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HomeMy WebLinkAbout95-02644 ~- "'.._,., ~;~- ~~, z:. f,:::~;: : , ! c. \F/ " r~ k:. '~ ~< "',;',' :.----.. :':t.-. P." ""'~ :.'~'..._,:.:.., ;), .,..<.... ..' '~ j r - -...... ... --... "~~~~~~.'" :~"llC-, ~:~_~'!.J(.:~~~~~"!I'::~~_'!"_~.~~ ~ . . . . . . . . . . . . . i . . . . . ; . . . . . ~ . . . , . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF '* PENNSYLVANIA PAMeLA L. KEISER, Pldntiff "('!'!olIlS PAV!D K. KEISER, Def",ndant No. 9:H\l4'l II) DECREE IN DIVORCE AND NOW,.., .V~, '21,.. 1911"',. It I. ordered and decreed that, . , ' . , , . , , ' . ,PAMELAL.t!EISEIl. . , , , , . . . ' .., , , , , . '. plaintiff, and. ., .. " , , " , . " , , " , ' . ,lJAVllJ. K. KElSl'Jt . , " , , ". d.fendant, are dlvorc.d from the bonds of ma!rlmony. The court retains jurisdiction of the following claims which have b..n rals.d of record In this Delion for which a final ord.r has not yet b..n entered; toN2... .!lll~J;"tion,"nd,l'roperty, Sl!tLJl!lOOnt ^qcoolllontdiltlld ,l)lJ{;,lJmbtH,IIl., 111116.,16. .~I1GQJ;pQ~"ted, ioto this, [Jeeree. . . 'J ' , , . . . , . , , / n, \'4;;;' AII..I:.:Y.;'", J/",w-,,/ t' 'tl), t,I(.. /:i.0(..~.6, J, '1'1:'( "I r~. '("';{. ),~'l .:7 ,/ . I',olhooolary . . . . . . . . . . . . . . t . . . . . " . . , . . . . . . . . ~ * ~ ~ - w II ----------.----------- . , Ueparati21LlUllL l'.r.Q1l11.W_ Settlement Aqreement TIllS AGREEMENT, made this J'i!:l day of J)lu..d:l(;"I - 1996, by and between PAMILA L. KIIBIR of carlisle, cumberland county, Pennoylvania, party of the first part, hereinafter referred to ao "Wire" and DAVID K. KI!IIBI!IR of Mechanicsburg, cumberland county, Pennsylvania, party of the second part, hereafter referred to as "lIusband". WITNESSETlIl WIIEREAS, in consequence of disputes and unhappy differences, the parties have been living separate and apart from each other; and WHEREAS, the parties desire to confirm their separation and make arrangements therewith, including the division of their marital property and other rights and obligations growing out of their marriage. NOW, THEREFORE, in consideration of the covenants and promises hereinafter to be mutually kept and performed by each party, as well as for other good and valuable consideration and intending to be legally bound it is agreed as followSl 1. It shall be lawful for each party at all times hereafter to live separate and apart from the other party at such place or places as he or she from time to time may choose or deem fit. 2. Except as herein otherwise provided, each party hereby releases the other from any and all claims, or demands up to the date of execution hereof. Pamela L. Keiser )/ J< _1___ David K. Keioer 7J,tJ{ I 11H,lJ..., .J,r\;,.' I fH~IJ"'''' I (c) Encumhr,lllCH Oil lIuahiHl<J'B viln; illld / / )l/( \ I J ((I) Lowu'a (.HU' L,"i l<<lld (ll) Medi",ll hll]s In ttw lIaml' ul I',lmelil I.. Keiser which are aD fullows: (I.) Carlisi..! lIospitill (h'lIlI'J/l-'.I) $ J';, 70 (ii) A,'/,. Hit7miln & A!'HlOL'" ll1c. (1lIlOhIl400) $207.00 (Ii i) lIoly lipid! lIospllill (',b<J;!01l2) $220,]1 (iv) A.Z. H1t7.man' ASIiOC., Inc, (11076714) $5!1. 00 (v) Community General Osteopathic 1I0sp. (272]17]4]8) $45.00 (vi) lIoly I>pirlt Hoepit'll (h407704) $1]1.00 (vii) Holy Ilpirlt 1I0spitilJ ((>111880) $2]0.00 (viii) lIo]y Ilpirit 1I0spital (h418b2<J) $229.00 Regarding the aforesaid expenses, lIushand agrees to indemnity and save harmless Wite tram any and all ~laimD and demands made against her by reilson 01 such debts or obligations. b. Each party relillquiohes any right, title and interest he or she may have to any I1n,1 all motor vehicles currently in pOllllession of the other party. Eilch party ohilll execute any document II necessary to hllVe aald vehklea property registered in ths other pal'ty's name with the I'HlllIsylviIIlia Ilepaltment of 'l'tanfipUI-t ilt ion. El1ch IJiIl t Y ..lIii II illl!Hlm.. 11111 t "spone i b I Ij ty of any encumhrance 011 the motol vehicle recHived hy siiid party, and l'Ameln L. K9iool' f ( / .....".., .J~'..