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HomeMy WebLinkAbout07-0217 DARLENE ZELAZNY, Plaintiff V. LOUIS ZELAZNY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA :NO.: 07 ', ?, ? L `-T?z,-, CIVIL ACTION - LAW 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, at the Cumberland County Courthouse, One Courthouse Square, Carlisle, PA 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 FOREMAXI/& FO is J?fsyPH D. CtRACIOLO, ESQUIRE 1 Market Street, 6TH Floor Harrisburg, Pennsylvania 17101 PH: (717) 236-9391 ID: 90919 Attorneys for Plaintiff DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA LOUIS ZELAZNY CIVIL ACTION -LAW Defendant IN DIVORCE COMPLAINT IN DIVORCE UNDER SECTIONS 3301(c) or 3301(d) OF THE DIVORCE CODE AND NOW, comes the Plaintiff, Darlene Zelazny, by and through her attorneys, Foreman & Foreman, P.C., and Joseph D. Caraciolo, Esquire and makes the following Complaint in Divorce averring as follows: 1. The Plaintiff, Darlene Zelazny, is an adult individual who currently resides at 15 Charisma Drive, Camp Hill, Cumberland County, Pennsylvania, 17011. 2. The Defendant, Louis Zelazny, is an adult individual who currently resides at 15 Charisma Drive, Camp Hill, Cumberland County, Pennsylvania, 17011. 3. The Defendant and the Plaintiff have been bona fide residents of the Commonwealth of Pennsylvania for at least six months immediately prior to the filing of this Complaint. 4. The Plaintiff and the Defendant were married by formal ceremony on October 19, 1983 in Mechanicsburg, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties. 6. The marriage is irretrievably broken. 7. At the appropriate time, Plaintiff will file an affidavit alleging the parties have been living separate and apart for a period of at least two-years. 8. The Plaintiff has been advised that counseling is available and that the Plaintiff may have the right to request that the court require the parties to participate in counseling. WHEREFORE, the Plaintiff, Darlene Zelazny, respectfully requests this Honorable Court to enter a decree of divorce in this matter. COUNT I - EQUITABLE DISTRIBUTION 9. The prior paragraphs, one (1) through eight (8) of this Divorce Complaint are incorporated herein by reference thereto. 10. Plaintiff requests the Court to equitably divide, distribute or assign the marital property between the parties without regard to marital misconduct in such proportion as the Court deems just after consideration of all relevant factors. WHEREFORE, the Plaintiff respectfully requests the Court to enter an order of equitable distribution of marital property pursuant to § 3502(a) of the Divorce Code. Re Date: o G ?OSEPH D. CARACIOLO, ESQUIRE 112 Market Street, 6TH Floor Harrisburg, Pennsylvania 17101 PH: (717) 236-9391 ID: 90919 Attorney for Plaintiff DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO.. LOUIS ZELAZNY CIVIL ACTION -LAW Defendant IN DIVORCE VERIFICATION I verify that the statements made in this Complaint are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. Date: l,A b4po Signature: Darlene Zelazn?) 0 ( ;rjl b ?V c c p, I r? P i T ? ca DARLENE ZELAZNEY, Plaintiff V. LOUIS ZELAZNEY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-217 Civil Term CIVIL ACTION -LAW IN DIVORCE PETITION FOR SPECIAL RELIEF IN THE FORM OF EXCLUSIVE POSSESSION OF THE MARITAL RESIDENCE PURSUANT TO 23 Pa.C.S. & 3502(c) OF THE DIVORCE CODE AND NOW, comes the Plaintiff, Darlene Zelazney, by and through her attorneys, Foreman & Foreman, P.C., and Joseph D. Caraciolo, Esquire, and files this Petition pursuant to rule 1920.43 of the rules of Civil Procedure and 23 Pa.C.S.§3323 (f) and 23 Pa.C.S. §3502 (f), and respectfully avers as follows: 1. Plaintiff is Darlene Zelazney, an adult individual, who currently resides at the marital residence, 15 Charisma Drive, Camp Hill, PA 17011. 2. Defendant is Louis Zelazney, an adult individual, who removed himself from the marital residence in April 2007 and his exact address and location are unknown to Plaintiff. 3. A Divorce Complaint was filed on January 11, 2007, with docket number captioned above. 4. At all times relevant to this action. Plaintiff has resided in the marital residence and since April 2007 has resided there without the presence of the Defendant. 5. Plaintiff and Defendant have a property interest in the marital residence. 6. In April 2007, Defendant removed himself from the marital residence and established his own residence. 7. When Defendant removed himself from marital residence, he took personal property, including marital property, without the permission or consent of the Plaintiff. 8. Recently, Defendant has been entering the marital residence at times when Plaintiff has been unavailable and slowly removing marital property. 9. Defendant's actions in entering the marital residence and removing property without the knowledge or consent of Plaintiff have caused disruption in Plaintiff's life. 10. Plaintiff is concerned that Defendant will continue to enter the marital residence and remove or destroy property in Plaintiff s absence. 11. Defendant has the means to support himself and to maintain a home outside the marital residence without the help of the Plaintiff. 12. According to Cumberland County local rule 208.2 (d), counsel for Plaintiff spoke with counsel for Defendant on September 6, 2007 who indicated that he does not concur with this request. WHEREFORE, the Plaintiff, Darlene Zelazney, respectfully requests that this Honorable Court enter an Order for Equitable Relief as follows: That Plaintiff is granted exclusive possession of the marital residence and the Defendant be prohibited from entering the marital residence without the permission of the Plaintiff. & FOREM/N, P.C. u Date: Q 4 /"-,7 eph D. Caraciolo, %fquire 12 Market Street, 6`" Floor Harrisburg, Pennsylvania 17101 Telephone: (717) 236-9391 Attorney ID: 90919 Attorney for Plaintiff DARLENE ZELAZNEY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07-217 Civil Term LOUIS ZELAZNEY CIVIL ACTION -LAW Defendant IN DIVORCE ATTORNEY VERIFICATION The undersigned, Joseph D. Caraciolo, Esquire, hereby verifies and states that: 1. He is the attorney for the Plaintiff Darlene Zelazney; 2. He is authorized to make this verification on her behalf; 3. The facts set forth in the foregoing Motion are known to him and not necessarily to his client; 4. The facts set forth in the foregoing Motion are true and correct to the best of his knowledge, information and belief; and 5. He is aware that false statements herein are made subject to 4904, relating to unworn falsification to authorities. 18 Pa. C.S. Joseph D.',araciolo, Esquire 112 Market Street, 6th Floor Harrisburg, Pennsylvania 17101 Telephone: (717) 236-9391 Attorney ID: 90919 Attorney for Plaintiff Date:0 °l /Ic, /c, DARLENE ZELAZNEY, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07-217 Civil Term LOUIS ZELAZNEY CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE I hereby certify I am this day serving a copy of the Petition attached hereto, upon the person and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by mailing a copy of the same, United States First Class mail, prepaid, and addressed as follows: Samuel L. Andes, Esquire 525 North Twelfth Street P.O. Box 168 Lemoyne, PA 17043 P.C. U I I/ L--" Date: 0'0711016--7 J eph D. Caraciolo, Esquire 12 Market Street, 6 h Floor Harrisburg, Pennsylvania 17101 Telephone: (717) 236-9391 Attorney ID: 90919 Attorney for Plaintiff cn DARLENE ZELAZNEY, Plaintiff V. LOUIS ZELAZNEY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-217 Civil Term CIVIL ACTION -LAW IN DIVORCE PLAINTIFF'S MOTION FOR AN ORDER TO COMPEL DEFENDANT, LOUIS ZELAZNEY, TO ANSWER INTERROGATORIES AND NOW, comes the Plaintiff, Darlene Zelazney, by and through her attorneys, Foreman & Foreman, P.C., and Joseph D. Caraciolo, Esquire, and moves this Court to enter an Order pursuant to Pa. Rule Civil Procedure 1930.5 (b) and 4019 (a)(1)(i) for failure of Defendant, Louis Zelazney, to answer interrogatories and in support thereof avers as follows: 1. Plaintiff is Darlene Zelazney, an adult individual, who currently resides at the marital residence, 15 Charisma Drive, Camp Hill, PA 17011. 2. The Defendant is Louis Zelazney, an adult individual, whose current residence is unknown. 3. On January 11, 2007, Plaintiff filed a Complaint under § 3301(c) or § 3301(d) of the Divorce Code. 4. Included in Plaintiffs Divorce Complaint on January 11, 2007, was a count for Equitable Distribution under the Divorce Code. 5. Interrogatories were sent to Defendant on March 21, 2007 in order to determine the marital assets and debts for the count of Equitable Distribution, a true and correct copy of the interrogatories is attached hereto as Exhibit "A" and incorporated herein by reference. i 6. Defendant's verified answers to the interrogatories were due on or before March 21, 2007. 7. As of the present date, Plaintiff has not received verified answers to the interrogatories. 8. Plaintiff contacted counsel for Defendant informing him of an extension to May 14, 2007, for the Defendant's answers to the Plaintiff's first set of interrogatories. A true and correct copy of the above captioned letter is attached hereto and incorporated herein through reference as Exhibit "B". 9. Counsel for Defendant responded that he "did not believe that his client would be able to respond to your discovery request by May 14, 2007". A true and correct of the same is attached hereto as Exhibit "C". 10. Plaintiff is entitled to answers to her interrogatories because the information is relevant to the Count for Equitable Distribution in dividing the marital assets and marital debts. 11. Defendant has made a good faith effort to resolve this discovery dispute by contacting Plaintiff's counsel in writing and requesting that the interrogatories be answered, including granting an extension of the time period in which to answer the same. 12. Defendant's verified answers have not been received. 13. Plaintiff has incurred four hundred dollars ($400) in attorneys' fees in pursuit of Defendant's verified answers including the preparation and filing of this motion. 14. According to Cumberland County local rule 208.2 (d), counsel for Plaintiff spoke with counsel for Defendant on September 6, 2007 who indicated that he does not concur with this request. WHEREFORE, the Plaintiff, Darlene Zelazney, respectfully requests that this Honorable Court order Defendant, Louis Zelazney, to provide verified answers to the interrogatories and to reimburse the Plaintiff for her reasonable attorneys' fees in the preparation and filing of this motion. Date• v 61 FO&EMAX & ?6seph D. Cvilaciolo, Esquire 112 Market Street, 6U' Floor Harrisburg, Pennsylvania 17101 Telephone: (717) 236-9391 Attorney ID: 90919 Attorney for Plaintiff a DARLENE ZELAZNEY, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07-217 Civil Term LOUIS ZELAZNEY CIVIL ACTION -LAW Defendant : IN DIVORCE ATTORNEY VERIFICATION The undersigned, Joseph D. Caraciolo, Esquire, hereby verifies and states that: 1. He is the attorney for the Plaintiff Darlene Zelazney; 2. He is authorized to make this verification on her behalf; 3. The facts set forth in the foregoing Motion are known to him and not necessarily to his client; 4. The facts set forth in the foregoing Motion are true and correct to the best of his knowledge, information and belief, and 5. He is aware that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. Date: blx/o t-1 ' Fra ph DCafraZ '10' Esquire aet Street, 6t' Floor Pennsylvania 17101 1 isb urg, Telephone: (717) 236-9391 Attorney ID: 90919 Attorney for Plaintiff DARLENE ZELAZNEY, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07-217 Civil Term LOUIS ZELAZNEY CIVIL ACTION -LAW Defendant : IN DIVORCE CERTIFICATE OF SERVICE I hereby certify I am this day serving a copy of the Petition attached hereto, upon the person and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by mailing a copy of the same, United States First Class mail, prepaid, and addressed as follows: Samuel L. Andes, Esquire 525 North Twelfth Street P.O. Box 168 Lemoyne, PA 17043 P.C. Date: &01 J seph D.(Cfaciolo, Esquire 12 Market Street, 6u' Floor Harrisburg, Pennsylvania 17101 Telephone: (717) 236-9391 Attorney ID: 90919 Attorney for Plaintiff EXHIBIT "A" DARLENE ZELAZNY, Plaintiff V. LOUIS ZELAZNY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : NO.: 07-217 Civil Term CIVIL ACTION - LAW IN DIVORCE PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS DIRECTED TO DEFENDANT TO: LOUIS ZELAZNY 15 Charisma Drive Camp Hill, PA 17011 PLEASE TAKE NOTICE that you are hereby requested to produce for inspection and other purposes, including copying, pursuant to Pennsylvania Rules of Civil Procedure, No. 4009.1, et seq., at the office of the counsel for the requesting party, Foreman & Foreman, P.C., 6th Floor, Veterans Building, 112 Market Street, Harrisburg, Pennsylvania, 17101, not later than thirty (30) days after service and supplemented thereafter in accordance with Pennsylvania Rules of Civil Procedure, No. 4009, of the below listed documents and/or items for purposes of discovery. DEFINITIONS AND INSTRUCTIONS Unless negated by the context of the Document Request, the following definitions are to be considered to be applicable to all interrogations contained herein: (A) "Documents" is an all-inclusive term, referring to any writing and/or recorded or graphic matter, however produced or reproduced. The term "Documents" includes without limitation, correspondence, memoranda, interoffice communications, minutes, reports, notes, schedules, analyses; drawings, diagrams, invoices, purchase orders, pleadings, questionnaires, contracts, bills, checks, drafts, diaries, logs, proposals, print-outs, recordings, telegrams, films, tax returns, and financial statements, and other such documents, tangible or retrievable of any kind. "Documents" also include any preliminary notes and drafts of all the foregoing, in whatever form, for example, printed, typed, longhand, shorthand, on paper, paper tape, tabulating picture film, phonograph records, or other form. (B) With respect to documents, the term "Identity" means to give the date, title, author, and addresses; "Identify" with respect to documents further means: (i) To describe a document sufficiently well to enable the interrogator to know what such document is and to retrieve it from a file or wherever it may be located; (ii) To describe it in a manner suitable for use as a description in a subpoena; and (iii) To give the name, address, position, or title of the person(s) who has custody of the document and/or copies thereof. (C) Whenever the expression "and/or" is used in these interrogatories, the information called for should be set out both in the conjunctive and disjunctive, and wherever the information is set out in the disjunctive, it should be given separately for each and every element sought. (D) No answer is to be left blank. If the answer is to a Document Request or subparagraph of a Document Request is "none" or "unknown," such statement must be written in the answer. If the question is inapplicable, "N/A" must be written in the answer. (E) These Document Requests are continuing, and any information secured subsequent to the filing of your answers which would have been includable in the answers had it been known or available, are to be supplied by supplemental answers. (F) If additional space is required for an answer, attach supplemental answer sheet which clearly identifies the Document Request number. (G) If you object to any Document Request, or if any information responsive to any Document Request is withheld based on any claim or privilege or protection from discovery of any kind, describe generally the information withheld, state the privilege being relied upon, and identify all persons or entities who have or have had access to said information. If you refuse to provide any document on the basis of a claim of privilege or protection from discovery or any kind, with respect to each such document, set forth the following information: (1) The date of the document; (2) its author(s); (3) all recipients of the document; (4) the present location and custodian of the document; and (5) the basis for the claim of privilege or protection from discovery. To the extent that the claim of privilege or protection applies only to a portion of the responsive documents, all portions for which privilege or protection are not claimed must be produced. (H) The terms "you" and "your" include, without limitation, Defendant, and his agents or other representatives acting or purporting to act on his behalf or at his direction. DOCUMENT REQUESTS 1. Copies of the federal and state income tax returns filed by you, together with accompanying worksheets including W-2 forms; copies of federal and state income tax returns and profit and loss statements for any and all corporations, joint ventures, partnerships or other corporate or business associations in which you hold an interest for the past two (2) years. 2. Documents sufficient to show your current income. t 3. All documents reflecting all income received by you, either individually or jointly with any other person(s) or entity(ies), for the past two (2) calendar years. 4. All documents evidencing or reflecting any interest in any entity that you presently hold or that you have held at any time during the past two (2) calendar years, either individually or jointly with any other person(s) or entity(ies). 5. To the extent not encompassed by the above, any other documents reflecting income received by you during the past two (2) calendar years, including, but not limited to, income from any of the following: a. Dividends b. Interest (including interest on tax-exempt securities) c. Partnerships in which you are a partner d. Pensions or annuities e. Profit on sale of assets reported on Schedule "D" of your Federal Income Tax Returns f. Business income (reflected on Schedule "C" of your Federal Income Tax Returns) g. Unemployment compensation h. Disability income payments i. Buy out or pay out from a business or professional group, association, partnership, or corporation 6. All documents reflecting or evidencing all benefits that you receive through any wage or income-producing activities in which you are engaged or have been engaged during the past two (2) calendar years. 7. All documents evidencing, reflecting, or relating to any pension, IRA or other retirement accounts in which you presently have an interest or in which you had an interest at any time during the past five (5) calendar years, including, but not limited to, all statements reflecting the current value thereof and any transfers or withdrawals therefrom. 