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9 09 4H '95
. I ,l.fl,'\JFFI~E
Of tilf, r'il'THONHAFY
CUMaEFL^~D CtlVN rr
PENNSYl.VANIA '
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3. Father shall have the child up to four (4) weeks of physical custody
annuelly end shall provide Mother with ninety (90) days written notice of tha dates
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and times of his periods of custody, The four (4) weeks shall be tekan with no more
than two (21 weeks consecutively,
4. Father shall have physical custody on Father's Day each yaar from 12:00
p.m. until 8:00 p.m. Mother shall have physical custody on Mother's Day each year
from 8:00 e,m. until 4:00 p.m.
.- .
6. The parties shall alternate the followlno maJor holidays: In odd numbarad
years, Mother shall have physical custody of the child on New Year's Day and July
Fourth; and Father shall have physical custody of the child on Memorial Day and Labor
Day. Tha schedule shall be tha opposite In even numbered years, Custodial parlods
shall be from 9:00 a,m, until 8:00 p.m.
6, The parties will alternata the birthday of the minor child, March 30. Tha
parent not having physical custody, will be afforded at least two (2) hours on the
child's birthday. The alternating schedule shall begin with thll child's birthday, March
30,1996, which shall be the Mother's holiday.
7. On the Easter holiday, the child shall remain In the custody of his mother
regardless of the waekend schedule from 6:00 p,m, the evening prior until 3:00 p.m.
on Easter Sunday, Father will heve custody from 3:00 p,m, until 8:00 p,m. Easter
Sunday,
8, On Thanksgiving, the child will be In the physical custody of his mother
from tha evening bafore Thanksgiving until 3:00 p,m" and from 3:00 p,m. until 8:00
p.m. with the fether.
9. The Chrlltmlll holiday shall be divided as follows: Father shall phYllcal
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cUltody each Christmas Eve Day from 12:00 p.m, until 4:00 p.m, and each Christmas
Day from 12:00 Noon until 8:00 p,m, Mother will have physical custody of the child
aach Christmas Eve Day from 4:00 p,m, until 12:00 Noon Christmas Day.
10. In the event a holiday for the fether begins on 8 Friday preceding Father's
weekend, his weekend custody period will begin at 8:00 a,m. Friday until 7:00 p,m,
Sundey, If Father'a hOliday falls on a Monday following his weekend custody period,
hla custodial period will extend to Monday at 7:30 p,m,
11. The holldey schedule shall take precedence over the oltematlng weekend
schedule,
12, At other times by mutual agreament of the parties,
13. Each party shall have reasonabla telephone access with the child when
the child Is not In the custody of that party,
14. Neither perty shall Interfere with the other's custodial relationship with
the child.
BY THE COURT:
-0'
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tj/C/J~ O~( ,
U J.
Friday, February 24, 1996, from 5:00 p,m, on Friday until 7:00 p,m, on Sunday
during the school yeer, and 9:00 p,m, Sunday during the summer. It will Father'.
responsibility to insure that the child attends Catholic church services on the Sund.ys
he has physical custody of the child.
2. Father shall have physical custody of tha child on Thursday evenings
following his weekend from 5:30 p.m, until 8:00 p.m,; and Tuesday evenings
following Mother's weekend from 5:30 p,m, until 8:00 p,m. The retum time shall be
9:00 p,m, during the summer,
3, Father shall have the child up to four (4) weeks of physical custody
annually and shall provldo MCither with ninety (90) days written notice of the dates
and times of his periods of custody, The four (4) weeks shall be taken with no more
than two (2) weeks consecutively,
4, Father shall have physical custody on Father's Day each year from 12:00
p,m, until 8:00 p,m, Mother shall have physical custody on Mother's Day each year
from 8:00 a,m, until 4:00 p.m,
5, The parties shall alternate the following major holidays: In odd numbered
years, Mother shall havo physical custody of the child on New Year's Day and July
Fourth; and Fathar shall have physical custody of the child on Memorial Day and Labor
Day, The schedule shall be the opposite In aven numbered years, Custodial periods
shall be from 9:00 a.m, until 8:00 p.m,
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BARRY V. PATCIIII, I III TII COURT or COIOlO. l'LBAII
Plaintiff I CUKBIRLAND COUIITY, PlIllI/SYLVANIA
I
V. I 110. qLf . 7;);) 5
I
CIIRYL LYMII PATCHIN, I
Defendant I CIVIL ACTtON - CUSTODY
AND NOW, ~~nlA':\( 'I L/'Ih , 1!t"{S , upon
consideration of the attached ComplAint, it is hereby directed that the
parties an~ cheir respective counsel appear before
~C."vJI) C:. " "",\"., , Esquire, thc conciliator, at the..A'e~rt;lI
F..l.lilo~ C"..farenQe Rnnm, ..cumber~and . County -. '~urthouse;"'--c-arl,isle,
Pennsylvania, on the \~.\~'day of "T-O\Y1'^'vy, 19.E..L, at
t\.m -Ll.......m" for a Pre-Hearing Custody Conference. At such
conference, an effort will be made to resolve the issues in dispute; or
if this cannot be accomplished, to define and narrow the issues to be
heard by the Court, and to cnter into a Temporary Order. All children
age five or older shall also be present at the conference. Failure to
appear at the conference may provide grounds for entry of a temporary or
permanent Order.
FOR THE COURT:
BY:
o~
:Y/'
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE.
IW YOU DO NOT HAVI A LAWYIR OR CANNOT AFFORD aNI,
GO TO OR TILEPHONI THE OFnCE SET FORTH BELOW TO
FIND OUT WHERE YOU CAlI GET LEGAL HELP.
OFFICE OF THE COURT ADMINISTRATOR
CUMBERLAND COUNTY COURT HOUSE
FOURTH FLOOR
CARLISLE, PA 17013
(717) 240-6200
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BUaY V. PATCRIH, I 1M THI COURT OW COMMO. PLaAS
Plaintiff I CUNBIRLDD COOll'1'Y, PI1DI8YLVUIA
I
V. I HO.
I
CIIUYL L YJIII PATCRI., I
Defendant I CIVIL ACTIO. - CU8TODY
YOU, Cheryl Lynn Patchin, Defendant, have been sued in Court
to obtain custody of the child. You are ordered to appear in person at
Cumberland County Court House, Carlisle, Pennsylvania, on the
day of ,19 , at o'clock, .M., for a
hearing. Pending the hear in9 -;-Custody is conf irmeJ in the' Plaintiff.
If you fail to appear as provided by this Order, an Order for. Custody
may be entered against you or the Court may issue a warrant for your
arrest.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE GO TO OR TELEPHONE THE OFFICE SET
FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
OFFICE OF THE COURT ADMINISTRATOR
CUMBERLAND COUNTY COURT HOUSE
FOURTH FLOOR
CARLISLE, PA 17013
(717) 240-6200
BY THI COURT I
J.
e. '!'he relationship of Defendant to the child is that of
mother. Defendant currently resides with the followinq persons:
Name Relationship
Harry Alexander Patchin Son
t. Plaintiff has not participated as a party or witness, or
in another capacity, in other litigation concerning the custody of the
child in this or another court. Plaintiff has no information of a
custody proceeding concerning the child pending in a court of this
Commonwealth. Plaintiff does not know of a person not a party to the
proceedings who has physical custody of the child or who claims to have
custody or visitation rights with respect to the child.
10. The best interest and permanent welfare of the child will
be served by granting the relief requested because:
A. Plaintiff is a fit parent.
B. The proposed relief will afford the child maximum
stabi li ty.
c. The proposed schedule of partial physical custody
will accommodate Plaintiff's work schedule and will afford the child
access to his father.
D. Both parties are loving parents able to care for the
child.
.. Placing sharlld custody with the parties will provide
- 2 -
continuity, stability and certainty to the child's lite.
11. Each parent whose parental rights to the child have not
been terminated and the person who has physical custody of the chUd
have been named as parties to this action.
12. Plaintiff has not been able to establish a mutually
satisfactory agreement for partial custody of the child with Defendant.
WHIRII'ORI, Plaintiff requests this Court to enter an Order
granting custody in this matter as follows:
A. Legal custody of the child shall be joint and shared by
the parties;
B. Primary physical custody of the child shall be with
Mother, Defendant, Cheryl Lynn Patchin;
c. Partial physical custody of the child shall be with
Father, Plaintiff, Harry V. Patchin in accordance with at least the
following schedule:
1. Father shall have physical custody of the child on
alternating weekends. During Father's designated weekends, his
visitation shall begin at 5:00 p.m., Friday and extend until 9:00 p.m.,
Sunday, or such other time as the parties may agree based on the work
schedules of the parties.
2. Father shall have up to four (4) weeks of physical
custOdy during the months of June, July, and August. Father shall
provide Mother with at least thirty (30) days notice of the dates and
- 3 -
times on which he choos.s to .xercise this period of physical custody.
3. Plaintiff shall have physical custody on Father's
Day each year. The custodial period shall run from 10100 a.m. through
9 p.m. Defendant shall have physical custody of Mother's Day each year.
The custodial period shall run trom 10:00 a.m. through 9 p.m.
.. The parties will alternate the following major
holidays: New Year's Day, Easter, Memorial Day, Independence Day, Labor
Day, Thanksgiving, and the child's birthday. The custodial period shall
run from 10:00 a.m. through 9:00 p.m.
5. The Christmas holiday shall be divided into two
segments. Segment A shall be Decel'lber 24th at 2:00 p.m. through
December 25th at 2:00 p.m. Segment B shall be December 25th at 2:00
p.m. through December 26th at 2:00 p.m. The parties shall alternate
custody in accordance with Father having Segment A in all even numbered
years and Segment B in all odd numbered years,
t. If a holiday in whioh Father is scheduled to have
custody falls on a Friday preceding Father's regular custodial weekend,
Father's custodial period shall run from Friday at 8:00 a.m. through
Sunday at 9:00 p.m. If a holiday falls on a Monday following Father's
regular cuotodial weekend, Father's custodial period shall run from
Friday at 5:00 p.m. through Monday at 9:00 p.m.
7. The holiday schedule shall take precedence over the
regular custody schedule.
- 4 -
424M-I-4'Jh')/ptmll'lUlTltlll'^l'IUW HIl.Vll'I'II.~,y 11, 'W,
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IIUJlY V. .ATCBIIf, I I~ TBI COURT or COHMOIf 'LlA8 "
nabtitt I COMBIRLAIrD COUWY, .IHIl8YLVAIIIA
I ,I
V. I ltO. 14-7U5
I
CRBaYL LY1III PATCRIN, I
Defendant I CIVIL ACTION - CUSTODY
I, JOSI.R B. D'AMICO, ISQUIRB, Attorney for Plaintiff, do
hereby certify that on the lOth day of January, 1995, I served a true
and correct copy of Plaintiff's Complaint for custody with attached
signed Order upon CHERYL LYNN PATCHIN, DErINDANT, by depositing same in
the United states First Class Mail, Certified Mail - Return Receipt
Requested, Restricted Delivery, postage prepaid, addressed as follows:
CHERYL LYNN PATCHIN
527 Devon Road
Camp Hill, PA 17011
The Custody Complaint with attached signed Order was picked up
on the 11th day of January, 1995 as evidenced by the attached signature
card.
SMIGEL, ANDERSON & SACKS
BY:
QUIRr:
17110-1223
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HARRY V. PATCHIN, 1 IN THE COURT OF ~ PLEAS
Plaintiff 1 CUMBERLAND COUNTY, PENNSYLVANIA
1
v. 1 No. 94-7225
.1 CIVIL ACTICN - CUSTODY , ,
CHERYL LYNN PATCHIN, 1
Defendant 1
COORT 0IUlIR
AND 1Of, this .:lfil12- day of February, 1995, the Conc:iliator
being advised that the part es have reached an agreement and stipulation .
resolving all custody issues, the Conciliator relinquishes jJriadic:tion
in thill. case.
(Cl~~~~
Dawn S. SU ay, Eaqu re
CUstody Conciliator
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Harry V. Patchin,
Plaintiff
In the Court of Common Plea.
Cumberland County, Pennaylvanla
v.
No.: 94-722/5
Cheryl Lynn Patchin,
Defendant
CIvil Action - Law
In Divorce
INVENTORY AND APPRAISEMENT
OEEJ.,AINIlFE
Plaintiff flies the follOwing Inventory and appraisement of all property
owned or possessed by either party at the time this action was commenced and
sll property transferred within the preceding three (3) years.
Plaintiff verifies that the statements made In this Inventory and
appraisement are true and correct. Plaintiff understands that false statements
herein are made subject to the penalties of 18 Pa.C,S. Section 4904 relating to
unsworn falsification to authorities.
~vzf1
Ha V. Patchin
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ASSmLOE..eAB.DES.
Plaintiff marks on the list below those Items applicable to the caae at bar
Ind ltemlztl the I..ets on the following pages. If an Item h._ been .pprll_ed,
I copy of tha appraisal report Is attached.
(x) 1. Real property
(x) 2. Motor vehicles
(x) 3. Stocks, bonds, securities and options
() 4. Certificates of Deposit
(x) 5. Checking accounts, cash
(x) 6. Savings accounts, money market
(x) 7. Contents of safe deposit boxes
() 8. Trusts
(x) 9. Life Insurance policies (Indicate face value, caah surrender
value and current beneficiaries)
() 10. Annuities
() 11. Gifts
() 12. Inheritances
() 13. Patents, copyrights, Inventions, royalties
() 14. Personal property outside the home
(x) 15. Businesses (list all owners, Including percentage of
ownership, and officer/director positions held by a party with
a company)
() 16. Employment termination benefits - severance pay,
workman's compensation claim/award
(x) 17. Profit sharing plans
() 18. Pension plans (Indicate employee contribution and date plln
vests)
(x) 19. Retirement plans, Individual Retirement Accounts
() 20. Disability payments
() 21. litigation claims (matured and unmatured)
() 22. MllltaryN.A. benefits
() 23. Education benefits
(x) 24. Debts due, including loans, mortgages held
(x) 25. Household furnishings and personalty (Include as a totlll
category and attach Itemized list if distribution of such
assets Is In dispute)
(x) 26. . Other
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ITEM DESCRIPTION NAME OF
NUMBER OF PROPERTY ALL OWNERI
3, Xytronyx Inc, H
100 shares
(See allached ExhlbU E - stetement)
3, Washington Mutual Investor. H
Mutual Fund - 333.649
(See allached Exhibit E - statement)
3. Fidelity Asset Manager H . UGMA
Mutual Fund - 212.065 ICCOUI'It for 8OI'l
(See allached Exhibit F - slatement)
3, Limited Term Municipal H&W
Mutual Fund - 643.027
(See allached Exhibit G . statement)
3., Oppenheimer Tax Exempt H&W
Fund -100.198
(See attached Exhibit H . slatement)
5, IBM Credit Union W
Checking Account. #11245-00
5. IBM Credit Union W
Checking Account- #11245-13
6, Dreyfus PA Municipal H
money market
(See allached Exhibit E - statement)
7. Dauphin Deposit Safe W
deposit box (conlenls unknov.n)
9, MassMutual H
Life Insurance
(See attached Exhibit I - stetement)
9, MassMutual H
Life Insurance
(See attached Exhibit J . statement)
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ITEM DESCRIPTION NAME OF
NUMBER OF PROPERTY ALL OWNERS
9. Central Life Inlurance H
9, Central Life Inlurance W
9, Life Inlurance policy provided W
by Wife'l fether (unknov.n)
15, Harry V, Patchin, D.M.D, H
Profe..lonal practice
17. Infinity Investment Advllorl H
Profit Sharing
(See allached Exhibit K. statement)
19. Infinity Investment Advllorl H
IRA
(See attached Exhibit L. statemenl)
19, Smith Barney IRA H
(See attached Exhibit M . statement)
19, IBM tax deferred savlngl W
(See allached Exhibit N . statement)
19, American Funds Group W
AMCAP Fund IRA
(See attached Exhibit 0 . statement)
25, Household Furnlshlngl H&W
26, Jewelry H&W
(Sae attached Exhibit B . statement)
26, Fur H&W
(See attached exhibit B . statement)
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~IAL..eRO.fERIY
Plaintiff lI,t. all property In which a spou.e ha. a legal or equitable
Intere.t which I. claimed to be excluded from marital property:
ITEM DESCRIPTION NAME OF
NUMBER OF PROPERTY ALL OWNER3
25, Magnavox 1V H
25, Panasonlc VCR H
25, Broyhill Bedroom H
25, Drexel Bedroom H
(sons - Alex)
MOf
Plaintiff lists all property In which either or both spouses had a legal or
equitable Intere.t Individually or with any other person and which ha. been
transferred within the preceding three years:
ITEM
NUMBEIi
DESCRIPTION
OF PROPERTY
DATE OF
TRANSFER
TO WHOM
CONSIDERATJ.QN
TRANSFERRED
N/A
.
II
DU00903310 91
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~NEW
X. RENEWAL
AMENDED
,
409 Penn Street, Huntingdon, Pennsylvania
BUSINESSOWNERS POLICY
PAGE 1
10/18/95
DIRECT DILLED
1. Named Insured and Addross Producer Nome and Address Code
.11, OECLARATIONS tOOlther wllh the Busineuowner. Policy (which consIlii 0' IIppllcabla Forml and Endorumentl, if any, IlIued'lo
form, pert or ill comple,.. thl. policy.
BARRY V PATCBIN DMD
527 DSVON RD
CAMP BILL PA 17011
CIlRISTIAN-DAKER COMPANY '2
RODERT A. PUGLIESE
P.O. IlOX 158
CMP DILl, PA 17001-0158
M1802
Fro.'!!.'..._11.IQJlL9.5__~o~__U/Q.D/9_~
DUILDING COVf~AGE - SPECIAL
12:0~. A.M. S~_~ndl!lrd Time at your MIlling Add,... above
CONTENTS COVERAGE - SPECIAL 001 001
INDIVIDUAL
Prom. No. Bldg. No.
001 001
LOCATION
407 S 32ND ST CAMPHILL PA 17011
DENTIST OFFICE' APARTMENT CUMBERLAND CO
7. COVERAGES AND LIMITS OF INSURANCE
In return for tho peymont of the premium, IInd lubJect to .11 the terms of thll policy, we egr.e with you to provide the Insurance al
lUlled In this policy.
)'1l0PERTY COVERAGES
ooductlblo $ 250
Bulldlngl:
DUlin... Perlonel ProPIf1y
BUlin... Income end Extr. Expen.. (Allo Included It bl.nk'
Aclull Cuh Value - Bulldlngl Option (YIN)
Aclual Cuh Volue - BUllno.. Porlone' Proporty Option lY/N)
~i1dlnB-Aulom.t1c Incr.I.1 (2 ercenl If Blenk'
LIABILITY AND MEDICAL PAYMENTS
&upl fCH' '1,. L..., Uablllfy, ..cll paid el.lm 10' ,tI, '''''owInl c.,.,,"... Nduu. Ihe emounl or In.ur."~e w. provldl dutt"1 Ih, .ppUubl. .nnUII JMlrfod.
Pl.... N'"r 10 r.ul....ph D.... 01 Ihl lu,lftn,OWft.,. Ulblllly eo-.."1I1 'orm.
$ ~l $
$ \ 181:00p $
$ $
N
N
Ueblllly .nd MediCI. up.n... $ 1,000,000
Medlcll E.pen.e. P.r Per.on $ 5,000
Flro Logol Liability Any One Fir. or EKplolion $ 50,000
OPTIONAl COVERAGES - Appllceblo only II on .X. II Ihown In bo....
_ Ouldoor Sign. Per Occurrence $ $
_. Exterior Building GII.. Coverlge Line.. It.
_ Burglory ond Robblry (BPP Stlndlrd Fonn) In.lde Ihe Premi.a. $ 10,000 $
or Oulllde the Pr.ml,," $ 2,000 S
X Money 80 Slcurlli.. (BPP Specio' Forml
_ Employe, Dllhon'll., No. of Empl. Per Occurrence $ $
_ Olhor (Splcllyl _
LIMITS OF INSURANCE
AL00040993
IL02460689
DP00020689
IL09100181
DP00060689
MBDP100693
01'00090689 BP12030689
MBBOI00791
9 POLley PREMIUM
COlJnter.lQ'n.d bv
----._._._.-.~-~--_._- lj
868.00 Tolol Duo $ 868.00
'RUINTATIVI ' D -r
I b. valid un I... countersigned by our alJthorlud reprll.nt.tlvl,
MB-BP-l00 IB/93) Thi. pollr.y
.'P03,
M~lI!)JAIl. ~l!~I!I1~1J' ~ ~1~ll).JlRj.\~I\C~ C@~lPA~l'if
409 PENN STREET, HUNTINOOON, PENNSYLVANIA IUS2
1 1.1013
. ..
