounllram line 31 (adjusled grass ,"came) .. , . . .. . . , .. .. .. .. .. .. . . .. .. .. . .. , . .. .. 32
33a Check il: 0 Vau were 6~/alder. 0 Blind; 0 Spouse was 6~/alder, 0 Blind.
Add Ihe number 01 boxe. checked above and enler Ih. lalal h.re . . . . . . . . . . .. ~ 33a
b II your par.nl (or sameon. .Is.) can claim you as a dep.nd.nl. chock here. . . .. ~ ~3b
o II you are marr1.d filing s.paral.ly and your spaus. itemiz.. d.ducllans or you ~ 330
are aduaJ-stalus alien, see page 23 and check here.......................
34 E I {Ilamlzed deducUan,'ram Sch.dul. A. IIn. 29. OR }
Ih~.r Slandord deducUan shawn b.law lor yo'" liIing s.lalU'. Buill you checked
I Iny box an line 331 or b, go 10 page 23 10 find your standard d.ducllan.
arger It you checked box 33c. your stanClard deduction Is zero.
01 8 Single -- $3,800 8 H.ed 01 hau..hald -- $3,600
your. 8 MarrI.d filing jalnlly or Cualllying widaw(er) -- $8.350
8 Married filing ..paral.ly -- $3,17~
35 SubtraCllln. 341ram line 32. . , . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . , . . . . . . . . . , . . . . . . , . .
36 IIl1n. 321. $a3,850 or I.... mulllply $2,450 by Ih. laral numbor alex.mpllan. claimed an
line Be, IIl1n. 321. av.r $83,850, ..eth. work.h..1 an page 24 lor Ih. amaunlla .nl.r . . . . . .
37 Taxable 'ncame. Subtracllln. 38 'ram IIn. 3~. IIl1n. 361. mar.lhan IIn. 3~, .nler -0-. . . . . . .
38 Tax. Chock Illram a IS! Tax Tabl., b 0 Tax Rale Schedule.. 0 0 Capilal Gain Tax Wark-
.hee~ or dO Farm 881~ (... ". ,.~ Amounllram Farm(.) 8814 ~ e
39 Addillanall..... Chock Illram aD Farm 4970 bD Farm 4972 ........,..........
40 Add IIn.. 38 and 39.....,........,.......................................... ~
41 Cr.dillar child & d.p.nd.nI car. .xp. Anach Farm 2441 .. ... 41
42 Cr.dillar Ih. .Id.rly or Ih. di.abl.d. Anach Schedul. R. . . . . . 42
43 Foreign tax cr.dll. Anach Farm 1116...,.......,......... 43
44 Olh.r cr.dilS (... page 25). Chock Illram a 0 Farm 3800
b 0 Farm 8396 0 0 Farm 8801 dO Farm 44
45 Add Iin.. 411hraugh 44. ... .. , , .. .. . . . , , ... . , ... . ... .. . , .. . .. , .. . . . . . , , ... . , , , .
46 Subtract line 45 from line 40. If Une 45 is more than line 40. enter -0-. . . . . . . . . . . . . . . . . .. ..
47 Sell-.mplaymenllax. Anach Schedul. SE............................,.......,.....
48 Alt.rnallv. ""nimum I... Anach Farm 6251 . , .. . .. .. . . .. . , .. , .. , .. .. . .. , .. . , .. .. .. . .
49 Recaplur. 'axe.. Check II from a 0 Farm 4255 b 0 Farm 8611 0 0 Farm 8828. . . . . . .
50 Social secunry and Medicare tax on tip income nol reponed to emplover. Attach Form 4137 .. .
51 Tax on qualified re~remenl plans. including IRAs. If requirod, attach Form 5329 . . . ... . .. ... .
52 Advance earned incomo credit payments tlom FormW-2. .............................
Tax
Compu-
tation
(See page
23.)
II you want
the IRS 10
ngur. your
lax, see
page 24.
Credits
(Se. page
0)4.)
Other
Taxes
(S.. page
25,)
Payments
Anach
Farms W-2.
W-2G. and
lD99-R an
pag.l.
Refund or
Amount
You Owe
Sign
Here
K.ep a copy
of this loturn
for your
records.
Paid
Preparer's
Use Only
,..rJJ
Paq. 2
45,281
i"':":'
,_.,:...::.
34 3,175
",.,'.
"'",.,;:
35 42,106
36 2,450
37 39,656
38 8,639
39
40 8,639
45
46
47
48
49
50
51
52 I
531
8,639
53 Add Iin.. 461hrauqh 52. Thl.ls vaur lalal tax. . . . .. . .. .. .. . . .. . . , . . . . . .. . , . .. , .. .. ~
54 Fldlril,n~mI1i. wltllnl'd.1f inrl,'rom ~o',"1'110n.C~ICll . .. ... 54 10 r 661
55 1994 ..bmaled lax payments & amI. applied Iram 1993 relUrn. 55
56 Earned Income credit II r.quired, anacn Sch. EIC (.ee pg. 27).
Nan'..able earned Income: amI. ~ I I
and type ~ '.56
57 Amount paid Wllh Farm 4868 (.xt.n.ian r.qu.st) .. , . . . . . . . . 57
58 Excess .aclal.ecurlty and RRTA lax Wlthh.ld (... page 32). . . 58
59 Other payments. Chock II from a 0 F"m ,.,. b 0 F"m 'm. 59
60 Add IIn.. 54 thrau h 59. Th... ar. your lalal ayrnenls............................ ~
61 IIl1n. 60 Is mar. then line 53. subtracllln. 53lram IIn. 60. This 1.lhe amount you OVERPA'D~
62 Amounl allln. 61 you wanl REFUNDED TO VOU . .. .. . .. . .. .. .. . .. .. .. .. .. .. .. .... ~
63 Amount 01 line 81 you wanl APPLIED TO 1995 EST. TAX... ~ 63 \',:11;::
64 II line 53 I. mare Ihan IIn. 60. .ubtract Dn. 60 Iram line 53. This 1.lh. AMOUNT VCU CWE.",
Far d.lall. on haw 10 pay. Including what 10 wril. on your pal"".nt. ... pege 32. . , . . . . . . . .. '64'
65 Estimated tax penalty (see paqe 331. Also Include on line 64. . . 65 :;11;::. J\;: 'i/fii;!!.I~!:i;~'i:I~!':"
Und.r penaJ1l.. 01 pe~ury. I declar. thaI I have examined Ihis r.lUrn and accan)panying .chedul.. and .tatemenlS, .nd to Ihe beSl
01 my knowl.dge and beliel. Ihey ar.lnJ.. carroct. and campl.f.. Declarallan 01 preparer (alher Ihan laxp.y.r) Is bas.d on all
Inlannallan at which preparer has any knawl.dg..
~ Your signature Date Your occupation
r CORRECT OFFICER
~ Spouso's signature. If a Joint relurn: BOTH must sign.
8,639
':'i
','),;'
:,.::/k'l
,,,.
:':::i'!il:
.,i.,l,j,.I'
60
61
62
10,661
2,022
2,022
Oal.
SpoW3e's occupation
Preparer.... Dale
SignalUr. r See Attestation 1/27/95
Firm'. name (or yours... H AND R BLOCK EASTERN TAX
If sell-employed) r5072 A JONESTOWN RD
"ndaddre.. HARR!S3URG. PA
104012 ~Tj:: 811 1
Check II
..II-.malaY.d
E.I, No.
ZIP cad.
Prepare"s social secunty no.
173-34-3533
43-1632899
17112-0000
Prepare" Edition
::~~,.~~~ :~....s ~:'~.....,. ':R,~. '9~' ......: .
PREPARER ATTESTATION
(For Computer Completed Returns)
TAXPAYER_1);:'~Nf (' R SHfl.J~!J~~ SSN /5!/" / .30 /1,9'7.5-
fiRST /lAME A1/D II/IllAI. LAST /lAME
SPOUSE
SSN
/
/
FIRST /lAME AND II/rrw.
LAST NAME
Tax Year: 1994
I AITESTTHAT ALL INFORMATION
CONTAINED IN THIS INCOME TAX RETURN
WAS OBTAINED FROM
"DENN IS R. SftE.L.L.E.t>J BE R<;:E.R
Name(s) of individual(s) who provided llIX relurn infolTlUltion
AND IS TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE.
PREPARER'S SIGNATURE: ~ /' M~
SSN 173,..31./ '3J-:g~
Date: ,/:U.!?,,-
TIDS ATTESTATION MUST REMAIN
ATTACHED TO TIDS RETURN WHEN FILED
~
COMMONWEALTH OF PENNSYLVANIA OFF'ICIAI. USE
1994 Resident Individual Income Tax Return
PA FILING STATUS: (Chock Ono) OCCUPATION:
o Fiscal Year Flier Beginning 199' 40R 'r- Your OccupaUon
Endino 1995 PA,,'DRII-I.t' J MBlTiod, filing a joinl roturn
YOUR SOCIAL SECURITY NUMBER SPOUSE'S :ISH l'~'" if 'illng ,lpI,atlly) M MBlTiod. nling separatoly CORRECT OFFICE
186-30-6875 204-30-9264 T Joint Claim lor Tax Forgivoness Spou.e's OccupaUon
La.1 Name Fir.1 Name. IniUaI & Spou.o'. F a'Clued, 0&11
FII'I,lrI1I1tn 01
SHELLENBERGER, DENNIS R o..t"
Home Address ~EnIDENCY STATUS: (Chock Only II A Part-Year Rosidenl)
623 STATE ST APT 2 P Patt Vt. A'I.d.lrom tie. to '190'
Cl1y or Post Olllco Stale ZIp Codo NAMElADDRESS LABEL OPTION
LE'iMONE PA 17043 fi 'Ch.ell ".,.1' you Uld. prlPAltland yOll only .'1'11 II) "CIlVI'
nUllflddr...lab,ln,.t I".
IT Check here II this Is a change 01 -\ DAYTIME TELEPHONE NUMBER OFFICIAL USE
address from Ialt year'. return. (717) 761-7378
SCHOOL DISTRICT NAME iw"," ,.. ,,,I a... 31, ..", I SCHOOL CODE INDICATE HOW MANY OF
WEST SHORE 21900 EACH FORM/5CH.IS An.
Please U.a
10. GROSS COMPENSATiON....,..................,... 1. 54,714 Your Coneet I 01 Forms W-2
lb. UN REiMBURSED EMPLOYE BUSINESS EXPENSES...... 1b 609 School DismcI Code I 01 Sched(s) UE 1
54,105 -
1C. NET PA TAXABLE COMPENSATION...............,..,.................... Ie I 01 Sch.d(s) A
-
2. TAXABLE INTEREST. . , . . . . . . . . . . . , . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 01 Schod(s) B
-
3. TAXABLE DIVIDENDS... , ..... .. .. . .... ... . .. .,. .. , ... ...... .. .. .... ... 3 . 01 Sched(s) C
-
4. NET INCOME OR [LOSS] FROM OPERATION OF BUSN.. PROFESSION OR FARM. . . . 01 SChld(.)AK-1
-
5. NET GAIN OR (LOSS] FROM SALE. e.XCHANGE OR DISPOSITION OF PROPERiY. . 5 . 01 Sched(s) F
-
. 01 Sch.d(s) C-F -
5.. AMOUNT OF EXCLUSION FROM LINE 20 OF PA AU.ch All Requirod
SCHEDULE PA-19 .. .. . . .. .. .. . .. .. .. . .. . . .. .. .... 5. Documents I 01 Schodes) 0
100 Notll'lctlldl.n!.ln,5.bov'l -
6. NET INCOME OR (LOSS) FROM RENTS. ROYALTIES, PATENTS & COPVRIGHTS... a . of 5cIII"II) 0-71
-
7. ESTATE AND TRUST INCOME... . ....... .... . , .. . .. .. , .. ... . .... ... . .... 7 . 01 Sched(s) 19
-
a. GAMBLING AND LOTTERY WINNINGS. . , . . . , . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . a I 01 Sch.d(s) E
54,105 -
9. TOTAL PA TAXABLE INCOME (TouILu'Il.lc. 2.3.....5, I. 7 &.--00 NOT OEDUCTILOSSESn. 9 . 01 Schod(s) J
-
10. TAX L1ABILliYMuttip!v Une9 bv2,a\~(.02a) ................................ 10 1,515
11. TOTAL PA INCOME TAXES WiTHHELD.................................... 11 1.532
12. ESTIMATED PAYMENTS AND CREDITS
12a Credit From 1993 PA Return.. .. , .. .. .. . .. . .. .... 12e This Renn" Must Be
12b 19941nslallmenl Payment........"............. 12b Filed On Or Belore
12c paymenl wilh 1994 Requosllor Extonsion... ........ 12c April 17. 1995
12d TOTAL PAYMENTS AND CREDITS. ................................... 12d
13. TAX FORGIVENESS FROM PA SCHEDULE SP Sae Insuuctions For
13. OIP.nd.ntsCwrn.d Itorn Lln. t.P.rtlll01 pAScll'dul.SP.... 131 Roponlng Eslimated
13b ElIllitlllity Incorn. hom LI",3, Part IV ot PA Scll.dul. SP ,. . . .. 13b Tex Credn And Claiming
13c lI:'.d.t.IAdju.t.d Gtolllncom. t,om I,ln. Z, P.rt III ot PAScII, SP 13c Tax Forgiveness
13d TAX FORGIVENESS FROM LINE a. pan IV 01 PA SChodule SP . . . . . . . . . . . . . . 13d I 01 SChed(s) SP
14. TOTAL CREDIT FOR TAXES PAID TO OTHER STATES OR COUNTRIES.... . ..... -
14 I 01 SChed(s) G
15. EMPLOYMENT INCENTIVE PAYMENTS CREDIT. . .. . . . . . . . . . . . . . . . . . . . . . . .. . -
15 I 01 sched(s) W
1a. TOTAL PAYMENTS AND CREDITS rTolal Unes 11. 12d. 13d.l' end 15)........... 1 532 -
la
17, TAX DUE See insuuctionslor paying yourt.. duo. II Ie.. than $1.00, no p.yment is required.... . . ,. . . .... . . 17
1a. OVERPAyMENT..............................,....................... 18 I 17 Double Cheek Your M.lh
19.. Amount 01 Un. 1a to be REFUNDED. ... . .. ..... ..... ......... .. . ..... .... ..... . .... . .... . . 19. 17
19b. Amounl 01 Uno 1alo be CREDITED 10 YOUR 1995 ESTIMATED TAX ACCOUNT. . . . . . . . . . . . . . . . . . . .. 19b
19c. Amount 01 Une 1ato be DONATED to Ihe WILD RESOURCE CONSERVATION FUND. .... . . ,.. . .., . . . 19c
19d. Amount 01 Une 1a to be DONATED to lh. U.S. OLYMPIC COMMmEE, PA DIVISION. .... , ... . ..... . . 19d
Unaer " .
o
A R
TM
TO
AN
CE
H.y
Co
H R
ED
CE
K R
~
TAX
A
P N
AD
YC
MR
EE
NO
T I
S T
S
o
TV
A E
X R
o P
U A
EY
M
o E
R N
T
carllcr:n:'~:~ 0,'.Y:,r1uty,II:llClall tnatl n.,,' ..IomlnlO trll, ,.turn.lnCIUOltlll.ccomplnylnll.cn.o"II..no 111ot.m.nll, and la tr'l' al.1 ot my lnowllOQI ana taM.' II'. tI".,
Your Signature Date S'II"""re at prep.,.,. Din.' tUn "'.ply'" oasu Dn allln'arm.llan at .....nlcn
".. arepatl' "as .ny Uo....I.OIl.
X X H AND R BLOCK EASTERN TAX
Spouse's signature 1"1011'11. BOTl1must "111'1 ."en I' only an. ".d Incaml' Preparer's Telephone Number Date
_ X (717) 652-1202 /27/1995
PA12 ~i; 1519
Slgn_
here
C~Dyr,~"' i=:l'~1 Saft.....'. :>'1''1'. 'n. .1It'~a. 'tic. l,jg..PA'
ALLOWABLE EMPLOYE BUSINESS EXPENSES
Each tAXpayer must anach a separate UE-11or each amployer.
Print or 8 aU Information.
Your Name Employer'. Name
SHELLENBERGER, DENNIS R COMMONWEALTH OF PA
Your SodeJ Secunty NUmDer Employer'. Addr.ss
186-30-6875 CORRECTIONS HARRISBURG PA
D.scrlbe In Whal Typ. 01 Job You Incurr.d Those Exp.ns..
CORRECTIONS OFFICER
1. PART A: UNION OUES (Name 01 union and amounlol du..)
AFSCME LOCAL 2495
2. PART B: WORK CLOTHES AND UNIFORMS (II r.qult.d by your .mploy., as a condlUon 01 c.nUnu.d
.ll1Illoymenland nol sunabl. la, ev. da u..)
(Wh.n r.qult.d by your .mploy.r as a condiUon 01 conUnu.d
.1l1Il1o monl and nol rovid.d u' ."",10 er
4. PART 0: PROFESSIONAL UCENSE FEES, MALPRACTICE AND FIDELITY BOND INSURANCE PREMIUMS
(Whon r.oult.d as a condiUon ., omcloymenll 4.
