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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
STATE OF .w PENNSYLVANIA
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......' .. .,JUDI~H.,.A ...NELSON ,........,......"""""",,,
N D. ,95-933"ci vLL",Terrl9
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Versus
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Defendi;l,nt,...... '..
DECREE IN
DIVORCE
AND NOW, ":J'.~ne..,,'.'t..,,.......... 19.1.$:.. It Is ordered and
decreed that ,....". JIJ,DtTH"II. . NELSP.f'./ , .. .. .. .. . . " . . .. . .. " plaintiff,
and.. . " . .. .. .. " . .. .~Q13;:.IlT . p,." ~F-,L,!lQtJ, , .. , . " .. .. .. . . .. '" defendant,
are divorced from the bonds of matrimony.
The court retains jurisdiction of the folloWing claims which have
been raised of record In this action for which a final order has not yet
been entered; NONE
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A
.
SEPARATION AND PROPERTY SETTLEMENT AGREEMENT
THIS AGREEMENT, made this / J day of tr/~J , 1995, by
and between ROBBRT P. NELSON, of 516 Woodcrest Drive,
Mechanicsburg, cumberland county, Pennsylvania, first part,
hereinafter referred to as "Husband",
AND
JUDITH Q. NELSON, of 516 Woodcrest Drive, Mechanicsburg,
cumberland county, Pennsylvania, party of the second part,
hereinafter referred to as "Wife",
WHEREAS, Husband and Wife are residents of the
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WITNESSETH:
WHEREAS, Husband and Wife were married on June
Dallas county, Texas.
of Pennsylvania and have been so for at least the past six
months;
WHEREAS, certain differences have arisen between the parties
hereto which have made them desirous of living separate and apart
from one another; and
WHEREAS, Husband and Wife desire to settle and determine
certain of their marital rights and obligations, and make an
equitable distribution of their marital property, determine their
rights to alimony and support and any other matters which may be
considered under the Divorce Codel and
WHEREAS, it is the intention and purpose of this Agreement
to set forth the respective rights and duties of the parties
while they continue to live apart from each other and to settle
all financial and property rights between theml and
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.
.
WHEREAS, the parties hereto have mutually entered into an
agreement for the division of their jointly owned assets, the
provisions for the liabilities they owe, and provisions for the
resolution of their mutual differences, after both have had full
and ample opportunity to consult with attorneys of their
respective choice, and the parties now wish to have that
agreement reduced to writing.
NOW, THEREFORE, the parties hereto in consideration of the
mutually made and to be kept promises set forth hereinafter and
for other good and valuable consideration, and intending to be
legally bound and to legally bind their heirs, successors,
assigns, and personal representatives, do hereby covenant,
promise and agree as follows:
ARTICLE I
SEPARATION
1.1
It shall be lawful for Husband and Wife at all times
hereafter to live separate and apart from each other and to
rea ide from time to time at such place or places as they shall
respectively deem fit free from any control, restraint, or
interference, direct or indirect, by each other.
Neither party
shall molest the other or compel or endeavor to compel the other
to cohabit or dwell with him or her by any legal or other
proceedings. The foregoing provisions shall not be taken to be
an admission on the part of aither Husband or Wife of the
lawfulness of the causes leading to
them living separate and
apart.
2
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.
.
ARTICLE II
DIVORCE
2.1
This Agreement is not predicated on divorce.
It is
specifically understood and agreed by and between the parties
hereto and each of the said parties does hereby warrant and
represent to the other that the execution and delivery of this
Agreement is not predicated upon nor made subj ect to any
agreement for institution, prosecution, defense, or for the non-
prosecution or non-defense of any action for divorce; provided,
however, that nothing contained in this Agreement shall prevent
or preclude either of the parties hereto from commencing,
instituting or prosecuting any action or actions for divorce,
either absolute or otherwise, upon just, legal and proper
grounds; not to prevent either party from defending any such
action which has been, may, or shall be instituted by the other
party, or from making any just or proper defense thereto. It is
warranted, covenanted, and represented by Husband and Wife, each
to the other, that this Agreement is lawful and enforceable and
this warranty, covenant, and representation is made for the
specific purpose of inducing Husband and Wife to execute the
Agreement.
Husband and Wife each knowingly and understandingly
hereby waive any and all possible claims that this Agreement is,
for any reason, illegal, or for any reason whatsoever of public
policy, unenforceable in whole or in part. Husband and Wife do
each hereby warrant, covenant and agree that, in any possible
event, he and she are and shall forever be estopped from
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,
.
.
asserting any illegality or unenforceability as to all or any
part of this Agreement.
2.2
It is further specifically understood and agreed that the
provision of this Agreement relating to the equitable
distribution of property of the parties are accepted by each
party as a final settlement for all purposes whatsoever. Should
either of the parties obtain a decree, judgment or order of
separation or divorce in any other state, country, or
jurisdiction, each of the parties to this Agreement hereby
consents and agrees that this Agreement and all its covenants
shall not be affected in any way by any such separation and
divorce; and that nothing in any such decree, judgment, order of
further modification or reviaion thereof shall alter, amend or
vary any term of this Agreement, whether or not either or both of
the parties should remarry, it being understood by and between
the parties that this Agreement shall survive and shall not be
merged into any decree, judgment or order of divorce or
separation.
2.3
It is specifically agreed that a copy of this Agreement may
be incorporated by reference into any divorce judgment or decree
if or whenever sought by either of the parties hereto. Such
incorporation, however, shall not be regarded as a merger, it
being the intent of the parties to permit this Agreement to
survive any such judgment or decree.
4
,
,
ARTICLE III
EOUITABLE DISTRIBUTION OF MARITAL PROPERTY
3.1
The parties have attempted to divide their marital property
in a manner which conforms to the criteria set forth in the
Pennsylvania Divorce Code, and taking into account the following
considerations: the length of the marriage; the prior marriages
of the partiea; the age, health, station, amount and sources of
income, vocational skills, employability; estate, liabilities,
and needs for each of the parties; the contribution of one party
to the education, training or increased earning power to the
other party; the opportunity of each party for future acquisition
of capital assets and income; the sources of income of both
parties, including but not limited to medical, retirement,
insurance or other benefits; the contribution of dissipation of
each party in the acquisition, preservation, depreciation, or
appreciation of marital property, including the contribution of a
party as a homemaker; the value of the property set apart to each
party; the standard of living of the parties established during
their marriage; the economic circumstances of each party,
including federal, state and local tax ramifications, at the time
of the division of the property is to become effective; and
whether the parties will be serving as the custodian of any
dependent minor children.
3.2
The division of existing marital property is not intended by
the parties to constitute in any way a sale or exchange of assets
and the division is being effected without the introduction of
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outsid<.l funds or other property not constituting marital
property. The division of property under this Agreement shall be
in full satisfaction of all rights of equitable distribution of
the parties.
3.3
Personal Propertv. The parties acknowledge that at the
present time while they are living separate lives, they continue
to reside at the marital residence of 516 Woodcrest Drive,
Mechanicsburg, Cumberland county, Pennsylvania. with that in
mind, it is acknowledged that the parties personal property,
inclUding household furnishings, appliances and the like have not
been specifically distributed. In contemplation of wife's
vacating the marital residence, the parties shall divide their
personal property, inclUding but not Umi ted to furniture,
household furnishings, and the like, to their mutual agreement.
In the event that there are items of personal property Wife
cannot retain in her possession at this time, she may so
designate those items, by providing a written list of those items
to Husband within fifteen (15) days, clearly indicating the items
which she wishes to remove with her when she is able to so remove
those items. Those items of personal property that Wife so
designates as her possessions may remain at the marital residence
until such time as the residence would be sold by Husband. At
that time, Wife must make arrangements to secure those items of
personal property in whatever fashion is appropriate. If Wife
does not secure those personal property items after being given
thirty (30) days notice of Husband's intention to sell the
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property, Husband may retain those items of personal property or
distribute them as he deems appropriate.
3.4
Life Insurance. Each party agrees that the other party
shall have sole ownership of any life insurance pOlicies owned by
the other party. Each party shall have the right to borrow
against, cash in policies, change beneficiaries and exercise any
other incidents of ownership of the respective policies free of
any right or claim by the other party. Each party agrees to sign
any documents necessary to waive, relinquish or transfer any
rights in such policies to the respective parties presently
owning such policies.
3.5
subseouentlv Acouired Propertv. Husband and Wife agree to
waive and relinquish any and all right that he or she may now
have or hereafter acquire in any real or tangible personal
property subsequently acquired by the other party. Husband and
wife specifically agree to waive and relinquish any right in such
property that may arise as a result of the marriage relationship.
3.6
Real Estate. The parties are the joint owners of real
estate located 516 Woodcrest Drive, Mechanicsburg, Cumberland
county, Pennsylvania, which property is currently held in their
joint names, as tenants by the entireties. Within thirty (30)
days of execution of this Agreement, the parties will secure a
real estate appraisal from Larry E. Foote, Real Estate Appraisal
Services, of Carlisle, Pennsylvania. The parties anticipate that
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they will simply stipulate to the appraised value of the marital
residence as being the fair market value of the property. Each
party, however, retains the right to refuse to accept Hr. Foote's
appraisal and rather, to secure an independent real estate
appraisal of their own. In the event that Mr. Foote's real
estate appraisal is accepted by both parties, it shall be the
fair market value of the property for all purposes hereinafter
described. In the event that Hr. Foote's appraisal is not
accepted by either party, then each party retains the right to
secure another independent appraisal. The parties shall then
average the two independent appraisals, of two that are secured,
or the Foote appraisal and the one independent appraisal: if only
one independent appraisal is secured and this average shall be
the fair market value for purposes hereinafter described.
Upon determination of the fair market value as described
above, the parties agree to take three and one-half (3.5%)
percent of that value as a perspective cost of sale of the rp.al
estate and deduct this amount from the fair market value. This
three and one-half (3.5%) percent figure shall be used as and
referenced as lithe cost of salell as hereinafter described.
Upon determination of the fair market value of the real
estate, Husband shall secure a payoff figure as would be required
to pay any and all encumbrances on the property in full. The
difference between the fair market value and the payoff figure
for the encumbrances on the property shall be deemed to be the
lIequityll in the property. Wife shall, then, be entitled to
receive from Husband fifty (50%) percent of the lIequityll in the
.,
8
property, through Husband making three (3) equal inatallments to
Wife which would then total the fifty (50\) percent equity due to
Wife. The payments due to Wife shall be three (3) equal payments
due to Wife herein shall be payable beginning with the date being
due eKactly one year from the date of this Agreement. The second
payment being due two years from the date of this Agreement, and
the third payment being due three years from the date of this
Agreement. At the time of each disbursement, Husband shall make
payment to Wife for one-third (1/3) of the equity as described
plus interest at the rate of five (5\) percent per annum on the
remaining balance due. Further, however, Husband shall be
entitled to deduct one-third (1/3) of the cost of sale as
described above from each such payment to be made to Wife at the
time the payment is made.
In the event that Husband would sell the marital real
estate prior to time when the third equal payment is due as
described above, Wife shall be entitled to any and all remaining
payment a due for her equity plus interest due less any cost of
sale credited to Husband.
In consideration of the foregoing, Wife agrees to eKecute a
special warranty fee simple deed conveying all of her right,
title and interest in the aforesaid real estate to Husband. Wife
shall execute such deed and deliver the deed to Husband within
thirty (30) days of being requested to do so by Husband or his
legal representative.
Husband agrees to execute a mortgage in an amount equal to
the equity duo to Wife aa described in tho formulation oet forth
9
above. Further, however, Husband shall aasume sole and exclusive
responsibility for repayment of the parties' mortgage due and
owing to Fleet Mortgage corporation, which mortgage requires
routine monthly payments to be made by the parties. Husband will
. indemnify Wife and hold her harmless against any and all
collection activity and account of the aforesaid mortgage and
shall save Wife from any and all collection activities then in
nature whatsoever, including demands for payment or litigation
for nonpayment of the aforesaid mortgage.
Husband's payment to Wife of fifty (50%) percent of the
equity less costs of sale as described above shall be Wife's sole
and exclusive claim to any interest in the aforesaid real estate.
3.7
Pension. Reti.rement. Profit-sharinq. The parties
acknowledge that Wife has secured a deferred compensation account
through employment with the Cumberland Valley School District.
Husband will make no claim whatsoever relative to Wife's deferred
compensation account and hereby waives, relinquishes, and
transfers any and all claim he may have in his individual
capacity or through his marriage to Wife and any and all such
account. In addition, Husband waives, relinquishes and transfers
any and all right, title and interest he has or may have in the
Fleet Bank of Massachusetts I.R.A. plans for Wife referred to as
Account Number 220-1000386584 and 212-1000135052. Husband agrees
to execute any and all documents necessary as to so relinquish
any interest he may have in said account individually or through
his marriage to Wife.
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The parties acknowledge that Husband maintains retirement
accounts identified as follows: (A.) Fleet Bank of
Massachusetts I.R.A. plans docketed as Account Number 220-
1000386575 and Account Number 212-1000135070; (B.) I.R.A.
account with Charles Schwab, referenced as a S.E.P. or loR.A.
account docketed to Account Number HG 6624-6166; (C.) loB.H. tax
deferred savings plan docketed as Division Code 120307/18/108095
and to employee's Serial Number 569003.
From Husband's retirement accounts hereinbefore described,
the parties shall pay their outstanding encumbrances and
obligations due and owing to Mellon Bank Credit Line, Sears
Credit or Charge Account and a VISA Credit or Charge Account.
These funds shall be withdrawn from one of Husband's accounts
described above, along with sufficient funds to pay any tax
consequence of removing the necessary amount to pay these debts
in full. From the balance in Husband's various retirement
accounts as hereinbefore described, the parties agree that
current balance statements shall be secured and that fifty (50%)
percent of the balance in these accounts shall be disbursed to
Wife, through the preparation and application of a Qualified
Domestic Relations Order. The parties acknowledge that counsel
for Husband shall prepare the Qualified Domestic Relations Order
in such a fashion as to simplify the transfer of funds from these
accounts, or from one account, if appropriate funds are
available, such that the roll-over being required through the
Domestic Relations Order shall be as uncomplicated as is
possible. The Qual i fled Domestic Relations Order will be
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promptly prepared by counsel for Husband upon notification and
confirmation that 'the above referenced debts have been paid in
full and a sufficient sum has been withdrawn from the accounts to
provide for the tax consequences of the removal of the funds to
pay debts.
upon receipt of the sum described herein, Wife waives,
relinquishes, and transfers any and all interest in these named
retirement accounts, will make no claim of any nature against
these accounts and shall execute any and all documents necessary
to so waive, relinquish and transfer her interests.
The parties acknowledge that Husband is, at present,
receiving a pension from his prior employment with I.B.M.
Husband agrees to have prepared a Qualified Domestic Relaticns
Order (Q.D.R.O.) which will disburse to Wife fifty (50\) percent
of his I.B.M. pension. The Q.D.R.O. will provide for the payment
to be made directly from the 1. B. M. Pension Administrators to
Wife for her fifty (50\) percent interest in the pension, on a
monthly basis, with each party bearing the tax consequences
relative to their respective share of the pension which they
receive. Each party will be responsible for their own tax
consequences relative to the receipt of fifty (50\) percent of
Husband's monthly pension payment. Husband shall, through legal
counsel, prepare a Q.D.R.O. within thirty (30) days of the date
of this Agreement for review by Wife's counsel and for review by
the I.B.M. Pension Plan Administrators. Pending implementation
of the Q.D.R.O., Husband shall distl'ibute to Wife fifty (50\)
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percent of the net pension benefit received effective May 1,
1995, on a monthly basis by making a direct payment to Wife.
3.8
Vehicles. The parties acknowledge that Husband shall retain
the 1991 Grand Prix, presently in his possession. Wife shall
retain the 1987 Oldsmobile stationwagon, presently in her
possession. Husband shall maintain the partiea 1984 Pontiac,
or a subsequent, equivalent vehicle for the parties' son's uae
throughout his college education. In the event any vehicles need
to be transferred from one parties name to another, that party
will execute any and all necessary documents within fifteen (15)
days of being requested to do so by the party securing ownership
and title of the vehicle.
3.9
Intanqible Personal Prooertv. The parties acknowledge that
they presently have a stock portfolio through Addison Securities,
Inc. docketed to Account Number 58146775. From this account,
shall be disbursed the sum of five thousand and XX/lOO
($5,000.00) dollars to Wife for her personal use as she deems
necessary. This distribution shall be made contemporaneously
with the execution of this Agreement by the parties. Further,
this account shall, then, be retained by Husband for use in
paying all costs associated with the completion of the parties
son's four year college education. Husband shall have sole and
exclusive responsibility for maintaining this account and
disbursing it for purposes of paying for son's college education.
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Upon completion of the son's college education, any remaining
balance due in this account shall be Husband's possession and
wife ahall make no claim upon this account.
Wife will, within
fifteen (15) days of receipt of the $5,000.00 disbursement
described above, provide a written statement to Addison
securities, Inc., requesting that her name be removed, for all
purpoaes, from this investment account.
Wife waives, relinquishes and transfers any and all right,
title and interest she has or may have in her individual capacity
or through her marriage to Husband in Husband's business known aa
Professional Resource Group, Inc.
Wife will make no claim
whatsoever against this business.
The parties jointly waive, relinquish and transfer any
right, title and interest they have in any other intangible
accounts owned or possessed by the other party.
ARTICLE IV
ALIMONY. ALIMONY PENDENTE LITE. SPOUSAL
SUPPORT. MAINTENANCE AND CHILD SUPPORT
4.1
The parties herein acknowledge by this Agreement they have
respectively secured and maintained a substantial and adequate
funds with which to provide themselves sufficient resources to
provide for their comfort, maintenance, and support in the
station of life in which they are accustomed. Husband and Wife
do hereby waive, release and give up any rights they may
respectively have against the other for alimony, spousal support,
or maintenance.
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4.2
Husband and Wife specifically waive, release, and give up
any rights for alimony, alimony pendente lite and spousal support
pursuant to Chapter 5 of the Divorce Code of 1980, as amended.
ARTICLE V
DEBTS OF THE PARTIES
5.1
The parties acknowledge that with the exception of the
mortgage, due and owing to Fleet Mortgage Company on the marital
residence at 516 Woodcrest Drive, Mechanicsburg, Pennsylvania,
the only other debts known to the parties are a line of credit at
Mellon Bank, a Sears Credit or Charge Account and a VISA Credit
or Charge Account. As noted in paragraph 3.7 above, these three
latter debts will be paid in full from funds to be released from
Husband's I.R.A. or pension accounts.
The parties acknowledge
each to the other that there are no additional or joint debts,
nor have they or will they incur any additional debts that will
create an obligation on the other party.
Wife will, within fifteen (15) days of signing this
Agreement, provide a written statement to Mellon Bank, with a
copy to Husband or Husband's legal counsel, indicating her desire
to have her name removed, for all purposes, from the Mellon Bank
peraonal credit line.
5.2
Each party represents to the other that except as otherwise
specifically set forth in this Agreement, and more particularly
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as set forth in subparagraph 5.1 above, there are no major
outstanding obligations of the parties; that since the separation
neither party has contracted for any debts for which the other
will be responsible and each party indemnifies and holds harmless
the other for all obligations separately incurred or assumed
under this Agreement.
ARTICLE VI
MISCELLANEOUS PROVISIONS
6.1
Advice of Counsel.
The provisions of this Agreement and
their legal effect have been fully explained to the parties by
their respective counsel, being Bradley L. Griffie, Esquire, for
Husband and Judith A. Calkin, Esquire, for Wife.
The parties
acknowledge that they have received independent legal advice from
counsel of their own selection, that they fully understand the
facts and have been fully informed as to their legal rights and
Obligations or otherwise understand those legal rights and
obligations. They acknowledge and accept that this Agreement is,
in the circumstances, fair and equitable, that it is being
entered into freely and voluntarily, after having received such
advice and with such knowledge that execution of this Agreement
is not, the result of any duress or undue influence and that it is
not the result of any collusion or improper or illegal agreement
or agreements.
6.2
Counsel Fees. Each party agrees to be responsible for his
or her own legal fees and expenses, and each party hereby agrees
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to waive any claim for alimony, alimony pendente lite, counsel
fees, expenses or costs.
6.3
Colleqe SUDDort. Husband agrees to be solely and
exclusively responsible for payment of any debts associated with
the parties son's completion of his four year college degree.
Husband will make no claim against Wife for any contribution
toward the son's college education.