~ l I HH. Ii' J 'J.t. / '" lJiivl<1 K. Keiser "I'!\,.:1__ shall hold harmless and indemnify the other' party from any lOBS thereon. 6. Except for the items attached lwreto as 1':xhi\Jlt "A", which shall be the sole ilnd exclusive pl'operty of Wife, the parties hereto mutually agree that they have effected a satisfactory diviolon of the furniture, hou~ehold furnishings, appliances, tools and other household personal property between them, and they mutually agree that each party shall from and after the date hereof be the sole and separate owner of all such property presently in his or her possession whether said property was heretofore owned jointly or individllally by the parties hereto. This agreement shall have the effect of an assignment or bill of sale from each party to the other for such property as may be in the individual possession of each of the parties hereto. 7. Each party hereby relinquishes any right, title or interest he or she may have n or to any intangible personal property currently titled in the name of or in the possession of the other party, including, but not limited to, stocks, bondB, insurance, bank accounts and retirement accounts. 8. Husband and Wife covenant and agree that Wife shall be entitle to receive one-half (\) of the marital portion of any retirement/pension which Ilusband is entitle to through his former employment with Fruehauf, to be implemented through a Qualified Domestic Relations Order. Ilusband to provide medical inourance Pamela L. Keiser jJL 4 David K. Keiser .Jk",-(" )../ , j l~lolI~" J,.J;I\, .t. I 111~f' I'~'" for W II II Ih!ou<jh Du<,ulnlml II, 1"'1/, 01 unt! I WI' u obI., I nK i nBunllwe Ihrou<)h hl'r oml'l OY"', wh I <'h {'vI'r "vI'nl (,,"'UI'S 'I rMI . <J. WII., hilH t 11.'d iln ilt'l lOll l(ll HI'OUHit! HUl'porl In the Domeetlt' RI'lal InnB Off 1<'., ot ('umh"lliln<l l'ounly ilU DR No, 21101. The part I eo 1l<)ltlU lIuabilllll w I II ('on I I nlw to IlilY und." I he current order unl II December II, 1'1')/, oil wh ich 11m.. I h" onllJl- wi II terminale 1H1<1 all IUTeal'e woul,l I,.. <llIe ilnd paYilble Imlnlldial:llly. 'J'he pa!lies agree thllt Iho cunent on1,,! Hhit!J not be modified regard I ess of Ilny dHln'Jlls 0' (' I!('umat dncea. 10, Wife hereby iI<)I'..,," to Irilnsf.n to 1I11Hband I'IJ I of his \'voir <In,! I (J We sf the cemetery lots at 1)/ t j)KK right, titlo and interelll III Holling Green Cemetery. Wile uhall, lIpon reqllest, eKocute any documsnts nucessary to have uald Iota titled in the Bole name of HUllband. 11. EKcept as otherwise provided herein, Husband shalJ not pay to Wlte liar WHe to lIuBh/lll<l Ilny BlIm whlltuo8ver alii alimony, alimony !;llmlllntll,lllJ!, or lor h I IS or her Bupport or ma i ntenanC8. 12. Each party Is repreBentud hy uounsoJ of his or her own choice, and eftch shall pay hie or her own attorney for all legal services rendered or to be rendored on his or her behalf. lJ. Neithet' party has cOlllact.ed not' shall t.hey contract or incur any deht 01' liability for wh lch tile ollie.' party or hiu or her property or <Hlta!.", IlIltJlit be . espalls t hI" <llltl each aha II indemnify Blld lIave the 01111>1 pill I Y halmleBB I rom /IllY /l1l<1 all cia i mil or demands made il(jid IlBI Ii I In or lie." by I eaBon of debts or obligat!ollu IllCllrn>lj by 1Ill! olhel 1,,"ly. Pamel/l I.. KalulH \)l k , ,,.."",,., s "", -t. I . ,,~!, !" ,) !lllYI,1 K. Kulaer ./)"'-;{' 14. Each of the parties shall from time to time, at the request of the other, execute, acknowledge and deliver to the other party any and all IUl'ther Instrllments that may be roasonably required to give full force and effect to the provision of this Agreement. 