S. TOTAL PARTS A THROUGH D. Enle' hl,e and on Une 12 on a 12l1addlUon.11 Inau clalmld. S.
PART E: TRAVEL' MILEAGE EXPENSES Corrol.l.lhl. Pill a' altlch F.d.reJ Form 2108. Allach AddlUonal Shllla If Nledld.
E1. Trav.'.,p.ns..'o, away f'om homo ov.rnlghl busln... (Includ.lIit lar.. car '.meJ.lodging. .'C.) ,.. . ... ., El.
E2. Busln... moal5 and .nl.nalnmonl..p.n.... .... . ..... ...... ... . . .. . . .... .... . ..... .... . . .. . .. E2.
E3. Parking I.... loll.. IoceJ uan.ponaUon. .IC.. .. .. .. .. .. . .. , .. . .. . . .. , . . .. .. . .. .. .. . .. . .. . . . .. ... E3.
E4. V.hlcla ..p.n,.,'rom Un.. I and ,below a, u..lh. Slandard MiI.ag. Ral. Irom Form 2106. . . . . . . . . . . .. E4.
6. TOTAL llIAVEL AND MILEAGE EXPENSES. ADD UNES El THROUGH E4 . . . . . . . . . . . . . . . . . . . . . . . .. 6.
General Information (If more than one vehicle, aUach additional schedules.)
a. Enter dale vehicle was placed in servj.ce.. . ..... . .... . ...... ... . .... . ... . ..... .... . . ... . .... .. a.
b. Tala! mil.ag. lonoxabl. y.ar.. . .. .. . .. . . . .. .. . .. . . . .. . . . . .. . . . .. . . , .. . .. .. . .. .. . . .. . . . .. ... b.
c. Bu.inossnil.ag.'orloxabl.year ................... ........................................ c.
d, Bu.in... p.rc.nlag. USO (divid. Un. c by Un. b) ...".......... . .. . . .. .. . .. .. . .. .. . .. .. . . .. . .. d.
e 01".rlllll..itlcL.IIl.ln,b:
. CO"''''UtlnG MIl..: Dally . Total . Other Persanal Miles
Do you have another vehicle for personal use?. . . ... . . ..... .... . '" . .... . .... .
Did your employer provide you WIth a vehicle? ... . .... . ..... ..... .... .... ..... .
If Y.'.I' p.rsaneJ u.. p.rmn.d?,.. . .,.. . .... ..... ..... ..... . .... .... . .... .
h. 00 you have documentation to support the mileage figures entered above? . . . . . . . . . . .
Depreciation Expense
. Enl.r co.lo' Olh., basi. 01 vehld. .......................................................... I.
Mulllply Un. I bylh. busines.porc.nleg.u... tram Un. d... ..................................... J
k.
I.
Enll' eI.prldlllan "'Itflad .....d Ind Plrcl"t.aOI.tFram For", 2101 or 01111' Oln,,"lly ICClp1.d "'ltnadllla.lbl' la,PA p~,pa...)
Enter depreciaUon ..p.nse (Multiply Un. J by Un. k). (Includ. on Un. E4 abov.) . . . . . . . . . . . . . . . . . . . . . .
Actual Expenses
m GasoUnetoU, repairs, malntenance,elc ..... ..... ..... ..... ......... ..... .......... ..... ...... m.
n. V.hlcl.'nsuranc.. . . .. . . . .. . . . .. . . .. . . . .. . . . .. .. . .. . . . .. . . . . . . . . .. . . . .. . . .. . . . .. . . . .. . . .. n.
o. TOlal v.hlclorenlal5 (whon own CO( 0' employer'. car not aveDabla). . . . . . . . . .. . . .. . . .. . . . .. . . . .. . . .. o.
Value 01 .mployer-provid.d v.hlcl. (onty n 100'k 01 annueJ I.... Is Indud.d In your W-2) . . . . . . . . . . . . . .. p.
Total Unos In, n.o and p.......... .......... .............. . . ... . ..... .... ..... .... . ....... q.
Multiply Un. q byth. business porconlag.'rom Un. d.. ......................................... ,.
(Includ. on Un. E4 abov..)
PART F: OFFICE OR WORK AREA EXPENSES Attach AddlUonal Sheets II Needed
Fl. DOl' ya""",plo)"',.q"lf' )'au to m&intaln" '''Itabl. worlt ..r'"lD&I'1 from hi, or h.rpr.m,...' ......
F2. I. IhIs work ar.alhe princlpeJ plac. wh.r. you p.rl.rm th. duUes 01 you, .mploymenl7 .
F3, I. IhIs work ar.a usod regularly and ..cIu.Iv.1y to p.riorm rh. duU.. 01 your .mployment?
If you an_red YES to ALL th,ee quuUon., conUnue. II you answ.red NO to any
quesUon, you may not claim work ara expenses.
F4. Enler h.r.tho lotal value 01 ollic. suppll.. which you purchas.d ..clu.Iv.1y for u..ln you, offic.. . . . . . . . .. F4.
Doscrtbe In Ih. ,p.c. below th. .uppn.. you purchas.d and Ih. CO'IS.
SOIClf)':
PA-40 UE-l (9-94)
3. PART C: SMALL TOOLS AND SUPPUES
l.
g.
I,
f.
k.
I.
p.
q.
r.
v..
Yes
y..
Y..
v..
V..
V..
SCHEDULE UE-1
PA DEPARTMENT OF REVENUE
Employ.'" Tel.phon. No.
(717) 737-4531
17120
Employ.,.sld.ntiflCation No. (EIN)
23-2172299
1.
609
2.
3.
609
No
No
No
No
No
No
No
F~, Ollic. 0' work ar.. .xp.nses. Ente, your tolal yearly am.unts.
a. D.pr.dation Is (homeown." only) . . .... . .... . .... . .... . ... . .... . .... . .... . .... . .... . . .. . ... ..
b. Real aSllta IllXes .. .... ..... ..... ...... .... ..... ...... ......... ..... .... ..... ......... ... b.
c. Mongag. inl.r..1 (homeown.", only) ... . , . ... . .... . ,... . .., , . . .. . . .. . , . ... . .... . ... , . . , , . .., c.
CONTINUE PART F ON PAGE 2 OF THIS SCHEDULE.
PAUE11 NTF1S23
COOY'I;"t FI),.... Soft...,. Ollly. In.. NII'I), U'Ic. N\I4PAU['
miles
miles
..
..
%
186-30-6875
d.
pag.2
PASch.dul.UE-1(9-94) SHELLENBERGER, DENNIS R
d. UbIiU.... .. .. .. .. .. . .. ... , , . , .... , .. .. . . .. ... , , ... . .. . . .. , . . .. ,.. , , ... . . , ... . ... .. . .. , . . .
8. Property Insurance. .. . ., . ... ....... ... .. .. ... .... . .. . .. . . , . ... . . . . . , . . .. . .. . .... ... ., .., .. 8.
I. Prop.rty Malnl.nanc. (d..cribe Ih. cOSl.lncun.d In malnlaining Ih. prop.rty b.low and 101al) . . . . . . . . . . . .. I.
Speelly:
g. ou;; Apponlonabl. Exp.n... (d.scribe Ih. cOSl.locun.d below and lolal). ..... ......... ............. g.
Speelly:
h. R.nl(only r.nI.rs may claim Ihis.'p.n..).. .................................................... h.
I. TolaI (add Un.. alhrough h) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . , . . . . . . . . . . . . .. I.
I. Busin... p.rc.nlag. of proparty. Divld.lolal.quar.loolag. 01 prop.rty u..d a. ollic. or work area by th.
total squBls1ootageofthe entire propeny (round to 2 dlgits) ........................................ I. ~.
F5. Appodionabl. Exp.n.... Mul1iply Un. I by Ih. p.rc.nlag. Irom Un. I. . . . . . . , . , . . , . . . . . . . . . . . . . . . . . . .. F5.
7. TOTAL OFFICE OR WORK AREA EXPENSES. ADD LINES Fa ANDFS....,......................,... 7.
PART G: MOVING EXPENSES Attach AddlUona' Sh..ts " N..ded
Gl. Old you work lor th..arno .mploy.r belor. end an.r your mov.? .. ., .. ... ..... .....,.. ~ No
GO!. W.r. you r.qulr.d by your .mploy.r 10 mov. Irom on. olliclal workplac. 10 anoth.r official
wor1<plac. .. a condition ol.mploymonl? . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ... 8 v.. 8 No
G3, Old you mov. alth. r.qu..t 01 your .mploy.r? . , .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. . v.. No
It you answered YES to an three quesUonst please conUnue.
G4. Enler th. number 01 mile.:
a. From your old horneto yournewworkplacB................................................... a. miles
b. From your old homo 10 your oldworkplec. ......,............................................ b. mile.
C. Subtract Uno b from Une a and enter here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. c.
Only If Une c Is 35 miles or mare. canUnue. It not, you may not claim moving expenses.
G5. TrensponaUon expen.e.ln moving hou.ehold good. and personal eneelS , . , . . . . , . . . . . . . . . , . . . . . . . . . .. G5.
Ga. Travel. meals and lodg!ng expenses in actual move from previous residence 10 your new residence. . . . . . . . .. G6.
a. TOTAL MOVING EXPENSES. ADD LINES GS and G6 , .. .. .. . . .. . . .. . .. . . . . .. . .. .. .. .. . .. .. .. .. .. a.
PART H: EDUCATION EXPENSES Attach AddlUonal Sheets" Needed
H1. Was this education required either by law or by your employer to relain your present position
or job?.. .. . .. .. . .. .. .. .. .. .. . . .. .. . . . .. .. .. . .. . , . .. . . .. .. .. .. . .. .. .. .. .. ." 0 Yes 0 No
If you answer YES. continue.
H2. Did you need this educauon 10 meet entry level or minimum requirements to obtain your job? 8 Yes 8 No
H3. Will this course 01 study or program. if continued, qualify you lor a new business or prolession? Yes No
It you answered NO to questions H2 and H3. please canUnue.
H4. Name ol.ducabonalln.nlUbon:
H5. Course 01 'lUdy:
H6. TuiUon or fees: ...........,............................................................... H6.
H7. Course malertals: ......................................................................... H7.
HS. Travel expenses: ......................................................................... He.
9. TOTAL EDUCATION EXPENSES. ADD LINES H6.H7 AND Ha...................................... 9.
PART I: DEPRECIATION OTHER THAN FOR VEHICLES AND OFFICE OR WORK AREAl Attach AddlUonal Shoets "Noedod
De.cripUon 01 (.) COSl or Other (b)Depreelation (c) Depreelabon (d) SeeUon 179 (.) Add (c). (d)
Prope Basi. Method DeduC1lon Exp.n..
10. TOTAL DEPRECIATION EXPENSES. ADD COLUMN (.1. ENTER HERE. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 10.
PART J: MISCELLANEOUS EXPENSES Attach AddlUonal Shoets " Neodod
De.cribe In delellln Ih. .pec. provided below or on a .eperet. .heot your e'pense.lrom Un. a 01 your Federal Form 210a & other exp.n.e.
a1lowabl.to cenaln .mploye. receiving nonemploy. compensalion lor PA Personellncomo Tex purposes. Descrtbe .ach expen.. & your cosL
11. TOTAL MISCELLANEOUS EXPENSES. ADD ALL EXPENSES AND ENTER HERE,.................,... 11.
PART K: TOTAL ALLOWABLE BUSINESS EXPENSES
12. ADD THE EXPENSES FROM UNE 5. PAGE 1 AND PARTS E THROUGH J . . , . . . , . . . . . . . . . . . . . . . . . . . . .. 12. 609
13. ENTER REIMBURSEMENTS FROM YOUR EMPLOVER. INCLUDING REIMBURSEMENTS FOR EXP. CLAIMED
ON UNE 12. WHICH YOUR EMPLOVER DID NOT INCLUDE AS INCOME IN 'STATE BLOCK" OF YOUR W-2. 13.
14. SUBTRACT LINE 13 FROM LINE 12. . .. . . .. , . , . . .. .. . . .. . .. .. . .. . . . .. . , .. . . .. .. , .. . .. . . , .. .. .. 14. 609
IF LINE 13 IS GREATER THAN LINE 12. ADD DIFFERENCE TO YOUR TXBL COMPENSATION ON UNE 18 OF YOUR TAX RTRN. IF LINE 12
IS GREATER THAN LINE 13, ENTER DIFFERENCE AS DEDUCTIBLE EMPLOYE BUSN. EXPENSES ON LINE 1b OF YOUR PA TAX RETURN.
PAUE12 NTF 1524
:::'1";i'I! r~,...S 5011.....111 Oi'll.,.. In.!'I.,lca.lIlc. NUPAUE2
Employ.,'a Id.nIIIICl,lon Numb.,
I 23-2172299
;1 Wapl.;:'lpa, O'N'_ C10mI*'UUOn':I':,:"
,\~::';,.~~'~.~~ ~~~.. .;.~~::~;. .~: ::'0.:50~l[?t:~~~I
Employ.,', ".m.. .del'.II. .nd ZIP cod.
COMMONWEALTH OF PENNSYLVANIA
CORRECTIONS
HARRISBURG PA 17120
3 Socl.1 ..eu'uy w'g"
54,713.B4
_.2~'.~'f'I!hfMOIM ;'ax.~I,,.,..,...;/,.. ..<:
:;~rFi"~8; ~~~1:~,r;~!.~%tf%5~}r;":;.;:!L
.. socl.1 IIcu,l,y ,.. wh"I'I.ld
3,392.25
& M.diClf, w.gtl .nd Up.
114,713.B4
I M.dIClr. ,.. wilhh.ld
793.45
Employ..', Soci.1 S.cur..y Numb.,
I 18B-30-B875
1.',I,dlll'.nc. EIC p..,m.nt~:"~..
,,;~;:~:,..;. .;.';~;.'<.: . :';<<..~'::f.-"
?"". .
'.'-"'..
10 C.p,nd.n' Clr. b.n.'i"
. Employ,,', nlm. (fir". mlddl.. lUll
DENNIS R SHELLENBERGER
" NonQu.llfl.d pl.na
12 8.n.I." Inclueled In 80x
13 5.. In,u,. lor 80x 13 15 O.c..nd P.naion O.I.,,,d
623 STATE 5T PI'n Comp,"ulion
LEMOYNE D ~ D
PA 17043
Employ..', 'e1e1ftS' .nel ZIP cod.
10.51'"1 Employer', 11111 10 No. " sra,. w.g.., tip. lie. " 51'" Incom. ,ax 19 Loc.lilY nlme 20 Lou I wig". IIPI, tic. 21 Lou I Incom. II.
....-..............................-.....-......-.......... ....................--...-.............. .-.-......-.............-.. .-....-..-..............-...-.. ..-....-..-............--....-. -.--
PA 23-2172289 54,713.64 1,531.97 LEMOYNE BORO 54.713.64 54":"i':j'-"--
:orm W-2 Wage and Tax
Statement
1994COPY 1 - TO BE FILED WITH EMPLOYEE'S CITY DR
INCOME TAX RETURN
O..1I111l.1I1 .1111' '''''11I, . 1fIIIIIl,l ",''''"''' S"YlU
LOCAL 0"'. iii,. '..5.000.
TIl.. ..1""'.1'" i......' 1.'III.h'UIIl. "'1""."."'"., S.fVlU
Biweekly
,
.
DENNIS R. SHELLENBERGER,
Plaintiff
.
.
IN THE COURT OF COMMON PLEAS
CUMBERLAND , PENNSYLVANIA
CIVIL ACTION - LAW
: NO. 930 CIVIL 1994
vs.
LORETTA SHELLENBERGER,
Defendant
.
.
INCOME AND EXPENSE STATEMENT
OF
DENNIS R. SHELLENBERGER
Plaintifff9ef~~ files the following Income and Expense
Statement and verifies that the statements made herein are true
and correct. Plaintiff understands that false statements herein
are made subject to the penalties of 18 Pa.C.S. 4904 relating to
unsworn falsification to authorities.
INCOME:
Employer:
Address:
Type of Work:
Payroll Number:
Pay Period (Weekly, Biweekly, etc.):
Gross pay Per Pay Period: $1.608.00
Itemized Payroll Deductions:
Federal withholding $
social Security
Local Wage Tax
State Income Tax
Retirement
Savings Bonds
Credit Union
Life Insurance
Health Insurance
Other (specifY)
Commonwealth of Pennsylvania
Correctional Officer
288.97
99.70
16.08
45.02
80.40
12.50
u.c.
Union Dues
Medicare
1.77
~4.J.4!
lJ.Jl
NET PAY PER PAY PERIOD
$ 1.016.12
1
Interest
Dividends
Pension
Annuity
Social Security
Rents
Royalties
Expense Account
Gifts
Unemployment Compo
Workmen's compo
support
4.81
20.83
250.00
.
other Income:
Week Month Year
(Fill in Appropriate Column)
TOTAL
$ 4.81
$ 20.83
$ 250.00
PLAINTIFF/DEFENDANT Week Month Year
EXPENSES WITH (Fill in Appropriate Column)
CHILDREN:
HOME
Mortgage/Rent $ 115.38 $ 500.00 $6,000.00
Maintenance
utilities
Electric 9.23 40.00 480.00
Gas
oil
Telephone 8.08 35.00 420.00
Water
Sewer
EMPLOYMENT
Public Transportation
Lunch
TAXES
Real Estate
Personal Property 2.88 12.50 150.00
Income
INSURANCE
Homeowners 1.48 6.42 77.00
Automobile 7.69 33.33 400.00
Life
Accident
Health 2.60 11. 25 135.00
Other Renters
2
EXPENSES:
AUTOMOBILE
Payments $
Fuel
Repairs
MEDICAL
Doctor
Dentist
Orthodontist
Hospital
Medicine
Special needs (glasses,
braces, orthopedic
devices, etc.)