6.4
Mutual Release. Husband and Wife each do hereby mutually
remise, release, quitclaim, and forever discharge the other and
the estate of such other, for all times to come and for all
purposes whatsoever, of and from any and all right, title and
interest, or claims in or against the property (including income
and gain from property hereafter accruing) of the other or
against the estate of such other, of whatever nature and
wheresoever situate, which he or she now has or at any time
hereafter may have against such other, the estate of such other,
or any part thereof, whether arising out of any former acts,
contracts, engagements, or liabilities of such other as by way of
dower or curtesy, or claims in the nature of dower or curtesy or
widow's or widower's rights, family exemption, or similar
allowance, or under the intestate laws, or the right to take
against the spouse's Will; or the right to treat a lifetime
conveyance by the other as testamentary, or all other rights of a
surviving spouse to participate in a deceased spouse's estate,
whether arising under the laws of (a) Pennsylvania, (b) any
17
. .
state, commonwealth or territory of the United states, or (c) any
other country, or any rights which either party may have or at
any time hereafter have for past, present, or future support or
maintenance, alimony, alimony pendente lite, counsel fees, costs
or expenses, whether arising as a result of the marital relation
or otherwise, except and only except, all rights and agreements
and obligations of whatsoever nature arising or which may arise
under this Agreement or for the breach of any thereof. It is the
intention of Husband and Wife to give to each other by execution
of this Agreement a full, complete, and general release with
respect to any and all property of any kind or nature, real,
personal, or mixed, which the other now owns or may hereafter
acquire, except and only except, all rights and agreements and
Obligations of whatsoever nature arising or which may arise under
this Agreement or for the breach of any thereof.
6.5
Warranties. Each party represents that they have not
heretofore incurred or contracted for any debt or liability or
obligation for which the estate of the other party may be
responsible or liable, except as may be provided for in this
Agreement. Each party agrees to indemnify or hold the other
party harmless from and against any and all such debts,
liabilities or obligations of every of them, including those for
necessities, except for the obligations arising out of this
Agreement. Husband and Wife each warrant, covenant, represent
and agree that each will, now and at all times hereafter, save
harmless and keep the other indemnified from all debts, charges,
18
. .
and liabilities incurred by the other after the execution date of
this Agreement, except as is otherwise specifically provided for
by the terms of this Agreement and that neither of them hereafter
incur any liability whatsoever for which the estate of the other
may be liable.
6.6
No waiver or modification of any of the terms of this
Agreement shall be valid unless in writing and signed by both
parties and no waiver of any breach hereof or default hereunder
shall be deemed a waiver of any subsequent default of the same or
similar nature.
6.7
Husband and Wife covenant and agree that they will forthwith
execute any and all written instruments, assignments, releases,
satisfactions, deeds, notes or such other writings as may be
necessary or desirable for the proper implementation of this
Agreement, and as theit" respective counsel shall mutually agree
should be so executed in order to carry fully and effectively the
terms of this Agreement.
6.8
This Agreement shall be construed in accordance with the
laws of the Commonwealth of Pennsylvania which are in effect as
of the date of execution of this Agreement.
6.9
This Agreement shall be binding and shall inure to the
benefit of the parties hereto and their respective heirs,
executors, administrators, successors and assigns.
19
. . I ..
15.10
This Agreement constitutes the entire understanding of the
parties and supersedes any and all prior agreements and
negotiations between them. There are no representations or
warranties other than those expressly set forth herein.
15.11
Severabilitv. If any term, condition, clause, section, or
provision of this Agreement shall be determined or declared to be
void or invalid ill law or otherwise, then only that term,
condition, clause, or provision shall be stricken from this
Agreement, and in all other respects, this Agreement shall be
valid and continue in full force, effect, and operation.
Likewise, the failure of any party to meet his or her obligation
under anyone or more of the articles and sections herein shall
in no way void or alter the remaining obligations of the parties.
15.12
It is specifically understood and agreed that this Agreement
constitutes an equitable distribution of property, both real and
personal, which was legally and beneficially acquired by Husband
and Wife, or either of them, during the marriage as contemplated
by the Divorce Code of the Commonwealth of Pennsylvania.
15.13
Disclosure. The parties warrant and represent that they
have made a full disclosure of all assets prior to the execution
of this Agreement.
20
. ~. ~
6.14
Enforceabilitv and Consideration. This Agreement shall
survive any action for divorce and decree of divorce and shall
forever be binding and conclusive on the parties I and any
independent action may be brought, either at law or in equity, to
enforce the terms of the Agreement by either Husband or Wife
until it shall have been fully satisfied and performed. The
consideration for this contract and agreement is the mutual
benefits to be obtained by both of the parties hereto and the
covenants and agreements of each of the parties to the other.
The adequacy of the consideration for all agreements herein
contained in stipulated, confessed, and admitted by the parties,
and the parties intend to be legally bound hereby. In the event
either party breaches the aforesaid Agreement and it is
determined through appropriate legal action that the alleged
party has so breached the Agreement, the breaching party shall be
responsible for any and all attorney's fees as well as costs and
expenses associated with litigation incurred by the non-breaching
party to enforce this Agreement against the breaching party.
IN WITNESS WHEREOF, the parties hereto have set their hands
and seals the day and year first above written.
,
,. )
, I. /-
\,_j~dl{i,{ /I, (;..;/4"
.</ '
72~~d
ROBERT P. HE ON
JUD~~'H-.~.LINEts~~t"'''.-
21
, ...
JUDITH ~. NELSON,
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95-933 civil Term
ROBERT P. NELSON
:le:enc.an-:.
c:v:~ hC~:O~ - IN DIVORCE
?~~!::?! ~O ~~~~Sp.:~ ?~CORD
~o ~ne ?~=~hcnc~a=:.:
. ~~a~s~:~ ~he :-eco=:, ~oqe~he: w~~h ~he :ollowin;
i~:o=ma~ior., ~o ~he COU~ :o~ ent=y 0: a divc:ce dec=ee:
l. G"o~~c. fo" eivo"ce: i"ret"ievable breaKdown
under Sec-:.ion (X) 3301 (c) ( ) 3301 (d) (1) of t~e Divorce
Code. ' ( Check
applica:le section).
2 ~ -. Da-:e z.~d ma::.ne: 0: se:-vice 0: ":ohe complaint:
.
Certified-Restricted Deliverv
? /?7/Qtj
.
',.1
3~", (Complete eithe" paraq"aph (a) or (bl.
, " ~
'[a) Date of e~ecution 0: the affidavit of consent
"e~ui"ed :y Sec-:.ion 3301(c) 0: the Divorce Coc.e: by
pleint:!.ff--'- . 6/B.,4l-5-
i-by de:e:lcan't
.'
6/1/95
(b) (1) Date of execution of the plai~tiff's
affidavit required by Section 3301 (d) of the Divorce Code:
: (2) cate 0: se:vice c: ~he Plai~ti:=ts
a:::davit upon ~he De:encan~:
.
4. Rela~ec claims ~e~din~:
NnNP
5. Date and manner of service of the notice of intention
to file ?raeci?e to transmit record, a copy of which is attached
N/A
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NOTICA
AVISO PARA DEFENDER Y RECLAMAR DERECHOS
USTED HA SIDO DEMANDADO EN LA CORTE. Si desea defenderse
de las quehjas expuestas en las paginas siguietes, de be tomar
accion con prontitued. Se le avisa que si no se defiende, el caso
puedo proceder sin usted y decreto de divorcio 0 anulamiento puede
ser emitido en su contra por la Corte. Una decision puede tambien
ser emitida en su contra por cualquier otra queja 0 compensacion
reclamados por el demandante. Usted puede perder dinero, 0
propiedade u otros derchos importantes para usted.
Cuando la base para el divorcio es indignidades 0 rompimiento
irreprable del matrimonio, usted puede solicitar consejo
matrimonial. Una lista de consejeros matrimoniales esta disponible
en la Cumberland County Court 0 f Common Pleas, One Courthouse
Square, Carlisle, Pennsylvania. Pennsylvania.
SI USTED NO RECLMA PENSION ALIMENTICIA, PROPIEDAD MARITAL,
HONORARIOS DE ABOGADO U OTROS GASTOS ANTES DE' QUE EL DECRETO FINAL
DE DIVORCIO 0 ANULAMIENTO SEA EMITIDO, USTED PUEDE PERDER EL
DERECHO A RECLAMAR CUALQUIERA DE ELLOS.
USTED DE BE LLEVAR ESTE PAPEL A UN ABODGADO DE 1NMED1ATO. S1 NO
T1ENE 0 NO PUEDE PAGAR UN ABOGADO, VAYA 0 LLAME A LA OFICINA
1NDICADA ABAJO PARA AVER1GUAR DONDE PUEDE OBTRENER ASISTENCIA
LEGAL.
~
r
I
I
COURT ADMINISTRATOR, FOURTH FLOOR
Cumberland County Courthouse
One Courthouse Square
Carlisle, Pennsylvania l7013-3387
Telephone: (717) 240-6200
counseling prior to a Divorce Decree being handled down by the
Court.
WHEREFORE, the plaintiff prays your Honorable Court to
enter a Decree in Divorce from the bonds of matrimony.
COUNT II
(Equitable Distribution)
9. Plaintiff and Defendant have acquired real and
personal property during their marriage.
10. Plaintiff and Defendant have been unable to agree
as to an equitabie division of said property as of the date
of the filing of this Complaint.
WHEREFORE, Plaintiff requests that the Court enter a
Decree equitably distributing marital property.
11. Count
COUNT II I
REQUEST FOR ALIMONY
(Request for Alimony)
I & II of the Complaint is incorporated
herein by reference thereto.
12. Defendant is unable to support hersel f through
appropriate employment.
13. Plaintiff is able to provide support to Defendant.
WHEREFORE, Plaintiff respectfully requests the Court
to enter an alimony award on her behalf.
COUNT IV
(Request for Alimony Pendente Lite and
Counsel Fees, Costs and Expenses)
14. Counts I, II & III of the Complaint is incorporated
herein by ref8renGp. thereto.
represent her in this matrimonial case.
16. Plaintiff is unable to pay her counsel fees, costs
and expenses and Defendant is more than able to pay them.
17. P laintlf f is unable to sustain herself during the
course of this litigation.
WHEREFORE, plaintiff respectfully requests the Court to
,enter an award of Alimony Pendente Lite, interim and final counsel
fees, costs and expenses.
~e.tfullY 'Ubmltted')
/dcd I! ~
I:Udith A. Calkin, Esquire
Attorney for plaintiff .
2201 North Second Street
Harrisburg, PA 17110
(717) 238-2312
.JlJ()I'1'1I A. NF.I,SON,
Plaintiff
IN 'I'IIB COlJR'J' 01' COMMON PJ,EAS
CUMBERLAND COUNTY, PA
VS.
NO. 95-933 Civil Term
llom:Il'1' 1'. NF.l,SON,
Defendant
CIVIL ACTION-LAW
IN DIVORCE
APFIDAVIT OF CONSF.NT
I. A complaint in Divorce under Section 3301(c) of the
Divorce Code was flIed February 22, 1995.
2. The marriage of Plaintiff and Defendant is
irretrievably broken and ninety (90) days have elapsed from the
dote of the filing of this Compiaint.
J. I consent to the entry of a Final Decree in Divorce.
4. I understand that I may lose rights Gom:erning
alimony, division of property, lawyer's fees, or expenses if I do
not claim them before a divorce is granted.
5. I understand I may request that tho Court require my
spouse anrl I to participate in marriage counseling, boing so
advised, I do not request that the Court require illY spouse and I to
participate in marriage counseling.
I understand that false statements herein are llIade
subject to the penaltles of 18 l'a.C.S. Section 4904, relating to
unsworn faisi.fication to i1uthod,ties.
DAn:: '11/9)
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vs.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - IN DIVORCE
JUDITH A. NELSON,
Plaintiff
ROBERT P. NELSON,
Defendant
NO. 95-933 CIVIL TERM
STIPULATION FOR THE ENTRY OF
"DOMESTIC RELATIONS ORDER"
AND NOW, the day and year hereinafter written, the parties,
Judith Q. Nelson, (a/k/a Judith A. Na1son) Plaintiff and Robert
P. Nelson, Defendant, do hereby agree and stipulate as follows:
1. The Defendant, Robert P. Nelson, (hereinafter referred
to as "Participant") is a former employee of IBM and is a
participant in the IBM Tax Deferred savings Plan ("TDSP")
(hereinafter referred to as the "Plan").
2. Participant's date of birth is December 18, 1937, and
his Social Security Number is 113-30-1409, and his Serial Number
for the Plan is #569003.
3. The Plaintiff, Judith Q. Nelson (hereinafter referred to
as "Alternate Payee") is the former spouse of Participant.
Alternate Payee's date of birth is December 4, 1938, and her
Social Security Number is 276-34-6317.
4. Participant's current residence and mailing address is
516 Woodcrest Drive, Mechanicsburg, PA 17055.
5. Alternate Payee's current residence and mailing address
is 2908 Westbury Court, Apartment B08, Camp Hill, PA 17011. It
is the responsibility of Alternate Payee to keep a current
mailing address on file with the Plan at all times.
1
6. Through their Separation and property Settlement
Agreement, the parties have determined that Alternate Payee is
entitled to receive certain benefits from the Plan. The Plan
Administrator of the IBM Tax Deferred savings Plan is directed to
make a lump sum distributions from Participant's various 'accounts
or funds in the amount of FIFTY (50%) PERCENT of all account
balances as of September 1, 1996.
The applicable evaluation for the account as of the date of
receipt of this Qualified Domestic Relations Order may be based
upon the preceding weekly valuation date. Funds shall be
withdrawn from the TDSP for the Alternate Payee and directly
rolled-over into an IRA account, account number 66213478, held
with Charles Schwab and Co., Inc. of 17 South Market Square,
suite lA, Harrisburg, Pennsylvania. The amount to be withdrawn
from the Participant's account for the Alternate Payee is non-
taxable as an authorized roll-over from one qualified ,plan to
another qualified retirement account.
7. A loan to a participant is made by taking invested funds
out of the participant's account. The total value of the account
is the value of the invested funds and any loan amounts
outstanding. The available account balance is the amount of
invested funds, which balance does not include amounts previously
loaned out to the participant. The distribution to the alternate
payee specified by Paragraph Six (6) is made up to the limit of
available funds as of the date of distribution and does not alter
the participant's obligation to repay any loans then outstanding.
2
8. The equitable distribution portion of the marital
property component of Participant's TDSP, as set forth in
Paragraph Six (6), shall be payable to Alternate Payee's named
account as soon as administratively feasible but expected to be
by no later than September 1, 1996, following administrative
approval of the Qualified Domestic Relations Order incorporating
this Stipulation and Agreement.
9. Alternate Payee may not exercise any right, privilege or
option offered by the Plan. Where relevant, the Plan shall issue
individual tax forms to Participant and Alternate payee for
amounts paid to each.
10. 'In no event shall Alternate Payee have greater benefits
or rights other than those which are available to Participant.
Alternate Payee is not entitled to any benefit not otherwise
provided by the Plan. The Alternate payee is only entitled to
the specific benefits offered by the Plan as provided in this
Order. All other rights, privileges and options offered by the
Plan not granted to Alternate Payee by this Order are preserved
for Participant.
11. The parties intend and agree that the terms of this
Stipulation and Agreement shall be approved, adopted and entered
as a Domestic Relations Order.
12. The Court of Common Pleas of Cumberland County,
Pennsylvania, shall retain jurisdiction to amend any Domestic
Relations Order incorporating this stipulation, but only for the
purpose of establishing it or maintaining it as a Qualified
Domestic Relations Order; provided, however, that no such
3
.
,
,
JUDITH A. NELSON, I IN THE COURT OF COMMON PLEAS Oll'
plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA
.
.
VII. I NO. 95-933 CIVIL TERM
I
ROBERT P. NELSON, CIVIL ACTION - IN DIVORCE
Defendant I
DEFENDANT'S FINANCIAL INFORMATION
PURSUANT TO PA RCP 1920.31
Defendant, Robert P. Nelson, by his attorney, Linda A.
Clotfelter, respectfully submits to this Honorable Court the
following financial information pursuant to PA RCP 1920.31(a) (1):
1. Defendant's most recent federal income tax return;
2. Defendant's payroll detail reports in lieu of pay
stubs for the preceding six months since Defendant
is self-employed;
3. A completed income and expense statement in the
form required by the practice and procedure
governing an action for support.
WHEREFORE, Defendant, Robert P. Nelson, respectfully requests
that this Honorable Court dismiss Plaintiff's requests for Alimony,
Ali~ony Pendente Lite, counsel fees, costs, and expenses.
Respectfully submitted,
LAW OFFICES OF CRAIG A. DIEHL
Dated:
.j/;.,jq5
.
By :Id /;J,(VfLCt{yt~tP,-'Ll{
Inda A. Clotfe1te , Esquire
Attorney 10 No. 72963
3464 Trindle Road
Camp Hill, PA 17011
(717) 763-7613
Attorney for Defendant
.
JUDITH A. NELSON, I IN THE COURT OF COHMON PLEAS or
plaintitt I CUHBERLANDCOUNTY, PENNSYLVANIA
I
VB. . NO. 95-933 CIVIL TERM
.
I
ROBERT P. NELSON, I CIVIL ACTION - IH DIVORCE
Detendant I
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on the date hereof, a
copy of the foregoing "Defendant's Financial Information Pursuant
to PA RCP 1920.31" was served on all parties of interest by way of
United states mail, first class, postage prepaid, addressed as
follows:
Judith A. Calkin, Esquire
2201 North Second street
Harrisburg, PA 17110
Date I
3;j,hf~
He e
3464
Camp Hill, PA
(717) 763-7613
r1040
Label
(SOl
In.tructlon.
on ""g. 12,)
Unth.IRS
I.bel.
Oth.rv.i....
pi.... print
or type.
Pr..ld.nUII
Election Clmpllgn
S.. . .1
Filing Status
(S.. page 12.)
Che!:k only
one box.
Exemptions
(S.. page 13,)
II mare than .Ix
dependents,
see paga 14,
Income
Mlch
Copy B of your
Form. W.2,
W.2G,lnd
1 099.R h.,..
If you did not
get a W-2. see
pag.l0,
Ifyouara
aUachIng .
check or monoy
order. put " on
lop o(any
Form. W.2,
W.2G, ot
1 Q99.R.
Adjustments
to Income
(S.. page 20,)
AdJustOd
Gross Income
Heo7
1993
IRS U.. Onl .00 not Wflt, Of It. I, 'n thl.. ac:t.
1993 ."din OM No'~ 74
List n.m. Your loclllltcurlty number
113-30-1409
SPOUI'" .oclal ..curUy number
'O'
Inn!"
ROBERT P. NELSON
~ ~ 'Iolnl ,.lum, IPOU"" ftrat nlmo ond In~ol
I
Lilt nama
276-34-6317
Apt. no.
For Prlvlcy Acl Ind
Plperwo,k Reduction
Act Notlc., .ee page 4.
516 WOODCREST DRIVE
City. town Of poll OMCI, stall, and ZIP cod.." )'ou n.v.. fOlllgn add"", It. pagli2.
MECHANICSBURG PA 17055
Doyouwanl$310goI0Ihlllund? . . , , , , , , ,
If nl relurn dOH our a u!te WBnl 3 to 0 to this fund? ,
Slngl.
X Maoled filing jolnl..lurn (even ~ only on. had Incom.)
M.rrltd ftllng "p.rll. ..turn. Enltr SPOUSI" locl,1 IKUrrty no .bov. and lull name hili. ...
He.d 01 hou.ehold (wilh qual~ying perlOn), (5.. p.g.13.) IIlhe qu.lifylng perlOn I.. child but nol you, dependenl,
enler Ihl. child'. n.m. here. ~
5 Qualif in widcw(er with de ndent child ellr I use died .. 19 S~ 8 e 13.
61 IXl Yours.lI. If your perenl (or 5Omeone e1..) c'n cl.lm you IS . dependenl on his or her I.x ) ~~.~~::r~~I6a
,.Iu,n, do not check box 60. But be .ure 10 chook Ihe box on lin. 33b on page 2.. and Ib -L
b S use No. of your
Dependenl.: 121 Check (31 hO.l 0' Old". 1.1 Dependln'l 151 flo. 01 mOl, children on Ie
Nam. (ftrst, Initial, and Int naml) tf und.r d.pend.nf.socl.1 r.lationshlp to li....d In )four who:
. .1 SKur number u hom.ln 1993 . lI...td wllh you-L
AUGHTER 12 edldn'lllvewlth
you dul' to
SON 12 dlvore.o,
..plt.tlon I'"
pegelll
Dependenllon
6c nolent.red
above
es No
X
X
Note: ChlCklng -...,,-
Will not ching. )'our
tax Of reduct your
r.rund,
1
2
3
4
c
(1)
EBECCA NELSON
ICHAEL NELSON
d tf your child didn't 11v. with you but II claimed II your d.pendent under I p'" 1985 IgrHm.nt, check her.. ... 0
e Tolslnumbercrexem lions claimed . . , . . . . . . . , . . , . . , . . .
