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IN THE COURT OF COl\1MON PLEAS
OF CUMBERLAND COUNTY
STATE OF
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PENNA.
RICHARD L. CLOUSER,
Plaint! ff
:\, I 2906
Civil II) 95
\' I I 'i
DONNIE M. CLOUSER,
Defendant
AN D NO
DECREE IN
DIVORCE
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. oM 2000 . it is ordered and
decreed that
and
Hi c1Jil rli
Clouser,
" plaintiff,
delendant,
Donnie M. Clouser
ore divorcod lrom the bonds 01 matrimony.
The court retains jurisdiction 01 the lollowing claims which have
been raised 01 record in this action lor which II linal order has not yet
been entered;
The at.tached Pruperty S.'ll: lement Aqreemenl is incoqJol"ated
but nol: n1erqed to the Decree in DivolTe.
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RICHARD L. CLOUSER,
Plaintiff
IN THE COURT OF COMMON Pl,EAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
No. 95 - 2908 civil Term
BONNIE M, CLOUSER,
Defenqant
CIVlI, ACTION - LAW
IN DIVORCE
PROPERTY
SETTLEMENT
, lit
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AGREEMENT
\
day of, r '."" \ 't-'
: (
2000,
THIS AGREEMENT made thio
by and between RICHARD L, CLOUSER of 1075 oyster Mill Road, Camp
Hill, Cumberland County, Pennsylvania 17011 (hereinafter referred
to as "Husband"), and BONNIE M. CLOUSER of 2470 Valley Road,
Marysville, Perry County, Pennsylvania 17053 (hereinafter referred
to as "wife").
WITNESSETH)
WHEREAS, Husband and \1ife were lawfully married on February
28, 1987 i and
WHEREAS, one child has been born of this marriage, Andrew
Briton clouser born on Septembel' 14, 1987 i and
WHEREAS, differences have al'isen between Husband and Wife in
consequence of which they have been separate and apart from each
other since Apl'il 23, 1995j and
NOW THEREFORE, the parties intending to be legally bound
hereby do covenant and alJree:
] .
llID'A!U\'rION)
Jt shall be lawful for each party at all
timel3 helea1ter to live lJeparate and apal't fl'um the other party at
"u"h "lac", 'II' h,' <))' oh.> may from time to time chool3" or deem fit.
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The foregoing pl"ovisionu shall not be taken as an admission on the
part of either pal'ty of the lawfulness or unlawfulness of the
causes leading to their living apart.
2, INTERFERENCE: Each pal'ty shall be fl'ee from
interference, authority, and contact by the other, as fully as if
he or she were single and unmarried except as may be necessary to
carry out the provisions of this Agreement. Neither party shall
molest the other or attempt to endeavor to molest the other, nor
compel the other to cohabit with the other, or in any way harass or
mal igr. the other, nor in any way interfere with the peaceful
existence, separate and apart from the other, and each of the
parties hereto completely understand and agree that neither shall
do or say anything to the child of the parties at any time which
might in any way influence the child adversely against the other
party.
3. WIFE' S DEBTS: Wife represents and warrants to Husband
that since April 23, 1995 she has not and in the future she will not
contract or incur any debt or liability tor which Husband or his
estate might be responsible and shall indemnify and save harmless
Husband from any and all claims or demands incurred by her.
4. HUSBAND I S DEBTS: Husband represents and warrants to
Wife that since the separation he has not and in the future he will
not contract or incur any debt or liability for which Wife or her
estate might be responsible and shall indemnify and save harmless
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Wife from any and all claims Ol' demands made against her by reason
of debts or obligations incurred by him.
5, OUTSTANDING JOINT DEBTS I All other debts, contracts,
obligations or liabilities incun'ed at any time in the past by
either of the parties will be paid promptly by said party, unless
and except as otherwise specifically set forth in this Agreement;
and each of the parties hereto further pl'omises, covenants and
agrees that each will now and at all times hereafter save harmless
and keep the other Ol' his or her estate indemnif ied and saved
harmless from all debts or liabilities incurred by him or her, as
the case may be, and from all actions, claims and demands
whatsoever with respect thereto, and from all costs, legal or
otherwise, and counsel fees whatsoever appertaining to such
actions, claims and demands, Neither party shall, after the date
of this Agreement, contract or incur any debt or liability for
which the other or his or her property might be responsible, and
shall indemnify and save harmless the other from any and all claims
or demands made against her or him by reason of debts or
obligations incurred by her or him and from all costs, legal costs
and counsel fees unless provided to the contrary herein.
6. MUTUAL RELEASE I Subject to the provisions of this
Agreement, each party has released and discharged, and by this
Agreement does for himself or herself anu his or her heirs, legal
representat i ves, executors, administrators and assigns, release and
discharge the other of and from all causes of action, claims,
rights, or demands, whatsoever in law or equity, which either of
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the partieG ever had or now has ilgain13\' the other, exc"pt any or
all causes of action for termination of the millTiage by divorce 01:
annulment and except for all causes uf action for la'each of any
provisions of this Agl'eement, Husband and Wife 8pecifically
release and waive any and all rights he or she might have to raise
claims undel' the Divorce Code of 1980 and the 1988 Amendments
thereto including, but not limited to claims for equitable
distribution of marital property, support, alimony, alimony
pendente lite, counsel fee8 or expenses. The parties agree that the
moving party in any divorce action which has been or which will be
commenced shall request the Court to incorporate, but not merge,
this Agreement into any divorce decl'ee. 1f this Agreement is
incorporated into a divorce decree, the parties shall have the
right to enforce this Agreement under the Divorce Code of 1980 and
the 1988 Amendments thereto in addition to any remedies in law or
equity and these enforcement rights are not waived or released by
any of the provisions of this Agl-eement, The fact that a party
brings an action to enforce the IJloperty agl'eement as incorporated
in the divorce decree, under the Divorce Code of 1980 and the 1988
Amendments thereto, does not give either party the Light to raise
other claims under the llivorce Code, specifically waived and
releaSEd by this paragl'aph and all li~lht8 and obli<)ations of the
parties arising out of the marriaqc shall be detellTlined by t.his
Agreement.
7,
DIVISION OF PERSONAL PRQf~~1
With the exception of
Husband's rock collection which Husband believes is in Wife's
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pOGsession and to which \11fe agrees to allow Husband to obtain
possession, the parties have divided between them, to their mutual
satisfaction, the ne1'sonal effects, household furniture and
furnishings, and all other articles of pel'sonal pl'operty which have
theretofore been used by them in common, and neither party will
make any claim to any such items which are now in the posoession or
undel' the conti-olaf the other. Should it become necesoary, the
parties each agree to sign any titles or documents necessary to
give effect to this paragraph upon request,
B, FINANCIAL ASSETS I The parties acknowledge that as of the
date of separation Husband had an interest in the following
financial accounts:
(a) TETHYS Consultants, Inc, 401K plan with a balance as of
June 3D, lQ95 of $11,551;
(b) An IRA with Commerce Bank with a balance as of April 14,
1995 of $1,255; and
(c) A Smith [larney Mutual Fund Retirement Account with a
balance as of Mal'ch 31, 1994 of $2.971.43.
Wife agrees to waive any and all right, title and interest she
has to said accounts and agrees to never make any claim to said
accounts in the future, in exchange fOl- which waiver, within 30
days of the date of this Agreement, Husband agrees to transfer
$0,000 [Ium his existing Charleo Schwab account (into which the
TETHYS Consultants, Inc, 401I< plan had been rolled over) and to
place said funds into a tax deferred retirement account oelected by
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Wife in Wifels name alone. Any costs of such transfer imposed by
Charles Schwab shall be paid by Husband.
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EACH PARTY RETAINS OWN PENSION PLANS:
Except as
specifically set forth herein, each of the parties does
specifically waive, release, renounce and forever abandon all of
his or her right, title, interest or claim, whatever it may be, in
any Pension Plan, Retirement Plan, Profit Sharing Plan, 401-K Plan,
Keogh Plan, Stock Plan, Tax Deferred Savings Plan and/or any
employee benefit plan of the other party, whether acquired through
said party's employment or otherwise, and hereafter said Pension
Plan, Retirement Plan, Savings Plan, Tax Deferred Savings Plan
and/or any employee benefi t plan shall become the sole and separate
property of the party in whose name or through whose employment
said plan is carried.
10. DIVISION OF BANK ACCOUNTS/STOCK/LIFE INSURANCE: The
parties acknowledge and agree that they have previously divided to
their mutual satisfaction all of their bank accounts, certificates
of deposit, IRA accounts, bonds, shares of stock, investment plans
and life insurance cash value; and hereafter Wife agrees that all
said bank accounts, certificates of deposit, IRA accounts, bonds,
shares of stock, investment plans and life insurance cash value in
the possession of Husband shall become the sole and separate
property of Husband; and Husband agrees that all the said bank
accounts, certificates of deposit, IRA accounts, bonds, shares of
stock, investment plans and life insurance cash value in the
possession of Wife shall become the sole and separate property of
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wife.
Each of the parties does specifically waive, release,
renounce and fOl'ever abandon whatever right, title, interest or
claim, he or she may have in any bank account, certificates of
deposit, IRA accounts, bonds, shares of stock, investment plans and
life insurance cash value that is to become the sole and separate
property of the other pursuant to the terms hereof.
11 , ALIMONY:
Husband agrees to pay Wi fe al imony in the
amount of $230 per month on an indefinite basis. The parties agree
that this amount of alimony shall be subject to modification in the
event of a significant change in either party's economic
circumstance,
The parties further agree that in the event that
Husband's existing child support obligation of $370 per month
should be increased or decreased that this change in Husband 's
child support obligation shall constitute a basis for modification
of Husband's alimony 'obligation, The parties agree that Husband 's
alimony payments shall continue to be paid by wage attachment
through the cumberland County Domestic Relations Office.
12. TERMINATION OF ALIMONYI The payments to Wife of alimony
as set forth heretofore shall continue indefinitely unless earlier
terminated by the terms of any of the subdivisions hereunder or the
first to happen of the following:
death of Wife;
(1 )
(2 )
(3 )
remarriage of Wife;
no decree in divorce having been entered within six
(6) months from the date of this Agreement or
within any extension of the said six month period
which.extension has been agreed to in writing by
Husband and Wife or their respective counsel,
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13. WAIVEIUL.Qf CLAtM!LAGAINS'l'-R'fA.ll1! I
Except as herein
othel'wille Inovitled, "ach pill.ty may dispol;e 01 his or hel' property
in ilny way, and teach pal.ty hl'n:L1Y Wdlves and H>linquishes any and
all dghtll he or shc may now have 01' hereafter acquil'c, undel' the
pl'esent 01' futun, laws of any jurisdiction, to shal'e in the
property or the estate of the other as a result of the marital
l'elatiol1ship, including without limitation, dower, cUl'tesy,
statutory allowance, widow's allowance, right to take in intestacy,
right to take aga i nst the \~i 11 of the othel', and right to act as
administrator or executol' of the othel"6 estate, and each will, at
the request of the other, execute, acknowledge, and deliver any and
all instruments which may be necessary or advisable to carry into
effect this mutual waiver and reI inquishment of all such interests,
rights and clainlEl.
14. SUBSEQUENT DIVORCE,
Bot h part i es agree to execute
Affidavits of Consent to Divorce and Waiver of Notice of Intention
to Request Ent ry of a Divol'ce Decree pursuant to Sect ion 330 I (c) of
the Divorce Code contemporaneous with the signing of thio Agreement
and shall db'ect their respective counsel to immediately file with
the Court oaid documents, Husband a91'ees that he shall direct his
counsel to immediately tile with the Court a Decree in Divorce from
the bonds of matrimony under Sect ion ]]OJ (c) of the DivOITe Code.
II" I.lRiAClll Jl eitlwl palt.y lneacheu any Plovision of this
Agn,,,ment, t h" ot her part y shall have the ] j ght, at hi B or her
elect ion, to u\Je fOI' dama<jea fol' Buch breach 01' uel"k ouch other
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remedies or relief as may be available to him or her, and the party
breaching this contract shall be responsible for payment of legal
fees and costs incurred by the other in enforcing their rights
under this Agreement.
16, ADDITIONAL INSTRUMENTS I Each of the parties shall from
time to time, at the l'equest of the other, execute, acknowledge,
and deliver to the other party any and all further instruments that
may be reasonably required to give full force and effect to the
provisions of this Agreement.
17. VOLUNTARY EXECUTION I The provisions of this Agreement
and their legal effect have been fully explained to the parties by
their respective counsel, The Wife has employed and had the
benefit of counsel of Debra K. Wallet, Esquire as her attorney.
The Husband has employed and had the benefit of counsel of J. Paul
Helvy, Esquire as his attorney. Each party acknowledges that he or
she has received independent legal advice from counsel of his or
her selection and that each fully understands the facts and has
been fully informed as to his or her legal rights and obligations,
and each party acknowledges and accepts that this Agreement is,
under the circumstances, fair and equitable, and that it is being
entered into freely and voluntarily after having received such
advice and with such knowledge, and 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, Also, each pal'ty hereto acknowledges that
he or she has been fully advised by his or her respective attorney
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of the impact of the new Pennsylvania Divorce Reform Act, whereby
the Court has the right and duty to determine all man tal rights of
the parties, including diV01"Ce, alimony, alimollY pendente lite,
equitable distribution of all madtal pl"Operty or pl'Opcl'ty owned or
possessed individually by the other, counsel fees and costs of
litigation and, fully knowing the same and being fully advised of
his or her rights thereunder, each party hereto still desires to
execute this Agreement acknowledging that the terms and conditions
set fOlth herein are fair, just, and equitable to each of the
parties and waives their respective right to have the Court of
Common Pleas of Cumberland County or any other Court of competent
jurisdiction to make any determination or order affecting the
respective parties' right to a divorce, alimony, alimony pendente
lite. equitable distribution of all marital property, counsel fees
and costs of litigation.
.
1 B . ENTIRE AGREEMENT:
This Agreement contains the entire
understanding of the parties, and there are no representations.
warranties, covenants, or undertakings othel' than those expressly
set forth herein.
19. MODIFICATION AND WAIVER: A modification 01' waiver of any
of the provisions of this Agreement shall be effective only if made
in writing and execut'ed with the same formality as this Agl'eement,
The failure of either party to insist upon strict performance of
any of the provisions of this Agreement shall not be cOllstrued as
a waiver of any subsequent default of tl~ same or similar nature.
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20, MUTUAL ACCEP'l'ANCEl The partieD accept the provisionlJ of
this Agreement in lieu of and in full and final Bettlement and
lJatiBfaction of all claims ilnd demands that they may now or
hereafter have against each other for their support and
maintenance, and alBo alimony, alimony pendente lite, counsel fees
ur for any other provision for their support ilnd maintenance, and
also alimony, alimony pendente lite, cOllnsel feeB, cOBtB and
expenses and any other charge of any nature whatBoever pertaining
to any divorce proceeding whlch may have been or may be instituted
by the parties in any court in the Commonwealth of Pennsylvania or
any other jurisdiction and/or any divorce proceeding which may be
instituted by either party in any court in the Commonwealth of
Pennsylvania or any other jurisdiction or any other counsel fees,
costs or expenses incurred or to be charged by any counsel arising
in any manner what BOeVeI' for breach of this Agreement.
21, APPLICABLE LAW. This Agreement shall be constl-ued under
the laws of the Comm~nwealth of Pennsylvania.
22. PRIOR AGREEMENTS. It is understood and agreed that any
and all proper'ty settlement agl'eementB which mayor have been
executed prior to the date and time of this Agreement are null and
void and of no effect.
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IllIiQl;OSURE.
'I'}l(' respect i ve pal't ieB do hereby warrant,
repreIJPllt ilnd rleclal'e alld do acknowledge and agree that each iB
alld has b,'ell fully and completely informed of and iB familiar with
and er~nizant of the wealth, real and/or perBonal property, eBtate
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THE LAW FIRM OF
KILLIAN & GEPHART
CERTIFIED ~OPY
, liB PINE IITAEEt
P 0 8011 8.11
HARRISBURG. PENNSYLVANIA 17108.0886
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RIClIARD I.. CLOUSER.
Pluinlil1'
IN TilE COURT OF COMMON PLEAS OF
ClIMBElU,AND COlINTY. PENNSYLVANIA
v,
No. 95 - 29011 Civil Term
BONNIE M, CLOUSER.
Iklcndanl
CIVIL ACTION -I.AW
IN DIVORt'I.:
PRAECIPE TO TI{ANSMIT IU:COIU>
TO TIlE PRllTllONOTAR Y:
Transmit thc rccord. logethcr wilh lhc lilllowing inlilrlllation. 10 thc Court till' cntry of u
divorcc decree:
I. (Jround !ilrdivorcc: Irretricvablc brcakdown undcr Scction 3301(c) of Ihc
Divorcc Code.
2, Dalc and manncr of scrvicc of Ihc Complainl: By ccrlitied mail. reslricled
delivery, rclurn rcceipl requcslcd. 10 dclCndanl. Bonnic M, Clouscr. on May 30. 1995. as
cvidcnced by Ihc reccipl IiII' ccrtitied mail which was liIed wilh thiS Court on Fchruury 2.
2000.
3. Datc ofcxeculion oflhe anidavilofCllnscnt rcquircd by scclion330 l(c) of the
Divorce Code: by Richurd I.. Clouser. plaintin: on May 25. 1999 which WllS tilcd with this
Court on June 7. 1999: hy Bonnic M. Clouscr. dclcndanl, on.lanuary 24. 2000. which wus
liIed wilh this Court on Fchruary 2, 2000.
4, Related claims pcnding: Thc allachcd Pl'Ilpcrty Selllcl1lcnl Agrcemcnl is
incorporatcd hutnotmergcd lolhe I knee in ))ivon:c.
5. Dalc of cxcculion ofWaivcr of No lice orlnlen hy plainlitl' on May 25. 1999
\\hich was liIed with this Court on .Iunc 7. 1999: hy d 'I ; 10n.lanUary~OO, which
was tiled wilh this Court on Fchruary 2. 2000. (~/') -,
.I )a~ Ie"y, I'squi;'~"--""
iIlian & l iephart
2111 Pine Slrect. 1'.1 l. 110.\ IIIII!
Ilarrishurg. I' A 17101l-01l1lh
(717) 232-11151
Allol'llC)' I)) 1/511.IH
Daled: Fcbruary ~ ,201111
AllOl'llc)', lill' I'lainl i Il'
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lHIl ......W FlAM OF
KILLIAN Ill, GEPf;!ART
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CERTIFIED COpy
III "ltf' I"AUf
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HARAIIBUI1CJ, PENNSYLVANIA 17101.01"
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provisions of the Soldiers' and Sailors' civil Relief Act of the
Congress of 1940 and its amendments.
6. There have been no other prior actions of divorce or
annulment filed by either of the parties hereto.
7. Plaintiff has been advised of the availability of
counseling and that Plaintiff has the right to request that the
Court require the parties to participate in counseling.