POliCY NUMBER
HOOO'):B69b
~NEW
X RENEWAl
....1 AMENDfO
PREFERRED lU/24/95
HOMEOWNERS CONTINUOUS RENEWAL POLICY
ORIGINAL
. ' ,
HARr,y V I!. CHEI,YI.. l. r'ATCH'f.N CHRIB11AN--~'AKr:::I~ COMPANY
!"iT? DEVON Rt' Rot'Ern 1'\, PUGI.. IEtJE
CMIP HILL F',~ 170:l,:l CAMP HILL PA 11()O:!.--0:L58
'11 7-76J -47.1;~ MHl02
POlICVTERM: . ") MOl FRO~(~/9~~ TO 1.1./tO/96 1101 AM Standard T,",~ olin. rn,d"t'lu p'fmiu,~
nu, ,.,Id.nu prim."" cowf"d by Ihl\ PQ!icy., locol.d 01 11'1. obo.... oddre" unl,,, oth,,.,...i'" \Iol,d
D. lon 01 f, P'rl(lt'lol liability f. M,dicol Poym.nh To
UII S Oth.n
E Eoch Qc(vrr,nu Each P.non
-----.-.----- C --.--
'f.6/ . 400 II 1,500.000 1.:1. ,000
PREMIUM .
CO"""IlQ''''~ p'O"ldrd .....h,',r II P'''''''Ojlll or !'Illd .,1 1",Ii,I,I, ,\ 11"'..1\ t" ,hi' '''o'''''\)1:'
S
E
C
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B. QttllH C P.nonol
SlrI,lCIVr" Prop.,ty
1.:,:,1,000
t33,'/O() ~2~!~,900
BAse F'r'~n\illfn ~i 7~5
E:tl(ll)l"~~eltlft'lt P,"cfniu," $ 332
T()tal Prel"i\lm $ J"O~1
DEDUCTIBLE. SeCTION I: IN CASE OF A lOSS
UNDER SECTION I. WE COVER ONLY THAT PART
OF THE lOSS OVE. THE DEDUCTIBLE STATED
DESCRIPTION OF DWELLING
VIAl
CONSUUCTtOH
CONST_veTtON
'1.:l()O F l.iI'~ '1949 MASl.1NRY
SUBJECT TO THE fOlloWING fORMS. ENDORSEMENlS. SPEC'Al PRO ISIONS AND. ex ePTION I
Et!U:IQI:LfJ~~Ir:: lJr.:m;EUi:Ill.1~
(04/91) SPEC I (.\1. 1"or,M
(03/87) ..I,\CI<I"".'1' FORM
(0-\/93) SF'f;:CJ:~\I.. F'I~()VIS'J:ONS
(01/fll) PENNSYL.VAN:lI~ NOTICE
(O"/8~5) [IECL,:)RATIClN FORM
(()/~/91 ) HOME flr-IY CN~E EXCl..\Jf.lHINS
(()9/'1~~) I..EAD CONTt:)MINATXOH LT.AFHLJ:1'Y
(04/91) F'r,01'F:.CTIVf:: [lEVIer: CRE1HT
(()9/93) r'F.:RS PROF' REF'l.....C[':MENT COST
( j ()/8t> ) DWELl... I N<l RF.'.PL,ACI::Mf:NT COST
(J.O/B7) fJAMAGE TCI CONTENTS .. m::FRWER
(()4/9J.) EICHE"J)UI..H:rJ PF:.RBCINAI.. PROF'fr.I~TY
(04/'H) SGHl'::mJl..,r:::II F'~~RfiClNAI.. PROPEJHY
EClBl::1:~
HClOO()~~
HO-'8~i9006,J
H110J.:57
H0291.
Ml:IH0850001.
H004',>(,
t.\1..0()04
H004'J. 6
HOMB04F'~\
MBHn1.3
MBHO','jOO
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HOBIl3aOE:r;s (B i I 1..11'1)
F'{.\ ~u\n()NAL fjANI<
4~~3 l TFH NDLF. t,ro
CAMP HILL PA :l'70t1
, .;',' 'j.l '!fl..n 1i',0(l1'1' IFn ("(I"
l~is i. Your RENEWAl.. Declar-
ation P~gD, Ple~Re pl..c~ It
with YOU)" ,"xrir'in9 poLicy
cont~ining th~ current formn
,.OUCTION ZONI milt. NO. 0' flU ..OM 'lOM
(un o_ou, AMILII 1111 HyD.....NT "l'
04 33 )01 001 000
5
t..lt:lU:_QE:_L.laru.~.U:y. CBI-Zl:11UI:lL
N/C
N/C
N/C
N/C
Hie
N/C
N/C
I NCI..,lJDED
1: NC:J..UIIf::T.t
N/C
..,:, N/C
9,<>00- rvl"' ,.,..-r :I~. 00
~~:t, 960 :r,W""1 :~()7. 00
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A.... BODY
Trd./n TYPE
1988 VOLKSWAGEN.A T .PS.AC.Conllnu.d
8425 Camper Gl 25 7600 10375
775 Add W,O S,lhl, 775 775
225 O.duct M.l",,,,1 1,.iI'\ 225 225
325 O.ducl V/ ,.,! .\,, (,,"") 325 325
1987 VOLKSWAGEN
FOx.FWD
975 Sedan 20
1400 Sedan 40 Gl
1425 Waeon 20 Gl
CA8RIOLET.FWD
5275 COllverlible 20
GOLr-FWD
2175 Hback 20 Gl
2275 H'back 40 Gl
2575 H'back 20 GT
2675 H'back 40 GT
2900 Wback 20 GTI
3325 Wback GTI 16V
JETTA.FWD
2500 Sedan 20
2700 Sedan 40
2850 Sedan 40 Gl
3375 Sedan 40 GlI
3600 Sedan GlL 16V
SCIROCCO.FWD
3075 Coupe 20
3650 Coupe 20r 16V
QUANTUM.FWO
2500 Sedan 40 Gl
2100 Wagon 40
VANAGON
3225 Wagon 25 2925
4425 Waeon Gl 25 4000
5626 Camper 25 4976
7026 Camper Gl 25 6326
660 Add 4V/0 S,r..., 660
600 Deduct 0,,\,1 [11~ln, 600
~
I MILEAGE CATEGORY: Volvo. IV
1994 VOLVO'AT'PS'AC
850.FWD
22900 Sedan 40
24100 Waeon 40
26000 Sedan 40 Turbo
27200 Waeon 40 TUlbo
940
18460 Sedall 40
19660 Wagon 40
21360 Sedan 40 Turbo
22660 Wagon 40 TUlbo
960
23860 Sedan 40
26100 Waeon 40
Av'". Av'" BODY
R.'~.<I Tr&J.ln TYPE
400 Add I '.tIIl"I S,',lI','
2!i0 Add [.1' PII,H'"
660 Add I'MI S",,',,}I'
400 Add ,,,,I! 11"f"'I"I1!
7 60 D.duct M,IIII(.11 ".111\
.~'j .,,:c,rIHbt) ~JbUW,!~\.l:1
1993 VOL VO'A T'PS'AC
1925240
2426 14326 Sedal1 40
2460 16376 Waeon 40
850,FWD
15 4750 677621026 Sedal1 40 GLT
940
3300 16660 Sedan 40
3426 17700 Wagon 40
3760 19460 Sedan 40 Turbo
3876 20600 Wagon 40 Turbo
4 126 960
4660 21960 Sedan 40 ~S9519776 26326
23000 Waeon 40 ~W9520700 26600
3776 376 Add I ~.'~htl Sed!,' 376 376
4000 200 Add ',I I'hont> 200 200
4160 600 Add' ,It! SUI"""I' 600 600
4800 300 Add T~.'I [Jef,'1 "'11 300 300
6060 700 O.duct M,lnua' 11,111, 700 700
':il,) c.I':1 Turbu. ~6u
53 2776 4460 1992 VOLVO'AT'PS'AC
53 3300 5100 240
12475 Sedan 40
32 2260 3776 13426 Wagon 40
33 1900 3326 13076 Sedan 40 Gl
740
4626 16600 Sedan 40
6976 16660 Wagon 40
7200 16800 Wagon 40 Gl
8850 19000 Waeon 40 Turbo
660 940
600 16625 Sedan 40 Gl
I 17826 Sedan 40 Turbo
18776 Wagon 4f! Turbo
. 960
I 18826 Sedan 40 ~S9516960 22000
19776 Wagon 40 ~Vl9517800 23026
326 Add :,.." ~I "lid %i], 326 325
IS5520626 26400 176 Add. 1'"", 176 176
lW5521700 27676 300 Add . ,I ,l41i I 300 300
lS572340029700 650 Daducl ',1,<'1..,111,111, 650 660
lW572460031026 1991 VOLVO'AT'PS'AC
240
IS8816625 21600 10300 Sedan 40
lW8817700 22876 11200Wagon 40
IS8719226 24700 12000 W,lgon 40 Sf
JW8720300 26026 740
11800 Sedan 40
~S9521476 27400 12700 Wagon 40
~W9523600 29800 13900 Sedall 40 Turbo
DEDUCT FOR HIGH MILHGE
EASTERN EDITION
30 900
30 1275
30 1300
17 1975
17 2060
17 2325
17 2425
17 2625
17 3000
16 2260
16 2460
16 2575
16 3060
16 3260
A
M(Jd~
II..
AV'II.
Ll)dn
AV'f1.
R.'d,'
400""400
260 260
660 660
400 400
760 750
AS8812900 17150
AW8813860 18275
IS5518926 24360
IS8816000 19660
IW8816960 20800
IS871762622676
11'18718460 23800
AS8811260 16176 I
AW8812100 16200 M
AS8811776 16825
P
o
R
T
S
fS8814060 18626
fW8814900 19650
fW8816126 19800
fW8717100 22200
IS8814075 18660
IS8716060 20960
JW8i16900 21960
AA884 9276
AA88510100
AA88510800
12800
13800
14660
fA88410625
FA88511450
fA87412626
14460
15425
16700
~/
Av'P. I BODY Modf'l Av',"" AV'". AV'II. 01, BOO)' Mod~1 AV'Q. AV'Q,
rrd./n TYPE No, LOdn R,tilll 1'rd./n TYPE No. LOdn Refilll
1987lSUZU.Conllnued 1991 JAGUAR'AT'PS.AC
1600 40 RS Turbo T51 1460 2660 18350 Sedan 40 XI6 FYI 16525 2 HiOO
IMPULSE 20250 Sed 40 Sowelgll HYl18225 23625
2160 Coupe RS lurbo ROI 1860 331622250 Sed 40 Vall Pial KYl20025 26100
PICKUPS 22300 Coupe 20 XIS rW520015 26150
1650 P'up B1l4 1600 2100 30060 COllY 20 XIS TW421050 34060
1115 P'up LB C1l4 1600 2860 150 Add l.,' 1'1, 't 160 160
2160 P'up LS B1l4 1960 3215 1990 JAGUAR.AT'PS'AC
1150 fup MPG-Oiml B1l4 1060 2150 14225 Sedan 40 XJ6 FYI 12825 11050
1215 P'up LB Oiml C1l4 1150 26300 15925 Sed 40 Sovereign HYl 14350 18815
2500 P'up Spacecab C1l6 2250 3 1~ 11626 Sed 40 Van Pial KYl 15816 20125
2960011 Spc.cab C1l6 2616 4116 19325 Sed 40 Maleltic MYl11400 22625
3000 LS Spacer.ab C1l6 2100 :~25 16600 Coupe 20 XIS NW514950 19600
~~~~ ~:~~ ~r~WO ~~l: ~~~~ 62~~ 21~~~0 JAnGdX~~~ T'P~~~~ 1921\ 21950
4100 LS S.f'cab 4WO CRI€ 4260 6150 11600 Sedan 40 XJ6 HYl 10350 14125
T~~O:~RUn;ty~~ 011 CH55 3315 5115 12150 Van Plzl 40 XJ6 KYl I 1415 16415
3915 Utility 40011 CH58 3600 5450 ~~~~~ ~~~~e 22g NsS ~~~ ~n~g ~~:~g
600 Deducl 0.",1 E ,,; 'e 600 500 1988 JAGUAR'A T'PS'AC
r- ---: I 8815 Sedan 40 XJ6 HVI 8000
I i I 9825 Van Pial 40 XJ6 KVI 8860
r- CiG C TEGORY IV -I 9900 Coupe 20 XIS NV5 8925
I MILUI E A : Jagm. I 14500 Cpe 20 Cabrio XIS NA313050
1994 JAGUAR'AT.PS.AC I 15425 Cony 20 XJS NV513900
39160Seuan 40 XJ6 HX13525043100 1987 JAGUAR
42160 Sed 40 Van Pial KXI38415 41415 B060 Sedan 40 XJ6 AVI 1250 10250
61660 Sedan 40 XJl2 MXI46500 56815 8815 Van Pial 40 XJ6 AYl 8000 1 I 150
Coupe 20 XJS6 NX5 9000 Coupe 20 XJS NV5 8100 11215 I
Coupe 20 XJSI2 NX5 13300 Cpe 20 Cabrio XIS NV31 1916 16060 M
Cony 20 XIS6 NX2 ~I
Cony 20 XJSI2 NX2 ~~
315 Add COP'J",,,S:, lj:! 315 3151 P
226 Add CM PO(O, 225 226 I MILEAGE CATEGORY: Range Rover.IV 0
660 Add p~,ju"I'PJ"IJEi 650 660 1994 LAND ROVER'AT.PS'AC.4WD R
400 Add ]r,,:t De,rr'"' 400 4001 RANGE ROVER
150 Deduct Manca' ]',".\ 150 1501 Util 40 County H~I T
1993 JAGUAR'AT'PS'AC Util County LWB HCI
31660 Sedan 40 XI6 HWI28600 35125 Add (". FI,," S
34460 Sed 40 Van Pial KWI31025 38125 Add 1"." ll"',rr.t
36060 Coupe 20 XIS NW532460 40425 . - ..,
40160 Cony. 20 XIS NW436 I 50 44150 1993 LAND ROVER'A T.PS.AC'4WD
360 Add ~D P'Jjt' 350 350 RANGE ROVER
200 Add lM Fh"r;, 200 200 32900 Utrl 40 County HVI29626 31100
600 Add r~ISIJ<1",F, .,I~ 600 60036200 Util County LWB HCI32600 40516
300 Add 1110,11 Utle"-' 300 300 -
100 Oeduct M,,"u",' :, 100 100 200 Add "'.r' ',- 200 200
1992 JAGUAR'AT'PS'AC . 300 Add 11,: ["d""! 300 300
24160 Sedan 40 XJ6 fYl21150 2112611992 RANGE ROVER'A T'PS.AC'4WD
26200 Sed 40 Sovereign HYl23600 299001 21900 Sporl Ulillty 40 HV12512531160
28600 Sed 40 Van Pial KYl26650 32400 1100 Add I" .", I., 1100 1100
30300 Sed 40 Majellic MYl2121li 34300 115 Add I,,' II,r,. 115 115
32625 Coupe 20 XJS NW529215 36100 1991 RANGE ROVER.AT,PS'AC'4WD
36415 Cony 20 XJS NW432850 40815 22800 SporL Ut,lity 40 HV 120526 26300
300 Add (0 PIJ,., 300 300 1200 Add l. ,"! ',f H, 1200 1200
115 Add CJr I'n,)",. 115 116 600 Add I, ^e' ')1,'" ,I 500 500
DEDUCT FOR HIGH MILEAGE
EASTERN EDITION
11150
12200
12216
11350
18326
A
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Infinity Investment Advisors, Inc.
PORTFOLIO APPRAISAL
Harry V Patchin
ptr50nnl Account
VClobtrJl. 1994
(1A1l Rclnvuted Diva.) Pel.
quanllty Security, Un!!..fC!1.! ._or!!!..a' C~!L_. Price Markel VaJuL. A.....
---. ~
CASH AND EQUIVALENTS
Capital RelCrv" 7.04 7,04 0.0
Dreyl\la PA MunicipDI M.M 15,373.29 _.-!~373,19 69,5
-
15.lBOJJ 15,380.33 69.5
COMMON STOCK
Drusa and Medical
1,000 BoslOn Life Science. . 1.55 1,54S.15 0.41 406.00 \.8
\00 XytrOnyx Inc. 11.11 2,112.50 4.06 406.30 -11'
3,660.65 811,30 3.7 .
-
COMMON STOCK Total 3,660.65 812.30 3.7
MUTUAL FUNDS
333.649 Wsshington MutuDI 14.24 ' ,4.74'.)')') 17.80 5,')311.95 . 26.8
InveslOrs -
----
4.749.99 5,938.95 26.8
TOTAL PORTFOLIO 23,790097 12,13l.l\S 100.0
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339WntOo-Rotd . Htnhty.PA \7033
(717) 1Jl.1I60
.
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Harry V. Patchin,
PlalnUff
In the Court of Common PI.a.
Cumbtrland County, Penn.ylvanla
v.
No.: 84-7225
Cheryl Lynn Patchin,
Defendant
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Civil AcUon . L.IIw
In Dlvorc.
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UMItED TERM. MUNICIPAL,
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EXHIBITS.lNV
file no.: 95-0091
QUlnlllY '_
,
Seeurfl)'
MUTUAL FUNDS
643,027 Limited Tcrm Municipal
Fund
TOTAL PORTI'OLIO
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J3PW...~...d o HmlMy,p" 17033
(711) m.lI60 .
..
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PORTFOLIO APPRAISAL
Harry II cI C"~ryl L Palchl"
Jol", Acco",,'
Octoh", J /, /994
(Lm Rclnvellcd Din)
Unll Cull Tollr COIl
-- --
13.39
8,1\06,94
8,606.94
8,606.94
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Pel,
Merkol Varue M!ill
8,,191.50 JOO.O
8,391.50 IelO.O
8,391,50 100,0
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Quantity
483.746
275.682
172.831
1.105.329
TOT,.ta>>oatlOuo
I
Securlly
J.nUl Fund
Lindner Dividend Fund
Mutual Qualified
Wuhlnston MUIUlI
Investors
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JJ9WalOo"""",Rood .H"'y,PA 170JJ
(717) 5JJ.lUO
Infinity Investment Advisors, Inc.
PORTFOLIO APPRAISAL
Harry V Patchin
Profit Sharing
OClohtrJl, 1994
(Le.. Relnyelled DIYI,)
Unll COil Total COil
Pcl,
PrIca Marlcet Valua . All,.!!
--
19.62 9,491.10 9.8
25.14 6.930.65 7,2
28.83 4,982.72 5.2
17.80 19,674.86 20.4
49,364.06 51.2
,
96,383;04 100,0
1860
25.39
28,93
13.93
9.000.00
7,000.00
5,000.00
15.401.32
41.401.31
84,313.J5
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Harry V. Pltchln,
Plllntlff
In the Court of Common Pie..
Cumberllnd County, Pennlylv.nll
v.
No.: 84-7225
Cheryl Lynn P.tchln,
Defendant
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CIvil Action. Law
In Divorce
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IHW=INITY INVESTMENT IRA . HUlblnd'
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EXHIBITS.INV
file no.: 95-0091
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CMnIlIr _ ,___ ,l!H.urtt.r .
MUTUAl. "Uj'j~
1,054,211 loll'll b~,"IllIdlI..I""'lt
l'\Ind.D
TOTAL POATPOLIO
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Infinity InvCllmcnl Advilorl, Inc,
PORTFOLIO APPRAISAL
Harry V Patchlll
IRA
MWl'mb.,.;O, /994
(I.... It.."".... III'~)
.JIll!l'''''' 'r"'orn'!l..
Yoo..
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_Mo""".V~"'L. .~
1.40
1,100.91
?96
1,392.04
100,0
1,10G.91
1,392,04
100.0
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IBM' TAX DEFERRED SAVIN' "LAN
DIVISION CODE
EMPLOYEE SERIAL
PAVROLL CODE
120001/.1 /041699
241311
02.