EDUCATION
Private school
Parochial school
College
Religious
PERSONAL
Clothing
Food
Barber/Hairdresser
Credit Payments
Credit Card
Charge Account
Memberships
LOANS
Credit Union
Week Month Year
(Fill in Appropriate Column)
61. 62
15.00
5.77
1.92
$ 267.00
61i.OO
2'i.OO
$3.204.00
780.00
300.00
8.33
100.00
19.23
69.23
5.77
83.33
300.00
25.00
1.000.00
3.600.00
300.00
MISCELLANEOUS
Household Help
Child Care
Papers/Books/Magazines 3.69 16.00 192.00
Entertainment 23.08 100.00 1.200.00
Pay TV 4.38 19.00 228.00
Vacation 9.62 41.67 500.00
Gifts 23.07 100.00 1,200.00
Legal Fees
Charitable Gifts 11.54 50.00 600.00
Other Child Support
Alimony Payments 145.00 628.33 7,540.00
OTHER
TOTAL EXPENSES
$ 537.09
$ 2,327.41
$ 28,406.00
3
,
PROPERTY OWNED:
Description
Value
ownership
H
W
J
Checking Accounts
savings Accounts
Credit Union
stocks/Bonds
Real Estate
Other
$
$
$
$
$
$
$
TOTAL:
INSURANCE
Company
Policy No.
Ownership
H
W
J
Hospital
Blue Cross
Other
Medical
Blue Shield
Other
Health/Accident
Disability Income
Dental
Other
* H = Husband / W = Wife / C = Child
4
--
HANUBL L.ANDIUI
of. PANT P.LONI!:
SAMUEL L. ANDES
ATTOltNEY AT LAW
Dal$ NOHTII TWRLI'TII STREET
11.0. UOx Imt
LEMOYNE, PENNSYLVANIA 17043
TBL.PIIONft
17111 JOI'~:Jnl
3 August 1995
PAX
(117) 1'OI'I4:J~
B. Robert Blicker, II, Bsquire
Office of the Haster
9 North Hanover Street
Carlisle, PA 17103
RB: Dennis R. Shellenberger vs. Loretta Shellenberger
94-930 Civil Term
Dear Hr. B1icker:
Enclosed you will find the Pre-Trial State.ent which I file on behalf of
the Defendant, Loretta Shellenberger. I apologize for the delay in filing
this. I have sent a copy this day to Peter Henninger, Bsquire, who represents
Hr. Shellenberger.
Please schedule a pre-hearing conference at your convenience.
Sincerely,
.&..
Ie
Bnclosure
cc: Peter R. Henninger, Jr., Bsquire
Ul
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("'./';:;:L..
DBNNIS R. SHBLLBNBBRGBR, ) IN THB COURT OF COHHON
Plaintiff ) PLBAS OF CUKBBRLAND
) COUNTY, PENNSYLVANIA
vs. )
) CIVIL ACTION - LAW
)
LORETTA SHBLLBNBERGBR, ) NO. 94-930 CIVIL TBRM
Defendant ) IN DIVORCE
DBPBNDANT'S PRB-TRIAL STATIlIIBNT
AND NOW comes the above-named Defendant, by her attorney, Samuel L. Andes, and
I submits the following Pre-Trial Statement pursuant to Pa. R.C.P. 1920.33Ib):
1. ASSETS. Attached hereto and marked as Schedules A and B are charts listing
Ithe marital and non-marital assets of the parties as they are presently known to the
I
I Defendant.
2. BXPBRT WITNBSSBS. Wife hopes the parties will be able to establish the values
10f assets and most other factual matters requiring expert witnesses by stipulation and
'I
!!that experts will not be required to testify. She reserves the right, however, to call
expert witnesses as follows in the event the parties cannot agree:
A. An appraiser to establish the value of the marital residence.
B. An actuarial appraiser to establish the value of each party's
pension.
C. An appraiser to establish the value of motor vehicles and household
furnishings.
D. Any other expert that may be necessary to respond to evidence
submitted by the Plaintiff.
3. WITNBSSBS. Wife anticipates testifying on her own behalf. 8he reserves the
(i9ht
II
II
to call additional fact witnesses as may be necessary to rebut any testi~ny
1
offered by the Plaintiff in his case and specifically reserves the right to call
Husband's girlfriend at the time of separation, Katherine Bish. if necessary. to
establish Husband's marital misconduct.
4. RXHIBITS. Again, Wife anticipates that the parties will be able to agree upon
the identity and value of most of the marital assets and that exhibits and formal
evidence will not be necessary. In the event that such testimony is necessary, in
addition to any exhibits she would offer to rebut any evidence submitted by Plaintiff,
she anticipates the following exhibits would be produced at the hearing and offered
into evidence:
A. Copies of statements from all bank accounts and similar investment
assets owned or controlled by the parties.
B. Copies of the parties' tax returns for the years 1990 through 1994.
C. Copies of documents establishing the pension benefits earned by each
of them through their employment.
D. Documents showing the Social Security benefits accrued by each of
the parties up to the time of the hearing.
5. INCOKB. Wife is employed by UPS in a clerical position. from which she earns
approximately $21,000.00 per year. Full details of her gross earnings. deductions. and
net income will be provided in an Income and Expense Statement which will be filed
prior to the hearing.
6. EXPENSES. Wife's current living expenses will be set out in detail in an
Income and Expense Statement which will be filed prior to trial.
7. RBTIRBKBNT BHNBFITS. The parties hope to stipUlate as to the value of each of
their pension benefits. If they cannot, the valuation of those benefits will be
determined by documents produced by the pension program (SERS for Husband and UPS for
II
2
Wife) and either a detailed report or live testimony frOM actuarial experts who will
establish the value of the pension benefits.
8. COUNSBL PEES. Wife makes a claim for counsel fees and has incurred counsel
fees up to this time of approximately $2,000.00. At the hearing she will submit a
detailed statement for those fees and testify that she has agreed to pay her attorney
$150.00 an hour for his services.
9. PBRSONAL PROPBRTY. There is no dispute known to Wife about the distribution
of the household furnishings. In the event the parties cannot agree as to a value,
they will have the items appraised and the appraisal will be available for the master
at the hearing.
10. HAlITAL DBBTS. The only significant marital debts are listed in the list of
assets attached hereto and marked as Schedule A.
11. PROPOSED RBSOLUTION. Wife proposes that she retain the house, that she be
awarded a portion of Husband's pension benefits (both a portion of the lump sum
I benefits and of the installment payments thereafter) so as to give her 60 percent of
the marital property, and that she receive alimony in the amount of $600.00 per month
for an indefinite term.
~~~
OL. Andes
Attorney for Defendant
II
3
SCHBDULB A = LIST OP ItARITAL ASSB'I'S
Asset
Residence at 113
Sharon Road, Bast
Pennsboro Township,
Bno1a, PA
Value
Date of
Valuation
Non-Marital
Portion
Liens
See
Below
$100,000.00
(est. )
7/95
100\
LIBNS:
a) Pirst ~rtgage to Pirst Pederal Savings Assn. (balance
unknown but believed to be about $10,000.00
b) Home equity loan to PNC Bank (balance believed to be
$12,000.00)
Husband's pension Unknown but 7/95 (but 100\ No Liens
with Co.Ionwea1th believed to be based upon
of Pennsylvania in excess of accullulations
$80,000.00 up to date of
separation)
iI/He's pension with Unknown but Date of 100\ (Based No Liens
:UPS believed to be separation upon contri-
, insignificant butions up
i because of short to date of
I employment prior separation)
I to date of separation
,
i
Il/ife'S account within Unknown Date of 100\ (Based No Liens
[UPS Thrift Plan Separation upon contri-
butions up
to date of
separation)
Husband's 8uper Now $30,000.00 3/93 100\ None known
. account at Dauphin (est.)
" Depos i t Bank ,
Trult COIIpany
(No. 77-56887-7)
NOTB: The parties owned several other accounts at Dauphin Deposit, about which
Wife currently has no information. Those accounts are:
SaVings Account No. 4-9337-0383-5
Club Account No. 4-9339-0073-4
Certificate of Deposit No. 80-0037486-3 or 01-33-46-0136164
Prime of Life Account No. 77-56886-9
Date of Non-Marital
Asset Value Valuation Portion Liens
Joint account $7.810.00 1/31/93 100\ None known
at PBBCU
Metropolitan Unknown N/A 100\ None known
Life Ins. Co.
(Life insurance
policy owned by
Husband)
Husband's 1988 Unknown N/A 100\ None known
Hercury Cougar
autOllobile
Husband's 1988 Unknown N/A 100\ None known
Mercury cougar
\auto.obile $500.00 3/93 lOO\ No Liens
\Wife'S 1970
OldSMObile Cutlass
lautollobile
I Husband's 1992 Unknown N/A 100\ None known
II Harley-Davidson
1111Otorcyc1e
!
!Husband's Yamaha Unknown N/A 100\ None known
II.otorcycle $2,500.00 7/95 80\ known
I Housho1d furnishings, None
I appliances. and
'similar i tells
II
NON-IlARITAL ASSBTS
There are no non-marital assets of the parties except the portion of pensions and
other investment assets that have been accumulated since the date of separation.
,
DENNIS R. SHELLENBERGER, . IN THE COURT OF COMMON PLEAS
.
Plaintiff CUMBERLAND , PENNSYLVANIA
. CIVIL ACTION - LAW
.
VB. .
.
NO. 930 CIVIL 1994
LORETTA SHELLENBERGER, .
.
Dofendant IN DIVORCE
INVENTORY AND APPRAISEMENT
OF
DENNIS R. SHELLENBERGER
Plaintifff~ftd~-files the following inventory and
appraisement of all property owned or possessed by either
party at the time this action was commenced and all property
transferred within the preceding three years.
Plaintiff/gefeft~ verifies that the statements made
in this inventory and appraisement are true and correct.
Plaintiff/~endan~-understands that false statements herein
are made subject to the penalties of 18 Pa.C.S. 4904 relating
to unsworn falsification to authorities.
vs.
. IN THE COURT OF COMMON PLEAS
.
. , PENNSYLVANIA
.
. CIVIL ACTION - LAW
.
:
. NO.
.
.
.
: IN DIVORCE
ASSETS OF PARTIES
Plaintiff/Defendant marks on the list below those items
applicable to the case at bar and itemizes the assets on the
following pages. If an item has been appraised, a copy of the
appraisal report is attached.
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
1. Real property
2. Motor vehicles
3. stocks, bonds, securities and options
4. certificates of deposit
5. Checking accounts, cash
6. Savings accounts, money market and savings certifcates
7. Contents of safe deposit boxes
8. Trusts
9. Life Insurance policies (indicate face value, cash
surrender value and current beneficiaries)
10. Annuities
11. Gifts
12. Inheritances
13. Patents, copyrights, inventions, royalties
14. Personal property outside the home
15. Businesses (list all owners, including percentage of
ownership and officer/director positions held by a
party with company)
16. Employment termination benefits - severance pay,
workmen's compensation claim/award
17. Profit uharing plans
18. Pension plans (indicate employee contribution and
date plan vests)
19. Retirement plans, Individual Retirement accounts
20. Disability payments
21. Litigation claims (matured and unmatured)
22. Military/V.A. Benefits
23. Education benefits
24. Debts due', including loans and mortgages held
25. Household furnishings and personalty (include as
a total category and attach itemized list if
distribution of such assets is in dispute)
26. Other
1
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LIABILITIES OF PAnTIES
Plaintiff/Befenda~marks on the list below those items
applicable to the case at bar and itemizes the liabilities on
the following page.
SECURED
( X) 1. Mortgages
( ) 2. Judgments
( ) 3. Liens
( ) 4. Other secured liabilities
UNSECURED
( ) 5. Credit card balances
( ) 6. Purchases
( ) 7. Loan payments
( ) 8. Notes payable
( ) 9. Other unsecured liabilities
CONTINGENT OR DEFERRED
( ) 10. Contracts or Agreements
( ) 1l. Promissory notes
( ) 12. Lawsuits
( ) 13. Options
( ) 14. Taxes
( ) 15. Other contingent or deferred liabilities
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COI\MONWEALTH OF PA - EMPLOYE STATEMENT - I ..... a.v . .. ....
GROSS EARNINGS 1.601.00 21,151.21
PAY PERIOD ENDING. 06-17-" PAY DATE. 0'-30-" NINUS DEDUCTIONS
VI'. 4911015'??oo DEPTI 011 coe. 3"31 FED NTH TX S 00 211.97 5,"'."
SDC SEC TX '.2~ ".70 1,745.11
EHP'. 060'77 POSl. 11"01 SSN. 11'-30-6175 SDC SEC/NED TX 1.450001 23.32 401.35
B/U: HI PAY RANGE. 3' STEP. H LEYEL, 21 STATE MTH TX PA 2.1_ 45.02 711.35
CORRECTIONS SCI CAIU' HILL LDC NG TX-RES PA 21 103 I.~ 11.01 211.57
UNENP CONP TX .IIClClO1 1.77 30."
RET PIU CON STATE ENP 5.~ 10.40 1,400.35
II.4GE MITH ORDER CUMIERLAND CO - DOH REL 290.00 3,770.00
UN OUES AFSCHE - 13 24" 24,12 313."
CREDIT UN PA ST EHP CU 133.31 1,733.94
SAY 10NDS 12.50 112.50
DENNIS R SHELLENBERGER
623 STATE ST
LEMDYNE PA 17043
NET EARNINGS. 592.74
STATE PAID IENEFITS . . PLUS REINIURSEMENTS
HEALTH IENEFITS CAPITAL ILUE CROSS
LIFE INSURANCE
NORKERS COHP
SOCIAL SECURITY
MEDICARE
RETIREMENT STATE EMPLOYES RET SYS
AU "NEFtlS Lt.u. ABOYE CONTlNUF &T FUll. YAI UF.
PAID LEAVE STATEMENT TOTAL CHECX AIIOUNT S ..592.74 .. ~.
..
SERVICE CREDIT: 20 YR 25 PP
PP END LEAVE USAlIE REPORTm HOURS PP END IREAXDONN GROSS EARN HOURS RATE. . I. . GROSS ....
0'-17-" REG SAL 10.00 20.10 1,601.00
TOTAL GROSS EARNINGS THIS PAY ..... s. 1.'OS.00
LEAYE ACTlYITY COMBINED SICX PERSlllLlL SENIORITY INFORMATION .. ..
IALANCE LAST STATEMENT 323.91 1.494.77
ACCRUAL THIS PP '.23 2.46
LY REPORTED THIS PP .00 .00 VTD .00
ADJUSTMCNTS .00 .00
IALANCE THIS STHT 333.21 1,497.23
ACCRUAL RAlE. AHIIUAI. 11.5 % SICX 3._
MESSAGE CENTER, LOCAL II.4GE TAX COUNTV/MUNICIPALITY. CUMIERLAND COUNTY LENOYNE 10RO
CONYERS ION PAY LIAIILITY. 171.40 FNT TAX GROSSI 1,527.10
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MIDDLETOWN. PENN~YlV^NI^ 17057-35UG
TEL1I110Nr
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PETtR. k.IIENNINGEk,IR.
DONALD L.IONES
lAMES 8. MNNEM.KER
July 25, 1995
E. Robert Elicker, II, Esquire
Office of Divorce Master
Cumberland County
Court of Common Pleas
9 North Hanover street
Carlisle, PA 17013
Re: Shellenberqer v. Shellenberqer
No. 930 civil 1994
our File No. 13514
Dear Mr. Elicker:
Enclosed please find an Income and Expense and Inventory and
Appraisement of Dennis R. shellenberger and let this letter
serve as my pre-trial memo. Please be advised that the only
expert we would intend to call at this time would be Harry
Leister who would testify to the value of Mr. Shellenberger and
Mrs. Shellenbergers pensions. Mr. Shellenberger's pension is
being valued at this time although we believe the value to be
approximately $40,000.00 as of the date of separation. The
current value would be approximately $48,000.00. A copy of his
1992 year end pension statement is attached hereto.
I believe the only other testimony we would present would be
that of Mr. Shellenberger. At this time we do not anticipate
attaching any further exhibits unless they become necessary by
way of any appraisals with regards to the home or where any of
the personal property is concerned.
Attached is Mr. Shellenberger's 1994 State and Federal
Income Tax Returns and a copy of a recent paystub.
with regards to a proposed resolution Mr. Shellenberger
would offer that he retain his pension and any property he took
with him, that Mrs. Shellenberger retain her pension, the
marital home, all the furniture, and any other items she may
have had at the time of separation and that she pay to Mr.
Shellenberger the amount of $40,000.00 as part of his equity in
the home. I believe this would grant Mrs. Shellenberger at
least 55% of the marital assets, if not more. We also ask that
no alimony costs or counsel fees be awarded to Mrs.