8. The marriage is irretriovably broken.
WHEREFORE, Plaintiff prays this Honorable Court to enter a
Decree in Divorce, divorcing the Plaintiff from the bonds of
matrimony heretofore existing between Plaintiff and Defendant.
Respectfully submitted,
KILLIAN , GEPHART
,/It ?;' t'
Datedl May 26, 1995
. Paul Helvy
218 Pine str~
P.O. Box 886"
HarriSburg, PA 17108
(717) 232-1851
Attorney 1.0. #53148
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HA""I"U"G. l'INNIVI-VANIA 17101.0...
R I CHIIRD I" CLOUSEIl.
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYINANIA
v.
No. 95 - 290B civil Term
BONNIE M. CLOUSER,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under sections 3301 (c) and 3301 (d)
of the Divorce Code was filed on May 30, 1995.
2. The marriage of Plaintiff and Defendant is irretrievably
broken and ninety (90) days have elapsed from the date of
the filing and service of the Complaint.
3. I consent to the entry of a final decree of divorce after
service of notice of intention to request entry of the
decree.
I verify that the statements made in this affidavit are true
and correct, I understand that false statements herein are made
subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to
unsworn falsification to authorities,
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L, Clouser
Dated: May 25, 1999
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RICHARD L, CLOUSER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYLVANIA
v.
No. 9S - 2908 Civil Tenn
BONNIE M. CLOUSEl"
Defendant
CIVIL ACTION ' LAW
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO
REQUEST ENTRY OF A DIVORCE DECREE
UNDER 13301101 OF THE DIVORCE CODE
1. I consent to the entry of a final decree of divorce
without notice,
2. I understand that I may lose dghts concel'ning alimony,
division of property, lawyer's fees or expenses if I do
not claim them before a divorce is granted.
3, I understand that I will not be divorced until a divorce
decree is entered by the Court and that a copy of the
decree will be sent to me immediately after it is filed
with the prothonotary.
I verify that the statements made in this affidavit are true
and correct. I understand that [alse statements herein are made
subject to the penalties of 18 Pa.C.S.A, section 4904 relating to
unsworn falsification to authorities.
lit/a--
cha d L, clouser
Datedl May 25, 1999
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RICIIARD L. CLOUSER.
Plnintilr
: IN TIlE COURT OF COMMON PLEAS OF
: CUMBERLANDCOUNTY,I'ENNSYLVANIA
v,
No, 95 - 2901! Civil Tcrm
BONNIE M. CLOUSER.
Dcfcndant
CIVIL ACTION - LA W
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO
n.EQUEST ENTllY OF A DIVORCE DECllEE
UNllIm ~330J(c) OF TilE DIVORCE CODE
I. I conscnttothc cntry of U Iinal dccrcc of divnrcc without notice.
2. lundcrstulld that I may losc rights conccl'lling ulimony, division of property,
lawyer's fces or expcnses if I do not claimthcm hclilrc U divorcc is gl'llnted.
3. lundcrstulld that I will not hc divorccd untilu divorce dccrcc is cntcred hy thc
Court und that a copy of thc dccrcc will hc scntto mc inllllcdiatcly uncI' it is
filcd with thc prothollotary,
I vcrilY that thc statcmcnts madc in this alliduvit arc truc und corrcct. lundcrstand
that tillsc statcmcllts hcrcin are Illadc subjcct to thc pcnaltics of II! l'a.C.S.A. Scction 4904
rcluting to unswol'll liilsiticatioll to authoritics.
,bj
'- ,'~,- :J::{
('Q
u.
Bonnie M. Clouse. Defendant
Il,,"", ~ >"",
HICIIAH(I L, "LUIJ:jVH,
PI d i nl 11 J
IN '1'111,: CUllin lW ('< )H~1UN PLVA:; UF
1:IJt,lBVHI.ANII CUIINTY, PI.:NN:;YLVANIA
V:.i.
NU. q~, - ;,"HII! 1,'1 V I L
lJUNNIE M. CI.OUS(O:H,
Defendant
IN IJIVOHCE
OHPEH OF
~,IJHT
1!'IY()J~
ANIJ NOW, this
l{
2000, the ecullC'U11C cldiIll:5 J iJJ:51.ld
III t Lv ptUl.'t!pdllltJ:.i haVIIUj
been resolved in accordance with d pruperty :jett:1l~munt
agreement dated January 24, ;'UUO, the appointment of the
Master is vacall~d and counsel Ciln file a praecipe
transmittin<) the record to the Court requeslil19 a final
decree ill (jlV()rce.
cc:
J. Paul Ilelvy
Attorney for Plaintiff
Debra Wallet
Attorney for Defendant
~ ./Yl'l
pd>>rl ~ fk
J.' t/ '00
Rt<S
I'..J,
RICHARD L, CLOUSER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
No. 95 ' 2908 civil Term
BONNIE M, CLOUSERI
Defenqant
CI VIL ACTION - LAW
IN DIVORCE
PROPERTY SETTLEMENT
"111
THIS AGREEMENT made this 71'
AGREEMENT
day of" [1. 1..
,r\.' '~
, )
, 2000,
by and between RICHARD L. CLOUSER of 1075 Oyster Mill Road, Camp
Hill, Cumberland County, Pennsylvania 17011 (hereinafter referred
to as "Husband"l, and BONNIE M. CLOUSER of 2470 Valley Road,
Marysville, Perry County, Pennsylvania 17053 (hereinafter referred
to as "Wife").
WITNESSETH,
WHEREAS, Husband and Wife were lawfully married on February
28, 1987; and
WHEREAS, one child has been born of this marriage, Andrew
Briton Clouser born on September 14, 1987; and
WHEREAS, differences have arisen between Husband and Wife in
consequence of which they have teen separate and apart from each
other since April 23, 1995; and
NOW THEREFORE, the parties intending to be legally bound
her~by do covenant and agree:
1.
SEPARATION,
It shall be lawful for each party at all
times hereafter to live separate and apart frem the other party at
such place as he or qhe may from tIme to time choose or deem fit,
:f:,\r'~ - - :_~r: '1.)1,- J,
The fOl'egoing provisions <3h,111 not be taken as an admission on the
part of eithel' party of the lawfulness or unlawfulness of the
causes leading to their living apart.
2, INTERFERENCE: Each pal'ty shall be free from
interference, authority, and contact by the other, as fully as if
he or she were single and unmarried except as may be necessary to
carry out the pl'ovisions of this Agreement, Neither party shall
molest the other or attempt to endeavor to molest the other, nor
compel the other to cohabit with the other, or in any way harass or
malign the other, nor in any way interfere with the peaceful
existence, separate and apart from the other, and each of the
parties hereto completely understand and agree that neither shall
do or say anything to the child of the parties at any time which
might in any way influence the child adversely against the other
party,
3, WIFE'S DEBTS: Wife represents and warrants to Husband
that since April 23, 1995 she has not and in the future she will not
contract or incur any debt or liability for which Husband or his
estate might be responsible and shall indemnify and save harmless
Husband from any and all claims or demands incurred by her.
4. HUSBAND'S DEBTS: Husband represents and warrants to
\'iife that since the separation he has not and in the future he will
not contract or incur any debt or liability for which Wife or her
estare might be responsible and shall indemnify and save harmless
~PJ..!':'.:"'_.,Hi' :" ;<:I~,;;
2
Nife from any and all claill1[' c'r dpm"nds mad.. ,1~1uinBt hel' by rf'anon
of debts or obligatJonG inculTed l'y l1im,
5. OUTSTANDING JOINT DEllr~1 All other <kbl6, contracts,
obligations 01' liabilities inc1I1Ted at any time in the paBt by
either of the parties will be paid plomptly by said party, unless
and except as otherwise Bpecifically set forth in thiB Agl'eement;
and each of the parties hereto [ul,tho' pl'omirJes, covenants and
agrees that each will now and at all times hel'eafter save harmless
and keep the other or his or her estate indemni f ied and saved
harmless from all debts 01' liabilities incurred by him or her, as
the case may be, and from all actions, cl a ims and demands
whatsoever with respect thereto, and from all costa, legal or
otherwise, and counsel fees what eoevel' appertai n i ng to such
actions, claims and demands. Neither palty shull, after the date
of this Agreement, contl'act or incur any debt OJ' li;lbility for
which the other or his or her p'operty might be l'esponsible, and
shall indemnify and save harmless the other fl'om any and all claims
or demands made against her cr him by leaEon of debts or
obligations incurred by her or him and frem all custa, legal costs
and counsel fees unless provided to the contlary hendn,
6. MUTUAL RELEASE I 8ubject to the lJl'ovisions of this
Agreement, each party has )'el eased ami d i schal'ued, and by t hi s
Agreement does tel hilf,Gelf 01' !:pnJelf and his nr her heinl, legal
representa t i VeB, Execut 01'0, adlll1r: i fJ t 1 at c'l fJ and aSH iljliB I 1 e lease and
discharge the ethel' of and flec\ ell; C"lUBeS lOt act ien, claims,
rights, or demands, whatsoever in law 01 egutty, which either of
: ~J-.!T" " '. ,;,>1 .J. 1,
)
the pan, iee ever had 01.' now haf' Olga ilwl the othel', except any or
all caUGes of action for termination of the marriage by divorce or
annulment ilnd "xcept fOl all causes of action fol.' bl.'each of any
provisions of this Agl'eemcnt, Husband and IHfe specifically
release and waive any and all rights he or she might have to raise
claims under the Divol-ce Code of 1980 and the 1988 Amendments
thereto including, but not limited to claims for equitable
distribution of marital property, support, alimony, alimony
pendente lite, ccunseJ. fees 01' expenses. The parties agree that the
moving party in any divorce action which has been or which will be
commenced shall request the Court to incorporate, but not merge,
this Agreement into any divorce decree. If this Agreement is
incorporated into a divorce decree, the parties shall have the
right to enforce this Agreement under the Divorce Code of 1980 and
the 1988 Amendments thereto in addition to any remedies in law or
equity and these enforcement rights are not waived or released by
any of the provisions of this Agreement. The fact that a party
brings an action to enforce the property agreement as incorporated
in the divorce decree, under the Divorce Code of 1980 and the 1988
Amendments thereto, ~oes not give either party the right to raise
other claims undel' the Divorce Code, specifically waived and
released by this pal'agraph and all rights and obligations of the
parties arising out of the marriage shall be determined by this
A{JIEemeJlt I
".
IUVIBION OF PERSONAL PROPKRIT I
With the exception of
Husband's rcck eol lect ion whi ch Husband bel ieves is in Wi fe's
4
possession and to which \~ife a~reetJ to allow Husband to obtain
possession, the parties have divided between them, to their mutual
satisfaction, the I;ersonal effects, household fUl'niture and
fUl'nishi.ngs, and all othel' articles of personal property which have
theretofore been used by them in common, ilnd neither party will
make any claim to ilny sl1ch items which al'e now in the posGension or
under the control of the other. Should it become necessary, the
parties each agree to sign any titles or documents necessary to
give effect to this paragraph upon request,
8. FINANCIAL ASSETS I The parties acknowledge that as of the
date of separation Husband had an interest in the following
financial uccounts:
(a) TETHYS Consultants, Inc. 401K plan with a balance as of
June 30, lQ95 of $11,551;
(b) An IRA with Commerce Bank with a balance as of April 14,
1995 of $1,255; and
(c) A Smith Barney Mutual Fund Retirement Account with a
balance as of March 31, 1994 of $2,971.43.
Wife agrees to waive any and all right, title and interest she
has to said accounts and agrees to never make any claim to said
accounts in the future, in exchange for which waiver, within 30
days of the date of this Agreement, Husband agrees to transfer
$8,000 from his exi sting CharI es schwab account (into which the
TETHYS Consultants, Inc. 401K plan had been rolled over) and to
pluce Baid funds into a tax deferred retirement account selected by
;'f;/If"; . - '~. ..~ I,
5
IHfe in IH(e' S Ilame ulon". AllY COGtG of such tranGfer imposed by
Charles Schwab shall be paid by Husband.
9.
EACH PARTY RETAINS OWN PENSION PLANS:
Except aB
sped f ically set fOl'th herein, each of the part ies does
specifically waive, release, renounce and forever abandon all of
his or her right, title, interest or claim, whatever it may be, in
any Pension Plan, Retirement Plan, Profit Sharing Plan, 401-K Plan,
Keogh Plan, stock Plan, Tax Deferred Savings Plan and/or any
employee benef i t plan of the other party, whether acquired through
said party's employment or otherwise, and hereafter said Pension
Plan, Retirement Plan, Savings Plan, Tax Deferred Savings Plan
and/or any employee benefit plan shall become the sole and separate
property of the party in whose name or through whose employment
said plan is carried,
10. DIVISION OF IlANK ACCOUNTS/STOCK/LIFE INSURANCE: The
parties acknowledge and agree that they have previously divided to
their mutual satisfaction all of their bank accounts, certificates
of deposit, IRA accounts, bonds, shares of stock, investment plans
and life insurance cash value; and hereafter Wife agrees that all
said bank accounts, certificates of deposit, IRA accounts, bonds,
shares of stock, investment plans and life insurance cash value in
the possession of Husband shall becclr.e the sole and separate
property of Husband; and Husband agrees that all the said bank
accounts, cel,tificates of deposit, IRA accounts, bonds, shares of
stock, investment plans and life insurance cash value in the
possession of Nife shall become the sole and separate property of
rI1Ari..;,.r;'lidl3,
6
13 . ~IVERS Ol".~..AIM~AGA.llmT-.iB.IAnB.1
Except as herein
otherwise prcvid.:d, each peaty 1lI,'!y dilipose of };in or he l' propel'ty
in any way, and each pal'ty hel'eby w..\ivelJ and l'elinquiEllcs any and
all l'ights he or she may now have 01' heteafter acquil'e, under the
present or future laws of any jurisdiction, to share in the
propel'ty or the estate of the other as a reoult of the marital
relationship, including without Ilmitation, dower, curtesy,
statutory allowance, widow's allowance, right to take in intestacy,
right to take against the Will of the other, and right to act as
administrator or exec'utor of the other's estate, and each will, at
the request of the other, execute, acknowledge, and deliver any and
all instruments which may be necessary or advisable to carry into
effect this mutual waiver and relinquishment of all such interests,
rights and claims,
14. SUBSEQUENT DIVORCE I Both part ies agree to execute
Affidavits of Consent to Divol-ce and Waiver of Notice of Intention
to Request Entry of a Divorce Decree pursuant to Section 3301(c) of
the Divorce Code contemporaneous with the signing of this Agreement
and shall direct their respective counsel to immediately file with
the Court said documents. Husband agrees that he shall direct his
counsel to immediately file with the Court a Decree in Divorce from
the bonds of matri~ony under Section 3301(0) of the Divorce Cede.
15. BREACH I If either party breaches any provision of this
Agreement, the other party shall have the right, at his or her
election, to sue for damageD for such breach or seek such other
I ~!I! 1- . '...r :;'1 r",
8
)'emcdien or relief lIU lnilY be .:ivai lable 1.1) Idm ur her, and tile pdll y
breaching this contl'uct "hall be 1'espclwible fUJ' rayment. uf lUlill
fees and costs incurred by the other in enfc'lcinl1 theil' light l!
under this Agreement.
16. ADDITIONAL 'INSTRUMENTS I Each of t.he palti "s fJlwJ 1 from
time to time, at the J:equest of Lhe othel', CXI'Cllto, acknowledge,
and del iver to the other party any and all turthel' instrument.s that.
may be reasonably required to give full force and cllect to t.he
provisions of this Agreement.
17, VOLUNTARY EXECUTIONl The provisions of this Agl'eement
and their legal effect have been fully explained to the parties by
their respective counsel. The WifE has employed and had the
benefit of counsel of Debra K. Wallet, Esquire as her attorney.
The Husband has employed and had the benefit of counsel of J. Paul
Helvy, Esquire as his attorney. Each party acknowledges that he or
she has received independent legal advice from counsel of his or
her selection and that each fully understands the facts and has
been fully informed as to his or her legal rights and obligations,
and each party acknowledges and accepts that this Agreement is,
under the circumstances, fair and equitable, and that it: is being
entered into frEely and voluntarily after having received such
advice and with such knowledge, and that execution of this
Agreement is not the result of any dUless or undue influence and
that it is not the result of any collusicn or improper 01 illegal
agreement or agl'eements. Also, each party hereto acknowledges L1at
he or she has been fully advised by his or he I,' l'espective attorney
[PAr:.. ';i~. ;,11 -, ~, ;-;::--:
9
of the imracl of l.!H' ""W l',,"nnylvaniil Divorce ~C'form Act, whereby
the Ccurt haG the right at;d duty to determine all marital rlghts of
the pan ieE, including divorce, alimony, alimony pendente lite,
equitable distJ'ibution of all marital property or property owned or
pOGE'eBEed individually by the other, counsel fees and costs of
litigation and, fully knowing the same and being fully advised of
his 01' her rights theJ'eundel', each party hereto still deslr'es to
execute this Agl'eement acknowledging that the terms and conditions
set forth I;erein are fair, just, and equitable to each of the
pan jeG und waives their respective l'ight to have the Court of
Commcn Pleas of Cumberland County or any other Court of competent
jurisdiction to make any determination or order affecting the
respective parties' right to a divorce, alimony, alimony pendente
lite, equituble distribution of all marital property, counsel fees
and cotHs uf litigation.
18. ENTIRE-AGREEMENTI
ThiG Agreement contains the entire
understanding of the parties, and there are no representations,
walranties, covenants, or undertakings other than those expressly
set forth herein,
19. MODIFICATION AND WAIVERI A mcdification or waiver of any
of the provisicns of this 1"<.Jn,ement shall be effective only if made
i Ii wr i t i W3 ilI;d executed wi th the same fOl'mality as this Agreement.
Tit" fal ltlle of either party tc insist upon strict pel'formance of
allY of the provisions of this Agreement shall not be construed as
a waiver cf any subsequent default of the same or similar nature.
, oJ
10
20. MUTUAL ACCE!'TANCE. Th.' pal'ties accept the provisions of
this Agl'eement in lieu of: and in full and final settlement and
satisfaction of all claims and demands that they may now or
hereafter have against each othel' fOl' their support and
maintenance, and also alimony, alimony pendente lite, counsel fees
or fOl' any other provision for their SUppol't and maintenance, and
also al:mony, alimony pendente lite, counsel fees, costs and
expenses and any other charge of any nature whatsoever pertaining
to any divorce proceeding which may have been or may be instituted
by the parties in any court in the Commonwealth of Pennsylvania or
any other jurisdiction and/or any divorce proceeding which may be
instituted by either party in any court in the Commonwealth of
Pennsylvania or any other jurisdiction or any other counsel fees,
costs or expenses incurred or to be charged by any counsel arising
in any manner whatsoevel' for bl'each of this Agreement.
21. APPLICABLE LAW I This Agreement shall be construed under
the laws of the ComtHinwealth of rennsylvania.
22, PRIOR AGREEMENTS. It is understood and agreed that any
and all property settlement agreements which mayor have been
executed prior to the date and time of this Agreement are null and
void and of no effect.