7 W.ge., III.nes. tips, elc, AU.ch Fonn(.) W-2. , . , , . , . , .
61 Taxlbl. Inleresl Income (s.. page 16), AU.ch Schedule B n over $400 . 6a
b "'ax..xempllnleresl (see page 17). DON'T Include on "ne ea . 6b tj~h
8 DMdend Income. AUach Schedule B n over $400. . , . , . . , ,
10 T...bl. relund.. credn., 0' off..ls olalole ond locallncom. I".. (s.. p.geH) .
11 Allmonyrecelved..."...,..",
12 Bu.ln...lncom. or (Ios.). AUach Schedule C or C,EZ. , .
13 C.ph.1 g.lnor (IOI,),AUach Schedule D, ", ",.
14 C.ph.1 gain dlslributlons not ,.poned on line 13 (see page 17)
16 Other goln. or (Io..es). AUach Form 4797 . . . . , . , . . . . . . . , , , ,
161 Tot.IIRAdislrlbutions, . , ~ I b Taxable .mounl (s.. pagele)
17. Tot.1 pensions and annunle. [ll!] b r.xable amounl (see p.gelB)
18 Renl.1 ,..lesl.I., roya"i.., pannershlps, S corporation.. 1",.ls, elc. AUach Schedul. E
18 Farm Income or (loss). AUach Schedul. F . . . . , , . , . , .
2C Unemploymenl compensalion ,see p~ge 19) , , , . , , , . , . . , , , , . ,
21. Social security benern. . . I1!!J I b Taxable amounl (s.. page 19)
22 Other Income. List typtlnd amount'IM pig. 20 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 22
23 Add the amounts In the far ri hi column (or linea 7throu h 22 This Is our tolallncome ... 23
24. Your IRA deduction (see page 20) . . , . , 24a
b Spou.....IRA deduction (see page 20), , . . . . . 24b
25 One-heW of saW..mploymenllax (see page 21). . . . 25
26 SeW..mployed heanh Insurance deduction (s.. page 22), 26
27 Keogh retiremenl pI.n and seW..mployed SEP deduction 2
26 Pen.hy on eany wilhdrawal 01 ..ving., , . , , , . 28
2g Alimony paid, Reclpi.nt's SSN ~ 29
30 Add linel24e throu h 79. The5.e Br~ our total ad uslmenls . . . . . . . . ... 30
31 Sublfllct line 30 Irom lino 23. Thl.1o your Idju.led g'ou Incom.. "Ihl. amounll. 1...lh.n
$23,050 and. child lived wilh you.... p.ge EIC-llo find out n you c'n el.lm Ih.
.Eamed Income Credof' on line 56 , . , . . , . ' . . . , . . , . , . , . ~ 31
Add number.
enlerl'don
line. .bove
29
1
4
238.
336.
238.
21.
6 277.
30 017.
307.
3 120.
70 554.
NONE
70 554.
Form 1~f!l/IlSl
Tax
Compu.
tatlon
(See plga
23,)
I( you want
IhalRS to
figura your
lax, aee
paga 24,
Credits
(See paga
25.)
Other
Taxes
Payments
Altach
Fo"", W-2.
W-2G. and
1099-R on
poga1.
60
61
Refund or 62
Amount' 63
You Owe
Sign
Here
Keep a copy
o( thl, relum
for your
recorda.
Paid
Pre parer's
Use Only
ROBERT P: NELSON & JUDITH
32 Amounl (rom line 31 (adjualed gronlncom.)
'331 ChockW: 0 You were 6501 oldor,O Blind, 0 spouuwa'65010Idor.
Add the numbo, o( box.. chocked above Ind .nlar Ih. lolal hore. . . .
b II your pa..nl (0' lomeon. elaa) cln claim 10U a.. d.pend.nl. chock hor.
If you ar. married r.ling leparately and your spouse llemizel deduction, Of
you are a dual.slalul alien, '" page 241 and check hel.. , . . . . .
homlztd deducllon. Irom Schedula A, Iln. 26, OR
Sllndl,d deducllon ahown below fOllour filing alllu. Bul If you chockod
Enl.r \ Iny box on IIno 33. or b. go 10 p.ga 2410 find lour .llndard d.duction I
::~ger II you chocked box 33c, youl a'"ndard doduction la z.ro
o( 0 Slngl.-$3.7oo · H.ad of hou.ehold-S5,45O
your: 0 Married filing loinlly 01 OUlldy,ng widow(.r)..S6,200
o Married filing ..palal.ly..S3.1oo
Subtract lino 34 from lin. 32, , , . . . , , . , , . . , . . , . , , , ,
II tin. 321. $81.350 or I.... muMiply 52,350 by Ihololal number 01 ...mption. claiM.d on
line 6e. If line 32 is over 581,350, lee lhe worksheet on pnge 25 for the amounllo enler .
Taxable Income. Subtract line 36 ftom line 35. If line 36 it more (hen line 35. enler -D. .
Tax, Check W flom 1 IKI Tax Tlblo. b 0 Tax RII. Schodul.., cD Sch.dulo D T..
Work,h.et, or dO Form 8615 (Sff pig' 25) A.mountfJom Forml') eel.... e
Addrtional laxea (... pago 25), Chock ~ !rom 1 0 Form 4970 b 0 Form 4972.
Add lin..38 and 39, , , , , . , , , . , , . . , , . , , '
Credrt (or child and d.pendent care expense. Anach FOlm 2441 41
Credrt (or Ih. aldorly or Ihe di.abled, Attach Schedul. R 42
For.Jgnlaxcredrt,AttachForm1116, , . , , , , . " 43
Olh.r credrt. (s.e page 26). Che<:k l!from a 0 Form 3800
b 0 FOlm 6396 c 0 Form 6601 d 0 Form Ispeclfy)
Addlinea41through44, . , , , , . , . , , . . .
Subtract line AS from line .40. If line ASls more than line 40 enler..Q. ,
S.tf..mploymlnl tall. Attach 5ch. SE. Also, 'M In 2S , , . , , , .
AIt.mallve minimum tax. Attach Form 6251 , , , . , , , . ,
Recaptull ta..s (lit pagl 26). Check If from a 0 Form 4255 b 0 Farm 8611 C 0 Farm 8828
Soclalaeculrty and Mediclr. lax on tip Income nolreported 10 employer, Anach Form 4137,
Tax on qualifi.d relil.monl plans. Including IRA.. If r.qulred, attach FOlm 5329
Advanc. earned Income credrt paym.nls from FOlm W,2, . , , ,
Add lin.. 46 Ih,ou h 52, This I. OUI total lax , , , . . , , ,
Fed.rollncome lax withheld. Kany I. from FOlmls) 1099, check . ~ IKI
1993 estimaled lax paymenl.and amount applied !rom 1992 return
Earned Income cr.dlt. Attach Schedul. EIC. . . . , . ,
Amounl paid with Form 4668 (oxlonslon requ..I). , , , , ,
Exc"s soclalucurtt)', Medlcar., and RRTA tal \\1lhheld (see p.g. 28)
D.ferral of addllional1993 laxe.. Attach Form B641. , , , .
Other paym.nl. (see page 26), Chock ~ from 10 Form 2439
bD Fo"" 4136, . . . . , , , . , , , , , . ,. S9
Add lines 54 throu h 59. These 8fe our total a ments. , . ' . . . . . . ..
If lina 60 I. morelhan lin. 53, .ublract linl 53 from line 60, Thia 1.lho amounl you OVERPAID, ~
Amounl ollina 61 youwanl REFUNDED TO yoU . . ' . , . , . , , . . ,
Amounl of line 61 you wanl APPLIED TO YOUR 1994
ESTIMATED TAX ~ 63
If lin. 531. mOI.lhan lino 60, subtract lin. 60 from lin. 53, Thi. is Ihe AMOUNT YOU OWE.
Fo, detail. on how 10 pay. Including whallo wrrte on your paymenl. ... page 29, , , , , 64
65 Estimated hue nalt see a e 29 . Also Include on line 64. .. 65 NONE ~j;;~~~t:~~:':.~Cr((1~~t:j%S;w:4~1
Under penattllS of pe~ury, I decl.,. th.tl h.ve 11.mlntd this IOturn and accompanying schedules .nd stalements, and 10 th. besl of my knowtedgt Ind
bell.r,lheV Ire tnJt, conect, and complelt. OKlllalion 01 plfpller Celhtr than la.payer) Is based on aUlnlormation of which prepller has.ny knowltdg..
Your Ilgnltur. 0.11 Your occupllion
Jot
. NELSON
113~30-1409 P. .2
32 70 554.
o Blind
, ~ 33a
, ~ 33b
9 400.
38 253.
c
, ~ 33c
22 901.
47 653.
3S
36
37
36
36
39
~ 40
5 920.
NONE
5 920.
39
40
41
42
43
44
44
5 920.
4S
46
47
46
49
60
S1
S2
63
"
S5
68
S7
S6I
b
sa
~
5 920.
S4
S5
58
57
S6a
S6b
~
6 179.
1 100.
64
7 279.
1 359.
1 359.
Spou.... slgnaturl. If. Joint IIlu'n, BOTH musllign
o.t_
EXECUTIVE
SPCU!l" occupation
ADMINISTRATOR
O.lt
Check I'
e.ell.em 10 II
EI UO
ZIP Codl
P,epa",', locial Stcurtly no.
210-36-0113
25-1638737
17011
Prep."r'1
Ilgnltur.
Firm', nlme (or YOUfI
If Ittr..mploytd) Ind
Iddr."
CRAIG A. DIEHL ES CPA
3464 Trindle Road
Camp Hill, PA
Page 3
SCHEDULES A&B
(Form 10.40)
Schedule A . Itemized Deductions
(Schtdult B Is on pagt 21
.
1993
^Nach to Form 1040, S..ln.trucllon. 'or Scheduln ^ and B
Attachment
S. uene. No. 0
Your .oclll ucurlty num~r
113-30-1409
Oeptrtment ot the T,..,ury
"tlm I R,v,nUI s.Me,
Nlml(') shown on Form 1040
ROBERT P.
Medical
and
Dental
Expen..s
TIXII You
Paid
(See
pogtM.)
Intornl
You Paid
(See
pogt A-2,)
Nott:
P.rsonal 10
Intere.lls
not 11
deductible,
Gins 10
Charily
(See page A.3.) 13
14
Clluallyand
Then LOSles
Moving
Ex nses
Job Expenses
snd Mosl
O1her
MIscenaneous
Deducllona
(See
pog. A,5 ''''
expenses to
deduct here.)
O1her
Mlsctnsneeus
Deductions
Tolal
lIemlzed
Deductlona
NELSON & JUDITH . NELSON
CaUllon: Do nollnclud. e'pens.. reimbursed or paid by oth.rs
1 Medicelend dentot expenses (see page A,1) ,
2 Ent.r emounl ',om Form 10.40,line 32 . " 2
3 Muhlply lin. 2 .bov. by 7,5% (,075) , , , ,
.. Subtract line 3 from line 1. If zero or less enter.()., . , . .
5 Slotund locelincom.,..... , , . , . , , ,
5 R.el estate Ie,.. (see page A,2) . . , , , , , , , , .
7 Other Ie,.., li.I-Include pe,.onal p'ope~y la'es ~ _ _ _ _ _ _ _ _
___~~[~~~~b~~______________
5 Add Iin.s 5throu h 7, , , , , , , , , , . , . , , . . , , ,
9s Home mo~gag.lnte'esland poinls 'epo~ed to you on Form 1098 .
b Home mo~gag.lnteresl not 'epo~ed 10 you on Fo,m 1098, If pa,d
to Ih. person 'rom whom you boughtlh. home, see page A.3
end show Ihat person's nam..ld.ntilylng no" and .ddre.. ~
1
3
4
5 1 300.
5 2 471.
7 379.
...
9a 12 459.
NONE
26 Is the amounl on Form 1040,lin. 32, more than $108,450 (more than 554,225
II married filing separately)7
. NO, Your deduction is not lim~ed Add line. 4, 8,12,16,17,18,24, and 25
Also enler on Form 1040, line 34, Ihe larger 01 this amount
'" vour slandard deduction,
. S Vour d uct me limij~ See a e A.5 fOf the Bmounllo enter
For Paperwork Reduction Act NOllce, .ee Fo,m 1040 In.!ructlons,
H807
12 891.
4 150.
12
Points nol repo~ed 10 vou on Form 1098, See page A.3
''''.peeiaINles , . , . . , . . . . . , , .
Inveslmentlnteres!. If required, a"ach Form 4952, (See
pageA-J,). . . SEE STMT. A-2. . , ,
Addllnes9athrouhl1""""..,.. ,
CIUllon: If vou made a char~able conlribulion and received a
ben.rrt In relum. .ee page A.3.
Conlributlon. by cash", check, . . , . . , . ,
O1her than bV cash or check, If over 5SOO, vou MUST
a"och Form 8283 . , , , , , . , , . , . ,
Cllrryover from prior year. . . . . . . . . . .
Add lin.. 13 throu hIS. , , . , , . , . . . . .
Db
10 160.
11 272.
...
13 1 155.
14 450.
15
,.. 18
... 17
NONE
15
18
1 605.
17
18
19
NONE
Mavin .. n..., Attech Form 3903 Of 3903F, See a e A-4 , ..
Unrelmbur.ed employee expenses-job IIBvel. union dues" ,
Job educalion. .Ic, " requi'ed. you MUST a"ach Form 2106,
(SeepageA-4,) ~ _________ ___________
__________~l1P_atlil_W_________ 5 381.
O1her expen.es-investmenl, la, prepa"lion, ..f. depoo~ bo"
elc. List Iype and amounl ..
_ _ _ _T.b2LFJ:!lLRB:)}Eil'EC::::::: :?:i5:; 20 285.
Add line. 19 Ind 20, , , , . , . , , . ,. 21 5 666.
Enle,amountfromForml040,lin.32 . ,. 22 70 554. ';C,;,'
Muhiplyline22aboveby2%(.02), . , , , , , . .' 23 1 411.
Subtract line 23 'rom line 21. If lero or less enter.o.. . . . . . . . . . . . . ~
Othe,-rrom list on page A,5. List Iype and amount .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
20
21
22
23
24
25
4 255.
~ 25
NONE
}
, , ." 26
22 901.
:: /--~'~;~,
Schedule A IForm 1040)1883
Page 4
I
I
I
L
r
f l012a'93
Schdults Me orm 10..0 1993
Nlmt(I)'''own on FI",," 10.0. Donotlnler nlm. .nd IOClllltculrty number If Ihown on "1;.1.
ROBERT P. NELSON & JUDITH . NELSON
Schedule B..lnterest and Dividend Income
OMB No IS.S.ool' P.. 2
Your IOCIII IKurlty number
113-30-1409
Atuchm.n1
S.qu.ncI No DB
8 Add Ihe amounls on line S , , . . . , , , , , , . , ,
7 Capijal gain dislributlons, Enle, he,e and on Schodulo O' . .
8 Nonlsxsble disl,ibutions, (Seelhe ins!. fo, Form 1040, I,ne 9 ). ,
9 Add lines hnd 8 . . . . . , . , , , , . , , , , ,
10 Sublract linf 9 from Iinf 6. Enter the result helf and on Form 104$0.lloe 9 . .
.If you recelvod capllal gain di.lributlon. but do not need Schedule 0 10 'epo~
8n other sins or lones 8M! the insln.rctions for ForRl1040 tines 13 end 14
If you had over $4$00 of Inlelesl or dividendi OR had II foreign account or were a granlol of. 01 IItranlferor
to, I foreign Irust. you must cl)mplele this part.
111 AI any time during 1993, dId you have an Interest in Of II signalule or other authorrty o\ler 8 financial
Dccount In 8 fOleign country. such 8S a bank account. secUrities accounl. Of other financial
Dccount? See page B.2 for ellceplions Bnd filing ,equilemenl' for Form TO F 90.221 . . , . . . , , .
b 1'''Ye,:enlerlhe name ofthe'oreign counlry .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(5.. 12 We,e you Ihe g,anlo, 01, 0' Irsnslo,o, 10, a foreign l,usllh,1 o,isled dUllng 1993, wOlhe, or not
page B,2,) ou hsve an beneriCiallnl.'o.lln~? If .Vos' ou ma havolo file Form 3520 352O,A 0,926. , , , , . X
For Paperwork Reducllun Acl Nollce, s.e Fo,m 1040 Inslrucllon.. Schedule B IFo,m 104011983
H807
F 2102194
ParI I
Inlor051
Incomo
(5..
psges 16
and B.1.)
Nolt: If you
received a Fo,m
1099,INT, Form
1099,010,0'
lubslHula
stelement flom
8 brokeregc firm.
lisllhe firm's
name 81 the
paye, snd enler
Ihe lolallnloro.t
Ihown on Ihat
form,
ParI II
Dlvldond
Incomo
(So.
pages 17
andB.l,)
Not.: If you
,eceived a Form
1 Q99.01V or
subslijut.
slslemenlf,om
. brokerage
firm, lilt Ihe
firm'. name 8S
the paye, and
onle, thelotsl
dividends
shown on that
form,
ParI III
Forolgn
Accounts
and
Trusts
Note: If yOU had o\ler 54$00 In IS)(Dble lnleres inc me ou muslal$O com lele P8r11l1,
inlerestlncome
1 Llsl name of paye" If any Inte,oslls f,om a aeUe"financed mo~gage and the
buyer used the ploperty IS 8 perlOnal residence. lee page 8.1 and lisllhis
Inlerest first. Also show that buyer', lociallKur~y number and addre" .._ _ _ _ _ _ _
Amount
---------------------------------
fNT-fMMK~l~-----------------------
lilM-PAEMPLOYEESCR~UNroN--------------
S.W-: -SECU-RITIES - - - - - - - - - - - - - - - - - - - - --
---------------------------------
3.
1 316.
17.
1
---------------------------------
---------------------------------
---------------------------------
---------------------------------
---------------------------------
------.---------------------------
---------------------------------
2 Add the amounls on line 1 , , , . , , , , , , , , , . . , , . , , 2 1 336.
3 Excludable interest on .eriel EE U,S. savings bond. issuod after 1989 f,om Form
881S, line 14,Vou MUST aftsch Fo,m 881Sto Form 1040 , , , , , , 3
.. Subtract line 3 from line 2. Enter the result here Bnd on Form 104$0 line 88. . ..... 1 336.
ota' I au had over 4$00 In ross dividends and/or other ~isllibutions on stock au musl 8150 com lele Part III.
Dividend Income Amoun
5 lIsl name of payer. Include U'OSS dividends and/or other dlshibuli('l'" on stock hele.
Any capijal gsin distributions snd nonlaxable disl,ibulions will be deductod
onlines7and8 ~ ______________ __ __ ________
IBM CORPORATION 3.
~.~~ :s]g:@liI};~:::::::::::: :::::::::::::::::::::::::::::::: 236.
5
8
239.
7
8
1.
~
9
10
1.
238.
~{.:~~/:/;;;s:r~?,:~;.}~}jJ[~~~f~~
Yes No
Page 5
M U' ..
SCHEDULE 0
(Form 1040)
Capital Gains and Losses
~ Attach 10 Fo,m 1040. ~ s..lnl',ucllonl lor Sch.dul. 0 (Form 10401,
~ Uullnu 20 and 22 10' more s aco to IIs1 'ranucllons 10' IInOl 1 and 9,
1993
AttIthmln'
S u,nc. No, 12
Your .ocl.lucurlty numbfr
113-30-1409
Less
tel Coslor
oth"bnll
(foOl p.gl ().31
I'I LOSS Ig GAIN
If (e) \. mO'1 than (dl. If (d) Is more thin (II.
sublrac d hom I sub ,.ct . hom d
&
93 7 552. 7 502.
900 SHS CENTIGRAM 93 19 344. 15 287.
600 SHS INFORMIX 93 15 216.
2 Enl.r your short.lerm lolals. ~ any. from
Iino 21. 2 32 350.
3 To'al Ihort-Ierm salOl prlco amounll.
Add column (d) ollinol 1 and 2 . 3 74 462.
4 Short,lonn gain from Forms 2119 and 6252, and short.l.rm gain or (loss)
from Fonns 4684.6781, and 8824 4
5 Net ahort.lerm gain or (Ion) from partnerships,S corporations, and
fiduciari.1 110m Sch.dul.(I) K-l . 5
8 Short,l.nn capilallo.. carryov.r from 1992 Schedul. 0, lin. 38 , 8 1 115.
7 Add lin.s 1,2. and 41hrough 6, In column. (n and (g~ 7 1 275.
5 Nallhor1~e'm ca 5
Lon -Ter
g400 SHS SW
SECURITIES 5 388. 4 002.
4 057_
6 823.
5 548.
1 386.
14
CopKol goln dillributlono,
1-
~~!;;0R~~~i~i';~
10 Enlo, your 10ng,l.rm lolals, n any. from
line 23. . . . . . . . . . . , 10
11 Totallong~erm sale. price amounts.
Add column (d) of line. 9 end 10 . . . 11 5 388.
12 Gain from Fonn 4797; 10ng,lenn gain from Fonns 2119,2439, and 6252;
and 10ng,lenn gain or (loss) from Fonns 4684, 6781. and 8824 , , . ,
13 Nellong.lenn gain or (Ios.) from partnerships, S corporalions. and fiducialies
from Schedulo(l) K-1. .