8. All statements from all bank accounts, including, but not limited to, money-market accounts and certificates of deposit, in which you presently have any interest or in which you had an interest at any time during the past two (2) calendar years, either individually or jointly with any other person(s) or entity(ies). 9. All financial statements completed by you, in either a personal or professional capacity, during the past two (2) calendar years. 10. All mortgage applications prepared by you, either individually or jointly with any other person(s) or entity(ies), during the past five (5) years. 11. Copies of any and all leases, deeds, mortgages, and settlement sheets with regard to any real property owned by you, either individually or jointly with any other person(s) or entity(ies) during the past five (5) calendar years. 12. All records pertaining to real estate in which you have acquired or may have acquired an interest during the period of your marriage, including any leases or mortgages related thereto (including monthly payments and present outstanding balance of principal and interest), together with any evidence showing all contributions in cash or otherwise made by you to the acquisition of such real estate. 13. Copies of all sales agreements and/or options for any real estate owned by you and those held by you in your name or in your name jointly with any other person or in your name in trust or in your name as guardian for any other person. 14. Copies of any and all brokerage account statements or securities owned by you individually, jointly with any person or entity, or as trustee, guardian or custodian, from October 19, 1983, to date including in such records dates of purchase and amounts paid for such securities. 15. Copies of any and all securities and investments owned by you and not reflected in any brokerage account records or statements. 16. All insurance policies of whatever kind currently in effect and those which have been in force during the three (3) previous years, together with any records indicating whether or not a claim has been made by you or anyone on your behalf relating to any of the policies enumerated. 17. To the extent not encompassed by the foregoing requests, all documents reflecting, evidencing, or relating to personal injury recoveries received by you, either individually or jointly with any other person or entity, for the past five (5) calendar years. 18. To the extent not encompassed by the foregoing requests, all documents reflecting or evidencing all income derived during calendar years 2005, 2006, and 2007 from any business operated by you. 19. Any and all documents utilized by you to answer or respond to Plaintiff's First Set of Interrogatories Directed to Defendant served concurrently herewith. 20. Any and all appraisals of any real property or personal property presently owned by you or titled in your name individually or your name jointly with any other person. FOREMAN ,.& FOREMANA1 C. Date: - -, I ' f Y: Joseph D. Cara solo, uire Attorney for Plaintiff r112 Market Street, 6th Floor Harrisburg, Pennsylvania 17101 ID# 90919 Tel. (717) 236-9391 DARLENE ZELAZNY, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO.: 07-217 Civil Term LOUIS ZELAZNY CIVIL ACTION -LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Joseph D. Caraciolo, Esquire, hereby certify that on the below-noted date, served a true and correct copy of the foregoing PLAINTIFF'S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS upon the following named counsel by depositing the same, postage prepaid, in the United States Mail, addressed as follows: Louis Zelazny 15 Charisma Drive Camp Hill,. PA 17011 Date: FOREMAN k FC B Y: .EMAN/.C. F12 ' ph D. C .olo, Esquire rney for Plaintiff Market Street, 6th Floor Harrisburg, Pennsylvania 17101 ID# 90919 Tel. (717) 236-9391 • DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO.: 07-217 Civil Term LOUIS ZELAZNY CIVIL ACTION - LAW Defendant IN DIVORCE PLAINTIFF'S FIRST SET OF INTERROGATORIES TO DEFENDANT TO: LOUIS ZELAZNY 15 Charisma Drive Camp Hill, PA 17011 PLEASE TAKE NOTICE that you are hereby required pursuant to Pennsylvania Rules of Civil Procedure No. 1930.5 and No. 4001, et seq., to serve upon the undersigned, within thirty (30) days after service of this Notice, your Answers in writing under oath to the following Interrogatories. Date:(-." r i FOREMAN & 6 M N' , P.C. By: Josep D. CaracfisYo, Esq Aftorney for Plaintiff 112 Market Street, 6th Floor 44arrisburg, Pennsylvania 17101 ID# 90919 Tel. (717) 236-9391 DEFINITIONS AND INSTRUCTIONS Answer every Interrogatory. No question is to be left blank. If the answer to an Interrogatory is "none" or "unknown", that must be written in the answer. Whenever a date, amount or other computation or figure is requested, the exact date, amount, computation or figure is to be given unless it is unknown. If so, give the best estimate or approximation thereof and note that such answer is an estimate or approximation. A. Whenever the term "document" is used herein, it includes (whether or not specifically called for) all printed, typewritten, handwritten, graphic or recorded matter, however produced or reproduced and however formal or informal. In lieu of identifying documents, you may supply the documents or true and correct copies thereof. B. "Identify," when used in reference to a person, means to state in the answer in each instance her/his full name, present or last known residence address and telephone number of his/her present employer and position, if known. C. "Identify" when used in reference to a writing or document, means to state in the answer in each instance whether or not such document is known to be in existence at the time of making the answer, and (i) the date of the document; (ii) the type of document, e.g., letter, memorandum; (iii) the present or last known location (s) and custodian(s) of the document and all of its copies; (vi) the name, address, employer and position of each person who signed and/or prepared the document; (v) the document was sent; and (vi) a brief statement of the subject matter of each document. If any such document is no longer in disposition was made of it, the date, and the identity of the person or persons responsible for such disposition and policy, rule, order or other authority by which such disposition was made. D. Whenever you are asked to "identify" an oral communication, the following information should be given as to each oral communication of which you are aware, whether or not you or others were present or participated therein: (i) The means of communication (e.g., telephone, personal conversation, etc.); (ii) Where it took place; (iii) Its date; (iv) The names, addresses, employers and positions (a) of all persons who participated in the communication; and (b) of all other persons who were present during or who overheard that communication; (v) The substance of who said what and to whom and the order in which it was said; and; (vi) Whether that communication or any part thereof is recorded, described or referred to in any document (however informal) and, if so, an identification of such document in the manner indicated above. (vii) If you contend that you are not yet separated from your spouse, then answer any questions asking for information as of the date of separation as if the question asks for information as of the date of response to the Interrogatories. E. The term "you" shall be deemed to mean and refer to the party whom these Interrogatories have been propounded for answer and shall also be deemed to refer to anyone acting on your behalf. G. These Interrogatories are deemed continuing and whenever additional information responsive to them is obtained by you, it shall be supplied to the Plaintiffs as though expressly requested by separate Interrogatories, as required by Rule 4007.4 of the Pennsylvania Rules of Civil Procedure. 1. State your name, age, date of birth, residence address, telephone number, social security number, and any other names by which you have been known, identifying the times and places during which you were known by other names. ANSWER: 2. Are you employed? If so, for each employment that you hold, state: a. Name and address of employer b. Date of Commencement of employment; C. Name, title and address of your immediate supervisor; d. Your job title and description of duties; e. Your hours and rate of pay on earnings, specifying gross average weekly salary, wages, commissions, overtime pay and bonuses, etc.; f. Expense and drawing accounts and allowances for transportation and other accommodations and expenses; ANSWER: 3. For each employment that you hold or held, state whether you participate, or have a right to participate, or have in the past participated in any the following employment related benefits: a. Defined Benefit retirement plan; b. Defined contribution plan; c. Money purchase pension plan; d. Any other type of employee pension plan; e. Savings or thrift plan; f. Cash or deferred plan (401) (k); g. Profit sharing plan: h. Employee stock ownership (including tax credit or payroll tax credit); i. Stock bonus plan: j. Tax deferred, 403 (b) annuities; k. Non-qualified, deferred compensation plans, including excess benefit plans, whether or not refunded; 1. Executive stock option plans, including incentive stock option plans; m. Welfare or insurance plans including group term life insurance and medical insurance; n. Voluntary employee's beneficiary association (VEBA); o. Any other employment related benefit not disclosed in your Answers to these Interrogatories; And for each benefit identified above in which you participate, state the benefit or amount you receive; identify the administrator of such benefit by name, address, title; and the current value of the benefit. ANSWER: 4. List and identify all sources of income you have, including employment, rents, dividends, interest, annuities, trusts, insurance settlements and/or payouts, etc., stating the amount received from each by you for the last three years, along with the anticipated monthly income. ANSWER: 5. As of the date of your marriage with the Plaintiff, please provide a complete listing of all property under your control, have in your possession or have taken as separate property, a monetary value for the property, and the manner in which you calculated the value and its current location and custodian. ANSWER: 6. As of the present date, please provide a complete listing of all property under your control, have in your possession or have taken as separate property, a monetary value for the property, and the manner in which you calculated the value and its current location and custodian. ANSWER: 7. As to the items identified in answer to the preceding interrogatory, indicate whether those items are, in your opinion, marital or non-marital assets and the basis of which you have made such determination. ANSWER: 8. Have any of the items identified in answer to the four preceding interrogatories been sold? If so, please identify: a. Each and every item that has been sold; b. The date each item was sold; c. The person each item was sold to; d. The amount each item was sold for; e. The receipt for the sale of each item; f. The disposition of any funds received for the sale of such items; ANSWER: 9. As of the date of your marriage to the Plaintiff, please identify by account number and bank name or financial institution, each and every bank account, in which you had an interest, including the names of the institution and office, the account number, the balance of the account, and the names, addressed and relationship of all owners or authorized users of the account. ANSWER: 10. As of the present date, please identify by account number and bank name or financial institution, each and every bank account, in which you have an interest, including the names of the institution and office, the account number, the balance of the account on the date of separation, and the names, addressed and relationship of all owners or authorized users of the account. ANSWER: 11. On the date of your marriage to the Plaintiff, identify all assets owned by you or titled in your name, including, but not limited to, real estate, stocks, bonds, CD's, securities, mutual funds, automobiles, trucks, intangibles, trailers, boats, airplanes, mobile homes, or other vehicles, identifying the same by name, model, serial number, purchase price and date, current, value, location and custodian. ANSWER: 12. As of the present date, identify all assets owned by you or titled in your name, including, but not limited to, real estate, stocks, bonds, CD's, securities, mutual funds, automobiles, trucks, intangibles, trailers, boats, airplanes, mobile homes, or other vehicles, identifying the same by name, model, serial number, purchase price and date, current, value, location and custodian. ANSWER: 13. Identify all debts, liabilities, charges, bills or claims, contingent or liquidated, secured or unsecured, against you, identify the same, including account, the course of the same, the date the same was accrued, security, is any, the name address and relationship of the creditor, the amount, payment schedule and history of payment, if any, for each. ANSWER: 14. Identify any safe deposit box or similar depository that you have or are utilizing including the location of the same, the owners or custodians of the same, the registered owners and renters of the same, the number or acquisition and value and the identity of all persons with access thereto. ANSWER: 15. List all insurance policies that you own, that insure you or your property or in which you are beneficiary, identifying the same by type of insurance, company policy number, coverage or amount; identify including name, address and relationship of custodian insured and beneficiary, premium paid and cash value. ANSWER: 16. List any and all institutions holding an Individual Retirement Account (IRA), SEP, or other similar non-pension retirement, in which you have an ownership interest, any and all account numbers, the current amount in each account, and the amount in each account as of the present date. ANSWER: 17. As of the date of marriage to the Plaintiff, please provide a listing of all real estate in which you have any ownership interest, along with its location and value. ANSWER: 18. As of the present date, please provide a listing of all real estate in which you have any ownership interest, along with its location and its value. ANSWER: 19. State the make, model and year, and approximate value of the car(s) you drove or owned on the date of your marriage to the Plaintiff. State the name and address of the person or entity in whose name this car(s) is titled. State the amount of monthly payments, if any, which are made on this car, specifying whether such payments are lease payments or lean payments, and state the name and address of the person or entity that makes such payments. ANSWER: 20. State the make, model and year, and approximate value of the car(s) you currently drive or own. State the name and address of the person or entity in whose name this car(s) is titled. State the amount of monthly payments, if any, which are made on this car, specifying whether such payments are lease payments or lean payments, and state the name and address of the person or entity that makes such payments. ANSWER: 21. Identify each person you intend to call as a non-expert witness at the trial of this case, and for each person identified, state your relationship with the witness and the substance of the facts to which the witness is expected to testify. ANSWER: 22. Identify each expert you intend to call as a witness at the trial of this matter, and for each expert, state the subject matter about which the expert is expected to testify; and the substance of the facts and opinions to which the expert is expected to testify and a summary of the grounds for each opinion. ANSWER: 23. State the qualifications of each expert listed herein, including schools attended, past and present professional employment, experience within his or her field of expertise, list of publications, etc., and list each such expert's professional licenses and registrations, including the issuing jurisdiction and the dates thereof, state whether any such licenses or registrations were ever suspended, revoked, terminated or restricted in any way and the basis therefore and relevant dates thereof, and identify all legal proceedings in which such expert testified within the past five years and the amount of fees generated therefrom. ANSWER: a A V. DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO.: 07-217 Civil Term LOUIS ZELAZNY CIVIL ACTION - LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Joseph D. Caraciolo, Esquire, hereby certify that on the below-noted date, served a true and correct copy of the foregoing PLAINTIFF'S FIRST SET OF INTERROGATORIES TO DEFENDANT upon the following named counsel by depositing the same, postage prepaid, in the United States Mail, addressed as follows: Louis Zelazny 15 Charisma Drive Camp Hill,. PA 17011 Date: FOREM#N &,FOREMAN, By: / Joseph D. Car olo, Esquire Attorney for Plaintiff 2 Market Street, 6th Floor ?arrisburg, Pennsylvania 17101 ID# 90919 Tel. (717) 236-9391 EXHIBIT "B" x+ . LAW OFFICES FOREMAN & FOREMAN, P.C. Bruce D. Foreman Jeff Forearm Joseph D. Caradelo Andrew P. Bainbridge Leonard Cowiteb, Jr. 6'H FLOOR, VETERANS BUILDING 112 MARKET STREET HARRISBURG, PA 17101-2015 TELEPHONE (717) 236-9391 FAX (717) 236-6602 brucela foremamforeman.com jeftforemaaforeman.com joaepb@foreman-foreman.com andrew@foreman-forenumcom leonard(oforeman-foreman.com Samuel L. Andes Attorney at Law 525 North Twelfth Street P.O. Box 168 Lemoyne, PA 17043 Re: Dear Attorney Andes: Zelazny v. Zelazny No.: 07-217 Cumberland County I am in receipt of your letter dated April 19, 2007. In response to your initial questions, enclosed, please find a Divorce Complaint filed on January 11, 2007, along with a cover letter sent to Mr. Zelazny with the Divorce Complaint. Service in this case was done by certified mail and regular mail in accordance with rule 1930.4(c). It is my understanding that your client has agreed to move from the marital residence, and has been given access thereto in order to take his personal belongings. If I am incorrect about this, please contact me at the telephone number captioned above in order to arrange a time when your client may remove items from the residence. At this point, I agree with the statement in your letter that our clients should be' allowed to temporarily divide the property among them without our interference. If your client';inakes an inventory of the items he removes, I would appreciate you sending