Shellenberger since she has a more than sufficient income at UPS
when coupled with the $145.00 per week that she has been
receiving in spousal support over the last couple of years and
it has given her plenty of time to "get back on her feet" not
that she was ever off of her feet and has given her sufficient
funds in which to pursue this matter especially since her
counsel fees to date would be absolutely minimal with regards to
the divorce.
If there is any further information that you request at this
time I would be gla~ to provide it.
~relY,
'Jib-/ Q lkLttuYt1-'1 fl.
Peter R. Henninger, Jr.'-Z7'
PRH:jmp L 07/25/95 (1)
Enclosures
celene: Samuel L. Andes, Esquire
Dennis R. Shellenberger
ijr
..
(ED
COMMONWEALTH OF PENNSYLVANIA
STATE EMPLOYES' RETIREMENT SYSTEM
STATEMENT OF ACCOUNT AS OF DECEMBER 31, 1882
Annuall, the Stat. ~101'S' R.ttr.-.nt 5,st.. (SERS) proyldes ..Ch ..-be,. with current r.tireMent ICCour.t tnfor.atton which should
be Mlpful In Lhd.rstandtng the benefits provided by the nUr..."t plan and In doing flnancl.1 plaMtng. thts stat.....t was
prepared using the dati recorded In your retirement ICCOU1' as of Deceber 31, UU, and Is subJlct to final audit by the SERS In
acco.danca .Ilh OIlPllcabl. la. .rd regulations. PLEASE REFER TO THE REVERSE SIDE FOR IMPORTANT
INFORMATIDN ABOUT YOUR STATEMENT.
PREPARED FORI D R SHELLENBERGER
011-103-36522 l500
SEO-018592
n'l 186-30-6875 EMP ,: 060677
Data.f Birth: MAY 18, 1940
51.: MALE Region Cod.: 7
M....I~at1r_t OIt"I' 3ALREADY REACHED
Credtt Servtce.S of .- 1-.2:
C ISS Servle.
A-50 18.5000 YRS.
FULL
ACCllUNT a,\LA:o:Ct
Covlnge TfPIi
Contribution Rate
Ftnal Anrag4l Sal'r7
1"2 Rettr..nt CoY.red Eamlngs
551 Non-Covlrld Elrnlngs
Jotnt Coverage Conver,ton AMount
Mandatory Datt
'5.00%
, $59.629.44
, $50.629.18
,
,
,
REGUlAR
.ill
a.lance .s of 12-31-'1
1"2 AettvUy
Cont,.'buttons
L~ SLrft Pa,..nts
Arr..rs 'ayments
AdJust1ntnts.
Credited Interest $1.475.15
Balanc, as of 12-31-92 $39.623.38
Arrears Balanc, as of 12-31-92 -
-ldiustments r,fl_ct corr'cttons to Jour account about ~hfch YOU haye been'notified.
$35.616.76
-----TAXABLE 8REAKDOWN OF ACCOUNT-----
$2, S31 .47
.
Tax-o.ferrld Contrtbutions
Previously Ta.ed Contrtbuttons
Credited lnt.rest
Account lalanc. as of 12-31-92
$23.648.17
$6,256.07
$9.718.14
$39.623.38
.
Dcneftt eUtlnUeS .,.e pr.,ared for -.ars ~ho haye reached No,..\ R,t,rement Ag, and for ...atrs who Nye at l.ast 10 1ears of
c~edfted s.rylc. for Regular R,ttrement and at l.ast 5 1fars 01 cr.~lted s.rvtc. for Dtsabtltty Rettrement (Stat. Poltce and Ltquor
Law Enforcement Offtcers haye no Mtntmum ,ervtce requirement for dtsabillty retirement).
If 10U bralnate pr,or to attatntng e1tglbl1tt1 for -.onthl, benefit:., that is prtor to beCCfttng vested. ,ou ~ould be enthleel to
ncehe 10Ut' account balance .tnus an, debts to the tonmonwaa1th as of :rout date of te"",tnatton.
BENEFIT ESTIMATES
FULL RETIREMENT - Thts optton proytdes the ..t_ MOnthly
beneftts to 'au for ltre. If 10U die befo,.. recetytng ,our
totll Iccurulated declucttons, the balance wtll be paid to
10ur beneflcl.r,ltesl.
OPTION 1 .. Thts option proytdes reduced I'IOnthl, beneftts to
'fl)ll '('I" lH~ All lM~thl;t" .,.".rtt.. .,.. r-n~lIWI 'rm t'"
Present Value. AnT balanc. r_tnlng at you" death 'Will be
paid to your benefictar,.tes).
PIRESENT VALUE - OIath lanoftt und.. Option I .. a d..lh
n Itate "rylee.
OPTION 4 - You .y recetve all or a portion 01 you"
acc~l.ted deductions Icontrtbuttons and tnt.r.stl tn a lump
sun or installlft1nt pa,...nts and rec.tve reduced monthly
bene,tts und.r one of the other rettr8lTllftt opttons. Optton 0\
is avat1.bl. onlr at the tt... 01 r...r....nt and .y not
exceed your' aCC\INJ1.ted deductions.
FULL RETIREMENT AD~USTED.UNDER OPTION 4
OPTION 1 AD~~STED UNDER OPTION 4
AD~USTED PRESENT VALUE UNDER DPTION 1 WITH OPTION 4
Current as 0'
12-31"'2
$1.838.57
Proj.cted to NOMllll
Rettrement
N/A
$1.739.89
N/A
$348.813.57
$39,623.38
N/A
N/A
$1,632.75
N/A
N/A
N/A
$1,544.51
$309,180.19
MAXIMUM DISABILITY - You ...sl be modlc.llr ca.tt/lad br SERS N/A
MedlcIl Enlllfn.,.s to be physica", 01" Illentallr incapable 01
perlol'll'l'ng YOUl' current Job duties. OPTION 4
WITHDRAWAL IS NOT AVAILABLE WITH A DISABILITY
RETIREMENT .
'REFER TO CODES A THROUGH Q ON THE REVERSE SIDE OF.;HIS FORM FDR AN EXPLANATION' OF THE FOLLOWING CODES
AS THEY APPLV TO YOUR BENEFIT ES;IMATES: P
ADDITIONAL RETIREMENT OPTIONS ARE AVAILA8LE. PLEASE TELEPHONE YOUR SERS REGIONAL RETIREMENT COUNSELOR
TOLL-FREE (1-800-633-5481) FOR QUESTIONS CONCERNING YOUR BENEFIT RIGHTS OR THIS STATEMENT OF ACCOUNT.
......,.Uf\I,.."1 .&.RrU".....11Ur" MDUUI IUUf\ :II
KEY TO BENEFIT ESTIMATE 'OES _ oue to one or mare of the following reasons. spe' 'candttlons apply to you'
benefit esttmates or the .atimateS have not been calculated:
You have more than 1 acttve account.
Your account has not been audtted by SERS.
You have a frozen present value.
You have Class 0 service.
Our records IndIcate you were compensated for Ie" than 1.650 hour a In at laast 3 of tha last 5 yaars.
The recent FOP Arb1tration Award was not included 1n your estimates.
Your benaflt estlmatas may ba understatad becausa you did not receive full-time credit during each of the
las't 5 years.
Your ratlrement and deeth beneftt estimates shown assume you wtll elect to convert to full coverage.
Your benefit estimates Include an addItIonal benefit derIved from your Claas C Regular Accumulatea
Deduct tons.
Your projected estImates may be lower this year than last because your Retirement Covered EarnIngs ware
lower thts year than last.
Your be~eflt estImates were calculated without the use of any early rettrement 'wlndaw' planl.
You have insufficient service credits to qualify for a regular retirement beneftt.
You have insufftc1ent serv1ce credttS to qualify for a dtsability retirement ben.ftt.
You have Insufftclent eerntngs Quarters to be used to calculate a dtsablllty retirement beneltt.
More than ten years remain to normal retirement date.
You have already reached normal retirement age.
ThIs ststement excludes all PSERS contrIbutions: tharefare. the monthly annuity benefits aftar an Option
4 withdrawal ere ovarstated. In addition. State servIce may be overstated If In any calender year you
have concurrent employmant (contributing to PSERS wnlle act,vely contrlcutlng to SERS). IF EITHER
SITUATION APPLIES TO YOU, CONTACT YOUR REITREMENT COUNSELOR PRIOR TO RETIREMENT TO RECEIVE A MORE
ACCURATE BENEFIT ESTIMATE.
A -
B -
C
0
E -
F -
G
H
I .
~
K -
L .
M .
N -
0
P
0 .
Retirement cove...d Earnlnos _ Includel all salary and wages (excludes bonuses and cash awards) on whlC~
contributtons were made to your account.
FInal Averaoe S.larv (FASl -The ftnal average salary assumel: t) you contributed at le..t 12 Quarters: .nd 2)
you are a full-tIme amplaye. IF YOU DO NOT MEET BOTH OF THESE CONDITIONS. YOUR CORRECT FAS WILL BE CALCULATEt
WHEN YOU RETIRE.
Arre"r~ B.1once _ The balance awing to your account for whiCh you are making payroll deductions far th_
purchase of service.
Mandatory Debt _ The amount awing to your retirement account about whIch you have been natlflad previOusly.
TnlS deat '5 to be sattsfled at the time of your retirement through an actuartal reduction to your presen'
value.
SSI Non..Covered Earnt nQ5
coverage since 01"01-56.
benefit esttmates.
_ Earnings which exceeded tne Feder-al soctal Security base for all year-s o~ 55:
These earntngs were used to determtne your 5SI benefit and are included in your
Credited Class of ServIce: A _ Normal Retirement Age of 60: A-50' Normal Rettrement Age of 50: C - Normal
Re"rement Age of 50 as a State pollca Officer or Enforcement Officer whose servIce began prIor to 03-01-74:
0-3 _ Norma I Ret I rement Age of 50 as a member of the Genera I Assembl Y whose serv Ice began pr lor to 03-01-74:
E-' _ Normal RetIrement Age of 60 for members of the ~udIClary: E-2 - Normal Rettrement Age of 60 as a dtstrlct
JustIce: PSERS _ Service with the Publtc School Employe.' Retirement Systam, SSI-60 - Normal Rettrement Age of
60: 551-50 - Normal Retirement Age of 50.
If you have any credttable State Qr
tnfOrmat\on on purChasing such credit.
STATUS.
nons tate servIce not Included. SEE YOUR RETIREMENT COUNSELOR fa'
ALL REQUESTS TO PURCHASE SERVICE MUST BE FILED WHILE IN AN ACTIVE PA\
Nnrm.l R.tlr"""'"~ A"ft ("'lIal . J' \'0" ~"l .e.....". 35 1'e.r" of creel I ted servIce orlor to the ..ge IndIcated abav
under Class of servIce. your NRA becomes your age on the date you Dchteve 35 years of cradlted servIce.
Normal Retirement Date - The date at WhiCh you will achieve NRA.
BENEFIT ESTIMATES _ Assumpttans used to proJact estImates: I) future earnings will be the same as 1992: 2) yo
will continue In your present class as a full-time .,mploya, 3) retirement tables and factors will remain t~,
same as those In use an 12-31-92: 41 any arrears Dalance will be paId (EXCEPTION: thOsa members who ar
currently vestees or In a furlough status); 51 your earnIngs wIll not exceed the Faderal SaClal..Securlt
taxable wage base after t992: 6) you ara a full coverage member: and 7) your mandatary debt. wIth approprlat
interest. has been actuaria\ly reduced from your present value.
DISABILITY RETIREMENT' To be eltglble far a disabilIty retIrement. you must be under normal retirement age ar
have at least 5 years of credited service (State Pol Ice and Ltquar Law Enforcement Off Icers have no minim.
servIce reqUIrement) and be mediCally certified by SERS Medtcal ExamIners to be physIcally or mental'
Incap.ble of performing your current joa duties. Meeting theSe ellgtblllty requIrements doel not guarantee yc
a beneftt. In order to apply far a disabIlity retirement. you must be an active contributIng member of SERS c
be a member In an InactIve leave wltnout pay status. see your RetIrement Caunsalor for further datal1s.
Keep thIs statement In a safe place, There Is a $5.00 charge far duplicate statements.
In tne event of your death. any benaflts due will be paId to your named benefIClary(les). If you are unsure c
who you have designated. you should update your benefIClarylles). See your RetIrement Counselor for the prop'
'form.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND SS:
DENNIS R. SHELLENBERGER,
In Ihe Court 01 Common Plea. 01
Cumberland Counly, Penn.yl.anla
Plaint ill
...
LORETTA SHELLENBERGER.
No
94-930
Tenl1, 19_
DclendlUll
MOTION }70R APPOINTMENT OF MASTER
AND NOW,
May 30
95
, 19_, comcs the undenlgned Allomey lor
Ihe plaintiff and eertlne. to the Courllhal the abo.e acllon In Di.orce i. al IlSue, Ihal no Issue ha. been directed
by Ibe Courl 10 be lrl.d by jnry, and Ih.rerore respectlnlly 1II0'es Ihe Conrl ror the appointmenl 01 a M..ter.
S....lce or lh. complaint was iliad. olllhe abo.e named dclendlUll 0'" March 7, 1994
certified mail
by
(penonal s....lce. publication, etc.)
Samuel L. Andes, Esquire
An appearance on behall or Ihe d.lendanl has be.n ent.red b)'
The Collowing allome)'l ha.e b.cn inlercsted in olher mallen
arillng between the plalnlUl IUId dcl.nanl: Equitable Distribution, Alimony, Alimony Pendente
Lite. Counsel Fees
AND NOW, 10 will
Crom abo.e plalntl/llhe .um DC $
,19_. Recel.ed
, as deposit on accounl oC Ma.ter', Cecs and cool..
ConI..,
lqdicated.
I , Prolbonolary
ANDNOW,~ ~)- ,I9V, r= .Re, l~~c~
"c.I.,t4>c.~<:~' c.;:~ (N....~.
Esq., I, bereby appointed M..ler In Ibi. proc.eding IJ> h..r ,h. ._tlmn..y ....1 ..him lb. r.on..! ....!. 1..tll.,lpl
~~ fl., ('UII.I 1"'5,,11'1;1 "Ill. ,l!nlIn""tnnf-wrrlllmnr...d..tIon. "_"
BY It COURT,
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DENNIS R. SHELLENBERGER,
Plaintiff
.
.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
.
.
vs. NO. 94 - 930
LORETTA SHELLENBERGER,
Defendant IN DIVORCE
THE MASTER: Today is Thursday, March 7, 1996.
Present for a Master's hearing are the Plaintiff, Dennis R.
Shellenberger and his counsel Peter R. Henninger, and the
Defendant, Loretta Shellenberger, and her counsel Samuel L.
Andes.
A divorce complaint was filed on February 28, 1994,
raising grounds for divorce of irretrievable breakdown of the
marriage and indignities.
Counsel have advised that the
parties, within a week of today's date, will sign and file
affidavits of consent so that the divorce can be concluded under
Section 3301(c) of the Domestic Relations Code.
On September 30, 1994, the Defendant filed a
petition for economic relief raising the economic issues of
equitable distribution, alimony, alimony pendente lite, and
counsel fees and expenses.
On March 21, 1994, the Prothonotary issued a rule
for Bill of Particulars. Counsel indicated they are going to
address that matter in the statement of the agreement.
The Master has been advis~d that after negotiations
this morning the parties and counsel have reached an agreement
..
with respect to the outstanding economic issues. The agreement
is going to be placed on the record in the presence of the
parties. The agreement as stated on the record will be
considered the substantive agreement of the parties and not
subject to any modifications except for correction of
typographical errors which may be made in the transcription.
After the agreement has been prepared in draft form by our
office, it will be sent to counsel for review for typographical
errors. After any corrections have been made, we will send the
original around to counsel and the parties for signature. The
signing of the agreement by the parties and counsel is
considered an affirmation of the agreement which is placed on
the record today which will be the final and substantive
agreement of the parties.
After the signed document has been returned to the
Master's office, the Master will prepare an order vacating'his
appointment and counsel can then prepare a praecipe transmitting
the record to the Court requesting a final decree in divorce.
Mr. Andes.
MR. ANDES: Thank you. The parties have agreed
upon the fOllowing items:
1. The Defendant will, by praecipe, withdraw the rule for
Bill of Particulars in this matter. The parties will
both execute and file with the Court, within one week,
affidavits of consent and waivers of further notice so
that a divorce can be concluded in the near future.
.
2. The marital residence at 113 Sharon Road, East Pennsboro
Township, Enola, Pennsylvania, will be transferred to
wife and husband will execute a deed and any other
necessary documents to make that conveyance.
Wife will be responsible to pay and satisfy, in
accordance with their existing terms, the mortgage
against the property owed to First Federal Mortgage
Company with an approximate balance of $840.00 at this
time and the home equity loan owed to PNC Bank with an
approximate balance of $8,000.00.
Wife will indemnify and save harmless husband from any
loss or costs caused to him by her failure to pay those
obligations.
3. Wife waives any claim to husband's retirement with the
Commonwealth of Pennsylvania with the exception of the
following:
a) Husband agrees that if he retires prior to
attaining full retirement benefits at his age 65,
he will pay to wife the sum of $18,000.00 promptly
upon his retirement. That sum represents
approximately 1/2 of the difference between the
value of his pension benefits, if he continues to
work to age 65, and those benefits if he retires at
age 62 as determined by the appraiser used by the
parties.
b) Husband will designate wife, irrevocably, to
receive $18,000.00 of the death benefits payable
upon his death*under the pension plan and continue
that designation until his age 65. ',In
*if hfs death occurs prior to his retirement~ G(p~
4. Husband waives all claims to any pension benefits wife
has with Gannett Fleming or her present employer, UPS,
and any claim he has to an interest in or claim against
her thrift plan with UPS.