,;'{ilRqf?::}lXMfwli
,>_..~.<._..;,~."~,V.i',,:,,,,!,(,
:,;;,~'~?,*;:;,1;:~:J:~~>,4W.
15
658.
15
Long,l.nn capKalloss calryov.r from 1992 Schedul. D.line 45
18
658.
18
Add lin.. 9. 10. and 121hrough 15. In columns (n and (g)
17 Net Ion .term ca ltal atn or lollS. Combine colums of line 16
I, Su mar 0 arts I and 11
1 a Combln. linOl 8 and 17, If a IOSI, go 10 Iin. 19. If a gain, .nl.r Ih. gain on F onn 1040, Iin. 13,
Nole: If bolh lines 17 and 18 are galnl, ..e Ihe Sch.dul. 0 Tax Worklheet on page 0.4 ,
19 If line 18 il e (Ion), enl.r h.re and o. 0 (loss) on Form 1040, Iin. 13, Ih. Imallor of Ih...lo....,
. Ihe (Ionl on Iono 18; or
b (S3,OOO)0I,Kmorriedfiling..paral.ly,(SI.500), , , , , . , , , , , , , , , , , ,
No't: S.olho Coplltl LOll Carryovor Worklh..t on page 0.4 ~ th. los, on I,n. 18 ",c..ds
lhe Ion OId,no 19 0' K Form 1040 lin. 35 I.. loss
For ptperwork Reducllon Act Nollce, "" Form 1040 Inltrucllonl,
Hea7
. . . . . .
17
. . . . . . . .
15
III
. . . , . . . .
. ;- ,:,,;;_,.);~;_!i::.-,,(:-r/C;/~' ,~:~ .
.,4 ." n'~':'i,""t.~.-.?, I'!'.J';'
,}~:' _":,,,;;"'-;l)'rlf_;':4")4-(;"(~7.
., '.,. -..',.;-;t'x-j''''1t..~;$j}::;':~"
50.
1 387.
729.
6 277.
Schodul. 0 (Form 1040) 1eU
r '717~11l3 Page 6
'.
h I
12
2
So odu. 0 (Fonn 1(40) 1993' An-ehm,n' S....u.nu No P.o.
N.mt(l) lhown on Form 1040. 00 nOl ,nt., n.mt .nd oocl,l HCurtty number If Ihown on p.g. 1. I Your loclalncu,Uy number
ROBERT P. NELSON & JUDITH n. NELSON 113-30-1409
I . ~ta' Gal I a;;-d -'--;:;-5101 :Asse~ 1I0ld 0"0 voa' o. I all "'ontlnuo'i-- 01 D.n I'
l'A Doscrl~on 01 ~l (bl Dol. la O.t....d ld) 5,11, Ftc. I.! crt:. or In LOSS Ig~ OA~
ro~rty IfImt' . q~rtd thtl ~ "tr~ 'mor~ r,:.n ldl' "(d~' or~ In \~,
00 Ih. y;yz o. (Mo.. .y, yr.) 0., diY, ",) 1M p.g. 3) (It. p.g. 3) I bld(d 10m. au trlC't(. om
20 06'29/93 09/13/93
1200 SHS CHECRERS 15 083. 15 243. 160.
500 SHS LORAL 08/26/93 12/13/93 17 267. 16 150. 1.117.
21 Short.lonn lotolo, Add coIumno (d), (0, and , 121 \... t:;.::.:~):^n'?t::;o!:<:....l'
1...\ of line 20 Enler here IInd on line 2 32 350. ,,,;;~~):t(r~*i";~~):..1 160.
. , :;,t1t, -;~1>~",'""';:~HP 1.117.
IParlVI L~ c;.:;Jtal Gains and Losses-Assols 110 Id Mora Tho" One Year 'Continuation or Part II'
22
23 long.lenn loto11, Add columns (d), (Q. and , 123 1i;;7t'; f'J(", I
I.' of line 22 Enl.r here and Dn line 10 , :",.,,.,,:,1
F 11104193
Page 7
Form 4952
Department of the Tr..sury
Int.mll R.v.nut ServlCI
Nlmt(I) shown on r.tum
~ Al1lch to YOU' tlX .eturn,
Investment Interest Expense Deduction
ROBERT P. NELSON & JUDITH NELSON
teliii.lJ Total Investment Interest Expense
1 Investmenllnterest expense paid or Bccrued In 1993. S..lnstructlons,
2 Disallowed Investment Intereslexpense (rom 1992 Form 4952, line 5
3
Totlllnveltment Interest ex nle. Add lines 1 and 2
li;ifili1 Net Investment Income
4a Gross Income (rom prope~y held (or Inveslment (excluding Bny nel gain (rom the disposhlon o(
prope~yheld(orlnve5Imenl) , , , , , , , , , , . , , , , , , , . ,
b NBt gain from the disposhion o( prope~y held (or Investment, , ,
4b
o Net cBphBI gBin (rom the disposhlon o( prope~y held (or investment
40
d Subtract tine 4c (rom line 4b. Ilzero or less, enter -0., , , , . . , , , , . ,
I Enler ell 0' pB~ of the emount on line 4c that you elect to Include In Investment Income. Do not
enter more than the amount on line 4b. See Instructions. . .
Investment Incom., Add linel4., 4d, end 4.. Seelnltructionl
5 Investment expenses, See Instructions , . . . , , , , ,
Nellnvestment Income. Subtract line 5 from line 4t. If zero or les5 enter.o. .
5
~It'iiij
:_.._v!
Investment Interest Expense Deduction
7 Disallowed Investment Inlerelt expenle to be csrrled forward to 1994. SubtrBct line 6 (rom line
3, I( zero Of Ie.., enler -0., . , . , , . , . . . , . . . . . , . , . . , ,
a Investment Interest ex nle dtductlon. Enler the smaller of line 3 Of 6. See Instructions .
Fo. Plperwo.k Reduction Act NOtlCI, s..lnstructlonl,
H807
F tf/18193
Identifying number
OMBNo, 15-1~191
1993
Attlchmtnt
Sequlnce No. 12A
113-30-1409
272.
2
NONE
3
272.
1 571.
6 277.
729.
4d 5 548.
,~ 4. NONE
41 7 119.
B NONE
5 7 119.
NONE
s
272.
Fonn 4952 (1993)
Page 8
Schtdulo E (FDrm 1040) 1993 .
N.m'(I) Ihov.n on r.tum. 00 nol.nl.r ".m. .nd soclll &eCurtty numbotf if Ihown on pig. 1,
AttJchm.nl S. Ultnc. No. 13 p, . 2
Your locl.llecurlty number
ROBERT P. NELSON & JUDITH . NELSON 113-30-1409
Notl: If yOU rlloort amounts from (ermine Dr fishina on Sche<1ule E \IOU must.mle, your Qrosllncome from those IIctlvities on Ijne 41 below,
PartUl Income or Loss From Partnerships and S Corporations
If yoo report I loss rrom In It.risk .ctiv~y, you MUST check e~her column Ie' or II) or line 27 to de..ribe your inveslmlnt in the Ictlv~y, See
DID.!;-4 If vou .heck .olumn rn "ou mu.t"""ch Form 6198
Ib) Enter P tor Icl ChKk" Id) EmplDyer In......tmtnl At Rllk7
27 (I)Ulml p.rtn.llhlp; 5 n. foltlg~ln Id.nbflc.tio" III Alii. (~J~mll.
fOf S cornnr.tion 'M."hl number ,t risk n ,trl,k
A PROFESSIONAL RESOU
B MECHANICSBURG PA. 5 25-1691769
C
0
1=
Passive Income and Loss Nonnass1ve Income and Loss
(gl Passive IOSlIIlOWflt (hi PAulv.lncom. (II Uonp.sslvlloSl OJ Section 179 'llpt"n Ikl Nonp.sslv.lncom.
(Ittach Form 8682 If required) flom Schtdule K.1 from Schedule K.1 deduction 'rom Schedule K.1
from Form .682
lJ.
B 307.
C
0
E S
281 Totels /C-,,"' I ;:<'ie',,', <P'> .. , {.?:"" 307.
b Totals r ';"""'.'."/':"';:""-':":' .. .. :::'t:
;X:;:.~'-;''''''v.,:....:-. .,.,.'e.
29 Add columns (h) and (k) of line 28a , , , 29 307.
30 Add columns (g), (i), Ind fj) of line 28b 30 I
31 Total plrtnellhip and S corporalion Income or (loss), Combine lines 29 and 30, Enler Ihe resun
here end Include In the lolal on line 40 below 31 307.
lpll,ulll Incomo or Loss !'rom Estates and Trusts
32 (1)lllml Ibl Employ..
Identification number
A
B
C
Passive Income and Loss Nonnasslve Incomo and Loss
lc) Passtv. deduction or loss allowed Id) Passive Income (e) Deduction or loss (f) Other Incoml horn
(1ltoch Form 8882 "roqulred) 'rom SctlMtule K.1 from Schtdule K.1 Sch.dull K-f
A
B
C
331 T olall I :'.~A:~~~~:~\~;:/$-~:;::t?h~ ~~j:</:/~:;;":.;,;~.t,,t; :;-. ':~,"~;:,:~:t' ~ \:;~::.:'~::~}:~n';:::c ,;,:"T; "~;' ':>>,
b Tolall I ;":.~;,t:~~;:::,:;)::~::'~(-:~:~;{~S~V:-~S:.:.:::.<;t:~:~. ~(>~\'.t~
34 Add columnl (d) end (I) or line 330. 34
35 Add columns (c) and (e) of line 33b, 35 I, I
38 Total eltale and trust Incoma or (loss). Comblnelinel 34 and 35, Enler the resun here and Include,
I" the tolal on Ii"e 40 below . . .. .... 38
/. Income or Lossl'lo ;;;Real Estate Mort aae Investment Conduits IREMICsI.Resldual Holder
37 (II Name (b~ EmploYlr Ic) Excess Inclusion from (d) Tax.blelncome (nit loss) (1)lncDml flDm Schedulu Q,
IdentJ cltion number Sched~I::o~' li~~ 2c from Scheduln Q, lin.1b Ine3b
(Set IIE...c
38 Combine columns Id\ and 'el onlv, Gnler the resu~ here and include In the lotal on line 40 b.!low 38
" Summaru
39 Net f.rm renlll income or (loss) from Fo,m 4835. Also, complete line 41 below. 39
40 TOTAL income or (Ios.), Combine lines 26, 31,36, 38, Ind 39, Enler the resuk here and
on Form 1040,Iine 18 , , .. 40 307.
4t Reconciliation 01 Farming and Fishing Incoma: Enler your gro.. ..,.'''"'''.
(, :'_H~<<'_:'f:}l:'~:>".. ~~. '"..'~
3r~\)'4~~!-.~ll~".' &: :. >,
farming and fishing Incom. reported in Parts nand III and on line 39 t~~l:ltt#;lt~~,:>.' -, lij~-
Is.. o.ne E.4\ , , , , , . , , , , . . . . , , . . 41 1;;
F 10127193
Page 10
. NO.1
113-30-1409 P'O. 2
b Vehlcl.
06 29 93
9B71 miles
6424 miles
65.1 %
12 miles
1464 miles
19B3 mile,
IZJ Ves 0 No
0 No 0 Not applicable
Form 2106 (1993) ROBERT P. NELSON
t Vehicle Ex nses See Instruction. to find oul which secllon. 10 com
Sectlo . e ra 0 a 10
12 Enler Ihe dole vehicle WBI placed In service 12
13 Tolal miles vehicle we, driven during 1993. 3
14 Business miles Included on line 13 . . . 14
15 Percenl of business use. ~ivide line 14 by line 13 15
16 Average daily round lrip commuting dlslance. . 16
17 Commuting miles Included on line 13. . . . . 17
18 Olher personal mile,. Add lines 14 and 17 and sublraellhe 10101 from
line 13 . . . . . . . . . . . . . . . . . . . . . . . . .. 18
19 Do you (or your spouse) have anolher vehicle available ror personal purposes? .
lele.
. Vehicle 1
05 24 B8
4526 miles
316B miles
70.0 %
12 miles
130B miles
50 miles
20 If your employer provided you with B vehicle,ls personal use during olf duty hours permi"ed?
IXI Ves
IZJ Ves 0 No
21. 00 you have evidence to support your deduction? .
IX! Ves 0 No
21b If.Ves.,lslheevldencewritten? . . . . . . . . . . . . . . . . . . . . .
Sectlo B. Standa d Mllea e Rate U.e this section onl If ou own the vehicle
22 Munlply line 14 by 28 cenl. (.28). Enler Ihe resun here ond on line 1. (Rural moil corrlers. .ee
Inslructions. .... . . . . . . . . . . . . . . . . . . .
Section C . Actual Ex en.es
23 Go.ollne, oil. repol... vehicle
Insurance, etc.. . . . . . .
24a Vehicle renlals . . . . . .
b Inclusion amounl (see Inslructions)
c Subtraelline 24b from IIna 24a .
25 Value of employer.provlded
vehicle (appllas only ~ 100% of
Bnnuallease value was Included
on Form W.2. seelnstNellons).
26 Add lines 23. 240, and 25 .
27 Munlply line 26 by Iha
percenlage on line 15 . .
28 OepreclaUon. Enler amount
from line 3S below . . .
29 Add line 27 and 2B. Enler lotal
here end on line 1 . . 29
Sect 0 . e reclatlo 0 Vehicles Use this. cllon onl If
887
1 401.
912.
912.
t~~l~slffiili)ll&~"
'~(:';1:~;!!~~~~~~i
3D Enler cost or olher basis (sea
Instruellons) . . . . . .
31 Enter amounl of section 179
deduelion (seelnsINcUon.) .
32 Munlply line 30 by IIna15 (see
Inslruellons ~ you elec1ed the
sec1lon 179 deducllon). . .
33 Enter depreciation melhod and
percenlege (s.. InstNelions~ .
34 Mu~lply line 32 by Ihe percenlage
on line 33 (s.. InslNellons) .
35 Add line 31 and 34. . .
36 Enter thellmijatlon amounl
from Ihalable In Ihe line 3S
Instruelion.. . . .
37 Muniply line 3S by Ihe
percenlage on line 15
38 Enler the smallar or Ilna 35 or
line 37. Also. enler Ihls amounl
online28sbove. . . . . .
F 10126193
3
32
33
34
35
36
37
38
Page 12
Form 4562.
Deproclatlon and Amortization
(Including Inrormallon on Lilted Proporty)
-1993
67
OM No I~s.o17
Departmlnt of the TfllIUry
nt.m.1 Rev nu Servlc.
Nlm.tl) shown on llturn
... 8ft.. .'I'e ".'ructlon'
A1t.ch this form 10 our rei urn.
Altlchm.n1
5 uencI No.
Identifying numbtr
l.SON & JUDITI
Ie tht. orm "1,1,,
,SON
113-30-1409
FORM 2106 NO. 1 LINE 2B
lp~!1 Election To Exponlo Cortaln Tonglblo Proporty (Secllon 179) (Nole: II you have any "Listed Property,"
m 1 b f r m I I
M...lmum doll., Ilm~.lion (If In '"ltlp'i" zone bUlin.tII, '" In,tructions) . . . . .
Tot.1 cosl 01 section 179 property pl.ced In service during Ih.l.. year (... Inslructlons)
Threshold cost of sechon 179 property belore roducl1on In I,m~.tlon. . . . ,
Roduc1ion In hm~stion Sublract hno 3 110m hne 2, but do nol .nler le"lh.n .o.
II ,11m' I " It , Iln 4 Iln n r I h
1
2
3
4
tfmllrl,drilln
1 500
4 926.
200000
NONE
17 500.
1.1 On"loliOtl of D'(I['1t'ty
b Cos
LI.ted property. Enlo, .mounl r.om I,no ~. , . . . . . , , . , . . , . . .
Totelolecled cosl 01 section 1 79 properly Add amolJnlsln column (c), hnos 6 ond 7 .
Tonl.livo deduction Enlor Iho small.r ul hno 5 01 hno 8. . , . . , , . . . . .
Clrryover of disollowod deduction f.om 1992 (..oln,lrUChons) , . . . . . , . .
Tlublelncome limit.llon. Enl., thl Imlll., of I...bl.lncom. Of Iln. 5 (lItllnllructionl)
Section 179 o.pen.. deduction Add I,nn 0 Ind 10. but do notonler morelh.n hno 11 .
r I II 4 n I 3 NONE
Note: Do not use Part Ii or Part III below lor hslod propert, (automobiles, ceneln other vehicles. ceUuler lelephones,
conaln computo". 01 propen, used 101 enl.rt.inmonl, recroohon. or .musom.nl). Inslead. use Pan V fOllisled property.
1~~~Jl;l MACRS Doproclallon For Assetl Placed In Service ONLY During Your 1993 Tax Year (Do Not Include
Lilted ProDorlYl
7
8
9
10
11
12
8
9
9
11
12
17 500.
NONE
tll CIUltncltlon of property
lbt Month .nd let OU..'Of d.pI.cI.lion
.,.., pl.e" In IbU'ln.u/lnvlllm,nt un
I _ ", n
(0) Otprec:l.llon
dtduction
14
n
e
b
4 926. 5-YR
HY
200D8
9B5.
',i
.r
a Ra.ldonll.1 ,enl.1 property
7.5 rs MM
75 rs MM
MM
MM
12~rs
40 II. MM
~~
S/I.
S
S
S
S/I.
h Non/osldenll.1 rOIl property
": fr~~'''''''''''''l~!''~%":r
r~m~ Olhor Doproclallon (Do Notlncluda Listed Proporty)
11 GOS.nd AD5 deductions for ...els pl.ced In service in I.. ,eers beginning berorel993 (see Inslruc1lon.)
17 Property subject 10 ,ochon 168(1)(1) elecllon (see In.INc1lons) .
A R and other d" rt'Clnlion 'M IMlructions . . . . . . . . , . . . . . . . . . . . .
~~IVJ Summary
19 LI.led p/openy. Enler .mounlfrom line 25. . . . . . . . . . . . . . . . . . . . .
20 Tol.1. Add deduc1ions on Iino t2, lInes 14 and 151n column (g). and lines 161hrough 19. Enler here
and on Ihe approprlalellnes or your relurn. (Partnerships end S corpor.lion...... Inslruclions). .
21 FOI.....ts shown above and pl.ced In service during Ihe current ,eer, enter Ihe portion
of thl! busll att,ibutnhll! 10 r.~ion 263A C0'511 &~ instructions . . . . . . 21
For P.perwork Roducllon Acl Notice, SH page 1 or lho ..par.lo Instrucllon..
H807
F 10113193
16
7
18
9
20 9 B 5 .
,~'~/t\:';,{i..1<~"~'l:1t~t:
/,~.-~{;:,<.jY;(&}~1)qr~h4'
:":" ~_ ~':I;,'~~JJ~)l{"V;'~f:';'~Y<<:1t;;
Form 4562 (1993)
Page 13
.-
.
Form ~562(1993) ROBERT P. NELSON & JUDITH O. NELSON 113-30-1409 P... 2
lfilrty;) Listed Property-Automobiles, Certain Other Vehicles, Cellular Telephones. .
Certain Computers, and Property Used for Entertainment, Recreation, or Amusement
For any vehicle for which you ara using Ihe slandard mileage rale or deduc1lng lesse ..pen,e. complete only 22a,
22b. columns (a) through (c) of Section A. all of 5ectlon S. and Section C ~ applicable.
Section A-Dtnreclatlon and Other Inronmatlon IClutlon' S...lnstructions for IImastlon, for automobile.. \
221 Do vou have evidence to sunnn" the buslness/lnve'lmenl use claimed? n Ves n No 22b If .Ves . Is the evidence wril1en? n V.. n No i
(c) I') (n (I) I
I') (b) Busln.ss! Idl Bill, ro, dlplKi.tion Rotey. Ig) (hI Eloc:tod ,
Tl'p"" \,:opo~ Olsl O.t. placid In Investment Cos'oroth., (busln..Ifln...."tm.nl ''1' Method! Oepltcl.tlon l.aion 179 !
v.hlc: " fbi' IINlce ~r~:~ta". buil use only) period Convention d.duttlon COI' \
~3 Pronl!rtv used more than 50% in 8 U811fied buslnen use ISH instructions" I
t
,
~4 ProMrtv used 50% or less In a nualrfied business use lsee lnstruelions\~ I
i
SIL. ~!~~~~~~~J,I,11f~;ij I
SIL. I
i
sn. ",J$'"''~l''' I
25 Add amounlsln column (h). Enlerthelolal here and on line 19, page 1 . . I 25 m?irtfigi&&M:~Th'
28 Add amounts In column lil. Enler the lolal here end on line 7_ Dace 1. . I 28 !
Section B-ln'ormltlon Reglrdlng Use or Vehicles ..If you deduct e'penses for vehicles: I
e/VNays complete this Helion for vehicles used by a sole proprietor. partner, or other "more than 5% owner,- or relaled person.