a copy of the sarfte to my attention. If it is your intention to enter your appearance in this case, please do sones and forward a copy of the praecipe to my attention. In the meantime, the deadline for providing answers to the interrogatories is April 23, 2007. In light of your recent involvement- th this e, I will take no action to enforce this deadline until May 14, 2007. / y J" Sinc ly, fJ -Jo / h D. Caraci o.Esquil`e JDC/ ///j Cc: Darlene Zelazny (V , I . EXHIBIT "C" i XAILDNO ADDRESS: P. 0. B08 166 LEMOYNE. PA 17043-0166 8-XAIL: L v4hndeeoaol.com Joseph D. Caraciolo, Esquire 112 Market Street, 6h Floor Veterans Building Harrisburg, PA 17101-2015 RE: Louis Zelazny Dear Joe: 3 May 2007 Thank you for your recent letter and a copy of the divorce complaint. TEX"NONE (717) 761-6361 PAX (717) 761-1435 I do not believe that my client will be able to respond to your discovery requests by 14 May 2007. For one thing, he will need some documents which are still at the residence and, at least the last time.1-spoke with him, he had no access to the residence or to the documents. I will work with him to get you that information in the near future, but I do not think I will be able to meet your deadline, even with. your extension. Be patient and I will get you the information when I can. In the meantime, I do not think it is necessary for you and I to be involved in arranging a time for my client to conie'to the residence to remove some additional items. I would certainly expect that our clients, who have been able to discuss other matters over the past several weeks, can handle those arrangements themselves. I think it is not necessary for you and I to put our clients to the extent of arranging a particular time and date for my client to go to the house. I think you and I need to be involved only if there is some problem. I have asked my client to contact his wife to set a time to get into the house and to prepare an inventory of the things he takes. In exchange for that, I would like your client to prepare an inventory of all the items remaining in the house after he removes-his-items. Thank you for your cooperation in this matter. Please call me if these arrangements are not satisfactory or if there is any other problem.. Thank you for your cooperation. Sincerely; Sam L. es amh SAMUEL L. ANDES ATTORNEY AT LAW 325 NORTH TWELFTH STREET F. O. BOX 168 LEMOYNE. PENNSYLVANIA 17043 cc: Mr. Louis Zelazny .' ?t ?,: ?. ? ? ( ? } ?? DARLENE ZELAZNEY, IN THE COURT OF COMMON PLEAS OF PLAINTIFF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-0217 CIVIL V. CIVIL ACTION - LAW LOUIS ZELAZNEY, DEFENDANT IN DIVORCE ORDER OF COURT AND NOW, this 18"' day of September, 2007, upon consideration of the Plaintiffs Motion for an Order to Compel Defendant to Answer Interrogatories, IT IS HEREBY ORDERED AND DIRECTED that: 1. A Rule is issued upon the Defendant to show cause why the relief requested should not be granted; 2. The Defendant will file an answer on or before October 8, 2007; 3. The Prothonotary is directed to forward said Answer to this Court. 4. A status conference with counsel will be held on Friday, October 19, 2007, at 8:30 a.m. in Courtroom No. 5 of the Cumberland County Courthouse, Carlisle, Pennsylvania. By the Court, ?doseph D. Caraciolo, Esquire Attorney for Plaintiff Aamuel L. Andes, Esquire Attorney for Defendant bas a d??drltilS?N?? KNnr cif 1'J Ch :S a i 83S LOOZ M'!0 ?} -3RL ? DARLENE ZELAZNEY, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW LOUIS ZELAZNEY, Defendant NO. 07-217 CIVIL TERM ORDER OF COURT AND NOW, this 25th day of September, 2007, upon consideration of the Petition for Special Relief in the Form of Exclusive Possession of the Marital Residence Pursuant to 23 Pa. C.S. §3502(b) of the Divorce Code, a hearing is scheduled for Monday, November 26, 2007, at 2:15 a.m., in Courtroom No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, ,kseph D. Caraciolo, Esq. 112 Market Street Sixth Floor Harrisburg, PA 17101 Attorney for Plaintiff I/amuel L. Andes, Esq. J 525 North 12'h Street P.O. Box 168 Lemoyne, PA 17043 Attorney for Defendant :rc bfN` A IASNN3d OZ : I Wd 9Z AS LOOZ AUVIO `)HIOW 3µl 30 301140-Q3113 s DARLENE ZELAZNEY, Plaintiff VS. LOUIS ZELAZNEY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN DIVORCE DEFENDANT'S ANSWER TO PLAINTIFF'S MOTION TO COMPEL AND NOW comes the above-named Defendant, by his attorney, Samuel L. Andes, and answers Plaintiff's Motion to Compel as follows: 1 through 5. Admitted. 6. Admitted. However, because of discussions between the parties directly, Defendant believes he was not required to formally answer the Interrogatories. Moreover, Defendant did not have the financial records and other information he needed to properly answer the Interrogatories because those items were in the family home and were not accessible to him after he moved out of the home at Plaintiff's request. 7. Admitted. 8. Admitted. 9. Admitted. 10. Admitted. By way of further answer, however, Defendant states that he needs access to his records and other information to properly answer the Interrogatories and has been denied access to them by Plaintiff. 11. Admitted. By way of further answer, however, Defendant states that he believed that he and Plaintiff were, by their direct discussions, making formal discovery unnecessary in this case. 12. Admitted. 13. Denied. Defendant has no way of knowing what attorneys fees Plaintiff has incurred in this matter to date because that information is within the control of Plaintiff and counsel and so Defendant denies those averments and demands proof thereof at any hearing. 14. Admitted. WHEREFORE, Defendant prays this court to dismiss Plaintiff's Motion to Compel or, in the alternative, direct Defendant to answer such discovery thirty days after Plaintiff gives Defendant reasonable access to his records, documents, and other possessions in the family home which Defendant reasonably needs to prepare his answers. 3 Sahel L. AnZies Attorney for Defendant Supreme Court ID # 17225 525 North 12th Street Lemoyne, Pa 17043 (717) 761-5361 f I verify that the statements made in this document are true and correct. I understand that any false statements in this document are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). Date: /& ar - IbOI ZELAZ C> ?' t? "7'i ?--..,? . ?? f"y ` ° _ ^-.... ' -.? : s , _ _... ? - f r" ... ": y.:? ?? ."C DARLENE ZELAZNY, Plaintiff VS. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM LOUIS ZELAZNY, Defendant IN DIVORCE ORDER OF COURT AND NOW, this 315 day of October 2007, upon agreement of counsel for the parties, we hereby order, in response to the Plaintiff's Motion to Compel, as follows: 1. Defendant Louis Zelazny shall file appropriate answers to the Interrogatories and to Plaintiff's First Request for Production within thirty (30) days of the date of this Order. 2. The status conference which had been scheduled for October 19, 2007 is hereby canceled. If further problems arise regarding discovery, the court will schedule another status conference upon the request of either party. BY THE COURT, Distribut'on: Joseph D. Caraciolo, Esquire (Attorney for Plaintiff) aor' rn?? / 112 Market Street, 6 Floor, Harrisburg, PA 17101 /f?r /07 Samuel L. Andes, Esquire (Attorney for Defendant) 525 North 12 th Street, P.O. Box 168, Lemoyne, PA 17043 DARLENE ZELAZNEY, Plaintiff v LOUIS ZELAZNEY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN RE: PETITION FOR SPECIAL RELIEF ORDER OF COURT AND NOW, this 26th day of November, 2007, upon consideration of the Petition for Special Relief in the Form of Exclusive Possession of the Marital Residence Pursuant to 23 Pa. C.S. Section 3502(b) of the Divorce Code, and pursuant to an agreement reached in open court by the parties and their respective counsel, it is ordered and directed as follows: 1. The Plaintiff, Darlene Zelazney, will continue to live in the residence at 15 Charisma Drive in East Pennsboro Township. The Defendant, Louis Zelazney, will have the right to come to the home and visit it, but only after giving notice to the Plaintiff at least 36 hours in advance of his intended visit; 2. The Defendant, Louis Zelazney, will have the right to use the vacation condominium owned by the parties in Ocean City, Maryland. The Plaintiff, Darlene Zelazney, will have the right to come to that property, but again only after giving 36 hours advance notice directly to the Defendant of her intended visit; 3. Notices required by this order will be given directly to the other party in person, by telephone, by mail, by e-mail, by a text message or by some other means. Neither party shall give notice to the other of an intended visit through a third party; and "? . 4. This order resolves the matters and claims raised in Plaintiff's Petition for Special Relief in the form of a Request for Exclusive Possession. By the Court, a Y J. esley 0 r, Jr., Joseph D. Caraciolo, Esquire 112 Market Street Sixth Floor Harrisburg, PA 17101 For Plaintiff Xmuel L. Andes, Esquire 525 North Twelfth Street P.O. Box 168 Lemoyne, PA 17043 For Defendant :mae 4 (5` DARLENE ZELAZNY, Plaintiff vs. LOUIS ZELAZNY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 2007-0217 CIVIL TERM IN DIVORCE MOTION TO COMPEL AND NOW comes the above-named Defendant by his attorney, Samuel L. Andes, and moves the court to compel Plaintiff to answer to Defendant's discovery, based upon the following 1. The moving party herein is the Defendant. The Respondent herein is the Plaintiff. 2. On 2 September 2008, Defendant's counsel served on Plaintiffs counsel Defendant's Second Request for Production of Documents and Things. A copy of that document is attached hereto and marked as EXHIBIT A. 3. The formal Request followed several informal requests for the same information. Plaintiff's counsel had not responded to those informal requests for information. 4. Plaintiff and her counsel have made no response to Defendant's Second Request for Production of Documents and Things and have offered no explanation as to why they have not. 5. Defendant needs the information he has requested from Plaintiff to advance this case. 6. Prior orders in this matter have been entered by the Honorable J. Wesley Oler. 7. Defendant believes that Plaintiff and her counsel do not concur in the request made in this Motion. WHEREFORE, Defendant moves this court to enter an order directing and compelling the Plaintiff to answer Defendant's Second Request for Production of Documents and Things. Samuel L. Andes Attorney for Defendant Supreme Court ID 17225 525 North 12th Street Lemoyne, PA 17043 (717) 761-5361 I verify that the statements made in this document are true and correct. I understand that any false statements in this document are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). Date: §AiKEL L. NDES CERTIFICATE OF SERVICE I hereby certify that I served an original of the foregoing document upon counsel for the Plaintiff herein by regular mail, postage prepaid, addressed as follows: Joseph D. Caraciolo, Esquire 112 Market Street, 6th Floor Veterans Building Harrisburg, PA 17101-2015 Date: 2 October 2008 Amy M. arkins Secretary for Samuel L. Andes DARLENE ZELAZNY, Plaintiff ) VS. ) LOUIS ZELAZNY, ) Defendant ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 2007-0217 CIVIL TERM IN DIVORCE DEFENDANT'S SECOND REQUEST FOR PRODUCTION OF DOCUMENTS AND THINGS TO: Ms. Darlene Zelazny c/o Joseph D. Caraciolo, Esquire 112 Market Street, 6th Floor Veterans Building Harrisburg, PA 17101-2015 You are requested, in accordance with Pa. R.C.P. 4009, to deliver to the office of the undersigned at 525 North 12th Street, Lemoyne, Pennsylvania, or otherwise make arrangements reasonably satisfactory to the undersigned, for his inspection or examination, copies of the following documents, articles, and things, within thirty (30) days of the date of this Request. For purposes of this Request, all computer records and information available on computer records or within computer programs, should be included within the Request for Production. That is, this Request is not limited to documents or "hard copies" of records, but should include computer records, tapes, disks, and other media as well as paper documents. 1. Copies of all Statement of Account or similar document that you have received from the Pennsylvania Statement Employees Retirement System, or any other retirement system or pension system in which you have participated at any time during the past twenty (20) years, which report, describe, or reflect the benefits you have earned within that system. 2. Copies of any estimates of benefits or other communications from the Pennsylvania Statement Employees Retirement System or any other pension or retirement system in which you have participated, which describes or reflects the retirement benefits you have earned in that system at any time since your marriage to the Defendant. Page 1 of 3 3. Copies of all written communications between yourself and any representative of the Pennsylvania Statement Employees Retirement System or any other pension or retirement system in which you have participated, relating to the benefits you have earned or accrued in said system since the date of your marriage to the Defendant. Samuel L. Andes Attorney for Defendant Supreme Court ID 17225 525 North 12' Street Lemoyne, PA 17043 (717) 761-5361 Page 2 of 3 CERTIFICATE OF SERVICE I hereby certify that I served an original of the foregoing document upon counsel for the Defendant herein by regular mail, postage prepaid, addressed as follows: Joseph D. Caraciolo, Esquire 112 Market Street, 6'hFloor Veterans Building Harrisburg, PA 17101-2015 Date: 2 September 2008 Amy M. Harkins Secretary for Samuel L. Andes Page 3 of 3 MAILING ADDRESS: P. 0. BOX 168 LEMOYNE, PA 17043.0188 E-MAIL: LnwAnde oaat.co- Joseph D. Caraciolo, Esquire 112 Market Street, 6' Floor Veterans Building Harrisburg, PA 17101-2015 RE: Zelazny Dear Joe: SAMUEL L. ANDES 'ATTORNEY AT LAW 525 NORTH TWELFTH STREET R0.BOX168 LEMOYNE, PENNSYLVANIA 17043 TELEPHONE (717) 761-5361 PAX (717) 761-1435 2 September 2008 I have repeatedly requested that you provide me with a copy of Darlene Zelazny's statement of benefits from SERS. I have not heard from you and, despite those repeated demands, I have not seen the document. To correct that, I enclose a Request for Production. Please see that I receive those documents as soon as possible and certainly within the time limit set by the Rules. Mrs. Zelazny appears to misunderstand the order entered last year regarding occupancy of the house. Mr. Zelazny notified her last week that he wanted to stop by the house to retrieve a few of his personal items. She advised him that he was not permitted to come to the house. She then told him that she had discussed the matter with you and you had confirmed to her that he was not permitted to come to the house. The order entered, by the agreement of the parties, clearly gives Mr. Zelazny the right to come to the house with 36 hours advanced notice. I enclose a copy of the order giving him that right and I request that you be certain that Mrs. Zelanzy is aware of that provision of the order so we will not have this problem in the future. Please get me the documents as soon as possible. Sincerely, amh / Enclosure Samuel L. Andes cc: Mr. Louis Zelazny ?i C30 c OCT 15 2008 6 DARLENE ZELAZNY, Plaintiff vs. LOUIS ZELAZNY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 2007-0217 CIVIL TERM IN DIVORCE ORDER OF COURT AND NOW this 11 S day of Ot. obcC , 2008, upon consideration of Defendant's Motion to Compel, we hereby order the Plaintiff to file appropriate answers, in accordance with the Rules of Civil Procedure, to Defendant's Second Request for Production of Documents and Things within 10 days from the date of service of this Order upon her counsel. BY THE COURT, J. Distribution: ?Joseph D. Caraciolo, Esquire (Attorney for Plaintiff) 112 Market Street, 6th Floor, Veterans Building, Harrisburg, PA 17101-2015 ?Samuel L. Andes, Esquire (Attorney for Defendant) 525 North 12th Street, P.O. Box 168, Lemoyne, PA 17043 lo?a?/d8 C S •8 WV 1 Z 130 OOOZ DARLENE ZELAZNY, Plaintiff V. LOUIS ZELAZNY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA : NO.: 07-217 Civil Term CIVIL ACTION - LAW IN DIVORCE ANSWER TO DEFENDANT'S SECOND REQUEST FOR PRODUCTION OF DOCUMENTS AND THINGS 1. See attached Exhibit "A". 2. See attached Exhibit "A". 3. Objection. There are no documents which satisfy this request. To the extent that Exhibit "A" satisfies this requests, please see Exhibit "A" attached hereto. Date: c P Respectfully submitted, FOREMAN, FOREMAN & CARACIOLO, P.C. la /-. e, ? Joseph D. raciolo, Esquire Attorney for Plaintiff f Attorney ID Number: 90919 112 Market Street, 6``' Floor Veteran's Building Harrisburg, PA 17101-2015 Telephone: (717) 236-9391 DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO.: 07-217 Civil Term LOUIS ZELAZNY CIVIL ACTION - LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing Answer upon the person and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy in the United States first class mail, addressed as follows: Samuel L. Andes, Esquire Attorney for Defendant 525 North 12' Street Lemoyne, PA 17043 Date: k n - ";,)© - 019 Respectfully submitted, FOREMAN, FOREMAN & CARACIOLO, P.C. Emily Wilson, Se eta to eph D. Cara lo, quiv Attorney for Plaint 112 Market Street, 6' Floor Veteran's Building Harrisburg, PA 17101-2015 Telephone: (717) 236-9391 EXHIBIT "A" COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM SE Ala 30 N THIRD STREET 12_ ROOM 319 S HARRISBURG, PA 17101 TOLLFREE: 1-800-633-5461 www.sers.state. pa. us October 2, 2008 DARLENE E ZELAZNY 15 CHARISMA DR CAMP HILL, PA 17011 Re: Domestic Relations Order Dear: DARLENE E ZELAZNY Outlined below are the requirements needed to obtain an approved Domestic Relations Order ("DRO"). A copy of the sample DRO developed by the State Employees' Retirement }System ("SERS") is enclosed for your consideration in drafting an appropriate order. Preparing the parties' DRO in accordance with the format outlined in the sample DRO may expedite SERS' review and approval. It is strongly suggested that you submit the draft DRO for review before it is executed and filed with the court? Before submitting a draft DRO to SERS for review, please make sure that both parties have agreed upon the terms of the draft. SERS will not choose the terms of a DRO for the parties. Because SERS is a governmental retirement plan for governmental employees, federal requirements contained in the Employee Retirement Income Security Act ("ERISA") and the Retirement Equity Act of 1984 regarding qualified domestic relations orders and spousal consent do not apply to SERS. Unlike ERISA plans, this means that in the absence of an appropriate court order, a member may take any action with regard to the member's retirement benefits without any notice or consent required from anyone, including the member's spouse. Attachment of SERS retirement benefits for purposes of equitable distribution must be accomplished through the terms of an Approved Domestic Relations Order ("ADRO"). There are several unique prerequisites that must be met before SERS can approve any DRO or amendment to an approved DR02 In no case can the DRO alter SERS' benefit structure. The State Employees' Retirement Code, 71 Pa. C.S. §§ 5901 -- 5956("Retirement Code"), provides a 1 Note: SERS' review of a DRO will only encompass the DRO's compliance with SERS' requirements for approval. SERS will not offer advice on the desirability of a particular option or plan of distribution and does not provide legal advice or representation to persons seeking a DRO. This letter and SERS' sample DRO do not constitute legal advice and are not substitutes for consultation with an attorney. 