15. The parties do hereby warrant, represent, acknowledge and agree that each is fully and completely informed of, and is familiar with, the wealth, real and personal property, estate and assets, earnings and income of the other and that each has made a full and complete dioclooure to the other of his or her entire assets and liabilities and any further enumeration or statement thoreof in this Agreement is specifically waived. IG. Husband and Wife acknowledge that each of them has read and understands his and her rights and responsibilities under this Agreement and that they have executed this Agreement under no compulsion to do so but as a voluntary act. 17. It is further specifically understood and agreed by and between the parties hereto that each party accepts the provisions herein made in lieu of and in full settlement and satisfaction of any and all of said party's rights against the other for past, present and future claims nn account of support, maintenance, alimony, alimony I1.@llii~gJll~, counsel fees, costs and expenses, equitable distribution of marital property and any other claims of each party, inclUding all claims which have been raised or may be raised in an action for divorce. Pamela L. Keiser \~Lt,_ 6 David K. Keiser .))~~ , 1P."!I'"~H',"~'II.lI'I~I'~ lB. Except as may be otherwise specifically provided in this Agreement, Husband and Wife, for themselves, their heirs, representatives and assigns, hereby forever releaaes, remises, discharges and quitclaims the other, and such other's heirs, representatives, assigns and estate, Crom and with respect to the following: (a) All liability, claims, causes of action, damages, costs, contributions, expenses or demands whatsoever in law or in equity; (b) All rights, title, interest or claims in or to any property of the other, whether real, personal or mixed and whether now owned or hereafter acquired; ID All rights of curtesy and dower and all claims or rights in the nature of curtesy and dower; (d) All widow or widower's rights; (e) All rights, title and intereat or claims in or to the other's estate, whether now owned or hereafter acquired, inclUding but not limited to all rights or claims: (I) to take against the other's wi 11; (ii) under the laws of intestacy; (iii) to a family exemption or similar allowances; and (iv) all other rights or authority to participate or intervene in a deceased spouse's estate in any way, whether arising under the laws of Pennsylvanian or any other country, territory, state or political subdivision. Pamela L. Keiser ~ ,- I-IJI"""""JJI\"... 1-' 11~1 ~,.. 7 David K. Keiser j)~ (f) All rightu ur claims tu allY accounting; (g) All rights, clAims, demandB, Illlbllities Bnd obligatlontl arising out 01 Dr In conm,ct lOll with the madtal relationship or the joint Dwnet'uhip of property, whether real, personal or mixed; (h) AI I dghts, claims, ,h,"lill1<lo, Ilabll itios and obligations ariaing under the provlslonB uf the Penllsylvanla Divorce Code as the aame may be amended Irom time to time, and under the pruvisiona of any aimllBr atBtute enacted by any other country, etate, territory or political SUbdivision; (I) All rightll, claims, demands, liabilities and obligations each party now has, or may hereafter have, against or with respect to the other. 19. 1~is Agreement shall be conatrued under the law of the Commonwealth of Pennsylvallia. If any provision of this Agreement is determined to be invalid or unenforceable, all other provisione shall continue in full force and effe~t. 20. The parties hereby acknowledge that Wlfs has filed a complaint in Divorce in Cumberland county, claiming that the marriage is irretrievable broken under the no-fault, mutual consent provision of uectlon llnl~ of the Pennsylvania Divorce Code. The parties hereby express their agreement that the marrlalJs Is Irretrievable broken all'! llxpress thtlll Intent, contemporaneoualy herewith, to execute any ilnd all affidavits or other documents necessalY lor the parties to obtain an absolute d i vorCl1 puruullnt to Hlwtloll I 11I1 ", ot tht' Illvot!:" ('o<lt! . 