.tfvou crovlded vehleles to our aml'llo\lees first answer the nUtSll"'ns In "KtIon C to loe tf\lOU meelan ell:e~Dllon to comDI~lina this tec1lon for tho'. v-hides.
(-, (bl Ie, Idl (t) In
27 Total buslnesslinvestmenl miles driven during Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle G
Ine yeer (DO NOT Include commuting miles) . I
28 Tot.1 commuting miles driven during Ihe year.
29 Totll other personel (noncommutlng)
miles driven
3D Totel miles driven during the year.
Add lines 27 Ihrough 29 . .
V.. No Ves No Ves No Ves No Ves No Ve. No
31 Was the vehicle available for personal
Use during off-duty hours? .
32 W.. tho vehicle used primarily by a
morelhan 5% """,er or related person?
33 Is another vehicle available for personal
use?
Section C-Questlons for Employers Who Provide Vehicles for Use by Their Employees
Answer these quesllonslo delermlne ~ you meelan e'ception to compleling Sec1lon S. Note: Section B muslalways
be comnleled for vehicles used bv sole nronrielor. nartners or other more than 5% owners or related N'rsons.
Ve. No
34 00 you maintain I written policy stalement that prohibb all perr.onal use of vehicles. including commuting.
byyour employ...s? . .
38 00 you maintain I written policy statement that prohibhl perlonal use of vehicles. e)'cept commuting, by
your employees? (See inslructionl for vehicles used by corporete officer.. directors, or 1 % or more owners.) .
38 Do you treat an use or vehicles by employ.... .. personal use? . .
37 Do you provide more than fIVe vehicles 10 your employees and retain Ihe Inrormalion received from your
employee. concemlng Ihe Use of the vehicles?
38 Do you meet the requirements concerning qualified automobile demonstration use (see inslructions)? . .
NOI.: It vour answer 10 34 35 3S 37 or 3S I. 'Ve. . vou need not comolel. Sec1lon B for the covered vehicles. it~FJ:@'. :~1,mji1
!D....Ull Amortization
(I) lb) (cl (dl Ie) In
Amortization
Description of costs Dale .morttlltion Amortizable Code periodeM' ,l,mo,llnUon
begins .mount section perc.ntage fOf this year
39 Amortization of costs lhat beains durina our 1993 tax vear' .:. . '. <.": ~j.;:. :';~:';'~'; l' ~'~ ~.\>::~:V.1;.-'l<;;rJ.~-iilli.:<Nr~1I
I
I
~D . n of cn<I' Ihet t>t-oen before 1993 I ~D
~1 T^h' "." '('\,h.. 'N' o Ion. nl vnu, r.llI'n I ~1
F 011127103
Page 14 L
r:
,--... --. . ----. ~t
O'
"" """-, .., -
ROSERT P. NELSON' JUDITH O. NELSON
\13.30'1409
REGULAR DEPRECIATION
FORH 2106 HO.l LINE 28 ACTIVITY 1
F~ THE YEAR ENDED 12/31/93
.......................................................................................................................
DEPRECIATION
C
ASSET DATE OEP L
N\J!I ACO HTH SLifE
OEPR
X
BUSINESS SALVAGE
8AS I S VALUE
SEC 179
EXP
IIC
TIP
IIC
BASIS
ADJUST
DEPR
8ASIS
PRIOR
CURRENT
ACCUH
EXPL
.......................................................................................................................
PONTIAC
2 062993 HCR B 05/00 20.00 4,926. 4,926. 985. 985.
BEGINNING BALANCES
ADD II IONS 4,926. 4,926. 985. 985.
DISPOSALS
ENDING BALANCES 4,926. 4,926. 985. 985.
FH 4562 PARTS II,III,V , VI 985.
CUR YR ELECTED SEC 179 EXP
SECTION 179 EXP CARRYOVER
TOTAL REP~TEO ON FORH/SCH 985.
Pogs 15
ROBERT P. ,NELSON & JUDITH Q. NELSON
113-~0-14Q9
ACTMTY LISTING
Ac1lvllv. OescrtDtlon
1 S CORPORATION
~
1
Form
~
SCH E, PT II
!!m.!
1
Proptll
~
1
.,
. Activity Types 1- Active
3- Active Pe~lclpalion Renlsl Reel Eslate
4- Other P..slvo
5- Other Rentsl R.sJ Esl.>l.
1041 Only
2- Po~fo1io
.. Ordinary Income
Page 16
. . VEHICLE EXPENSE WORKSHEET . .
ACTIVITY NUMBER 1 SCHEDULE FORM 2106 APPLICATION CODE J
Vehicle 1 Vehicle 2
DATE VEHICLE WAS PLACED IN SERVICE OS/24/B8 06/29/93
TOTAL MILES USED IN 1993 4526 9871
BUSINESS PORTION OF TOTAL MILES 316B 6424
PERCENT OF BUSINESS USE 70.0 % 65.1 %
STANDARD MILEAGE RATE CALCULATION:
1. BUSINESS PORTION OF TOTAL MILES BV .2B B87.
2. TOTAL DEDUCTION USING STANDARD MILEAGE RATE 887.
ACTUAL EXPENSES CALCULATION:
1. TOTAL ACTUAL EXPENSES 1,401.
2. BUSINESS PERCENT OF ACTUAL EXPENSES 912.
3, DEPRECIATION OF VEHICLE
4. TOTAL DEDUCTION USING ACTUAL EXPENSES 912.
TOTAL AUTO EXPENSE DEDUCTION ALLOWEO BB7. 912.
Hl107
F101271ll3
Page 17
SUPPLEMENTARY STATEMENTS
.
ROBERT P. NELSON & JUDITH Q. NELSON
113-30-1409
---------------------------------------------------------------------------
SCH A - LN 7, OTHER TAXES
STATEMENT: A-1
DESCRIPTION
PERSONAL PROP TAXES
OCCUPATIONAL TAX
PA UC TAX
AMOUNT
315.
20.
44.
TOTAL AMOUNT
379.
---------------------------------------------------------------------------
STATEMENT: A-2
SCH A - LN 11, INVESTMENT INTEREST DESCRIPTION
S.W. SECURITIES
AMOUNT
272.
TOTAL AMOUNT
272.
---------------------------------------------------------------------------
STATEMENT: A/4952-1
4952 INVESTMENT INTEREST EXPENSE ADJ
AMOUNT
1. CURRENT YEAR INV INT EXP.......................
2. PLUS PRIOR YEAR DISALLOWED INV INT EXP.........
3. TOTAL INV INT EXP BEFORE LIMIT (LN1+LN2).......
4. LESS DISALLOWED CURRENT YEAR INV INT EXP.......
5. LESS AT RISK INV INT EXP ADJUSTMENT............
6. CURRENT YEAR ALLOWABLE INV INT EXP.........
272.
272.
272.
---------------------------------------------------------------------------
,
Page 18
SUPPLEMENTARY STATEMENTS
ROBERT P. NELSON & JUDITH Q. NELSON
---------------------------------------------------------------------------
113-30-1409
STATEMENT: 4952-1
FORM 4952 LINE 4a GROSS INCOME FROM PROPERTY HELD FOR INVESTMENT
INTEREST INCOME (FORM 1040, LINE Ba)
LESS PARTNERSHIP & S-CORP INTEREST IHCOME
NON PARTNERSHIP & S-CORP INTEREST INCOME
DIVIDEND INCOME (FORM 1040, LINE 9)
LESS PARTNERSHIP & S-CORP DIVIDEND INCOME
NON PARTNERSHIP & S-CORP DIVIDEND INCOME
NET INCOME FROM ROYALTIES
INTEREST EXPENSE FROM ROYALTIES
LESS PARTNERSHIP & S-CORP ROYALTY INCOME
NON PARTNERSHIP & S-CORP INV INC FROM ROYALTIES
INVESTMENT INCOME FROM FO~I BB14
INVESTMENT INCOME FROM PARTNERSHIPS & S-CORPS
INVESTMENT INCOME FROM PTP's
GROSS INCOME FROM PROPERTY HELD FOR INVESTMENT
1,336.
3.
1,333.
238.
238.
NONE
NONE
NONE
NONE
---------------------------------------------------------------------------
1,571.
STATEMENT: 4952-2
FORM 4952 LINE 4b NET GAIN FROM THE DISP OF PROP HELD FOR INVESTMENT
TOTAL CAP GAIN(LOSS) BEFORE PASSIVE LIMITATIONS
LESS PASSIVE CAPITAL GAIN(LOSS)
PLUS CAP GAIN(LOSS) ATTRIB TO PTP PASSIVE INC
LESS SEC 1231 GAIN BEFORE PASSIVE LIMITATIONS
LESS GAIN ON SALE OF RESIDENCE
NET GAIN FROM PROP HELD FOR INVESTMENT
6,277.
---------------------------------------------------------------------------
6,277.
STATEMENT: 4952-3
FORM 4952 LINE 40 NET CAPITAL GAIN (NET L-T CAP GAIN IN EXCESS OF NET
S-T CAP LOSS) FROM THE DISPOSITION OF PROPERTY HELD FOR INVESTMENT
NET S-T CAP GAIN(LOSS) BEFORE PASSIVE LIMITATION
'LESS S-T PASSIVE CAPITAL GAIN(LOSS)
PLUS S-T CAP GAIN(LOSS) ATTRIB TO PTP PASS INC
LESS S-T GAIN ON SALE OF RESIDENCE
NET S-T INVESTMENT CAPITAL (LOSS)
NET L-T CAP GAIN(LOSS) BEFORE PASSIVE LIMITATION
LESS L-T PASSIVE CAPITAL GAIN(LOSS)
PLUS L-T CAP GAIN(LOSS) ATTRIB TO PTP PASS INC
LESS SEe 1231 GAIN BEFORE PASSIVE LIMITATIONS
LESS L-T GAIN ON SALE OF RESIDENCE
NET L-T INVESTMENT CAPITAL GAIN
NET CAPITAL GAIN FROM PROPERTY HELD FOR INV
5,54B.
NONE
729.
729.
729.
---------------------------------------------------------------------------
Page 19
SUPPLEMENTARY STATEMENTS
ROBERT P. NELSON & JUDITH Q. NELSON
113-30-1409
---------------------------------------------------------------------------
STATEMENT: K-1 SCH B-1
K-1 SCH B -
INTEREST INCOME
DESCRIPTION.
EIN
INTEREST
PROFESSIONAL RESOU
MECHANICSBURG, PA.
25-1691769
3.
TOTAL AMOUNT
3.
---------------------------------------------------------------------------
page 21
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noc DArt .0iR WS OI,SOI WII uem ~'lI 11'11 1.11 SOil !UiA "II CWII 0111 OEPuel NtfPAT
......... ........... ............ ............ ........... .......... .......... ............. ............ ........... .............
t"lr e}ll mo Fellft F, NdlCl
01/Il/54 WO,CO 0,00 0,10 lor 0 0,10 Il5,(0 JUS JUO 55.14 0,(0
01/11/54 11 J.l5 I Sl.OO JUS HUO 10.eo 0,00 Ul JUO o,eo 1545,eo
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Ol/14/54 IIl.ll 155.10 lLll llU 0 10,00 lor 0 US IUO 10,00 1!ll,OO
04114114 /HO,OO 0,00 0,10 0,00 0,00 IlUO l!,ll 0.10 19,1l 0,00
(4/14154 411.15 155.00 lU5 lIU 0 10.10 0,10 US ll,OO o.co ISH.OO
051ll/H mo,oo 0,00 UO 0,(0 0,00 155.G0 lU5 UO 0,00 0.00
05/1lIH q1.IS 155.00 JUS llU 0 10,00 0,00 US 15.00 0,00 1545.00
01/15/54 /HO,OO 0,00 c.oo 0.10 0,00 155.00 lU5 0.10 0,00 0,00
OlliS/54 41J.lS 155 ,00 JUS 1I5.G 0 10,00 0.00 l.75 Il,OO 0,00 1545,00
tl/l5/H WO,OO 0.00 0,00 0,00 0,00 15UO lU5 0.00 0,00 0,00
tl/ll/H 411.15 155,00 lUS lIS,eo lUO 0,00 US lUO 0,00 1l45.00
01/11/54 WO,OO 0,00 0.00 o,eo 0,00 Ill.OO lU5 0,00 0.00 0.00
01/11114 qJ,1l 155,00 lI,/l lIS,OO 10,00 o,eo US Il,OO 0,00 IlH,OO
09/14151 llOO,OO 0,00 0,00 0.00 0,00 1!5,OO lU5 0,00 0.00 0,00
e5tH/54 qJ,IS l55,eo JUS lIS.OO 10.00 0,10 US lUO 0,00 ISH,OO
10 III III llOO.OO 0,00 0.00 0.00 0,00 155,00 lUS 0.00 0,00 0,00
10/ll/91 qJ,/l 155,00 lUS lIS.OO 10,00 0,00 US 15,00 0,00 1545.00
11/14/91 llOO.OO 0.00 0.00 0.00 0.00 155.00 lU5 0,00 0,00 0,00
11/14/H m./l 155,00 ll,/l m,oo 10,00 0,00 l.IS IUO 0.00 ISH,OO
11/l0/91 0,00 0.00 0,00 0,00 15000.00 9l0,OO 111.50 0.00 0,00 0,00
11 Il O/ll lHl.lO 5l0.00 117.5 0 000,00 00.00 0,00 /l.50 150,00 0,00 9060,00
ll/H/ll llOO.OO 0.00 0,00 0.00 0,00 155,00 lUS 0,00 0.00 0.00
Il/H/91 ql.lS I5S,OO lU5 Hl,OO 10,00 0,00 US Il,OO 0.00 ISH.OO
........... .............. .............. .............. ............... ................ ................. ........... .............. ................
SaltGlsI lOOOO.OO 0,00 0,00 0,00 15000.00 11l0,OO fll,SO SUO lOI.05 0.00
HOl.SO 2190,00 151,SO 11IO,OO !lEO.OO 0,00 11,50 450,00 10,00 l2l90.00
Cat. '. ol/20/n
T1Jl:I f 1.35 """
rrefe..1c~&1 ~e.ource Crcup. :ne.
1001 S. ~~:ket Street .. S~~t. t
~te~a~~c.kur91 FA litIS
rig. no. 1
h)'rell t-etul ~tFe:'t IScrttd toy Cc:!. hnk,d by :Utl
~EG tAAJl 0\71 C\'7 :I ,:,:rs C:1l tAAN
SS '''''If M:J..F.E 1o'H SUI "H S:I 1o'H r[~ ~H 5'\.11 1 LIo'H 1 LIo'H l C:1l tte
55 L:J.B ~Wt L:hB SCl LIIJl 5:1 l.1JJ1 rt.~" S\.11 2 :''''"H :I t.Io:H 4 C:1l LIIJl I;tT FM
........... ........... .......... ........... ........... ............ ............ .......... .......... ..........
tr:",;:lc)'ee ~2CO F.cbtrt p, t:e~.en :,.. :.U C~/~3/f5 Froe ::.te 01/1l/IS Oept e2
HOD.DD 0,00 0.00 e.CiD 0.00
HS.QO ~E.:l5 J. ':'5 O.CO :0 '5 ":0.:0 _s.co 0.00 o.CD
:'55.00 JE .:5 U,U D.CO Ie co C. eo o.eo 0,00 411.:5 1541.25
::-.k Pate C:/~~/f5 Free tate C2/1S/fS
:2500.CO O.too O.CO O.CO O,CO
~E5.00 36.25 2.75 O.CD :O.'~S '70.:0 :S.eo 0,00 0.00
a5.00 l! ,IS fS.E4 0.00 ::.00 0.:0 0.00 0.00 411.25 1141.25
::-.k :;ue el/:<lI5 Pro\: Date el/14/H
::I!OD.oo 0,00 O.CO O.to 0.00
US.oo J6 .::15 2.'75 0.00 :U. ':'5 '0. CD 2S.00 0.00 O.CO
:'fS.oO 16.25 fS.U 0.00 :{.:o 0, " 0.00 0,00 .11.25 1147 .25
............... .......... .......... .......... .......... .......... ........-. .......... .............. ..............
'1500.00 0.00 O. CO 0.00 0,00
.uS.DD HI.'75 9.:5 o.co ';~l.:a :lO.tO 7S.00 0.00 0.00
U5.00 101.'75 :U. S2 O.CD H.OD 0.:0 0.00 0.00 1:2J].7S 5UO. '5
.......... .......... .......... .......... .......... .......... .......... .......... .......... ..........
.,
'7500.DO 0.00 0,00 0.00 0.00
.uS.OO .101. '5 9,2S 0.00 'ILlS :lO.CO 75.CO 0.00 0,00
U5.DO .1CI.'1S :66.5::1 0.00 H.oO O.CO 0.00 0.00 1::1)),'5 5140,'15
. ,
Household Child Household Child
Week Week Month Month
EXPENSES
Mortgage/Rent ,?t,.;f.~,':.~,':.~,'::?..........",.. S S S /3 ?/..!!f S
Maintenance .....,.............................,..,.... S S S .5'0.<10 S
Utilities (telephone, hcatlng 7'1
electric, etc,) .................'...................... S S S 3 =,41.- S
Employment (transportation, '1S: !!:3
lunches) ............................................... S S S S
Taxes ~ .
Real Estate ....:~.. ?;,~..'!?~.'!:!:!!:~,f:.d... s s s S
Personal Property .....................;r............ S S S 2'1.33 S
Income .{1.i.tr.l:~,r.Jd~If!:.,7j,I.....r.o.:~!,r!IlYS S S S
Insurance i6. 2
XNM.",n;t>r-b S S
Homeowners ..... .......................... ,...... S S
Automobile .............................................. $ S s 107. oS" S
Life/Accident/Health .......'.....................' $ $ $ 36::1.33 $
Other ........................................................ S S $ $
Automobile (payments, fuel,
repairs) ................................................. $ $ S /lS-0.1X) S
Medical
Doctor, Dentist, Orthodontist ................ S S S $
Hospital"................................,................ S S S S
Special (glasses, braces, etc,) ............... $ S $ $
, Education
Private, Parochial School....................... S S S $
COllege .................,................................... $ S $ $ li'oS.oo
Personal ,
Clothing ................................................... $ S S 60. (to $ 6 (7:00
Food ."..,..........,..,.....................,..........",.. S _______., $ $ /po. 6'0 ~ 10drJ
Other (household supplies,
bafber, etc,) ........................................., S S S :J. (I. pO S ~ O. C'1>
Credit payments and loans .................... S $ S 33(}.76 S
Miscellaneous
Household help/child care ...................., S S S S
'-IIIUI lallllln;lu \111~. pd~t::rs, 'ls-. ~
books, vacation, pay TV, elc,) ............ S S S S
Gifts/Charitable contributions ............., S S S ~.>. ~ S
Legal Fees ................................... ........., < S ______ S ____ S ..._._ ___ ._
. -
Other child support/alimony
payments ............,.................,.........".., S S S S
Other (speclly) ,..y.Il1.(;~....Cf.'!.':!r.Ry..c;,.1!!l S S s .2 {, O.!!E ~ O.t!2
$..___
Total Expenscs ........,.................................... $ S s 369/.4'1 9SS.f!!
$ ------
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I
I
. Conllol numb,r
b Emplo.,..r"lld,nhr,calion number
25-1691769
c Employ.", nam., addtt5l. and ZIP cod'
Professional Resource
1001 S. Market Street
Mechanicsburg, PA 17055
d Employ...'loeI81 &ecuhty number
113-30-1409
. Employ.e'. name, add!tu, and ZIP cod,
Robert P. Nelson
516 Woodcrest Drive
Mechanicsburg, PA 17055
L_
a. " __
OMU No
Tho, Inl(Wmal'O" I' l,p'l'lg fu'n"h'd 10 Ihp Inl'll'lal n".,l'lu' S."VICI. II)'ou 'fl
l!>'&~.OOOB "Qu'lfd 10 l,it' a la.Itlum, a ntg:'g,nc. Pf'na'Ty Of oth'l Ianc1oC'In mly N
. Inlpoud on ~ou 11th.. If'COfn, " la.,bl, Il'ld you 14,110 If pO" It
Wa~fll."'. Ott1" ComPfnsal'Oi'\ 2 Ft>der.I income ta. withheld
45000.00 7380.00
Group, I nc
Suite E
16 SIlt' Employe"s'IAle 10. No.
PA j7109-899
...... ...........................
17 ~:a'f ........, It' ,Ie
45000.00
~ W 2 Wage and Tax 1994
,f . Statement
Copy C For EMPLOYEE'S RECORDS (S.. Noll" on back,)
----------
3 SotIA' IPcu"I.,. Ywtgo' . Social ..CUrllv IIU wilhh,lct
45000.00 2790.00
5 Medicllfll VoS'" and l,pI 5 f,1Pd'CIIC! ItLl wllhheld
4 000.00 652.50
7 Soc,al't'cufl'y t,p' e Allocaled liP'
0.00
9 AchallcC! EIC payment \0 Dependenl CD,e bonelll'
0.00
\1 NOf'lQua1rr'l'd plana 12 DoneM, mcludl'd in BOI 1
13 Sfe tnS1f1 to' BOll 13 U Olher
18 Sla!' If'lcomt la.
1260.00
19locahly name 20 leu! ""WfII;M. tll:
45000.00
21LotI'~t.u
450.00
................