5. Husband shall pay to wife within sixty (60) days of the
entry of a final decree in divorce the sum of $20,000.00.
That sum shall, among other things, represent the
equitable distribution of the following assets:
a) Any bank accounts held by the parties at the time
of their separation.
b) Husband's Harley-Davidson motorcycle.
~
c) Any other motorcycle or automobile owned by the
parties at the time of separation and the proceeds
of any vehicles of which they have made any
disposition.
6. The current support order shall continue in effect
and be managed by the Domestic Relations Office of
Cumberland county until the last day of the month in
which the final decree in divorce is entered in this
action. Husband acknowledges that he will be liable to
make all payments due under that order through the
final day of the month in which the final decree in
divorce is entered even though the parties may be
divorced for a portion of that month.
Wife agrees that, upon termination of the support order,
any arrear ages existing as of today will be cancelled
and remitted. Any arrearages which arise under the
support order after this date shall not be cancelled and
husband will be obligated to pay those at the time the
support order is terminated.
7. Husband shall pay alimony to wife at the rate of $575.00
per month, commencing on the first day of the first month
following the entry of a decree in divorce in this
action. The alimony will be paid through the Domestic
Relations Office with a formal attachment of husband's
wages. The alimony will continue until terminated by
wife's co-habitation with a man, not her spouse; wife'S
remarriage; wife's death; husband's death; or a
subsequent order of this court.
The parties agree, however, that if the incomes of the
parties are such at the time of and after husband's
retirement, that an alimony order is not appropriate on
the then existing income of the parties, that the alimony
order will be suspended and not be terminated, so it can
be reinstated if the financial circumstances of the
parties change significantly thereafter.
Nothing herein shall be interpretated to prevent either
party from petitioning the Court to request a
modification of the alimony based upon a change in
economic circumstances. The only limitation is that, if
husband's income decreases significantly because of his
retirement, the Court may not absolutely terminate
his alimony obligation at that time, but may only suspend
it so that alimony can be reinstated if his income
significantly increases after his retirement because of
other employment or other income.
8. Husband shall retrieve from the family home his pool
table, a craftmatic bed, a 42 inch television, and his
personal tools from the garage within sixty (60) days of
the entry of the final decree in divorce.
Wife shall retain the other items of furniture and
household furnishings in the family home and each party
waives any further claim to such items in the possession
of the other.
9. Wife waives any further claim to counsel fees or alimony
pendente lite, as does husband.
10. Except as herein otherwise provided, each party may
dispose of his or her property in any way and each
party hereby waives and relinquishes any and all rights
he or she may now have or hereafter acquire under the
present or future laws of any jurisdiction to share in
the property or the estate of the other as a result of
the marital relationship including without limitation,
statutory allowance, widow's allowance, right of
intestacy, right to take against the will of the other,
and right to act as administrator or executor in the
other's estate. Each will at the request of the other
execute, acknowledge, and deliver any and all instruments
which may be necessary or advisable to carry into effect
this mutual waiver and relinquishment of all such
interests, rights, and claims.
MR. ANDES: Mrs. Shellenberger, YOU've heard
everything that I've dictated?
MRS. SHELLENBERGER: Yes.
MR. ANDES: Do you understand it?
MRS. SHELLENBERGER: Yes.
MR. ANDES: Do you understand that by making this
agreement today we are making a final agreement and that if this
afternoon or tomorrow morning we have misgivings, we can't
change the agreement?
,
MRS. SHELLENBERGER: Yes.
MR. ANDES: You've had a chance to meet with me and
we've had a chance to review the assets. We haven't had
everything formally appraised, but are you satisfied that you
have enough information to intelligently reach this agreement?
MRS. SHELLENBERGER: Yes.
MR. ANDES: And are you satisfied with the terms of
the agreement as satisfying your claims in this divorce action?
MRS. SHELLENBERGER: Yes.
MR. ANDES: And is this your agreement that you are
willing to stand by?
MRS. SHELLENBERGER: Yes.
MR. HENNINGER: Mr. Shellenberger, you've heard Mr.
Andes set forth, quite eloquently -- and I don't even have any
comments, which is surprising in these matters -- with regards
to distribution of property, with regards to your responsibility
as far as alimony is concerned, and specifically with regards to
how your pension would work upon your retirement? Do you
understand that by saying, yes, that you understand and agree to
these things and that you are not going to be able to come and
change your mind in the future unless we can show some fraud or
major misrepresentation on your wife's behalf? You understand
that?
MR. SHELLENBERGER: Yes.
MR. HENNINGER: And you understand and are willing
to agree that the terms as set forth by Mr. Andes as per our
discussions are correct?
MR. SHELLENBERGER: Yes.
I acknowledge that I have read the above
stipulation and agreement, that I understand the terms of
settlement as set forth herein, and that by signing below I
ratify and affirm the agreement previously made and intend to
bind myself to the settlement as a contract obligating myself to
the terms of settlement and subjecting myself to the methods and
procedures of enforcement which may be imposed by law and in
particular section 3105 of the Domestic Relations Code.
WITNESS:
DATE:
~~
Attorney for plaintiff
erger
~
Attorney for Defendant
lJ.-/t;. 9t,
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Loretta Snellenberg
DENNIS R. SHELLENBERGER, . IN THE COURT OF COMMON PLEAS OF
.
plaintiff . CUMBERLAND COUNTY, PENNSYLVANIA
.
vs. NO. 94 - 930
.
.
LORETTA SHELLENBERGER,
Defendant IN DIVORCE
ORDER OF COURT
AND NOW, this
Ie ;/+
~ day of
f\ ,f/~ ) l.-., 1996,
the parties and counsel having entered into an agreement and
stipulation resolving the economic issues on March 7, 1996, the
date set for a Master's hearing, the agreement and stipulation
having been transcribed and subsequently signed by the parties
and counsel, the appointment of the Master is vacated, and
counsel can conclude the proceedings by the filing of a praecipe
to transmit the record with the affidavits of consent of the
parties so that a final decree in divorce can be entered.
BY THE COURT,
Ha
P.J.
cc:
Peter R. Henninger, Jr.
Attorney for plaintiff
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Samuel L. Andes
Attorney for Defendant
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DBNNIS R. SHBLLBNBBRGBR,
Plaintiff
IN THB COURT OP COKHON PLBAS
OP CUMBBRLAND COUNTY,
PBNNSYLVANIA
CIVIL ACTION - LAW
NO. 94-930 CIVIL
IN DIVORCB
vs.
LORETTA SHBLLBNBBRGBR,
Defendant
AFFIDAVIT OP SBIlVICB BY CBIlTIPIIlD HAIL
LOU ANN GRISSINGBR, being duly sworn according to law, deposes and says as
follows:
1. That she is an employee of Andes, Vaughn & Bangs, attorneys for the Defendant
herein.
2. That on 24 March 1994, she delivered to the U.S. Postal Service in Lemoyne,
Pennsylvania, as certified mail (Receipt No. P274 290 748) return receipt requested,
addressed to the Plaintiff's counsel of record herein, a true and correct copy of
Defendant's Praecipe for Rule for a Bill of Particulars together with the Rule issued
thereon.
3. Said return receipt card is attached hereto as Bxhibit A showing a date of
delivery to the Plaintiff's counsel of 25 March 1994.
Sworn to and subscribed
before me this , / '" day
of MR./L , 1994.
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Lou Ann r ss er ~
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Nota Public
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LOREnA II. SIIELLENIlERGER,
PLAINTIFF
: IN TIlE COURT OF COMMON PLEAS OF
: CUMIlERLANDCOUNTY. PENNSYLVANIA
VS
: DOMESTIC RELATIONS SECTION
: CIVIL ACTION - SUPPORT
DENNIS R. SIIELLENIlERGER.
DEFENDANT: NO. 930 CIVIL 1994
AMENDED
ORDER OF A nAClIMENT OF INCOME
TO: Commonweallh of Pennsylvania. Ilureau Payroll Operations, Allaehmenl/Researeh Unit.
P.O. Box 8006/General Employees. Harrisburg, Pennsylvania 17105-8006
AND NOW. this 31st day of~. 1996. pursuant to the laws of the Commonwealth
of Pennsylvania. the income of Dcnnis R. Shellenberl!cr. defendant/obligor. social security
number 186-30-6875, of 623 Stoic Street. Lemovne. Pennsvlvania 17043. is hereby allaehed
to the following extent.
You are directed to pay to the Domestic Relations Section oflhe Court of Common Pleas
of Cumberland County. the sum 01'$ 595.00 per month out of the income due the
defendant/obligor. within ten (10) days after the date the defendant/obi igor is paid.
Onmcstic Relations Section
1'.0, !Jnx 320
Carlisle. Pennsylvania 17013
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Make checks payable to:
.
IDENTIFY THIS PAYMENT BY PLACING OR 21.542 ON YOUR CHECKIPAYMEN~
".
Upon receipt of the support payment. the Domestic Relations Oniee will distribute the
payment as follows:
$ 575.00
$-
$ 20.00
$-
$-
per month
per _
per month
per _
per _
Support
Arrearage due DPA $.
Arrearage due plaintiff $ 2.305.00
Blood Test Costs $_
Service Fees/Costs $_
This order of allaehment for support is binding upon you until further notice and shall
have priority over any allaehment. execution, garnishment or wage allachment undcr state or
local law exccpt onc relating to n prior support order. You must commence thc allachment of the
defendant/obligor's income as soon as possible but no Inter than fourteen (14) dnys from the date
of issuance of this ordcr of allaehment.
You are notified further that pursuant to law:
I. The defendant/obligor has been notificd that an order of allachment for support
would be issued.
,
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Edgar B. Bayley. -
J.
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2. Wilful failure to comply with this order may result ia (I) your beiug adjudged in
contempt of court aud committed to jail or fined by the Court: (II) your beiug
held liable for any amount not withheld or withheld but nol forwarded to the
Domestic Relations Section. and (111) attachment of your timds or property.
3. The attaehment of income or the possibility thereof as a basis. in whole or in
part, for the discharge of an employee or any disciplinary action against or
demotion of an cmployee is prohibited. Violation may result in (I) your being
adjudged in contempt and commilled to jail or fined by the Court, and (11) an
action against you by the employee for damages.
4.
If there are in your employment. one or more additionnl employees whose
incomes are subject to order ofthc Court of Common !,Iens ofCllmberlnnd
County for allachment for support. you may combine the allachment payments
into a single payment to the Domestic Relations Section and separately identify
the portion allributable to each obligor.
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~; You must notify the Domestic Relations Section when the defendant/obligor
?:, terminates employment and provide the Domestic Relations Section with the
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. '. employee's last known address and the name and address of the new employer
',~< if known.
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The maximum amount of the allachment shall not excess 50% of the defendant's
disposable earnings.
7. The tenn "income" as defined by law includes compensation for services.
ineluding but not limited to: wages. salaries. fees. compensation in kind.
commissions. and similar items. income derived from business. gains derived
from dealings in property. interest. rents. royalties. dividends. annuities. income
from life insurance and endowment contracts. all fonus of retirement. pensions.
income from discharge of indebtedness, distributive share of partnership of gross
income, ineome in respeet of decendent, income from an interest in an estate or
trust, military retirement benefits. railroad employment retirement benefits.
social security benefits. temporary and penn anent disability benefits. workmen's
compensation and unemploymcnt compensation.
You may dedud Crom the balance due the deCendant an amount equal to two
percent (2%) oC the amount paid Cor clerical work and expense Invllh'ed In eomplyin~ with
the order (see Pennsylvania Law 1985-66, Sed ion 4348).
BY THE COURT,
DRO: Joseph M. Topichak
ee: Dennis R. Shellenberger. defendant
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LORETtA II. SIIELLENBEIWER
PLAINTIFF
: IN TIlE COllin OF COMMUN PLEAS OF
: CUMBERLAND COUNTY.I'ENNSYLV^NIA
VS
: DOMESTIC RELATIONS SECTION
: CIVIL ACTION - SlJPl'ORT
DENNIS I~. SIIELLENBEIWER
DEFENDANT: NU.930 D 94
AMENDED
ORIlElt OF AIT^CIIMENT OF INCOME
TO: COMMONWE^LTII OF I'A. BlJRE^lll'A YROLL OI'ERATIUNS.
ATI'ACIIMENT/IWSEARClIllNIT. P.U. BOX 8006/UENERAL EMPLOYEES.
IIAI~RISBllRG. PA 17105-80116
AND NOW. this 9th dny IIf.1!!h.. 1'196. pursullnttllthc 11Iws IIfthc ClImmonwcnlth of
PcnnsylvlInill. thc inClllllC IIf Dcnnis R. Shcllcnbcrllcr . dcfclldnntlllbligllr. slIcinl sccurity
nUlllbcr 18(,-30.(,875. Ill' (,:!3 StlltC Strcct. LClIIllvnc. P^ 17043. is hcrcby 1I1laehcd to the
following cxtcnt.
Youllrc dircctcd to pllY tothc DOlllcstic Rclations Scction of the Court IIfC0l111110n Pleas
of Cumberland County. thc sumllf$ 575.011 per month mil ofthc ineomc due thc
dcfcndant/obligor. withintcn (10) days allcr thc dalc thc defcndant/obligor is paid. ," :-',
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Make eheek.s plIYllhle to:
I)nmeslie Rellltinns Section
I'. O. nox 3211
ClIrlisle.I'ennsyl\'lInlll 17013
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IDENTIFY THIS PAYMENT ny I'LACING I)R 21.542 ON YOUR CHECKlI'A YMF.NT
Upon recciptofthc support pnymcnt.the Domcstic Relations Olliec will distribute the
paYlllent as follows:
$ 575.00
$-
$-
$-
$-
per 1II0nth
pcr _
pcr _
pcr _
pcr _
$-
$-
$-
$-
SUppllrt
Arrcnrugc duc DI'A
Arrclll1lgc due plaintilT
Blolld Test Costs
Servicc Fccs/Costs
This IIrdcr IIf llltnchlllcntli,r support is binding upon Ylluuntil furthcr uotiec and shall
hnvc priority IIvcr nn)' nllnchlllcnt. cxccutiou. gnrnishlllcnlor wngc allachmcntundcr stnte or
locallllw cxccptonc rclllting tOll prior support ordcr. YIIUIIIUSt cOlllmcuce thc 1I1lnehment of the
dcll:ndnnt/lIbligllr's inClllllC liS SllonllS possiblc bUlnolntcr tllllnlilurtccn (14) dnys from thc dnte
of issunncc IIf this ordcr IIf nllllcluucnt.
YlIullrc nlltilicd lilrthcr thllt pursunnttlllnw:
I. Thc dcll:ndnnt/lIbligllr has bccnnotilicd thlllllnllrdcr Ill' nttachmcnt for SUpp"rt
wlluld bc issucd.
2. Willilllililurc to com pi)' II ilh this ordcr 111I1)' result in (I) )'our being adjudgcd in
contcmptofcourt und conll1lillCd tojnilor Iincd b)' thc Courl: (II) )'our beiug
held linhlc lilr nn)' nmountnot withhcld or withheld hutuotlilfl~nrdcd tothc
Domcstic Relntions Scction. uud (III) ullnchmcnt of)'our fuuds or propcrt)'.
3. Thc nllnchmcnt of incomc \1f thc possibilit)' thcrcof ns n basis. in wholc or in
pnrl. lilr thc dischnrgc of un cmplo)'cc \1f 1111)' diseiplinnl')' Ilctionngainst or
dcmotion of nn cmplo).cc is prohibitcd. Violationmn)' rcsult iu (I) )'our being
ndjudgcd in contcmptnnd commillcd tojuil or Iincd b)' thc Court. and (II) nn
nctionagainst )'ou h)' thc cmplo)'cc lilr damagcs.
4. I I' thcrc nre in )'our cmplo)'mcnt. onc or morc ndditionnl cmplo)'ccs whosc
iucomcs nrc subjcctto ordcr ofthc Court ofCon1l1lonl'lcns of Cumberland
Cmmt)' lilr nllnchmcntli,r support. )'oumn)' combinc thc nllachmcnt paymcnts
inton singlc pll)'mcnltothc DllI1lcslic Relntions Scctionnnd scpaflltcly idcntify
thc portion Illlributnblc 10 cnch obligor.
5. You must notily thc Domcstic Rclations Scction ,vhcnthc dclcndnnt/ohligor
tcrminatcs cmploymcntnnd pro~idc thc Domcstic Relntions Scction with thc
clllplo)'cc's last knownnddrcss lllld thc namc and nddress of thc ncw cmploycr
if known.
6. Thc mllsimumnmmmtoflhc allachmcnt shall not csccss 50% oflhc defcndant's
disposnblc cnmings.