23.
IUS CLOSURE I
The respective parties do hereby warrant,
represent, and declare and do acknowledge and agree that each is
and has been fully and completely informed of and is familiar with
and cognizant of the wealth, real and/or personal property, estate
;..1,1:--""'..,,1 "
11
IlICIlAIW J.. CLOlJSEIl,
1'1 ai nti II
IN TilE COlJH'J' OF COMMON I'LEAS OF
CUMBEIlt.AND COUNTY, PENNSYLVANIA
CIVI I. ACTION.. LAW
vS.
BONNIE M. CLOUSEIl,
Defendant
NO . I) 5 .. :1'J 0 Il C I V I I.
19
IN DIVOIlCE
STATUS SllEET
DATE:
ACTIVITIES:
12/30/9B I,etter to counsel directing pretrial statements 1/22/99.
t---- ,-,---- ,,------ , ,- ,- . -nE--~---------. - .'
(-1fYLJ~,~~ 13df,~t: ~it~\~~~L~~J ' '~TI;m~~~-~:
\___':::<.~,=__=__~=__ ~-\B.,^\"'n J7").~,J}_:..~_~~n~*'~;,, ,hJ~:'..".t;::,b,_~_ 19,
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-'rv ~ 2 If ,.- ~ ~ Jvl1tn~~~ '--7ltrJ"'- w~i Sf- 'j
~/-'(';.: -ll~:L ~~lJ;~:j, ,,,,'If!tniti',/,.. ,/
~lJII'I_'I~i" ,II' "f'~/! ;Li'.(l .",.....(..../
..._.______._..,_._._._._____~__..... l_ ___. ____."_______..__ _. .._.i-...__.,__ ____._.._.___,_______.~__.L ...-..-.-.----~-
-_._--~--~-- --.--.-- -_._-------~-~.-._.._----------
--.--- -----.--..--....---.--------
,
.
.
OFFICE OF DIVORCE MASTER
CUMBERl.AND COUNTY
COUIlT OF COMMON 1'1 EAS
9 Not1h Hanover Street
Carlisle,I'A 17013
(717) 240,6535
E. Robert Elicker, II
DivorcB MaslBr
Tracl Jo Colver
0'"C9 ManagBrtllBporlBr
Weal Shore
697.0371 Ex!. 6535
December 30, 1998
J. Paul Helvy, Esquire
KILLIAN & GEPHART
218 pine street
P.O. Box 886
Harrisburg, PA 17108-0886
Debra Wallet
Attorney at Law
24 North 32nd street
Camp Hill, PA 17011
RE: Richard L. Clouser vs. Bonnie M. Clouser
No. 95 - 2908 civil
In Divorce
Dear Mr. Helvy and Ms. Wallet:
By order of Court of President Judge George E. Hoffer
dated December 18, 1998, the full-time Master has been appointed
in the above referenced divorce proceedings.
A divorce complaint was filed on May 30, 1995, raising
grounds for divorce of irretrievable breakdown of the marriage.
No economic claims were raised in the complaint. On December 1,
1998, the Plaintiff filed an affidavit under Section 3301(d) of
the Domestic Relations Code averring that the parties have lived
separate and apart for a period of at least two years, since
April 23, 1995. consequently, grounds for divorce do not appear
to be an issue.
On December 15, 1998, the Defendant filed an answer and
counterclaim raising the economic issues of equitable
distribution, alimony, alimony pendente lite, and counsel fees
and expenses.
In accordance with P.R.C.P. 1920.33(b) I am directing
each counsel to file a pre-trial statement on or before Friday,
January 22, 1999. Upon receipt of the pre-trial statements, I
will immediately schedule a pre-hearing conference with counsel
bt~
OFFICE OF DIVORCE MASTER
CUMIlEI1I AND COUNTY
COlJIH OF COMMON PI EAS
9 North Hanover Street
Carlisle, I'A 17013
(717) 2406535
E. Robert Elicker, II
Divorco Maslu
Weal Shore
697,0371 Exl6535
Tracl .10 Colyer
Ollieo Manago,iRapo'tar
January 19, 1999
J. Paul Helvy, Esquire
KILLIAN & GEPHART
218 pine street
P.O. Box 886
Harrisburg, PA 17108-0886
Debra Wallet
Attorney at Law
24 North 32nd street
Camp Hill, PA 17011
RE: Richard L. Clouser vs. Bonnie M. Clouser
No. 95 - 2908 civil
In Divorce
Dear Mr. Helvy and Ms. Wallet:
I am writing in response to Ms. Wallet's letter of
January 13, 1999. The directive to file pre-trial statements on
or before January 22, 1999, is withdrawn. Counsel are directed
to file pre-trial statements in accordance with P.R.C.P.
1920.33(b) on or before Monday, February 8, 1999. Upon receipt
of the pretrial statements, I will immediately schedule a
pre-hearing conference with counsel to discuss the issues and,
if necessary, schedule a hearing.
Very truly yours,
E. Robert Elicker, II
Divorce Master
NOTE: Sanctions for failure to file the pre-trial statements
are set forth in subdivision (cl and (d) of Rule 1920.33.
THE ORIGINAL PRE-TRIAL STATEMENT SHOULD BE FILED IN THE
MASTER'S OFFICE AND A COPY SENT DIRECTLY TO OPPOSING
COUNSEL.
.JOll"lD ....,LlIAN
6~ITH e O[PH"'RT
THO~A5 w. SCOTT
.JANI: OOWeN PI::NNY
TCRIlI:NCf::.J McGOWAN
PAUU\.J McDtRMOTT
THE LAW f.' lRM OF
KilLIAN & GEPHART. llP
218 PINE STREET
P. 0_ SOX eBa
HARRISBURG, PENNSYLVANIA 17108'0888
TELEPHONE t7171 232 1851
FAX NO. \7171 2380592
www kllhangephlJfl com
J. PAUl.. HClVV
BRADlt'f '" SCHUT.JtR
CHADW'CIot 0 BOOAR
February 2. :!OOO
Office of the Prothonotary
Cumberland County Court of Common Pleas
Cumbcrland County Courthouse
I Courthousc Square
Carlisle.PA 17013
Re: Richard L. Clollser v. Bonnie 1\1. Clouser
No. 95-2908; In Divorce
Our File No.: 11271-02
DcaI' Sir or MlIdam:
Encloscd fllr filing please find an original and two copies of Plaintill's Petition to
Revoke Appointmcnt of Mastcr. along with threc extra copies of thc Ordcr in the above-
rcfcrenced mallcr. Please retnrn a time-stamped copy of the Pelitionto me in the envclopc
providcd,
Once the Order has becn signed. plcase return one copy of the Order to me, onc cop)'
to the Dclcndant's counscl and one copy to Master Elickcr in thc envelopes providcd,
V~d' truly yours.
,/
f
I I
,j, Pnulllelv)'
.Il'lllmbl
Enclosures
cc: E, Rohert Elicker, II, Divorce Masler
Dehra K, Wallet, Esquire
Richard L. Clouser
THE. \.AW FIRM OF
KILLIAN '3c GEPHART
CERTIFIED CO~Y
... ".N" B1RH.'
~
.p 0 SUIl 88ft
HARRISBURG, PENNSYLVANIA 17108,0886
.J P"UllitLVY
1 HE LAW FlHM OF
KilLIAN & GEPHART, llP
21B PINE STRE(l
P. 0 80X BBB
HARRISBURG, PENNSYLVANIA 1710B'OBBB
TELEPHONE 1717t 232 1851
FAx NO. 17171 23B-0592
www killianuephall com
.JOliN 0 Htlll"N
9MIlli a (ll PI...."'
11<0"-4"'& W !le011
JI'\.Nl: QOWLN r'l:NNY
ltRRf.NCl: J ..."00.......'"
P"ULA J Mdll"M011
OR"'DI r...." 6CtHJ1JPt
CI....OWICl'l 0 UOU"'R
Februury 2. 201111
E. Rohert Elicker. II. Divorce Master
Office of I>ivorce Master
Cumherland County CourtotToml11on I'leus
9 North Ilanover Street
Curlisle. I' ^ 17013
IU~: Clouser v. Clouser
No. 95-2908; III Illvorce
Our File No.: 11271-02
Dear Muster Elicker:
Enclosed pleuse Iind two copies oflhe fully executed Property Selllemellt Agrccmcnt
in this mUlier,
Ye~y truly yo~rs.
/ i
-
')
l
J, I'uulllclvy
Jl'll/mbl
Enclosure
cc: Dcbru K, Wallet. Esquire
Richurd L. C10uscr
,~
l!ll'IIAIW I'LIJ\J:Wi',
1'1,11111 III
I N TilE 1,'lJUH'1' OF COMMON PLEAS OF
,'UMlJEI,I,^ND COUNTY, PENNSYINANIA
v,
NO, \1', ;,\JOIl ,'IVIL TEi'M
BuNNIE M, ,'LOUSEI<,
Dell'll<lillll
IN IJIVOHCE
I<E: PI" ",'.., 111<] ''<lIll''I''III'" Ml'lIIl)1'alldulII
DATE:
FlJd..y, May I-I, 1\1\1\1
1'll'll1'1I1 tOI lit" Plalnlll I, I<ichard Clouse!.' il3 J,
Paul Helvey, alld pl1'Bl:1I1 "'1 Ih.' D,'lendullt, lJollllie M, Clousel'
iu Debld K, W,ll 1.'1,
A divOII'" 1'''llIpl,lilll W.1B tIled 011 May ,lO, 1995,
raiBllIlJ IlrolllldB IUI dIVOII'!: III Iln:lrievable breakdown of the
rnalrlaqe. No ('{'UIlUl\llC CldllllH WL'le l-ained in the complaint.
011 Decelllbel 1, l\J\lIl, dl. ,Ill Id...vll ,,"del Sectioll 3301(d) was
filed clVP1-lll1tj i] twu YCd! Ht'lhiJat lOll, und a counteraffidavit
WiW Ill"d llll DeCClllbL'1 I'" IClClfi, by tile' nl.'fC'lIuallt, indicating
tlt...1 1311<' Wlulll'd II) I,ll"" "1'",1011\]1' L'LdllllJ, Al the same time
tltill t hI' I:IJIIIII ." ill I Id,I'l11 W,lfI t J1cd, tIle DC'lplldallt did file
dll dnHwt'l dnd CtlUIlIf.'I('ldllll } ,'llfllJl'j tile' (l('unomic issues of
f,'q\1itabjp dlUlll111lt iU!)j alItllony, al illluny pendente lite, and
l'uuJlHPl f f'L'B alPi ('(Jot n.
("'"11>3"1 IH'l" 111<11",II,-'d tltal' t1H' parties will sign
and 111(' d1fJddvltn ,-,1 ('(TH3f'nl dlld Wd.iV0}'B of notice of
illtE'lltil_11l t(l IPlPll'l-1l IIlII)' {;f d1VC)!Tt. decl-pc BO the divol-ce
call lJ{~ c'OIIl'ludf,d UII,j!.} ~;f,,(.t 1(:,11 ~ ~Ol (e) 01 the Dc:;rnesl ic
I<eJal.lulll! {'"dr', ('1)1111""1 fUltil"1 ildvl'H'd that \'lith I'espect to
t-he alillluny {"laJlll {)f \-,.'1fl-', t lJP)' will nul pLelH!l1l allY
lL'Btll1lullY 1t'IJdld111'1 llklllt;11 !l\lHf"!1I1d\lCt au tllLit facto!' relates
tu till: idi1l\UIl')' {'ldlll1,
1I11Ul'<1I1d III 'I', ,/1'.110 \:,1 <iqr" ,:1I1d It>l:li(h~B at l07~J
(I)lHt p) M111 I~"'d,j, "'ll1lJ; III i J, h'1111U')'.lVdl1id, ill d tt'~Bjd.ence
Wlll"lt' lit. It! Ulldl IIlLl ">'.1 f'/d'I'l; Wit 11 ,1Iwlt !H:I llldll. He' han a
H,--lI'llf-'11>J 'Il Ill,'llf" .tlll! II! I'll," }"'IJul "l\I)lltlYflcl by Tpthy's
l,'llllBlllldllfn 1111'. ("-I1!I",lii")\ lid!1lf' llciH c'll<1l1ql'd lH~(',-llJf]t: ol il
l'lIy{)\i1). IlllHl:"IJl'ltfi Ii. \ I lw('..kl'/ Ilif'I'llll~ III ~;;YH'I.O{). lie is
l'\v(.l}pd 1"ll1lf(tl~"fJ jli:liil,lli"" Itil")I'lll IIIH (,mIJ}()Yf'l', and lie heiS
1J!>t 1<11Ued dll/ lil'dltll liiHIH-'~;. II;' IH ('IJII<'lltly payinq (1
1l11PI;LiJI ('111t'1 I" wlf/~ 111 II,!' ,WI( lllll (:t O(.t)(l,lJO I)(~l month,
1'1111,'1< 1)1 ,.II"',tI,,d :;;'111,'" I, I )Ii' l'dltll'll' dllld Andn-w, who
\lIdO 1",111 ':/j ~-{'It!-l!\h_'! j-t, l'ti;-I, dlld :;;~:-H).()O f(ll I3piHIBdl
J!iij;I" I'
'.
NIl,' I u ,19 yeaH1 of i1lJe' ;lIld Il'"ndl'u ,It: 24'70
Valle,' HOdd, M,lIYl1vllll', P!'llIlBylvilniil, \~hel'l' Bite I ives with
the partieB' 8011 ^J1dn~w. She lhlH -:1 BachelortB DL"grr:~(> .lnd is
cIIITt'ntly self-emp]uy!'d III tltl' ill1tlqU" 'llld collectible
buu i I1l"EHl, The II Cl II 1')\1Il Ilam!' IIndel' wit i eh fill!! t I'aden in
MaAOII Jill', She h,HJ n.'plJl'lt.d 11(.'1 net monthly income, wl11ch
includeu $100,00 In baul It.'nt, to be $'LlS,'IS, Nife will loue
hel' medical inBIIUiIlC!" bellpl i ts IIpon till' ent IY 01 a divolTe
decree; t:hel'elol't.', HillCl' it: IS likely that COBl~A benefits
will be availabll' au a n.'slIlt 01 husb.lnd'l1 e'mployment, we
need to know the eOl3t 01 thOBr.' benel i LJ to wi Ie, Ni fe has
reported health ploblemH involving joint inflammation, which
is documented by cOlTespondellce Il'om 01', Magill, Mr, Helvey
has l'alsed an iunue 10ganiing wife's eauling capacity and has
l'equested that IlH'dical relea130s be signed by wife to allow
him to have an independent medical evaluation and examination
of wi fe to determine hel' CU1Tent health status, The
detennination by the physician who does the examination will
help us in al3sesl3ing wife's L\bility to earn an income,
One of the concerns that Attorney Nallet has
expressed is that her client does have, on occasion, days
when she is able to function fairly nonnally, but on othel'
occasions she IS basically immobilized because of the joint
Inflammation and palll. Then.'f!ne, finding employment
considering the uncel:tainties 01 when she will be feeling
well and when Ghe will be incL\pacitated makes it difficult
for her to be a l'eliable employee, Nife does have an alimony
claim, and Ms, ~Iallet has indicated that she will consider
accepting alimony on an indefinite basis based on the current
spousal SUppol't amount, which is $230,00 a month,
The parties discharged ull of their marital debt
through bankruptcy proceedingB,
The parties do have marital assets involving some
accounts which amount to a total of around $16,000,00, The
accounts include a 401 (K) WIth Tethy's Consultants, lnc., an
IRA with Commerce LJank, and a mutual fund account with Smith
Barney,
Tlwl't.' are 110 IUlJlleS WIth n'Bpect to vehicles 01'
household tL\ngibl!.' personL\l property t'xcept that husband
would like to have n!tul'lll'd to him l'ock namples and two
pt-esf3ure gLlugeH which lie ndYu t'll'e Clll-n?'llt 1 Y III the possession
of wife,
Ml. 1l"lvl'Y il,w HIJ'.J<J"Btl'd that wllce JB livlll<j in ,]
!tome whl':h iB oWIl!"d by d <jl'nt IPlII']1l who !t;w iJ"PIl afJsinting
Wl fe, !tl' bed il.'v,"J, I ill,lIlCl;d Iy, ,1Ild h" wo\lId Ilkl.' to have
some infol'lnation regarding the Lype of financial ilssistance
which wife is receiving from the (nend,
E. Robert Elicker, II
Ne have also disclHH3ed an issue regal'din9 wife's
disability and why Bhe has noL been making applicat.ion (or
social Secul'ity benefits, Ms, NalleL has given a l'easonable
explanation regarding tllis isslle, and specifically states
that her client's age works against he l' in making a claim, as
well as the fact that she is showing income of al'ound $500,00
per month, which seems to be a bench llIal:k whel'ein disability
benefits would not be awarded,
counsel und Lhe Master have discussed the
possibility of having a four'party conference prior to the
hearing as soon as the medical infol'Olation has been provided
and the evaluation has been done on wife's health complaints,
The Mastel' has indicated that he will schedule a conference
as quickly as possible upon notice from counsel that they are
ready to discuss issues and that the medical reports have
been made available and have been reviewed by counsel.
A hearing is scheduled for Tuesday, November 23,
1999, at 9:00 a,m, Notices will be sent to counsel and the
parties.
cc: J. Paul Helvey
Attorney for Plaintiff
Debra K. Wallet
Attorney for Defendant
HICIIAllIJ L. CLOllSEH,
PI aint. ill
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYLVANIA
NO. 95 - 2'Hlll
VB.
CIVIL ACTION - LAW
BONNIE M. CLOUSEIl,
Defendant.
IN DIVORCE
OIlDEIl AND NOTICE SE'I"I'ING IIEAIlING
'I'D: Ilicharu L. Clouser . Plaintiff
J. Paul lie Ivy . Counsel for Plaintiff
Bonnie M. Clouser . Defendant
Debra Wallet . Counsel tor Defendant
You are directed to appe~r for a hearing to take
testimony on the outstanding issues in the above captioned
divorce proceedings at the Office of the Divorce Master, 9 North
lIanover Street, Carlisle, Pennsylvania on the
23rd
_, day
of __-1iQy.cmb.e.L._' ]1)9<J, at,
place and time you will be given
a.IIl., at which
'1:00
the opportunity to present
witnesses and exhibits in support of your case.
Pn.!sident. .Iud'll'
IJate of Order and
Not i ce I _..204 / ')9
By:
15TVtJ-[-ce -MiJ6 ter
II' YOU DO NUT IIAVE A I.M1YEH UI\ CANNOT MTll\W UIW, GO TO Oil
TELEPHONE TilE OFFICI: SI"I FOlfl'lI BELOW TU F1 Nil OUT WIlEllE YUU C!II~
(;ET LEGAL HELP.