2Requirements for SERS' approval of a DRO are set forth at 71 Pa. C.S. §§ 5102 (definitions of alternate payee, approved domestic relations order, domestic relations order, irrevocable beneficiary and irrevocable survivor annuitant), 5705, 5953, 5953.1, 5953.2, 5953.3, and 5953.4. Upon request, SERS' Legal Office will provide information to attorneys seeking to draft DROs acceptable to the agency. DARLENE E ZELAZNY October 2. 2008 Page 2 myriad of benefit options to SERS members. All DROs must utilize the benefit structure established by the General Assembly. Any substantive changes to the benefit structure are outside the jurisdiction of the Courts of Common Pleas3 At the member's request, SERS will provide the member's total credited service, final average salary, and total accumulated deductions credited to the member as well as the present value of the member's retirement account as of the date of the request or the date of separation, if the parties have already separated. SERS can also provide an estimate of the benefits the member could receive as of the date of the request or the date of separation, whichever is earlier. The member may also request a retirement benefit estimate projected to the end of the current calendar year. Any other actuarial calculations must be made by an outside actuarial consultant at the parties' expense and submitted to SERS for final approval. Upon request, SERS will provide outside actuaries with information regarding the actuarial factors used to formulate estimates. Please note that SERS cannot release benefit estimates to anyone other than the member without the member's written authorization. An interactive estimate calculator is available on SERS' website at www.sers.state.pa.us. Members can use the calculator to create benefit estimates based on their account data or experiment with different figures. If the member is receiving or will receive a disability retirement pension based on an injury or disability that occurred during the marriage, the disability portion of the pension is attachable through a DR0. Disability retirement benefit options are more limited than regular retirement benefits under the Retirement Code and therefore different issues must be taken into consideration in drafting a DRO dividing a disability retirement pension. If your current DRO matter involves a member of SERS who is receiving or will receive a disability retirement pension, please contact SERS' Legal Office to discuss the issues that must be addressed. The division of benefits must be clear and unambiguous within the four corners of the DRO. SERS will not approve any DRO that requires reference to property settlement agreements, trust documents, etc. to calculate benefit formulas or determine payout information. SERS has no power to compel a party's compliance with the terms of a DRO. Therefore, SERS cannot accept a DRO containing terms contingent on an event other than the member's death or retirement, such as the sale of the marital home or the purchase of life insurance. Generally, the following information should appear in the DRO: A. The portion of the retirement benefits attributable to the marriage. This statement must include the actual dates (month, day, year) of the measuring period, if such dates are necessary to determine the benefit to be split. 3 See Millick v. Millick, 592 A.2d 788 (Pa. Cmwlth. 1991). 4See Drake v. Drake, 555 Pa. 481, 725 A.2d 717 (1999). 5 Equitable distribution occurs only after a divorce decree is issued. In re Estate of Bullotta, 575 Pa. 587, 838 A.2d 594 (2003). Therefore, a DRO must be issued contemporaneously with or subsequent to the parties' divorce unless the court retains jurisdiction over equitable distribution of a deceased member's marital property pursuant to 23 Pa. C.S. Section 3323(d.1). DARLENE E Z.EIAZNY October 2, 2008 Page 3 B. The marital share of the retirement monies, expressed as either a percentage or dollar amount. The dollar amount payable to the alternate payee cannot exceed the amount of the total retirement benefit. The parties should also specify whether the benefit awarded to the alternate payee includes post-separation enhancements such as post-separation purchases of credit for service rendered during the marriage. C. The benefit to be split. The actual retirement benefit option to be selected should be identified as it is described under the Retirement Code (Maximum Single Life Annuity, Option 1, etc.). If the benefit option to be selected is not identified in the DRO, then the member is free to select any retirement option available at retirement. Further, a lack of specificity may render the DRO unenforceable due to vagueness and may trigger further litigation as to how distribution should occur. D. Whether or not the member may take a lump sum withdrawal of all or part of his or her member contributions and interest ("accumulated deductions") and how that withdrawal is to be divided between the member and alternate payee. The DRO should be explicit with regard to the member's authorization to take a lump sum, the extent of the withdrawal the member may take, and the share, if any, payable to the alternate payee. If the DRO does not state that the member may elect to take a lump sum withdrawal, the member will not be permitted to do so. E. The address of the alternate payee must be included in the DRO. The alternate payee must maintain a current address on file with SERS at all times. This duty must be noted in the DRO. Unlike ERISA plans, the rights of the member's spouse are entirely derivative of the member's rights. To that end, the member's spouse may not elect beneficiaries, choose benefits, and so forth. Additionally, the DRO must require the Member to execute a release authorizing the alternate payee to access the information SERS maintains on the member, so that the member's compliance with the terms of the DRO may be monitored6 Please note that the "present value" indicated on the annual account statements of vested SERS members is a statutory term which refers to the amount of money SERS will need to have at the time of the member's retirement (invested at an assumed rate.of 4% annually) in order to pay a member's retirement annuity for his or her expected lifetime. The term as used in the account statements and the Retirement Code accurately shows the available Option 1 death benefit but may not reflect current market indications of the value of the future stream of income from a member's retirement benefits. 6 71 Pa. C. S. Section 5953.1(a)(7). DARLENE E ZELAZNY October 2, 2008 Page 4 Please be advised that if the DRO provides that the alternate payee is entitled to a marital portion of a member's lump sum death benefit, the DRO must nominate the alternate payee as an irrevocable beneficiary? The parties should also be aware that all benefits paid by SERS are subject to the terms of the Public Employee Pension Forfeiture Act, 43 P.S. § 1311 et seq. Under certain circumstances, the member's conviction for one of the crimes enumerated in the Public Employee Pension Forfeiture Act may cause the forfeiture of all benefits payable to the member and alternate payee. Please contact SERS' Legal Office at (717) 783-7317 if you have any questions or to review a draft DRO. Very truly yours, Jane Kuklish State Employees' Retirement System Enclosure Revised 9/27/2006 7 If the alternate payee is to receive an annuity for his or her lifetime in the event the member predeceases the alternate payee, the DRO must specify that the alternate payee will be nominated as an irrevocable survivor annuitant, and the member will be required to fill out the SERS application necessary to elect such a benefit option. In certain instances, the member may be required to nominate the non-member spouse as beneficiary on a SERS Beneficiary Form, depending on the facts of the case. SAMPLE DOMESTIC RELATIONS ORDER COURT OF COMMON PLEAS OF Plaintiff COUNTY, PENNSYLVANIA FAMILY DIVISION V. NO. Defendant ORDER IN DIVORCE AND NOW, this day of , 20_, the attached Stipulation and Agreement dated of the parties in this case is incorporated, but not merged, into this Order of Court. J. ATTEST: Sample Domestic Relations Order-Page 1 COURT OF COMMON PLEAS OF V. Plaintiff Defendant COUNTY, PENNSYLVANIA FAMILY DIVISION NO. IN DIVORCE STIPULATION AND AGREEMENT FOR THE ENTRY OF "DOMESTIC RELATIONS ORDER" AND NOW, this day of , 20the parties, Plaintiff, and Defendant, having been divorced by Decree dated of the Court of Common Pleas of County, entered at Docket Number , do hereby stipulate and agree as follows: 1. The Plaintiff, , (hereinafter referred to as "Member") is a member of the Commonwealth of Pennsylvania State Employees' Retirement System (hereinafter referred to as "SERS") 2. SERS; as a creature of statute, is controlled by the State Employees' Retirement Code, 71 Pa. C.S. §§ 5101-5956 ("Retirement Code"). Sample Domestic Relations Order-Page 2 3. Member's date of birth is and the Member's Social Security number is 4. The Defendant, , (hereinafter referred to as "Alternate Payee") is the former spouse of Member. Alternate Payee's date of birth is and Alternate Payee's Social Security number is 5. Member's last known mailing address is: 6. Alternate Payee's current mailing address is: It is the responsibility of Alternate Payee to keep a current mailing address on file with SERS at all times. 7. [This paragraph should define the portion of the retirement benefits to be assigned to the Alternate Payee. The following are merely suggestions.] [(a) The marital property component of Member's retirement benefit equals (1) the Coverture Fraction multiplied by (2) Member's retirement benefit on the effective date of Member's retirement calculated using the Retirement Code in effect on Sample Domestic Relations Order-Page 3 mm/dd/vy, the date of the parties' separation, and Member's final average salary as of the effective date of retirement. (b) The Coverture Fraction is a fraction with a value less than or equal to one. The numerator is the amount of Member's service, as defined by SERS, for the period of time from mm/dd/vv (date of marriage), to mm/dd/yy (date of separation). The denominator is the total amount of Member's service, as defined by SERS, on the effective date of Member's retirement. (c) percent (!%) of the marital property component of Member's retirement benefit is to be allocated to Alternate Payee as the equitable distribution portion of this marital asset.] OR [Alternate Payee's share of Member's retirement benefits is $ (dollar amount).] [Your method here] OR 8. Member's retirement benefit is defined as all monies paid to or on behalf of Member by SERS, including any lump sum withdrawals or scheduled or ad hoc increases, but excluding the disability portion of any disability annuities paid to Member by SERS as a result of a disability which occurs before Member's marriage to Alternate Payee or after the date of Member's and Alternate Payee's final separation. Member's retirement benefit does not include any deferred compensation benefits paid to Member by SERS or any enhancements to the Member's retirement benefit arising from postseparation monetary Sample Domestic Relations Order-Page 4 contributions made by Member. The equitable distribution portion of the marital property component of Member's retirement benefit, as set forth in Paragraph Seven (7), shall be payable to Alternate Payee and shall commence as soon as administratively feasible on or about the date Member actually enters pay status and SERS approves a Domestic Relations Order incorporating this Stipulation and Agreement, whichever is later. 9. Member hereby nominates Alternate Payee as an irrevocable beneficiary to the extent of Alternate Payee's equitable distribution portion of Member's retirement benefit for any death benefits payable by SERS. This nomination shall become effective upon approval by the Secretary of the Retirement Board, or other authorized representative of the Secretary, of any Domestic Relations Order incorporating this Stipulation and Agreement. The balance of any death benefit remaining after the allocation of the equitable distribution portion payable to Alternate Payee and any other alternate payees named under other SERS-approved Domestic Relations Orders ("Balance") shall be paid to the beneficiaries named by Member on the last Nomination of Beneficiaries Form filed with the Retirement Board prior to Member's death. If the last Nomination of Beneficiaries Form filed by Member prior to Member's death (a) predates any approved Domestic Relations Order incorporating this Stipulation and Agreement, and (b) names Alternate Payee as a beneficiary, then: (1) the terms of the Domestic Relations Order shall alone govern Alternate Payee's share of any death benefit, and (2) for purposes of paying the Balance via the last Nomination of Beneficiaries Form filed with the Retirement Board prior to Member's death, Alternate Payee shall be treated as if Alternate Payee predeceased Member. No portion of the Balance shall be payable to Sample Domestic Relations Order-Page 5 Alternate Payee's estate. In addition, Member shall execute and deliver to Alternate Payee an authorization, in a form acceptable to SERS, which will authorize SERS to release to Alternate Payee all relevant information concerning Member's retirement account. 10. The term and amounts of Member's retirement benefits payable to Alternate Payee after SERS approves a Domestic Relations Order incorporating this Stipulation and Agreement depends upon which option(s) Member selects at retirement. Member and Alternate Payee expressly agree that: [pick one] (a) Member may select any retirement option offered by SERS under the Retirement Code at the time Member files an Application for Retirement Allowance with SERS. OR (b) Member shall select the following retirement option(s) upon filing an Application for Retirement Allowance with SERS': Retirement options are found at 71 Pa. C.S. Section 5705. An option commonly used with the coverture fraction is the joint and equitable distribution annuity. If the parties decide to use a joint and equitable distribution annuity, insert the following language in Paragraph 10 and make an appropriate adjustment to Paragraph 12: Special Option 4. --A joint and equitable distribution percent [or portion] (as defined in paragraph 7) annuity payable during the lifetime of the Member, with an equitable distribution percent [or portion] (as defined in paragraph 7) of such annuity payable thereafter, to the Member's survivor annuitant, if living at the Member's death, as set forth in 71 Pa.C.S. Section 5705(a)(4), or any succeeding statute. The Member shall designate the Alternate Payee as an irrevocable survivor annuitant. The intent of this Special Option 4 selection is to maintain level payments to the Alternate Payee for the Alternate Payee's life in the event of Member's death after retirement. The Alternate Payee's portion of the Member's benefit will be deducted from the Member's monthly annuity payment and paid by SERS to the Alternate Payee during the Member's lifetime. If the Alternate Payee dies while the Member is receiving retirement benefits, the Sample Domestic Relations Order-Page 6 [insert description of retirement option here] 11. Alternate Payee may not exercise any right, privilege or option offered by SERS. SERS shall issue individual tax forms to Member and Alternate Payee for amounts paid to each. 12. In the event of the death of Alternate Payee prior to receipt of all of payments payable from SERS under a Domestic Relations Order incorporating this Stipulation and Agreement, any death benefit or retirement benefit payable to Alternate Payee by SERS shall: [pick one] (a) Be paid to Alternate Payee's Estate to the extent of Alternate Payee's equitable distribution portion of Member's retirement benefit as set forth in paragraphs 7 through 9. OR (b) Revert to Member. (Footnote continued from previous page) Alternate Payee's portion of the Member's annuity shall [choose one: (revert to the Member) OR (be paid to the Alternate Payee's estate)] for the remainder of the Member's lifetime. If the Member predeceases the Alternate Payee after retiring, the Alternate Payee will receive the Alternate Payee's equitable distribution portion of the Member's benefit in the form of a survivor annuity payable to the Alternate Payee for the duration of the Alternate Payee's life. In any event, all payments to any person or estate will stop when both the Member and Alternate Payee have died. NOTE: If the parties choose the Special Option 4 annuity described above and wish the Member to have a choice of options for the Member's portion of the benefit, Paragraph 10 must contain a statement to that effect. For example, the parties may add the following sentence to the end of the first paragraph of the description of Special Option 4 above: "Member may select any option offered by SERS under the Retirement Code at the time of retirement for the portion of the retirement benefit payable to Member." If the DRO does not contain a statement such as the one quoted above, SERS will presume that the Member wishes to receive a Maximum Single Life Annuity with no withdrawal of accumulated deductions. Sample Domestic Relations Order-Page 7 13. In no event shall Alternate Payee have benefits or rights greater than those that are available to Member. Alternate Payee is not entitled to any benefit not otherwise provided by SERS. Alternate Payee is only entitled to the specific benefits offered by SERS as provided in this Stipulation and Agreement. All other rights, privileges and options offered by SERS not granted to Alternate Payee by this Stipulation and Agreement are preserved for Member. Member and Alternate Payee acknowledge that benefits paid pursuant to this Stipulation and Agreement are and shall remain subject to the Public Employee Pension Forfeiture Act, 43 P.S. §1311, et seq. 14. It is specifically intended and agreed by the parties hereto that any Domestic Relations Order incorporating this Stipulation and Agreement: (a) Does not require SERS to provide any type of benefit, or any option, not otherwise provided under the Retirement Code; (b) Does not require SERS to provide increased benefits (determined on the basis of actuarial value) unless increased benefits are paid to Member based upon cost of living adjustments or increases based on other than actuarial values. 