THE FOLLOWING 15 A 5TATEM[. on YOUll ACCOUNT AS OF:
TOTAL ACCOUNT VALUE (nEFLl _ CunnENT 'NVESTMENT
\,It,LlJE PLI.'C CUTSTANDING LOAN PRINCIPAl) $
10/oe/94
el.64~.~0
PATCHIN. CHERVL L
621 OEVON RO
CAMP HILL PA 1101'-2121
SOCIAL SECURITV. 111'4a'~601
Inlormallon appearing In Ihe 'CURRENT PERIOD" porllon 01 Ihis
atatement reflects weekly Iransacllons, and earnings. processed
from July 7. 1994 through October 6. 1994, Including July,
AuguSl, and Seplember conlrlbullons. The "CURRENT YEAR"
segment or the summary section represents Ihese contributions,
Ye.r 10 Dale earnings. and .11 olher activity (I.e. New Loans.
Loan Rspayments, Withdrawals and Dividends) reporled
belween Oecember 31, 1993 and OClober 6, 1994.
'" MORE INFORMATION ON REVERSE SIDE" , .
\!~;:wi:i'II\I'i~HT 'P~IClll
!',' ,I:' \;!"~~;~'~I'?i' i!I!!?;\ii!:~~~'I:'~"\~'!"
LARtlI CllIIPA/l'l ,
. ' INDb
.IIIALL CllIIPA/lY' d
STOCK
CURRENT INUESTMENT ELECTION 100%
OPENING BALANCE 01/01/94 S 0.00 S 18.131. 16 S U5,190.98 S 16,12~.26
CONTRIBUTIONS
MATCHED DEfERRALS S 0.00 S 0.00 S 0.00 S 0.00
UNMATCH,O DEfERRALS S 0.00 S 0.00 S 0.00 $ 0.00
EMPLOVER MATCH S 0.00 S 0.00 S 0.00 S 0.00
LOAN REPAYMENTS S 0.00 $ 0.00 S 0.00 S 0.00
FUND TRANSfER S 0.00 S 0.00 S 0.00 S 0.00
NEW LOANS S 0.00 S 0.00 S 0.00 S 0.00
WI H'ORAWAL S 0.00 S 0.00 $ 0.00 $ 0.00
GAINS/LOSS,S $ 0.00 S :Z~8.61 $ 239.23 S 402. 2S
10/08/1M $ 0.00 $ lS.311.77 $ III 430.21 $ Is 127.114
CI.IlltINT PERXOD XIII STOCK ' 1/, S. IDYIRNIIINT INTERNATIONAL, IALANeID.ASSIT 'TOTAL'
SECURITIES STOCk
CURRENT INVESTMENT ELECTION
OPENING BALANCE 01/01/94 S 0.00 S 0.00 S '3.814.S' S 0.00 S SO,B22.21
CCNTRIBUTIONS
MATCHED DEfERRALS S 0.00 S 0.00 S 0.00 S 0.00 S 0.01l
UNMATCHED DEFERRALS S 0.00 S 0.00 S 000 $ 0.00 S. 0.00
,MPLOVER MATCH S 0.00 S 0.00 $ 0.00 S 0.00 0; S 0.00
LOAN REPAVMENTS S 0.00 S 0.00 $ 0.00 S 0.00 S' 0.00
FUND TRANSFER S 0.00 S 0.00 S 0.00 S 0.00 S O.UO
NEW LOANS S 0.00 S 0.00 S 0.00 S 0.00 S 0,00
WITHDRAWAL S 0.00 S 0.00 S 0.00 S 0.00 S 0.00
GAINS/LOSSES S 0.00 S 0.00 $ 123.17 S 0.00 S , .023~29
10/08/1M S 0.00 $ o.ooJ $ 13,S87.8I $ 0.00 I S 11,_.110 I
" .
------------------- LOAN ACCOUNT .--..--.---------.- SUIIIAR'I ClIlRINT VA SlNCI ENRDLLMlNT
LOAN AMOUNT AVAILABLE S 0.00 MATCNEO OEFERRALS S 0.00 ~ 28,3S1.69
UNMATCHED DEfERRALS S 0.00 $ 10.763.78
EMPLOVER MATCH S 0.00 S 7 ,6'~. 27
LOAN REPAVMENTS S 0.00 S 0.00
NEW LOANS S 0.00 S 0.00
WITHDRAWALS S 0.00 S 0.00
GAINS/LOSSES $ 18S.36- S I1.S19.86
TOTAL
S
188,311- $ 81,546.110
· YOU AnE SCHEDULED TO nECEIVE 4 OlfiTRIBUTlON FRO" TOSP IN "AV.2029.
our, 'IECOROSINOICATE THAT YOU ARE MISS'NG THE CONVEN,ENCEOF
AEOllilSTING A LOAN, DISTRIBUTION OR WITHDRAWAL VIA THE rosp
SERvICE CENTnn. WE HAVE NOT YET ReCEIVED YOUR TRANSACTION
AUTHORIZATION CARD (TAC). PLEASE RETURN YOUR SIGNED T AC TO
THE TOSP SEnVICE CENTER SO TH4T yOU CAN TA~E ADVANTAGE OF
oun NEW SEnV'CE. ,F YOU HAVE OUESTlONS on NEED A NEW T AC,
PLEASE CAll THE SERVICE CENTER AT 1.000-7:16.1000,
I.
Harry V. Pltchln,
Plaintiff
In the Court of Common Plea.
Cumberllnd County, Pennaylvanll
v.
No.: 84-7225
Cheryl Lynn Patchin,'
eeftndant
Civil Action - Law
In Divorce
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EXHI~IT P
PA NAT'L BANK MORTGAGE - No: 18814
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EXHIBITS.INV
file no.: 95-0091
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,:,'IOUNT .." "f
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PER YEAr, 1:7.
.JF PAY~lENTS 162
,ON r DUE DATE TUl.'" I mEREST PR I NC I F'AL BALANCE
i<ER DATE PAID F'AYMEN: PAY~ENT PAYMENT DUE
---------------------------------..------------------------------------------
..; I NN I NO BALANCE $89,092.32
1 ('1 ('1 (. ~'" 96(..47 674.19 2B6.28 89,606. (14
II 2 11 M 0 "!-:.( I"~) 960.47 672.<15 28B.42 89.317 . 62
II ;J, 21 01 (. 1..7./!.!IJu... /IIi 960.47 669. BS 29(', 59 89,027.03
II 4 31 01 0 l':Jr::.l,l 1/9} 960.47 667. -":1 292.77 8B, 734.26
II , 41 01 (:. J...:.t.I:.::u.. ?1 96(' . 47 66~.51 294.96 88,439.31)
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II 6 51 01 (. 'i/ftflJ..../ jI r 96':1. 4~ 663.29 297.18 88,142.12
II 7 61 ')1 (I 96(..4'f 661.(.7 299. 4(' 87,042.72
II 8 71 (II 0 (' 96(1.4:' 6~a.82 3':'1. "'5 87,541.('7
II 9 81 (II (. .JL_ 96(1.47 6~6.56 3rJ3.91 87,237.11>
II 1<) 91 (II n " 96(1.47 654.28 3(16, 1 '7 86. 9;J,,:' , 97
II 11 101 (,I <"E 96(l.47 6~1 .98 308.49 86,622.48
II 12 111 01 n 96(1.47 649.67 310.8(1 86,311.68
II 13 121 (II <. 't ._- 96(..47 647.34 313.13 85,998.5~1
II 14 11 01 1 -"-- 96') . 47 644.99 315.48 85,68:~. (17
II 15 2/ (1/ 1 96(',47 b'~2. 62 317.60 83~365.22
-.--.,.--
,t lb or I 01 1 9~(), 4:' 64.).24 ~2C . 2~S e';;l~(:14a." .90
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" 17 41 01 1 I'll "', '~60. 47 637.84 322.63 84,722.36
II 18 51 0/ 1 ~L_, 96().47 6:35.42 325.05 134 < 39" . 31
II 1'1 6/ 01 1 (II' 96':1.4' 632.913 327.49 8'1. 069.82
,
II :(1 7/ (II 1 -f;~ 96(' . 4'7 630.l:I2 :32~. 95 83, TJ9 . 87
II ::1 81 ('1 1 v"'" 960.47 628.1:)~ t 332.42 8,~,,407. 45
II :2 91 01 1 !1= 96<).47, 625. 56 334 . 9 1 83,072.54
II .."., 101 (II 1 960.47 6:J3.04 337.43 82,735.11
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II ::4 11/ (II 1 .. 96(1.47 62(:,.51 339.96 82~39~.1~
II :5 121 01 1 (J<./ 96(1.47 617.9'6 342.l':I1 82,052.6~
II 2:. 11 01 2 ..1..1,) / 96(..47 6.u.~. 39 34.:3.013 81.< 707. :36
II '27 2/ ('I 2 96(1.47 612.81 347.66 81~359 .90
--'--'
II 28 :31 (II 2 96t:),4'," 6HI.2(1 350.27 8,\,()()9.63
----
II :=~9 41 0/ 2 960.47 b07.:n 352.9(1 80,65,.,.73
It ~(I :3/ 0/ 2 96,;1.47 6(14.93 :~~~. !<4 80.30.1.19
i;j) ----..
" 61 01 'f 9bO.47 6 'I" "9 358.:2 :. 7~.9"+2.98
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1 ";"; 7/ (1/ :' 960,47 ~-;9. ~'7 ,"\60. 90 79 ~ 58':~~. (18
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II .,.'t 81 01 2 960.47. 596.87 363.6<:' 79,2.18.48
'.'-.' -"--
ij '!.4 91 01 ~ 9bO.47 ~9'l.1.4 3{'6. :S3 70,81;2.15
-
.~ ,5 H'/ <:'1 ~ 96(1.47 ~91. 39 3/~9.(18 7B, 48:;'.07
... --
~f .~', ~J 11/ 01 2 96(1.4'7 5BB.62 371.85 7B, t 11. .22
II TI 121 01 2 96(1.47 ~f35.83 374.64 77 , 77>6.58
II 313 11 01 " 9/:).;1.47 5e~3 . cY2 377. 4~ 7'1~359.13
'.' --
H :-9 2/ 01 .. " 96':',47 580..19 380.28 76,97~,1?~
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II 4',' 51 0/ 3 9M :47""--' ~71.57 3BEJ79'O -- 75,820.82
~~ 4~!, 61 (1/ ~, 96(',47 568. bl. 391.81 75,429,01
~*' 44 '11 0/ .. ".....) .47 M5.n, 394.75 7~, 07,4.26
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--,,--
II ",6 ~/ (;1/ ::r. 96(1,47 ~59 . 7'7 40') . 7(1 7'~, ::3:~. <;3:3
---.....
.--- --.,--"
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, . .
Harry V. Patchin,
Plaintiff
In the Court of Common Pie..
Cumberllnd County, Pennaylvanla
v.
No.: 84-7225
Cheryl Lynn Patchin,
Defendant
CIvil Action. Law
In Divorce
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,EXHIBIT S
WP DOHONEY BUSINESS LOAN
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EXHIBITS.lNV
file no.: 95-0091
r"f-\YI,I:: ,
F'IWm~,
BEGINNIMJ BALAM:E
(W1NUAL I N Tl~F~nn f\I,HE
PAYi'lENT ImOUNT
PAY~ll;:Nn; PER YEI)R
NUi'IDFI, UF 1"(\Yt'IENTS
F'?\Yi'lENT DUE
NUNBER DATE
DATE
PAID
, . ' ..
I'IUTL': I ',,','I,\':IL', bCHUjl,'1,Y:
p<:\t<::hin
cJl1htJllay
$39/1302.25
9.0(1(1(1:1,
$420. 79
1'?
llJ'2
TOTAL
PAYMENT
INrEREST
PAYMENT
,',J _ .~
1.1 ,-,,'
PRINCIPAL
PAYi'IENT
[lI\LANCE
DUE
--.-----------------------------------------------------------------------------
F.IEG INN ING BAl.ANCE $39,. 3S:? 2~\
II 1 10/ ('/ 14 fj:;~(.. 420.79 295.37 125.42 39 ~ 25~:. :8:3
II ., 11/ 01 14 ~X ""Y~I 420.79 294.43 126.36 39,13(',47
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It .. i'V 0/ 14;':' " II ~:i 420.79 29~~. 46 127.31 39.0(,:,.16
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41 4 11 o I 1 ~ l~J:::::!.!.". S 420.7'7 292.52 12B.27 38,874.89
It 5 2/ 01 15 t~2i.. /1 'J 7 420.79 29.1.56 129.23 38 f 71~.t.~.. 66
II 6 ::'/ (1/ 15 .'1. I. ,)'1' 420.79 29(1. 59 13().20 38,b.t5.46
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It 7 4/ 01 15 ,II' /'l \ ~ 42t.1.79 28'1.62 .1.3.t..17 38,484.29
It 11 ~;.i / 01 15 "", 420.79 2f.l13.6:5 132.16 38~352..L3
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II 9 61 0/ 1 ~5 ~ 420.79 287.M .133.15 38~218.98
II 10 7/ 0/ 15 -14.- 420.79 2136.l)4 .134.15 3B, 084, <13
II 11 131 0/ 15 47-- 42(1.79 285.64 135.15 37 , 9'~9. 68
II 12 9/ 0/ 1:3 ,~_ 42t).7C] 284.6.2 136.17 ~57!l8.L3,:'1
It 1-' 10/ 01 1 0 ---. 0(.." _ 4'2(1,79 283.60 137.19 ::r.7,676.3':~
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II 14 J. J.I 01 15 ~ 42(1.79 282.\57 138.:22 :~?.." ~)3a . 10
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II 17 :~/ 0/ 16 -.-l!:.b..._ , 420.71,:/ 279.44 141.35 :,7.117,20
" ,W 31 0/ 16 ....J!:.Uc:-, 420.79 2713.313 142.4l 3.~,1:t'74.79
41 l'i 4/ (II ,16 -C..fi:-:- 420.79 277 . 3,1 143.413 3,!',831.31
II 20 51 0/ 16 II'" 420.79 276.23 144.~6 36,,686. '7::'
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" 21 6/ 01 16 ,..IJ _ 42(1.79 275.15 145.64 ~~II~ ~ :'l'+1.-:Tl
II ~:>,.> 7/ 01 16 _::;I'~_ 42(1.7'1 274. ':.,,, :"46.73 :36. :;':l.i4. ~~";8
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41 2~~ 8/ 01 16 ,..,.!..')-- 420.7') 272.96 14" .8:;:- -, ~36 ~ 246. '5::
11 24 9/ 01 16 :1..tt- 42(1.79 271. 135 148.94 36,097,61
II 25 101 01 16 420.7', 271~. 73 150.06 35.947,5~\
II 2b 11/ 0/ 16 -M!~,- c..J C; 't 420.7'1 269.6'l, 1iH.,1F.l 35:<"796.37
II 27 12/ nl 16 f}U... 4~~O.7:1 2f.>8.4'l .152.32 3E\ ~ t..44 . (J~)
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It 2(:} 1/ 0/ 17 _:J..th-_ 420. ~'9 ~~!J"l It :5::~ .1 ~53 . 46 ::'5, 4'-?(1. ~:;9
tl 29 2/ (1/ J.7 ,.J3.!L 420.79 266.18 1:.14.01 :: ~5 .. :':;."5:1 . '=;'f..-=)
II ,:::/~ .:::;/ t'),' 1.7 _...q,..f~:___ 42(1.7'? .7U,5. C:I2 .L~5. 77 ' :~:,..ll~').:1.
tl ~'D 4~ / u/ J.7 420,'/'7 203.85 1 ~\6 . ~11~ ,3 ::'. ',):2 ~:~. . '2 7
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It ~, 9/ 1)/ 1 "I '-'816 .. 4:;~i). 7/i 257.m3 162.91 ::~...:.. 2:::0 . 7'~
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ij ..,.-, 10/ 01 17 ..L2(). ~""-I 2~1.').6,~ 164.13 34.056.6:
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II -::.9 12/ 0/ 17 ~":~j~-<::~ 'if 420,7'1 2!;:14.1f;3 166.61 33,7::4.6:3
jl 41) 1/ (II l>J --'---' 4:;~t). 79 :2~7"~.. 9~:' 167.86 3~::. .' 5 =-r:::, . 77
II '!A ';:/ 01 18 _._-- 420.79 251.68 169. .t1 33. 38': . 66
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ij 42 ':'; I 0/ LB 420. 7~~ ~.2~~(l.. 4.L 17(,'.38 33.'2T7~e
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Harry V. Patchin,
PIII!ltlff
In the Court of Common Pie..
Cumberllnd County, Pennaylvanla
, .
.
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v.
No. 84-7225
Cheryl Lynn Patchin,
Defendant
CIvil Action. Law
In Divorce
CERTIFICATE OF SERVICE
I, James A. Miller, Esquire, hElreby certify that I have mailed a copy of the
foregoing Plaintiff's Inventory to the following persons and In the, following
manner on the date indicated below:
Samuel A. Andes, Esquire
525 North Twelfth Street
Lemoyne, PA
17043
DATE:
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Harry V. Patchin,
Plaintiff
In the Court of Common Plea.
Cumberland County, Pennaylvanla
v.
No. 84-7225
Cheryl Lynn Patchin,
Defendant
CIvil Action - Law
In Divorce
INCOME AND EXPENSE STATEMENT OF PLAINTI~f
INCOME:
Employer:
Address:
Type:
SSt:
Self-employed
407 S, 32nd Street, Camp Hili. PA 17011
Dentist
209-46-1732
S.. attached tax return for Income Information.
OTHER INCOME:
B.entt:
$346,66 per month from apartment rental:
. $380.00 for 8 months and $280,00 for 4 months averaQlng out over 12 month. to $348.88 per
month.
EXPENSES:
MONTHLY
YEARLY
Home
Rent
Maintenance
$725.00
Utilities
Electric
Ga.
011
Phone
. $ 45.93
$ 37,05
Employment
Lunch
$ 90.00
/
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U.S, Individual Income Tax Return
~@94
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d If V'" ,Iilll' 414,', lh, "nil 'tOil .w' I, tI.I.... II VIlli ",,"Iillll 11114" . p,,-IOIb '''''/111''1, t"'rj,~;;;-j;.O
Tot.1 number of eurn liotls cllim,li. . . . . . . . . . . . . . . . , . . . .
W'II". .~.I... lip'. .le, Auee. forml.) W-2 " . , . , , . . , , . . , ,
TIX.bl. Inl"..1 Incom. I... P'll' 151, Attee. Sch.dul. B If .ver $400
TIX-...mpt inl""" Is" P'll' 161. DON'T Includ. .n lin. 80 I 8b I
Dlvld,nd Income. AIt.ch 5ch.dull B If OYlr $400.. . . . . . . . . . . . .
Tu~le refunds, credits, or offsets 0' S111,.,d loul Incomo tues Isn PIYI 16).
Alimony received .........................
Dusinul Income or (Ionl. Atllch Schedule C or C~EZ. . . . . . .
Copi'~ gOln or UOIII, II roqulrod. ,"eeh Sch.dul. 0 I... p'g' 161, ~13D,
Other g.ins or (lossGS), An.ch Form 4797. . . . . . . . . . . . . . . . . . . . , . . . . 1~L
Tot.1 1M dlstrlbulions lts..I_. I b TI.ubhl amount (,n p.g, 171 t~1l
Totl! p.nslons .,d wm~lttrlS' : Llfl...c='=== b Tlxablo .nounl (sOl p.go 171 !@.~
Renl.1 reltl ul.te, ioy.llios, pWlnerships. S corporllions, IrUlts, elc. Attach Schedule E . J.7_
Fwm Inr:ome or 1I0ss), A<<.ch Schedull F . . . . . . . . . . . . . . . . . . . . . . .. ....lB....
Unemployment compenUljon (s.. Pille 18). . . . . . . .. ......,...... .. 1L
SociI! ..cur iI, b,n.flll , , ,120.1_____~ b T.."'le omounl I." p'g. 181 ,~!1.
Other Income. LIlt type IIld inlaY", - SOl page 18 Soo Statemont 1 1
Add Ih, .-nounts shown in the fM' rl hi column for hnas -7"thr~u- h '21, T"'jl"i~ -o~r- i~t~ -I~;;";;~ 22
y.", IRA d.ducllOn I... pogo 191 , , , , , . . , , 23.
Sp.u,,', IRA deductIOn II" p'g' 191 , . . . . , ,
Moving ..p.n.... Attee. form 3903 or 3903-f . .
On.~h.1f of selt.,mploymonl tu . . . . , . . . .
S.lt-employed he.llh InsurlllCI deduclion ISI. p.ge 211 .