.............. ..................................
Dl'par1m~nl ollhe Treasury-Inlernal Revenue SeMce
U.S. Income Tax Return for an S Corporation
.. On not file this form unltlS the corporaUon hns IIml'lv fllrd
form 255~ to elect to be nn 5 corpornUon.
n'r~lrl..nl 01 U..1U"o1'lj'W
10'1.......11".....,. ("''0>1.. .. Stl up;.,n'e Inltrucllons.
for cnlcndilf year 19U.1, or la.. yeill beY"llllllU I 1994, and cllding . 19
A OIl, ul e'or.llOll aJ.m Use C El1lplo~" Id.nliflClUnn nUMlhlf
5 ""PO"""" inS * ** * * **** * 5-DIGIT 17055 _25 i 1691769
lobol. PD 25-1691769 DEC911 S28 8980 N I -
....J.:...l5-92__ ollher. PROFESSIONAL RESOURCE GROUP INC n o ll'"1",O'IN'''''"
o n"..,,""O"'''O'''' wise, lUUl S MAr-KET ST STE E SO PT OFF 001 9-15-92
5,,,,,"'1""""""" ~'~~I'~ MECHANICSBURG PA 17055 S - ['0,.,...."''".51"'''<I''''''''~''.1
8980 Iype, $ _1_-
F Clleck opp"c.llle 1I0,e5: (1) lJ In.li.llolI"n (7) LI r,n.l.ell"n 131 [) CII.nge In .~d.ess (4) 0 Amended return
G ChIC' Ihll ~OI.llhll S to.pora"on IllUblW 10 "" (o",n"\I,"O audl' Ol(,(/du'" n' mllOns ~141lhroulh ~1,1\ lilt mllluthon, bllo" thll.ml Ihll bo.) " 0
tl Enler number 01 Sh.!.".!.>.?,?~~~~~~Pp,!,!i9~~.~!'.<!.2U!!".!~,".ye.r , ' , , ' , , , ' , ' , ' , , , '-1.
Coutlon: '"c/ude only tfade or husiness income lInd e1pc/lSCS on/mes 'a IIl10ugh 21. See 'he instructions fOf mote In/ormation
ro.", 11205
-..---
(lMn Uo 'M!am:1O
~@94
---,-''-- -.------.----.-- -.. - -....--. - 5 7'1.4ir:-'
la G'CIIlfctlpll o. 5al" I L_J b lm lllillnl and a'lowanCIII 1 Ie Bol. lc
-
Cl 2 Cost of goods sol~ IScllodule A, lino 01 2
E 3 Gross profit. Suhlr11rtlinn ? from line 1 c . 3
0
u 4 Net gl1i" (10551 frorn rOf", ,1797. r",'I1. lille ~o (nllitch rOtm 47971 4
.5 5 Other income, (;r:;fo~t;ee Inslrucllol1!\) (.llf,lC/I sclJPdu/e' 5
6 TotDllncome 1055. Combine lmes 3 Itllouoh 5 . . ,~ 6 577.427
- 7 Compensalion of olticers , L ~.5..Jl.o.O
.;
c 8 Salaries nnd wages (less employment credits) -'1- 403.555
.2
~ 9 Repairs nnd maintenance. 9
~ 10 B.d dellls 10
12 11 Rents. .J.L --2J2Q.L -
12 Ta)!es and licenses_ 12 35.915
'0
c 13 Interest 13 93
.2 'I ;4;1 ' 'hi> " .
U 14a Depreciation (see instruclions) I
2 :1 14bT -1
Vi b Depreclnlion claimed on Schedule A nnd el~ewhele on relurn
.5 c Sublract line 14h tram line 140 . 14c 936
~ -
15 Doplellon (Do no\ deduct 011 nnd 9.s deplellon,) 15
1Il 16 Ad,o~lslng 16 1 656
c: 17 Pension, profit-sh;uing, ale.. plans. ...1L 6.750
0
::: 18 Employee benefit progrnms . 18
u -
" 19 Olher deducllOl\s (sf'e inslrllclionsl (.lJtach ~cllp.d."e' . 19 80 8BB
"0
Cl 20 Total deductions. Arid the nmounls "hown In the f;'It rlghl colum" for lines 7 through 19 ,~ -~Q.. ...21.~.. 3 9 3
C
21 Ordinary Income (loss) Irom Hilde Of huslness ncltvilies. Suhtract line 20 ham line 6 . 21 ( 9661
22 TDa: n eJlcess 1101 pnssive incomp. In)!. 1.,It"cll sctlerlulo). 22.1 I ~~
b Tn' from Scllodule 0 (Fo.m 11205) 22bl ~
~, .,\"
1Il c Add lines 2~n ilnd 2:'h (see instHlclion!i fm nctdilinnnl tnlPs) rt.~ NONE
- -.-....::- --
c: 23. ~~
Gl 23 raymlnls: a 199,lllhm,l,d '" poym,nl' .1\11.0101111' oppllPd 110m 1993 re'""
E '~
b T., tJoposiletJ w.'1I FOIm 7004 23\> .- ~~;
,., '~:..~,
"' c Credll for redcrnllnlC pnid on fuels (.ltt.,cll (otm 4J3(i) 23c ~....~'\:
Do .....,:
"0 d Add lines 23n tlnough 23c 1J<! --
c: 24 Es1imaled In)! ppnnllv (sre Inslructions). Chpck il rorm 2nO Is nllachpd. ,..0 24
"'
" 25 Tna due. II the lolnl of linr.s ~2c Olnd 2<1 Is I:vuer Ihan line :'3d, enler arnounl owed. See
{: instfllclions for t1rposil;uy melhod of pnyment . ,~ 25 llONE
--
26 Overpayment. II line 23d is l:ugcr limn the tolal 01 lines :?2c nnd 24, cnler amount overpaid .,. 26
2? Enl/l amounl ollinl ~G you Vlwl Cr.dlled 10 199\ esllmaled I" .1 R.lunded ~ NONE -
2?
UIlllt'II'I'H.,n."" III 11f'111",.I Ih'd.lll! 11..,llll,hf 1"iIlWIl~d llll!o 1,,1111/1. ulClu(j~.q l'ltClIIII(lllll,.i'lg ,c1H!dull1' aflll ,lalt'IllI'Hl&. arl(j 10 IIII' \tnl 01 In)' l<Hn",I"dO~
Please anllllf'l'I!I. II I~ h"e!. rIllrrcl. AUII (1IIlll,h.l" 1)~ll.lloll.flIll,ll"rll"''''ln\l'''1 UI.1l1ltt'Pll,1'111\ t):!!,f,l on ~lllIlhll"ll'lhnfl 01 whel, prparPlll"\ 'my l<llov.lrr1ye
Sign
Here ~ s'\I,~.:;,;;~ii:; ,;; - .6-' ._-- -. . -.. -.-.- .._.___J____ ~ YXJ!s.itlejl.t
U:llft 1.lIe
Paid r"fl""'" ~ C 11s:~1 1""10 I I J~ . ["fl""''''''''''''''''''''''''''
(, c r ^ 15' c"". " ..II
"'1"""" '\......~ "" ' .1 I~ '"'ll''''''' RJ ;:
Pfcparcr's ---~ -' ._- ._.._.. - ._....~- - --.- -- ._..~-- ----... _. --..-.--. ..._---_._..~
~~::::,:'~~;;.':::,,''','''l l,aw_Or Uses .oLCndgJl ._J)j,ChL1-U!'~.2-__?,;U,6JO..7.;tL
Use Only ."",,,,,,,,.. 3464 Trirr.lJc fl,ililu. Cil:nDJillLJ'h lIr co<1. · 1 OIl
1
For p~p.rwnrk n,.dllr.llon /1.1':' "oflr.p, !iPP pngp 1 of ~"pj\rjllf'l In-.tructlnl11.
r:"I Un 11'.lnll
r..", 11205 1100'1
rOlm 1120S 1'99" r.g. 2
~ Cost of Goods Sold (See Instructions.)
1 Invenlory at beginning 01 year
2 Purchases, , , , , , , , , , , , . . . , .
3 Cosl 01 labor , , , , , , , , . , ' . , , . .
4 Additional section 263A cosls (see Inslructions) (attach schedula)
5 Olher costs (ettach schadule).
6 Totel, Add lines 1 Ihrough 5, , , , , , , . , , . ,
7 Invenlory al end of year , . , , , , . , . , , . ,
6 Cost of goods sold. Sublraclllne 7 from lina 6. Enler here and on page 1, line 2 ,
ga Check all melhods used for velulng closing Invenlory:
(I) 0 Cosl
(II) 0 Lower of cost or merkel as described In Regulations section 1,471-4
(i1Q 0 Wrlledown 01 .subnormal' goods es descrlood In Regulations sactlon l,4?1.2(c)
(Iv) 0 Olher (specify malhod used and etlach e.plenatlon) ~ ...........................................................................
b Check IIlhe LIFO Inventory melhod was edopled Ihls la. yeer for any goods pI checked, ettach FOlm 970), , , . , . ~ 0
c II the LIFO Invenlory melhod was used lor Ihls la. year, enter percentage (or amounts) of closing
Inventory com puled under LIFO, . , . . , . , . . , . . , . , . , , , . , I gc I
d Do Ihe ,ules 01 section 263A (for property produced or acquired for resale) apply to Ihe corporation?
. Was Ihere any change In determining quantllla" co,l, or valuations belween opening and closing Invonlory?
If .Ves,. atlach e.plenation.
1
2
3
5
6
8
I
o Vas KlNo
.0 Ves KlNo
~ Other Information
1 Check method oleccounling: (0) rn Cesh (b) 0 Accruel (c) 0 Olher (specify) ~ ...........................
2 Reier 10 Ihe list In the Instructions and stete the corporation's principal:
(0) Business ectivlly ~ ~~9.Yll!~,D.t.p.+ill<~nL. (b) Product or service ~ ....~!!!::YJ~~....................
3 Did the corporation al th~ end of Ihe tex year own, dlrectiy or Indlrectiy, 50% or more of Ihe voting stock of e domestic
corporation? (For rules of atlribution, see section 267(c).) II .Ves; atlach a schedule showing: Ie) neme, address, end
employer Identlllcation number end (b) percenlege owned, , . , . . , , , , . , . . . . , . . . )(
4 Was Ihe corporation e member ole controlled group subjecllo Ihe provisions of section 1561? . . , . . . . )(
5 AI any time during calendar year 1994, did the ccrporation have en Inlareslln or a signature or olher euthorlly over e
financial eccount In a foreign counlry (such as a benk accounl, securities eccounl, or other financial accounl)? ISee
Inslructions lor e.ceptions end IIIlng requlremenls for Form TO F 90.22.1,) , , . , . , . , . , , . . ,
II 'Ves; enter the name of Ihe foreign counlry ~ ..........................................................................
6 Was Ihe corporallon the granlor of. or transferor to, a foreign INsllhal e.isted during Ihe current te. year, whelher or
nollhe corporation has eny beneficial Interest In II? II 'Ves; the corporetlon may have 10 file Forms 3520, 3520.A, or
9~6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Check this bo. II Ihe corporation has filed or Is required 10 file Form B264, Application for Reglslration ot a Tax
Sheller, , , , . . , , , . , , , , , . . . , , , . . , . , . , . , . , , ~ 0
6 Check this box IIlhe corporation Issued publicly offered debllnslrumenls wllh original Issue discount . . ~ 0
II so, the corporation may have to lIIe Form B281. Information Relurn lor Publicly Ollered Original Issue Discount
Instfllmenls.
9 tllhe corporotlon: la) lIIed lIS election 10 be an 5 corporation afier 19B6, (b) was a C corporation belore It elecled 10
be an S corporotion or Ihe corporotlon acquired en assel wilh a basis delerrnlnad by relerence 10 lis basis (or Ihe
basis 01 any olher property) In Ihe hands 01 a C corporetlon, and Ic) has net unrealized bulll.in gain (defined In section
13741d)(1111n e.cess ollhe nel recognized bulll.ln gain from prior years, enler the not unreellzed built-in gain reduced
by nel recognized buill. In gain from prior years (see Instructions) , , , , . , , ~ $ .........................
10 Check Ihls box il Ihe corporation had subchapter C earnings and profils al Ihe close of Ihe 10. year Ise.
Instructions) , . , , . . , , . . , . . , . , . , , , . , . , . . , , , . . ~ 0
DeSignation of Tax Mallers Person (See Instructions,)
Enler below Ihe shareholder designated as the la. matlers person (TMP) for the te. year 01 this relurn:
Name 01 It. Identifying It.
deslgneted TMP r Robert P. Nelson number olTMP r 113-30-1409
Address 01 It. 516 Woodcrcst Drive
deslgnaled TMP r Mechanicsburq. PA 17055
r.g.3
. r:&t Shareholders' S!:!!!!.cs of Income, Credits Deductions etc.
(n) Pro lal" sh:ue items (b) Total amount
1 Ordinary Income (1055) 110m trada or business activilleslpage 1. line 21) , 1 1966\
2 Netlncorne (Ioss)lrom renlal real eslale aclivlties (n/lach Form 8~25) . '1 ' .
3a Gress Income Irom other fcnlnl nclivilies. , . . . . 30
b EMponses from olher renlnl activllies (JltncJl scheC1uID), I 3b I I
i c Net Incomo (loSS) horn other renlnl aClivltles. Sublrncllino 3b horn line 30 3c
~ 4 Po~lolio Income (loss): .~
u D Interest Income . 4e 192
E
0 b ~ividend income. 4b
u
.5 c Royally income 4c
d Net sho~.term capilal gain (loss) (,1/lach Schedule 0 (Form 11205)) 4d
e Net long.term capllal gain (loss) (a/lnch Schedule 0 (Foun "205)). 40
, Olher po~lollo Income (loss) (a/lach ,chedule) 41
5 Net gain (Iosslunder section 1231 (olher than due to casually or thell) (a/lach Form (797) 5
6 Other Income (loss) (a/lach sc/ledul.I, , . , . , . ' , , . , . , . ' , 6
~ 7 Char liable conlributions (see Instrucllons) (allach schedule) , 7
0
'" 8 Section 179 e'pense deduction (,1/lach Form 4562). 8
u
, 9 Deductions related to po~lolio Income (losS) (see Inslrucllons) (lIemlle) 9
'2
c 10 Other deductions (n/lnch schndule', . , . , . . , . , , , 10
:a';i lle Interest e'pense on Investment debts, lla
.!it! b (1) Investmenllncome Included on lines 40, 4b, 4c, and 41 above llblll
ji (2) Investment CJIl,penses Included on line 9 above llbl2\
12e Credlllor alcohol used as a luel (a/lach Form 6(78) 12e
, '.
b Low.lncome housing credil (see Inslructlons):
(1) from parlnershlps to which mlloa 42(j)(5) applies ler ploperty placed In se/vlce belore 1990 12bl1l
(2) Olher than on line 12b(1) lor prope~y placed In seNlce belore 1990, 12b12\
III (3) from parlllershlps 10 which seclion 4211115) aD plies lor property placed In serviCe aller 1989 12b13\
-
ii 12b14\
e (4) Olher than on line 12b(3) for propP.~y placed In seNlce elter 1989
CJ c Oualifled rehabilitation e'pendllures rel,led 10 renlal real estate actlvllles (a/lsch Form 3(68) , -
d Credlls (other than credlls shown on lines 12b and 12c) relaled to renlal real estate ectlvltles ~ '"
(see Instructions), 12d
e Cn:dits relnled to olher rentnl Dclivillcs (see instructions) . 120 .
13 Olher credits (see Inslructlons) 13
. 14a Depreciation adjustment on property placed In seNlce alter 1986 14a
I! 11
!~ b Adjusted gain or loss 14b
n ~ c Depletion (olher than oil and gas) \ 14c
a a , 14dll
u u d (1) Gross income hom oil, AilS, or geothermal properties
e ~
_ u 14d12)
ll- (2) Deductions allocable to 011, gas, or geolhermal properties ,
-E
::l e Olher edlustments and la. nrelerence items latrach schedulel . 140
.. 15a Type of Income ~,..,. ...,....................,................................................ .
.. b Name ollorelgn country or V,S. possession ~ ..... ............ ........ .............. .......
K
{:. c Tolal gross Income !rom sources oulslde the Unlled 51 ales (allach schedule) 15c
c d Tolal applicable deductions and losses (a/lach SChedule) , 15d
01
.~ o Tolallorelgn to,es (check one): ~ 0 Paid o Accrued 150
& . Reduction in tnlles Available tor credit (attach schedule) 151
9 Olher tcrcign tall information (aUach sc;tJcduTe) 150
16a Total e,pendllures 10 which a seclion 59{e) elecllon may apply, 16a
b Type ot clCpendltures'" .."................ .................................................. ~
17 TalC.exempt Inlerest income 17
18 Other tax,cllempl income. 18
~ 19 Nondeductihle cllpen~C!s 19
u
:5 20 Tolal proper1y dislribulions (including cash) other limn dividends reponed on line 22 below 20
0
21 Other lIems and amounts required 10 be reported separalely to shareholders (see .
Instructions) (a/lach schedule)
22 Totnl dividend dislrihulions paid hom nctumUlilled earnings nnd rHofils . 22
23 Income (In os), (nequlrP.d only II Schedule M.l mnst be compleled,) Combine lines 1 ~.~
~
ttllough 61n column (hI. From Ihe result. subtrncllhp. sum 01 Un05 7 through 118. 150. ond
16. , 23
Form mas 1199')
Form 11:105 (1094)
-.!lal~~.l!Jihee!~
Aucls
..............................................
Expenses recorded on books this yem nol
Included on Sctledule K, lines 1 through
1 Ie, 15e, and 160 (1Iemlze):
D Oepreclallon S ................. ...........
b Trnvel nnd enter1:lil1lllcnl $
3
r.o. 4
flld ottlU ~lIr
nr\~~g 01 la_ ~f';'ll
Id)
I.' IbI
~~~,*~~~~~,~'~~~1: ~ 212
~>:-~~,i\~}~}~~k~,~'%~~
~-~~~\\~!~%
..";~.,,,;&~~~
~.~~.
~'l\~~~'"
'~1'!~
~i~'i"'"''''''''''''
~~~~~~~\~~
3,B06
1,027
..~,
".&,
~'&~~..-.~
--~~,~;
~S\~~'!i'!i'i:,'i!.;~~~~~;: 4 ,966 ~~.~ ~ ~
1,979 2,763 2,203
~,~,,,,~~,,,,,,,\;~~~y,~ ~~ ~ ~
~~t~~~~~~~~'}~'\~.
621
B,OB3
B,OB3
t Cash , , , , , , , , ,
2a Trnde nolcs and accounlS ff~c:p.lvilhle
bLess nllowance for 'lnd ophls
3 Inventories . . . . . .
4 U,S, Govemmenl obligalions,
5 Tnx.exempt securilir.s. . .
6 Other current ossels (nlt.,ch sclJeduleJ,
7 Loans 10 shmeholc1crs . . . . .
o Mor1gngc ilnd renl estale 1011115. . .
9 Olher Inveslmenls (.,ttach sc/lcdllfe) .
10a 8uildln~s nnd oHlOr depreclilble assets
bLess nccumulnled deprecii1Uon .
11 a Oeplelable assels , , , ,
bLess accumulaled deplelion, ,
12 Land (nel of any amo~lzalion) ,
13. Inlanglble assels lamOltl,able only).
bLess accumulnled i1Olol1iznlion .
14 Olher assels (",rach schedu'e) , ,
15 Tolal assels, , ' , , , , ,
Liabilities and Shareholders' Equity
16 Accounls pnynblc. . . . . . .
17 Morlgages, noles, bondS p,'Yable In 1m Ihaa 1 yeJI
18 Olher current liilbil1lies (Mtac/) !:clledufe}
19 Loans from shareholders. . . . . .
20 Morlgaoes, noles, bonds pa,able '" 1 ,ear 01 male
21 01 her liabilllies (all"cl, sChed,,'e)
22 Capllal slock, , , , ,
23 Paid.ln or cilpilill 5urplllS .
24 RetAined comings. . .
25 Less caS! 01 treilsury ~tock . . .
26 Tolalliob,l,lies and shaoeholdelS' equil 4, B12 4, 03B
"'r.lIT1t./II~",!:li' Reconciliation 01 Income (Loss) per Books With Income (Loss) per Return (You are not required 10
complete thiS schedule IIlhe tolal assets on line 15, column (d), of Schedule L are less than $25,000,)
1 Nellncome (loss) per books. , , , , 5 Income recorded on books Ihls year not
2 Income Included on Schedule K, Iil1es 1 Included on Schedule K, lines 1 through
throuqh G, flnl rp.cOIcted on hnnks Ihis yem 6 (itemize):
(lIemlze): """"""""""'"'''''''''''' a Tax.exempllnlClesl $ ,,,,,,,,,,,,,,,,,,.