15. The parties intend and agree that the terms of this Stipulation and Agreement shall be approved, adopted and entered as a Domestic Relations Order. 16. The Court of Common Pleas County, Pennsylvania, shall retain jurisdiction to amend any Domestic Relations Order incorporating this Stipulation and Agreement, but only for the purpose of establishing it or maintaining it Sample Domestic Relations Order-Page 8 as a Domestic Relations Order; provided, however, that such amendment shall not require SERS to provide any type or form of benefit, or any option not otherwise provided by SERS, and further provided that such amendment or right of the Court to so amend will not invalidate the parties' existing Domestic Relations Order. 17. Upon entry of a Domestic Relations Order incorporating this Stipulation and Agreement, a certified copy of the Domestic Relations Order and this Stipulation and Agreement and any attendant documents shall be served upon SERS immediately. Such Domestic Relations Order shall take effect immediately upon SERS approval and SERS approval of any attendant documents and then shall remain in effect until such time as a further Order of Court amends or vacates the Domestic Relations Order. WHEREFORE, the parties, intending to be legally bound by the terms of this Stipulation and Agreement, do hereunto place their hands and seals. Plaintiff/Member Attorney for Plaintiff/Member EAL] Defendant/Alternate Payee [SEAL] Attorney for Defendant/Alternate Payee Revised 12/5/2005 Sample Domestic Relations Order-Page 9 Authorization for the Release of Account Information to Alternate Payee I, (Print Name of Member) authorize the Pennsylvania State Employees' Retirement System ("SERS ") to release to any (Print Name of Alternate Payee) and all information that he/she may request regarding my SERS benefits or retirement account. This authorization is granted under the terms of the Approved Domestic Relations Order entered by the (County) (Date) County Court of Common Pleas on at Docket Number which names as (Alternate Payee) Alternate Payee. A photocopy or faxed copy of this Authorization shall have the same force and effect as the original. Date Member's Signature Member's Printed Name Member's Social Security Number Reviscd lo/26/w T: - - - "' 77 ?Tj --3 0 Jm L ? O y r+ ? A ? O d J H X _ s L _ H (D (o 3 M S (? W ` - v O n `C '° o - J 5 O O v 4i - Q. C s. -D O co (n Z, ti aw(D < En = s 0 o Q 0) v - (D n s .5 a lD (D 'D 0 J rt C(D Q rD C co rr n ?p !D v ? N -? ? C n. ? rs - ?. I D O 0 E3 m 6 m o m ? B r CD cr, o. - CD 1 r+ rs L! s 1 =t If U: ?o L f 0 c J? art` m T J. C J C `s < < G rt r C rG i _ - f:?L O -, n CL m IT J T u _ , Z n 2 < rp O n - rJ - -' < V r C O _ n- O C J s rl r ?' G Cn rJ?j Dc co k G n 6 y G J n G_ 6 0 CF C 0 0 E: 'D 0 CL a O U' -? D = O -- - 3 h < =7 G C m\c-, J Q=macro n? n :5 C n _. 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D C)-s Ir o c `1- c o v 0) a) v Q) E c" j u = C1 0 O c O, D -c a) rc i Ln D E a` oD Cf) :E E w2 N, 2 - 3: 4, E c o > O oDTW ,0 ,n C V ,p ` (n r °> u o E E c° N D L Q V =0 -0 N Q O 0 d' C 0 v >- v u a Q ro .? E a?Dia ? O C ,p c ? u O u C ? U v u O OC C a o E G7 p O o_ O ++ d C O ° Q oO (6 c ;a c D o E - c E a) Q Q = o E c T m m ? 1 O ? ac m a E v a) v E > E mu ,o a) Q _U ?-+,Z ° v CD a) 1 0) C) O U ,Q QELn O E F-- 0 m aJ ? Q U E 3 a C D r #? ? ? c r µ r? t j ry?? ,# ? ? 2007 Statement of Account Prepared especially for: DARLENE E ZELAZNY 15 CHARISMA DR CAMP HILL PA 17011 .I K -? xw?rWAi• ,» +Y. N ri i k 1 S?. n 'p- ?Fi YS ** REPRINTED STATEMENT ** fall ULQVUU LUl U111C1C1Ll 1C111C111C1LL VFUVILJ, L,U1LLal,l yuul L\C61viwi 1\%::tnv tt:m Counseling Center at 1-800-633-5461. In addition, you can produce your own individualized retirement estimates, testing a wide range of scenarios, by using the Interactive Custom Calculator on our Web site: www.sers.state.pa.us. Leonard M. Knepp SEP?S Executive Director st 1 t 2007 Statement of Account, Basic Data I as of December 31, 2007 S Prepared for SERS Member: DARLENE E ZELAZNY a Personal Data Social. Security Number XXX-XX 5773 Sex FEMALE' Birth Date Au 25, 1953 Coverage Type FULL Contribution Rate 6.25% Counseling Center HARRISBURG Normal Retirement Date ALREADY REACHED Final Average Salary $75,380.54 2007 Retirement Covered Earnings $79,554.88 Total SSI Non-Covered Earnings ,Joint Coverage Conversion Amount Mandatory Debt Service Purchase Debt Acc ount Balance Regular Contributions SSI Contributions December 31, 2006 Balance $112,293;98 Contributions $4,972.26 Lump Sum Payments Arrears Payments Credited Interest $4,591.41 YTD Adjustments December 31, 2007 Balance $121,857.65 Total Accumulated Deductions: $121,857.65 NOTE: YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification. Arrears Balance Class Service Years of Service Credit Class Years of Service AA-60 35.3389 Total Service 35.3389 NOTE: If you are eligible to purchase Creditable State and/or non-State. Service, contact your Retirement Counselor. All requests to purchase service must be filed while you are an Active, contributing Member. 1- 0 Regular SSI Taxable Breakdown of Your A Taxable Contributions ccount $68,829.23 Pre 87 Non-Taxable Contributions $5,195.78 Post 86 Non-Taxable Contributions Credited' Interest (Taxable) $47,832.64 December 31, 2007 Balance $121,857.65 NOTE: SERS is treated as a Defined Benefit Plan under Internal Revenue Code, Section. 401(a). Special Conditions Principal LOUIS ZELAZNY NOT`F: Information filed on a Beneficiary Nomination form before 1993 or since December 31, 2007, or involving special circumstances (such as the designation of an estate or trust as your Beneficiary) may not appear. A maximum of 10 Beneficiaries may be shown here; however, you may have more Beneficiaries on your retirement record. Keep your Beneficiary information current. You may change your Beneficiary nomination at any time by filing a new Beneficiary Nomination form with SERS. Forms are available online at www.sers.state.pa.us, from your agency Human Resources Office or your Regional Retirement Counseling Center. Please contact us if you do not want your Beneficiaries listed on future statements. The following special conditions apply to your benefit estimates or are reasons estimates were not calculated: You have already reached normal retirement age. W 2007 Statement of Account Estimated Retirement Benefits ., Prepared for SERS Member: DARLENE E ZELAZNY E Normal Retirement Date: ALREADY REACHED R _. S Estimated retirement benefits are provided if you have at least Multiple SeVice Note five years of Credited Service or you have reached your Normal If you have Credited Service as a Multiple Service member (service Retirement Date and have at least three years of Credited Service. in both SERS and PSERS (Public School Employees' Retirement System)), your estimate does not include your ]'SERS contributions. If you have projected benefits, any limits mandated by the Internal Your estimated benefit may be overstated if in any calendar year you Revenue Service or the State Employees' Retirement Code, have have concurrent service; that is you contributed to both systems at not been applied. the same time during any year of membership. Options with NO Withdrawal of Your Accumulated De ductions As of As of Normal Beneflt Payment Option December 31, 2007 Retirement Date Maximum Single Life Annuity This option provides you with the maximum monthly annuity for life. If you die before $5,549.72 receiving payments equal to your Accumulated Deductions, the balance will be paid to your Beneficiaries. You may name one or more Beneficiaries and may change Beneficiaries at any time. Option 1 Retirement This option provides you with a reduced monthly annuity for life. When you retire, a Present $5,281.17 Value is placed on your retirement account. If you die before receiving; payments equal to your Present Value, the balance will be paid to your Beneficiaries. You may name one or more beneficiaries and may change Beneficiaries at any time. Disability Retirement You must be certifiedby an independent Medical Examiner retained by SLRS as physically or mentally incapable of performing current job duties and have at least five years of $5 549.72 Credited Service (except State Police and Enforcement Officer-category employees, who have , no minimum Service requirement). Only active, contributing; members or those on leave without pay may apply for Disability' Retirement. You cannot withdraw your Accumulated Deductions if you take Disability Retirement' Death in State Service If you are Vested (eligible to receive a SERS monthly pension) and die while an Active employee, it will be assumed you retired under Option 1 the day before your death. The $1,079,480.92 Present Value of your annuity will be payable to your Beneficiaries. If you are not vested, your Accumulated Deductions will be payable to your Beneficiaries. OptionS Adjusted for a TOTAL Withdrawal of Your Accumulate d Deductions Balance of Accumulated Deductions $121,857.65 AdJuSted Maximum Single Life Annuity This option provides you with the maximum monthly annuity for life. When you withdraw $4 923 24 your total Accumulated Deductions, there is no Death Benefit payable . Adjusted Option 1 Retirement This option provides you with a reduced monthly annuity for life. When you retire, a Present $4 685 00 Value is placed on your retirement account. If you die before receiving payments equal to your , . Present Value, the balance will be paid to your Beneficiaries. Key Terms-----------, Accumulated Deductions - Total of your member contributions plus credited interest earned on your member contributions. Final Average Salary - The highest average compensation received during any three non-overlapping periods of four consecutive calendar quarters. Typically, it is the average of your last three years of compensation. Normal Retirement Date - The age at which you are eligible to receive an annuity that is not reduced by an Early Retirement Reduction Factor. Normal Retirement Age, also called Superannuation Age, is either age 60 or age 50 (depending upon your service classification) with at least three years of Credited Service, or any age upon attaining 35 years of Credited Service. Age 60 is the Normal Retirement Age for most members. How Your 2007 Statement of Account Was Prepared Y I The account balances and Credited Service contained in this statement or produced by the SERS' Interactive Custom Calculator, found at www.sers.state.pa.us, are based on payroll information provided by your employer and are subject to final audit by SERS in accordance with applicable laws. Your annual statement of account provides you with important information concerning your personal State retirement account. You may use this data to help with pre-retirement planning. The projected benefit amounts shown on your statement are estimates only. Your actual benefit may not exceed either 100% of your highest 12 months of earnings or the IRC §415 limit. Additionally, members enrolled on or after January 1, 1996 are subject to the IRC §401 (a)(17) compensation limit. The estimates shown are based on the following assumptions: (1) Your future service will be full-time with no breaks in employment. (2) Your future earnings will be the same as your 2007 earnings. (3) Your future service will be in the same Class, Category and. Coverage as your most recent employment. For questions about your SERS retirement account, please call your Regional Retirement Counseling Center at 1-800-633-5461. . .?,? -,-Important Reminders pay. Keep Your Beneficiary Information Current The financial protection offered under your retirement plan in the event of your death could amount to a large. sum of money. Death benefits are paid to your designated Beneficiaries. You should review your Beneficiary designation frequently, but especially if you have any major life changes such as changes in marital status, birth or death of family members, or changes to Beneficiary names and addresses. Keeping your Beneficiary form up-to-date will ensure that benefits are paid promptly and properly. You may change your Beneficiary nomination at any time by filing a new Beneficiary Nomination form with SERS. The form is available from your Human Resources Office Disability Retirement If you. are unable to perform your job because of injury or illness, you may be eligible for Disability Retirement Benefits. To be eligible to apply, you must have at least five years of Credited Service:. (This service requirement does not apply to State Police officers and enforcement officers.) The State Employees' Retirement Code also requires that you apply for Disability Retirement Benefits while you are still employed; that is, you are still actively working, on paid leave, or on leave without Present Value - The total. value of your retirement account, including your contributions and your employer's contributions and interest, which fund annuity payments over your lifetime. Social Security Integration (SSI) - Optional coverage available to most members between August 1, 1968 and March 1, 1974. Judges and magisterial district judges currently may elect SSI while they are active contributing members. Please refer to the SERS pamphlet, Social Security Integration Coverage for SERS Members (SERS-151) for more information. NOTE: The SERS SSI program and the federal Supplemental Security Income program under Social Security are separate and distinct programs, or your Regional Retirement Counseling Center, or they can be downloaded from the SERS Web site: www.sers.state.pa.us, through the "Forms" link. Beneficiary Designation After Divorce If you nominate your spouse as your Beneficiary and later divorce, you should file a new Beneficiary Nomination form. Whether your pre-divorce designation of your spouse as a Beneficiary would be effective under the Pennsylvania Probate, Estates, and Fiduciaries Code, in the absence of such filing, will depend on the date of your designation and your state of residency at the time of death. Federal. pension statutes and requirements contained in the Employee Retirement Income Security Act (ERISA) do not apply to SERS as a governmental plan. Multiple Service Electing Multiple Service combines your SERS and PSERS (Public School Employees' Retirement System) credits toward one retirement benefit. Your decision to elect Multiple Service is voluntary. You must be an active contributing member of SEP.S or PSERS to elect Multiple Service. If you want to elect Multiple Service credit, you must make your Multiple Service election within 365 days after your effective date of membership in SERS nr P4FT?C 2006 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY BASIC DATA Personal Data 1 Social Security Number: 205-38-5773 Sex: FEMALE Birth Date: Auq 25, 1953 Coverage Type: FULL j Contribution Rate: 6.25% Counseling Center HARRISBURG Normal Retirement Date. Auq 28, 2007 Fi l A S l 103 70 $71 verage ary: na a , . 2006 Retirement Covered Earnins _ $73,327.50 Total SSI Non-Covered Earnings: Joint Coverage Conversion Amount: Mandatory Debt: Service Purchase Debt: Account Balance D_ec 31, 2005 Balance -Contributions _ _ _ Lump Sum Paym( Arrears Payments Credited Interest Regular SSI Contributions Contributions -$103,480_52_ _? - - - __$4,582.89 - ----- - $4,230.57 YTD Adiustments*** i Dec 31, 2006 Balance $112,293.98 112,293.9$ Total Deductions $ - -- _ -- - _. -- - - Arrears Balance as of Dec 31, 2006 --- -- --- - - - Re ular SSI Taxable Breakdown of Your. Taxable Contributions ;ount**** $63,856.97 $5,195.78 Credited Interest (Taxable) $43,241.23 Dec 31, 2006 Balance $112,293.98 ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification Pre 87 Non-Taxable Contributions Post 86 Non-Taxable Contributions ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS -- -- -------- *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. * *Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 2006, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Beneftciary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your beneficiary(ies) listed on future Statements. The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: 2006 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 28, 2007 Options with NO Withdrawal of Member's Money MAXIMUM SINGLE LIFE ANNUITY This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or j more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). Options Adjusted for a TOTAL withdrawal of ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneticiary(ies). As of 12/31/2006 As of 08/28/2007 $4,898.70 $5,283.00 $4,678.85 $970,055.52 $5,086.71 $970,055.52 As of 12/31/2006 $112,293.98 $4,331.63 $5,033.85 $1,034,011.62 As of 08/28/2007 $118,288.58 $4,678.64 $4,137.23 $4,457.99 ADJUSTED OPTION 1 PRESENT VALUE $857,761.54 $915,723.04 2005 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY BASIC DATA Personal Data Account Balance Social Security Number 205-38-5773 1 If ! Regular SSI . - _ _ __ _ Sex: FEMALE Birth Date: Auq 25, 1953 Coverage Type: FULL Dec 31, 2004 Balance Contributions $95,121.58_ Contributions Contribution Rate. ---- - 6.25 % ' I Contributions - L P t ! S $4,465.70.1 .. Counseling Center: HARRISBURG ! ump um aymen s ; -- Normal Retirement Date Auq 28, 2007 Arrears Payments _ - 1 _ _-. - Final lary: Average a - $68 8 Credited s I -- $3,893.24 - 2005 Retirement ment Covered Earnings: - 45 .60 $71,1 1 YTD Adju tments Total SSI Non-Covered Earnings I Dec 31, 2005 Balance 1 - $103,480 52 --- -- Joint Coverage Conversion Amount. Total Deductions $103,480.52 Mandatory Debt Service Purchase Debt: F Arrears Balance as of Dec 31, 2005 a Regular SSI Service Credit as of Dec 31 2005 Class Years of Service Class Years of Service I i " Taxable Breakdown of Your Account?xx ! _ r AA-60 33.3389 Taxable Contributions $59,274- _.'08 -- Pre 87 Non-Taxable Contributions $5,19 5 .78 . _ Post 86 Non-Taxable Contributions Credited Interest (Taxable) $39,010.66 ?