7. Thc ten1l "incomc" ns dclincd hy 11IW ineludcs compcnsntion lor scrviccs.
including butnotlimitcd to: wngcs. snlnrics. Iccs. compcnsation in kind.
eonll1lissions. and similar itcms. incomc dcrivcd from busincss. gains derived
from dcalings in propcrty. intcrcst. rents. royalties. dividends. annuities. income
from Hlc insurancc and cndowmcnt contfllcts. all forms of retirement. pensions.
incomc fron' dischnrgc of indcbtcdncss. distributivc share of parlnership of gross
incomc. incomc in respcct of dcccndcnt. income frolll an interest in an estate or
trust. milital')' rctircmcnt bcnclits. railroad cmplo)'mcnt retirement benelits.
social sccurit)' hcnclits. tcmporary and permancnt disability hcnclits. workmen's
compcnsation and uncmplo)'mcnt compcnsation.
Vou may deduct from the balance due the defendant an amount equal to two
percent (1./0) of the amount paid for clerical work and expense Involved in complylnlt wilh
the order (see l'enns)'lvanhl Law 1985-66, Section 4348).
IlV TilE COURT.
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DRO: Joscph M. Topichnk
cc: dclcndant
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LORE'ITA II. SllEl.l.ENIlEIHiER
PI.AINTIFF
: IN TilE COURT OF COMMON PI.EAS OF
: ClJMIlERI.ANDCOUNTY.PENNSYLVANIA
VS
: DUMESTIC RELATIONS SECTION
: ('I VII. ACTION. SlJl'PORT
DENNIS R. SIIEI.LENIlERGER
DEFENDANT : NO.93U 6 94
ORIlER OF COURT
AND NOW. this 9th day of July. 1996. upon cousidcrationllfthc rccolllmcndation of
thc Domcstic Rclations Ol1iccr.
IT IS IIEREIlY ORDERED AND DIRECTED IIlllt hllscd uponthc ngrccmcnt hctwccn
thc pllrtics liS stlltcd intcstimony hcli.rc thc Divorcc MlIstcr 0111.7.%. clli:ctiw 5-1-%. all
lIrrellrllllcs lire to hc cllnccllcd. rcmittcd.
As oflhis dlltc. 7.9-%.lIrrcllrs lIrc $290.38. Thcsc arrcaragcs havc lIccrucd sillcc thc
clTcctivc datc of 5-1-96.
This ordcr shllll hccolllc lillllltcn days 1I1lcr thc mllilillg ofthc noticc ofthc cntry ofthc
ordcr to thc Pllrtics nnlcss cithcr pllrty IiIcs n writtcn dClllllnd with thc Domcstic Rcllltions
Scction lilr a hCllring dc novo hclilrc thc Court.
ORO: Joscph M. Topichak
cc: plaintilT
dcfcndllnt
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
i)),I/, /1f/l!_y:;tJ (lIt'll.
State Commonwealth of Pennsvlvanla Akl~''f S' ,)/7..") (:D {,('-:I.ll
CoiCily/Dist. of CUMBERLAND .\
Date of Order/Notice 07/30/02 Ij/<!.. .;J./'Jl/:>-
Court/Case Number fSee Addendum for case summary)
@Original OrderlNoIice
o Amended Order/Noliee
o Terminale OrderlNotice
EmployerlWilhholder', Federal EIN Number
PA STATE RETIREMENT SYSTEM
EmployerlWilhholder', Name
BOAS SCHOOL BLOG
EmployerlWithholder', Addre..
909 GREEN ST
HARRISBURG PA 17102
IRE:SHELLENBERGER, DENNIS R.
) EmployeelObllgor's Name ILaSl. First. Mil
I 186-30-6875
) Employee/Obligor', SocialSeeurily Number
I 3590000028
) Employee/Obligor', enelde.liller
I ISH Addrndum tOl pI.ln/1ff /101m.. aJSOCi.tfd with ca... on .It.dun../)
I Custodial Parent's Name (last. Firs.. MI)
I
See Addendum for dependent names and birth dates associated with cases on attaehment.
ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. 8y law, you are required to deduct these
amounts from the above-named employee's!obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 575.00 per month In current support
$ 0 . 00 per month in past.due support Arrears 12 w""~, no ~-~aterl 0 yes @ no
$ 0.00 per month In medical support
$ 0 . 00 per month for genetic test costs
$ per month In other (specify)
for a total of S 575.00 per month to be forward
You do not have to vary your pay cycle to be in compliar ( '\ A ( "\ r pay, cycle does not matc.h . .
the ordered support payment cycle, use the following to I ',//:. . .
$ 132.69 per weekly pay period. <;) ~
$ 265.38 per biweekly pay period (every two we 0 - . O;;l.
$ 287.50 per semimonthly pay period {twice a m~""",
S 575.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working da~
Order/Notice. Send payment within seven (7) working days of the paydateldate of withhold;
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of ,..... ~........,~~ M ".~
the allowable amount. The total withheld amount. and your fee, cannot exceed 55"10 of the employee's! obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information Is
needed (See #9 on pg. 2).
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDUl Employer
Customer Service at 1.877-676-9580 for instructions.
Make Remitlance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID fshown
above as Ihe Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
JllL '.\ ~ 2(.~2
"TH'~~'1~
7VtYrc=.
Form EN.028
Worker 10 $OINC
Dale of Order:
Service Type M
'. r/)c/-Jt:.
""U "J-;a
'e'"''
M >>, ~- I)M8No-0'1lU-(}1\4
..1_ { ;; ",,,.,~D..11I\1""
-
/', /.>>-}Vt:.E Y
""
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
I)W~ l11fl-93t) (l/('1t.
State Commonwl!allh of Pl!nnsvlvanla A./(1<;'f~ .)l7.:Jf:fJ(;{i";l_lj
CoiClly/Dist. of CUMBERLAND .\
Date of Order/Notice 07/30/02 11<. ,:).15(1:>-
Court/Case Number fSee Addendum for case summary)
@origin.1 OrderlNoIice
o Amended Order/NoIlce
o Terminale OrderlNoIlce
EmployerlWilhholder's Feder.1 [IN Number
PA STATE RETIREMENT SYSTEM
EmployerlWllhholder's N.me
BOAS SCHOOL BLDG
EmployerlWilhholder's Address
909 GREEN ST
HARRISBURG PA 17102
I RE: SHELLENBERGER, DENNIS R.
) Employee/Obligor's N.me (l.... First. Mil
) 186-30-6875
) EmployeelObligOf's Soci.1 Security Number
I 3590000028
) Employee/Obligor's C...ldenliner
) CS..,Iu/lkndum IlK pI.lntlff ""mo. .uochrod with caul OII.tt.drmonV
} Custodial Parent's Name (lasl. First. MI)
I
See Addendum for de~ndent names and birth dates associated with cases on allachment.
ORDER INFORMA TION: This Is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's!obligor's income until further notice even If the Order/Notice is not
Issued by your State.
$ 575.00 per month In current support
$ 0 . 00 per month in past-due support Arrears 12 weeks or greater? 0 yes <Xl no
$ 0 . 00 per month In medical support
$ 0.00 per month for genetic test costs
$ per month In other (specify)
for a total of $ 575.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle. use the following to determine how much to withhold:
$ 132.69 per weekly pay period.
$ 265.38 per biweekly pay period (every two weeks).
$ 287.50 per semimonthly pay period (twice a month).
$ 575.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydateldate of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed SS% of the employee's! obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding. the following Information Is
needed (See #9 on pg. 2).
If remilling by EFTIEDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service atl-877.676-9S80 for Instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID fshown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Jl\L 'J 1 2~\l2
BYTHE~?J,,~
;". /.l.}VLGY :rv~
Form EN-02B
Worker 10 $OINC
Date of Order:
Service Type M
.0 _.. r /)L'I.J~
~ '.,,('il)
.a' .. OMBNo.:M;o..olS4
'- ,I _ { -t 'q"M"," OM' ""''''0
'.
"'
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o I€ checked you are required 10 provide a copy of Ihis form 10 your employee.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law agalnstlhe same income.
Federal tax levies in effect be€ore receipt of this order have priority. If Ihere are Federal tax levies in effect please conlact Ihe requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment
10 each agency requesting withholding. You must. however, separately identify Ihe portion of the single payment thai Is attributable to
each employee/obligor.
3. . ReportinB1he-Paydall!JElal~ofWilhholdingrl'ou-mU!l-1eport thepaydateldat...ofwithholdjng~endmg.lh~pa) me, ,I. The
paydateld_ofwilhholding-k-thedale"OrtwhidHlmountwa.-withheld-frorntheemployee',~ You mUSI comply with the law of the
state of Ihe employee'slobllgor's principal place of employment with respect to Ihe time periods within which you must Implement Ihe
withholding order and forward the support payments.
4.' Employee/Obligor with Multiple Support Holdings: If there is more than one OrderlNotice to Withhold Income for Support
against this employee/obligor and you are unable 10 honor all support OrderlNotices due 10 Federal or Stale withholding limits, you must
follow the law of the state of employec'slobligor's principal place of employment. You must honor all OrdersINotices 10 the greatest
extenl possible. (See #9 below)
S. Termination Notification: You must promptly notify Ihe Requesting Agency when the employee/obligor Is no longer working for
you. Please provide Ihe information requested and return a copy of this OrderlNotice to the Agency Identified below.
WITHHOLDER'S 10: 5273100092
EMPLOYEE'S/OBLlGOR'S NAME:
EMPLOYEE'S CASE IDENTIFIER:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
SHELLENBERGER. DENNIS R.
3590000028 DATE OF SEPARATION:
6. Lump Sum Payments: You may be required to report and withhold from lump sum paymenls such as bonuses, commissions, or
severance pay. If you have any questions aboullump sum paymenls, contact the pe!1;on or authority below.
7. Liability: If you fall 10 withhold income as the OrderlNotice directs, you are liable for both Ihe accumulaled amounl you should
have wllhheld from the employee/obligor's Income and other penalties set by Pennsylvania Stale law. Pennsylvania State law govems
unless the obligor Is employed In anolher Stale. in which case Ihe law of the Slate in which he or she Is employed governs.
B. Anti-dlscrlmination: You are subJect 10 a fine delermined under State law for discharging an employee/obligor from
employment refusing to employ. or laking disciplinary action against any employee/obligor because of a support withholding.
Pennsylvania State law governs unless Ihe obligor Is employed In another State, In which case Ihe law of the Slate In which he or she Is
employed governs.
9.' Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by Ihe Federal Consumer Credit
Protection Act (15 U.S.C. S 1673 (b)1: or 21the amounts allowed by the State of Ihe employee'slobligor's principal place of employment.
The Federal limit applies 10 the aggregate disposable weekly earnings (ADWE). ADWE is Ihe nellncome le~ a~er making mandalory
deductions such as: State, Federal, local taxes: Soclal5ecurity laxes; and Medicare laxes.
10.
'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the slate Ihat issued this order with respecl to these items.
Requesting Agency:
DOMESTIC RELATiONS SECTION
13 N. HANOVER ST
P.O. 80X 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
conlact WAGE ATTACHMENT UNIT
by lelephone at (7171 240-6225 or
by FAX at f7171 240-6248 or
by Internet @
Page 2 of 2
Form EN.028
Worker 10 $OINC
Service Type M
OM!I Nt).: ()'}]()..()ISo.t
('PifMiunD.ttr-lIlJlA'O
r';" <~,..~....
... ...
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: SHELLENBERGER, DENNIS R.
PACSES Case Number 272000024 J.;r l'lll). PACSES Case Number
Plaintiff Name i' Plalnllff Name
LORETTA H. SHBLLBNBBRGBR
I2Ws:1 Anachment Amount
930 C 94 S 575.00
Chlld(ren)'s Name(s):
DOB
Attachment Amount
S 0.00
Chlld(ren)'s Name(s):
Docket
DOB
o If checked, you are required to enroll the chlldlren)
idenllfied above in any heallh Insurance coverage available
through the employee'slobllgor's employment.
o If checked, you are required to enroll the chlld(renl
Identified above In any heallh insurance coverage available
through the employee'slobllgor's employment.
PACSES Case Number
Plainllff Name
~ Attachment Amount
S 0.00
Chlld(ren)'s Name(s):
DOB
PACSES Case Number
Plaintiff Name
~ Attachment Amount
S 0.00
Chlld(renl's Name(s):
DOB
o If checked, you are required to enroll the chlld(ren)
Idenllfied above in any health insurance coverage available
through the employee'slobllgor's employment.
o If checked, you are required to enroll the chlld(ren)
Identified above In any heallh Insurance coverage available
through the employee'slobllgor's employment.
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
S 0.00
Chlld(ren)'s Name(s):
DOB
PACSES Case Number
Plalnllff Name
Docket Attachment Amount
S 0.00
Chlld(ren)'s Name(s):
DOB
o If checked, you are required to enroll the chlld(ren)
idenllfied above In any health Insurance coverage available
through the employee'slobllgor's employment.
o If checked, you are required to enroll the chlld(renl
identified above In any health Insurance coverage available
Ihrough the employee'slobllgor's employment.
Addendum
Form EN.028
Worker ID $OINe
Service Type M
()M8No.:0')1~1\"
h~'oiIior1 0...(": 11''''00
~ -- ~
~
D .. ::>..;
~;( C'l 0'.
:C .JZ
h'~) '- ...~
6~': 0.. :":l~
, ,. C-.J ..-:,.[h
Co:. I ~..l ;~
ll-~ . ,.-;.-
~ ~:: ',';'ltrl
u... \~~ :;;:t ::!.\o-
" :':::
" C"..l ':;)
Go e-" D
~
,
,.
.,~,..::~-~""
.
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
i);/ I'Jficj - 93 t, (? ( ('l L
State Commonwealth of Pennsvlvanla /I/r"l ~ ,T/,'J!'f',rI .) yr
CoiCily/Dist. of CUMBERLAND JJi
Date of Order/Notice 07/30/02 I... ';/1'71!d-
Court/Case Number (See Addendum for case summary)
o Original Order/NoIice
o ^mended OrderlNoIice
@ Te,minale O,de,lNotlce
EmployerM'ilhholder's Federal EIN Number
COMMONWEALTH OF PA
EmployerlWithholder's Name
C/O PAYROLL OPERATIONS
EmployerlWilhholder's ^<Idless
ATTACHMENTS RESEARCH UNIT
PO BOX 8006
HARRISBURG PA 17105-8006
IRE:SHELLENBERGER, DENNIS R.
) Employee/Obligor's NamelLas'. Firsl, Mil
) 186-30-6875
) Employee/Obligor's Social Security Number
I 3590000028
) Employee/Obligor's Case Idenlilier
) (See AdMndum 101 pI./nll" "'m.. ...od.red with ca... on .rt.r:hmonU
) Custodial Parent's Name (last. First. MU
I
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TION: This is an Order/Nolice 10 Withhold Income for Support based upon an order for support
from CUMBERLAND Counly, Commonwealth of Pennsylvania. 8y law, you are required to deduct these
amounts from the above-named employee's!obligor's income until further notice even if the Order/Notice is not
issued by your State.
So. 00 per month In current support
So. 00 per month in past-due support
S 0.00 per month in medical support
S 0.00 per monlh for genetic test costs
S per month in other (sper" .
for a total of $ 0.00 per mor,
You do not have to vary your pay cycle tt
Ihe ordered support paymenl cycle, use th,
S 0.00 per weekly pay period.
S 0.00 per biweekly pay period I
S 0.00 per semimonthly pay peril
S 0.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no laler than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment wilhin seven (7) working days of the paydateldate of Withholding. You are entitled to
deduct a fee to defray the cost of wilhholding. Refer to the laws governing the work state of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on pg. 2).
If remitting by EFTIEDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
.
lrs 12 weeks or greaterl 0 yes <&> no
I.
\j~~
t order. If your pay cycle does not match
" to wilhhold:
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106.9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order:
JUL 3 1 2Cil2
BYTH~rt1J
~--\fv&~~
t I){,-I'}A' 13 tJr} VI F Y
Service Type M
~~~~"'!J_'
1.;,..ij~1l.1. .....r~.' ' O,"8No;IJ'J!().0I'J"
'--. '~_I' . hplI,thun DoItf', '}"UIO
..' -0.-
Form EN-028
Worker 10 $IATT
.
ORDER/NOTICE TO WITHHOLD INCOME fOR SUPPORT
DJ:I. !'Jt?t/- ?U' (7 !I I L
Slale Commonweallh of Pennsylvania /I/I"l C; ,.7-;; ,J.![C C.J}I
ColCity/Dist. of CUMBBRLAND " .
DaleofOrder/Nollce 07/30/02 .iJI( .;J.F7f/)-
Court/Case Number (See Addendum for case summary)
o Orl81nal Order/Notice
Q Amended Order/NOIice
<R> Terminate Order/Nolice
EmployerM'ilhholder's Feder.1 EIN Number
COMMONWEALTH OF PA
EmployerM'ithholder's N.me
C/O PAYROLL OPBRATIONS
EmployerM'ithholder's Address
ATTACHMENTS RBSEARCH UNIT
PO BOX 8006
HARRISBURG PA 17105-8006
IRE:SHBLLENBBRGBR, DBNNIS R.
) Employee/Obligor's N.me IL.II. FirS!. Mil
) 186-30-6875
I Employee/Obligor's Soci.1 Security Number
I 3590000028
) Employee/Obligor's use Identifier
I (S.. Addondum (01 "u(n"" ....m.....oo.,ed with ,as.. on .1I.dun.nll
) Custodial Parent's Name (last. First. MU
I
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TION: This is an Order/Notice 10 Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonweallh of Pennsylvania. 8y law, you are required 10 deduct these
amounls from Ihe above-named employee's!obligor's intome unlil further notice even if Ihe Order/Notice is nol
issued by your State.