Keogh retirllmlnr pI., .,d SlIf -employed SEP doduction
Penl!ty on e.ly wlll'ldrowal of IlYlng. .........
Alimony p,ld, Reciplent'1 SSN ...
Add lines 23. lhr~ 29. These 11'8 your ~2!!Lad ultmen I .. . . . . . , . . . . . ,.. 30
~ublrlCl Ime 30 from lin. 22. ThIS I' yourlldju.l.te groll ncome. on t 10
~25,2~6 .,d . child h,~od WIth you lIess thlWl S~.OOO If . child didn't hve with you), seD
e.ned Income Credll on It 1,', ....,............."...".., ~ 31
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12.090,
For Prluc)' Act and
P'perwork R,ductlon
Act Notlc., ... p.;. 4.
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~r::li:,e~t~.mp.lgn IIrrr... Do yo,", wanl $3 10 go to lhil lund? ..............
Ilu "0' 12.! ,..- If . oml rnltlrfl dOli our n I w""ll J In n 10 1I1Is IIml7
_ Slngl.
MMrl,d filing joint relurn lenn t' tlnly one hid income)
hlt/apollu"lOclll UCllllIV n..-
Mvri.d filing "p..le relurn, ,bu. ... lull RUII. hili, ______..___._M__
Hud of houuhold (Wtth quelifymg perlon), IS.. peg. 13,1 If the qu.lif.'lng P"Ion II . child but nol ycut drp.ndll1t.
Inler this child's nllTlI hete"-
u It in widow or with rid ,ndonl chUd ew I oun died .19 , 51. .. 1 .
8. X Your.elf.lf your p..ent (or 10mtUne "Ilel CIA cl.im you '1 . dependent on hl5 or her tu
Exemption. relurn, do not check box 6.. But bo lure 10 check the box on line 33b on pig. 2
II'. pi" 1).1 b W Spouse .......................... ....... ...."
~ Depend,"ta. lifttiu.- 121 II .g. I II It... ifO.p.II..lIl'1 Br- a, I
, II lid.. .111111..111', IOcl.1 IICl1lltv rtr'lIan,hill 10 mOnlll1 II,,.
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. MO<. ".. ,,. tjARRV PATCH I N ___ _.__ HI L ,_.1L_
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I" ,.g. 14,
Filing Status ~
(I.. p.g. 11.' 3
tIl.d Illy 4
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527 DEVON ROAD
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22
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AdJuatments b
to Income 24
Caution: 500 26
1ns"""'I.... , . 28
27
28
29
30
Adjusted 31
Gross Incorne
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3.504.
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7 000,
193 568,
22 021,
171 .547,
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Tax
Compu-
tation
1St. pag.
23,1
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24,)
45
48
47
48
48
50
51
52
83
54
Paymanta 55
Attoch 58
FlImlI W-2,
WoW. wi
10n-R on
tht IronL
Othar
Tax..
(S.. P"Il'
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81
Rafutld or 82
Amount 83
You Ow. 84
SIWl
Her.
K..p . copy
0''''11''1'1'"
IOf "'II'
(lewd..
P.ld
Pr.par.,',
UIt Only
UIUO J.DOO
1 4 R Y RY HIN
32 Amount Iron) hn. 31 IldJus1ad glGU I~~m.) .................... _. . . . .
33. Check if: C.I You wlr. 65 or ordar, L. J Ohm'; [ I Spoule wn 65 or ordur.! I Ullnd.
Add tho numbe, 0' bo.al chacked Ibova /rId unlut thu tol.1 hDru . . . . . . ... 3301
b If YO\If" pll'.nt lor lom.on. .111) ,In cl'lm you II . d.pend.nt. chack hi" . ... 33b
a If YO" .. m.rl.d Wing Up..I.,y II1d your SPOUII 111m',.. doductions
or you .. . dull"ltltul .1I.n, .11 Plgo 23 lInd Lhock hi" . . . . . . . . .
It.mlz.d d.ductlon. Irom Sch.dul. A, IIno 29, OR
St.ndlrd d.ductlon .hown b.low for your IIIlng 11.1.., But II you ch..k.d
.ny bON on IIn. 33. or b. g. 10 P"Il' 23 10 find your IIl1ld.d d.duclion,
If you ch.cked bON 33c, your Itlndwd d.d4J~Uon II lira.
. Slngl. - $3.800 0 H..d 01 hou..hold . S5.600
o MII,I'd filing J'lnUy Of Qu.lifying wldowler) . $6.350
. MII,I.d filing "p.,"ly . $3.115
38 SubUKI IIn. 31 I,om lino 32 , , , , , , . , . , . , . . . . , , , . , , , , . . . . , , , , , ,
38 If lin. 32 I. $83.110 Of I.... multiply $2.450 by tho lotll numb" 01 ...mpUon. ,llIm.d on
lin. 80, " lin. 32 I. 0'" $13.850, ... th. work.hool on p.g. 24 '" th. 1I110unl to .nllr, , .
37 Tu:.bl. lnoom.. Subtract IIn. 36 from /in. 35. If /in. 3& II man th., IIn. 3S. .nler "0-.
38 ria. Chtek If from.O Tn flbl.. be] fix RII. Schodul.s. C[[)CIfUltlGllnTuWork-
"".1. Of dO Form 1615 I... p~41, Amounl from Forml.) SS14 ....
S8 Addltlonol 1..11. ChICk If from . U Form 4910 bO Form 4912 " , , , , ,
40 Ad~ Ii .. 1Il~ .."""""",.""",
41 C,.dll for thlld .,d dlp.ndenl c.. up.nlls. AIIKh form 2441.
42 Ct.dlt for th. .Iderly or th. dl..bl.d, Altoch Sch.dul. n ." ,
43 fortign tu cre~il AttKh Form 1116 ........ . . . . . .
44 Other c..dlt. b.. P'9o 261, ChICk If Irom . [] Form 3800
b 0 Form 8396 cD form 8801 dCllalm bpnU~L_n_ 44
Add lin.. 41 through 44 , , , , , . , , , , , , , , ,
ubtrect line 45 from line 40. If rind 45 is more thlll lino 40 entar -0.
S,"-.mploym.nt I.., AItKh Sch.dulo Sf, . , , , , . , , , , , , , . . . , . ,
Altern.live minimum tu. AttKh Form 6251. . . . . . . . . . . . . . . . . . . . . . . . .
Rmp"". 1..11. ChICk II from . [] Form 4255 bD Form 8611 .0 Form 8828 ,
Soci" stewlty Wid Medic.. In on lip income not raportad 10 amp/oyar. AltlCh form 4137.
fu on qullltied ntinment pi...... including IRA.. If reqwad. 'Ulch Form 5329
AdvlOCI ..ned income credit plymanls from Form W- 2. . . .
Add linn 46 throu!:lh 52. This il 'lour tot I tl)( . . . . . . . . .
Foderollncom. to, withh.ld, If .,y I. Irom Fo,ml.) 1099, ,ho,k ...
1994 .stim.tld t.~ p')'menls Mld amount applied from 1993 relurn.
Earned Income credit. If reqUIred, Ilttth Schedule fie Isoe p.g.
27). No~tl.lltbl. ,.ned income: Imount ...1
ondlyp.... ............,....,..,....,., 58
57 Amounl plid with Form 4868 ("I.n.ion roqu.,,) .,.".,'. 57
68 b,... .0ei.1 "'''lly .,d RRTA I.. withh.ld Is.. p,!Il!-,321 '., 5
58 Other p.ymonll, Chock Ilfrom . 0 Form 2439 b U Form 4136 59
Add IIn I 4 throu h . These.8 our obi . ments . . . . . . . . . . . . . . , . . ..
If lin. 60 I. mdr. ltI., IIn. 53. 'ubtrlCt Unll 53 from line 60. This is tho Imount you OVERPAIO.
Amounl 01 IIno 61 you WillI REFUNDED TO YOU .""" . . , , , , , , , ,...
Amount of Ifna 61 you WWlt APPLIED TO YOUII IIn Un"'ATlD TAX. 63
If lin. 53 " mor. thon IIno 60, lUbUKI lin. 60 from IIn. 53, This I. th. AMOUNT YOU OWE.
For detll/s on how 10 PlY, including wh.t 10 write on your plym.nt. SlIO Ptgl 32. . . . . . . .
65 hUmlt,d tll( an.lt III I' 3. Iso includo on line 64. . .. 66 2 .
u..... '.11111.. 0' '''IIlI'~. I 'relu. 11111 I bu. ...mll," Ilil IIIUrll u, reeomplnV1ng Hh.dulll 1ft' 11.I.m.llll. .~, 10 Ih hll 01 "'V h..'.... ...
IlI.U.I, Ihv If' ,",, CD/IIU, ... campl.I.. O.elll.II'1I 01 PIIPll" ('Ihl lllu Iuply"l II II.... all .11 illlarm.llan 01 wllllll pllplllr ... ..., lll..I",.,
IirIl... YC\Ur signature Oltl Your Getupltion
,. ENT I ST
SpOUS'.S IllJl.tUrll. If I Join...--rilurn, BOTirmuir-i1gn:-- pouuTIccupiiiOi1
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43
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135 317
34.248,
4 4 ..
49
19 86 ,
NONE
1
Prep..r's IirIl...
SlgnolM. ~
Hrm'"liiimIror yours
If 101I-'MjII.,.dl ""
Iddrul
ALES
ChICk ,I
It!!.:!!" 10 .~_Cl 169-44-3973
C, _,h'dE.LNo.,._.23-2324837
~ ~~K ~R G~~ ~~~~~ ~~Igc-I A TTs P.
HERSHEY -- ,--------
pona I ty and Interest
Addl t lanai
124,
PA ZIP cod. 17033
See Statement 3
"1'3
,
,
.I...:., ..
BF9875-M166
08/14/95 04:23:03 V409
25
Form 2210
Underpaymant of
Estimated Tax by Indlvldualll, Elltatall, Ind Trulta
Ii'> S.. lip",.. Inltructlonl.
.. A loch to Form I 40 Form 1040A Form 1040 R or F m 104 I,
o.".LMII .. tll. TI..._,
......11I II...... h,~lu
....w ..... .. "11M.'
c'
I
10
0.... fill. 1&41.0140
~@94
Atilt.....
.....,Ie. NI, 08
IIUlIlyl., ...iu
,
HARRY V & CHERYL L PATCHIN 09-4 - 732
Noto: In molt "'''. Y'u do not n..d 10 Iii. Form 2210, Ih. IRS will llgur. lilY p.nelly you ow. IIld ..nd y.u . bill, fll. Form
2210 only If one Of mOrt bOA" In P.I I 'PplV to vou. If you do not "lid to fill Form 2210. you Itlll ml, un II 10 'lglM" yOUI' plnllly.
tw chi ImO t I, /in. 2 or IIn on thl ,n,U hn. 0' our relurn but 0 nol .IlKh Form 221 ,
Part Re.aona For Filing - II 10, b, or c below ""pli.. I. you, you m,y b. obi. " I.w" or .lImin." y.ur p.n.lly.
But you MJSI chock tho b.... III., ""ply IIld III. form 2210 willi Y'" I,. rel..~ II ld below opp"" '0 you.
check &hit bOll .,d fiI, FOfm 2710 wilh 'lour In nlum
I CII.ck which.." b.... 'l'ply Of non. ""ply. I" III. Not. 1iI."I:
. D You r.qul'l I w.lver. In cert.in cjrcumll~". the IRS will w'lva .11 or p.t of lhe pen,lIy. S.. W.lnr of Plnalty on
P-Ve I of lh, inltfucUon..
bO You us. lhI annUAlized Income In.t.llment method. It ~our Income vlti,d during thl y.... this method m.~ reduel
en. ImOl.I1t of Ont or mOrl required installm.nt.. S.. page 4 of th. InlllucUanl.
a 0 You had fldlllJ income UlI withheld from ~18'1 ."d you IIl1t it '1 p.ld for .stim.ted tl.ll putpOIt. when It WI' ICtu.lly
w1tMold InIl1ed of In .quo! ...unll on III. p.ym.nl d" d.,.., S.. Ih. inllrucUonl lor lin. 22.
dO Yout required muoj p.ym.nl Oint 13 belowl il b.ud .n your 1993 ,,. IIld Y'u lIIod or w. lIIing , jOinl return lor .ither
1993 or 1994 bul naf for both ye..s.
Part II Required Annual Peymunt
2 Enl... )'OUf 1994 tax .ft" creditl (III Inltructlons' . . . . . . .. ....................
3 Other w,. (see instruclions' . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Add IIn.. 2 Old 3, , , , , , , . , . , , , , , , , , , , . .,. , . , , , , , , ,
6 EItMc:llncorn.crldlt ....................... ....... 6
. Crtdlt for F.d,ral IIX p.id On fUlls ............... .......
7 Addllnl.Slnd6 ........................ .......
s ell'rlOt ye.. 11X. Sublllet line 7 from Hno .. . . . . . . . . . .. ............
8 MllUply lin. 8 by 90% L901 , , , , . , , , , , , , , , . , , " .."", W
10 Withholding lUll. Do not Includ, lilY uUmll.d Iu p.ymonl' .n thil IIn. In. Inllrucli.nll , . . , , , ,
I I SIAIIrICI line 10 from IIn. 8, II 1m 1II11l $500. .I.p hore; do not compl.l. or fll. thll rorm, Y.u d.
nol owe the penlH~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
II
12 Enl" tho II. "'own on your 1993 Iu roturn 1110% or 11I.1 ..ounl If III. edlull.d grOll Incom.
shown on lII,t rel..n il more 1II11l $150,000, or if m.rl.d filing IOp..I.ly for 1994, m're thWl
$75,0001. C.utlon: S.. InltrUellMI """."""."""".,.."",."., 12
13 Required .MUII p,ilyment. Enter the Imlll.r of IIno 9 or li.,o 12 1
Not.: If lin. 10 is Iqual 10 or more thin lin. 13, stop hlr.; you do not OWl thl pon.lt~. 00 not Iilo Farm 2210 unl... you
checkld box ld Ibove.
Part III Short Method IC.ullon: noed 11I0 Inllruelion. 10 I.. If you Clll use III. thorl molll.d, If you chock.d
box 1b Dr c in P.I I, skip Uus pitt II1d 90 to P!t IV.I
14 Enter the .-nOu,lI, If .,~. from lin. 10 lIbovI. . . . . . . . . . . . . . . . .. 14
15 Enllf" thl t011l ItnDUIlt. If Wly, 0' Istim.,.d tilt p.~m.nts you mldo .. . . . . 15
IS Add llnel 14 IIld 15 " , , , , , , , , , . , , , , , , , , , , , , , , , , , , , , , , , , , , , . , , , ,
17 Togl underpayment for yelf. Subtllet Iino 16 from linG 13. If lara or loss. Il0p hero; ~ou do nal
OWl thl plNlly. 00 not m. Form 2210 unless ~ou checked bOll ld lbovl ... . .
18 Mllliply lin. 17 by .05725 , , , , , , , , , . , , , , , , , , . , , , , . , , , , . . . , . , , . . , , ,
18 · II tho ""'unl .n lin. 17 WII p,;d on or .tt" 4/15/95. .n'" -0-.
IIf th.. ImOIM'lI on lin. 17 was p.ld b.far. 4/15/95, rn... th. following compul.tion to find thl
~I to tnter on IInl 19.
h... 01 Hllmbfl 1l'1)I5 p.l.
Un 11 1It1"14/161U .00021.........
20 PENALTY, SublrICI IIn. 19 from lino 18. Enl" III. mull h,re WId on Form 1040. Ii'" 65; Form
4 In 'or 1 4 NR lin . or f 41 Ii
For Plperwork R.ductlon Act Notlc., ... pig. 1 of IIpltlte Instructlonl.
18
,.. 20
H7~
4."" I.DOG
33 949,
19 86 ,
63,811,
63 811.
53 811 '_
44 75 ,
44 755,
form 221011994)
/.
,
)
"
""-
V409
25
209-46-1732
P". 2
BF9876-M166
08/14/95 04:23:03
'Of. U10 I"'" HARRY V & CHERYL L PATCH I N
Part IV Regullr Molhod lSoo 111. 10011.,lIono II 10. ... Ilhng Form 104ONR,I
Seotlun A - figure Vour Underp.ymonl
Plrmonl Due 01111_
Ibl 101
1/15/94 9/1 194
III
4/15194
21 ....,,,. 1111.11...11. II -.. 111 .,,11'" .11" Ill'
__ .... .dl..I, AI, IIN II. 0."...1", PI"
114 of 11M I~f ,... :1210, I. lid (II... ...
22 bU..... III ,.111I 11I4 lu wi'''." lIl. IMlII{U,.w.
'eI (1-' (., ",,", .... .11..,.. ....Ilftt 'n. Un
II I' Ill. II. II II.. n I. ,,,,,, I. .. ...ft ,... HI'
II'. III ,..,.... 11"'''', I'" hu: 11'011 II. U"..'
1M .-I(y. D. lOt fII. ,... nlo ,.,... Y"
.elM.... 11,..11. ...... . .....
CMlfI.,. II... U tlll...1I It If ... "'u..
"'". III.. 'I Ill, ..., ulllllll.
23 lIu, ...... U IllY. Ir,. II.. II If pl.'I.... ul....
21
1
11,189"
11 1
-
3 000,
1
24 ..... 11M, 21 1M U .. . . . . . . . . . .
2& 1M ...... .. II... 27 ... U ,I lit. ,,,,t...
13
14
ul_ ... ........... ....
28 ""'KI U.. 2t ". III' 24. 11 It" It I..., .Ill., -0-,
fl. Cle.. lit ..Iy. HI" lh ...... h.. II.. n . . .
27 . 01 ...... II U.. 21 " '''', I"'ntl II.. U II..
'11, 11. OU....I... ,_.t -0- . . . . . . . . . . .
28 U.4.",ro...'. .. II.. 11 II ....1 " Dt IIIfI ,...
II., 2.1, .....1Id u.. 2.1 ".. 110. 11. n.. '1'1 II..
13 II "'1 ul.... ~"I... .' " 1111' 11 . . . .... 28
28 Ch.~. . .11. 1. It;.... 'II.. II., 11. ..,"'"
II 2.1 "" lIill U. h. . I' II,. 23 01 IU' nhl,"'
11000.
12 811.
14 822
189,
51Otlon B - figure I"" Plnolty ICllII'flll' IIn.. 10 1/Irough 35 of on. .olumm b.lo" going to 111. nut coho"".!
April 111, 1894-Ju... 3D, 1994
o ....., .. '.... 'ROM III, ..1' III'.. ....
u.. :aa TO ," ... ,lit .... u. II.. 21 WII
,.14 Ir "~1I4, .lIld,,,, II ..,11"
1 UH.''Y..1l ,NwaJj" .,
.. II.. II X 'OVI II II., :10 X .01
tI.o &.alncUlNlII 3811
July 1. 1994-Sepllmbor 30. 1994
:2"1f If ..... fROM III' .oc, Ibow. .""
U., 32 TO III. '11. III, ._,Mt d. II.. 11 .11
,.11 ., 1130114, .kld..., I. ",u.,
3 UIl..,.'Y.... "MIlII 01
M II.. U X hy. .. II". 32 X .08
till IMI'KlltuI 311&
Dotober 1. 1994-Aprll 15. 1995
4........ If '1)'1 fROM .1It '.0 ,".w. .....
n.. )4 TO U1. ,". III. "'II" o. n.. 21 wu
~
4/15/94 1/15194
Otylt Dtylt
30 Stm 4
31 2,
5/30/94 II 01 4 9/15/94
O'VI: D'VII n'YOl
I
...
i
N
]
Ii
...
.
~
...
9/30/94
O,y,:
9/3 194
DIYI:
/30/94
DIYt:
'!
i
...
.
i
,." " 4/11"1, _lIld... I. ,,,UtI
5 UHtr''Y'" ..,,, .,
. II.. 21 X 'ey. II 1111. 34 X .09
tall 11ICI1d1.~ 385 ...
PENAL TV, Add ~I .......... '" Iln.. 3l, 33. ..d 35 In 011 colIlMO, Enler III. 10101 her.
1040, IIn. 65: Form 1040A, IIn. 33: Form 104QNA, lin. 61: " Form 104 I, IIn. 26 "
Ind on Fo,m
311
-Ino ludes 1993 overpaymenl of $
1.135. applied at 4-15-94,
II11S
4.4010 UOO
38
...~
(
11
(ell
1/1 I
1
3.433.
16 4 3
1/ 15/95
0..,.,
BF9876-M166
SCtEOlA.E A
(Form '''''01
"
\.!