--Dec 31, 2005 Balance $1.03,480.52 Total Service 33.3389 ***YTD (Year-To-Date) Adjustments reflect corrections to - - - - -- - -- - - - your account for which you already have received notification Principal Beneficiary(ies) ** LOUIS ZELAZNY *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 2005, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum oj' 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Beneficiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benefieiary(ies) listed on future Statements. ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: L 2005 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS j Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 28, 2007 Options with NO Withdrawal of Member's Money As of 12/31/2005 As of 08/28/2007 MAXIMUM SINGLE LIFE ANNUITY This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay. may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). I. Options Adjusted for a TOTAL withdrawal of ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. $4,349.71 $4,169.02 i $876,352.07 i $4,779.16 $876,352.07 $5,199.45 $4,954.24 $1,017,657.73 As of 12/31/2005 As of 08/28/2007 $103,480.52 $3,836.09 $118,087.46 $4,596.11 ADJUSTED OPTION 1 RETIREMENT $3,676.74 $4,379.36 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). j ADJUSTED OPTION 1 PRESENT VALUE $772,871.55 $899,570.27 f, 1 2004 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 2004, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by f fling a new Nomination of Beneficiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your beneficiary(ies) listed on future Statements. BASIC DATA Personal Data ccount Balance Social Security Number 205-38-5773 j Regular - I Contributions Dec 31, 2003 Balance - $87,320.21 f Contributions $4,226.50 Lump Sum Payments Arrears Payments -- ssI - - - Contributions Final Average Salary: $66,498.13 i Credited Interest $3,574 87 -- - -- 2004 Retirement Covered Earnings: $67,624.83 1 t- De D Ad?004 Balance $95,121.58 c 31, Total SSINor-Covered Earnings: ------------- Joint Coverage Conversion Amount. - -Mandatory Debt - -- - -- -- - --I - - ---- -- - Service Purchase Debt: I Arrears Balance as of Dec 31, 2004 - Sex: FEMALE Both Date. Auq25, 1953 Coverage Type: FULL Contribution Rate: 6.25% Counseling Center HARRISBURG Normal Retirement Date. Auq 28, 2007 Class ! Years of Service Regular -- SSI 31, 2004 ------ --- -- --- Class I Years of Service Principal Beneficiary(ies) ** - LOUIS ZELAZNY Taxable Breakdown of Your Account**** Taxable Contributions _$54,8_08_.38 Pre 87 Non-Taxable Contributions $5,195.78 Post 86 Non-Taxable Contributions Credited Interest (Taxable) $35,117.42 Dec 31, 2004 Balance $95,121.58 ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: 2004 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. As of 12/31/2004 As of 08/28/2007 MAXIMUM SINGLE LIFE ANNUITY i $3,855.89 $4,978.55 Normal Retirement Date: Aug 28, 2007 Options with NO Withdrawal of Member's Money OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). Options Adjusted for a TOTAL withdrawal of ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE $3,708.03 $789,928.82 $4,480.16 $789,928.82 - --- -------- - As of 12/31/2004 $95,121.58 $3,391.57 $3,261.51 $694,807.24 $4,743.76 $974,422.93 i i As of 08/28/2007 $117,417.69 $4,378.64 $4,172.14 $857,005.24 r 2003 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY Personal Data BASIC DATA Social Security Number: 205-38-5773 Sex. FEMALE Birth Date: Auq 25, 1953 - - - - _.-------_ Coverage Type: FULL Contribution Rate: 6.25% Counseling Center. HARRISBURG Normal Retirement Date: Auq 28, 2007 Final Average Salary: 2003 Retirement Covered Earnings: Total SSI Non-Covered Earnings. Joint Coverage Conversion Amount: Mandatory Debt: Service Purchase Debt _ Seryice_Cre0.t a Class Years of Service AA-60 31.3389 $66,724.36 Total Service 31.3389 - Principal Beneficiary(ies) **- - _ - LOUIS ZELAZNY j --- - - --- ---- - --- ----- -1 Dec 31 2002 Balance Contributions Lump Sum Payments Arrears Payments Credited Interest--- YTD Adjustments*** Dec 31, 2003 Balance Total Deductions $87,320.21 Arrears Balance as of Dec 31, 2003 I_ Regular I SSI Taxable___ Breakdown of Your Account**** Taxable Contributions $50,581.88 Pre 87 Non-Taxable Contributions $5,195.78 - --------------------- - ------------------ - Post 86 Non-Taxable Contributions Credited Interest (Taxable) $31,542.55 Dec 31, 2003 Balance $87,320.21 ***YTD.(Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: *1 f you are eligible to purchase creditable state andlor non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Benefieiary(ies) form before 1993 or since December 31, 2003, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by f fling a new Nomination of Benefneiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benef iciary(ies) listed on future Statements. $65,318.00 2003 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 28, 2007 Options with NO Withdrawal of Member's Money MAXIMUM SINGLE LIFE ANNUITY This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT I You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. j i DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option I the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). I Options Adjusted for a TOTAL withdrawal of j ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION I RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE As of 12/31/2003 As of 08/28/2007 $3,472.81 $4,881.19 $3,350.21 $4,651.01 $722,994.21 $955,368.22 $4,264.57 $722,994.21 As of 12/31/2003 As of 08/28/2007 $87,320.21 $3,053.38 $2,945.59 i $635,674.00 $117,198.41 $4,282.40 $4,080.45 $838,169.81 r 2002 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY BASIC DATA Personal Data Social Security Number: 205-38-5773 Sex: FEMALE Birth Date: Auq 25, 1953 Coverage Type: FULL Contribution Rate - - 6.25 % 1 Counseling Center HARRISBURG Normal Retirement Date: Auq 28, 2007 Final Average Salary: -- ------- $63,737.48 -- - --- - a 2002 Retirement Covered Earnings: - $64,797.50 Total SSI Non-Covered Earnings. Joint Coverage Conversion Amount: Mandatory Debt: - - Service Purchase Debt: _ Service Credit as of Dec 31,2002* Class Years of Service Class Years of Service AA-60 30.3389 i I Total Service 30.3389 Principal Beneficiary(ies) ** LOUIS ZELAZNY Account Balance j Regular I SSI Contributions Contributions Dec 31, 2001 Balance , $72,828.63 Contributions $4,049.76 11 Lump Sum Payn Arrears Payment Credited Interest Y_TD_Adjustments"* _Dec 31, 2002 Balance Total Deductions $2,992.91 - - $79,871.30 r-- ---------- -- ?I -- - 79 $79,871.30 Arrears Balance as of Dec 31, 2002 Regular SSl Taxable Breakdown of Your Account**** Taxable Contributions $46,411.69 Pre 87 Non-Taxable Contributions $5,195.78 L Post 86 Non-Taxable Contributions Credited Interest (Taxable) $28,263.83 Dec_31 2002 Balance $79,871.30 ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). *I f you are eligible to purchase creditable state andlor non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 2002, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Beneficiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benefieiary(ies) listed on future Statements. SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: 2002 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least S years of credited .service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 28, 2007 Options with NO Withdrawal of Member's Money MAXIMUM SINGLE LIFE ANNUITY This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. As of 12/31/2002 $3,105.93 $3,005.35 $656,721.26 As of 08/28/2007 $4,760.89 OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you j are not vested, your accumulated deductions will be payable to your j beneficiary(ies). j $4,028.59 $656,721.26 As of 12/31/2002 Options Adjusted for a TOTAL withdrawal of ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE $79,871.30 $2,728.18 $2,639.84 $576,849.96 $4,536.36 $931,820.33 As of 08/28/2007 $116,581.80 $4,165.24 $3,968.81 $815,238.53 2001 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY i. BASIC DATA Personal Data Account Balance Social Security Number: 205-38-5773 Regular ? I i Contributions Contributions - -- - -- Sex FEMALE Birth Date Auq 25, 1953 I Coverage Type: FULL ? Dec 31, 2000 Balance _$66,869.93 - - -- - - -- - --1 -- -- - - Contribution Rate: 6.25 % ; Contributions $31221.55 Counseling Center HARRISBURG Normal Retirement Date: Auq 27, 2007 Final Average Salary: $61 743.46 Lump Sum Payments_ _-- Arrears Payments _ -_ - _ J_ - - _ - Credited Interest $2,737.15 2001 Retirement Covered Earnings $64,432.161 - k De D Ad200 Balance - $72,828 63 Total SSI Non-Covered Earnings - Joint Coverage Conversion Amount. Total Deductions $72,828.63 Mandatory Debt_ j Service Purchase Debt: Arrears Balance as of Dec 31, 2001 L Regular SSI Service Credit as of Dec 31.2001* Class Years of Service I Class Years of Service Taxable Breakdown of Your Account**** I AA-60 ! 29.3389 Taxable Contributions $42,361.93 Pre 87 Non-Taxable Contributions $5,195.78 Post 86 Non-Taxable Contributions ------ --- ---- - - -- - I ?- Credited Interest (Taxable) - _$25-2.70.92 Dec 31, 2001 Balance $72,828.63 Total tal Service _ 29.3389 ***YTD (Year-To-Date) Adjustments reflect corrections to - - your account for which you already have received notification Principal Beneficiary(ies) i LOUIS ZELAZNY *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be fled while you are an active, contributing member. ** Information filed on a Nomination of Benefieiary(ies) form before 1993 or since December 31, 2001, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Bene, ftwiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benef ciary(ies) listed on future Statements. ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: 2001 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 27, 2007 T-- - Options with NO Withdrawal of Member's Money j As of 12/31/2001 As of 08/27/2007 MAXIMUM SINGLE LIFE ANNUITY This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries.and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). $2,756.22 $4,735.35 $2,674.54 $4,512.08 $591,540.31 $926,867.80 $3,773.93 $591,540.31 i As of 12/31/2001 As of 08/27/2007 Options Adjusted for a TOTAL withdrawal of $72,828.63 $116,414.82 ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY $2,416.88 $4,140.59 This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT $2,345.26 $3,945.36 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary (i es). ADJUSTED OPTION 1 PRESENT VALUE $518,711.68 $810,452.98 2000 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY Personal Data BASIC DATA Social Security Number: 205-38-5773 Sex: FEMALE Birth Date Auq 25, 1953 Coverage Type: FULL j Contribution Rate 5.00% Counseling Center HARRISBURG i Normal Retirement Date: Auq 27, 2007 Final Average Salary $59,592.70 2000 Retirement Covered Earnings $61,888.18 18 Total SSI Non-Covered Earnings: Joint Coverage Conversion Amount: Mandatory Debt: Class Service Years of Service as oCass 31 Year 2000c* Service -------------- --------- -- Account Balance ! Regular ! SSI Contributions Contributions Dec 31, 1999 Balance ! $61,265.12 Contributions ---- ----- ----- $3,094.42 i_ Lump Sum Payments y Arrears Payments Credited Interest $2,510.39 ? YTD Adjustments*** - ? 4 Dec 31, 2000 Balance $66,869-93 ; Total Deductions $66,869.93 Arrears Balance as of Dec 31, 2000 Regular SSI Taxable Breakdown of Your Account"" Taxable Contributions $39,140.38 Pre 87 Non-Taxable Contributions $5,195.78 Post 86 Non-Taxable Contributions Credited Interest (Taxable) $22,533.77 Dec 31, 2000 Balance $66,869.93 ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification Principal Beneficiary(ies) ** LOUIS ZELAZNY i i *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. * *Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 37, 2000, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by faling a new Nomination of Beneficiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benefieiary(ies) listed on future Statements. ****SERS is a defined benefit plan under Internal Revenue Service Code Section 407 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: ?r 2000 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least S years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERSJ), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 27, 2007 Options with NO Withdrawal of Member's Money As of 12/31/2000 As of 08/27/2007 I MAXIMUM SINGLE LIFE ANNUITY $1,948.42 $3,635.30 This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT j $1,895.64 $3,463.91 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE I $424,209.07 $711,552.44 j DISABILITY RETIREMENT $2,814.65 You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE $424,209.07 If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present j Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). As of 12/31/2000 As of 08/27/2007 Options Adjusted for a TOTAL withdrawal of $66,869.93 $110,349.84 _ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY $1,641.28 $3,071.53 This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT $1,596.82 $2,926.71 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE $357,339.14 $601,202.60 1999 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY BASIC DATA Personal Data ? Account Balance ' Social Security Number. 205-38-5773 Regular SSI Sex: FEMALE Birth Date. Aug 25, 1953 Contributions Contributions Coverage Type: FULL Dec 31, 1998 Balance ! $56,021.77 Contribution Rate: 500 o Contributions $2,945.60 Counseling Center: HARRISBURG Lump Sum Payments _ Normal Retirement Date Auq 27 2007 ; 1 Arrears Payments , Final Average Salary: $57,902.10 - 1 Credited Interest $2,297 75 - 1999 y l Retirement Covered Earnings: $58,910.05 Tot -i 'YTD Adjustments*** - - - ---- - - Dec 31 1999 Balanc 6 a Earnings: i 1_265 12 I e-L_ - - --_ $ Joint Coverage Conversion Amount: ! j Total Deductions $61,265.12 mandatory Debt: - _ Arrears Balance as of Dec 31, 1999 * Service Credit as of Dec 31,1999 Regular SSI _ - - - - - -- --- - _ Class Years of Service Class Years of Service - _ -- - ? __ __ _ _ __ _ .; - Taxable Breakdown of Your Account**** -A-60 27.3389 '. __-- - ' --. ? _ -- ----I - Taxable Contributions $36045.96 - -- l --_- -_- ___. - - -- - -- - . ---- _ Credited Interest (Taxable) ,023.38 --- ---- -- --- - --- $20 _ L Dec 31, 1999 Balance $61 265 12 - - - _ - Total Service 27-3389 , _ ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification Principal Beneficiary(ies) ** I LOUIS ZELAZNY ****SERS is a defined benefit plan under Internal Revenue - - - - -- - Service Code Section 407 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit " j estimates or reasons estimates were not calculated: *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselorfor Injormation on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneftciary(ies) form before 1993 or since December 31, 1999, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary injormation current. You may change your beneficiary nomination at any time by filing a new Nomination of Beneficiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your beneficiary(ies) listed on future Statements. 1999 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 27, 2007 Options with NO Withdrawal of Member's Money ? As of 12/31/1999 As of 08/27/2007 MAXIMUM SINGLE LIFE ANNUITY $1,732.14 $3,472.44 This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. i OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service i requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). Options Adjusted for a TOTAL withdrawal of ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneticiary(ies). $1,689.24 $382,335.60 $2,638.30 $382,335.60 As of 12/31/1999 $61,265.12 $1,454.58 $1,418.56 $3,308.73 $679,674.60 As of 08/27/2007 $109,022.32 $2,915.45 $2,777.99 ADJUSTED OPTION 1 PRESENT VALUE $321,070.48 $570,652.28 1998 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY BASIC DATA Personal Data Social Security Number: 205-38-5773 Sex: FEMALE Birth Date: Auq 25, 1953 Coverage Type: FULL Contribution Rate 5.00 % Counseling Center HARRISBURG Normal Retirement Date Auq 27, 2007 Final Average Salary: $56,533.92 j 1998 Retirement Covered Earnings $57,9.79.8_7 Total SSI Non-Covered Earnings: Joint Coverage Conversion Amount: j Mandatory Debt: Service ervice o Cass 31 Years Class Years of of Service' Principal Beneficiary(ies) LOUIS ZELAZNY Account Balance i Regular SSI Contributions Contributions Dec 31 1997 Balance $51,025.05 L Contributions $2,899.08 Lump Sum Payments Arrears Payments Credited Interest $2,097.64 YTD Adjustments*** Dec 31, 1998 Balance $56,021.77 Total Deductions $56,021.77 Arrears Balance as of Dec 31, 1998 j i Regular SSl Taxable Breakdown of Your Account"" Taxable Contributions $33,100.36 I I I Credited Interest (Taxable) $17,725.63 Dec 31, 1998 Balance $56,021.77 ***YTD.(Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 1998, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Benefwiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your benefteiary(ies) listed on future Statements. The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: 1998 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 27, 2007 Options with NO Withdrawal of Member's Money MAXIMUM SINGLE LIFE ANNUITY This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries, at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). As of 12/31/1998 As of 08/27/2007 $1,546.23 $1,511.25 $345,818.23 $2,481.74 $345,818.23 As of 12/31/1998 Options Adjusted for a TOTAL withdrawal of i $56,021.77 ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY $1,295.74 This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT $1,266.43 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE $289,796.46 $3,409.67 $3,248.91 $667,387.42 As of 08/27/2007 $108,544.97 $2,855.12 $2,720.50 $558,842.45 1997 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY G BASIC DATA Personal Data Account Balance Social Security Number: 205-38-5773 Regular SSI Sex FEMALE Birth Date Auq 25 1953 - Contributions Contributions Coverage Type: , ___ ___ FULL Dec 31, 1996 Balance 1 ---- --- --$46,297.,45 ? - - J Contribution Rate - -- 00% Contributions 5 7 $2,817 84 Counseling Center. . HARRISBURG I Lump Sum Payments Normal Retirement Date. Auq 27, 2007 1 Arrears Payments Final Average Salary: Credited Interest $54,735 .67 - -- - -- $1,909.76 __ __ -. _ .. 