'rho PamelA J.. I<(,J I rH!I \\L \- II Ililvllj 1<. I<"laer . ;Jg~/ , 1l~'"''''H,.,~ I H'''~I'-' parties hereby waive all rights to request court-ordered counseling under the Oivorce Code. Neither party to such action shall sesk alimony or support contrary to the provisions of thia Agreement. It is further specifically understood and agreed by the partlss that the provisions of this Agreement relating to equitable diBtribution of property 01 the parties are accepted by each party as a final settlement for all purpoaes whatsoever, as contemplated by the Pennsylvania Divorce code. Should a decree, judgment or order of separation or divorce be obtained by either of the partlea In this or any other state, country or jurisdiction, each of the parties hereby consents and agrees that this Agreement and all of its covenants ahall not be affected in any way by any such separation or divorcel and that nothing In any such decree, judgment, order or further modification or revision thereof shall alter, amend or vary any term of this Agreement, whether or not either or both of the parties shall remarry, it being understood by and between the parties hereto that this Agreement shall survive and shall not be merged into any decree, jUdgment, or order of divorce or separation. Notwithstanding the provisions of the Pennsylvania Divorce code or of any law to the contrary, none of the terms and provisions of this Agreement shall be sllbjecl to modification by the court or in any fashion other than as set forth hereinafter. It is specificallY agreed, however, that this Agreement shall be subject to enforcement under the provisions of the Pennaylvania Pamela L. Keiser \-It L/ ~\.~.~~~I--_- j)d 9 David 1<' Keiser , 11Jo W." ~J!I' ..t' I 111~1 ~ I'," .. I .. . . 1 It ',I I t, t \1 n I . . " ( Cc.o1d 0 Elheu~ D pic Pane fomato Press fer c8nninv ~ Weed W"Ckel"1l (onll large. one smalll Lawn Howe l' Small l\ir Conditioner Large Air Condit 10n81' chr letmau Lightll 2 or8ndmoth~r8 Sewing Macninlle Dooks . Paper B~ck 1'100,1 Book Shill t Brase nook Shelf End 'rable litccional S(lf" alilss Dog porce lllin Oo,:! Chchtmafl Alburrll Blender Electric Frying PAn Rolling Pin i'aatry Board ~: \(1 " l.fl '\ P) , ..1 \.') ,,'1 Jr.' r-l \~ ((I' ,. t .' ~\_-U ... :i >, I'.l '~~ o' j ''I IU .,! . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA PAMELA L. KEISER, Plaintiff V. I I I I I I I CIVIL ACTION - LAW IN DIVORCE NO. 95-2644 CIVIL TERM DAVID K. KEISER, Defendant PRAECIPB TO TRANSMIT RECORD To the Prothonotary I Please transmit the record, together with the following information, to the Court for entry of a divorce decreel 1. Ground for divorcel irrotrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and manner of eervice of the Complaintl Certified Mail, Restricted Delivery, Delivered May 20, 19951 (The original domestic return receipt ie attached ae Exhibit "A"). 3. Date of execution of the affidavit of coneent required by Section 3301(c) of the Divorce Codel by the Plaintiff-- December 19, 19961 by the Defendant--December 19, 1996. 4. Related claime pending I Separation and Property Settlement Agreement dated December 19, 1996, is incorporated into this Decree. Datedl /l.