;
4.
08/14/95 04:23:03 V409
25
12
OMl It,. 1'''-0074
Schedule A - Itemized Deductions
~@94
hJll'." II Ih TlIlllff., I .."......",...,....., 07
1....1 ..."... 1...llI 1111 ... Attach to Form 1040. ... See Instructions 'or Schedule A (Form 1040. ,tI~1
NlnNttll Ihown on P'otm 1040 'II' IId,l .....'n' .....,
~RRV V
Madlcal
IIf'Id
Dental
Exptln...
Tax... You
Paid
(S..
P'II' A-l.I
'ntar..t
You Paid
ISH
P. A-2.1
Not.:
P.nonol
Intere.. II
nol
d'lNcUbl..
Gift. to
a.arlty
If you midi I
gift ond gOl .
hnofll rOf I~
... P'Il' A- J,
C..ulty Ind
Theft Lo....
Job ENpen.e.
.nd Mo.t
Other
M'lGell,neouI
Deductions
IS..
pogo A-S fOf
expense. to
dolNct her..1
Otller
Mlac.n....oul
Deduction.
Total
Itamlzad
Deel/cllon.
& CHERYL L PATCHIN _ '
Cullul 0..11 lid... ..,..... IIIMbllltd " p.l. ~., ""11. tt=
I ModlC~ ond d.ntll 'wln'" (,.. pogo A-II. , , " I
2 I~" ...... ,,,. ,... 2.
U4U, II.. U. . . . .
3 Mllllply IIn. 2 11I0.. by 1.S% tOl!!. , , , , , , , ,
.. SubtrlCl lin. 3 from Un. 1. If lin. 3 II moro thin Un. , ,nl., 'Oil-. . , . , . . . .. ..
5 SII'. ond lo,~ Incom. I.... . ;>,t(ll.t. Jj, , . , . _. 5.,400 ,
8 R,,' ..",. I.... (,,, pogo A-21 i ~,.....'! 80"_
7 P.nonlfproplft)'l,ul .......... -'7-
8 Other lUll. Lilt IYP' rnd' ~~~I..._._._~~:~~~_.
209~46-1732
8
8 A.i-d-'ln;;i-;";;lIh -a-~:~-.-.-~::-:-.-.-~:: -..... . . . . . . . . . . . . . . . . .. I
10 H... .11111" IIC".., M' '011111 '.,IU" II vn II h,. 1011 1n 17 . 871.:-
11 HI'" "111'1' lilt"... Ill' ..,ond I. VI. .. h,.. lOll. II ,."
I. Ill, II"'" Ill. wll.. VII !lowlIhl Ill, hll', u, p'IJ' ^~:1 ...
tIl,. 111I1 ,....... 1111I1, 1~'IllI'VI.. '1., u~ d...., ...
8 "80.
================================ 'I
12 Polnll nol "port.d 10 you on form 1098, S.. P'Il. A-3
fOf .p.cl~ rul.. _"", _ . , , . . , , , , , " to
13 Inv.llm.nl interll\. If requIred. .nKh Form 4952, IS..
pog. A-3.1 , , , , , , . , , , , . , , , , . . , . " to
14 Add IIn.. 10 ttvou"h 13 " , , . . , , , , , . , , . , , , , , .
15 Gills by cosh Dr <lleek. Uf ony gll' of $250 Dr more,
... P'll. A-31 , , .", , . , ~,tt".t,~. ., " I'
18 Oth.r 0\., b)' cash or cheel(. III '''V 1111 II UIO 'f molt,
bu ,." A,'3.1 \I "" noo. VIU Mun '"ltll hUll 1213 .. 1R
17 C.r)'over from prior yer .............. - :'--7-
IS Add II... 15 throuqhl1 . , , , , , , , , , . , . , , , , , , . . , .
'G CHu.ll" or Ih.f' 10..IDI', Atlor.h Form 4684, IS.. .-. A-4,
20 l.kv.imbursad .mplo)'" upensel . job lilY' I. union
dull. job educ.tlon. .tc. If requlr.d. you MUST IU"'h
Form 2106 or 2106-EZ. IS.. P'll. A-5.' _ _ _ _ __
, . . . , , , , , . . 14
17 8.2L
4 515.
. . . . . . 1A
4 515,
.....,I,DI
21 Tax pr.p..Uon fell . . . . . . . . . . . . . . . . .
22 Other ....p.n... . in'llllmlnt. Slf. d.posit bu. etc,
LIII Iyp. ond II110unl ~ ______n_________
I,n
, ~,
I"
23 Aid-,in;;20U;;;'lh'22:~-'-::::~-'-'-:::-'-' I ~~
24 Irl!, 'r.~~l"~ ~':',ll!1
25 Mlltiply IIn. 24 11Im by 2% t021 .. . . . , , , , :,.
~. 'UbUKI IIn. 2< from IIn. 23. II lino 2' I, mo" thon IIn. 2], .nl" -0-
27 Moving ..p.nus Incur"d b.,o" 1994, Anoch Form 3903 Dr 3903-F, IS" pogo A-5,)
28 Other - 'rom 1111 on P'Il. A-5, Lilt Iyp. .,d ""ounl ~ __________________
--
I'R
I ~~
I ~.
29 I. Form 1040. IIn. 32. ov.r $111,800 lover S55,900 If morri.d filing ..por'I.'~1
NO. Your d.ducUon II nOI Iimit.d. Add the ~ounts in the Ir rIght column
'or IIn.. 4 lIvough 28, AI.o. .nllr on Form 1040. line 34. tho luger of > ~'~o
this <<nount or ~our Itwlwd deduclion.
VI:C1: Your deduclion mrJ b. limil.d. S.. ftM. A"S (or the Imounl 10 Inter.
29 17~
See Stmt 6
For Plplrwork Reduction Act Notlc., I.. Form 1040 Inltructlonl,
.'0
441400 UOO
Sch.dulo A IForm 10401 1884
.'
'( .
.I,
.
BF9875-M166
08114195 04:23:03 V409
25
14
S<H:Dl.U: C
(form 11140)
0.,111... .. lh '.....1)1'
11It.1..1 "n.... ,."Iu
1I.... ".,,1....
Profit or Loss From Business
(Solo Proprlotorshlp)
... P"tnerahlpl. joint yen turn, etc., mUlt file Form 1066.
.. ""U~ II ,.,. IU40 ., ,,,. 1041. .. S.. lullulllll& "1 ith,.,. C If,,_ 10401.
htl.1 unlll)'
OMI Nt. IUft~OD'L
~~94
AllUM..
5" w.~u Nt. 09
..,.'"IU".
I'"
HARRY V PATCHIN _____
A PrincipII bUline" or profusion. including product or .ervice lsee pig. eM 11
DENT I STRY - SERV ICE __,___
C Business nwno. It no IIp..to bUllnon ".n., leave bllllk. 0 1_,I.)I'U ID ....., Ill".. II U)l'
HARRY V PATCHIN ~ 2 -226 627
E Bu.loo.. oddro.. Oncludlng .ult. or room n,,1 ~.9]__~_~~tlP__~TJ3J;;EJ_s;A~e_.H..IJ..I._PA.,1?9jJ_______n_n___
City. lown or oil officI It.te II'Id IP cod. .__
F I..:c....Ung m.d.od: 111 C.." 121 Accruol 131 Od", (spoelfyl ~ __________________n________
G Mothod(ll 'lid to low.r .f COlt 011I" I.ltoch 0... nol opply Ilf
vol.. clOllng Inventory: 111 0 COlt 121 0 or m.k.t 131 0 ..pl.,.II.nl 141 W chock.d. Iklp lin. HI
H Was ther. ..y ch..g. In determIning qu.,tiU.s. COlts, or v.lu.Uons batwun opening Ind clolmg inventor)'? If "YII," .UKh
Illpl..,uon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
fF
...~
I Old you "mlt'rillly p.tlcip.tl" in the oporation 0' this bUlinln dl,lring 19947 If "No," 110 page C-2 for IImll an 101101
J It you It.tod or erqulr.d this bUllness during 1994, chick hen ...... . . . . . . . . . . . . . . . . . . . . . . .
Part' Inuome
.__.._._.,_.__~_h_..___~__.__._ ._._._....,.. -- _n' ---'''-.' ,--.-.-. . .__...-. n...._.. He,.. ----,----
1 GrOll "nipls or 1110'. Caution: II this Incomo WIS reportod to you on form W-2 .,d lhu "SI.tulory
employ.." box on 11I'1 form w.. chlck.d. ." pig. C-2 .,d check hore , , S,t(ll,t, '}, , .lJ 1 361,563...
2 R'turnl " allow..". ........... . ...... . .... . ......... . .. ., 2
3 SubltICt IInl 2 (rom linl 1 ......... . ...... . .... . ......... . ... . 3 361,563.
4 COli of good. .old Itrom Iln. ~O on pog. 21 ...... . .... . ......... . .... . 4
6 Grall proflL SubltllCt IIn. ~ from lin. 3 . . , .............. . ......... . ... . 5 361 563.
8 Odw income, including fld.ral rid .t,tl g.lolln, or fu.1 tax credit or refund In. pig. C-2) . , . .... . B
7 r~ftU lnoft- Add lin.. , .,d 6 , , , . . , , , , . , , , , , , , , , . , , , , , . , , , , , , , .. . 7 <lA1 5R<l
PlIrt II EXDllnalls, Enter eXDenses for bUSiness use of vour home onlv on line 30,
8 Advord.ing . , , , , , , . . , , , , 8 18 P.n.lon .,d profll-.h,,'ng pi.,., , . . . 1A 2 8153
8 Bid dttIts trom urn or .lrvlc.. 20 R.nt or I.... 11.0 pog. C-41: !fiB
(I" pogo C-3) . , , . , , , . , . . 8 . Vehlcll', mKhlnery, MId .quipment. . . . 20-
10 C. and truck upenses bOther bUllnus prap'r1y ....... . 2nh
(s" pogo C-31 . . . , , , . , , , . 10 927, 21 Repairs rid mllnt,nMlCI ........ I.. " 184,
11 COO'VTUlSronl WId tte. ...... . 11 22 S'ppli.. Inot Incl"d.d In P..t 1111 , , . . , I.,
12 CopllUon , . _ . , , , , , , , , , . 12 23 lax.. and HClnles . . . . . . . . . . . ~ 9,851,
13 Depnu:lation WId secti~n 17q upenn 24 Tny.l, me.rs. and enterl.iM1enl;
deduction (not includld in P.l lilt . frlYII. . . . . ..... . . .J.... ~
t..1 pogo C-31 , , , . . . , , , . , ~. -, 30 202. b Me.I. and
14 [mploy.. bonlfil pr.9'''''' IntlrtalMlent . 1,116,
(olllor lIIo1 on llno ,gl, , . , . . - 14 Chi" f10% 01
16 Insurw. (.11I" Ill., hOlIIllI. . . , . 16 7.295, IIn. 14b II/bllel
10llmll,IIoftl
18 Inlor..t mkK 1""'111[-41. . 559,
I Mortgog. (pold 10 b.,k.. IIc,I, , , 161 d Subl...ct line 24c from hne 2~b . , . . . lli. 569,
bOlllor" , . , , , , , ..... . 16b 11 545. 26 Ulililies 2~ 9 851:..
.............. .
17 llgol lid prof...lonol 26 Wages Oess employment cllldltsl ... . 2R 93,698,
servicls. . . . . . . . . . . . . . 17 Um.!L 27 Other expenses lfrom line 46 on
18 Offlc, U-Inse . . . . . . . . . . 18 9 603. pogo 21 .........., .. .. 21 73 659.
28 Toul IMpenlel blto,. e"p.nSII for busIness use 01 home. Add Une. 8 thraugn 27 In calumns. " , . 28 "54 085
28 Tontotlvo profit 110111, SubltICI lino 28 from line 7 ..... . " , , , ..... . ... . .... . 28 107 4"78
30 hpensll for bUllne.s 1.111 of your home. Anach form 8829 ................ . , , .... . 30
31 Net profit or no..l, S,b~ICt IIno 30 from lino 29,
. If I profit. enler on Form 1040, line 12, ..d ALSO on Schedule SE, line 2 (st.lutory employse..
.., pag' C-S). Est'llS end trusts. nnt., on Form 1041. line 3. 31 107 478,
J
· If, I.IS, you r.tJST g. .n to lin. 32,
32 It you nw, e 10'.. check thl bu th.t d,scrib.. yaW' investmenl in this .ctivity Isee pege c-sl.
· If you chock.d 32.. ontor 11I0 Ion .n Form 1040, Un. 12. .,d ALSO on Schldull SE. IIn. 2
(staevtory employe... see plge C-S). Estates II'ld 'rusts. Inll1 on Form 1041. line J.
· If YlI\I chock.d 32b, you r.tJST .""" Form 11198,
For Plporwork Reduction Act Notice, "" Form 1040 In.tructlon.,
"11:1
l
32. B ~~.t""'''''1II I. ..
32 '...1....'....... ""1
b 11I11....
Schldull C (Form 10401 111114
410110 1.000
.~, ..'
.oft
BF9875-M166
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25
15
It....t. c 111111 IIMOI 1114 HA R V P ^ TCH I N
8I't 08t 0 00. 0 see page
33 Irrvlntor)' ,I b.glMlng of y.... If diff.renl from 1.$1 YI.'I dOling invlntory. .ItKh up/IIl.lion . . . . . . .
34 Pwch'''I lu, COlt 0' 111m' wlthdllwn tor perunll use. . . . . . . . . . . . . . . . . . . . . . . . . . .
36 CO'I 0' Ilbo<, CD no' Includ. "I.., p"d 10 ,.u,..1f ",.,." , , . , . , , , . . . , , , . . , . , , ,
31 ~lN'ills .KI supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
37 QU\It COlt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38 Add IIn.. 33 Uvough 31 .,. . , . , , . . . , , , , , , , . , , , . . . . , . . , , , , . . , , , . . . , ,
38 Inv,"loIy It find 0' )I'.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
09-46-17
,.. 2
33
34
3
.1!"
37
38
I
I you are c aiming car or uc expenses
for this businoss, See the Instructions for line
41 When did you plec. your ,ahlcl. In IOrvlco for bUlln... purp,"s? {monlll, d.,. ,....)
~
42 0' the IDtallM1lber 0' mil.. you drove yOUI' vehlel. durlne 1994. anler thl number 0' mil., )OU ulld your v.hlel. 'or:
. lluslntu_________n________ b CDIM1Ullng __________n_______ a 011I"____________________..________
43 00)'011 lor )'OUt spoo,,' /lov. ...lIIer vehl.l. IVoIllbl. lot p."on. u..7
........................ .
o Y..
o Y..
o Y..
o VI'
DNa
DNa
44 W. your vehlcll 1'111111I1. 'Of' UII 4urlnll Off-duty houn? ................................
415. Do you M' .vidence to support )'our dldueUon? .....................................
b If '"VI.." I. tt.. Ivlo;tlnc. wrltt.n? ............................................
B:
PIIrt V Other Exp.n..., List below business expenses not Included on lines 8-26 or line 30,
QyF_~_~~Q_PY_~~!9PlT_Lq~~_______________________________________________
POSTAGE'
---------------.--------------------------_.~----------------------------
5 412,
1 255,
32 557,
696,
1 643.
647,
31 449,
LAB FEES
-----------------------------------------------------------------------
OUTSIDE HIRE
-----------------------------------------------------------------------
.
SEM I NARS & ME ET I NGS
-----------------------------------------------------------------------
PENS I ON ADM COSTS
--------------------------------"._--------------------------------------
9g~_~~~_~Ypp_~l~~______________________________________________________
-------------------------------------------------- --------------------
-----------------------------------------------------------------------
40 Total Dther .....".... Enllr hltl Iftd on Pili 1. IInl 27 . . . . . . . . . . . . . . . . . . . . . . . .. 41
73 659,
Mill
UflZII UCG
1("., . .
BF9876 -M166
08/14/96 04:23:03 V40!J
25
.:
16
SOED\.A..E C
(Form 10401
a"III.'1I ., I" TIU'IIlY
1.......1 R...... hnlu IUI
H.. .. ",,.1.111
Profit or Loss From Business OMI No, ....'....
(Solo Proprietorship) <(110'194
... Partnanhlpl, joint venturel, etc" muat 1111 Form 1005, ^.ItC~.~
... Allu' II hr. IQ4Q If F.r. 1041. .. h. lullteU.... ,., leh,.I. C Ih,. 10401. !of ..IIU fiCa 9
hll.1 ..n'lI~ ...." IIINI
CHERYL L PATCHIN
A PrincipII bullnln or protlnlon. including producl or "r'iicI Is.. Pig' e-1)
CONSUL T I NG "
c: BUlintSl n~l. If no IIP"III bUllnlu nlml, 11"'1 blWlk. 0 ..,I,V" ID a..h, (lUll, II ...,.
~CHIN ASSOCIATES 26-1713121
E BUIInI" Iddrtls (Including suitt or room no,) ...______ ..____________.,____________________________________
ell 10wn or 011 offiCi 11111 IIld lIP codlJ
F Ac'OIlI\tlng m.lI1.d: III Cuh 121 A,,,uol 131 00111" i1pocllyl ~ __"u'u,.,___________u_____
G Mathodbl used to Lower 0' coli Othlr 1IIIlth DOli nOI iPply (If
v~u. 'IOIlng In"nl.ry: III 0 C.st 121 0 or mork'l 131 D..pll1.ll.nl 141 m ,hock.d, .klP IIn. HI
H Wu ther. .,y ch.,g. In delermlnlnlJ quwultlll, cous, or velultlonl b.tw..n opinIng .nd closIng Inv.ntory? If "Vu," 1t1lCh
~.. No
~.~ 'p~; i::2' f~; I:m;. 'o~ io;,;,' . . .. X -
........................ ..
..plll\ltlon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. Old you "materillly p.llclplll" in the operation 01 this bUllnu, during 19941 If "NlJ,"
J II you '''lid or ICqulrod \hI. bu,'n... during 1994. ,hock h." " . , , , . . . , -
Pert I Income .
1 Gloss reclipts or slles. C.l.Itlon: If this Incoml WIS r"ported to you on form W- 2 .,d the "51ltutory
.mploy.... boa on thl1 form WI; chllcked, sn pegl C-2 IRd check hlr. . . S.t(Tl.t. t3. . . . "'0
2 R.turns.,dlllow.,c.s ................. ...... ""
3 SiAI~KI IIn. 2 from lin. 1 """,."",.' . . , , , ,
4 COII.f g..d. !DId (fr.m IIn. 40 .n p.go 2) .",., . . , , , ,
5 Gro.. profit SubtrKI IIn. 4 'rom Iln. 3 . . . . . , , , , . , . . . , , , , , , .
8 Olhll' Incom.. including Fedenl end stile g"oline or fU1l1 IIll Cledtt or refund tau pig. C~2)
7 Grall Income. Add lines 5 end 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pert II Ex Ln.8., Enter ex enses for buslnoss use 0 your home only on line
8 Advtru.1ng , , , , . , , , . , , ,8 786, 19 P.n.lon lid pr.IiI..harlng pi"'.. .
9 Bid d.bts from Illes or IIr...IClI 20 Rent or llllle (SII pege e"4):
(s.. Pili' e"31 . . . . . 9 . Vehlcl"', m.chlnery, and equipment.
10 c.. of truck up.nsn bOther bUlinUI property
I... P'll. C'31. , _ . , . , , , " 10 1 012, 21 R.p'illl1d m.inl.nl1" ,.,.
11 Commlnlon. "'" f... .""" 11 22 Supplln ~.I includ.d in Pari III) .
120eplltlon . . . . . . . . . . . . .. 12 23 TI.IIOI.,d lie!!nSII . . . . . . .
13 D.pncl.tJon aid lection 179 ..penll 24 Tr",el, mells. .,d entcrllinmant:
d.due1ion (not Include' In P.1 III) . TrlVel. . . . . . . . . . . .
1m P'll. C'31 . . , _ . . , , , " 13 843, bM"I' lid
14 Employ.. blnlfit progr~1 enlorUiMlent
(oth., IhIn on lin. 19). . . . . .. 14 cllll"'''' 01
15 Ins\l'IO" (other Ih.., hllllhl 15 1111. 10 I"'l'd
..... lollmll.lI.ftl
181nter'11: II.. Pll' c-4I. .