So. 00 per month in current support
S 0.00 per month in pasl-duesupport Arrears 12 weeks or greaterl Qyes <&> no
S 0.00 per month in medical support
S 0.00 per month for genetic test costs
S per month In other (specify)
for a lolal of $ 0.00 per monlh 10 be forwarded 10 payee below.
You do nOI have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following 10 determine how much 10 withhold:
S 0.00 per weekly pay period.
S 0.00 per biweekly pay period (every two weeks).
S 0.00 per semimonthly pay period (twice a month).
S 0.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7J working days of the paydate/date of withholding. You are entitled to
deducl a fee to defray the cost of withholding. Refer to the laws governing the work slate of your employee for the
the allowable amount. The total withheld amount, and your fee, cannot exceed 55"10 of Ihe employee's! obligor'S
aggregate disposable weekly earnings. for the purpose of the Iimilation on withholding, the following information is
needed (See #9 on pg. 2).
If remilling by EFTIEDi, please call Pennsylvania State Collections and Disbursement Unil (SCDUl Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order:
JUL 3 1 2C~2
",'HCS2~~~
l- t)C.I'}^' 13 IJr) ,/1 FY
form EN.028
Worker ID $IATT
Service Type M
~"'~n'~~
l ,." ~/\""~' -ltt- LJ ~ O"18No;O'J]IHIl'i~
'-...."'lllJJ... . (~"'."un O.ll.. '111l.11O
..,".('-eJ-.
"
.
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If checked you are required 10 provide a copy or Ihis form 10 your employee.
1. Priority: Wllhholding under Ihis Order/Nolice has priority over any other legal process under State law against Ihe same income,
Federalla. levies In effecl berore receipt of Ihis order have priorily. If there are Federal tax levies in effect please conlad the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more Ihan one employee/obligor's income in a single paymenl
to each agency requesting withholding. You must. however, separately identify the portion or the single payment that is aUributilble 10
each employee/obligor.
3.' -Reporting1h~I'ayd.leJOateofW~hholdin!;.-Vou.mu'I.ll'JIOrt Ihe p.ydaleld.t~ofwilhholdlng whelHendlng1h~paymenl;-The-
paydateldat...ofwrthholdlng1S1hedale1lnwhichllmount-wMwilhheIMrom Ihe employee'sWoIges; You must comply with the law of Ihe
slate of the employee's!obligor's principal place of employmenl with respect 10 Ihe time periods within which you must implemenllhe
withholding order and forward the support payments.
4.' Employee/Obligor with Mulliple Support Holdings: If there is more than one OrderlNotice 10 Withhold Income for Support
against this employee/obligor and you are unable to honor all support Order/Notices due 10 Federal or State wilhholding limits, you must
follow Ihe law of the stale of employee's!obligor's principal place of employment. You must honor all OrdersINotlces 10 the greatesl
extent possible. (See #9 below)
S. Tennlnatlon Notification: You must promplly notify the Requesting Agency when the employee/obligor is no longer working for
you. Please provide Ihe inronnatlon requesled and retum a copy of Ihis OrderlNotice 10 Ihe Agency identified below.
WITHHOLDER'S ID: 2321122990
EMPLOYEE'S/OBLlGOR'S NAME:
EMPLOYEE'S CASE IDENTIFIER:
lAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
SHELLENBERGER. DENNIS R.
3590000028 DATE OF SEPARATION:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions aboullump sum paymenls, contact the person or authority below.
7. Liability: If you fall to wilhhold income as the OrderlNotice directs, you are liable for both the accumulated amount you should
have withheld from the employee/obligor's income and other penalties set by Pennsylvania Slate law. Pennsylvania Stille law govems
unless the obligor is employed in another State, in which case the law of Ihe Stale In which he or she is employed govems.
B. Anti-dlscrimlnatlon: You are subject to a fine delennlned under State law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary adion against any employee/obligor because of a support withholding.
Pennsylvania Slate law govems unless the obligor is employed In anolher Stale, In which case Ihe law of Ihe State in which he or she is
employed govems.
9.' Withholding Limits: You may nol withhold more than Ihe lesser of: 1) the amounls allowed by Ihe Federal Consumer Credit
Protection Ad (1 S U.S.C. ~ 1673 lb) 1: or 2) Ihe amounts allowed by the Slate of the employee's!obllgor's principal place of employmenl.
The Federal limit applies to the aggregate disposable weekly eamings IADWE). ADWE Is the nel income leli alier making mandatory
dedudions such as: State, Federal, local taxes; Social Security taxes: and Medicare taxes.
10.
'NOTE: If you or your agenl are served with a copy of this order in Ihe slate that issued the order, you are to follow Ihe
law of Ihe state that Issued this order with respect to Ihese items.
Requesting Agency:
DOMESTIC RELATIONS SECTION
13 N. HANOVER ST
P.O. 80X 320
CARLISLE PA 17013
If you or your employee/obligor have any questions,
contact WAGE ATTACHMENT UNIT
by telephone at (7171 240-6225 or
by FAX al 17171 240-6248 or
by Inlernet @
Page 2 of 2
Form EN.028
Worker 10 $IATT
Service Type M
OMS No. ()IJl~U \..
1",,,oItlClI'ID.II..ll"'oUll
II ....,-
>- -. ?i
~ C":
>-' .. :::J~
~C) C\j
& ;.:: 0-.
-(" o~
a: "'-
'.J:::. "":l::::::
C" ''7.,..J
-' .
~ " "I :,"U;
t:" I d2
".
-~ ;' . E? i'"t:2
iLILU
c: 0-1 a.
~
t.. <'': ::l
(', .:.., u
".
;;.1), 0000.)-1
q~o Dvd cr /,/
o Origin..1 Order/NoIice
o Amended OrderlNoIice
@ Terminate Ordpr/Notlce
.1
ORDERlNOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of Pennsylvania
CoJCity/Dist. of CUMBERtJ\ND
Date of Order/Notite 12/2~/02
Tribunal/Case Number fSee Addendum for case summary)
RE: SHELLENBERGER, DENNIS R.
Employee/Obligor', Name ILa", Firs.. Mil
186-30-6875
Employee/Obligor', Sueial Security Number
3590000028
imployee/Obligor', Ca..ldenliO..
ISH Arkhndum (01 ",.Inll" nom..
."ocI,'rd wllh co... 011 .".ehm.n')
Cu\lodial Parent's Name (last. First. Mil
Employer^V,'hhnld.r', Fed.ral EIN Number
PA STATE RETIREMENT SYSTEM
BOAS SCHOOL BLOG
909 GREEN ST
HARRISBURG PA 17102
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERtJ\ND County, Commonwealth of Pennsylvania. 8y law, you are required to deductthe<e
amounts from the above-named employee's!obligor's income until further notice even if the Order/Notice i~ not
issued by your State.
So. 00 per month in current support
So. 00 per month in past-due support Arrears 12 weeks or greaterl 0 yes <&l no
S 0.00 per month in medical support
S 0.00 per month for genellc test costs
S per month in other (specify)
for a total of S.D. 00 per month to be forwarded to payee below.
Ynu do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
S 0.00 per weekly pay period.
S 0.00 per biweekly pay period (every two weeks).
S 0.00 per semimonthly pay period (twice a month).
S OJ..Q.per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydateldate of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
allowable amount. The total withheld amount, and your fl't!, cannot exceed 55% of the employee's! obligor'S
aggregate disposable weekly earnings. For the purpose of the limitation on withhulding, the following information i~
needed (See #10 on Pl!. 2).
If remitting by EFTIEDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877.676.9580 for instructions.
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITfON, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Ordl'r: I.> /3/)/ d;r-
Service Typl' M
(l""B~1 fI'JiOtll\.a
rt"/7 \
V' \j \(0.1.1\ ~
Fo~m EN:'!128
Worker 10 $OINC
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"
.,; ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If thecked you are r('(luired to prp~i\le a rOilY of Ihis form 10 your "mployl'l!. If yoUr employl'l: works in.a slate Ihal is
ditlerenllrom Ihe slate thaI issul'dlhlS onler, .1 copy musl be provide'll 10 your employee even If Ihe box IS nol checked.
1. We appreciale Ihe volunlary raml>lianre of F('(lerally recognill'lllndian Iribes, Iribally-owned businesses. and Indlan-owned
businesses located on a reservation Ihal choose to wilhhold in .leramance wilh Ihis notice.
2. Priority: Wilhholdlng under Ihls Order/Nolice has priorilY over any olher legal process under Slale law agalnsllhe same Income.
Federal lax levit'S in effect before receipl of Ihis omer have priorily. If Ihere are Federal lax levies in effecl please conlactlhe requesting
agency IIsled below.
3, Combining Payments: You can rambine wilhheld amounts from more than one employee/obligor's inrame In a single paymenlto
each agency requesting withholding. You must, however. sepMalely identify Ihe po~lon of Ihe single payment that Is attributable to each
employee/obligor.
4. '_R~~ingt~Payda~at.,.oIWithholding'-Youmusl.report the paydalMlale of withholding whensendingthepayment.-The-
paydate'dale"<lfwithholding-h-thedale"oo which amounl was wilhheltHromthe employee's.wagesc You must comply wilh the law of Ihe
stale of Ihe emploYl'l!'slobligor's principal place of employmenl wilh respect to the time periods within which you musllmplemenllhe
withholding ooler and forwamthe suppo~ paymenls.
5.. Employee/Obligor with Multiple Support Holdings: If Ihere is more Ihan one OrderlNotice 10 Wilhhold Income for Suppo~ againsl
this employee/obligor and you are unable 10 honor all suppo~ OolerlNotices due 10 Federal or Stale wilhholdlng Iimils. you must (ollow
Ihe law of the slate of employee'slobligor's principal place of employment. You musl honor all Orders/Notices 10 Ihe greatest exlent
possible. (See #10 below)
6. Termination Notification: You musl promplly nOlify Ihe Requesting Agency when the employee/obligor is no longer working (or you.
Please provide Ihe information requesled and relum a copy of Ihis Order/Nollce 10 Ihe Agency identified below.
WITHHOLDER'S 10: 5273100092
EMPLOYEE'S/OBLlGOR'S NAME: SHELLENBERGER. DENNIS R.
EMPLOYEE'S CASE IDENTIFIER: 359000002B DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
7. Lump Sum Payments: You may be required to repo~ and withhold from lump sum paymenls such as bonuses, commissions. or
severance pay. If you have any questions aboullump sum payments. contacllhe person or authorily below.
8, liability: If you fail to wllhhold infome as the OrderlNotice diO'('(ls. you are liable for bolh Ihe accumulaled amounl you shoulr! have
withheld from the employre/obligor's income and olher penallies sel by Pennsylvania State law. Pennsylvania Slate law govems unle"
the ollligor is emplo\l'll In another Slate. In whirh case Ihe law of Ihe State in which he or she is employed govems.
9. Anlkllscrimlnatlon: You are subject 10 a fine determined under Slale law for discharging an employee/obligor from employment,
refusing to employ, or taking disciplinary action against any employee/obligor because o( a suppo~ wilhholding. Pennsylvania Stale law
govems unless the obligor is employe'll in another Slate, in which case Ihe law of Ihe Slale In which he or she Is employed govems.
10.' Withholding Limits: You may not withhold more Ihan the lesser of: 1) Ihe amounls allowed by Ihe Federal Consumer Credit
Protection Act (15 U.S.c. S 1673 (b)l; or 2) Ihe amounts allowed lly Ihe Slate of Ihe employee'slobligor's principal place of employmenl.
The Federal limit applies to Ihe aggregale disposable weekly eamings IADWE). ADWE Is Ihe nel income leh aher making mandatory
deductions such as: State, Federal, locallaxes; Social Security laxes: and Medicare taxes.
11. Additional Info:
.NOTE: If you or your agent are served with a copy of this order In the state that Issued Ihe order, you are to follow the
law of Ihe state that issued this order with respect 10 these items.
Submitted By: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION conlact WAGE ATTACHMENT UNIT
13 N. HANOVER 51 by telephone at (7171 24().622S or
P.O. BOX 320 by FAX at 17171 24()'6248 or
CARLISLE PA 1 7013 by internet www.childsupport.state.pa.us
Pdge 2 or 2
Form EN-028
Worker 10 $OINC
Service Type M
n..'BNtI'O.j1Hm....
~somz
- .
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
j))j '1'30 ~ /9 'Ii;
1!JI{'~fS ;) 71C()()v;;1-'1
Olt. ,:t 1'iY)
@origlnal OrderlNotice
o Amended OrderlNotice
o Terminate OrderlNotice
State Commonwealth of Pennsvlvania
Co.lCily/Disl. of CUMBERLAND
Date of Order/Notice 12/31/02
Tribunal/Case Number (See Addendum for case summary)
Employer/Wilhholder', Federal ElN Number
RE: SHELLENBERGER. DENNIS R.
Employee.'Obligor', Name (la,t. First, Mil
186-30-6875
Employee/Obligor', SocIal Security Number
3590000028
Employee/Obligor" ease Identifier
IS.. Add<ndum (01 ""/n/l(( ",m.'
...ocI.rod with ca... on .".dun.nll
Custodial Parent's Name {last. First. Mil
PA STATE RETIREMENT SYSTEM
BOAS SCHOOL BLOG
909 GREEN ST
HARRISBURG PA 17102
See Addendum for dependenl names and birlh dales associaled wilh cases on allachmenl.
ORDER INFORMA TION: This is an Order/Nolice to Wilhhold Income for Support based upon an order (or support
(rom CUMBERLAND County. Commonwealth of Pennsylvania. 8y law, you are required to deductlhese
amounts from Ihe above-named employee's!obligor's income until further notice even if Ihe Order/Notice is not
issued by your Slale.
S 275.00 per month in current support
So. 00 per month in pasl-due support Arrears 12 weeks or greater? Oyes <Xl no
S 0.00 per month in medical support
S 0.00 per monlh for genetic lesl cosls
S per monlh in other (specify)
for a total of $ 275.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle 10 be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use Ihe following to determine how much to wilhhold:
S 63 .46 per weekly pay period.
S 126.92 per biweekly pay period (every two weeks).
S 137.50 per semimonthly pay period (twice a month).
S 275.00 per monlhly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than Ihe firsl pay period occurring len (10) working days after Ihe dale of this
Order/Notice. Send paymenl within seven (7) working days of the paydateldate of withholding. You are entitled III
deducl a fee 10 defray Ihe cosl of wilhholding. Refer to Ihe laws governing the work slate of your employee for Ihe
allowable amounl. The lolal withheld amounl, and your fee, cannol exceed 55"10 of the employee's! obligor's
aggregale disposable weekly earnings. for the purpose of the limitation on withholding. Ihe following informalion is
needed (See 1110 on pg. 2).
If remitting by EFT/EDI, please call Pennsylvania Stale Colleclions and Disbursement Unit (SCDUl Employer
Cuslomer Service at 1-877-676-9580 for instructions.
Make Remitlance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Idenlilier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DD NOTSEND CASH "~'L "'"(tV.: r7T)
Date of Order: .\J.\\~ - ... .(1~c,' \( \;i..~~
F')t.,'~r!. d. ;3/JVlEY -J(L-'Df&,l'
Form EN-028
Service Type M ""....""'''''',,, Worker 10 $OINC
.~
.
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If theckl>d you are IC<Iulred to prp~i\le a copy of Ihis fonn 10 yoursmployee. If yo~r employeq works in a state that Is
ditterent from Ihe slate Ihallssued thIS onler, a copy must be provi I'd to your employee even If IIII' box is not checked.
1. We appreclale Ihe volunlary compliance of Federally recognllrd Indi.m Irihes. Irill.1l1y-owned businesses. and Indian-owned
businesses localed on a reservalion Ih.ll choose 10 withhold in acconlance wilh Ihis nollce.
2. Priority: Wilhholdlng under this ORier/Nolice has priorily over any other legalllrOCeSS under Stale law againsllhe same income.
Federal lax levies in effect before receipl of this onlrr have priorilY. If Ihere are Frderall.lx levies in effed please conlact Ihe requesling
agency listed below.
3. Combining Payments: You can combine withheld amounts from more Ihan one employl'l'lobligor's income in a single payment 10
each agency requesting wilhholding. You must, however, separalely idenlify the portion of Ihe single paymenllhal is allributable to each
employee/obligor.
4. o-Reporting the Pa,da1e1aa~of Wilhholding~-You.mU!treport the paydateldate ofwilhholdingwhen .endingth...payment;-Th..-
paydateld.le of .. ilhholding-b-Ih.. dat.. on whichlImount WMwilhhelMmm Ihe empIOV""'. wagt!!c You must comply with Ihe law of Ihe
Slate of Ihe employee's1obligor's prlncll)al place of employment wilh resped to Ihe lime periods within which you musl Implement Ihe
withholding oRier and forward the support payments,
5.0 Employee/Obligor with Multiple Support Holdings: If there is more than one ORier/Nolice 10 Wilhhold Income for Support agalnsl
this employee/obligor and you are unable to honor all support ORier/Nolices due 10 Federal or State withholding limits, you must follow
Ihe law of Ihe slale of employee's1obligor's principal place of employment. You must honor all ORiersINolices 10 the greatest extenl
possible. (See #10 below)
6. Termination Notlflcallon: You must prompUy notify Ihe Requesling Agency when the employee/obligor Is no longer working for you.