('l.olf~ Reepectfully submltted, W 1 am C. Vo e, Esqu re Attorney ID No. 65208 11 W. Pomfret Street, Suite 2 Carlisle, PA 17013 (717) 249-5373 l'IfaMl:U'tU'^*-lftDUftAIllllANI P M( () 11 i' , -':1 '" : I ~lJ VJ l , iii., r,\ PI (j, 1:'... . r i;" ''',) :~ ,,0 , ~f " t,. , .. . f P ,. "j ,:I "" I \ \ I P \j') (') (n ""1 ~r "I '?J t:r; j .... ,",) ;i t' '';'.J ., r '., if., ,; ..., '.. ,., ,( C' ;~) ,(I ;.', ;..' I :-, 'JJ -. ':J .... IN THE COURT 0' COMMON PLEAS or CUMBERLAND COUNTY, VA CIVIL ACTION - LAW IN llIVORCE NO. 95- , ',~ \ 6v . ,I I~~ PAMJLA L. KEISIR, Plaint1tf v. II I"J.IJ .,U pd 0\\:1, .') UU"':.Q\ DAVID K. KUSER, Detendant _~_c"'<.....__ ,., I ~\i ''')0 {X~ (tH'j COMPLAINT IN DIVORCE ('11 t.l , "lev 'l 'i'if';l f< II HAN'T . YOH' ATlOIlNIVI AT LAW 11 WIlT I'OMl'IIIT 1f1ll1T, IUITI . CAAUIlJ,I'A nOli (11 7) "1-1373 !'AX "11) ...-041' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA PAMELA L. KEISER, Plaintiff v. CIVIL ACTION - LAW IN DIVORCE DAVID K. KEISER, Defendant NO. 95- K I I q l f', \ ,,\. \. ,\., NOTICI TO DI'IND AMD CLAIM RIGHTS YOU HAVI BIIN SUID IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree of divorce or annulment may be entsred against you by the Court. A judgment may also be entered against you for any other claim or relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Offics of the Prothonotary, cumberland county Courthouse, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE TilE RIGHT TO CLAIM ANY OF THEM. YOU SIIOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE TilE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Court Administrator Fourth Floor, Cumberland county Courthouse Carlisle, PA 17013 (717) 240-6200 IN 1'HE COURT ot" COMMON PLEAIl ot' CUMBERLAND COUNTY, PENNSYLVANIA PAMELA L. KEISER, Plaintiff CIVIL AC1'ION - I.AW IN IHVOHCE; v. DAVID K. KEIIlEH, Defendant NO. 9~- COMPLAINT IN .~lY~ AND NOW, this 17th day of May, 1995, comes Plaintiff, Pamela L. Keiser, by and t,hrough her attorneys, HANFT' VOIlS, and fi les the following complaint in Divorce, and in support thereof avers as followSI 1. The Plaintiff is Pamela L. Keiser, who currently residel at 270 susquehanna Avenue, Enola, Cumberland County, Pennsylvania. 2. The Defendant is David K. Keiser, who currently re.ide. at 235 susquehanna Avenue, Enola, cumberland county, Penn.ylvania. 3. The plaintiff and Defendant are sui juris, and both parties have been a bona fide resident of the commonwealth of Pennsylvania for a poriod of more than six (6) months immediately preceding the filing of this complaint in Divorce. 4. The parties were married on octuber 19, 1914, in cumberland county, Pennsylvania. 5. Tho marriage is irretrievably broken. Tho foregoing facts are averred and brought under Ractlons ]]OI(c) or ]]OI(d) of the Divorce Code of 19HO, ao amended. 1 N 'I'IU: COIlIl'I' OF COMMON PLEAIl 01-' CIlMIIEIILANll COIlNTV, I'ENNliVLVANIA l'AMfa.A L. I<t:J!lEll, l'lalnt! ff V. CJVII. ACTION - LAW IN l> I VOlleJ': DAVlD 1<. I<EIIlEll, llefendant NO. <)',-:<(,44 AffIDAVIT 01 COMIIMT I. A complaint in dlv(H"E! under "eet ion ])O} (c) of the Divorce Co(\e was filed on MIIY 1'/, I~~~. 2. The marrialJ" of the Plaintiff ilnd llefendant is irretrievably broken "nd more than ninety (90) days have elapsed trom the date of the filing of the Complaint in llivorce. ), I consent to the entry of a tlnal decree in divorce without notice. 4. I understand that I may loso rights concerning alimony, division of property, lawyer'g fees or expenses if 1 do not claim them before a divorce is granted. ~. I understand that the costs of these proceedings will be paid for by Plaintiff. 6. 1 understand that 1 will not be divorced until a divorce decree is entered by the Court /lnd that a copy of the decroo will be sent to me immediately after It is filed with the l'rothonotuy. 1 verify thllt the I!tlltements madl;! In thio alfld/wit are true and correct. 1 undetstalHl thllt talBe ntiltemente horoln are made subject to the penaities of 10 l'a. (;, U. 6ect1on 4!104 relating to unsworn falsification to IIUIIJ[ldtiel!l,.. ~. 1-)'\ ...\/~ Datedl/t/,,/?