II'I~I\II': 1,:;1' IIIIiNTY II!"", ,1,\IIIlN
i t 1\1-:1\1 Y ^\'I ',' 'I
',!.I JI'j,).', 1';\
Ii 11')1" (." I l' II
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0(
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Ii.., ' ,I I !~ frr 1~';t'J
IN TilE COllin OF COMMON PLEAS
('\ IMIlElU.AND COUNTY , PENNSYLVANIA
IUCIIAIW Cl.OlISElt
I'lainlitl
v,
Nil, l)5,2l)()K
IN IJIVOltCE
BONNIE M, Cl.OlISElt,
Dckndal11
INCOME ANI) EXI'ENSE S'J'A'J'El\tENT
011
1I0NNIE M. CLOllSEIt
TIle undersigncd IiIcs lhc Illllllwing Inmmc and Expcnsc SlalCIIICnl.
I undcrstand thatlalsc statcmcnts hcrcin arc madc suhjCl:lllllhc pcnaltics Ill' 181'a, C,S,
~4l)(}4, rclaling tll unSW1l1ll falsilkalilln III aUlhllrilies,
Dalc: ~/.5h 'f
~") .,
l /~~~"
1I0NNIE M ('1.0
(.J2.L---
EXI'ENSES: Wl'l'kly I\tonthly Yl'nrl}'
HOME
MortllllllClHcl1\ $450,(Kl
Muil1lCl1ul1CC
Utilitlcs
Elcctric !lO,tKl
Gus
Oil !lO,OO
Tclcphonc 25,00
WUlcr
Sewer
Trush 10,00
EMPLOYMENT
Public Transportlltiol1
Lunch 8,00
BUSINESS EXPENSES
Costs, Inventory, and Rent
TAXES
Real Estate 100,00
Pcrsonal 34,75
Property (land)
Incomc (schoo\)
INSURANCE
Homeowners
Automobilc 60,00
Lifc
Accidcl1t
Hcalth
Other (Spccify):
AUTOMOIIILE
Paymcl1ts
Fucl 100,00
Rcpairs 25,(Kl
MEDICAL
Doctor
EXPENSI<:S CONTINUE!) Wl'l'kl~' I\lolllhl)' Yl'url)'
- -._-
Dentist
,-
Orthodontist
,,'
Hospitlll (Iah) ---,-- -----
-_.-
Medicine
+--- --
Special Needs (glasses, hraces.., ) $1700
,---_.
'..--- -
EllUCA TION ,-
Private School
I'lIrochial
College (ICS)
Religious
I)ERSONAL
Clothing
Food I 00 , llO
BarberlHairdresser
Creditl'ayments
-.......,-
Charge Accounts
Memberships
LOANS
Credit Union
Other (specify): I'ersonal Loan
-,
-
..
MISCELLANEOUS ,-,
Household Help - ---... ---
Child Care -.>-- ..-.,-
Papers, Books, Mllgazines - --~~ ,-----
--+...-- ~._. , ..-,.---- ~--_._--
-_..-- -.---- _._.._-~--~. ,~,,~-~'-'---'-'- _._--
...". ...u....._.___..~_..____..__+ --_._~-_..-
ENTERTAINMENT f------,.. -_.'_.._---~ -------_._,--"....
Cahle TV -- ---_.._~~~_."-_. ,-,----"",..,--
2HlXI
Vacation ..-. ..'-".,-,.'..", ,,'.' ---.--.....-.., -~--.-_._------
Gins -----.-------.-.., ._._- __._.,,_~____..__._.M I" -_._--,-,._.,----, - ----
- ~--_._--+-- - '" .". ._h" _. ._____~_~___.
IN TilE COllin OF COMMON PI.EAS
CUMBEIU,AND COUNTY, PENNSYI.VANIA
IHCHARD CLOUSER,
Plaintiff
v,
No, lJ5,2lJOll
IN DIVORCE
BONNIE M, CLOUSER.
Defcndant
I'ROOF OF SEltvlCE
I, Dehra K, Wallel. Esquire. herehy certily that on Fehl1Jary 5, 1999, I served a copy of
the INCOME AND EXI'ENSE STATEMENT OF BONNIE!\t. CLOUSER. hy tirst class
mail. postage prepaid addressed as Itlllows:
J, Paulllelvy, Esquire
KILLIAN & GEPIIART
218 Pine Slreet
1',0, Box 886
Harrishurg, PA 17108
~1t.~
Dehra K, Wallet. Esquire
24 N, 32'~ Street
Camp llill,PA 17011
(717) 737.1300
I.D, # 23lJlllJ
Attorney ftlr Defcndant
.. I .f.
. _ 1 ..
... ! .. ~
THE LAW FlAM OF
KILLIAN a GEPHART
~ ' 118 raNI aT....,
'0 0 80a ...
HA,,"'S.URG. PENN8YLVANIA 17108,0888
I~ f~ :J.IS!q9
Llb
.'
CERTIFIED COpy
..
...
.
.
with the filings of Bankruptcy. consequently the parties are debt
free and have minimal assets.
II. MARITAL ASSET(S):
See Exhibit A - Inventory and Appraisement
III. NON-MARITAL ASSETIS):
See Exhibit A - Inventory and Appraisement
IV, WITNESSES:
The parties.
V, EXHIBITS:
A. Husband's Inventory and Appraisement.
B. Husband's Income and Expense Statement,
VI. HUSBAND'S INCOME AND EXPENSES:
See Exhibit B - Income and Expense Statement.
VII, COUNSEL FEES
To be provided at trial.
VIII. PERSONAL PROPERTY:
Any remaining household furnishings and personal property were
divided at the time of the Bankruptcy filings.
IX. MARITAL DEBT(S) :
All marital debt was discharged with the termination of the
Bankruptcy filings,
RICHARD L, CLOUSER,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
v.
No. 95 - 290B Civil Term
BONNIE M. CLOUSER,
Defendant
CIVIL ACTION - LAW
IN DIVORCE
Date of Marriage: February 2B, 19B7
Date of Separation: April 23, 1995
Submitted by RICHARD L, CLOUSER, Plaintiff
INVENTORY AND APPRAISEMENT
MARITAL ASSET(S)
DATE OF PORTI ON LIENS OR
JI. ~ Yl\lAlli VALUATION NON'MARITAL ENCUMBRANCES
1, Tllthy' 8 Conlult anl Inc.- 6/30/95 $11,5S1.17 HOlle None
4011k I phn Ofl,\ See !,;lIh. 1
" IRA.Commelce Blnk 04/14/95 6 1,255.28 None None
Act. ft2426 HIlel See Elth. ,
), Smllh Barney Ol/l1/94 6 2,911.4] NOI1I1 Hone
Hulud fund. 01111 See Ekh. )
1Icl. t!901-589fi'1-1-5
. This entire account balance has been rolled over to Charles Schwab Account
H238448B6 on J,'nuary 26, 1999, See Exh, 4,
NON-MARITAL ASSET(S)
i
ASSET
VALUE
DATE OF
VALUATION
LIENS OR
J;N'l MRRn.N(""Faq
1.
Commerce Bank
Checking Act,
H5120B6422
H512086935
$ 301,77
$1,636,22
See Exh, 5
12/20/98
12/20/98
None
None
MARITAL DEBT(S) :
I1nI
AMOUNT
OF DEBT
OEBT AS
QLJ2Q!i
INITIAL AMT
OF DEBT
PURPOSE OF
I1nI
AMT .. OATES OF
PYMTS S I NeE DOS
All marital debt was discharged with the Ilankruptcy filings of the parties,
, ,.,.... ~ . "
999 - 370
PAGE 7
EMPLOYEE .
4
TETHYS CONSULTANTS, INC,
401(K) PROFIT SHARING PLAN
AS OF 6/30/95
RICHARD L. CLOUSER
SUMMARY - ALL ACCOUNTS
ACCOUNT BALANCE ON 1/01/95
CONTRIBUTIONS
GAINS/LOSSES
$9,512.21
$1,241. 69
$797.27
$11.551,37
ACCOUNT BALANCE ON 6/30/95
DEATH, DISABILITY AND TERMINATION BENEFITS {PRIOR TO RETIREMENTl
FOLLOWING ARE BENEFITS PROVIDED UNDER THE TERMS OF THE PLAN: THE BENEFIT YOUR
BENEFICIARY WILL RECEIVE IN THE EVENT OF YOUR DEATH; THE BENEFIT YOU WILL
RECEIVE IN THE EVENT OF YOUR DISABILITY; AND THE VESTED INTEREST IN YOUR
ACCOUNT DUE SHOULD YOU TERMINATE EMPLOYMENT FOR REASONS OTHER THAN DEATH,
DISABILITY OR RETIREMENT,
DEATH DISABILITY -----TERMINATION----
BENEFITS BENEFITS VESTED , BENEFITS
FIXED INCOME FUND
EMPLOYER MATCH FIXED INCOME $0.00 $0.00 100,00 $0.00
, PROFIT SHARING FIXED INCOME $0.00 $0,00 100,00 $0.00
1
..1 EMERGING MARKETS FUND
BEFORE-TAX EMER MARKETS EOU $1,292.21 $1,292,21 100,00 $1,292.21
;
\ PROF SHARE EMER MARKETS EOU $75,25 $75,25 100,00 $75.25
'1 ER MATCH EMER MARKETS EOUIT $321. 63 $321. 63 100.00 $321.63
~'.
COMPANY STOCK FUND
I
COMPANY STOCK PROFIT SHARIN $2,106.63 $2,106,63 100,00 $2,106.63
SMALL CAP VALUE EQUITY FUND
BEFORE..TAX SM CAP VALUE EOU $666,10 $666,10 100,00 $666,10
EMPLOYER MATCH SM CAP VAL E $166,37 $166,37 100,00 $166.37
PROFIT SHARI NO SM CAP VAL E $36,35 $36,35 100,00 $36,35
SMALL CAP GROWTH FUND
BEFORE-TAX SM CAP GROWTH $1,626,10 $1,628,10 100,00 $1,628.10
EMPLOYER MATCH 8M CAP GROWT $404,21 $404.21 100,00 $404,21
~}-',.::"'~~;Gr (:~I' i,..,c.
.<;;,,:m~u.~'1rJ!tl'"[~~m;3Zl.Jg~;!lLu..~t\I~T~,.~~~l~:r.~.;.'r.:JIi.'1.:.:~:~t7~)~IL:~~;:,:..~.~14:~:':~:::_~~;;]i5~~~tl4!~;.j r,
.I
j
~'.,
c
,}
8
;r,
,,,
,
'Ii
','.
:1
,I
j
I
'I
"1
I
I
:'1
;
999 - 370
PAGE 8
EMPLOYEE .
4
TETHYS CONSULTANTS, INC,
401(K) PROFIT SHARING PLAN
AS OF 6/30/95
RICHARD L, CLOUSER
DEATH DISABILITY -----TERMINATION----
BENEFITS ,. BENEFllL VESTED' BENEFl TS
PROFIT SHARING BM CAP GROWT $95,89 $95,69 100,00 $95,89
LARGE CAP GROWTH FUND
BEFORE-TAX LGE CAP GROWTH $792,40 $792.40 100,00 $792,40
EMPLOYER MATCH LGE CAP GROW $197,61 $197,61 100,00 $197,81
PROFIT SHARING LGE CAP GROW $4 7,36 $4 7,36 100,00 $4 7,36
I
INTERMEDIATE FIXED FUND j
BEFORE-TAX INTERM FIXED $1,426,71 $1,426,71 100,00 $1,426,71
EMPLOYER tlATCH INTERM FIXED $355,65 $355,65 100,00 $355.65 I
PROFIT SHARING INTERH FIXED $64,37 $84,37 100,00 $64.37 I
TOTAL RETURN FIXED FUND "1
BEFORE-TAX TOTAL RET FIXED $1,417,39 $1,417,39 100,00 $1,417.39
EMPLOYER tlATCH TOTAL RET FI $353,30 $353,30 100,00 $353,30
PROFIT BHARING TOTAL RET F $83,64 $83,64 100,00 $83,64 ,
i
TOTAL ALL ACCOUNTS $11,551.37 $11,551.37 $11,551. 37 i
,
THIS STATEMENT WAS PREPARED ON THE BASIS OF INFORMATION FURNIBHED BY
TETHYS CONSULTANTS, INC,
ALL BENEFITS ARE PAYABLE SOLELY ACCORDING TO THE TERMS OF THE PLAN
if
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STATEMENT OA'TE 00/3U/911
RETIREMENT ACCOUNT
CONSOLIDATED ACCOUNT STATEMENT
REPORTING PERIOD
08/01/96 TO 08/30/96
BSDT AS SEP/IRA CUST FBO
RICHARD LEE CLOUSER
96 FRONT STREET
WEST FAIRVIEW PA 17025-3211
SMITH BARNEY
11 NORTH 3RD STREET
2ND FLOOR
HARRISBURG PA 17108
DEALER #
6701
BRANCH #
0724
F.c. #
0400
ACCOUNT NUMBER
906-58967-1-5
SS OR TAX 10 NUMBER
209-46-2240
III 'ACII tllR(
POST TRI\DE
DATE DATE
SMITH BARNEY MONEY FUNDS, INC,
CASH PORTFOLIO CLASS A
D8/01/96 06/01/98 6AlANCE FORWARD
06/09/96 08/09/98 DIVIDEND REINVESTED
TYPE OF TRANSACTION
T RANSAC 11 ON
AMOUNT
TRAN6AC1I0N
SHARES
TOTAL
8ltARES
SHARE
PRICE
12.I2D
3265,20'
3297,41'
.--...... 12,12
''('71 ~ /1,
'l)~~/',I\
( ~'. "(I-~ \
r:- '\.:---::1 )
I ' "J12SJ" /1
(. 'ol' r
\i.:.:~ ,/ ",II
'------~.
1.00
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..... ~""'- ~... c.~ .... oJ.
1\1 1 ',,,'I 1
'" -'!rj '-11 -\ ", . \1
J Iltl,.n. t 'L t,S1C.~,-,
IMPORTANT. THE INFORMATION REFLECTED BELOW IS AS OF 08/30/96
PLAN SUMMARY
1996 CON:~~: ~ ~ON - OED C~~:~ ~:~rlO~LOVER '~ON;~,f1(;::~ ~~~'~:~~~~E~~~-~ TA~_~~i~~~
TOTAL VALUE OF PLAN -FilE ~~I~f~~1~~~~~~~H ~~U~~~~Nf~Nt~~D I TEFCf~'III].l.~f~~~up
AS OF 08/30/96 3297. 41.l I It l'HE BUS I NESS SECTION OF yaUIi i .. ;
" LOCAL NEWSPAPEli. ! n. OO! 0.00
QS SHR 000
6701 6
43 13356
PAnE I
CHARI,ES SCHWAB & CO,
AC'CT ~ Ol\TE
2384-4RRfi 01/26/99
A.NOUNT $::7,018. 3ll
1l0LLOVEIl CONTHIIllJTION
ACCOUNT !lAME & ADDRESS
RI C'IIAHD L CLOllSER
CHARLES SCHWAB & CO INC'. CUST
IRA 1l0LLOVER
1075 OYSTEIl M!l.L RO
CAMP H U,L PA 17011
IlGML
TETHYS CONSULTANTS, INC.
TETHYS CONSULTANTS, INC. 401(k) I)IWFIT SHARING PLAN
Fro/ll 1101/99 tlll/211/99
IUCIIAIU> L, CLOUSEI{ Dale uf Binh IOil2!\l/65
Sucial Security Numher 209.4(',2240 Dale ufllire 114i04il'IH7
Cumpensatiun $1l.l10 Date of Panicipalion 07,1111191) I
lIuurs 0 Date of HClirCIlICI11 119iOli2017
CUlTent Stains Tenn. \\'lthtlUI ,I break in scr"kc Vested (l.o of Employer Matching Cuntribulinn 100%
Beneliciary BONNIE L. CLOlJSEIl, WIFE Vested tin of Empluyer Prolil Sharing Contribution 100 U\,
Beginning Ctllllribuliuns Ilealiled Unrealized Trnnslcrs Luan Distrih Ending Vesled
ITotal By Source Balance Forf'citures (juin/(luss) (Jain/(Loss) Loan Pay Dimihuliuns Ilnlanee Ilalallce
Employee Deferml SIH,77'115 SIIIIII SII 00 ~4H7 104 SII Oil t$19.2hh.791 SII,OIl SIIIIII
Employer Malch SU25 1'1 SIIIIII SIIIHI S111'/2 sn Oil IS4,5111 1 I) $11011 SIIIJIJ
Profil Sharillg $1,121710 $01111 SII.1I11 SKU2 SIIIIO I $1,2122H) SIIIIII SII.1I11
Totols Sllo,312 111 SO 1111 SIIOIl Sl,Kh OH SIIOO 1$27,OIH ,1HI SIIIJIJ SII,IIII
Beginnillg Cuntributions Ilealiled lJnrealized Transfers Luan DiSlrih Ending VeSled
ITolallly Fund Balallce Forfeitures Gain/(Luss) liailli( Luss) Lonn Pay Dimihnliuns Balance Ilalance
Muney Markel S1.25439 SIIIIII SIIIHI SII.OIl 11100 ISU54 I'll SIIOIl SIIOil
N&1l LId Matllund S1.2I554 SO IHI SII OIl ISlm SO 00 ISI.21U21 SII Oil SIIOIl
Shares 113 1~6 o IHIII 00111' 11000 112.11510) 1111110 IIIHHI
N&ll Guardian S3,H4K loll \111111 SO 110 S I '/7,11 SIIIIII IS4,041o Ill) SIIIIII $111111
Shures 17110103 011110 0000 11000 1171 (,loll IIIHJIJ IlIlOil
Schwah 1000 S5.3H121 SIIIIO SO IHI SIO'II') SO 1111 IS5,4'10 4111 $11 00 SIIIIII
Shares Ihll5K5 0111111 III1IHI 11111111 11r.t15Hl) 11.11110 ilOilO
Heanland Value \2.-1%21 SIIIJIJ $11 Oil ~~7 7:! In 00 IS2,123 '11) III 00 SO Oil
Shores 85:!:!4 o IIIHI IIIHIII 110011 (H~ :!~..) 11111111 1111111'
MOlllgull1ery Growlh SI,nll'1I1 \111111 $11 1111 \'N~h $11.1111 ISl,Hhll4(,) SIInll SII 1111
Shares ~79 Rhl) """" 11111111 111100 (271) 8691 ".111'" 11,1111"
1'13110 Growth S2,IIKl.14 SIIIIII III "" Sll."l Ill."" IS2,12147) SII."" SIIIIII
Shnres 81.h~H 0(11111 nllon """" IHI hlH) 1111"" "."""