1997 Retirement Covered Earnings: - - - --- -, YTD Adjustments*** 56,357.40 i $ -- - l 11 d r Dee J $51,025.05 - - Joint Coverage Conver sio A mount: - - - Dedu tions $51,025.05 Mandatory Debt: - ! ' Arrears Balance as of Dec 31,1997 Regular SSI Principal Beneficiary(ies) I ' I *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 1997, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by Paling a new Nomination of Benefieiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your beneficiary(ies) listed on future Statements. - - ----- - -------- Taxable Breakdown of Your Account**** Taxable Contributions $30,201.28 Credited Interest (Taxable) $15,627.99 Dec 31, 1997 Balance $51,025.05 ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: 1997 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS)), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 27, 2007 Options with NO Withdrawal of Member's Money j i As of 12/31/1997 As of 08/27/2007 MAXIMUM SINGLE LIFE ANNUITY $1,367.50 $3,294.86 This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT $1,339.23 $3,139.52 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. i OPTION 1 PRESENT VALUE $309,717.47 $644,916.38 I DISABILITY RETIREMENT $2,311.58 You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at 1-east five years of credited service (except State Police and Enforcement i Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE $309,717.47 If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). As of 12/31/1997 As of 08/27/2007 Options Adjusted for a TOTAL withdrawal of $51,025.05 $107,593.92 ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY $1,142.21 $2,745.17 This option provides the maximum monthly benefit to you for life. When you j take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT $1,118.60 $2,615.74 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the j Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE $258,692.42 $537,322.46 r. 1996 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY Personal Data BASIC DATA Social Security Number: 205-38-5773 Sex: FEMALE Birth Date: Auq 25, 1953 j Coverage Type FULL Contribution Rate: 5.00% Counseling Center: HARRISBURG Normal Retirement Date: Auq 27, 2007 Final Average Salary: $53,014.94 1996 Retirement Covered Earnings. $55,264_50 Total SSI Non-Covered Earnings: Joint Coverage Conversion Amount. Mandatory Debt: Principal Beneficiary(ies) *'s *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be filed while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 7993 or since December 31, 1996, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Bene flwiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your beneftciary(ies) listed on future Statements. Account Balance Regular SSI Contributions ' Contributions Dec 31, 1995 Balance $41806.30 I Contributions $2,76V5 - - -- Lum Sum Pa ments j Arrears Payments Credited Interest $1,727.80 ' YTD Adjustments*** i Dec 31, 1996 Balance 1 46,25.45,.,1 Total Deductions -- -- ---- --- ----- - $46,297.45 Arrears Balance a9lDec 31, 1996 I Regular SI -- ----- --- ---- Taxable BreakdownYour Account Taxable Contributions $27,383 44 i Credited Interest (Taxable) - $13,718.23 Dec 31, 1996 Balance -- $46 297.45 ***YTD (Year-To-Date) lnents reflect corrections to your account for which y, ady have received not cation ****SERS is a defined plan under Internal Revenue Service Code Section 4 S15 CONDITIONS The following Speciestons were apply not calculated.- estimates or reason 0 ??t O ./` 1996 STATEMENT of ACCOUNT - ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least S years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Aug 27, 2007 Options with NO Withdrawal of Member's Money As of 12/31/1996 As of 08/27/2007 MAXIMUM SINGLE LIFE ANNUITY $1,208,68 This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. j OPTION 1 RETIREMENT $1,185.81 This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of j your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE DISABILITY RETIREMENT You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option I the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). Options Adjusted for a TOTAL withdrawal of ADJUSTED -MAXIMUM SINGLE LIFE ANNUTTY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE :I $277,057.00 $2,150.54 $277,057.00 As of 12/31/1996 As of 08/27/2007 $46,297.45 $1,006.70 $987.65 $230,759.55 1995 STATEMENT of ACCOUNT For: DARLENE E ZELAZNY BASIC DATA Personal Data _ Acc_ ount Balance Social Security Number: 205-38-5773 Regular SSI Sex: FEMALE Birth Date: Aup 25, 1953: Contributions Contributions Coverage Type: FULL I Dec 31, 1994 Balance -- --- $37.61918 Contribution Rate: 5.00% Contributions $2.629.29 Counseling Center: HARRISBURG ;--Lump Sum Payments Normal Retirement Date: Jul 31, 2007 Arrears Payments Final Average Salary: $50,332.97 !_Credited Interest 1 $1,557.83 - -- -- 1995 Retirement Covered Earnings: 1 $52,585.12 YTD Adjustments i-- -- - - - Total SSI Non-Covered Earnings - Balance LDec 3 1, _ 1995 __-._.___ L _- $41,806 30 j - Joint _ Coverage Conversion Amount. ? Total Deductions I $41,806.30 J Mandatory Debt: i -- ---- -- - ----- - - -- i t Arrears Bala nce as of Dec 31, 1995 Regular SSI Taxable Breakdown of Your Account"" - Taxable Contributions $24,620.09 Credited Interest (Taxable) $11,990.43 Dec 31, 1995 Balance $41 806.30 ***YTD (Year-To-Date) Adjustments reflect corrections to your account for which you already have received notification Principal Beneficiary(ies) ****SERS is a defined benefit plan under Internal Revenue Service Code Section 401 (a). SPECIAL CONDITIONS *If you are eligible to purchase creditable state and/or non- state service, contact your Retirement Counselor for information on purchasing service. All requests to purchase service must be f led while you are an active, contributing member. ** Information filed on a Nomination of Beneficiary(ies) form before 1993 or since December 31, 1995, or involving special circumstances (such as the designation of an estate or trust as your beneficiary) may not appear. A maximum of 10 beneficiaries may be shown here; however, you may have more beneficiaries on your retirement record. Keep your beneficiary information current. You may change your beneficiary nomination at any time by filing a new Nomination of Benefieiary(ies) form with SERS. Forms are available from your agency Personnel Office or your regional SERS Retirement Counseling Center. Please contact us if you do not want your beneficiary(ies) listed on future Statements. The following Special conditions apply to your benefit estimates or reasons estimates were not calculated: O Y' 1995 STATEMENT of ACCOUNT ESTIMATED RETIREMENT BENEFITS Estimated Retirement Benefits are provided if you have at least 5 years of credited service or you have reached your Normal Retirement Date and have at least three years of credited service. Note: If you have credited service as a Multiple Service member (service in both SERS and the Public School Employees' Retirement System [PSERS]), your estimate does not include your PSERS contributions. Your service may be overstated if in any calendar year you have Concurrent Service. If you have projected benefits, any limits mandated by the Internal Revenue Service or the State Employees' Retirement Code, have not been applied. Normal Retirement Date: Jul 31, 2007 Options with NO Withdrawal of Member's Money I As of 12/31/1995 As of 07/31/2007 MAXIMUM SINGLE LIFE ANNUITY $1,045.94 This plan provides the maximum amount each month for life. If you die before receiving in payments an amount equal to your total accumulated deductions, the balance will be paid to your beneficiary(ies). You may name one or more beneficiaries at any time. OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). You may name one or more beneficiaries and may change beneficiaries at any time. OPTION 1 PRESENT VALUE You must be certified by SERS Medical Examiners as physically or mentally incapable of performing current job duties and have at least five years of credited service (except State Police and Enforcement Officer-category employees, who have no minimum service j requirement). Only active, contributing members or those on leave without pay may apply for Disability Retirement. You cannot withdraw your accumulated deductions if you take Disability Retirement. DISABILITY RETIREMENT DEATH IN STATE SERVICE If you are vested and die while an active employee, it will be assumed you retired under Option 1 the day before your death. The Present Value of your annuity will be payable to your beneficiary(ies). If you are not vested, your accumulated deductions will be payable to your beneficiary(ies). Options Adjusted for a TOTAL withdrawal of ADJUSTED - MAXIMUM SINGLE LIFE ANNUITY This option provides the maximum monthly benefit to you for life. When you take a total withdrawal, there is no death benefit payable. ADJUSTED OPTION 1 RETIREMENT This option provides reduced monthly benefits to you for life. A Present Value is placed on your account. All payments you receive are subtracted from the Present Value. Any balance remaining at the time of your death will be paid to your beneficiary(ies). ADJUSTED OPTION 1 PRESENT VALUE $1,027.83 $242,532.51 $1,957.86 $242,532.51 As of 12/31/1995 $41,806.30 $865.65 $850.66 $200,726.21 As of 07/31/2007 .... ,' i -i ?. . ?., ? : . _.! _'} E 7 vV- , i. ? , DARLENE ZELAZNY, Plaintiff ) VS. ) LOUIS ZELAZNY, ) Defendant ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN DIVORCE DEFENDANT'S PETITION FOR ECONOMIC RELIEF AND NOW comes the above-named Defendant, by his attorney, Samuel L. Andes, and makes the following Petition for Economic Relief: COUNT I EQUITABLE 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. WHEREFORE, 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 ALIMONY 2. Defendant lacks sufficient property to provide for his reasonable needs in accordance with the standard of living of the parties established during the marriage. 3. Defendant is unable to support himself in accordance with the standard of living of the parties established during the marriage through appropriate employment. 4. The Plaintiff is employed and enjoys a substantial income from which she is able to contribute to the support and maintenance of Defendant and to pay him alimony in accordance with the Divorce Code of Pennsylvania. WHEREFORE, Defendant prays this Honorable Court to enter an 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 he has become accustomed during the marriage. COUNT III ALIMONY PENDENTE LITE 5. Defendant is without sufficient income to support and maintain himself during the pendency of this action. 6. Plaintiff enjoys a substantial income and is well able to contribute to the support and maintenance of Defendant during the course of this action. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay him reasonable alimony pendente lite during the pendency of this action. COUNT IV - COUNSEL FEES AND EXPENSES 7. Defendant is without sufficient funds to retain counsel to represent him in this matter. 8. Without competent counsel, Defendant cannot adequately prosecute his claims against Plaintiff and cannot adequately litigate his rights in this matter. 9. Plaintiff enjoys a substantial income and is well able to bear the expense of Defendant's attorney and the expenses of this litigation. WHEREFORE, Defendant prays this Honorable Court to order Plaintiff to pay the legal fees and expenses incurred by Defendant in the litigation of this action. S 1 L. Andes Attorney for Defendant P.O. Box 168 Lemoyne, PA 17043 (717) 761-5361 I verify that the statements made in this document are true and correct. I understand that any false statements in this document are subject to the penalties of 18 Pa. C.S. 4904 (unsworn falsification to authorities). DATE: 44(0 CQD ?I /? l? LO ELAZNY -?r}rr.-? ? i z, E T HE OF HE 2099 AUG 25 AM 11: 16 .j5a. oo Pts A-rrY Gk 7' 4 ?*g710 DARLENE ZELAZNY, Plaintiff VS. LOUIS ZELAZNY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN DIVORCE NOTICE TO PLAINTIFF If you wish to deny any of the statements set forth in this affidavit, you must file a counteraffidavit within twenty (20) days after this affidavit has been served on you or the statements will be admitted. DEFENDANT'S AFFIDAVIT UNDER SECTION 3301(d) OF THE DIVORCE CODE 1. The parties to this action separated in mid-April, 2007, and have continued to live separately and apart for a period of at least two years. 2. The marriage is irretrievably broken. 3. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. I verify that the 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. 4904 relating to unsworn falsification to authorities. Date: l Cl ??11 ev LOUIS Z LAZNY DARLENE ZELAZNY, Plaintiff VS. LOUIS ZELAZNY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN DIVORCE PLAINTIFF'S COUNTER-AFFIDAVIT UNDER SECTION 3301(D) OF THE DIVORCE CODE 1. Check either (a) or (b): (a) I do not oppose the entry of a Divorce Decree. (b) I oppose the entry of a Divorce Decree because (check (i), (ii) or both): (i) The parties to this action have not lived separate and apart for a period of at least 2 years. (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): (a) I do not wish to make any claims for economic relief. 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. (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I verify that the statements made in this Counter-Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date: DARLENE ZELAZNY NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU NEED NOT FILE THIS COUNTER-AFFIDAVIT. OF THE PROl" rr.,':OTAPV 2009 AUG 25 Aid II' 1, 5 DARLENE ZELAZNY, Plaintiff VS. LOUIS ZELAZNY, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN DIVORCE PLAINTIFF'S COUNTER-AFFIDAVIT UNDER SECTION 3301(D) OF THE DIVORCE CODE 1. Check either (a) or (b): (a) I do not oppose the entry of a Divorce Decree. (b) I oppose the entry of a Divorce Decree because (check (i), (ii) or both): (i) The parties to this action have not lived separate and apart for a period of at least 2 years. (ii) The marriage is not irretrievably broken. 2. Check either (a) or (b): (a) I do not wish to make any claims for economic relief. 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. A (b) I wish to claim economic relief which may include alimony, division of property, lawyer's fees or expenses or other important rights. I verify that the statements made in this Counter-Affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unworn falsification to authorities. Date: 9-1-09, DARLENE ZELAZN V NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECREE AND YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU NEED NOT Ftt THIS COUNTER-AFFIDAVIT. FILEID-G-H-l OF THE RRC THr': 'NI TAPY 2009 SEP I I PM 2: 16 Clffe?i Li' _''. 1iNly ry DARLENE ZELAZNY, ) Plaintiff ) vs. ) LOUIS ZELAZNY, ) Defendant ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-0217 CIVIL TERM IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Defendant moves the Court to appoint a Master with respect to the following claims: Divorce Distribution of Property (Zl) Alimony Alimony Pendente Lite Support (_) Annulment (?) Counsel Fees (_C) Costs and Expenses and in support of such motion states: 1. Discovery is complete as to the claims for which the appointment of a Master is requested. 2. The Plaintiff has appeared in the action by her attorney, Joseph D. Caraciolo, Esquire. 3. The statutory ground for divorce is: 3 3o 1 4. Check the applicable paragraph(s): The action is not contested. An agreement has been reached with respect to the following claims: (_Xj The action is contested with respect to the above-marked claims. 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take hours I day. 7. Additional information, if any, relevant to this motion: Date: (Q Ncj'b.??/ zv'- uel . An es Attorney for Defendant AND NOW , 2009, E. Robert Elicker, II, is appointed Master with respect to the above claims. BY THE COURT, J. T` 1L.C.?t'?t..i 2009 NOV 16 AH 9: 3 i NOV 17 20 61 12-,., DARLENE ZELAZNY, ) Plaintiff ) VS. ) LOUIS ZELAZNY, ) Defendant ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-0217 CIVIL TERM IN DIVORCE MOTION FOR APPOINTMENT OF MASTER Defendant moves the Court to appoint a Master with respect to the following claims: Divorce () Distribution of Property (_) Support Annulment Alimony Alimony Pendente Lite (?) Counsel Fees (?) Costs and Expenses and in support of such motion states: 1. Discovery is complete as to the claims for which the appointment of a Master is requested. 2. The Plaintiff has appeared in the action by her attorney, Joseph D. Caraciolo, Esquire. 3. The statutory ground for divorce is: 33oi 4. Check the applicable paragraph(s): (_) The action is not contested. An agreement has been reached with respect to the following claims: The action is contested with respect to the above-marked claims. 5. The action does not involve complex issues of law or fact. 6. The hearing is expected to take hours day. 7. Additional information, if any, relevant to this motion: Date: C 6 N (A 2-2 ` mfiuel-L. A 6es Attorney for Defendant AND NOW 0 , 2009, E. Robert Elicker, II, is appointed Master with respect to the above claims. BY THE C URT, G J. OF THE PMTWXYM 2189 MOV 18 aM 1P 14 CUMB,L-.Hla,'ql4b COUNTY PE} W `?7141irt'tl KJV'1 i, 4 flC jr .; ASHY THE 2599 NOV 10 31 r r D L, (1p1ts nki &-i-y d de?ab b t , F p r? R11- 7 Pr`s ,? ?? ? . ?'? SY LV <, r.: " DARLENE ZELAZNY, Plaintiff ) vs. ) LOUIS ZELAZNY, ) Defendant ) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 07-0217 CIVIL TERM IN DIVORCE ORDER OF COURT AND NOW, this day of , 2011, upon consideration of the attached Petition for Spe al Relief, we enter the following order: 1. Plaintiff Darlene Zelazny is hereby enjoined and prohibited from selecting any retirement option for her retirement benefits within the Pennsylvania State Employees Retirement System, or designating any party or person other than the Defendant Louis Zelanzy to receive death benefits or any survivor benefits from her account within that System, pending further order of this court. 2. A hearing is hereby scheduled before the undersigned, to be held in Court Room No. of the Cumberland County Courthouse in Carlisle, Penns lvania, commencing at 1. 3C1 o'clock ?.m. o " the l l day of 2011. 