2 000
13 249
1B,520
2,000
13,249
(19,294 )
.............................................
6 Oeduclionslncluded on Schedule K, lines
1 Ihrough 1 la, 15e, and 16e, 1101 charged
Rgalnst book Income Ihis year (itemIze):
a Oepreclnlion $ ............................
.............................................
..................... ,..... 7 Add lil1C!S 5 nnd 6. . . . . . . .
4 Add lines 1 th,ou h 3 , 8 Income (10551 (SCh'dule K. hne 2j) lin, 41m 1m, 7
~ 9 Analysis of Accumulated Adjuslments Account, Other Adjustments Account, and
. '1iI Shareholders' Undlstrlbulet! Tax~ble In~l!..~evlcu~y Taxed (See Instructions,)
1 Balance at heginnin9 of Iilll: yem
2 Ordinary Income horn page " line ~1
3 Olher .ddillons, , , ,
4 Loss from pnge " lil\n ~ 1 .
5 Olher reducllol1s
6 Comhlne lines 1 i1ul1ugh 5 , "
7 Olsllillllllons oilier llian dlVldelld dlsllllilllions ,
8 P.al:lncr:1I tllll 011;1' Y';U $11~II,l'llint 7110"' IIn!! G
In) Ac(':umul.,If'd
;'llllll"trlll'I'I' "CCOllnl
~___( 10-,2tQJ
192
L.__---2S;~
(
_. (1'.l"~9.4J
( 1'), )')4 )
(hi 01her adjustmenls
account
Ic) Shaleh~de'" undlllllbultd
la.ahl, Incom' rwevioulty lluPd
"-"""'"""",,, '''''''~~'''''~'' '''''>.'''''~..~
"",~'0:..~ :~~,~~, ~"~~~~"':~'\'~., "-\\. ~
: :~~~.&~~~~':"~~'~\i .-""
Professional ReSQurce Groml
DUlin... 01 acli\'.t)' 10 which thll form ,,,Iales
Depreciation 11205
ImI Election To Expense Certain Tangible Property (Section 179) (Nolo: If you havo any "Listed Properly,"
com lete Parl V before ou com lete Pan I.
Maximum dollAr limilatlon (If an enterprise zone business, see Instrucllons,) . , ' ,. 1 $) 7 ,500
Tolal cost 01 section 179 properly placed In service during the tax year (see Inslructlons) , 2
Threshold cost of section 179 properly before reducllon In limitation. , , , , , ,. 3
Reduction In IImilatlon, Subtract line 3 from line 2, If zero or less, enler .0. . , . " 4
Dollar IImilatlon for lax year. Subtract line 4 from line 1. If zero or less, enter -0-, (If married
1II1n se aratel , see Inslructlons" , , , . . , , , , .
1-) Oncriphon 01 propen)'
7 Listed properlY, Enter amount from line 26. ' , . , . , , ,. 7
B Total elected cost of section 179 properly. Add amounts In column (cl, lines 6 and 7
9 Tentative deduction, Enler the smaller 01 line 5 or line B , ' , . ' , , , . .
10 Carryover 01 disallowed deduction from 1993 (see Instructions), . . , , . , ,
11 Taxable Income Iimilation. Enter Ihe smaller of laxable Income (not less Ihan zero) or line 5 (see Inslructions)
12 Section 179 expense deduction, Add lines 9 and 10, but do not enler more than line 11 , .
13 Car over of disallowed deduction 10 1995. Add tines 9 and 10,Iess line 12 ~ 13
Note: Do not use Pari /I or Part 111 below (or listed property (automobiles, certain other velllcles, cellular telephones,
certain computers, or properly used (or entertainment, recreation, or amusement). Instead, use Pari V (or listed property.
MACRS Depreciation For Assets Placed In Service ONLY During Your 1994 Tax Year (Do Not Include
Listed Pro e '
Form 4562
Depreciation and Amortization
(IncludIng Information on Listed Property)
~oIINT,...ury
~..""n..,.nu.~'
Nlmt(l) ,hown on ,alum
... Se. separate Inslrtlcllons.
... Attach this form to your return.
1
2
3
4
5
(b) Cosl
(c) [lllcllld cost
6
e.) Clanlhcation 01 Pfoper1y
lbl Month Ind (el Bas~' lor depreciation (d) RKoveN
Y'" pllcl'd In (bullnenllnvUlmllnl use period "
,eNlce onl -lee mslluclions
Section A-General Depreciation System (GDS) (see Instructions)
14a
b
c
d
e
f
9
1.160
5 r.
I'Q
MM 5/L
MM 51 L
MM S/L
MM S/L
Section B-Alternatlve Depreciation System (ADS) (see Instructions)
S/L
S/L
5/L
27 ,5 rs,
27.S yrs,
39 rs.
h
15a Class life
b 12- ear
c 40- ear
12
40 rs.
rs.
MM
Iil!DIIII Other Depreciation (Do Not Include Listed Property)
16 GOS and ADS deductions for assels placed In service In ta. years beginning belore 1994 (see Inslrucllons)
17 Properly sublectto section 168(Q(11 election (see Instructions). . . , , , , , , . ,
16 ACRS and olher de reclatlon (see Instructions , , , , . , , , . , , , . . , .
Im1!I Summary
19 L1sled properly, Enter amountlrom line 25, , , , , , , , ' , . , , , , . , '
20 Tolel. Add deductions on line 12, lines 14 and 15 in column (g), and lines 16throtJgh 19. Enter hero
and on the appropriate lines ot your rei urn. (Pnnnershlps and S corporations-see Inslructlons
21 FOt assets shown above and placed In service during tho current year, enler
the orllon of the basis altrlbulable to section 263A cosls (see InslNctlons
For Paperwork Reduction Act Notice, 188 page 1 of the separate Instructions. ell. Ho 1190r,"
OMD No. IS4..0172
~@94
AII.chm.nl
S.qu.nc. No, 67
Id.nlltylng numb.r
25-1691769
$200.000
5
-
8
9
10
11
12
10) D.pr.claUon deducllon
CRS
145
16 152
17
16 639
19
20 936
~~~Rt~\~~~\
."'~\'\'i~t~~~~~~~
room 4562 11ll94)
rOlm '162 (199') r... 2
LIsted Property-Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and
Property Used for Entertainment, Recreation, or Amusement
For any vehiete (or which you are using Ihe slond"rd mileege ..,Ie or deducting lense c.pense. complele only 220,
22b. columns (a) through (c) o( See lion A, all 01 Sectioll D. alld Sectioll C i( appticable.
Secllon A-Oepreclallon and Other InlormLtlon (Caullon: See insl/uctiolls lor limitations (or aulomobiles.
22a Do ou h3ve evidence 10 IU ort Ihe bUllnmflnveslmenl U\e cl3lmed? 0 Ves 0 No 22!1 If "Ye!; is Ihe evidence wrlllen? 0 Yes 0 No
\'1 1.1 1'1
(I), (b) OUI.ne." (dl n I r, If) 101 (hi E
Type of plOpll1V (tIS' Oil! placed Ir, Inwl.ln,.nl COil 01 olh~f (Ins, 0 Sf'pI8~lal'on n,coy,,')' 1,111lhodl Oel'llec:iallon IrCI&d79
-vehlcltl hllll uNlce Ut., b",it )!..lSIIlf'S II1V,"1 menl pP'lfld Cunvf'nhnn d"duclion sechon I
re";:ln 110' uJl 011 Y cOil
" "O'~E""TI"" '",om T~ .""'''''1-1 I I~
24 Pro~ used 50% or less in a uahlled business use (se~~lrllCl1~~:
%
25
26
Add amounts In colllmn (h), Enter the tolal he,e and on line 19, page 1,
Add amounls In column (I). Enler the tolal here and on line 7, a e 1
Secllon B-Informatlon on Use of Vehicles-if I (Ill deduct expenses (or vellietes:
. Always complete this section (or vehicles used by n sole proprie'or, pm1ner. 01 arhet "more tllan 5% owner," or lelated person.
. II j'OU provided vehicles 10 your employees, '''5/ ""","I Ihe Queslions in See lion C 10 see ,t )'OU m,,' an ..ceplion 10 complering lliis seclion tOT/hOle vel"cles.
- -
25
~
.~~
.~
%
%
5 1...-
SI!. -
S/L -
26
27 Tol31 businessflnvellmenl miles driven during
Ihe yw (DO NOT Inclll~e commllllng mile I)
2B Tol31 commullng mile I driven dUllng Ihe ye3r
29 Total olher personal (noncommuting)
miles driven, , , . . , . , ,
30 Total miles driven during the year.
Add lines 2? through 29, . . , ,
(.\
Vf'hltle 1
Ib)
Vetllcll,2
(,\
VflhiCl, 3
Idl
VetnCI!! 4
I')
Vehlel.5
IQ
VehIcle 6
Yes No
Yes No ~s_ y~ ~s No
Ves No
Yes No
31 Wns the vehicle nvnilnble for personi11
use during off-duly hours?, ' , ,
32 Was Ihe vehicle used primarily by a
more than 5% owner or related person?
33 Is another vehicle available lor personal
use? , , , ' . . . , ' , ,
Section C-Questlons lor Employers Who Provide Vehicles for Use by Their Emptoyees
Answer these questions 10 delermine i/ you meel an exception 10 compleling See lion B. Nole: See/ion B musl always be
completed (or vehletes used by sole proprielors, partnels, or oIlier 1II0le /IIan 5% owners or related persons.
Yes No
34 Do you malnlain a wrlllen policy statement Ihal p,ohlblls 011 pOlsonaluse of vehicles, Including commuling,
by your employees? . , ' , . , , . , , ' , . , , . . . , " ",.,'
35 Do you malnlaln a wrillen policy stalement Ihat prohibits personal use 01 vehicles, except COll1mullng, by
your employees? (See Inslructlons lor vehicles used by corpora Ie officers, dlleclors. or , % or more owners.)
36 Do you treat 011 use 01 vehicles by employees as personal use? . . , ' . ., ' ' , ,
37 Do you provide more than live vehicles to your employees and relain Ihe Inlormalion received from your
employees concerning the use 01 the vehicles?,. ,.".,' . . , ,
38 Do you meel the requlremenls concerning qualllled automobile demonstration use (see Instructions)?
Not.: II our answer to 34. 35, 36, 37, or 38 is 'Yes,. 'ou need MI com lele Section B for Ihe coveled vehicles.
Amortization
1'\
OeSCliplion al coMI
Ibl
Pall' ,mo111UIl0l1
hP.Qins
I')
^rnOlll/ahre
"mnulIl
(d)
Code
,..chon
IQ
Am0t1II.11on IOf
lhit Yell
39
40 Amor1lzelion 01 costs Ihal begon be/ore 1994 , , , , , ' , , . , , . .
41 Total. Enler here and on .Olher Deductions' or 'OlhOl Expenses. line of your relurn
40
41
168
16B
Robert P. Nelson
516 Woodcrest Drive
Mechanicsburg. PA 17055
Shareholder's Share of Income, Credits, Deductions, etc.
~ See separ,ate Instructions,
For calendar year 1994 or tax YII'
I 1994, nnd endIng I 19
Cor oretlon'sld.nll In number ~ 25: 1691769
Corporatlon's name, address, nnd ZIP code
Professional Resource Group. Inc.
1001 S. Market St.. Southpoint Office
Suite E, Mechanicsburg. PA 17055
0"'0 No. 15.\.0130
SCHEDULE K.1
(Form 1120S)
~@94
o.part/Nl'll of 1"- T"..",
nt_M1 ne...".,. $Ar.tC. beginning
Sher.hold.r'sldenll In number ~ 113-30-1409
Shareholder's name, address. and ZIP code
A Shareholder's percentege of stock ownership for tax year (seelnslrucllons for Schedule K'l). , , , , . ,~....J.9.9..... %
B Intemel Revenue Service Center where corporallon filed II. return ~ .....P.htl,Rp,I\!.+.P.l:JJ.~.........................................
eTa. shelter registration number (see Instructions for Schedule K-l) . , . , , , , . , . ~ ...................................
o Check appliceble boxes: (I) 0 Final K-l (2) 0 Amended K.1
i
cti
I
I:
I
I,
I
I
I
I
I
(e) PIO role shal. Item. (b) Amount (c) Form 10.0 filers enler
the amount in column (b) on:
1 Ordinary Income (loss) from trade or business ecllvltles 1 (q66\ } S.e Shmholdrr's
2 Net Incoma (loss) lrom rental real eslale activities 2 InslrucllonS lor Sch.dule
3 Net Income (loss) from other rental acllvllles , 3 K.\ (form 11205).
'iii' 4 Po~follo Income (loss): ~
III e Inlerest, 4a 192 Sch. e, Pa~ I, line 1
:1 b Dividends , . 4b Sch. e, Pe~ Ii, lino 5
CIl c Royalties , 4c Sch. E, Pa~ I, IIno 4
E d Nel shM.term capllal geln (loss), 4d Sch, 0, line 5, col. (I) or (0)
0
u . Not long.term capllol gain (loss) , 4. Sch. O,lin. 13, col.ll) or (0)
.5
f Olher pMrollo Incomo (loss) (e"ech schedule) 41 l(n,"onUPll(lbltWoIYOU'lIll1fn,
5 Net gain (loss) under section 1231 (olher than due to cesually or 51! Shmholder's Inslrucllcns
thell) , ',jl . . . . . , , ' 5 101 Sch.dul. K.l (fOlm 1\205).
6 Olher Income loss) (.".ch schedule) . 6 llnIIlOl\IPplltabllWDltOllflllllln)
.. 7 Cheriteble contrlbullons (see InstNcllons) (0".0.11 schedule) 7 Sch, A, line 15 or 16
..
.2 8 Secllon 179 e'ponse deduction. 8
'ii
" 9 Deduction. relaled to portfolio Income ~oss) (attach schedule) 9 } 51! Sh'I!holdrr'. Inslrucllon.
"" 101 SCh,dul. K.t (fOlm 11205).
.. 10 Olher deductions {attach schedulel. . . , , . . , . 10
c
:u 118 Inlerest e.pense on Investment debts . lle Form 4952, line 1
j!e b \1) Investmenl Income Included on lines 4a, 4b, 4c, and 41 abovo bill I } 51! Shareholder's InslrutUon.
MU
='ii (2i Inveslment exoenses Included on line 9 ebove, . . , ' bl21 lor Sch.dul. K.l (form \1205).
S-
128 Credit for alcohol used as luel ~ Form 6478, line 10
b Low-income housing credil: ~
(11 From secllon 420)(5) pa~nershlps lor prope~y placed In bIll
service berore 1990,
(2) Other than on line 12b(\) for prope~y placed in service before bf2\
1990 Form 8586, line 5
~ (3) From secllon 420)(5) pa~nershlps for prope~y placed In bl31
'6 service aller 1 989
e .
0 (4) Other Ihan on line 12b(3) for prope~y placed In service aller bl41
1989
c Ouallned rehabllllallon expenditures releted to renlel raal est ale
ectlvilles (see Instrucllons). 12c
d Credlls (olher Ihan credits shown on lines 12b end 12c) related See ShJl!holde,'s InsltuClions
to renlal real estate ecllvitles (see Instructions) 12d 101 Sch'dul. K'I(form 11205),
,
8 Credit' reI8t~~, to other renl~~:CtiVllleS (soe InstNcllons) . 12e
13 Other credits see InslrucllJns . , , . . , , . . 13
1& 14e Oepr8clallon edlustment on prope~y placed In service aller 19B6 148 See Shareholder's
N.l! Adlustod g81n or loss 14b
lID b , , In.tructlons lor
-e c Oeplellon (other than oil and gas) , , , , 14c Schedulo K-l (Form
t~ d (1) Gross Income from 011, ga., or geolhermal prope~le' . dill 11205) end
~~ (2) Deduction. allocable to oil, gas, or geolhermal propor1les . dl21 Instrucllon. for
N 8 Olher .dlustmenls end tox oreler.nce lIem. {a".ch schedu/~l . 1441 Form 6251
0-
For Paperwork Reducllon Act Notlc'IIe' pAOli of InstNetlan. for Form 11?OS.
elll Uo. 115'00
Sch.dul. K-llForm 11205)1994
"
'.
JUDITH A. NELSON, . IN THE COURT OF COMMON PLEAS OF
.
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
:
vs. . CIVIL ACTION - IN DIVORCE
.
.
.
ROBERT P. NELSON, .
.
Defendant : NO. 95-933 CIVIL TERM
QUALIPIBD DOMESTIC RELATIONS ORDER
NOW, this 'lolL day of o:r:.Lr, 1995, the
attached
AND
stipulation for Entry of a Qualified Domestic Relations Order is
hereby approved, affirmed and made an Order of Court.
BY THE COURT,
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JUDITH A. NELSON,
PlllintHf
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLY1\NIA
CIVIL ACTION - IN DIVORCE L.'
vs.
.r.
ROBERT P. NELSON,
Defendant
NO. 95-933
CIVIL TERM
r'
,.
- ,
STIPULATION POR THE ENTRY OP
,-,."
"DOMESTIC RELATIONS ORDER' _
.. U.J
v,
parties,
AND NOW, the day and year hereinafter written, the
Judith Q. Nelson, (a/k/a Judith A. Nelson) Plaintiff and Robert
P. Nelson, Defendant, do hereby agree and stipulate as follows:
1. The Defendant, Robert P. Nelson, (hereinafter referred
to as .Participant") is a tormer employee at IBM and is a retiree
receiving benefits under the IBM Retirement Plan (hereinafter
referred to as the "Plan").
2. Participant's date of birth is December 18, 1937, and
his social Security Number is 113-30-1409, and his Serial Number
for the Plan is '569003.
3. The Plaintiff, Judith Q. Nelson (hereinafter referred
to as "Alternate Payee") is the former spouse of participant.
Alternate Payee's date of birth is December 4, 1938, and her
Social security Number is 276-34-6317.
4. Participant's current residence and mailing address is
516 Woodcrest Drive, Mechanicsburg, PA 17055.
5. Alternate Payee's current residence and mailing address
is? 90B Westbury Court, Apartment 808, camp Hill, PA 17011. It
is the responsibility of Alternate Payee to keep a current
mailing address on file with the Plan at all times.
6. The parties have determined that Alternate Payee's
share of Participant's monthly Core retirement benefit is FIFTY
(50t) PERCENT. Alternate Payee shall be entitled to receipt of
this sum beginning December 1, 1995. Alternate Payee shall enjoy
any cost of living increases or other ad hoc increases, on a
percentage basis, provided to participant for his monthly
benefit.
7. Participant's retirement benefit is defined as all
monies paid to or behalf of Participant by the Plan, including
any scheduled or ad hoc increases, but excluding any deferred
compensation benefits paid to Participant by the Plan. The
equitable distribution portion of the marital property component
of participant's retirement benefit, as set forth in Paragraph
six (6), shall be payable to Alternate Payee and shall commence
as soon as administratively feasible but expected to be by no
later than December 1, 1995, following administrative approval
of . the Qualified Domestic Relations Order incorporating this
stipulation and Agreement. It is further specifically noted that
Alternate Payee's benefit herein shall be a set monthly benefit
as described. Alternate Payee shall not enjoy any additional
disbursement from any lump sum disbursement received by
Participant, except for any lump sum paid in the form of "back
pay" or arrearages accumulated from the inability or failure of
tho Plan to pay the monthly agreed upon amount in a timely
fashion.
B. Alternate Payee may not exercise any right, privilege
or option offered by the Plan. The Plan shall issue individual
tax forms to Participant and Alternate Payee for amounts paid to
each.
9. In no event shall Alternate Payee have greater benefits
or rights other than those which are available to Participant.
Alternate Payee is not entitled to any benefit not otherwise
provided by the Plan. The Alternate Payee is only entitled to
the specific benefits offered by the Plan as provided in this
Order. All other rights, privileges and options offered by the
Plan not granted to Alternate Payee by this Order are preserved
for Participant.
10. It is specifically intended and agreed by the parties
hereto that this stipulation and resulting Order does not require
the Plan to provide increased benefits (determined on the basis
of actuarial value) unless increased benefits are paid to
Participant based upon cost of living or increases based on other
than actuarial values.
11. The parties intend and agree that the terms
StipUlation and Agreement shall be approved, adopted and
as a Domestic Relations Order.
12. The Court of Common Pleas of cumberland County,
Pennsylvania, shall retain jurisdiction to amend any Domestic
Relations Order incorporating this stipulation, but only for the
purpose of establishing it or maintaining it as a ,Qualified
Domestic Relations Order; provided, however, that no such
amendment shall require the Plan to provide any type or form of
benefit, or any option not otherwise provided by the Plan, and
further provided that no such amendment or right of the Court to
so amend will invalidate this existing Order.
of this
entered
13. Upon entry of this stipulation as a Qualified Domestic
Relations Order, a certified copy of the Qualified Domestic
Relations Order and this stipulation, as well as any attendant
documents
shall
be served upon the
Plan Administrators
immediately.