Fuullders Worldwide S2,hllH4 SIIIIII SII 1111 \ 104 IIH 111011 IS2,71h H2) III "" SII"II
Shnres 11'1.1"3 ""1111 "111111 """11 11I'lllll) 11.11"" 11.111111
Strong Intemationnl S 1.1047 'IH S" "" $11 "" S12~11 S""" ISI.771l,1'11 SII 0" SII 1111
Shares 1107 HI9 """" 11111111 """" I 1t.7 HI'II 11111111 II III II I
Luan \11 lItl \111111 SIIl'" $".1111 $".1111 SII.Oll $11 ""
N&II LId MOllJond 1""" \11 1111 $11 "" $""" SIIlIII $11 Oil $11 ""
r-.&II Guardian 1111111 \11 1111 SII.IIII S""" S" 1111 SII Oil SII ""
Schwab 1000 1111111 \111111 SII Oil S""" S".II11 SII "" III 1111
Heanland Vnllle \0011 $11 1111 SII 1111 $" Oil \" 1111 $11 "" S" nil
Montgumery Uruwlh SIIIIII $11 "n SII 1111 I" Oil S" 1111 $"."" SII ""
PIJIlG Growlh \11 "" \11 1111 Slltlll \" Oil S" 1111 Slltlll SII ""
Fuunders Worldwide Slltll' SII 1111 $111111 S" "" $" 1111 SIIIIII SII 1111
Strung Intcmnlilllll1l SII "" \11 1111 \11 1111 S" "" S" 1111 \11 "" 1111111
Telhys CIl, Stock SII "" SII 1111 SIIIIII S" Oil S" 1111 SII "" SII 1111
TlIlllll \~h..1JLHI SII 1111 SIIlIII \flHh 08 $" "" 1$27,IIIH lKI SII 1111 \11 1111
TETHYS CONSlILTANTS.INC.
TETHYS CONSlJLTANTS. INC. 4(11(1.) PltonT SIIAIHNG PLAN
Jinlm 1/01 1')9 III 11211/99
Sudnl Security NUl11hcl
Ctlll1pCnsntitHl
lIuurs
Clmenl Slnlus
lIenelidnry
20l},41>,2240
~OOO
o
rl'nn. wlIhlllllu hlcak ill ~cl"\'il'l~
1I0NNIE I. ('I.OIISl'Il. WilT
nale "llIulh 111'12 IlIl>~
nnle "llIile 114,041l1H7
Dnle nl Partll'lpnlulIl 07:01/ II)IJ I
nale "lllelUell1CIII IIl1 'III /21117
Vcslctlll,o lit rlllplo)l" Mllh.:hing ('ontrihuliun
Vesled IIn Ilfll1lllltl~':1 Plllfil Shnnl1~ l'nnlnblJliull
IOU %
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IUCIIAIW L. ('L()lISEl~
Allucllllunl'erccnlullc8
Fund lI.rnr.' MilIch I'r"nl Sh.rlng n"u""u
M,,"ey Mnrkel Y,lu ~Qn ~tlu
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, , ' "
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Schwah 11100 I ~\1 I) I ~"11 I~\IQ
Ileanland Vulue I\Illil 101lil 100'0
Montgomery t iU)\\lh ~Ollil 20"11 2Ullu
I'lIlHi lilllwlh IOU" tUU" lUll"
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Commerce
.Bank
Commerce Banll/lfarri5burg N.A.
100 S,nll, A~.n\J'
P 0 Do. 8~99
Camp .illl, PA 17011
(71719755630
STATEMENT DATE
'I ( !,\ I L '"I. 1111 ~, .,
I" IY 11 .I"l I t.l_ . 1'-)
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ANU wE'LL GIVE '.',TI< ['f 'YeW .10 WH..'N
NEW ACCOUNT liIl TIl Lc'it' [jr' "C'<ll
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SSN 20q
'J't-' II 11(1 DRN DATE
THIS STATEMENT MUST BE FILLED OUT
P Ji(,'l Vilrt,IQQ.9
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(II you are sell'employed or It you are salaried by a bUSiness of which you are owner ,n whole or in part, you must
also I,ll out the Supplemenlal Income Stalement which appears on the last page 01 this Income and Expense
Statamenl.l
INCOME
(a) Wages/Salary
Employer & Address t3i. lEI/LYL LtL
Job Tille/DeSCription ,,(.. I' 1~7' f I-
Pay Period (weekly, bi,weekly, monthly) ).;-lL'UJd,
Gross Pay per Pay Period "....""......"",..""....,,,....,.,,,,,,,..,,,,..,,,,,,,,,,,,,,,..,,..,,,........"""",,,,,,,,,,..,,,,,,,,, $ I 'I i' J . ,I to
Payroll Deductions:
Federal WlthholdinQ.""""",..",,,$ I '1~, 11",
Social Security WII!.(~,(t,9.rr.,..,"$ ~(. , "'L.1Jll..} 1
Local Wage Tax "",..",..""""....,,$ 1'1, 21
Stale Income Tax ..",,,,,..,,,,,,,,,,,,$ 3;l lj
Retirement ..................................$ -
Health Insurance ..,..",,,,,,,....,,,,,,$ "3 If"
Other (specify) ,,,,..,..,,,,,,,,,,,,,,,,,,,$
CA.t,f S,~" f"",,,,,,,,,,,,....,,,,$ J"frJ' r 1-
S',:>n,, I~ / .Jo.y.Vo?e.,ot.,,,,....,,,$ 10(" If
Net P~y per Pay Period ..",'..",.."""""..'""",..,,,..,,,,,,,,,,....,....,,,,,,,,,,,,,,,,..,,,,",,,,,,,..,,,,,,,,,,,,,,,,,,,,,,,,,,,, S 708, c:: it-
(bl Other Income Week Month
InleresllD,vldencls "",.., """....",,$ '0 $ () $
PenslonlAnnurty """..""".."""",$ CI $ 0 $
Social Security ",....""""",,,,,,,,,,$ 0 $ (I $
Renls/Royallles , ,..""..",,,,,,,,,,,,,$ 0 $ ..' $
Expense Accounl """""""""""'$ 0 $ ('I $
Gills '" """""".."",,,,,..,,,,,,,,,,,,,,$ 0 $ tI $
Unumploymenl Compensation ,$ " $ (I $
WOlk01C~~ Cilmpen~atlon "," $_ 0 $ (1 $
Total, Other Income "..,,,,,,,,,,..,..,, ,$ 0 $ (? $_
INCOME ANO EXPENSE 51 AUMENT or
I 'o'er1lv thai 'he slalements made In thiS Income ano E .pente Slale
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EXIJC11 Witnesses
None antidpated unless Ihere exists a dispute with respcct \II Wile's mediclll condltionor
the value of lIushllnd's pensionllnd prulil-sharing accounts,
Other Witnesses
Bonnic M, Clouscr, Delendant
Exhihils
D,I Leller dated May 30, 1995 from IHchard M, Magill, M,D,
D,2 I~ller datl>J Novemhcr 19, JIJIJII from Richard M, Magill, M,D,
D-3 Inlimnationdaled Ikloher 211, 11J911 from TETHYS Consullants, tnc,
401(k) I'rolit Sharing Plan
D-4 l{eservcdlilJ' Wile's Counsel Fees
Defcndant's Gross and Net Income
D-5 DelCndanl's Federal income las retnrn IiII' 1997
Pension and Retirement
Wife is awaiting responses 10 IntellogatOlies served on January II, 1999 in which
infimnalion was spedlically reqllcsledllholltllnshllnd's relirement plans,
Counsel Fees
Wile requesls thallIushllnd he required to pay Witi.:'s cOllnsellees,
I'crsollall'ropcrtv
The Masler is not heing asked to IIwlInl any personal party, Each party to kcep whlll
he/she hilS, There should he a sliglu credit (approslmlllely $1,tllllU10, to Wife wilh respcct 10
perSllnal property,
consultentsj
233 5054 j
Ooc,8,98 lO:<8AMj
I'ego ;)
TETHYS CONSULTANTS, INC.
TETHYS CONSULTANTS, INC. 401(k) PROFIT SHARING PLAN
From 1/01/98 109/30/98
RICHARD L. CLOUSEH Dnlo of Birlh 1011 211 96~
Social Security Number 209-40-2140 Dlte orlllre 04/04/1987
Compensation $ 18,50004 Date orl'Il1I"palion 01101/1991
Uours 1,040 Dale of Reliremenl 09/0112011
CWTenl Statu. Continuing ,to pal1iciplle VeSl.d % of Employer Matching Contribution lOO ~.~
nen.fielory BONNIE L, CLOUSER, WIFE Vested 'Ie of Employer Profit Sharin~ Cu"uibutIon 100 ~;
Beginning Contributions Realized Unreahud Transfers Loan Diunb Endins Vested
I ToLl I By Source Balance ForfeiN",s Gail\l(LOI') aainl(loss) Loa" Pay Oisuibutiuns 1l.I.nct n.lance
Employ.e OeftTTlll $16,305,78 SI,10995 S116.85 (SI,166,59) SO,OO SO 00 SI~,76599 S 15, 16199
Employer Match S3,827,93 S2Jl2~ 52.7,11 (S4093~) 50,UO 5000 53,67694 U,b1694
ProfltSbaring $2,902,13 SO 00 52U5 152945\) SOOO 5000 SU:9,67 S2,b29b7
ToLlls U3,036.44 5 I ,34 \.20 516~,41 (S:..170 45) SO 00 50 UO ~.;:2.0i1.60 s22001:,60
Ileginning Contributions ReaUzed Unr UlilOd Transfers Loan Distrib Endin~ VOSIed
ITotal By Fund aalance ForfeIrurcs GainlCLoss) aaw(Loss) loan Pay Di.nibution. llaI01<' BalaulO&
Money Ml5fket 5\,034 62 561,08 576,61 So 00 SO 110 SO IlU 51,1'UI SI,I18 ) I
N&B Lid Matllond 51,095,47 S61.08 551 59 I.S338) SO,OO 5000 SI.;:016 ~1.l10 76
Shares 109.438 6,718 5,162 0000 u.UUO I.,JII I21.JJ8
N&B Guardian SJ,57974 520\.18 514,16 (566908) SO,OO SO 00 SJ,126 OIl 53,126,00
Shares 138,214 6,916 O.~44 0,0011 0,000 14~ 734 145714
S.hwab 1000 54,054,63 5201.18 5U,UO ~11166 5000 SO 00 54,413,41 S4,41341
Shares 152,639 6612 0,000 0000 0.000 IlY.1l1 Il9331
Heartland Value 52.44915 S134,U 50,UO ,$40131) SO 00 SO 110 S1, 116 5~ S2,I1655
Shares 12,328 317~ o UOO 0000 II non 76 I III 16,\1l3
Montgomery Growth 55,038.31 ~26U3 50,00 (5691.58) SO,OO SO 00 54,614.98 54,614,98
Share. 230,165 Illl I 0000 o OUIl 1l1l00 241.496 241.496
PBHQ Gruwlh $1,943.31 5134,15 50,00 15441 04) SO,OO 50,00 51.636,42 S 1.636 42
Shares 76.617 1041 0.000 u.uuu O,ouo 81.6\8 81.b38
Founders Worldwide 52,191.20 $133,98 50,00 ISIIUl) 5000 SO,OO s:,mI3 S2,212 83
Share. 103,199 3,m 0000 0,000 0,000 109.384 109314
StroDa Inkmalional 5 I ,647.4\ 513415 523 03 IS301.JJ) SO 00 50 DO S I.lU3 28 U,5032R
Shares 153,105 11.116 2,0:3 0,000 0,000 1M 1146 166146
loan 50,00 50,00 50,00 SOOO ~O DO ~o 00 So 00
NkB LId MDt Bond so.oo SO,UIl SOOO So.oo 100U SO 00 ~o 00
N&B Guardlll/l 5000 51100 5000 SO 00 so 00 So IIIl SO Oil
Schwab 1000 $000 SO 00 SO 00 5U UIl SO UU SO 00 so 00
Heartland Value SOW $000 ~o 00 sn no SO no ~u IIU sn IJO
Montaomel)l Growth SO 00 ~O,OO 50,00 5000 ~O,ou \01111 SU IIU
PBIlG Growth 50,00 SO 00 SOUO SO,OO ~O 00 So 00 5000
Foundon Worldwide 50,00 SIlOO SOUO 5000 soou SIl 00 SO 00
s,trnng International 50,00 SO ou 50,00 SO 00 1000 SO OU ~u uo
Tethys Co Slack SOM Su 00 snon SO (~J SO 110 SO 00 SO 110
TOlals 523,03644 S J.J4I 20 SI65,41 1$2,47U,41) ~O UU ~1I ou '.!~.U12 f.,l) S~2.071 blJ
nt By: TETHYS c~nluitantS;
, .
c...,o,J ...........,
......... .,',
.'
Dl.,..::cT ROLLOVEll ELECTION
Company Name TETHYS Con~u1tu1l.S. Inc. 401(lr.) Profit Sharin!! Plan.
Participant Name and A~ (p1c:ue complete or correct below)
Mr, Richard L. Clo~
1075 Oyster Mill Road
Camp Hill, PClUUylvania 17011
Social Security Number 209. "6 . 2:40
Daytime Phone Number ( )
Spouse's Blnhdare
~/~ /50
~~}).:.1' ~-'~{,::,~':O;-;:~~ ~-:~l,,::~::'~~i:,;iE~ ;.~'~ :.:,~~-~~~.~~~:~~,;:@
A. Direct Rollover Notke
You are entitled to a distribution from the retirement planes) of the company Ilamed
above. This distribution can be:
· paid to you ~t1y,
. paid in a Dircl:t Roliover to an indiYidual retirement arr.UJgemc:nt (IRA) or to the
defined contribution plan of another employer, or
. paid in part to you directly anc\ in part as a Dire.;t Rollover.
The part of the distribution paid to you diJe,."1ly i3 subject to federal income \aX withholding at
the r:ue of 20 ~, The pan of the distribution paid as a Direct Rollover is not subject to
withholdine. For more information regarding the tax con~ucnce" of your dbtribution, pl=
read the enclosure, .Special Tax Notice Regarding Plan Paymenu..
B. DlrKt Rollover Election Cbt:ck one,
1. [] Pay the distribution directly to me. 20% federal income \aX will
be withhcld. (If you checked thii option, go to Section m.)
2. IX] Pay the distribution as a Dire.:t Rollover. (If you checked this option,
go to Section 11,)
3, (J Pay $ (indic:1tll dol1ar amount or percentage) of the
distribution din:ctly to me, withholding 20')1, federal income laX, and
S (indic:1le dollar amount or pem:ntage) of the distribution as
a Dln::ct Rollover. Dln:ct Rollover portion must be at least 5500, (If you
checked thls option. go 10 Section U,)
TETHYS Con6ultant6j
233 5054;
Dec,8,08 10:32AMj
.'
SPECIAL TAX NOTICE REGARDING PLAN PA.YMENTS
This notice contains important infonnation you will need before you decide how to
receive your bencfiu from the ~YS COn5nII2nU, Inc. 401lk\ Profit Sharinf Plan.
SUMMARY
A. payment from the Plan that is eligible for 'rollover" can be taken in two ways. You
can have aU or any porrion of your payment either I) PAID IN A "DIRECT ROLLOVER" or
2) PAID TO YOU. A rollover is a payment of your Plan bcnc:fiu to your individual retirement
arrangement (IRA) or to another employer plan. This choice will affect the Wt you owe.
If)'oo chOOl!le a DIRECT ROLLOVER
. Your payment will not be taxed in the current year and no income tax will be
withheld.
. Your payment will be made directly to your IRA or, if you choose, to another
employer plan that w:epts your rollover.
. Your payment will be taxed la1er when you take it out of the IRA or th( employer
plan.
If )'ou chOOK to have )'our Plaa beael1ts PAID TO YOU
. You will recclve only SO" of the payment, because the Plan administrator is
n:qulrcd to withhold 20" of the payment and send It to the IRS as income Wt
withholdin& to be credited aplnst your lUes.
. Your payment will be ta.lted in the current year unless you roll it aver. You may
be able to use special ta.lt rules that could reduce the tax you owe. However, if
you m;c!ve the payment before age 59'h, you also may have to pay an additional
10" Wt.
. YoU can roll over the payment by paying it to your IRA or to another employer
plan that aa:epts your rollover within 60 days of n=ivinll the payment, The
amount rolled over will not be Wted until you ta.kc it out of the IRA or employer
plan,
. If YOII want to roll over 100% of the payment to an IRA or an employer plan,
you mwrjlruJ owr mon.ry /0 repUli:e /~ 20% lhoJ was wi/hheld, If you roll over
only the SO" that you re:c:eived, you will be llUed on the 20" that was withheld
and that II not rolled over.
TETHY6 Ccn.ult.ntoj
iJJ 5054;
OQc,U,98 10:JJAMj
Page 8116
I. PAYMENTS THAT CAN AND CANNOT BE ROll.ED OVER
IJaymenLS from the Plan may be "eligible rollover dislJibulions." nus means that they
can be rolled over ID an IRA or 10 anolhcr employer plan that acuptl rolloven. Your Plan
adminbtralDr should be able 10 tell you what portion of your payment iJ an eligible rollover
distribution. The following types of payments Cl1IIIIOt be rolled over:
Nun-uuGbt. PilYfII,IIII, In general, only the "taxable portion" of your payment is an
eligible rollover dhtribulion, If you have made "afta-w;" employee contributions ID the Plan,
these contributions will be non-lAUble when they are paid to you, and they cannot be rolled
over. (After-laX employee contributions generally are conlJibutions you made from your own
ply that wen: alread y lUed,)
Paym,1IlS Sprud our lAn, P,riods. You cannot roll over a payment if it is pan of a
aerics of equal (or almost equal) paymcnLS that arc made at least once a year and that will last
for
. your lifetime (or your life expectancy), or
. your lifclime and your beneficiary's lifetime (or life cxpccWlcies), or
. . period of lClI years or more.
R'f/uind MlIIlmU1ll Paym,IIlS, Beglnning in the year you tach age 7Q1,"z, a certain
portion of your payment cannot be rolled over because it II a "required minimum payment" that
mUlt be paid 10 you.
n. DIRECT ROLLOVER
You cart choose a direct roUovCl of all or any ponlon of your payment that 11 &1\ "eligible
rollover c1I.tribuuon, " u deil:rlbed above, In a dlm:l rollover, the e11J1ble rollover distribution
iJ paid directly from the Plan to an IRA or another employer plan that IW!pts rollover.. If you
chaole . direct rollover, you lUll nOl lUed on a payment until you law take it out of the IRA
or the employer plan,
DUwcl RuU.."r IQ All lILt. If you are employed by a new employer that hu a plan, and
you want I dlm:t rollover to that plan, uk the adminiltrator of that plan whether it will ~I
your rollover, An employer plan is not legally required to acc.epl a rollover, If your new
employer', plan does not accept a rollover, you ~ choose a direct rollover 10 an IRA.
DU-tcl RuUo...r of II S.m, of Pllymulll, If you reaive r.Illlible rollover disuibutions
that are paid in . seriea for Icsl than Len yc.ara, your choice 10 mm or nol maU a direct
roUOVIT for a payment will apply 10 all lall!r 11lIyments in the aerie, until you change your
election, You are flee 10 charlie your clCl:tion for any lalc.r paymml in tJle acriel,
TETHYS Con6ultant6j
233 5054 i
Dec-S'OS 10:34AMj
Page 0/16
m. PAYMENT PAID TO YOU
If you have the paymCllt made \D you, it is subjcct \D 20% income WI: withholding. TIle
payment b taxed In the year you receive it unless, within 60 days, you roll It over to an IRA
or another plan that accepts rolloven. If you do not roll it over, special tax rules may apply.