/r '1.../U1"I!UJ jfl<~l"",__""L~_~(.t;.k'./ '"me t\ " eUU.it r- . llt..,.,- ~H'.".'! _'to. ,-., ,,-+ ..,.",.,- P VI n en 'II , i~ " ;:H'. ~:~ D.! ., ~.a ~ '" 6j 0 . ~ .....~ . ~~ ~' ''0 -=';f :-.J; S;~ ~ :..-.. .., :11 ~ , 17\ 1 N 'rilE COUll'!, OF COMMON PLEAH OF CUMIlEIlLAND COUNTY, PENNSYLVANIA PAMELA L. KEISER, PIa inti ff V. CIVIL ACTION - LAW lN DIVOIlCE DAVID K. KEISER, Defendant NO. <)1)-2644 AFFIDAVI7_Ql_~QMiItir 1. A complaint in divorce under section 330l(c) of the Divorce code was filed on May 17, 1995. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and more than ninety (90) days have elapsed from the date of the filing of the complaint in Divorce. 3. I consent to the entry of a final decree in divorce .. without notice. 4. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expensea if I do not claim them before a divorce is granted. 5. I understand that the costs of these proceedings will be paid for by Plaintiff. 6. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statementa herein are made subject to the penalties of 18 Pa. C. S. section 4904 relating to unsworn falsification to authorities. ) Dated: 1'Z.~ \~. ~L , /' /"v' , 'VI' ,::,~~'e/ ~'^--?<4.'4 'fi<il.iT,rK;-KeI ser ----,--,-'---,-- , JI~Wlu_JJI\'..'1 UI~I.AII..I' """1, ~ ~ ~ ~i ~ ~~~ ~/: '" j;' Q 1 ....J. r. "'t' , ~" ~J' . .., f-'( r;~ I' p,' , '.J1 '. -. 11'\ .~ IN TilE coun'l' 01' COMMON PLEAS 01' PEnny COUNTY, PENNSYLVANIA PAMELA L. KEISER, Plaintiff V. CIVIL AC1'ION - LAW IN DIvonCE DAVID K. KEISER, Defendant NO. 95-2644 !AlYER or NOTICE or INTENTION TO REOUEST ENTRY or A DIVORCE DECREE UNDER 51301(0) or THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statementa made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904 relating to unsworn falsification to authorities. Datedl /L/,'/O tl1JW...'"\-'.'t-..'lto""'II"".Al\UUIollI p. ~ q 'if '1 ro: " "'JJ ..... 1',) '~ , ii I;.> " ft..' I F 'T1 li- "-' - ;1>; i !tt; (..,) I .. ~ -.., ":I H "'~ 1;1 .... I N TilE COlI/lT 01' COMMON PLEA/J 01' PEIlIlY COUNTY, PENNIJYLVANIA ""HE!.A 1" I<EI/JEH, Plaint! tf v. CI VI L ACTION - LAW IN IJIVOHCE IJAVIIl K. 1<1':1 /JEll, lJefendant NO. '1'>-2644 IlAIYlILQr...JIQUQI.,.QI'._lllTU'llON TO RlOUIl8T JJI1'U~A.JUVOJ!.CI,D.IQJII UNDII!. IlUl{gLO''l'HIDlYQRQI~1 1. I consent to the entry of a final decree of divorce without not ice. 2. 1 understand that 1 may 10S8 rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. J. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the pennltles of 18 Pa. C.S. S4904 relating to unsworn falsification to authorities. Datedl 11..-' ,. ~~ ,. )y L~. //~ David K. Keiser , HU"~'_'JiI\." 1.1"""'~".,"\I,;,hl.I-'t P, ~ "1 Wi ''".1 '1 j', "'I;:tl .., I, I'.) J~ (;' r.... ~ A' ri "n ....\ .~ ~ ~~f :...1 ,~ " ;, c. " , ~ ...; I;:' IN 1'IlE COUIlT OF COMMON PLEAS OF CUMBEHLAND COUNTY, PENNSYLVANIA PAMELA L. KEISER, Plaintitf CIVIL ACTION - LAW IN DIVollCE V. DAVID K. KEISER, Defendant NO. 95-2644 CIVIL TERM QUALIFIED DOHE8~_BlMATIOH8 ORDER AND NOW, this ~_ day of ~ , 1997, upon consideration of the Property Settlement Agreement dated December 19, 1996, upon receipt of a certified copy of this judgment, the administrator of the plan shall divide the account of David K. Keiser into two (2) accounts: one for Pamela L. Keiser consisting of one-half of the account from the date of employment until the date of termination of employment, after adjustments for earnings, appreciation, and contributions; the remaining balance in the account shall be retained for David K. Keiser. 