. MorI9'll' Ip.ld I. bri.. .Id, , " 18. dSub.ICllln. 24, fr.m lin. 24b,
bOth" , , . , , , . , . . , . , . ., 18b 25 Utllili" ",. . , , , . , ,
17 l'9~ ond pr.'...'.n" 26 W'g" OIlS .mploymlnl ,rodlll)
"rvlell. . . . . . . . . . I . . .. 17 27 Olher uplnus !from Iin. 46 on
18 Olli" IX .."., . , , , , . . . .' 18 462 , P'1l. 21 ""."""
28 Toql IMp.n.'. bl'ore uplnles 'or buslnus UII of horn". Add lines 8 Waugh 27 in columns...
28 Tllltlllvo pr.m <<01.), Subtrocl lin. 28 fr.m IIn. 7 , , . , , . , , . , , , , , . , , , .
30 bpo.... for bu.ln... v.. .f y.ur h.m., Attoch Farm 8829 .."""""",."".
31 Not profit a' 110111, Sub."1 lin. 30 'r.m line 29.
· If . pr.f1t. .ntor .n Form 1040, IIn. 12, lid AlSO on Sch.dul. SE, lino 2 Ialllulory .mpl.y.... J
." P'lI" c-al. EJlot.. ond ~UJl'. .nllr .n F.rm 1041, IIn. 3.
· If . I.... y.u ~ST 9. .n t. 11M 32,
32 If you hove . I.... ch.ck 111. b.. 111" d.."lb" y.ur In...un.nl In Ihl. oc"VIlY I... P'1I. C-al,
· If Y.u ch,ck.d 32.. .nlor 111. I... .n Farm 1040. IIn. 12. ond ALSO an Schodul. SE. IIn. 2
Ialltut.ry employ.... ... pog. C-a). E.tot.. ",d ~UIII. .nt.r .n Form 1041, Ii" 3.
· If YOU checkld 311:1. YOU MJST IUK'" Form 8188.
Fa, Plperwark Re<lucllon A,t Notlc.. ... Farm 1040 Inltrucllono,
H113
379,
190,
4..110 1.000
1 9 89,
2
3 90 ~
4 1
5 76 52,
8
7 7 2
210.
4
189.
373 .
~
27
28
29
30
3 676"
72 9 7
31
72 977.
J
321 8 ~~.I"UI"UI II It
32 S.",.lanltlll.1I111l1
b II 111i.
Schodul. C IForm 10401 1994
J , ..'
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~
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V409
25
17
CH RYL L PATCHIN
08t 0 00 S 0 see a e
lnventlH'Y at beglMing of ya.. If different Irom 105t ya..'s closing inventory. attlch uplllllllon . . .
PwchM.. Ius cost or Items wil.hdrrwn for porson.1 use . . . . . . . . . . . . . . . . . . . . . .
COlt of labor. 00 not include sal.y plld to yourself .... ........ . . . . .
Motorl~. .,d .uppll" , .. .. . .. . .. .. .... ,....
Other costs. . . . . . . . . . . . . . . .
Add 11111' 33 tIvough 37 , , . , , , ,
31 Imontory II end of y.... , . . , , . ,
40 Coat af aood. lold. Subtr.ct Un. 1 fr In II
Part IV Information on Your ehlele. 01Tll ete IS par
on line 10 and are not required to file Form 4562
13 on page C-3 to find out if you must file,
177-4 -
,..2
3,~_
3.
36
38
37
.t8
II
13 , 337 ,
13 , 337 ,
, II 4
Y you are e aiming car or true expenslis
for this business, See the Instructions for line
41 When did you place your vehlclo In service for business purpose.? (month. d.y. ye.)
~
42 Of thl (otel number of miles you drove your vehicle during 199.4, enter the number of mUel YOII us.d your vlhicl. for:
. Bu.Ine"___________________ b Commuting _....___n_.._____ .___ .011I"____..____________..___________
4&. Do you hlVI ,vldlnce 10 support yOIJl deduction?
b II "Y..: I. tho e,ld.nce wrltt.n? ",",'
..... .
. . . ~ . .
0 V" o No
0 V" ONo
a v" aNO
v" No
line 30,
43 0., you (or your spousel hIVe .,othar vehicle IVlilebl. for ponon.1 uu?
44 Was yaW' vehlcl. wlilable for UII during off .duty hours?
. ......
Part V Other Expenses, List below business expenses not Included on lines 8-26 or
EDUCATION
-----------------------------------------------------------------------
-------------_.._---------------------~---~-----------------------------
-------------------------------------------------------------------~--'-
48 Totll other .xpenl.... Enter hlr' end on Pili' 1, IIn. 27 . . . . . . . . . . . . . . . . . . . . . . I .. 48
HII3
4XOlID LDOO
(
I......-
.
J. '. .
"
BF9876 -M166
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19
SCtEOULE SE
(Form 1040)
Self-Employment Tax
.. See Inltructlonl far Schedule SE IForm 1040).
~ AttiCh 10 Form 1040,
n shown on Form 1040
OMl No, 1545-0074
~~94
AlIlt....'"
Stmt,)lo, 17
alplll..1lI .. 111I T.u'IllV
IItllul II...ft" hr.lu "
Nan. I1f penon wj1Jl self-employment Income
HARRY V PATCHIN
Who MUllt Fllo Schodulo SE
You must fila Schadule Sf H:
. You hid net ...nlngl from lolf+omploymenl from other thlWl church employoe Income (Una 4 af Shorl Schlldule Sf or line 4c of long
Sch.dul. SE) of $400 or more: OR
. You hid church emplllY" income of S 108.28 or more. Income from IervlclJ& you performed .s . mlnlU" or I member of .
rellgioul order Is not church employee Income, See pig. Sf ~ I.
Note; EYen if you hi'll' loss or I small .-noun\ of incomu from nU-omployment, it mly be to your bllneflt to fHe Schedule SE end
ule lither "optional m.,thod" in r.,.l II of Long Schedule Sf. See pig" Sf-2.
Satl.\ utwlltv nWlllbll" P,llIft
wIth ..n.....pl.v....1 '"111m. ..
209-46-1732
ENceptlon. If JOur only solf-employment Incomu WIS from e..nings .. I mfnlUlr. member of I religious order. or ChrlsU., Scllnce
practitioner. en you filed Form 04361 Ind receIved IRS approvII not to be tl.llld on thon 11I'01ngs. do not fill Schedule Sf.
InSl.od. writ. -Exempt-form 4361" on Form 1040. IIn, 41,
May I Uso Short Schodule SE or MUST I Uso Long Schodule SE?
Did you recalve wlgel or tips in 199~?
No
Y..
All you e minister. membllr of I religious order,
or CtviSlilf1 Science prlClltloner whoJ racelved
IRS approvaf not to be tlxed on earnings from
theu sources, but you owe self-employment 11.1I
on other ..nlngs?
v..
WII the total
socl.1 sacurlly
nel IlI'nings
S60,6007
of your WIgIS Ifld tips lubj.ct to
or uMoed retlroment tlX plul your
'rom seU-employment more thin
Vel
I N' Y'" u.lng on. 0 f tho option.1 m.thod.
'Ill'''' your n.t ..rnlng. Is.. pog. SE - 211
No
to Vel
-to
No Did you recelv. tips sUblect to soclft.! ucurily or
Medic.. tn thlt you d d not roporl to your
employer?
Vel
No
Old you receive church employe, income Vel
re orted on Form W-2 0' $108.28 or more?
No
YOU MA Y USE SHORT SCHEDULE SE BELOW
YOU MUST USE LONG SCHEDULE SE ON THE BACK
SKtlesn A - Short Schedule SE. Caution: Rud Ibove to se. If you can use Short Schedule SE.
1 Net f.m profit or 1I0ul from Schedule F, line 36, Ind farm pll'lnerships, Schedulr, K.1 (Form
10651. lin. 15. ,.""""""""""""",.,.",.""
2 NI' profit or 1I0nl ',om Schedule C. Une 31; Schedule C.EZ, line 3: and Schedule K-l (Form
1066). line 15. lother th.... '.mlngl, Ministers .,d members of religious orders see plijD SE..1
lor .-nOlMns to report on this line. See pig. SE-2 for other Income to report. . . . . . . . .
1
2
107 478.
3 COmbln.lln.. 1 Illd 2 """",.""",'.' _ , . ~ll,e, ~,t /I,tlltnpn;t. ;lP, 3
4 Net urnlng. from ..If-employment MlIUply IIn. 3 by 92,35% (9235), II I... thlll $400.
do not file this sc.hedulll; you do not OWl self -employment IIX . . . . . . . . . . . . . . . . . . . .. .. ,4
6 Self-employm.nl IIx, II tho omount on IIn. 4 Is:
· $60,600 or I.... mulliply IIn. 4 by 15,3% l1531, Enlor tho r..ult her. ond on }
Form 1040. line 47. . . . . . . . . . . .
· Mor. thlll $60.600. multiply IIn. 4 by 2.9% (029). 7hon, odd $1.514,40 to tho
result. Entlf the tot.1 her. .,d on Form 1040. line 47.
107 478,
99,258,
I Oeducllon for one-hall of .ell".mploym.nll.., Mlltlply IIn. 5 by
50% l51. Enl" tho IIIult her. Illd on Form 1040, line 26 ' . , , , , , , " 8
For P.p.rwork Reduction Act Notice, lee Form 1040 h\ltructlonl.
5
H1I3
4~ I,DOG
A ..
~
BF9876-M166
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21
J:~ N~~jf-
Alln.....
51 .....CI H.. 21
"If nd.1 IInrll, ...,.,
HARRY L PATQ!IN 209-46-1732
You n..d to underlt.,d lhl following 'Irma to camploll thIs form:
Qualifying PenDolal, Dependent Car. Oenefltl, QUllifled
Exp.n..., end E.rned Income. Sea Import.nt Term. on page I
of the Form 2441 InltrucUonl.
Part I PlIl'aona or Organlzatlona Who Provided tha Care - You muat complete this part.
(If au need more space, use the bottom of p.!lle 2,1__ ____,,__,
1 t-I e.. provlde,'s (bJ Addtlll lei ldonllt)'lng numbe'
name umber streot t. no. ell lI.to II1d ZIP coda) (SSN or EI~
Child and Dependent Care Expenses
~ Att.ch to Form 10~O.
... Se. .. .r.t Inlt""ctlon.
Form 2441
-------------------'.-----_..------~----
S tmt 12
--------------------------------------
2 Add IhI 1m01Ilts In colunVl Idl .f IIn. 1, . , , . , , , , , . , , . . , ,
............ .
. . . . .. 2
..,~GJ
1 497,
3 Ent.r the number of qu,lIfylng penon a c..d for In 1994' . . . . .
Did you rlcIIYI
dependont c.,o bonoflh7
NO
YES
~ C.mpl.t. .nly P..I II b.l.w,
~ Compl". PO'I III on tII. bock ""w,
Part II Credit for Child end Depel,dent Care Expenses
.. Entlt the .-naunt of qualified IMp.nlle. you Incurn4 Mld p.ld in
1994, IlO NOT .nlor mar. tho> $2.400 lar .n. qu~ltying pOrIOn
or $4.800 far two ar m.n porson.. If y.u campl.l.d P..t III, .ntor
tII. .....1111 from IIn. 2G ' , , . , ., "..",.""",.."" 4
1
5 Entlt YOUR earned income .... ..................... 5
. It ....'I.d IIlIng . j.lnl roMn. .ntor YOUR SPOUSE'S ...n.d
IncomI 01 .tud.nt or dl"bl.d. ... in.tructi.n,); .11 otho,.,
.nttrthearnountrromllna5 .... .......... ............ 8
.
7 Enl<< Ill. lmello.\ of lin. 4. 5, .. 6 .'".'".
8 Enltr th, .nount 'rom Form 1040. line 32 ....... ...........
I Ent., on linl 9 the dlcimal nount shown below th.t 'PPlles 10 Ih. ~Dunt on line 8
If II.. . II . Dul..1 " II.. . II.
D.d..1
"I u' ....., ....., ......
n"., Iller ,. n.... 11IU 1.-
lO .. 10,000 ," no,ooo. :n,OOO ,14
10,000 . 11,00' ,1' 2:2,000" 14,000 ,Il
12.000 .. 14,000 ,II 14,000 .. 18,000 ,II X
14,000 .. 18,000 ,17 111,000" 11,000 .11 0
1',000 . 11,000 ... 18,000" Hg IIllllI .ID
1"000 .. 10,000 ...
10 Mlltiply line 7 by tII. docim.1 ..Dunl .n lin. 9, Enlor tho r..ull Th.n, ... th. In.trucll.n. for
the MMIUr'It of CI'.dit to Inter on Form 1040. line 41 . . . , . . . . . . . . . . . . . . . . . . . . . . . .. 10
C.utlon: If you p.ld $50 or mar. In . c~.nd.. quart" t. . p....n who work.d in your ham., y.u mU'1 III. ., .mploym.nl
till return. G. Form 942 for del.ils.
0.. IJMrwo .. UG on 0 0 c., .1' lep.r.. nl ructlonl, Form 2.441 (1994)
M7U
4.14400 1.000
~
"
BF9875-M166
04:23:03
25
08/14/95
V409
Form 6251
Alternative Minimwn Tax - Individuals
D.,..I." .. lilt T"u...~
1.....1 "".... S.nlu
... SOD SOp.uto Inltructlonl.
~ Attoch to Form 1040 or Form 1040NIl
~
22
JL"!..'!.~!:!!!L_
~~94
All.......
. .
32
N.".la) shown on Form 1040
tll\RRY V & CHERYL.!....PATCHIN
Part I Adjustment. and Preference.
Vou, loolal "0.,111 numb.,
..2.Q.\}.:!!J'-::..1ll.L
If you it,mlred deductions on Schedule A (Form 1040). go to Itn. 2. If you did nal Illmlll
d.ductionl, Inter yow It.,d_d deduction from Form 1040. IIna 34, .,d skip to line 6 .,.....
2 Modi." 0'Id donI", Enl" tho 1I110010r of Scll.dul, A. line 4, or 2 1/2% of Form 1040, IIn. II . . . , . , . ,
3 llAll. Ent., the .-nount from Schedule A, Un. 9 . . . . . . . . . . . . . . . . . .. .......
.. Ctrllln Int.".t on I horn, morlgage not uled to buy, buil~. or Improve YOU( horn... .......
6 MIClII.,.oUI It.mlred deductions. Enter th, nount from Schodulo A, IIn. 26 . I . . I . .
I Refn 0' '1""". Ent.r .,y I." refund from Form 1040, IInl 10 or 21 ..,.". ...,...
7 tnvlltmlnl int,,"t. Entlr differlncl bltwnn regulll' Iu .,d AM' deducllon . I . . . . .
8 pou.1986 dlprocl.tion. Entar dUfarenCl betw"n r.gur.. tu Ifld AMr d.precl.UQn.. .... ~.t(Tl.t. .1~.
I Adjulted gain or 1011. Enter differ.nce bltween AMT I'ld r'9ul. In glin or 1011 . . , . I . . . . I . ,
10 "endv. Itock option.. Enter uc.sa of AMY incom. over ro9\1'. tlM income .... ............
11 P.llv. ecUvillls, Enler difference between M1r .,d regulAr tu incom, or Iou . . . I :U In.'. .1:1.
12 Blnellcl..i'l of .u.tes .,d trusts. Enter th. .nol,lnl 'rom Sch,dwl, K., I Ihun 104 U. hll' I, . .. ....
13 hA"Utmpt Int.rtll from priv.t. ICtivlly bondl luu.d Ifler '11/18 . . . . . . . .. ,... " ....
14 O1hu, Enl" tho ......t, II ony, for ...h 11.01 ond .nl" tho 101~ on IIn. 14
. Owitlbll contribiltlons h lOll limlt.Uonl . . .
b Clreulltlon oxp.ndllur" I Mining COIl. , , . .
o o.pllllon . . , , , , , ) P.lron'. IdJu'lm.nt . , . , ,
d o.I".dltlon (pr.-198)) k Pollullon conlrol ,..11111", , ' __"........ ....,,__
. Inltlllment SlI.I. . . . I R..e.ch Mld I.IIp.rlmtntll . _._U"_______.
f Intqlbl. drilling .011. m T.. .h,ll" '.01 ..'''Ill'', ____.,_,_,______
g long-term conlnclO, . n Rol.l.d Idlu.lmonll ~.t\Tl.t, t4_,_J.J!P.9-,
T t" d UI Inti ,n p",.,..nc.. Combln I'nes 1 1M u . . . . . . . .
,
" .
Part II Alternative Minimum Texeble Income
~--~_.._'.-
18 Enter the ."o",t from Form 1040, line 35. If II" lh..-. ..ro. .nl,r .1 . Uo..) . . . . . . ,
17 Net operdin; 1011 d.ductlon, If "y, (rom Form 1040, lin, 21. [nler at . pOllhV' Imount . . I . . .
18 II Form 1040. IIn. 32. I. 0'" $111,800 lov" $$5.900 II m.".d IIling "p.'"lyl, ond you
ltemil.d deductions. filter the nount. II "y, from IIn. 0 at !h. wotluhu' for Schedul. A. Iln. 29 . . .
18 Comblno II... 15 lhrou9h 18 , , . , , , . , , , , , . , , , . . , , , , . . . . . , . , . . . . ,
20 AJlernttJve tu ntl operating Ion deduction. S.. Inllluctlonl ...................
21 Alternative Minimum Tu:.ble Income. Sublrlel lin. 20 Irom hn. 1~. Uf lilt tI.. 111111'
.etel .,d line 21 Is more then 1 I I . . . . . . . . . . . . . . . . . .....
Part III Exemption Amount and Alternallve Minimum Tax
_.._---.~.'.--. --.-
22 E)Cemptlon Amount 01 this form II 101 . chUd undlr 1111 14. lee lnllrucllonl.l
If your flUng It.tul I.:
Slngl. or h.1d of houllhold , , , , . , . , . , ,
M.nl.d IIlIng lolnlly or qu~lIylng wldowl"I, , ,
Mwrl.d IlIIng lip. ,"ly , . . , , , , , , . . . ,
An" 1'~1. "11, ftft'. ^v..'_,..,__,I~..r. on"!!!l0}'2:
=wJl.! $ ('too~' ."~ , . . , , ':"~ m,780 .....
180,000 , . . , , . , . . , . .. 45,000 ,
1~.OOO . . . . . . . . , . , .. 21.500
If IIn, 2. I. aver lh. Imount Ihown Ibov. 'or ~N IIUnl 11.IUI, ... 1RllllotcUonl.
23 S""~ICt II.. 22 f,om IIn. 21, II 10'0 or I.... .nl" '0, her. ond on IIn.. 28 ond 28 , . , . .
24 II llno 23 I. $175,000 or I... 1$87.800 or I... II m.,lld flllnl .0p.II.ly). multiply IIn. 23 by
28% '28~ Olllorwlll, multiply IIn. 23 by 21% UIl ond 1UtI",,, $3.800 1$ 1.750 II m.,I'd
filing ..p.It.I~) from Ihl r.lull . . . . . , . , . . . . . . . . . .. , . . . . . . . . . . .
26 AllIrnltlvo Olin..... ,.. for.lln ... mdll. $.. In.lru.tlon. .",.....,...,.",.
28 1"'1_ minimum I.., SublrlC' IIn. 28 from IIn. 24 ".,.,......",.,.,..,
27 Inl" your tn 'rom Form 1040. IIno 31 Iplu. ony "'0""' 110m Form 4970 ,"clud.d on Form
1040. IIno 391. nil"". ony lor"go tn CI.dll f,om Form 1040, IIn. 43 "".,'.'""
28 AltlrnaUv. Minimum Tu. UI thil form II 'or. child undll 'V' 14, sn instructions.' SubtrlCt
lint 27 from line 2&. If "'0 or 1.11 .nler . .. Ent , h.re .,d on Form 1040 line 48 .... . . . . .
For Paperwork Reduction Act NOtlCI, I.e ..p.,.t. Inltrucllonl.
"'1>>3
4X000 1.000
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form 4562
Depreciation and Amortization
(Including Information on Listed Property)
~ See lieparat., instructions. .... Attach this form to your return.
OMI H,. '....0171
~~94
O'PIII_III of 1111 TuulIlY
,,11111' "...nuI S.r~lu (991
/iC...w 1".11 al 1,lur.
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Until Vi.. .....,
HARRY V &, CHEFJ.'L~_l,,_P1\IQ.tU.J\J.___.__.___,,_,_ ______.,_n_. _ _____..