3.' Defendant's counsels all serve a copy of this order upon a legal office of the Pennsylvania State Employees Retirement System at 30 North Third Street, Harrisburg, Pennsylvania, promptly upon entry of the order. BY THE COURT, K-, OOpiPS ' , l/ J. /,/I/ Distribution: 1 lD DO Joseph D. Caraciolo, Esquire (Attorney for Plaintiff) 112 Market Street, 6' Floor, Veterans Building, Harrisburg, PA 17101-2015 Samuel L. Andes, Esquire (Attorney for Defendant) 525 North 121' Street, P.O. Box 168, Lemoyne, PA 17043 .i. is E„ L 1^y s s ; , DARLENE ZELAZNY, ) IN THE COURT OF COMMON Plaintiff ) PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ) CIVIL ACTION - LAW LOUIS ZELAZNY, ) NO. 07-0217 CIVIL TERM Defendant ) IN DIVORCE ORDER OF COURT AND NOW, this -- f=- day of G , 2011, upon the agreement of the parties as expressed to the co rt by their respective counsel, the hearing scheduled in this matter for August 11, 2011 is continued generally. The matter will be scheduled for another hearing on Defendant's Petition for Special Relief at the written request of either party. In the meantime, the provisions of Paragraph 1 of our Order of June 7, 2011 shall remain in full force and effect until further order of court. BY THE COURT, J. Distribution: Joseph D. Caraciolo, Esquire (Attorney for Plaintiff) 112 Market Street, 6U' Floor, Veterans Building, Harrisburg, PA 17101-2015 d Samuel L. Andes, Esquire (Attorney for Defendant) n/?je 011/17 525 North 12t` Street, P.O. Box 168, Lemoyne, PA 17043 `0P p K3 Joseph D. Caraciolo, Esquire FOREMAN & CARACIOLO, P.C. 112 Market Street, 6th Floor < " J'• r' Harrisburg, PA 17101 L! 112 31jL 24 PH : Attorney ID No. 90919 I i Telephone(717)236-9391 CUMBERLAND NUN - Facsimile (717) 236-6602 P E N N S Y LV, N I) 3 Attorney for Plaintiff DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 07-217 Civil Term LOUIS ZELAZNY CIVIL ACTION -LAW Defendant IN DIVORCE PETITION FOR SPECIAL RELIEF AND NOW, comes the Petitioner, Darlene Zelazny, by and through her attorney, Joseph Caraciolo, Esquire, and respectfully requests this Honorable Court grant the Petition for Special Rel and in support thereof avers as follows: 1. Petitioner is Darlene Zelazny, Plaintiff in the above captioned divorce action, presel? residing at 15 Charisma Drive, Camp Hill, Pennsylvania 17011. 2. Respondent is Louis Zelazny, Defendant in the above captioned divorce action, wh? current address is unknown. D. 3. A Divorce Complaint was filed to the above captioned term and number on January Ill, 2007. 4. A Marriage Settlement Agreement was entered into by the parties on August 30, 201 (a true and correct copy is attached hereto labeled Exhibit "A"). 5. A Divorce Decree was granted on November 10, 2011 (a true and correct cop is attached hereto labeled Exhibit "B"). 6. Ms. Zelazny has fully complied with her obligations under the Marriage Settlement Agreement. 7. In accordance with Paragraph 11 of the Marriage Settlement Agreement, Respondent to "cooperate with each other to effect as prompt a sale of the properties as can be done at a fair mi value." 8. Since the date of the Divorce Decree, Respondent has failed to cooperate with the list and selling of the property such that the property remains unlisted and unsold. 9. Plaintiff's equity is being affected by Defendant's failure to comply with the provisi of the Divorce Decree. 10. Defendant appears to want to prevent the sale of the residence and by his actions, wo against any sale. 11. A copy of this Petition has been provided to Attorney Sam Andes and it is antici that he does not concur with the relief requested herein. WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter an Order Defendant to immediately sign a deed transferring ownership of 2800 Gettysburg Road to wife for sal in accordance with the specific language of this agreement. L ate Respectfully Submitted, FOREMAN & CARACIOLO, P.C. J&ph D. CaracU6, I"sq>Y A orney ID No. 90919 2 Market Street, Sixth Floor Harrisburg, PA 17101 Telephone (717) 236-9391 Facsimile (717) 236-6602 EXHIBIT "A" I . Nr.. C.0 M 1 -1 -<r -' Q z ORDER OF COURT D ? -0 20 ? C AND NOW, this day of ft ,m 2011, counsel and the parties having entered into an agreemen. VS. NO. 07 - 217 CIVIL G o LOUIS ZELAZNY, "Tr- Defendant IN DIVORCE x DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF'', Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA and stipulation resolving the economic issues on August 30, 2011, the date set for a Master's hearing, the agreement and stipulation having been transcribed and signed by the parties, 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 and waiver! of the parties so that a final decree in divorce can be entered. BY THE COURT, - V54'. Kev' A. Hess, P.J. cc: i/ Joseph D. Caraciolo Attorney for Plaintiff v Samuel L. Andes Attorney for Defendant Ccp.es rwa.`EHai 4 A a DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 07 - 217 CIVIL LOUIS ZELAZNY, Defendant IN DIVORCE THE MASTER: Today is Tuesday, August 30, 2011. This is the date set for a Master's hearing in the above-captioned divorce proceedings. Present in the hearing room are the Plaintiff, Darlene Zelazny, and her counsel Joseph D. Caraciolo, and the Defendant, Louis Zelazny, and his counse: Samuel L. Andes. This action was commenced by the filing of a complaint in divorce on January 11, 2007, raising grounds of irretrievable breakdown of the marriage. The parties are going to sign affidavits of consent and waivers of notice o] intention to request entry of divorce decree later this morning so that the divorce can conclude under Section 3301(c) of the Domestic Relations Code. The affidavits anc waivers will be filed by the Master's office with the Prothonotary's office. The divorce complaint raised a claim for equitable distribution; the Defendant, husband, on August 25, 2009, filed a petition claiming economic relief on his own behalf for equitable distribution, alimony, alimony 1 6' pendente lite and counsel fees and expenses. The Master has been advised that the parties with the assistance of counsel in negotiations this morning and previously, have reached an agreement with respect to the economic claims. 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, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. Counsel and the parties will return later today, if we have time to have the agreement transcribed, t< review the agreement for typographical errors, make corrections as necessary, and then affix their signatures affirming the terms of settlement as stated on the record. In any event, the parties are bound by the terms of settlement as stated on the record, even though there is no subsequent signing. They are bound by the terms when they leave the hearing room today. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment and counsel can then file a praecipe transmitting the record to the Court requesting a final decree in divorce. 2 The parties were married on October 9, 1983, and separated mid-April 2007. The parties have one child of the marriage who is emancipated. Mr. Andes. MR. ANDES: As the Master noted, the parties have been at this this morning and they have actually been at this for several years, and we have reached an agreement to settle all the economic claims in the case and the terms of that agreement are as follows: 1. The residence at 15 Carisma Drive, Camp Hill, Pennsylvania, which is now owned jointly by the parties, will be transferred to wife to be her sole and separate property, subject to the mortgage against the property which wife shall be responsible to pay. Wife shall indemnify and save husband harmless from any loss, cost, or expense causec to him by her failure to pay the mortgage or any other expenses arising out of her use, ownership or occupancy of the property. 2. The parties shall transfer to husband the apartment building at 4225 Roth Lane, Mechanicsburg, Pennsylvania, and the six-unit rental property at Old Cabinhollow Road, Dillsburg, Pennsylvania, to be the sole and separate property of husband hereafter. Husband will be responsible to pay in accordance with its terms, the mortgage against the Roth Lane property and will indemnify wife for any loss, cost, or expense caused to her by his failure to pay that debt or any of the other expenses arising out of his use, ownership, or occupancy of the property. 3. The condominium at 205 125th, Ocean City, Maryland, will be transferred to husband to be his sole and separate property hereafter. There is no mortgage against that property. 4. The parties have an agreement of sale for property located at 403 David Drive in Camp Hill in which they have agreed to sell that property to David and Erin Trout. There is approximately $60,148.00 due now on that agreement of sale. Wife shall transfer to husband all her right, title, and interest in the property and shall assign to him all her 3 right, title, and interest in the agreement of sale which i dated the 1st of May 1996. Husband shall be responsible to perform the obligations of the parties under that agreement of sale and shall indemnify and save wife harmless from any loss, cost, or expense caused to her by his failure to do so. 5. Wife is employed by the Commonwealth of Pennsylvania and as a result has accrued certain benefits within the Pennsylvania State Employees' Retirement System. Husband hereby waives, relinquishes, and releases any claim to or interest in those benefits and confirms them to be the sole and separate property of wife free of any further claim by him. 6. As a result of her employment by the Commonwealth of Pennsylvania, wife has a small balance in the Pennsylvania Deferred Compensation Plan. Husband hereby waives, relinquishes, and releases any claim to or interest in that account and confirms it to be the sole and separate property of wife free of any further claim by him. "7. The parties own two IRAs, wife's IRA being with America Funds and husband's IRA being with Fidelity Funds. The parties agree that each of them shall retain those assets free of any further claim by the other and each of the parties hereby waives, relinquishes, and releases any claim to or interest in the IRA held by the other party. 8. The parties owned three motor vehicles at the time of separation and they have agreed that husband shall retain the 2003 Mercedes Benz and the 2000 Chevrolet van, and wife shall retain the 1979 Mercedes Benz. Each of the parties agree to execute any documents necessary to complete the transfer of the title to these vehicles and waives any claim to or interest in the vehicles awarded to the other party by this paragraph. The parties also owned at the time of separation a Lexus automobile which was subsequently destroyed in a collision and the parties previously divided the proceeds of the insurance on that vehicle. 9. Husband owns a boat which he keeps in Maryland at or near the condominium in Ocean City. Wife hereby waives, relinquishes and releases any interest or claim to the boat and confirms it to be the sole and separate property of husband hereafter. 10. At or shortly before the time of separation wife 4 withdrew from a joint account the sum of $15,000.00. Thereafter, the parties divided their assorted and various bank accounts, including accounts at credit unions, to their mutual satisfaction. Each of the parties hereby waives and releases any claim to or interest in any of the bank accounts that the parties owned at the time of separation and agrees that the party who retained the funds from those accounts shall retain them free of any further claim by the other. 11. The parties own an investment property on Gettysburg Road in Lower Allen Township, Cumberland County, Pennsylvania, and two unimproved lots in Cape Coral, Lee County, Florida. The parties have agreed that these properties will be sold and to cooperate with each other to effect as prompt a sale of the properties as can be done at a fair market value. In the event that it is necessary to make improvements or repairs to the Gettysburg Road property to promote and facilitate its sale, wife has agreed to advance funds to do that on the condition that, immediately upon the sale of the property, and from the proceeds of the sale of the property, she will be reimbursed any funds she advanced for those purposes. Otherwise, the parties agree that the proceeds of the sale of both of those properties shall be divided and distributed as follows: a) The proceeds will first be applied to pay the cost of sale, including any reality transfer tax or its equivalent; b) Wife shall then receive the first $190,000.00 of the proceeds; C) The balance of the proceeds, if any, shall be divided equally between the parties. The parties agree to cooperate with each, their attorneys, and the realtors involved in the sale of these properties to complete the sale as promptly as possible hereafter. The parties agree that wife shall be primarily responsible to work with the realtor and negotiate the sale of the Gettysburg Road property and the Florida lots. Both parties, however, will cooperate in that effort. Within thirty (30) days husband will deliver a key to wife for the Gettysburg Road property so that she may gain access to the property. 12. Husband shall pay to wife, within thirty (30) days of 5 today's date, the sum of $30,600.00 as further equitable distribution of the marital property. i3. The parties have previously divided their personal property and tangible household furnishing with the exception of several items, and they have agreed to divide those items as follows: a) Wife shall receive one (1) box of jewelry which had previously been in the house, which is now in husband's possession and one Jade statute, which is also in husband's possession. Husband will return those items to wife within thirty (30) days of today's date. b) Husband shall receive a baby grand piano and stool and piano light, and a gym set which is at the Carisma Drive residence. Husband shall be responsible to remove those items from that residence within thirty (30) days of today's date. 14. The exchange of deeds to the properties described above, including the assignment of the Trout sales agreement, shall be made within thirty (30) days of the date of this agreement. 15. The parties agree that they shall terminate the order of support entered by the Domestic Relations Office of Cumberland County entered on the 22nd of August 2011 to No. 512 S 2011 (PACES No. 302112528). Wife shall notify the Domestic Relations Office within ten (10) days of today's date that the order and any credits or arrears under it shall be canceled. 16. All other claims which have been raised or could have been raised in the divorce action are waived. Specifically including without limitation, any further claims for equitable distribution, alimony or spousal support, alimony pendente lite, counsel fees and expenses. The parties agree to accept the terms and provisions of this agreement in full satisfaction of all economic claims arising out of their marriage and the divorce action which has been filed. 17. 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 6 take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. MR. ANDES: Mr. Zelazny, you've been here while I dictated this agreement. You've been here all morning while we negotiated it and you've been in this case for several years. Do you have any questions about what we have just agreed to do? MR. ZELAZNY: No. MR. ANDES: Are you satisfied that you understand the settlement? MR. ZELAZNY: I do. MR. ANDES: You understand that once we get up today and leave the room, this is the final settlement? We cannot change it next week; we cannot change it next month? MR. ZELAZNY: I understand. MR. ANDES: And being aware of all that, are you satisfied to settle the case on these terms? MR. ZELAZNY: I am. MR. CARACIOLO: Darlene, you were present while attorney Andes has read the settlement agreement into the record? Did you hear and understand everything that he read? 7 MS. ZELAZNY: Yes. MR. CARACIOLO: Is that the settlement agreement that you intended to reach today? MS. ZELAZNY: Yes. MR. CARACIOLO: Do you understand that once this agreement is finalized, we cannot come back and cha any portion or any term of the agreement? MS. ZELAZNY: I understand. MR. CARACIOLO: Is it your intention today enter into the agreement as read by attorney Andes? MS. ZELAZNY: Yes. THE MASTER: Thank you. 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. WITNESB: y-'seph Ca6ociolo ttorney for Plaintiff 4mu-4ellL.? tAndies--- Attorney for Defendant DATE: 8 3t3 Darlene Zelny 1PA. i Asbi 4eYz-nZy?L 0 8 EXHIBIT "B" IN THE COURT OF COMMON PLEAS 0 DARLENE ZELAZNY CUMBERLAND COUNTY, PENNSYLVANIA V. LOUIS ZELAZNY NO. 07-217 DIVORCE DECREE AND NOW, ld , -2-0 f , it is ordered and decreed that DARLENE ZELAZNY plaintiff, and LOUIS ZELAZNY , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") The Marriage Settlement Agreement dated August 30, 2011 is incorporated but not merged with this Decree. By the Court, Joseph D. Caraciolo, Esquire FOREMAN & CARACIOLO, P.C. 112 Market Street, 61h Floor Harrisburg, PA 17101 Attorney ID No. 90919 Telephone (717) 236-9391 Facsimile (717) 236-6602 DARLENE ZELAZNY, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07-217 Civil Term LOUIS ZELAZNY CIVIL ACTION - LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Joseph D. Caraciolo, Esquire, hereby certify that on the below-noted date, served a true and copy of the foregoing Petition for Special Relief upon the following named counsel by depositing the postage prepaid, in the United States Mail, addressed as follows: Sam Andes, Esquire 525 North 12"i Street P.O. Box 168 Lemoyne, PA 17043-0168 Date Respectfully Submitted, FOREMAN & CARACIOLO, P.C. eph D. Ca a*.fo, Esquire ttomey ID No. 90919 12 Market Street, Sixth Floor Harrisburg, PA 17101 Telephone (717) 236-9391 Facsimile (717) 236-6602 DARLENE ZELAZNY, Plaintiff V. LOUIS ZELAZNY Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-217 Civil Term CIVIL ACTION - LAW IN DIVORCE ORDER AND NOW, the day of JG? 2012, based upon the Petition for Special Relief filed by Plaintiff, Darlene Zelazny, a hearing is hereby scheduled for the a?, /;3o Rm. day of Ojj? , 2012 m Courtroom of the Cumberland County Courthouse, Carlisle, Pe sylvania. BY THE COURT: Distribution: it - Joseph D. Caraciolo, Esquire (Attorney for Plaintiff) 112 Market Street, 6`h Floor, Harrisburg, PA 17101 ? - Sam Andes, Esquire (Attorney for Defendant) 525 North 12`h Street, P.O. Box 168, Lemoyne, PA 17043-0168 gyp; Ps A1G _J? rrl GFi ? > N CJl ? (D t ' ?'Tt Xa c -a ~ ~~,~ ~ CA ~tL~~1-QF~~~ ~" TUB i~ft4T~C~QTAR~ 24t2 AUG 27 PM ! ~ 33 DARLENE ZELAZNY, ~~ ~~ ~ 'COURT OF COMMON PLEAS OF Plaintiff RLAND COUNTY, PENNSYLVANIA v. NO. 07-217 Civil Term LOUIS ZELAZNY :CIVIL ACTION -LAW Defendant IN DIVORCE PRAECIPE TO WITHDRAW PETITION FOR SPECIAL RELIEF To the Prothonotary: Kindly withdraw the Defendant's Petition for Special Relief filed on July 24, 2012 the above docketed case. Respectfully Submitted, Foreman & Caracipllo. P.C. ~ eph D. C'aracidl6, Esquire torney for Plaintiff ttorney ID No. 90919 112 Market Street, 6~' Floor Harrisburg, PA 17101 Telephone (717)236-9391 Facsimile (717)236-6602 Distribution: - Joseph Caraciolo, Esquire (Attorney for Plaintiffl 112 Market Street, 6th Floor, Harrisburg, PA 17101 - Sam Andes, Esquire (Attorney for Defendant) 525 North Twelfth Street, P.O. Box 168, Lemoyne, PA 17043