1'he plan adminiatrator shall distribute to Pamela L. Keiser the lump-sum amount set aside for her in the account as set forth below. Receipt of a certified copy of this judgment by the plan administrator shall fulfill all requirements of the plan as to notice and request for withdrawal by Pamela L. Keiser. Distribution to Pamela L. Keiaer shall be made immediately. This provision is designed to meet the definition of a Qualified Domestic Ilelations Ordsr under Section 206(d) (3) (e) and (D) ot the Employee Retirement Income security Act of 1986 as amended and Section 414(p) (2) and (3) of the Internal Revenue Code of 1986 as amendod. The requisites for such an order are , nfo""'."~J'I"'~'tlltlll~"P~ fulfilled in t.he following proviAtonH of thlu tnstnlmUl1t. The name, address, and soci/ll M>t'llrlty nllmher Ilf tho participant., David K. Koiaol', IU-ll IlIi fullllwfll Participant: David K. KeiNer Address: 121'1 GI'OSS Ilrlve, Mochllnl('lll>llr<j, I'A Hu!)') social Security No.1 11I2-4b-2119 The name, address, and social security lIumhol' uf thu alternate payee, Pamela L. Keiser, are liS follows: Participant: Pamela I.. KelBer Addressl Lot 'II, I{egenuy Waoda North, Carllslo, I'A 1'/01] Social Security No. I 191-46-22'1!J Pamela L. Keiser's interest shall be determlnod by taking one-half of the plan accumulated during David K. KelBer's employment. The benefit for David K. Keiaer shall be the balance of the plan. Pamela L. Keiser's intereat also shall IlIulude any interest, dividends, or other prm:eode lltl'r I bllt.ah let 0 I'amo III L. Keiser's share up to the date the plan 10 ilctlllllly IlIvldud. In addition, Pamela L. Keiser shall he troi\t(ul 111' II ullrvlving OpOUBO for the full amount of her ahare lint II tho plllll /let 1I11l1 Y i Ii divided. The number of payment.s roqll i ro'! Iii (Jnu (I) I nun I he p IlIn. The name of t.he pliln lor which thla oldl!1 Ilppllon ISI Fruehauf corporation. ! I"WI~""H\"~' 1111'1) '''Of The tel'ms and provisions of Ihle inst.rument llre not t.o be construed tOI . RequirQ a plan to pl'ovidll !lny t.ype or 101m of benefit or any option (with Ihe exception ot the payment to Pamela L. Keiser aD provided abovo) not othorwise provided under the planl . Require a plan to provide IlIcreaDod benefits (determined on the basia of actuarial value) I or . Require the payment of bsnefita to Pamela L. Keiser, which are required to be paid to another alternate payee under another order previously determined to be a qualified domestic relations order. l'amu1l\ /" Keiser Ilhall have the duty to notifY the plan administrator(B) in writing of any change in her mailing address. It is the intention of the court that the distribution by the plan to Pamela L. Kl!lser shall be taxable to Pamela L. Ksiser under the provisions of Section 72(m) (10) and 402(a) (9) of the Internal Revenue code of 1986. Hubject matter jurisdiction ovsr the parties i. expressly reserved for the purpose of amending this Instrument in the event that a plan administrator or any court of competent jurisdict ion determines that this inlltrument l10es not meet the definition ot a qualified (Iomootiu relations order. If possible, llavt,! K. KelBer shall itllow tills plan to be amendpd 1'10 that the portion itWill<led to I'amela L. Kalaer is portllble, a", lun<J au ,loin,! so ,lues not result III IIn adverae tax , lijololi,,,.,,h.;..IIH'II'j"t con.equence to Oavid K. KeiBer or the employer. BY Tilt: (,OUR1', _n~.. J. / 1.....U.4>!"."..U..,W.., ( v. IN TilE counT OF COMMON PLEAS OF CUMBEnl~ND COUNTY, PENNSYLVANIA CIVIL AC'I'ION - tAW IN DIVORCE PAMELA L. KEISER, PlaintUr DAVID K. KEIBEn, Defendant NO. 95-2644 CIVIL TERM DU~LIrIID DONIITIC alLATlaMI DaDI. IT IS llEJlEBY ORDEJlED AS FOLLOWS I 1. Thh order cnatee and ncognh.. the existence of an Alternate Payee's right to receive a portion of the participant'. Total Account Balanoe accumulated under an employer-.ponsored defined benafit plan which ia qualiried under I 601 of the %nternal Revenue Code (the "COde") and the Employee Retirement Inoome Security Act or 1974 ("ERISA"). It ie intended to constitute a Qualified Domeatic Relationa Order ("QDRO") under I 414(p) or the Code and S 206(d) (3) or EnISA. 