IlIcom' T4% WUhlwldin6:
AAnntlnlOrv Wirhholdinr. If any portion of the payment \D you is an eligible rollover
distribution, the Plan is required by law to withhold 20~ of that amounL This amount is sent
to the IRS as income tax withhulding, For example, If your dlgible rollover distribution is
$10,000, only 58,000 will be paid to you because the Plan must withhold $2,000 as income tax.
However, when you prepare your income tax return for the year, you will report the full
$10,000 as a payment from the Plan. You will I'qIOrt the 52,000 as tax withheld, and it will
be credited against any income tax you owe for the year.
Voluntarv WirhholdIne. If any portion of your payment is not an eligible rollover
dlsttibution but is taxable, the mandatory withholding rules described above do not apply. In
this cue, you may elect not 10 have withholdins apply to that portion. To eket out of
withholding, uk the Plan administnltor for the election form and related information.
Sizrv-Dav RolloW!r Dorion, If you have an dlgibLc rollover distribution paid to you, you
can still decide to roll over all or pan of it to an IRA or another employer plan that accepts
rollovers. If you decide to roll over, you mwl rJIIJU tht: rollover within 60 days qfter you
receive Iht paymelll. The portion of your payment that is rolled over will not be taxCl' until you
takIl it out of the IRA or the employer plan.
You can roll over up 10 100" of the dlgible rollover distribution, including an amount
equal to the 20" that WaJ withheld. If you choose to roll over 100", you must find other
money within the 6O-day period to contribute to the IRA or the employer plan to rep1ace the
20" that was withheld. On the other hand, If you roll over only the 80" that you received, you
will be taxed on the 20" tha1 wu withhc1d.
Example: your eligible rollover distribution Is $10,000, and you choose to have it paid
to you. You will rcc.eive 58,000, and $2,000 will be sent to the IRS as income tall withholding.
Within 60 days after receiving the S8,OOO, you may roll over the entire S10,000 to WI IRA or
employer plan. To do this, you roll over the 58,000 you n:cdvcd from the Plan, and you will
have to find 52,000 from other sources (your savings, a loan, ele.). In this case, the entire
S10,000 Is not taxed until you take it out of the IRA or employer plan. If you roU over the
entire 510,000, when you file your Income tax return you may get a refund of the 52,000
withheld.
If, on the other hand, you roll over only the $8,000, the $2,000 you did not roll over is
taXed in the year it was withheld. WIlen you file your Income tax retUrn you may gel a refund
of part of the 52,000 withheld. (However, any refund is lik.ely to be larger if you roll over the
entire $10,000,),
.
TETHYS Consultants;
<33 5054 i
Oec,8,08 10:35AM;
Page 10/16
AddJtloruU 10'1 Tax 1( fOil Art' rJrulLr Agl! 59H. If you receive a paymenl before you
rc:ach age :1911. IIJId you do no! roll il over. lIlen, In addition to !he reaular income laX, you may
have to pay an extn equal 10 10'1 of lIle wable portion of the payment. The additionallO',ll,
lal does not apply 10 your payment if it is (I) paid to you because you separalc from service
willl your employer during or after lIle year you n:.ach aae 55. (2) paid because you retire due
to disability, (3) paid to you as equal (or &Inion equal) paymenu ovcc your life or life
expectancy (or you and your beneficiary's live.l or life expectancies), or (4) used 10 pay certain
medical expenses. See IRS Form 5329 for more infonnalion on lIle additional 10" laX.
~clal Tax TrealmLnt. If your eligible rollover diJtributilln is not rolled ovcc, it will be
laled in the year you reCeive it. Howevcc, if il qualifies as a "lump sum distribution,' it may
be elislble for speciall.< treatment. A lump sum distribution II a paymenl, within one year,
of your entire balance under lIle Plan (and certain olller similM plans of the employcc) thaI is
payable to you because you have reached lie 5911.1 or have aeparatai from SCJVice with your
employer (or. in the case of a self-employed individual, becauiC you have reached age 591h or
have become disabled). For a payment 10 qualify as a lump sum distribution, you must have
been a participant In the Plan for at lClLllt S ycan. The SpcciallU l1'eatment for lump sum
distributions il described below.
F/W-Yl!or AwropfnR, If you receive a lump sum distribution after you are lie 5911.1. you
may be able 10 make a one-time election to figure lIle tax on lIle payment by uiing 'S-year
ave.raaing." Five-year avenging oftc.n rcd~ the l.< you owe because It trcau the payment
much IS If It were paid over 5 years.
Tl!lI.Yl!tJr Awra,ln8' {froll Wlrt' Born 8(-'0" Janua/'V 1, 1936. If you receive a lump
sum distribution and you were born before January I, 1936, you can make a one-time election
10 fillure the \ax on the payment by using 'lo-year aVer.lgIn&' (using 1986 tax rates) instead of
S.year avc:raainB (using current tax rates). Like the 5-ycar averaging rules, lo-year llveraging
often rcdUc:c:l the laX you owe.
CQDltaJ Galli Trt~1Il1f YOII WIl!rt' Som &(orl Jmllm/'V 1. 1936, In addition, if you
receive a lump sum distribution and you were born before January I. 1936, you may elect 10
have the part of your payment that Is attributable to your pre-1974 panic:ipation In the Plan if
any) taxed as long-tenn capital gain at the me of 20~.
Th~ arc olhcr limits on lIle special laX treatmenl for lump sum distributions. For
CAample, you can generally elect this special laX lrca.lment only once In your lifetime, and the
election applies 10 all lump sum distributions lIlat you n:ccive in that same year. If you have
previously rolled over a paymenl from lIle Plan (or certain olller similar plans of lIle employer),
you cannol use this spociall.< treatment for later payments from lIle Plan, If you roll over your
payment 10 an IRA. you will nOI be able to use thil special laX treatment for lalCr payments from
the IRA. Also, if you roll over only a portion of your payment 10 an IRA, IIlls special tax
treatmenl is not available for lIle reat of lIle payment. Additional restrictions are described In
IRS Fonn 4972, which has more infonnatlon on lump sum distributions and how you cl&:et the
special tax treatment.
.aa bOM j
lJec,ti,~ti 1U:JbAMj
.'oge 1 1 /1 b
.
IV. SURVIVING SPOUSES, ALTERNATE PAYEES, AND 011lEK
BENEFICIARIES
In general, the rules summarized above thai apply 10 paymcnu 10 employees also apply
10 payments 10 surviving spouses oC employees and 10 spouses or Conner SPOUSC5 who are
.allcma1c JlllYees.. You are an a1ternale payee if your InlUC5t In the Plan Il:$ulu Crom a
.qualified domestic relations order; which Is an order issued by a court, usually In connecdon
with a divorce or legal separation. Some DC the rules summ.a.rUed above also apply 10 a
dec~sed employee's beneficiary who Is Dot a spouse, However, then: are some exceptions Cor
payments 10 surviving spouses, a1wnate payees, and other beneficlartes that should be
mentioned.
If you are a surviving SPOUIC, you may choose 10 have an eligible rollover d stribution
paid in a direct rollover 10 an IRA or paid 10 you. If you have the payment paid 10 you, you
can k=p it or roll it over yourself 10 an IRA but you cannot roll iI over 10 an employer plan,
If you are an altern ale payee, you have the same choices as the employee, Thus, you can have
the payment paid as a direct rollover or paid 10 you, If you have it paid 10 you, you can keep
it or roll It over yourselC 10 an IIlA or 10 another employer plan thai ac.ce)Jts rolloven. If you
are a beneficiary other than the survivin& SPOUIC, you CaMOr choolC a direct rollover, and you
ClWIOr roll over the payment yourself.
If you are a survivina spouse, an a1tt.rN1e payee, or another beneficiary, your payment
is not subject 10 the additlonallO'<' tax described In section m above, even IC you ale younger
than qe 5911.1.
If you are a surviving spaule, an a1te.ma1l: payee, or another beneficiary, you n':.\ly be able
10 use the special tax treatment for lump lum dlstributiODS and the spcciaJ rule Cor payments that
Include employer stock, as ductibed in section ill above. If you receive a payment because oC
the employee's dc.a1h, you may be able 10 trcal the payment as a lump surn dlatribution iC the
employee met the appropriate lie requirements, Whether or not the employee had 5 yws of
participation in the Plan.
How To OblaiJJ Addlt\oPIII InronnatJon
This notice summariJ.es only the CederaI (nol stale or local) w rulu that might apply 10
your payment. The rules deaaibed above are romplex and rontain many condItion I and
cxC'.eptiona that are not included in this notice, Thererore, you may want to ronlult with a
proCeJslonal tax advisor btfrJIY you take a paymenl oC your beneflu from the Plan, Also, you
can find more specific InConnaUon on the WI tn:.a1mcnl or paymenl from ljualilied retirement
plan In IRS PubUc.ation 57S, Peru ion and Al\1IJdry IN:omt, and IRS PubUc.ation 590, IndividUDI
Rtrlrtmtlll Arnvtgt~nlS, These publications are Ivail&ble rrom your local IRS office or by
calling I.SQO-TAX.FORMS,
nt By: TETHYS Consultantsj
;/33 5054;
Oec,U,GU 10:37AMj
Page '2/16
DISTRlBtmON NOTICE AND ELECTlON
ANNUITY WAIVER AND SPOUSAL CONSENT
CompaDy Name TETHYS ConsultanlJ. Inc. 401(\(\ Profit Sharin~ Plan.
Participant Name ud Addresl (please complete or com:ct below,)
Mr. Richard L. Clouaer
1075 Oyncr Mill Road
Camp Hill, Pcnnaylvania 17011
Social SKurlty No. ~09. 46 - 2240
Daytime PhoBe No. (
)
. Any elections or waivers made with this {ann will not apply if (I) your vested benefit Is
$5,000 or lell, or (2) the Plan cont.al.ns a provision dcferrin& participant distributions until the
participant attains I certain ace or a certain time period elapses.
. Do not complelC thiJ form If you an: the beneficiary cf a dece:oU'11 participant.
. You should conlUlt your taX advisor to detennine the best option far your situation.
I'Itue read this section.
A. Joint and 50'" Survivor and Sb1&le LiCe Annuity
If you are married, your benefit will be paid \0 you in the form of a joint and 50%
Survivor Annuity, unless you waive this form of payment, A Joint and SO'J(, Survivor AMUlty
providu you with monthly paymcnLS {or the rcJt of your life, and, upon your death, a monthly
payment for your IpDIIIC equal \0 atlealt :\O'J(, of the monthly payment you r~lvcd prior \0
your death.
If you are single, your benefit will be paid to you in the {arm of a Single Li{e Annuity,
unless you waive thll {arm of payment, A Sin&1e tife Annuity provides you with a monthly
payment far the rest of your life. Upon your death, paymenU will cease with no death benefit
available to your beneficiaries.
You may waive the annully form of payment applying \0 you and have your distribution
paid in all alternative form, To do this, you mUlt &ign the waiver and, I{ you are married, have
your spouse consent In writing, in the ~nce of B Notary l'ubUt or an Authorized Employer
Representative, If you execulC \he waiver, you mUlt select an aitcmative {orm of benefit
described in PaIt B,
B. Alternative ."OI1Di or Benefit
Sinew Sum DbtrlbutlOD
If you elect a single lum distribution. your benefit may be paid to you in one payment.
The amount of your benefit 11 the vested portion of your acrount balance u of the valuation date
used Ul calcula\C your distribution,
lent By: ,TETHYS Consultenta j
233 5054 j
Oee.8.B8 10:3BAMj
Page 13/16
... nn'IItJ
An annuity can provide you with paymcntl for your life or for your ute and that of your
bencficlary. AlIo available arc lDIluiliC$ that provide JlIIyments for your ute and lUInUltee that
paymenll will be made for a specific period of time, even If you die before the end of that
period. However, thil period of lime cannot be gJa1a' than your life C.llpeclancy or the joint
life and last swvlvor cxpectancy of you and your designated beneficiary. There are other IRS
rulCl that may further limit the period during which payments may be made.
Tnef,II"",nh
If you c1ca 10 n:ccive your benefit In installments, you may specify the dollar amount
and frequency of your payments. The period of time over which you rccdve th=e payments
cannot be &rcater ltw1 your life expectancy or the Joint ure and last survivor C.llJ*tancy of you
and your daicnated beneficiary. There are other ms rules that may further limit the period
over which you receive payments.
PutJdpaut mwt eompkte A through D and sip.
A. When Beodib Are to Bqin Check one.
Under the Plan, you have the option to defer the receipt of your benefit. However, your
benefits must beJIn by April 1st following the calendar year that you reach lie 7(}'1h.
1. [) I elect to receive my benefits as 100I1 u administratively possible.
(Comp1ele the rest of Section n and Sectioo m, If you are married and
waive the joint and SO" Survivor Annuity.)
2.
Defer my distribution until further notice or until
the end of Scc:t1on n, but do not complete the re-
mainder of this fonn,)
I I _' (Sign at
SpeJIr tIaI
[ )
B. FonD of BeDen1 CIcek one.
1. [ ) SlnaIe Sum
2. [ ] Annuity Choose one option.
[ ) Single Life Annuity
[ ) Life Annuity with 5 years certain
[ ] Life Annuity with 10 ycan certain
[ ) Ufe Annuity with IS yean certain
[ ) Joint and 50" Survivor Annuity
( ) Joint and 100% Survivor Annuily
Other
It .8:: TETHV6 CQn.ult.n~'i
I
A. spouaal Intormalloa Check one.
To be completed by participant.
1. IX I am married and my spousc's wrincn con5&:l1tlo my dection is below,
2. [] I am married but my spousc' I wnttA:l1 consent Ie this election is not
rcqui.rtd because:
(Check applicable n:ason below,)
a, [] My spouse cannot be located. I agme lo infonn the Plan
Administrator if the I~on of my spouse become! known.
b, [1 My spouse and I are legally sepanted and a copy of the court order
lo that effect is alUChed. (Note: A qualified dome!oc relations order
may require you lo obtain your spouse's consent,
c. [] My spouse has abandoned me and a copy of the court order to that
effect is albChcd.
d. [] I selected a joint and Swvivor Annuity other than a joint and SO'JO
Survivor AMuity) with my spouse as beneficiary.
B. Spousal COD5eJ1t to Waher
To be s1&Ded by the spouae DC a married pa.rtk.lpanl, IC walvina the quallfie.. annuity
Conn or beDel1t.
I herthy voluntarily coosentlo the foregoing dection by my spouse nollo have benefits
under the Plan piid In the fonn of i Joint and SO~ Survivor AMuity. FUrther, I hereby
acknowledge that I unl1cnWld (1) that the effect of my consent may be 10 forfeit benefits that
I would have been entitl.e.d 10 receive upon my spouse', death; and (2) that my consent Is
irrcYocable unleu my spouse n:vIJW the waiver. 1 further consent 10 have bc:neiits under the
Plan paid in lICCOrdanc.c with the foregoing election made by my spouse.
I agn:c Ie rclc.uc and discharge the Trus~. !'Ian Administrator and Employer from all
liability for acting pursuant 10 this consellt.
'-,
S1GNIm1,)..y 'f.!11, ,
--
, -----
Date
I I
/ _2../ ,J '/ /' I'll
I /
11lb SpoWollI Coru.eut rn~t be wiluC!>\04:d by II Notal')' Public or IIn Authorlud Employer
Rep~lIlliIIYr.
. '
Ferm 1040
Label
U..Ih.IR9
labll,
PrllldlnUl1
EllcUon Campaign
(Soepogo 10)
1
FIling Status 2
a
4
Chock onlv
one bok.
Exampllons
Ilmorelhensil(
depondents,
seepago 10.
Income
Attach
Copy B 01 yoer
Forml W-2t
W-2G, .nd
108l-R hlrl,
II yoe did nol
goll W-2,
seepage 12
Encloso, but do
nolanach any
payment Also,
please use
Form 1040'Y,
Adjusted
Gross
Income
IIUno 32 is under
$29,290 (under
$9,nOllachlld
dId nollivo with
you), GOO Ele 011
pago21
KBA
Olp"tm,"' of thl '''''UI)'. Int""I' 11.....nu. S.,,,'U
U.S. Individual Income Tax Return
1997
1"1
illS UuUol)'.. nonnl IIIIlllot "Ipt.In Itu..pac_.
Do you wonl $310 go 10 Ihlulund'l
II 0 loinllolurn, doos VOtll5POU5lJWOnl $3loqo 10 IIllsfund?
51nglo
Morrlod,hUng jOlr\l tulUlf' (o\'ulIlI unly onu had 1I1C0l1lU)
MOlllodfiUng liOpOIOlofolurn. [nl" 'POUII't 55N .t:u~. .nd hllln.rn. ""' ...
Head 01 houoohold (With qualllYlIlg por6(J1l1. (500 pagu 10,)111110 quahlYlng pOlson 19 0 child bulnol your dopondenl,
X unlolllus child's nan'lO hmo, ...
Ouollfylnq WldOW(OI) wIth dependant ctllld (yoor spouso died ... 10 ). (Soo pogo 10 )
Yourself. 11 your parenl (Of someono ulso) can chllln you as a dopllndfllll on 11m 01 hOllak
relUlIl,do not check bok6o
rOlth..,II,J&n. 1- OIC. JI, ItIfH,u'oll'llltU.,11I blg,nn,nll
,1II111,lndlnll
BONNIE M CLOUSER
2,170 VALLEY
MARYSVILLE,
IWAD
PA 17053
5
6a
b Souse
e Dependents:
1 Firol nama Losl namo
ANDREN CLOUSER
(a) Dependen!'s
ICl0tlonDhlp 10
au
(2) Dependen!'.
social SOCUllty number
210-68-5330 SON
d Tolnl number 01 mmmpllons Claln10d
7 Wagos, salanos, lipS, ole. Anacll FOIm(n) W-2
8a
b
9
10
11
12
la
14
15a
16a
17
18
19
20a
21
Tuablelnleresl. Anoch Schodulo B II required
Tu-elllmpt inlerest. 00 NOT include on Iino eo 8b
Dividond Ineomo, Anoell Sehedulo 8 if roqullCd
Tll)(oble rolunds, credita, or Of/setB 01 ~i1olo and loeollllcomo laxes (seo pago 12) ,
Alimony received
Business income or (loss), Atlaeh Schodulo C or C-E2
Capital gain 01 (loss), Altach Sehodule 0
Othor gains or (Iosoos), AUnel1 Form 4797.
Tolal IRA distribullons ~ I b T8)(abloamt
Tolnl pensions and annullIus ~!...I b Takable amt
RenlallDo.l oslalo, royalllDs, partnorship9, S corpora1l0ns, !lusls, ele, Attach Schedule E
Farm incorne or (loss), Altacl1 Schodule F
Unemploymenl componsotlon .