1.1.... IN ,ulwlly III whltll IlIli 101m ,,1'115
09-46-1732
Surrmarv Form 4562
Part I Election To Expense Certain Tengible Property (Section 179) (Note: If you have any "Listed Property,"
complete Part V before \(,OU corTlplete Part 1.1
1 Maximum dQII... limil.tion (If ., enterpriso lone businoss. seo instrucllonsl . . . . . . . .
2 Tatel cost 01 ulclion 179 properly placod in scrvll':o during tho lu YOGI' Iso" instructions)
3 ThI.5hold cosl of section 179 properly boforo rcduchon in hmilltion . . . . . . . . . . .
4 Reduction in limil.tion, Subt,.c! line 3 from line 2. If lero or loss, enler .0.. . . . . .
5 Doll. IImit.tion for tlX ~ur. Sublflct lina 4 Irom Iino 1. If zero or Ius. enler .0.. (If mimed
flllng sep.,..tel~instructjons.I' ......................
III DIICllpllllllGI piG"llIy
1
--~.
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4
,._ __Ec~9_q-,-
__,Z5 , 338 ,
200 , 000 .
5
(Ill CUI
lei 1I1,1,. nil
6 See Activity Form 1562 Dotall
17 500.
7 llsled property. Enter ~ount from line 26 . . . . . . . . . . . . . , . . . . . . .. 7
8 Tolal elected coU of snction 179 property. Add amounts in column leI. tines 6 end 7 . 8
9 Tentative deduclion. Enler the sm.II" of line 5 or line 8. . . . . . . . . . . . . . . . 9
10 C.ryoyer of dlsellowed deduction from 1993 (see instructions) . . . . . . . . . . . . . 10
11 Teuble income Umilatfon. Ellter the smlller of tlXable income {nOI leu then lerol or Uno 5 (see instructions) . --1L
12 Section 179 e;llpense deduclion. Add Iinos 9 II(ld 10, but do not enter mora than line 11 ."......,. 12
13 C.ryover of disallowed deduction 10 1995. Add lines 9 II'1d 10. re~s line 12. _:_:...~..l!i]----NONE ;,.".,.;
Note: 00 not use P..t II or P...t lit below for hued propert~ {lNtomobilu, cort.in other vehicles, cellular telephones,
tertlin c/HTlplJters, or property used for antert,inmont, recroation, or MTlusemend. Instud, use Part V for hUed property.
Part II MACRS Depreciation For Assets Placed in Seryice ONLY Durln9 Your 1994 Tex Year (Do Not Include
Listed Property)
17 ,500.
17 ,500 ,
17 ,500 .
17"!?OO'
"""\l!i"&f1illij
:':~:n:~m~t'w,. .::-\>.:!,;;-",:......
II' CI.uIlIClI!on III plOptrlV
~bfMonlll 1n4 f(rU..li-~'-dep'''I'llolI ('1'
VII' plul. In (blislnUl/lnmlm.nl un ICOUIV hI CGnnnllan
. ui~ICI olll~ R SI. IMllllttlOll51 plllal
Section A - General De reelatlon 5 stem (GOS IS80 inSltuctionsl
ee
Ac t I V I t
F rm
62
De t a II
III a'p"elIIlCl. ."lIuIDA
14, 3.... 0 ert
b 5-Yllw proPerty
c 7-Vllr property
d lO-year ElrODert
It 15-y... proDerlV
f 20-Y,,, property
g Residential rent.1
ploperty
h NCWlaidentlal u.1
ploperty
843.
518,
1ll.~ -~ SIL
27,6 rs, M\'I S/L
39 ., ~ S/L
~ S/L
stom lADS) .ee instructions
15. Clu. IIf. S/L
b 12-yoer 12 s, SIL
c 40-yo.. 40 rs, M\1 SIL
Part III Other Dep(eclatlon (Do Not Include Listed Property)
18 GaS Ind AOS deductions lor .uets pl.ced in service in tu yo.. bllginnlng before 1994 1st" instructions) 18
17 Property .ubjec' 10 "'lion 16811111) .Ioclion (... in.truction.) 17
18 ACRS .,d other deprllci.tion (seo instructlonsl ............................... 1
Part IV Summary
19 Listed propert~. Enrer Mnovnt from hne 25 19
20 Total, Ad4 d.ductlOns on line 12, lin.. 14 ';d'lS 'I; ~ol~~; (~I: ~,j ii;.; ;6' ~r~uih ;9: Eni,; her,
II1d on the epproprilte hnes of ~our return. (P.tn.nhips and S corpofltionl see instructions 20
21 For usets shown lbovlI .,d placlld in service during thll curnnt year, enlor
thl Dortion of the bnis Illribulable 10 see lion 26JA costs (see instructions) 21
For Paperwork Reduction Act NOtlCII, lee page 1 of the seplr.tll Instructlans.
H7e::J
5 981,
6 618,
31 480
foil" 4582 11114)
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08/14/95 04:23:03
V40S
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24
fOfm 4562
Depreciation and Amortization
(Including Information on L1slod Proporly)
OMIt .t. "4t.0I72
~@94
0.,111..11 II ... l'nlllfy
I....~ ~."... hnln 1111
...... Ib...1I nlllll
... Site IIIp.,.t. Inltructlonl.
... Att.ch thll form to your return.
Alllt~fI',"
$"1j.~n N,. 67
U..lI'~I., I..h,
HARRY V & CHERYL L P^Tj;l~Jl!___.
'.1"&1 II nll,ll)' I, ,dldl 11111 lor III 111.1"
__..______~____..__._..___~__u.___.._
HARRY V PATCHIN DDS - SCHEDULE C
Part I Election To Expense Certain Tangible Property (Section 1'19) (Note: If you havo any "Listed Propflrty."
c~lete Part Y before you cClIllJlelo Perl I.)
1 MullTM1l doll_ IImlt.tlon (It ,en enlerprlse lone businlll, 110 lnllruclionsl . . . . . . . . .
2 TOlal coli of lOti ion 179 propnrl)' pl.cod In urVlce during tho till ye.. (110 instructlonl) .
3 Thn&hold colt 0' seclion 179 prOpllrl)' before reduclion in IlmiUlion . . . . . . . . . . . .
4 R.duction In limitation. Subtflct line 3 from line 2. If zero or Iln, enler -0" . . . . . . .
6 Doll. IImlt'tion for (.... YIIII'. SublrlCt hne 4 from Iino 1. II loro or loss, enler -0-. (If mll'rlld
filing IIP..tel~ Inst~l.'chon5)_:"":~_'~~:'_~~~.~' ~__:-:....~ ......:..-~...:.:~...:....:..._ 5_
8 1.1 ''''''pll," ~~,'~~~~':_,_,_ ..,_-=_ f III '01' "~.::~:
7 lilt.d property. [nt"r ."ount from Iino 26 . . . . . . . . . . . . . . . , , . . 1. .---- -
8 Tolll .Iecled cDS I of $Iction 119 property. Add amounts In column (c), lines 6 II1d 7 . . . . '}i
8 TontativI deduction. Enter the smtller of hne 5 or lin. 8. . . . . . . . . . . . . . . . . . . . _ 8
10 C.ryover of dlSlllowed deduction from 1993 lue inSl1uclions) . . . . . . . . . . . . . . . . . . . 10
11 h;uble Income IImlt.tion. Enler the smlUer of tuible incomo (not less thM'l 11((11, or line 5 (sel instructions) . J1_
12 S.ction 179 upenn d.ductlon. Add Imes 9 IOd 10, but do not ontor more lh.., hne 11 ........... 12
13 C.,yam of dl.~law.d d.dUtll'n ,t' 1995. Add IInOl 9 Ifld 10. I... IIn. 12.~C
Not.: Do nol un P.t II or Plt't III below for listed prop'rl)' (IUIomobile5, Clrllln other v.hicles, collulll' letophonlS,
c.,tlln computers. or proporly uud lor enlert.inmont, (lcr"tlon, or MTlusllmentl. Inste.d. use Pit" V lor listed properly.
Pert II MACRS Depreciation For Asaets Placad In Service ONLY During Your 1994 Tax Year (00 Not Include
L1elod Property)
_1..
-L
3
~,
1.1 (1...lIlu1l011 II plGplltv
.-[-lbl~Monl~--;;;'
y"1 pl"dln
. 1I,.,Ir,
Section
Connnllon
IIID""11.1I01 .dnll'l
-
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Dopracliltlon System fODSI soo instruchons +_____..
14. ~-Ye.. properly
b 5-YIII' prollerly
c 1- yl. property
d 10-y",. prDl!.!!L-
., 1S-yew property
f 20-y,. pro eft
g Residential rent.1
_~oper'y _
h Norvesidentia! real
property
3 623, 7,000
HY
OOOB
518,
Section 8 - AIl!!.n~tl1l8 De
16 ~ ~~~s e~ e ~~1:\~~~:t~~~1~S;1R~(!h1 12 n.
o 40-y,r 40 rs.
Part III Other Depreciation (Do Not Include L1sled Property)
16 GOS *1d ADS deductions for '55ets pllced in service in 11.1I. years begiMing before
17 Properly subject to section 168(f)(1l eleclion (ste inSl1uc\ionst
18 ACRS and other dQllreclelion (s e inslruction, ........
27.5 rs, IR>1 SIL
27.5 rs, ~ - S/L
39 rs, ~ SIL
~ SIL
ranl'Uan 5 .Iom IADSI (... instruclionsl
M\\
SIL
S/L
Il
199~ Is.. In.truch,n.)
18
17
1
5,566,
Part IV Summary
19 LI.t.d prop,ny, Ent.r omounl from lin. 25 ~9
20 Tolll, Add d.ductlOn. on Iln. 12. IIn" 14 ';d '15 ',n' ;ol~~n' 1;1: ~.j i,:.; ;6' ~,~u'9h 19: En;.; h"'" ' , , .
.,d on the ~prop(l.te lintS of your return. (PlI'tnllrshlpS rid 5 corporalions - SII instructions ....,... 20
21 For assets shown .bove Ifld pllClJd in service durln~ lhe current y..... elnler
the tlor'Jon of the basis Iltribvllble to saction 263A costs {see instructions
For P'porwark Roduotlon Act Notice, 1.0 pago 1 of the leparate inltrllctlons.
KII' . So,> Depreclat Ion Detail
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BF9875-M166
08114195 04;23;03
V409
25
28
form 4562
Depreciation and Amortization
(Including Information on Listed Prop arty)
OMa Ho. "0-0172
~@94
0.,.1"" II lle TII""~
I ..1 flu..u hlvh. 1111
JII.1b1 ..... o. "hn
.. Se. aep"ilte In,tructlon..
.... Attach thll form to yuur return.
:~I':::~"'Nn. 67
14..Ufyl'l ...h,
HARRY V III CI:iI;B.y'~_~_,E~E'J:!L~L.._
..,.... If utl,lIV II ,dldt IllIa lalm 1I1.e..
09-46-173L_
I T
PIIrt I Election To Expense Certain Tangible Property
complete Part V before ~ complete Part I.)
1 M..lmum doll. Umllatlon (If In ontllrpme lone buslnoll, SI" insl1uctlonsl . . . . . . . .
.2 TOllI to51 of 'tclion 179 pr"pllrly pJlCud III ""\lltll during tho lu YOI!' lsoe instrllcllonsl
3 Ttnlhold COlt 01 .0Clion II!) propllrly boloro roducllun III Ilnlllllion . . . . . . . . . . . .
4 R,ductlon In IImit.lIon. Subt"ct IInu J from hnu 2. If loro Ilr lon, anlur ~O- . .. . . . . . .
6 0011. IImltltlon for I.x YII', Subtract line" from line 1. If uro or IUI. Inter .0-. Ut m.rled
fllirl4 leD."lly. lee Instructionl.) . . . . . . . . . . . . . . . . . . . . . . .. .,.
e 1.1'.."""..."",.", ~"C'" EI<lII""'"''
7 lI1l.d plopor'y. Entor omoun' from hno 26 , , , , , . , , , , , , , , , , , , , , , , CL1=
B TtJtll elecled coli of IIcllon 179 properly, Add .nounlS m column (cl. hnus 6 IIld 7 B
9 Tentltive dedUClton, Enter Il'le sm.ller of line 5 or line 8. . . . . . . . . . . . . . . . . .. ....... 9
10 C.ryover of dillllowld dlduction from 1993 Isee Instructions) . . . . . . . . . . . . . . .. ....... 10
11 la.uble Income limit'llon. Enler 11'1., Imlller of tullble Income (not len than rero) or hne 5 (see inSlrucllonsl 11
12 Section 179 expense deduction. Add lines 9 and 10. but do not Imtor more than line 11 . '~-"..~2.~_.~'...J..!.
13 C.rvov.r of diullowed deduction to 1995. Add linlls_9 III1d 10. Ion line 12. . . ~_u~iI_~ NONE ~k:~:
Note: 00 not use P.t II or P.t III below for listed property (lIUtomoblles. cert.in other vehicles. collulll' teleph'1nClI,
c.,tllin computers, l,\r proporty used for enlertainmont, recreation, or ImlJument). Instud, use Pll't V for Iisled property.
Part II MACRS Depreciation For Assets Placed In Service ONLY During Your 1994 Tex Yaar (Do Notlnclucle
L1stOld Pro e )
Note: If you have any "Listed Property."
..1....
2
,t.
4
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-
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b 5... ro ert
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e lS-y.. Droperly
f 20-v,.. prOperly
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property
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property
4 215, 5, 000
HY
2000B
843,.
Section B - Alternative
16. ~~~s .~fll :.!!i~~ti~:1r:f~1~ri1:~{~::~: 12 n.
o 4 . .. 40 n.
Pert III Other Dapreclation (Do Not Include Listed Property)
-------------
18 GaS Ind ADS deductions for assets pl.ced In service in tex ye.1 beginning beroro 1994 (SflO instructions!
17 Property subject to section 168ltll1l election (see instructions)
18 ACRS ...d other dePfeci.tion (see inslrucliol1s ...............................
Part IV Summery
U-5 II. M'oI _ .......lli
27,5 II, M'oI S/l
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De reelatlon S stem IADSI 1.0. instructions)
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1'1 listed property. Entor wnount from line 25 ...........................
20 Tot.I, Add d,ductions Oil (,no 12, ('nos 14 ond 1\ in column Igl, ond hnos 16 through 19, Enter her'
n on lhe 'Pproprilte lines of your relurn. lPlI'tnlnhips Ind S corporetlons
21 For asuts shown Ibove .,d pieced in ler',Ic. during the current ye., enl,r
the Dortion of the buis .1tributable to section 263A cos15 see Instructions
For Paperwork Reduction Act Notlc., lee page 1 of the lep,rate Instructiona,
~~ - See Depreciation Detal I
19
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08/14/95
04:23:03
V409
25
31
Form 4562
Depreciation and Amortization
!Including Information on Llstod Propurtyl
.. Se. .ep.rate InltrucUon~ ... Attach thl, form to YDur return.
:~"::::Ill fil. 87
I'nlllyll' ...lter
OMI .... I,,,,.om
~@94
D.,_I... " Ill. 'I"U'~
IMIfIII' "....II. SlIwh. lnl
N...w u,., III lilt...
HARRY V & CH~B.YL_\' ___PAIQ.H I N ___,,.,,. __,.__.._____ ,____
a.l.eu If "lit/IV II Jlllld till. 101111 Ill.."
_ Q!l-46-1732
-- SCHEDULE..&....-
you have any "Listed Property,"
APAATMENT RENT
Part I Election To Expense Cortaln Tangible Property (Suction 179) (Nota: If
complete Part V before you co~le Pert I.)
1 Mulmurn doll. llmil.lh~n IIf -' enterprise lonl buslnell, 11II1 instructionsl . . . . . . . . . .
2 Talll coil of nclion 179 proper I)' ~I'clld in service during tho tll\ ~tlr Is,t instructional. .
3 Ttvuhold cost of I.cllon 179 property bolor. reduction in Iimit.lion . . . . . . . . . . . . .
4 R,duction in IImlt.hon, Sublnct hne 3 from Ilfle 2. II IIro or 1.11. .nlar -0.. . . . . . . . .
5 Doll. IImlt.liol' for t.... yur, Sublr"t lint! . from Hne 1. If rero or Ian. enter .0-, III mMrled
e 11I1", "P"""'o..!.~~':;:'!~;:;~::i!;' ,;- ~:.~.:~~_' " .: ' , '..: : '-'~:-'L:T.;'~'~ '_:,':.' : ."_;;;;,:,;:,'-;;;,_!L
1 listed property. E~;r-;llount ';;n- hnu 2~'~-:-.-~~~~~-:-:-: . ~~'-:-:U__ -~==-==--=-_-=
8 Total ehlclod cost of soction 179 properly, Add alllounts III colunm lei. linos 6 MId 7 _.J!_
Q Tinllllve deduction, ~nter the smlller 0 f line 5 or line 8. . . . . . . . . . . . . 9
10 C.ryover of dislllowed deduttion from 1993 {SOl instructionsl ... . . . . . . . . . 10
11 hA1b11 income limitation, Enlor the smaller of tulble incomo (not Ius than uro) or hne 5 (sOD instructionsl 11
12 Sfc~on 179 Iltpense deduction. Add lines 9 .,d 10, bUI do not enter more th., lino 11 ,........, 1
13 C.ryOYer of disallowed deduction 10 1995, Add ~neJ 9 W1d 10. leu line 12. . . .... UiJ
Note: Do not u~. PM'1 II or P..1 III below for listld properly (eulomobillS. urtain other vlhlcles. e.!lulll' telaphones.
eertlin computers. or propflrly uud for enlertainment. recrullon. or wnusemenl), Instud. use PM't V for listed properly.
Pm /I MACRS Deprecletlon For Assets Placad In Service ONL V During Your 1994 Tax Year (Do Not Include
Listed Property)
hi C/uIUlullu 01 prop.rly
UI M.lllo' III D.plleI..loll '."'ell,.
see Inllructl~
14. 3~YI" property
b S-v'. prop~lv
a l-YI. property
d lO-YI.. property ...._______
. 1S-vI. pro2!!!L-.__._____
f 20-yo. proportL-_..__._.__.
g Resldlnti" renlal
property
h NONeslduntill re.1
property
27.S " MM S/L
27.S r1, MM S/L
39 n, MM,___ S/L
MM S/L
.tom lADS) ,.. Inltruellons
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b 12-v.. 12 1'..
c40-.. 40rs,
Part III Other Depreciation (Do Not Include Listed Property)
MM
18 GOS IIld ADS deductions for IsseiS pllcod in service In lu yew, blglnning before 1994 (see instructionsl
17 Proporly 'ubi oct I. ..""n 1681f)(1I .,oclion I'.. InsUuclion,)
18 ACRS Ind otner depreci.tilln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pert IV Summary
415,
Ie
17
1
19 listed property. Enler <<nount from line 25
20 rotal, Add d.duction, on 'in. 12, lin.. 14 ";d '15 'I; ~'I'u,;,; (;,: ;",j ii~'; 16 ti.r~u~h ;9: En;.;
...d on the Ippro~rille hnes 0' your return, {Pwtnerships Il'ld S corponlions . see instructions
21 for assets shown above .,d placed in service during the current ye.., enler
the portion of Ih. bnis ,"ribullble to lOelion 26 A cosls see instructions
For P.perwork Reduction Act Notice, see page 1 of the soplrlte Inltructlons.
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BF9876 -M 166
08/14/96 04:23:03
V409
26
38
HARRV V & CHERYL l PATCHIN
CAMP Hill, PA 17011
St atement 3
209-46-1732
Supplement to Form 1040
-------------------------------------.---....-------....._---_.._-~--_._--------
Summery of belenoe due, penaltlee end Intereet
------------.-.-.--------------------..-.-----
Tax per Form 1040 (line 53)
Less: payments
Ba Isnoe
53.B11,
50.0~0 ,
...........----
3.811,
Plus: Penalty from Form 2210
Interest due on unpaid balanoe
Total balanoe due
2,
124,
3.937,
-.--.._---
Oetell of additional penalty and Interest
-----._._----..-----~----------------_..-
Interest due on unpaid balanoe
"
Underpayment
3,811,
3,891,
04/16/95
06/30/95
End, date Days " Interest
--------- ,.- ---...------
06/30/95 76 10 80,
08/15/915 46 9, 44.
--..-------
124,
...-----.-
Beg, dato
Total Interest on unpaid balanoe
.
I, .
Statement 3
" .
.