The Qualified Domestic Relations Order shall take
effect immediately upon the Plan's approval and the Plan's
approval of any attendant documents and then shall remain in
effect until further Order of Court.
14. Alternate Payee confirms her approval, acceptance and
confirmation of the terms hereinbofore stated by execution of ths
attached Exhibit "A".
WHEREFORE, the parties, intending to be legally bound by the
terms of this stipulation, do hereunto place their hands and
seals.
~e~a~
d'; ,
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--- ~a ~&k-r'--
~r.orney for PIa ntiffl
~ternate Payee
/C~-f!(1f-et'.---
Defendant/Pa~ icipant
f
Dated:
1/-1..[-. '1~
,y -1'/- ? S'"
Dated:
Dated:
/.<J,?!;/c/.;--
,
Dated:
/oL/9S
/ I
.- '
CERTIFICATION OF ALTERNATE PAYEE
1. I certify that I have read the informational material
and that by completion of this stipulation, and my witnessed
signature affixed hereto, confirm that the foregoing stipulation
and Qualified Domestic Relations Order properly references and in
agreement with Form B as provided by the IBM Retirement Plan, and
is to be implemented by the IBM Retirement Plan.
2. Such implementation will give me my entire entitlement
regarding the Participant's Retirement Plan benefits, which is
not subject to change except as indicated on the foregoing
Stipulation and Qualified Domestic Relations order, or a
subsequent order by a Court of competent jurisdiction.
3. If I subsequently disagree with the terms of this
Stipulation and Qualified Domestic Relations Order, as a matter
of law I have a right to seek a revised Court Order, to the
extent allowed by state law and the Retirement Equity Act of
19B4.
4. Alternate Payee agrees to keep the Plan Administrator's
representative advised of any address changes.
5. I understand that prior to payments from the IBM
Retirement Plan, I must submit the applicable required documenta,
EXHIBIT "A"
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JUDITH Q. NELSON,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 933
CIVIL 1995
ROBERT P. NELSON,
Defendant
IN DIVORCE
OUALIFIED DOMESTIC RELATIONS ORDER
WHEREAS, Robert P. Nelson, ("Participant") and Judith Q.
Nelson, (Alternate Payee) have agreed to a division of marital
property,
which
agreement has included provision
for
a
distribution from Participant's account with Galaxy Funds, of
Box 7, 440 Lincoln street, Worcester, Massachusetts, 01653-0007;
and
WHEREAS, this Domestic Relations Order (hereinafter the
"Order") provides for the division and disposition of the marital
components of the participant's account in the Plan, which is a
retirement plan p.stilblished Ly Participant;
WHEREAS, Social security Number for the Participant, Robert
P. Nelson, is 113-30-1409.
WHEREAS, Participant, Robert P. Nelson, intends to grant the
Alternate Payee, Judith Q. Nelson, rights to such benefits in
such amounts on the terms and conditions prescribed hereinafter
as provided for in the Plan; and
WHEREAS, this Order is intended to be a Qualified Domestic
Relations Ord~r (QDRO), as thilt term is defined in section 414(p)
of the Code and section 206(d) (3) of ERISA.
NOW THEREFORE, !T IS ORDERED AND DECREED AS FOLLOWS:
1. The parties intend for the Order to constitute a
"Qualified Domestic Relations Order" as defined in Section 414(p)
of the Internal Revenue Code of 19B6 as amonded.
2. This Order applies to the following Qualified Retirement
Plan: Galaxy Funds, Individual Retirement Account (IRA)
Fund/Account #220-1000386575.
3. Robert P. Nelson, Social Security Number 113-30-1409
(hereinafter referrod
participant/own(~r of an
to as
Individual
"Participant") is
Retirement Account
the
(IRA)
Fund/Account #:l20-100038G575 with Galaxy Funds ("Plan").
4. Judith Q. Nolson, Social Security Number 276-34-6317,
(hereinafter
referred
to as "Alternate Payee"),
is
the
Participant's fo~er spouse.
5. Participant's date of birth is December 1B, 1937, and
his current and last kno~.'J\ Mailing address is:
Drive, Mechanicsburg, Penns}'lvania 17055.
6. Alternate Payee's date of birth is December 4, 193B, and
516 Woodcrest
her current and last known mailing address is: 290B Westbury
Court, Apartment BOB, Camp Hill, Pennsylvania 17011.
7. The Participant's account in the Plan is marital
property subject to tho distribution by this Court.
Effective
with receipt of this Order, executed by the parties and the
Court, the Plan Administrator shall distribute the sum equal to
Fifty Percent (50%) of the balance in the account including all
principal,
interest and dividends as of that day.
This
~
designated balance of Fifty percent (50%) of the balance in the
fund shall be withdrawn from the Participate's account in the
plan. Funds shall be withdrawn from the plan for the alternate
Payee and direct be rolled over into an IRA account, account
number 6621347B, held with charles Schwab and co., Inc. of 17
South Market ~quare, Suite lA, Harrioburg, pennsylvania. The
amount to be withdrawn from the Participant's account for the
Alternate payee is non-taxable as an authorized roll-over from
one qualified plan to another qualified retirement account.
B. A signat.lIt'~ Guari1ntee has been attached hereto and
incorporated herein 35 l-;xhibit "A".
9. This Order uell'S not require the Plan to provide any type
of form of benefit, or option not otherwise provided under the
Plan; or require the paymen~ of any benefits for the Alternate
payee which ar~ rcquir~d to UP. paid to another Alternate Payee
under c.nother ol:dcr prilviollsly d.'lterrnined to be a Qualified
Domestic Relation:; Or-del': or require the Plan to provide
increased benef.its which result ft'OIR future contributions to the
Plan. Any provision of this order, which appears to be otherwise
shall be null and void and have no effect.
10. In no event shall the Alternate PaY13e have a greater
right than those which ar.e aVi\ tJ.'lble tl) the Participant.
11. t.ny reason;tble ::m.t inc.:urred by the Plan Administrator
to effectuate the te~ms and provisions of this Order may be
assessed aga.inst that party requiring the servitudes of the Plan
Administrator. In the event both parties require services of the
Plan Administrator. In the event both parties require services
of the Plan Administrator, such expenses shall be divided equally
between them.
12. The parties shall promptly submit this Order to the
Plan Administrator for determination of the Qualified Domestic
Relations Order. The Plan Administrator is Galaxy Funds, 440
Financial Distributors, Inc., 440 Lincoln street, Worcester,
Massachusetts.
13. A copy of this Order shall be mailed promptly, return
receipt requested, to thA Plan Administrator. If this Order has
been predetermined by the Plan Administrator to constitute a
Qualified Domestic Relations Order, the Plan Administrator shall
properly carry out the provisions. If this Order has not been
predetermined by the Plan Administrator as a Qualified Domestic
Relations Order, then the Plan Administrator shall within a
reasonable time after the receipt of this Order, 'determine
whether this Order is il qualifiad DOr.1<lstic Relations Order and
notify both the Participant and Alternate Payee of such a
determination. Until such time as a determination has been made,
the Plan ~dministrator Rhall comply with all requirements imposed
upon him by Section 404(p) (7) of the Code and section
206(d) (3) (h) of ERISA. If the Plan Administrator determines that
this Order is nut iI QUill i f ied Domesti\~ Relations Order, then he
shall notify the Participant and Alte.rnate Payee of such a
detenulnation and reason therefcr.
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JUDITH Q. NELSON,
Plaintiff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 933
CIVIL 1995
ROBERT P. NELSON,
Defendant
IN DIVORCE
STIPULATED DOME8TIC RELATIONS ORDER
APPLICATION TO THE IBM TAX DEFERRED SAVINGS PLAN
WHEREAS, Robert P. Nelson, ("Participant") and Judith Q.
Nelson, (Alternate Payee) have agreed to a division of marital
property, which agreement includes a division of Participant's
account in the IBM Tax Deferred Savings Plan ("TDSP"); and
WHEREAS, this Domestic Relations Order (hereinafter the
"Order") provides for the division and disposition of the marital
components of the participant's account in the Plan, which is a
benefit plan administered by IBM TDSP Service Center, P.O. Box
292677, Nashville, Tennessee, 37229-2677; and
WHEREAS, Participant, Robert P. Nelson, intends to grant the
Alternate Payee, Judith Q. Nelson, rights to such benefits in
such amounts on the terms and conditions prescribed hereinafter
as provided for in the Plan; and
WHEREAS, this Order is intended to be a Qualified Domestic
Relations Order (QDRO), as that term is defined in section 414(p)
of the Code and section 206(d) (3) of ERISA.
NOW THEREFORE, IT IS ORDERED AND DECREED AS FOLLOWS:
1. The parties intend for the Order to constitute a
"Qualified Domestic Relations Order" as defined in Section 414(p)
of the Internal Revenue Code of 19B6 as amended.
2. This Order applies to the following Qualified Retirement
Plan: IBM Tax Deferred Savings Plan ("TDSP").
3. Robert P. Nelson, Social security Number 113-30-1409
(hereinafter referred to as "Participant") is a participant in
the IBM Tax Deferred savings Plan ("TDSP").
4. Judith Q. Nelson, Social Security Number 276-34-6317,
(hereinafter referred to as "Alternate payee"), is the
Participant's former spouse.
5. Participant's date of birth is December 18,1937, and
his current and last known mailing address is: 516 Woodcrest
Drive, Mechanicsburg, Pennsylvania 17055.
6. Alternate payee's date of birth is December 4, 193B, and
her current and last known mailing address is: 290B Westbury
Court, Apartment 80B, Camp Hill, Pennsylvania 17011.
7. A loan to a participant is made by taking invested funds
out of the Participant's account. The total value of the account
is the value of the invested funds and any loan amounts
outstanding. The available account balance is the amount of
invested funds, which balance does not include amounts previously
loaned out to the participant. The distribution to the Alternate
Payee specified by paragraph four (4) is made up to the limit of
available funds as of the date of distribution and does not alter
the Participant's obligation to repay any loans then outstanding.
B. The Plan Administrator of the TDSP is directed to make a
lump sum distribution from the Participant's accounts in the TDSP
to the Alternate Payee, as follows:
(a) From the Fixed Income Account, Fifty Percent
(50%) of the entire balance of principal and
interest or dividends in the account on the day of
receipt of this Qualified Domestic Relations Order
as executed by the parties and the Court of
appropriate jurisdiction; and
(b) From the Small Company Index Fund, Fifty
Percent (50%) of the entire balance of principal
and interest or dividends in the account on the
day of receipt of this Qualified Domestic
Relations Order as executed by the parties and the
Court of appropriate jurisdiction; and
(c) From the International stock Fund Account,
Fifty Percent (50%) of the entire balance 'of
principal and interest or dividends in the account
on the day of receipt of this Qualified Domestic
Relations Order as executed by the parties and the
Court of appropriate jurisdiction; and
(d) From the IBM stock Fund Account, Fifty
Percent (50%) of the entire balance of principal
and interest or dividends in the account on the
day of receipt of this Qualified Domestic
Relations Order as executed by the parties and the
Court of appropriate jurisdiction.
The applicable evaluation for the account as of the date of
receipt of this Qualified Domestic Relations Order may be based
upon the preceding weekly valuaton date.
Funds shall
withdrawn from the TDSP for the Alternate Payee and directly
rolled-over into an IRA account, Account number 662l347B, held
with Charles Schwab and Co., Inc. of 17 South Market Square,
suite lA, Harrisburg, Pennsylvania. The amount to be withdrawn
be
is
plan
from the Participant's account for the Alternate Payee
taxable as an authorized roll-over from one qualified
another qualified retirement account.
9. If the Alternate Payee dies after the issuance of this
Order, the Plan Administrator is to make the applicable
distribution to the Alternate Payee's estate.
10. This Order does not require the TDSP to provide any
type of form of benefit, or option not otherwise provided under
the TDSP; or require the payment of any benefits for the
Alternate Payee which are required to be paid to another
Alternate Payee under another Order previously determined to be a
Qualified Domestic Relations Order; or require the TDSP to
provide increased benefits which result from future contributions
to the TDSP. Any provision of this Order, which appears to be
otherwise shall be null and void and have no effect.
11. In no event shall the Alternate Payee have a greater
right than those which are available to the Participant.
12. Any reasonable cost incurred by the Plan Admiriistrator
to effectuate the terms and provisions of this Order may be
assessed against that party requiring the servitudes of the Plan
Administrator. In the event both parties require services of the
Plan Administrator. In the event both parties require services
of the Plan Administrator, such expenses shall be divided equally
between them.
13. The parties shall promptly submit this Order to the
Plan Administrator for determination of the Qualified Domestic
Relations Order. The Plan Administrator is IBM Corporation.
non-
to
14. A copy of this Order shall be mailed promptly, return
receipt requested, to the Plan Administrator. If this Order has
been predetermined by the Plan Administrator to constitute a
Qualified Domestic Relations Order, the plan Administrator shall
properly carry out the provisions. If this Order has not been
predetermined by the Plan Administrator as a Qualified Domestic
Relations Order, then the Plan Administrator shall within a
reasonable time after the receipt of this Order, determine
whether this Order is a Qualified Domestic Relations Order and
notify both the Participant and Alternate Payee of such a
determination. Until such time as a determination has been made,
the Plan Administrator shall comply with all requirements imposed
upon him by Section 404(p) (1) of the Code and section
206(d) (3) (h) of ERISA. If the Plan Administrator determines that
this Order is not a Qualified Domestic Relations Order, then he
shall notify the participant and Alternate Payee of such a
determination and reason therefor.
15. This Court shall retain jurisdiction for enforcement
purposes and to make any changes in this Order to the extent
required to carry out the intent. of the parties as evidenced by
their affirmations in their Separation and property Settlement
Agreement.
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JUDITH Q. NELSON,
Plaintiff
IN T~E COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
vs.
NO. 933
CIVIL 1995
ROBERT P. NELSON,
Defendant
IN DIVORCE
OUALIFtED DOMESTIC RELATIONS ORDER
WHEREAS, Robert P. Nelson, ("Participant") and Judith Q.
Nelson, (Alternate Payee) have agreed to a division of marital
property,
which
agreement has included provision
for
a
distribution from participant's account with Galaxy Funds, of
Box 7, 440 Lincoln Street, Worcester, Massachusetts, 01653-0007;
and
WHEREAS, this Domestic Relations Order (hereinafter the
"Order") provides for the division and disposition of the marital
components of the Participant's account in the Plan, which is a
retirem~nt plan est.ablished by Parth1ipant;
WHEREAS, Social Security Number for the Participant, Robert
P. Nelson, is 11J-30-1409.
WHEREAS, Participant, Robert P. Nelson, intends to grant the
Alternate Payep., Judith Q. Nelson, rights to such benefits in
such amounts on the terms and conditions prescribed hereinafter
as provided for in the Plan; and
WHEREAS, this order is intended to be a Qualified Domestic
Relations Order (QDRO), as that term is defined in Section 414(p)
of the Code and Section 2061d) (3) of ERISA.
NOW THEREFORE, !T IS ORDERED AND DECREED AS FOLLOWS:
1. The parties intend for the Order to constitute a
"Qualified Domestic Relations Order" as defined in section 414(p)
of the Internal Revenue Code of 19B6 as amended.
2. This Order applies to the following Qualified Retirement
Plan: Galaxy Funds, Individual Retirement Account (IRA)
Fund/Account #212-1000135070.
3. Robert P. Nelson, Social Security Number 113-30-1409
(hereinafter referred to as "participant") is the
participant/r.MnP.r of ;~n Illdi\'idual Retirement Account (IRA)
Fund/Account #212-1000135070 with Gala~y Funds ("plan").
4. Judith Q. Nelson, Social security Number 276-34-6317,
(hereinafter rofel:loed to as "Alternate Payee"), is the
Participant's formar spouso.
5. Partlcipant'3 date of birth is December lB,
his cIJrrr.nt ilnd la~lt knolm mailing address is: 516
Drive, ~lech"nics\:.urg, Peillls~ll vania 17055.
1937,' and
Woodcrest
6. Alternate Payee's data of: birth is December 4, 193B, and
her current and last known mailing address is: 290B Westbury
court, Apartment 80B, camp Hill, Pennsylvania 17011.
7. The Participant's account in the Plan is marital
property subject to the distribution by this COUrt. Effective
with receipt of this Order, execut~d by the parties and the
court, the Plan AdministratoJr flhall distribute the sum equal to
Fifty Percent (50%) of the balance in the account including all
principal, interest and dividends as of that day. This
designated balance of Fifty Percent (50%) of the balance in the
fund shall be withurawn from thl3 participate's account in the
plan. Funds shall be withdrawn from the plan for the alternate
Payee and direct be rolled over into an IRA account, account
number 66213478, held with Charles Schwab and Co., Inc. of 17
South Market Square, suite lA, Harrisburg, pennsylvania. The
amount to rJe withdra~m from the Part icipant' s account for the
Alternate payee is non-taxable as an authorized roll-over from
one qualified plan to another qualified retirement account.
6. A Signature Guarantee has been attached hereto and
incorporated herein uS Exhi.bit """.
9. This order doe~ not require the Plan to provide any type
of form of bOI1~f.lt, Clr uption not othan/ise provided under the
plan; or requir.e the pnYlUt::n1: vf any b,:.nefi.tD for the Alternate
Payee which are required to r.a paid ~o another Alternate Payee
under .mother Order pr'i<'1iouslY dAtermined to he a QUdlifled
Domestic Relations Ortler; or require the Plan to provide
increased bencfi~s which result from future contributions to the
plan. Any pl:o.>vision of: tlli!! Order, ~/hlc;h appears to be o~herwise
shall be null ;;InrI Vl1id and have roCI effc~,:t.
10. In no event ~hall the Alternate Payee have a greater
right than those which ara o'/a:llable to the Participant.
11. Any rt':asonable cost incurred by the Plan Administrator
to effectuate the terms and provisions of this Order may be
assessed against that party rcquirinq the Dervitudes of the Plan
Administrator. In the event both pClrti~s require services of the
Plan Administrator. In the event both parties require services
of the Plan Administrator, such expenses shall be divided equally
between them.
12. The parties shall promptly submit this Order to the
Plan Administrator for determination of the Qualified Domestic
Relations Order. The Plan Administrator is Galaxy Funds of 440
Financial Distributors, Inc., 440 Lincoln street, Worcester,
Massachusetts.
13. A copy of this Order shall be mailed promptly, return
receipt requested, to the Plan Administrator. If this Order has
been predetermined by the Plan Administrator to constitute a
Qualified DomeRtic Relations order, the Plan Administrator shall
properly carry out the provisions. If this Order has not been
predetermined by the Plan Administrator as a Qualified Domestic
Relations order, then the Plan Administrator shall within a
reasonable time after thE! receipt of this Order, determine
whether this Order is a Qualified Domestio Relations Order and
notify both Lha P~rLicipant and Alternate Payee of such a
determination. Unt.il such time as a determJ.nLlticn has been made,
the plan Administrator shall comply with Ll1l requirements imposed
upon him by Section 40"(p) (7) of the Code and Section
206(d) (3) (hi of ERISA. If the Plan I\dministrlltor determines that
this Order is not a Qualified Dom~stic Relations Order, then he
shall notify the ParticIpant and Alternate Payee of such a
determination and re;,,,;on tt-en'flJr.
14. This Court shall retain jurisdiction for enforcement
purposes and to make any changes in this Order to the extent
required to carry out the intent of the parties as evidenced by
their affirmations in their Separation and Property Settlement
Agreement.
IT IS INTENDED THAT THIS ORDER SHALL QUALIFY AS A QUALIFIED
DOMESTIC REJ~TIONS ORDER AS SUCH DEFINED UNDER SECTION 414(p)
INTERNAL REVENUE CODE OF 1986, AS AMENDED. The Court retains
jurisdiction to amend this Order as might be necessary to
establish or maintain its status as a Qualified
Relations Order.
Domestic
WITNESS:
(.. -1.1-- Y'f-.
Date
/-7/ ,<);'; /
. )-- ,U)" ~~//:l--...
Robert P. Nelson
, _)ldJ!u IlidA'V ~-J-~_%
~~dith A. Cal~in, Esq. Date
"I
~,,~tl;"-t l- '1.ll.L t.~
Ju ith Q. Nelkon
,IUDI'I'II A. Nf':I.,SON,
PLaLnti[f
VA.
IN 'l'lm COllll'/' OF COMMON PLf:AS
ClIMB8RIJANDCOllN'/'Y, PENNA
NO. 95-933
HOnJ~R'1' l'. NI~I,SON,
Defendant
CIVIL, AC'I'ION-IN D[VORCr.
PRAECIPE
Please withdraw Counts II, III & IV in the above
captioned matter.
Datel
.)
C;,dd~ /! (JuY~
JJ6ith A. Calkin, Esquire
I!
,/
Prothonotary
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