Socialaocurity bcnolils . 120a I I b Tnxoblu omounl (saepg 15)
Olher Incorne. USI typoond omounl- seopage 15
," OMB No, 1&45,0074
Your loclllllcurUy numb.r
184-38-0621
Spouae'lloclalllcurtty number
For hllp In flndlng IIn.
Inltrucl'onl,..1 plgll
and 3 the ooklel.
YII No Not.: Chocking
X "YDa'will nol
chango your laIC or
roduco OUl folund.
} No_ olbul"
thlc.ldun
h"ndlb
No, 01 your
(4) No. of months thll~"n on Ie;
lIvodmyour who.
homo If1 1097 . hll.d Wllh "OLl
12 . did nol hili Wilt!
you dUllo OllfOr(l
o'uplrlllon
I.UPlgl ")
1
1
22 Addlhoamoul1lsinlhelarri hlcolumnlorllno~7throU 11~1,Thi5js
23 IRA deduction (soo pogo 16)
24 Modlcal savings occounl duductlon, Alloell Form BB5J
25 Movmg Q)(pon~;es, Attacll FOrll1390J or 300J-F
28 Ono-hall of soll-mnploymollt tOK, Attach Schcdulo SE
27 Soil-employed hoalll1lnuuronco dodlJclion (500 pogo 17)
28 Kp.ogh and soll-olllplovod SEP and SIMPLE pions
29 Pnrmlly on oOlly wllhdrawal 01 !;o....mg:J
30a Alimony paId, b Rl!clpiunl'!; SSN ...
31 Add li!los;'J lIuolJql1 JOa
32 !:;llblrncl hnu :)1 lrolllll!1ll;'~. 1 hl~i I!J your adjusted groBs Income
For Privacy Act and Paperwofk Reduction Act Nollca, nee page J8.
OIPlndlntlontlt
nO'lnll"dlbo\ll_
Aod numb.,.
,nll!ldon
llnel&bolfl
2
~;:::;
7
8a
,?,/-
9
10
"
12
la
14
15b
16b
17
18
18
20b
~;;:{-
21
~ 22
2,770,
4,335,
7,105,
our total Income
23
24
25
28 306,
27
28
29
aOa
Form 1040 (1997) F01040-1V 1,19
fill'" !lullwllI Lup\'''lJhl 'I.lllfl H"fllll,,, ~ l.u 'I"~''''.. IPIl
Jill, ,
~-:---~T~)~} -,-
11111040 (lUlU)
DEFENDANT'S
EXHIBIT
5
FOlm 1040(1001)
33
34.
.
Tax
Compu-
ta\lon
llYOUW8111
Ihe IRS to
figUlo Vow
tlUl,Soe
pago 18
Credits
Other
Taxes
paymenta
Allach
ForOll Wp2,
W-2G, .nd
l00D-R on
plgD one
Ralund
Hlvolt
dllOCUy
deposited I
~~ nlrM'\;~T"
62c .lId 02d
Amount
You Owa
Sign
Here
Koop. LUIlV
ofthl6lUhllfl
101 vow
lonllds
Itemized deduction. "(Jill SchudlJln A.lIIIU~O. OR
Standard deductlon shown bnlow lor Y011l hllllq claluti Out suo
pogu 1011 YOIl (;hncked OilY b(l11 011 linn J40 III J4b or GOllllHlllU
COil dOlln YOlln!> 0 (jOpOIHHHlI
. Sillylo -~ $4.150 . MOlllUd llllllg jlllllllVtJ1 tJlJO!llYIIlg WldUW{(!I) -- $6,000
. Huod 01 huuGutlald -- 16,0&0 . MotlltltJ tiling liUpl1llllnlv -.. $J.4flQ
Subl/8t:lllnoJ51roI11I1I1033
II Uno JJ is $gO,90oo/luau, fllull1n1v $2,650 bV 11ll! lolnllllllllbm olulllllnpllollu 1:lnllllud nil
lino lid tlli111l33 Is O'lUl $Oo.uno. 8UO lhnworkslmul 011 pogo 191011ho 0IlkllJI11 to UII101
Taubl. Incom.. Subtrac1l1nu 37 tlomlll1ll3G Illlno 371M InOloltlon 1111" :.Ill, (lllllll ~()-
T.II.ChocklloIlVIOMllOrll I r01f11(lij0014 b FOII1\49n
Cludlllol child orld dupandulll COIO uMpnn~n~. Attach Fml1l ~441
Clodlllol ttlUtJldUl1V ilIUm dltlotJlod. Altacl15r.tmdulu R
Adophollt:lodil. Allaell FOl1110039
FOlolgn lax cfCdil AUDell FOIIl11 , '6
Olhe! _ Chock 11 flam . B r 011113000 b 0 FOlIll OJ96
cD FOIIT18001 d FOIIll(Spuclly)
Add IIIl0s 40 lhrough 44
Subllnclllno 45 homlinHJ9 II line 45 mmolo Ihan hnoJ9. efllU! -0-
Sull-employment 1ax. At1acll Schedulo 5E
Alternatlvo mll1lft1UllllBX, Altsell FOImfi251
SOCial 60cUllly Dnd Medicare lax on lip Incomo nOII()p,)lled 10 cmployOl AUaet1 Form4'J7
Taxon quallliod 101ll01110nl plans (iIU;ludll1g IRAs) and M5AG. Allach Forlll5329 II loqullod
Advallco car nod IflCOIl1Q CIOdl1 paymonls 110m FOInl(G) W-2
Hmmllhold ol1lploVmenl laxel3 Alla<.:h Schodulo H
Add lines 40 lhrough fl2. 1'1119 is VOU! total tall ..
FedOlslincome tax wllhheld horn Forms W-2 and 1099 54
1997 QSll/l1810d lax paymcnls and BmounlappllDd hom 199(j leluI n 65
Elmed Income credit. Ansell Schedule Ele if you have a qualilYlng ~,.r::::0X
cluld. b N0f11axableeslllud jn~olno: amounl ..I I {;;:;~:
, ' ~ ,.~,/
8ndtype.. 66. 1,369,
Amounl paid with FOlm~668 (roquosllol el<tenSlol1) 57
[1<(;058 6ociBIsocUIlly Bnd HRT A tBM Wllhhold (sue page 21) 58
Other paymonls, Chllck II hOI11 I DFOll112439 b l]rU111141J6 69
Addllnes501l111011 h59,lhesuUlo oU/total . ments ..
ItlineGOislnolu Ihanlll1d 53, Ullllllacllin6 63 trofllhno60_1111Ul!llho amoIJnlYOlJ OVERPAID
ArnounlolUno 61 you wanl REFUNDED 10 YOU ."
Ruul"'9 numb... 1--'-~.!i'!'.!'Jl Chuck"'g 0 SO."'9'
AccuunlllulllbfJI [ _.._____~
AIllCHIIllollilln01 llU wonl APPLIED TO 19VI ESTIMATED TAX" 63
UIHmtn 18 Ilkllolhan lUlU 60. uuLlrm:lllflOOOhomhl1ll fJ] TillS m Ihu AMOUNT YOU OWE.
ror d(J1Blh~ 011 howltl pay, Him pllq827 ..
E91lfllOlod lax punallv Alfjo 1I11:ludo on IIIIU l.i4 65
b
BONNIE M CLO\JSEH
Amounl 110m IlnD 32 (odluulfJd O'OUS Illcolnul
Chock II lJ You WOlD 65 01 oldO(. I] [JiIlld. U 5poUII 'h'1l9 65 01 oldur,
Add IhllllumbOl 01 VOllU9 chudud abovn nlld nnlU! Ihu lotnl l1ulo
It you 11{lllllrl1Ud liIing Bopnrotulv und YOllr npolluo 111l11111UU dudw..:lJonn U/
YOll woro 8 dual-slalus eilUIl, Glllt pago 10 lInd tllOCk horo
QUllnd
.. 348
.. 34b 0
184-38-0621
33
~
~~
,X,/;
/;/,u
/:/<<
?;?::;
>j%:,~,
/,.,,//';-
'////
",//-
~;/,>?;
35
>:-:,.;.
'.-;,.x<;.
,'/,',cr
6,050,
36
[nlm
tho
larg.r
ul
YUUI
36
31
31
3D
40
41
42
43
44
40
41
42
43
749,
..
35
:;-'~
31
31
3D
5,300,
0,
0,
44
46
41
41
45
40
60
61
62
63
54
6&
66.
61
61
50
60
61
62.
.. b
.. d
63
64
66
~ "{}lJl hlqruUUro
~
DaHl
..
>:>'/'.:
,<'l/:
-,,.,:,,/;(.
',~'/
/<(~
;~y/j;
,-:;~/~,
;%'
%(;;/.-
//%;-,
//1/1-
46
41
41
41
41
60
6\
62
%,0,
63
612,
',pOlIl,t!!.l LlqnahHll II II IlJlnlll!hJ/ll. nOT II111U!it !il~]1l
011111
0,
612,
;;t/
0j'
I
:~
%'
~
60
61
62.
:1'J:
W
,~
:!~~
////;
1,369,
7
757,
f'rl!lliUI!I!; ... !lain
~i~!J.I~~ll~I_~fJ _r ~l.."'~\....loj}.....:_~',.jf. '~.J~__ _ ... J! ~ 1 I')H
IUIII'j/HIIIlH(lJlVfj!J/!~dJl_1 .1~_lt_IJH'V rt\~:Tl-:I.'rJ ;-('I\X' :;1
ll!wll un~IIc'YHfllllHJ liT I'}II "1'-11'-:.-'- I"
1111~__~__ \. , .' ~ ~lrf 1\
Paid
Preparer'.
Ule Onlv
KRA
lu'," 1040 (10811 IIIto40 2V I 10
1",,,.1,,,/1...,., "I .'.q'" "1'lll ""Ii I'". ~ H ,., '''~. .,,,
64
/ '/-'_./ )< /
IIt',ll!lI'"IIU", tll fl"'U!), I dln'.,.tb.I 111......"1111.1111". "1,,,,, .,,,l".'-"'''I,llIvtllg,,ll'l1ul..,nd .I,lImI'1l1.. loll lu Ih. b'llol my~nlly.rl.dg..nd
1,,,1>.1. 1111} I" UVI,' 0"'11. .I'd '.!l"'I'II'I" Ii", 11,.1,,,n ,,1/""1'''''''0;11;11 11,." 1,:a'll.v"I,' Illlli.lll un "lIl!llu,m.lmn "I wh'j.h prep'!'1 h.,.ny knowl.dg..
YOUI OCt:lJpOIIIHl
S^LES
5potH>(fG oCUJpnlion
(:huck II PI(!PIUOf'UBUC10160ClJlIly no.
!;1!1I.umplll_VHd U 204 -- 4 8 - S 00 1
FvF'L'--- - [IN 43-1632899
....-.,"~.----,,-_._._-- lIPU1~ 1'7112 - 4 905
fnrml040 (1001)
.:' '" ... ...'~. ~....... ..
. ....-..'.-
PA-40 1"1"17
"I7001U330
L
164 -36 -Ob21 CL ~ 0 FY 0
8 0 RS R
CLOUSER 80NNIE M AC 0 FS S
2470 VALLEY ROAD PN 717 -"IS 7 -2b09
MARYSVILLE PA 17053 SC 50bOO
LA 0.00 18 0.00 ],( 0.00
2 0.00 3 0.00 4 4335.00
5 0.00 5A 0.00 b 0.00
7 0.00 6 0.00 9 4335.00
10 0.00 11 4335.00 12 121.00
.. -"~-------------------------------------------------------------~----------- - . -_.-------------------
Pl.... Fold PIg. Along Thll Un.
Flocol Y.II AI..., MIII1< Ihll IpOC.,
II Ihll Is on AMENDED lelUm,
MII10hll .~.c.,
QpUon lor I 1811 BookJlL IIvou do nol"",nl.1888
T.. Booklal n... V.II, MlII1llhll .pIC., II vuu Iln:d I
PloplUlH, uk II h.or .""Is u.lng Ihl. opllOn,
D.ytlme Phon.
Number: 717- 957 - 26.1'0'
184-38-0621 CL
CLOUSER
BONNIE
M
2470 VALLEY ROAD
MARYSVILLE PA 17053
Loc.llntorm.Uon. Enlorwhsfo)'ol'.r' .'.1 as of 12131/97.
Counly: PERRY
Munlclpollly: RYE TWP
SchaolDI.ll1ct SUSQUENITJ\
n..ld.ncy 51.1U.,
Fill In onlv on. chalco,
R X R..ld.nl
NR Nonr.oId.nl
P PIU1 Yell Resld.nl
ham:
10:
TVp. Flier, Fill-in onlv on. cholc.,
S X 8inlll. F
M Ma"l.dFlllng J
8,p.'II.I,
D Du....d D.t. ot O..th:
fInal
MIIIladF1Unll
Jointly
8chool DI.trict Cod.: 50600
85N, Nlm. or Addr... Ching., II ANV ollho lbov.lnlormlUon VOU .nl.r.d II dllf.,.nll,om
VOUI 1998 PA I..,.lum OIUIO libel, .nd II you did nol m. .1988 PA'.lurn, mlll1< Ihll Iplce,
II
lb
Ie
2
3
.
8
51
n
7
"
o
Gf08IPATllXabluCompunaetionfromW-2IonnS8ndotherwlIgoallltorTlOnls,..,.,.,.......,....... .
Unrelmbure.dE1r(>IoVIIOBu.ln...EJ<p."...flornPASch.dul.UE """"""""""""""",
N.IPAT...bleCofTll.n.IUon,Subttactlln.lblloml. """"""""""""""""""'"
PA T,,"blelnI8l1llll, CofTlllol..ndIU.eh PA Sch.dul.Anov.r'I,OOO ,',',"""""",',,",""
PA T..lbI. Dlvid.ndl, COfTlll.t..nd IlIleh PA SehoduloBllov., '1,000 """"""'..'"",..,,,
Notlncofnoor(LDaalfromOperltlonoIBuslnoss.ProlossIOl1orFlml ."'.','..",.,..",,.....,...
Nal Ooln orltolll horn Ih. Sol., Ekehlng. a' DI,poslUon 01 PropOl1y , , , , , , , , , , ' , , , , , , , , , , , ,
AmounloIOolnEJ<clud.d(I,omPA5cl1oduloPA'19) '" ,',',',",'
Nollncoll1O 01 (loll) 110m Ronll, RoVoIUo., Pllonl. Ind CopV'ighl1 , , , ' , , ' , , , , ' , , ,
Estatelnd Trult IncorT18 , , , . . , . . . . . . . , , , . . , . . , ' , . . , , , . . . , , . . . . . , . . , . . . . , , . , . ,
Gombllng Ind lollOlY W1l1nlng. "" . , , , ,. , , , , , , ., ,,',',',,",',",'"
Total Ora.. PA Taxabl. Incom.. Add th.lncom. .moun" from 111108 1C, 2.3,4.6,0,7 and O.
DO NOT 8UBmACT ANY (LOS8ESI REJ>ORlt.D ON L1NE8 4,5 OR a , , , , , , , ,
CONT1lIBUTIONS TO YOUR MEDICAl SAVINGS ACCOUNT (II' plgo 2a) , , , ' , , , , , , , , , ,
NET PA TAXABLE INCOME. Subulcrlln.l0I,ofll,'n09 .."'..'"..""..'"""..',,,....,..
Tolal PA To Liability, Mul1lplvlln.11 by 2,B%(O,02B), EnlOl VO<JlI.. duo "010 Indon Un. 13 on plgo 2 , ,
1. .00
lb ,00
Ie .00
2 .00
3 ,00
4 1,335,00
B ,00
81 ,00
8 ,00
7 ,00
8 .00
9 1,335,00
10 ,00
11 1,335,00
12 121,00
.
10
11
12
. _.-_'..-'r._......-r~-...
".,.'~""'''' ----...t.,'.I'r-'f!'.~..~..
..~. .-:t:"'!...."lt '-.l~"'- ... ~.. ,
.
\: ."~'"
.......
.::.
" .:'
, ; "t:i;:iii~~L~~lliii.jk:~~~
~';'!','11002:L:L331l '
I.
"
. ;......,1.
--.J
PA-~O 1'1'11
PAGE 2
L
"" ....:;'!~'~ I..;
CLOUSER BONNIE M 164 -36 -0621
13 121. DO 14 0.00 15 0.00
1b 0.00 17 0.00 16 0.00
1'1 0.00 20A 1 20B 7105.00
20C 121.00 21 0.00 22 0.00
23 0.00 2~ 0.00 25 0.00
2b 121.00 27 0.00 26 0.00
2'1 0.00 30 0.00 31 0.00
32 0.00 33 0.00 3~ 0.00
35 0.00
13 TolaI PA To Uoblllly , ,
EnIIllYOUrt..dullromUnl'20nlhenf1tpage..""........"",...."..""..""".."".. 13
1. TolalPATuWlUlheldfromW-2loltT11 ,..., "'..." "':"'"":"1':""'" .,...........,........ 1.
15 C'edll lrom your lvvoPAlncormTaxRltum....,.... :,; .,',';, ;:,...., ;'.....",..,.."", ,,',' '5
, . " .