2. The name, addreas, birth date, and aooial security number or the plan "Participant" arel DAVID K. KEISER 1217 Groaa Drive, Mechanicaburg, PA 17055 Birth Datel 12-16-54 Social Security Numberl 182-46-2139 3. The name, addreaa, birth date, and social aecurity number or the "Alternate Payee" arel PAMELA K. KEISER Lot 71, Regency Wooda North, Carlisls, VA 11013 Birth Datel 6-13-51 social security Number I 191-46-2218 .. The Name of the Plan to which thie order appliee is the Freuhaf Trailer corporation Retirement Plan, hsreinafter referred to as the "Plan". 5. This Order ia entered pursuant to the authority granted in 23 p.C.S.A S 3502. 6. This Order relates to the provision or property right. to the Alternate varee as a reault or the Divorce Decree between Participant and A ternat. pay.e iSBued on December 19, 1996, which Incorporated a Separation and Property Settlememt Agreement ("Agreement") . 1. The Agreement ..eigns to Al ternate Payee an amount equal to the actuarial equivalent of 50\ or the Participant's vested accrued benetlt under tho Plan aB of December 23, 1996. The Defined I Retirement Benefit will be divided into two separate accounte, one for the Participant, and one for the Alternate Payee. B. The Alternate Payee shall be paid her benefite ae eoon ae administratively feadble under the Plan. The Partioipant will attain the al1e of 55 on December 16th, 2009. Ae th18 18 the earliest age of retirement under the Plan, the Alternate Payee will be paid ae eoon ae administratively feasible after thie date. The Alternate payes ehall be paid in installments ae the Plan providee. 9. On and after the date th18 Order 1& deemed to be a Qualified Domeetio Relations Order, but before Alternate Payee reoeives her distribution from the Plan, she will be entitled to all of the ril1hte and benefits that a survivinl1 spouee would be afforded. 10. This Order is not intended, and ehall not be construed in such a manner as to require the Planl (a) to provide any type or form of benefit option not otherwise provided under the terms of the Planl (b) to require the Plan to provide increased benefits determined on the basis of actuarial valuel or (c) to require the payment of any benefits to the Alternate Payee that are required to bs paid under another Order previously deemed to be a QDRO. 11. All payments made pursuant to this order shall be conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator of such information ae the Plan Administrator may reasonably require from such partiee to make the necessary calculation of the benefit amounts oontained herein. 12. In is the intention of the parties that this QDRO continue to qualify as a QDRO under 5414(p) of the Internal Revenue Code, as it may be amended from thle to time, and the Plan Administrator shall reserve the riqht to to reconfirm the qualified statue of the Order at the time benefits become payable hereunder. 13. It is the intention of the Court that the Alternate Payee be required to pay the appropriate Federal Income Tax on the distribution of the Plan as under 5402 (a) (1) and 572 of the IntErnal Revenue Code. 14. In the event that the Plan Trustee pays to the Participant any benefits that are assiqned to the Alternate Payee pursuant to this Order, the Participant shall immediately reimburse the Alternate Payee to the extent that he has received such benefit payments in error, and shall pay such amount to Alternate Payee within ten (10) days of receipt. 15. The Court shall retain oriqinal jurisdiction to maintain the oriqinal intent of the parties as stipulated herein, or for the purpose of amendinq this illBtrument in the event that a plan administrator or any court of competent juriediction determines