, ,
BF9875 -M166
08/14/95 04:23,03 V409
25
41
HARRY V & CHERYL L PATCHIN
OAMP HILL, PA 17011
Statement 8
209-48-1732
Supplement to Sohedule A
-----...----.-----.------.-------..---...--..........._......._.~---_.-.-_.-_.--
Itemlzod Deduotlon Worksheet
---------~-*----------------
1 . Sohedu Ie A.
2, Sohedule A.
Ine. 4. 9, 14. 18. 19, 26. 27 and 28
Ine. 4. 13. 19 and Qambllng los.es
30.988,
------------
3,
Line 1 Ie.. I I ne 2 ""."""."
........ .
30 . 988 ,
.......--...
4,
Line 3 mu I tip I I ed by 80% ,,"',"
...... '"
24.773,
---------..-
5. AdJu.ted gross Inoome . ,"',' ..'" """,'.
6, '111.600 (S5s.aOO/marrled tiling separately)
171,647.
111.800,
-...-----...----
7, Llne5 Ie.. IIn86 ,..,........,....,......
69.747,
,-.-".-..-...
8, Line 7 multiplied oy 3% ..,....,....,......
1,792,
--.-.......-..
9, Smaller at amount. on lines 4 or 8
1.792,
..--...-----
10, Total Itemized deduot Ion. (line 1 lau line 9)
29,174,
-----.-.----
.
, "
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Statement 6
" ..
, . .
BF9875-M166
06/14/95
04: 23 : 03
V409
25
44
HARRV V & CHERVL L PATCHIN
CAMP HILL, PA 17011
Statement 9
209-46-1732
Supplement To SQhedul. E
----------...------.------.....-.---..........--.........----------.---.....----
,
Depreolatlon and Depletion, Sohedule E - Page 1, Line 20
-~----w........__.....____...._......__........___...
Kind of property:
Looetlon of property:
APARTMENT RENT
CAMP HI LL PA
Depreolatlon and ourrent year 'eotlon 17& expen'e
Total depreolatlon end d.pletlon
416.
415,
.---------
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, "
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.
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Stetoment 9
, , ,
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of ., .
BF9876-M166
08/14/95 04:23:03 V409
25
49
HARRY V & CHERYL L PATCHIN
CAMP HILL, PA 17011
St at emen t 14
209-46-1732
Supplement to Form 6261
------------------------------------.-------...----...---...--...--.--.---------
Pa..lve Aotlvlty - Inoome and Lo.s Oetal I
-----.---...--..------......----...------
Regu I.r
Ino,llon
AMT
Ino,/lo..
Ao t I v I t Y - APARTMENT RENT
Gro.. Inoome
Total deduotlons lexcludlng daplatlon)
Post-SS depreolatlon
Inoome or lo.s before Ilmltat Ions
4,260,
766,
N/A
4,280,
768,
103,
------------------------
3,604,
3.607,
------------------------
Allowable Inoom. or Ion
3.504,
3,807,
- ____ - - - - __ - - - - - - - __ 0'- __
Net Inoome or Loss
3,604,
3.807,
----..------------------
Related adjustments
---------.----.----
Deduotlon adjustments (a)-Ib)
la)
Rsgular
Amount
(b)
AMT
Amount Adjustment
------~----------------------
---------- ------------
Keogh ret I rempnt/SEP deduot Ion
Total to Form 6261. line 14n
12.090.
10.090. 2.000,
2.000,
------.-..--
Line 22 - Exempt I Ol~ Wor ksheet
--------.--------------------
1, $33.760.
$46,000.
$22.500.
If single or head of household
If ma" led filing Jt, or qual.wldowler)
If married fl ling separately
46,000,
2, Alternat Ive minimum taxable Inoome. line 21 163.743,
3, $112,600. If single or head of household
$160,000, If MF J or qual, wldowler) 160,000,
S 76.000, If marr led filing separately ----------,-'-
4. Line 2 less line 3 3.743.
Cont Inued on next page
Statement
14
.
INCOME,STA. Pllchln
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QUARTERLY TAX PAYMENTS
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flIe no,; 95-0091
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~ 1040-eS (OCR)
w. 11'1.,1"''''''-'' 'Jilt'... "'o1U~1) 1995 Payment 4
jl:'''.1I fle,r"I" ti.,~,t. Voucher
Filt! only If you 4rt milk In!) t1 pllymenl of ft5tllllJled IU;ll R I h '
"Internnl A,vlnue Silvie.." Ple05lJ WtthJ your socIal ~ec~r~~n~IJ~;:ul~h:~llNllh ctllck or money "tOIr paYlIbl1 to Ih,
or mn~~, order 00 '101 511nd C3$11. Enclo!ie, but (Jo nol Mnpl II 'h and ~199& Fotm 1040.ES" Oil ~ou, chllck
41 or B ae . your Pdynllmt WUh1h11 voucher. '
20~4b1732 UY PATC 30 0 9512 430 28
OMS No, f~'~'OOB7
Calendar yeer-
~an, 18, lBB8
28 20~-46-1732 UY 177-48-5601 ~512
~~~R~E~O~ ~~ERYL L PATCHIN
CAMP HILL PA 17011-2121
~~~~/Il'k Ikdur;lum AI;I Nnlln!, 1il'I.' lII~\'LJ(htllH.
--
1'01' N,l I,lO'(jf'V
Amount of paY'11l;lnt S ,.,..1.,).: cJ p (I
Chon'go nOllll) or SSN II InconeCI 11"d not I -...--
corrected. CrQ!i5 QuI flilllle "ncl SSN '-,f (1~~~Ys:~IIY
(1Iv01,od 'POllG" Gol Form 8822, Chan e 01 Ad r or
10 I('port a now il(/d'I!~'II!'o.CI} Inr.lrlJCllGn~J. d e$5,
PA.40ES
INDIVIDUAL
1-" I,LI-I.',II!1 III Llt 1_{',tt,I.'1.
1995DECLARATlON of ESTIMATED
PERSONAL INCOME TAX
. ...-... . ----.---_._----",-----
Il'L rlo1j
JAN.
1b, 1'1'1b
. ._________.._u._..'_
"
209-46-1732
PA32
['-"-] X lHi5
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L._. lOUM."
SUI.i',\Itllti'::'
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DECLARATION OF E5TIW\TEO T^X
PA 17011
RUD
IN,IftUCTIOHS
"'''IINIIAI''L
OOU,UAMOUHIS
PHOTOCOPIES
ANllOTKEA
FACSIMILES
Olf THIS
FORM.AAE
HOT
ACCEPT.lBI.E ,_
D 'X' THIS IM.OI;K I' you "'~l
A FI6C.AL FILER, INDICAn
BEGINNING
ENDING
I
I
~__., .~..,.__.._'.._ I
AM()UNT OF HilS PAYMENT
HARRY V l.
PATCHIN
527 DEI": .,~
CAMP HILL
...ERYL L
'2700QU
.
BUREAU USE ONLY
01210020'l4b1732003000DDOOOOb
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1 T.t.~P~YEA SIGN"TUAE 1 PHm..E NUMBER 15POV5E 6 SIGNJ,TURE oIF " JOlt~T DECLAf;ATIONI I DATI 1
PHONE 17171 7el.4QOO
West Shore Tax Bureau
3e07 ROSEMONT AVE., P,O, 80X e~8
CAMP HILL, PA 17011
Querterly Payment InvoIce
HARRY V
PATCHIN
0-131-555
MAKE CHECK PAYA8LE TO
WE!\T SHORE TAX 8UREAU
"1,
OUR RECOROS INDICAn YOU
ARE A RESIDENT OF:
98050 CA"P HIll BORO
"'
QUA"TI" DU' ....
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OU'''TlIt QUI to."
'TH ,~"n 9Jr
QUA'''U DUI t2.~t ,0,
DlN)
SOCIAL SECURITY.
209-46-1732
IF ADDRESS IS INCORRECT
CHANGE BELOW
1995
.
527 DEVON RD
CAMP HIll PA
17011
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HARRY V. PATCHIN, ) IN THE COURT OF COMMON
Plaintiff ) PLEAS OF CUMBERLAND COUNTY,
) PENNSYLVANIA
)
VI. I CIVIL ACTION. LAW
)
) NO. 94.7225 CIVIL TERM
CHERYL LYNN PATCHIN, )
Defendant ) IN DIVORCE
DEFENDANT'S PRE-TRIAL STATEMEN1'
Defendant, by her attornay, Samuel L. Andes, flies this Pra.Trlal Statement In
accordence with Pa, R,C,P, 1920.33(b):
1, ASSETS, A list of the marital assats is attachad hereto and marked as Schedule
'-A, A list of the non-marital assets, as known to tha Defendant, Is attached hereto and
marked as Schedule 1-8,
2, EXPERT WITNESSES, Defendant would plan to call the following expert
witnesses:
A, A real estate appraiser if the parties are not able to agree upon the
fair value of the real estate which they own,
8, An accountant or other qualified expert to establish the value of
Husband's dentel business if tha parties cannot agree upon a value.
C, An appraiser of personel property if the parties cennot agree upon
either the disposition or the value of those items,
The Dafendant reserves the right to call additional expert witnesses. if necessary, to rebut
I the evidence of the Plaintiff,
3. FACT WITNESSES, Defendant Intende to call herself aa s fact wltneas and
reserves the right to call euch additional feet witnesses as may be necessary to rebut
evidence offered by Plaintiff,
4, EXHIBITS, The exhibits will consist of tho parties' federal Income tax returns for
at least the past five years. copies of documents relating to Husband's purchase of his
dental business and real estate, copies of statements showing the balances in various
accounts and the value of the other investment-type assots, Copies of those exhibits are
not attachad to this pre-trial statement because either exceed three pages In length or they
are not yet available because the statements offered at the hearing date will be ones that are
the closest to the hearing date and those statements are not now available,
5, INCOME STATEMENT, Defendant will file en Income and Expense Statement at
the time of the pre-trial conference or prior thereto,
6, EXPENSE STATEMENT, Defendant will file an Income and Expense Ststement at
the time of the pre-trial conference or prior thereto,
7, PENSION INFORMATION, The retirement benefits of the parties consist of
deposits into var;ous plans and accounts which can be valued fairly simply by a review of
statements showing the balances in the accounts at the time of separation and a calculation
of tho growth of that marital portion of those assets up to the time of the hearing,
Defendant will offer exhibits showing the value of those assets et the time of separation and
her calculations of the present value of that marital portion,
8, COUNSEL FEES, Dafsndant has agreed to pay her attorney $150,00 per hour.
At the hearing she will offer exhibits showing the work done by her attorney up to the time
I of the hearing and setting forth the precise amount she has incurred in counsel fees up to
that time,
SCHEDULE '.A . MARITAL PROPERTY
DATE OF MARITAL AMOUNT OF
ASSET VALUE VALUATION PORTION LIENS LIEN
Residence at 527 $300,000,00 10/97 100% (a) PNC Bank (a)
Devon Road, Cemp (estimate only) mortgege $153,916.74
Hili, PA (b) PNC Bank (presently)
home equity (b)
loan $29,267,26
(presently)
Office building at $220,000.00 10/97 100% Mortgage $82,053.00
407 South 32". owed to prior
Street, Camp Hili. owner, Patrick
PA Dohoney
Husband's dental $200,000,00 10/97 100% Thera are $95,000,00
business (estimate only) debts but Wife (approx,)
does not
know the
particulars of
those or to
whom they
are owed,
1994 Volvo 850 $27,657,00 10/94 100% $15.646.00
automobile
1966 Jequar XJ6 $11 ,150.00 100%
397 shares of IBM $29,576,00 10/94 100% None None
stock
Infinity Investment $22,131,58 10/94 100% None None
Advisors stock
portfolio
Limited term $8,606,94 10/94 100% None None
municipal fund (with
Infinity Investment
Advisors)
Oppenheimer $1,131,24 10/94 100% None None
Pennsylvania tex
exempt fund A
II
I
i
I
I
I
....--
IBM Federel Credit $10,427,00 10/94 100% None None
Union Account
11 245,00
IBM Federel Credit $3,952,00 10/94 100% None None
Union Account
11245-13
Massechusetts $1,147,78 10/94 100% None None
Mutual Insurance
policy
Husband's Interest $96,383,04 10/94 100% None None
In his business's
profit-sharing plan
Husband's IRS with $8,392,04 11/94 100% None None
Infinity Investmant
Advisors, Inc,
Husband's IRA with $6,727,51 11/94 100% None None
Smith-Barney
Wlfe's tax-deferred $61,645,50 10/94 100% None None
savings plan with
IBM
Wife's IRA with $8,457.70 12/94 100% None None
Amcap Fund
Husband's account $40,019,22 11/94 100% None None
with PNB (Account
#240-0266)
Other bank Value unknown 11/94 100% Unknown Unknown
accounts In
Husband's
possession 1
-
Household Unknown 10/94 100% None None
furnishings and
other tangible
personal property
U,S, Savings Bonds $250,00 11/94 100% None None
in joint names
'Wife believes that Husband had other bank accounts at the time of
separation but she has no detailed information about them at this time,
'I,
ASSET VALUE VALUE LIEtiS
DAD:
, R~al PrQp~rty
-107 S, 32NtlSt., Co"", Hili 5181 000,00 10/95 H /S82 053,00
527 DnoN Road, C't"'D Hili $337 000,00 10/95 W ($183,820,00)
-, 1$33,481,011)
Busin/!ss ---, .,-
_.___... J)"P.'/st H .. ($36,950,00
1513 150.00
Automohiles
199-1 Volvo ,850 _ $27 875,00 11/94 W ($15 846,00
STOCK - ,fhares
- IBM. 397 $29 576,00 10/94
80wmo, 200 ? Wife's DOs.,esslon
Mutual Funds
Uti. Te,m Mun, 6-IJ,027 $22131,00 10/94 H
Oppenheimer lax .mpl, 100, /98 $1 116,00 10/94 H
&nk Acct,'
IBM Cft, UN, 11111-15.00 $18427.00 11/94 W
IBM Cl!::..Il,N, 1111 1-IJ./3 $3 052,00 11/94 W
Dphn Dep Safe IJep .. W
Life Ins
Moss Mulual1l87U1-I9 $1 146,0Q. 8/94 H
olher polide. ,""1st,
PrQjit sharillg
Int/../lv Inv, Adv 385 780,00 10/94 H
Bet/rement
Int/n/tv IRA $8 392.00 10/94 H
Smith Barney IRA $6 843.00 11/94 H
IBM lax del.v!!. $61 645.00 10/94 W
AMCAP IRA $8678.00 11/94 W
Household Furnishings
Jewelry/Fur
,.rt...
",r..
Y..
Y..
Y..
Y..
Y..
Y..
Y..
Y..
Y..
Y..
Y..
Y..
HARRY V, PATCHIN, ) IN THE COURT OF COMMON
Plaintiff ) PLEAS OF CUMBERLAND COUNTY.
) PENNSYLVANIA
)
vs, ) CIVIL ACTION, LAW
)
) NO, 94-7225 CIVIL TERM
CHERYL LYNN PATCHIN, )
Defendant ) IN DIVORCE
DEFENDANT'S PRE.TRIAL STATEMENT
Defendant. by her attorney, Samuel L, Andes, files this Pre-Trial Statement In
accordance with Pa, R,C,P, 1920,33(b):
1, ASSETS, A hst of the marital assets Is attached hereto and marked as Schedule
1-A. A list of the non, marital assets, as known to the Defendant, Is attached hereto and
marked as Schedule 1-B,
2, EXfiRT WITNESSES. Defendant would plan to call the following expert
witnesses:
A, A real estate appraiser if the parties are not able to agree upon the
fair value of the real estate which they own,
B, An accountant or other qualified expert to establish the value of
Husband's dental business if the parties cannot agree upon a value,
C, An appraiser of personal property If the parties cannot agree upon
either the disposition or the value of those items,
The Defendant reserves the right to call additional expert witnesses, if necessary, to rebut
the evidence of the Plaintiff,
3, FACT WITNESSES, Defendant Intends to call herself as a fact witness and
reaerves the right to call such sddltlonal fact witnesses as may be necessary to rebut
evidence offered by Plaintiff,
4, EXl:t.lJIlIS, The exhibits will consist of the parties' federal Income tax roturns for
at least the past five years, caples of documents relating to Husband's purchase of his
dental business and real estate, caples of statements showing the balances In varIous
accounts and tha vslua of the other Investment. type assets. Copies of those exhibits are
not attached to this pre-trial statement because either exceed three peges In length or they
are not yet available bacause the statements offered at the hearing date will be onas that are
the closest to the heerlng date and those statements are not now available,
5, IN.C.O.MkSIATEMEN:[, Dafendant will fila an Income and Expanse Statemant at
the time of the pre-trial conference or prior thereto.
6, EXPENSE STATf;lIl1eil, Defendant will file an Income and Expense Statement at
the time of the pra-trlal conference or prior thereto,
7, fEl\ISION INFORMATION, The retirement benefits of the parties consist of
deposits Into various plans and accounts which can be valuad fairly simply by a revlaw of
statements showing the balances In tha accounts at the tlma of saperatlon and a calculation
of the growth of that marital portion of those assets up to the time of the hearing,
Defendant will offer exhibits showing the value of those assets at the time of separation and
her calculations of the present value of that marital portion.
S, COUNSEL FEES, Defendant has agreed to pay her attorney $150,00 per hour,
At the hearing she will offer exhibits showing the work done by her attorney up to the time
of the hearing and setting forth the precise amount she has incurred in counsel fees up to
that time,
SCHEDULE 1-A . MARITAL PROPERTY
DATE OF MARITAL AMOUNT OF
ASSET VALUE VALUATION PORTION LIENS lIf:N
Residence at 627 $300.000,00 10/97 100% (a) PNC Bank (a)
Devon Road, Camp (estimate only) mortgage $163,916,74
HIli, PA (b) PNC Bank (presently)
home equity (b)
loan $29,267,26
(presently)
Office building at $220,000,00 10/97 100% Mortgage $82.063,00
407 South 32"d owed to prior
Street, Camp Hili, owner, Patrick
PA Dohoney
Husband's dantal $200.000,00 10/97 100% Thara ara $96,000,00
business (estlmete only) debts but Wife (approx,)
does not
know the
particulars of
those or to
whom they
are owed,
1994 Volvo 860 $27,667,00 10/94 100% $16,646,00
automobila
1986 Jequar X,J6 $11,150,00 100%
397 shares of IBM $29,576,00 10/94 100% None None
stock
Infinity Investment $22,131,58 10/94 100% None None
Advisors stock
portfolio
limited term $8,606,94 10/94 100% None None
municipal fund (with
Infinity Investment
Advisors)
Oppenheimer $1,131,24 10/94 100% None None
Pennsylvania tax
exempt fund A
IBM Federal Credit $18,427,00 10/94 100% None None
Union Account
11 245,00
IBM Federal Credit $3.952,00 10/94 100% None None
Union Account
11 245,1 3
Massachusetts $1,147,78 10/94 100% None None
Mutual Insurance
policy
Husband's Interest $96,383,04 10/94 100% None None
in his business's
profit'sharlng plan
Husband's IRS with $B,392,04 11/94 100% None None
Infinity Investment
Advisors, Inc,
Husband's IRA with $6,727,51 11/94 100% None None
Smith-Barney
Wife's tax,deferred $61,645,50 10/94 100% None None
savings plan with
IBM
Wife's IRA with $B,457,70 12/94 100% None None
Amcap Fund
Husband's account $40,019.22 11/94 100% None None
with PNB (Account
#240,0266)
Other bank Value unknown 11/94 100% Unknown Unknown
accounts in
Husband's
possession 1
Household Unknown 10/94 100% None None
furnishings and
other tangible
personal property
U,S, Savings Bonds $250,00 11/94 100% None None
in joint names
'Wife believes that Husband had other bank accounts at the time of
separation but she has no detailed information about them at this time,
, ,
, ,
,
,
SCHEDULE '.B . NON-MARlY AL PROPERTY
DATE OF REASON AMOUNT OF
ASSET VAl.UE V ALUA TlON FOR LIENS LIEN
EXCLUSION
Fidelity Asset $3.107,06 10/94 Funds held for None known None
Meneger child,
Mutusl funds
held by the
parties for tha
benefit of their
minor child,
Alexender
Patchin
In addition to the above, a portion of Husband's profit-sharing plan snd Wife's tax-deferred
savings plan, and perhaps a portion of the parties' Individusl retirement eccount ara non-
marital because contributions were made to those assets after the date oflleparatlon,
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