Please provide the InfoRnalion requesled and retum a copy of Ihis OrderlNolice 10 Ihe Agency identified below.
WITHHOLDER'S 10: 5273100092
EMPLOYEE'S/OBLlGOR'S NAME: SHELLENBERGER , DENNIS R.
EMPLOYEE'S CASE IDENTIFIER: 3590000028 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
7. Lump Sum Payments: You may be required to repcrt and wilhhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions aboullump sum payments, conlact the pe~on or aulhorily below.
8. Liability: If you fall 10 wilhhold Income as Ihe ORier/Nolice directs, you are liable for bOlh Ihe accumulaled amounl you should I. we
wilhheld from Ihe employee/obligor's income and olher penaities set by Pennsylvania Slale law. Pennsylvania Slalelaw govems unles;
Ihe obligor is employed In anolher Stale, In which case Ihe law of Ihe Slale in which he or she is employed govems.
9, Antkliscrimlnallon: You are subject to a fine delennined under Slale law for discharging an employee/obligor from employmenl,
rerusing 10 employ, or taking disciplinary adion against any employee/obligor because of a support withholding. Pennsylvania Slale law
govems unless Ihe obligor Is employed In anolher Slale. In which case the law of Ihe Slale in which he or she is employed govems.
10.' Withholding Limits: You may nol wilhhold more Ihan the lesser of: 1) Ihe amounls allowed by the Federal Consumer Credll
Prolection Ad (15 U.S.C. ~1673 (bl1: or 2) Ihe amounls allowed by Ihe Slale of Ihe employee's1obligor's principal place of employment.
The Federallimil applies 10 Ihe aggregale disposable weekly eamings (ADWE). ADWE is Ihe net Income left after making mandalory
deductions such as: Stale, Federal, local taxes, Social Securily laxes: and Medicare laxes.
11. Addilionallnfo:
ONOTE, If you or your agent are served with a copy of this order In the state that issued the order, you are to follow the
law of the state that Issued this order with respect to these items.
Submitted By: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST by telephone at (717) 240-6225 or
P.O. 80X 320 by FAX at 17171 240-6248 or
CARLISLE PA 17013 by internet www.chlldsupport.stale.pa.us
Page 2 of 2
Form EN-02B
Worker 10 $OINC
Service Type M
0\\8 No,: 0')10..01 ')~
Defendant/Obligor: SHELLENBERGER, DENNIS R.
PACSES Ca.e Number 272000024/~.V?'1' PACSES Ca.e Number
Plaintiff Name Plainliff Name
LORBTTA H. SHBLLBNBBRGBR
Qmt Attachment Amounl
930 C 94 S 275.00
Child(ren)'. Name(s):
DOB
..... .
ADDENDUM
Summary of Cases on Attachment
DOB
Attachmenl Amount
S 0.00
Child!..n)'s Name(.):
Docket
o If checked, you are required to enroll the childlren)
Identified above in any health In.urance coverage available
through the employee's1obllgor's employment.
011 checked, you arc required 10 enrolllhe chlldlren)
Identified above In any health In.urance coverage available
Ihrough the employee's1obllgor'. employment.
PACSES Ca.. Number
Plaintiff Name
~ Attachment Amount
S 0.00
Child(ren)'s Name(s):
PACSES Ca.e Number
Plaintiff Name
DOB
~ Allachment Amount
S 0.00
Chlldlrcn)'s Name!s):
DOB
o If checked, you are required to enroll the chlldlren)
Idenlified above In any health Insurance coverage available
through the employee's1obllgor's employment.
o If checked, you are required to enrolllhe chlld(ren)
Identified above In any health In.urance coverage available
through the employee's1obllgor's employmenl.
PACSES Ca.e Number
Plalnliff Name
Docket Attachmenl Amount
S 0.00
Child!ren)'s Name(s):
DOB
PACSES Case Number
Plainlirf Name
Dockel Attachment Amount
S 0.00
Child!ren)'s Name(s):
DOB
o If checked, you are required to enrolllhe childlren)
Identified above In any health Insurance coverage available
Ihrough the employee's1obllgor's employment.
o If checked, you are required 10 enroll the chlldlren)
Idenlified above In any health In.urance coverage available
through Ihe employee's1obllgor's employment.
Addendum
Form EN.028
Worker 10 $OINe
Service Type M
OM8 No.; M1O-Ql~-4
J.:'J 8 LJ lJ 1::' ~I S
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonweallh of Pennsvlvania
Co.lCity/Disl. of CUMBERLl\ND
Dale of Order/Nolice OS/25/06
Case Number (See Addendum for case summary)
272000024
94-930 CIVIL
@origin.JIOrderINOCice
o Amended OrderlNotice
o Terminate OrderlNoIice
RE: SHELLENBERGER,
DENNIS R.
EmployeeJObligOf" N.me (l..t, Flrsl, Mil
186-30-6875
Employ..,/ObllgOf', Social Security Number
3590000028
Employee/Obligor', ease Idonliflor
/S.., ),dMndum (or pIIl.,lff ..mOl
assod.t<<l with C'Sf'S on .tluhmrntJ
Custodial Parent's Name llast. first. MIJ
Employ.r/Withhold..', Fod.r.1 EIN Number
BRENNER MOTORS INC
1812-30 PAXTON ST
HARRISBURG PA 17104
See Addendum for dependent names and birth dates assoclated with cases on allachment.
ORDER INFORMA TION: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. 8y law, you are required to deduclthese
amounts from Ihe above-named employee'sfobligor's income until further notice even if the Order/Notice is not
issued by your State.
S 275.00 per month in current support
So. 00 per month in past-due support Arrears 12 weeks or greaterl Qyes C&> no
S 0.00 per month in current and past-due medical support
S 0.00 per month for genetic test costs
S per month in other (specify)
for a total of S 275.00 per monlh to be forwarded 10 payee below.
You do not have 10 vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
S 63 _46 per weekly pay period.
S 126.92 per biweekly pay period (every two weeks).
S 137.50 per semimonthly pay period (twice a month).
S 275.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) working days of the paydateldate of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sf obligor'S
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on page 2).
If remitting by EFTIEDI, please call Pennsylvania State Collections and Disbursement Unit (SCDUl Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: PA SCOU
Send check to: Pennsylvania SCOU, P.O. Box 69112, Harrisburg, Pa 17106.9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as Ihe Employee/Obligor's Case Ident/fler) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL. H~
BYTe rOU\RT~
Date of Order: JUN 0 5 2006 '-...::
Edgar B.
Drol R.J. Shadday
Service Type M
0"'8 No: M10..0I;"
ge
Form EN-028
Worker 10 $IATT
'"
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If [hecke'll you are rcrluired to prpvi~e.l (Opy of this form to your emllloycc. I( your employee works in a slale Ihat is
dilfercnl (rom the SI~ll(! Ih.!1 issued Ihls DRIer. a copy must be provided to your cmJ)loyee even I(the box is nol checked.
1. Priority: Wilhholding under Ihis Order/Nolice has priority over any olher legal process under State law against the same income.
Federal lax levies in effect before receipt of this order have priority. If there arc Federal tax levies in effecl please contact the requesting
agency listed below.
2. Combining Payments: You can combine wilhheld amounts from more Ihan one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separalely idenlify the portion of the single paymenllhal is attribulable to each
employee/obligor.
J.' Reporting the Paydate/Dale of Withholding:-You must rrportlhe paydatrldalt' ofwilhholdingwhen.endingthe paymenl;-The-
paydatrldate of withholding i. :he date on whichamounl wa.withheld-from the employee'. wages; You must comply wilh the law of Ihe
stale of the employee's1obligor's principal place of employment wilh respect to Ihe time periods wilhin which you must implementlhe
wilhholding order and forw.mllhe support payments.
4.' Employee/Obligor with Multiple Support Holdings: If Ihere is more than one OrderlNotice to Wilhhold Income for Support againsl
Ihis employee/obligor and you are unable 10 honor all support Order/Notices due 10 Federal or Slate withholding limils, you must follow
Ihe law of Ihe state of employee's1obligor's principal place of employmenl. You musl honor all OrdersINotices to Ihe greatest extent
possible. (See #9 below)
5, Termination Notification: You muSI promplly notify the Requesting Agency when the employee/obligor is no longer working for you.
Please provide the information rcrluestcrl and relurn a copy of this OrderlNotice 10 the Agency identified below.
THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2312656840
EMPLOYEE'S/OBLlGOR'S NAME: SHELLENBERGER , DENNIS R.
EMPLOYEE'S CASE IDENTIFIER: 3590000028 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. lump Sum Payments: You may be required to report and withhold from lump sum paymenls such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, conlad Ihe person or authorilY below.
7. liability: If you fail to withhold income as the OrderlNolice directs, you are liable for both the accumulaled amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania Slate law. Pennsylvania State law governs unless
the obligor is employed in anolher Stale, in which case the law of the Stale in which he or she is employed governs.
B. Anti-discrimination: You are subject 10 a fine delermined under Stale law for discharging an employee/obligor from employmenl,
refusing 10 employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania Stale law
governs unless Ihe obligor is employed in another Stale, In which case Ihe law of Ihe Slate in which he or she is employed governs.
9. . Withholding limits: You may not withhold more than the lesser of: 1) Ihe amounls allowed by Ihe Federal Consumer Credit
Prolection Act (t 5 U.S.c. 51673 (b)l: or 211heamounts allowed by the State oftheemployee's1obligor's principal place o( employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes: Social Security laxes: and Medicare taxes. For Iribal orders, you may not withhold more
than Ihe amounts allowed under the law o( Ihe issuing tribe. For Iribal employers who receive a Slate order, you may nol withhold more
Ihan the amounts allowed under the law of Ihe state Ihat issued Ihe order.
10. Additional Info:
. NOTE: If you or your agent are served with a copy of this order In the state that issued the order. you are to follow the
law of the state thai issued this order wilh respect to these items.
11.Submitted By: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
1 J N. HANOVER ST by lelephone at (717) 240-6225 or
P.O. BOX 320 by FAX al (7171 240-6248 or
CARLISLE PA 17013 by internet www.childsupport.state.pa.us
Service Type M
Page 2 of 2
Form EN-02B
Worker 10 $IATT
('''8 Nu: '''''0-01 \.I
ADDENDUM
SummarY of Cases on Attachment
DefendanllObllgor: SHELLENBERGER, DENNIS R.
PACSES Case Number 272000024
Plainliff Name
LORETTA H. SHELLENBERGER
QlK!!!:l Attachment Amount
94-930 CIVIL S 275.00
Childlren)'s Namels):
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
S 0.00
Childlren)'s Name(s):
Doe
Doe
Dlf checked, you are required to enroll the childlren)
idenlified above in any heallh Insurance coverage available
through the employee's1obligor's employment,
o If checked, you are required 10 enroll the chlld(ren)
idenlifled above in any health Insurance coverage available
through the employee's1obllgor's employmenl.
PACSES Case Number
Plaintiff Name
Dockel Att.lchment Amount
S 0.00
Childlrenl's Name(s):
PACSES Case Number
Plaintiff Name
~ Attachment Amount
S 0,00
Chlld(ren)'s Name(s):
Doe
DOB
o If checked, you are required 10 enrolllhe child(ren)
Idenlifled above In any heallh Insurance coverage available
through Ihe employee'slobllgor's employment,
o If checked, you ire required to enroll the chlld(ren)
Identified above in any health Insurance coverage available
Ihrough the employcc's1obllgor's employment.
PACSES Case Number
Plalnliff Name
Dockel Attachmenl Amounl
S 0.00
Child(ren)'s Name(s):
PACSES Case Number
Plaintiff Name
Docket Attachment Amounl
S 0.00
Child(ren)'s Name(s):
DOB
DOB
o If checked, you are required to enrolllhe chlld(ren)
Identifle'll above In any heallh Insurance coverage available
through the emIJloycc's1obligor's employment.
o If checked, you are required to enroll the chlldlren)
identified above in any heallh insurance coverage available
through the emllloyee'slobllgor's employment.
Addendum
Form EN.m8
Worker 10 $IATT
Service Type M
OMB No: O'J70..(II....
-
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Common u.m.lth rR PA vs Shellenbe~er, ~nnie, R
All Filings before
Jun€. I ~, 8.00(.,
Have not been scanned!
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ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
~7(20{)OO<2t/-
94-Q..30 t2lv,1
State Commonwealth of Pennsylvania
Co./City/Dist. of CUMBERLAND
Date of Order/Notice 06/09/06
Case Number (See Addendum for case summary)
o Original Order/Notice
o Amended Order/Notice
o Terminate Order/Notice
BRENNER MOTORS INC
1812-30 PAXTON ST
HARRISBURG PA 17104
RE: SHELLENBERGER, DENNIS R.
Employee/Obligor's Name (Last, First, MI)
186-30-6875
Employee/Obligor's Social Security Number
3590000028
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Parent's Name (Last, First, MI)
EmployerMithholder's Federal EIN Number
See Addendum for dependent names and birth dates associated with cases on attachment.
ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support
from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these
amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 0.00 per month in current support
$ 0 . 00 per month in past-due support Arrears 12 weeks or greater? 0 yes @ no
$ 0.00 per month in current and past-due medical support
$ 0.00 per month for genetic test costs
$ per month in other (specify)
for a total of $ 0.00 per month to be forwarded to payee below.
You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match
the ordered support payment cycle, use the following to determine how much to withhold:
$ 0 . 00 per weekly pay period.
$ 0.00 per biweekly pay period (every two weeks).
$ 0.00 per semimonthly pay period (twice a month).
$ 0.00 per monthly pay period.
REMITTANCE INFORMATION:
You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this
Order/Notice. Send payment within seven (7) wJrking days of the paydate/date of withholding. You are entitled to
deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the
allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's
aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is
needed (See #9 on page 2).
If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer
Customer Service at 1-877-676-9580 for instructions.
Make Remittance Payable to: P A SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
Date of Order:
JUN 0 9 2006
Service Type M
OMB No.: 0970-01 S4
Form EN-028
Worker ID 21205
'\....-:. ~ -. ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
D If !:;hecked you are required to provide a copy of this form to your. employee. If your employe~ works in.a state that is
ditterent from the state that issued this order, a copy must be provided to your employee even If the box IS not checked.
1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income.
Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting
agency listed below.
2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to
each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each
em ployee/obl igor.
3. * Repolting ti,e Paydate!Date of Vv'itl.l,oldil,g. You IIIUst report ti,e paydate!date of witl.l,oldillg wl,el, selldillg ti,e paylllellt. Ti,e
paydate/date of vvitl,l,olding is ti,e date 011 vvl ,jel, alllOl.illt vvas vvitl.l,eld flOll1 ti,e elllployee's vvages. You must comply with the law of the
state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the
withholding order and forward the support payments.
4. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against
this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow
the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent
possible. (See #9 below)
5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you.
Please provide the information requested and return a copy of this Order/Notice to the Agency identified below.
THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 2312656840
EMPLOYEE'S/OBLlGOR'S NAME: SHELLENBERGER, DENNIS R.
EMPLOYEE'S CASE IDENTIFIER: 3590000028 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
NEW EMPLOYER'S NAME/ADDRESS:
6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or
severance pay. If you have any questions about lump sum payments, contact the person or authority below.
7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have
withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless
the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment,
refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law
governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs.
9. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (15 U.S.c. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment.
The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory
deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. For tribal orders, you may not withhold more
than the amounts allowed under the law of the issuing tribe. For tribal employers who receive a state order, you may not withhold more
than the amounts allowed under the law of the state that issued the order.
10. Additional Info:
*NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the
law of the state that issued this order with respect to these items.
11.Submitted By: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST by telephone at (717) 240-6225 or
P.O. BOX 320 by FAX at (717) 240-6248 or
CARLISLE PA 17013 by internet www.childsupport.state.pa.us
Page 2 of 2
Form EN-028
Worker ID 21205
Service Type M
OMB No.: 0970-0154
".' ~-
ADDENDUM
Summary of Cases on Attachment
Defendant/Obligor: SHELLENBERGER, DENNIS R.
PACSES Case Number 272000024
Plaintiff Name
LORETTA H. SHELLENBERGER
Docket Attachment Amount
94-930 CIVIL $ 0.00
Child(ren)'s Name(s):
PACSES Case Number
Plaintiff Name
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
you are required to enroll the child(ren)
in any health insurance coverage available
through the employee's/obligor's employment.
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
o If checked, you are required to enroll the child(ren)
identified above in any health insurance coverage available
through the em p loyee's/ob I igor's employment.
If checked, you are required to enroll the child(ren)
above in any health insurance coverage available
the employee's/obligor's employment.
PACSES Case Number
Plaintiff Name
PACSES Case Number
Plaintiff Name
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
Docket Attachment Amount
$ 0.00
Child(ren)'s Name(s):
DOB
If checked, you are required to enroll the child(ren)
above in any health insurance coverage available
the employee's/obligor's employment.
If checked, you are required to enroll the child(ren)
above in any health insurance coverage available
through the employee's/obligor's employment.
Service Type M
Addendum
Form EN-028
Worker 10 21205
OMB No.: 0970-0154
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