'6 1DD7E.1tlrnaledlnstallnwnIPlyrnenbl.,............ I I. '.', ..... I. II..... I.'........,.",.,.".. 18
17 Plymonlmldewl1hyourtIqUlI81lorln...enDlonoIUrmlonleyour'VV7PA-40"""""""""",,'7
Unl till lor nonl8llclent Plrtnl.., Ihareholcle.. Ind mlmbe.. only
15 T..wIIhheldureportldonyourPASchedul8(I)NRK-l, , ,.. ;'""..""""", ,..", ....""", '0
'V Total Tax W1lhheld, Plvmen1llnd Ctedlta. " ,
AddUn..'5throughl0 ".."""",.."""", :",..,.,....,..""..",.."",....",.. 'v
Unll 201, bend. 1"'0 Ulllnlormlllon !rom PA Schedule SP ;,
201 Dependenll, PIrIB, Une2 . , ". , . . . ,., ... ,. , :. : II ;1, , ,",",'. . , .,. ,', . ,', , , ,. . , ,.. , ...., ,. , I , I. 20.
rob TOlolEllglbllllylncoma,PertC,Une" ........",,, I..; :;,..,..".. ,;....",.."..""".." rob
20C T..ForgIveMaCledlllromPII1D,Une'8 "..",:..,,,..;.,',',,,..,,,,,'..,..,,,,..,..,...., 20C
21 Tolol Cledl1 forT.... PoId to Other 511... or Counll1ea,
AnlchyourPASchedUIe(.)GorPASchedule(I)RK-l """""""""""""""""" 21
22 PA E/r1>loymonllncenllve Plymont CfedJl ~
AnochPASchedule(.)WorPASchedule(.)RK-' orNRK-1 ..",....",..".."".."",.., 22
23 PAJobCl8lllon T.. Cledn. Anach your certl1Icate 01 C18dll lrom the PA Departmenlof Corrmmlly Ind
EconomlcDevetopmanlorPASchedUIe(.)RK-lorNRK-l ','"....",.."""""",...."", 23
24 PA WUle T1nl RecycUng Inv..lmenl T.. Cledll, Mlch your certl1Iclle 01 aedlllrom the
PA Department 01 Envlronmenlol Ptolecllon or PA Schedule(.) RK-l or NRK-l , , , .. , , , , , , , , .. , , , , , , " 24
25 PA R..elll:h Ind DevelopmanlT.. Cledl1 """"'"",.."...,...."..",.."""..""" 25
20 Tolol Plymomund Credlta, AddUneo 14, lVand2OCUvough25 , , ..-:, , , , , , , .. , , , , " , .. , .. , .. , , " 28
27 TAX DUE. Une'3lamorelhlnUne28, Enlllllhedllllll8ncehllle ., '..""" "," """""""'" 27
28 OVERPAVMENT. Une28 II mo,e Ihonllne 13, Enlerthedlllerencehere "',""","""""""" 28
2lI Retund - lImounloline28youwlntul.hlckmolledblckloyou ,'"""""""""""""", 2lI
30 CredU-- lImounl 01 line 28 you wanl U Icredlllo your 1DD8 Eatlmaled T.. Account """""""'" 30
31 Oonlllon -- lImounlol Une 28 you wonllo give 10 Ihe Wild Reaoutce Conl8f1llUOn Fund ,;"""""" 3'
32 Donlllon -- lImounlolUnuoyouWlnl1o give 10 Ihe U,S, OlytrCllcCormiltoe, PAOlv\.lon """""'" 32
33 Donlllon -- lImounl 01 UnU8 you wlnllo give 10 lI1e Orgln Donor Aw"ene.. Trull Fund, , , , , , , , , , , , " 33
34 Donlllon -- A1munlolllne2ByouwlntloglvllotheKo,eeMelnomMemoltol,lnc """"""""" 34
35 llon.llon -- Amounlolllne28you wlnl 10 glvI 10 Bte,,"nd C8lv1colC.ncerR"'''tl1 ","',"",',' 35
TIll lolal 01 IIn"" 21 through 3B mUll aqullUne 21,
818"""'''')' Unll" pln,IU" 0' r.rl"", I dnll'. 'hili hhl ..,ml"ld thl"llu,n. Includll\g 11I1c.tolllp'"r1ng .ell'dlllu,nd ILlt.m.nl..
,"lIlolh. II". of '" ou, bll. Ih, "' tur.. COffleland com 1.11.
Yo",Sill"'luft 0.1. YOI/I
Ottup.lIpn
SpOIl....81""lluI. 0.1. !!pu"u.
fluuplllQn
121,00
,00
.00
,00
,00
.00
,00
1
7,105.00
121. 00
,00
,00
,00
,00
,00
121.00
,00
,00
,00
,00
,00
,00
,00
,00
,00
S/\LEIl
h,tPhlO' Numlt"
71 '1/ {')2, 120;!
'1700211336
. .o-!'..-.....t '":"- ." I' I ~
" :\>jll~;; . ~~r;:;..,'~,. ". ';;':T,.:;;,~.~"i.';u.:' t";:".,3i~;,;"
... .~ ..t';~\ N~' .',: ,!.9t.~'lJlIU~ '\'1Ui'tll~~.''I'
PA SCHEDULE SP". ,- \, :~...'..:"'" I'~f', ,I'" '0:,;4"
SPECIAl. TAX FORGIVENESS CREDIT' ',,:W~,.'n 0],],],], 3 3 "t' : \
;' ....., .
PA'8P(OI'I7) PAD!l'AATMENTOFREVEHUE ,';" '
En,OI you. nanw .nd Soclll 5ecu~ty Number, Ent8/ you. apou.e'. name and 55N e.el1lln1lng .ap",a,ely,
You, Nan.
BONNIE M CLOUSER
5pou..'a NlI/tl8
- "H'f~' ._.a. . .~...-. -
,.", .
'. I
, ' ,
. . j~:'" -'..... ....;' ,
,.,1-1"'''1-1, ..',
lll~'~tl , .'
:, i ~ ;.1 ,; \; ,,~i ,:,. ,
l. '~'. :::;"'! ;
':- ".,[
L
1997
Your Soclll SocUllty Numbot
184-38'0621
SPOU60'1I Social SOClJllty Nu"\oor
PART A, C8I1llIc.1II 01 Eligibility, Check one 1>0. only and .,,1.. all olh.. ..qu..'.d Inlo""ollon,
1 SINGLE S lamclllni 1..101 I..n......n.1I Ibl.clllmonl.
2 MARRIED (J) F1Ilng alolnt I.. return .nd PA Beltedul. 5P, W.lI1lIdBlning lax lo.gl.."... JolnUy,
3 MARRIED (M) FUlng ".p8l.lIItax ,.lUrn and PA Beh.dul. 5P,
My"""u... being clBImud u. d.p."dunlon Ih.lederlllrlCOnMlI., '01"/11 01 (Name)
.nd (Bocllll Security Number)
My opou.. h.. Ponnrylyanl. taxable Income ond Ie nllng ...p",al. PAr.lUm (Check on. 1>0.) Y.. 0 No 0
M u...nll . PABehedule5P, Checkonebo.: Y.a No
4 OECEA5EO 0 I amnII onbehaltol.dece...d urwonwhowouldhay. uBl/n.dlorlaxlo. lye"""",
PART B, Oependenl Chlld.en '
" O. endunlNIlIT18 0
ANDREW CLOUSE
1, Provlde all thelnfonnallon ",quested lor each dependenlchlld, '
A e R8I.lIonohl Soclll Secu NumbOl
10 SON 210-66-5330
TolBllnco.ne 118"
.
.
.
.
.
.
2, Number 01 dependenl chlld.en clllmed 10. I.. lorglYel188ll pUIp.O", U..U,la number and Unel1lrom PlUt C below and one 01 II'.
EJlglblllty InconwT.blue 10 celcul,'e you. l..lorglyeneosCledlt. ": ,::,::""",.."""""""", "",",""" , '" 2. 1
PART C, Eligibility Incom., For Ihla PlUt, IInllng u 5lngle, Monted, Filing Oep8lalolyolto. a Oeceuod laxpayer, u.. YOUR Column, II IIl1ng II Maroed,
Filing Jointly, you complele YOUR Column and your apou.. complel81the apou.. Column, Then, add lI,e Column. and ','" Ihe JOINT
COIU'M amounla, Your ou.. Jolnl
" PA T..able lnoome hom you. PA To Roturn, . 4,33
2, Nonl..abIe Inl.81" Olvldunda, ond Glllna, .
3 AlImony $ 2,77
4, lnour"""" PICC88da ond Inh.lllUlC111 .
5, GIIIa, Awarda, .nd Pr1zea S
6, Norvll8ldenllnconw $
7, NonloableMIIUery Inconw, 00 Nollnclude Combol Poy, S
6, Galno Exduded On The S.le 01 A POIlOn" Reoldence, .
0, Nonl...bIe Educ.lIonlll....lIlalllnce, .
10, C.ah paymenl ,""",y.d homperoona outold. your hoU~hold, S
1\, Tolol8l1lblll Income, AddUneallh.ou h 10, . 7,10"
PAino, CaJoul.Un" You. To Forgl.en..o CredUo YOUR 5P
12, PA To Uablllly Iro.n you. PA T..'elurn $ 12
13, te81 Relldenl Credit horn line 21, $
14, Nel PA To. Uoblllty, Subu.clUnel3 homUnel2 $ 12
15, POICenlllge 01 To FOIglye.,... 110m ",. .pprop.lolo Ellglblllly
Incorm Table, U..PART 8, Uno2and PART C, Uno II.nd
hom Ihelu 000"1&1 find YOU! POlc8111lua of laxlurglvono!JlI. 1,00
10, Tuforgtvln...CredlL M\llllpl~ u". 14 U'r tht dlm",1 on tin. II.
Enla, hare .nd on your PA Tn flaw," $ 12J
._--
'17IlHHJ3'1
o
O"lyll.llh.
d'J1,nd.ntchlld
Dr chtldllnth.l
yOll".cla.mlng
onyou,hd".1
lncom,III
,.Iu,",
s
.
$
$
$
.
.
.
.
.
.
'lC/
';:;'1fl
"",~,
!;~
~/{i
~, <' ,,', . --V
, ,K~-
:':.'::;;'~i~,__
E/llto, IltdmaJ; ,
__. ",' ~1Val8!1.!.::-t-
Fltn J
use Table 2
s
.
S
$
$
$
.
S
S
,
$
JOINT SP
S
$
$
$
'17()1111]]'l
--.J
,
A
Principal bUBinos8 or plainsman, IncludIng product 01 servlco lnoD pago C-11
ANTIQUE'S ANTIQUE'S
Profit or Loss From Business
(Sol. Propr1.lor.hlpl 1997
... Plrtnerahlpa.lolnt venturi I, etc., mUll file Form 1065. AttBchmonl
~ AllJlchloForml0400rForm1041, ~ S..lnltnJctlona'orSch.duIIC Form 1040 , Se uenceNo, 09
Socllla.cur1ly numbor(SSN)
184-38-0621
B Enl.r pr1nclpll bualn... cod.
see e oC-6 ~ 4614
o Employ.r 10 "umb.r(EIN), IIlny
OMBNo,l&4e- 74
Schedule C
(Form 1040)
Oa,,111mlntolthl ""'UfY
Inllfnll RI....nUI StlVIU llllll
Name 01 prop"elor
BONNIE M CLOUSER
C
Business name. II no soporotobuSHlOSS nnrno,loQ\lo blank.
B C ANTI UES
F
G Old you "matorially porticipalo" in tho operation 01 this bUSlnoss dUllIlg 19971 II "No," 500 pogo C-2lor Umlt on lossos . ~ :oa Wo
H If VQU started or aCQuired 11115 businoss durlna 1997, chock hOlo
Ipart I I Income
1 GrosBlocolpts 01 8010s. Caution: If thts income was Icpor1od 10 you on FOJmW-2 Dnd 1110 "Statutory
emplovee~ box on that 101m was chucked. see page C~2 and check horo ~O 1 11,397,
2 Relull19 and allowancos 2
3 SublJectlino2lromllno 1 3 11,397,
4 COSI 01 goods Gold (lIomlino 42 all page 21 4 1,900,
6 Gross profit. Subtraclhno4110mlillo 3 6 9,497,
6 Other IIlCOmo, including Federal and 5lato gasoline orluellax credit or rotund (500 page C~2) 6
7 Groaslncoml. Add lines 5 and 6 ~ 7 9,497,
Ipert III Expenses. Enler e.r enseslor businoss usoel \lour home onlv on line :10.
6 AdvertiSing 6 125, 19 Ponsion end plolit-sharlng plans. . 19
9 Bad dabls from Gales or 20 Ront or lease (GOO pogo C.4): @
sorvices (see pogo C-3) , . aVlhlclu.machm.ry.anlJlqUlpmlnt 201 1,200.
10 Car and truck oJl:ponaos bOther businoss property 20b
(60e pogo C-3) 10 21 Repairs and maintenance. 21
11 Convnlssions and 1009 . . 11 22 Suppllo. (notlncluded In POll III) , 22 379,
12 Depletion 12 23 Tax09 and licenses. ~
13 Depreciation and soctlon 179 24 TraveL meals, and entertainment:
expense deduction (not lncl. a Travel 24.
In Pert III) (.eo pogo C-3) 13 bMosls and on-
14 Emplovee bcnelit programs Icr10lnmcnl
(olherthononllns 19) 14 e Enter 50% 01
16 Insuranco (olher than health) 1S line24bsubjocl
16 Interest: @';~ 10 Iimllalions
(,ee pg, C-4)
. Mortgage (paid to banks, ole.) 161 d Subtr8ctline 24c lromUllo24b. 24d
b Other 16b 25 Utllltios 26 3,458,
17 Legol and professional 26 Wages (loss employment credits). 28
services 17 27 Other (Jltpensos thom line 46 on
16 Olllcs OJl:oenso 16 nono 2\ 27
26 Total expenaes boforeoxpullsus for bU9inos9 use 01 homo. Add lines 0 through 271n columns ,~ 26 5,162,
29 Tentallve prom (loss). SUbtract hno 20 from Iino 7 . 29 4,335,
30 EJl:ponsos for business uso of vour home. Attach Form 8829 30
31 Net profit or (1088). Sublractlino 30 110m Uno 29.
. If a prolit, cnter on Form lo4o,lIn~ t2,andALSO on Schedule SE, line 2 (r.lallJloryull1ployous,
seepageC-5). Eslates alld tJusls, unlor on Form 1041, IIno J. 31 4,335,
2470 VALLEY
MARYSVILLE,
Acc,u.1 (3)
RD
PA 17053
01hol (spocllv)'"
E
. Ualos3,youMUSTgoonlolJno32,
32 II you hove a 1059, chock tho boll lhat descrlbos vour Illvoslmenlln thiS actlvlly (SOO pago C~5).
. "you chockod 328, orller lho loss on Form 1040, line 12, D.ndALSO on5chedul. SE, line 2
(stoMory employees, tieD page C-5). Eslalus and trusts, erllOl Oil Form 1041. IIno J.
. it you chocked 32b, you MUST al1ach Form 6198.
KBA For Paperwork Reduction Act NollcDI see Form 1040 Instructions,
}
}
32a 0 Alllnvestmontls 81 fisk,
3:Zb 0 Sarno Investmenlls nol
otllsk.
Sch.dulo C (Form 104011997
5chC-1040(1997) rOC,tV 1.16
Fll.m Sufi....." (uIJY"Uhl lIHlIllIlI1l Hlul l ,_,. ',e,,'l I", Inr
1 84 - 3 8 - 06 2 1 Pog.2
33
Melhod(s) used 10 luwOl 01 (:051 OthOl(attach
veluo closIng Inventorv' I ~ Car.l b lJ OIIl111r!l.el c 0 B)Cptana\lon)
Was UlOID any change In dOIOllllllllf1g qusnllllu!3, cosls. 01 'Valuations belwoon oponing and c1oslf1g UlvuI11ory7 If "Yos," allacl1
ollplanaUon
InvOIlIOIY 01 boginnmg 01 voa,. If dlth.llllnl1follllosl VOSI'S closing ItlvenlOlY, al1adl okplanallon 3&
34
36
36 PUlchoses 1058 cosl 01 1101119 wlllldrawnlm pUl501101 uuo 31
37 COSI 0118001.00 not Includo salary paid to VOIHBOlf 37
31 Materials and supplms 31
31 Othm costs 31
40 Add IInos 351hrougl139 40
4' Invenlory 01 end of YORI 4'
42 COil of ooda lold. Subtl8clhne411romline 40, Entor the rOBullhufo Indo" . e 1, I1n84 42
Pert IV Information on Your Vehicle, CDmpl.'.'hl. part ONLY il VDU." cl."n"'g C., OlllllOk ..p."...u"
IIno 10 and are not rcqUllOd to We FOlm 4562 lor Ihis bUSUlUtJB Soe Ihe UIDlIllctlonl1or Une 13 011 pogo
C-3to Illld oul il YOIJ muslfllo
43 Whon did you placo VOUI volucle In lilllVICO 10' blJUI'lefi5 purposes? (month, day, v~ar, ..
44 Ollho lolall1umbor 01 nlllesyou dlOVllVOlJl vulllt:lu dlJIII'g 1997, fjlllmllm fllJfl1Utll Olllllluli you uliod VOI.r vuhldelor'
. Business
b COflll1llJllIlg
o OlhOl
45 00 you {or YOUl spouse} have arlOlhm volllclo il\lRllablo lor pursunal ljl:iD1
41 Was your vehicle available fOl use dUllng ot1- duly hoUls"
471 00 you hav89videncelo supporl VOU! duducllon?
b lI'"Yos.~lslhoe\ljd9ncBwfllloll?
I Part V I Other Expenses. USI Ufflow bUBHlP.S9 11)( allsas nol includedonlinUl8-26 or line 30,
41 Tolll other ~~f!~_...!_._,._t,:,~~~II!_I_~Il~IIBlldOlII_)ll~JI_ll 11l~~:1;!1_.
KSA
SchC"040(1DI1I file 'V, I.
I Illm Cijll...".t "I'l"V'" '\1111> "111111",.. I.. '.t.." pi d't
1'41
Y..
Y..
Yo.
Y..
o Y.. ijgNo
1,200,
2,500.
3,700,
1,800,
1,900,
No
Nu
ND
ND
6thedul, C (furm 1040) 1997
"
..~,..:""tt"'!II~IaIIIIIn;:".....--r.r." .
, __\'" _ 'f~,ll""":'IiI!1~"""_".""",-,,,""~41'u,-,._,-::::,
--.----- ."-~.. ~.-
PA-40-C (t.lfl
,
.. '::'l-l',ii-:~~;:'_~i;~"';'
" ""I'~'.~1"t'l' ;..,-.r~'~I:J,'. '" .'
.",;f~:,',< j;'.' , 'l7113HJ.337'",,,,r;:,I; ,
COMMONWEALTH OF PENNSYLVANIA
Pro", or (Loll' From Bu.ln.1I or Prololllon '
(sotE PROPRIETORSHIPI
SCIiEDULE C
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192,2
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; p,oducl UI "H~k:O ..
r~ ut rAn'MINIOI III ~IIWr
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Sudlt IOCUllty flUl1llMlIUllllUllIlo,nl
104-311 t),,~!1
l\NTIQUE':.J ,,___"_'__'
c '..pIYIM ltlalllllk:llInfl IlUllllHII
AII.eh 10 101m
PA-.O, PA-85 01 PA-.l
nl .1 Proprllt., II .hown on PA Wlllum,
JNNIE M CLOUSER
','.,lIbu.ln....c1lvlly ~ ANTIQUE'S
Uu.ln...NIIl.. ~ B C ANTIQUES
nu.in... .ddl... (numbol.nd 111""1 24 70 V l\LI~EY RD
Cily, SI.I..nd ZI Cod. ~ MARYSVI I~E Pl\ 17053
Molhod(.) ul4ld 10 valu. cIollnQ InV.llloIY, mO/~ Ihe epPIOPIIII. bo"
(1) ~ Cost (2) 0 1oW8l 01 cost 01 nw~.1 (3) 0 Olh.1 (1Iolhor, .lIach.,pllnllloll)
^ceounllng ",,'hod milk Ihl epploprt.l. boN: (1) DCalh (2) !tlAccIUal 1310 Ollllu(npucily) ~
Wa!l1hofB any chang. In dewminlng qUlntlUol, colli or va!uallonll>olween opunlng and clOllng Illvonlory1
II '"Yos," 8n8ch BMpllnlUon.
Old you doduct DMpensol tor an atflco In your homo? .
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PART I Jlloon\.,;q"i>
"". ,--y,~""- .~~,;;':,:."
t a GroBltecelpll or 11181 ,...,.,......,.,.
bRe1urnlandaJlowancel .".....,.......,..
eBaI.nc.(IUbV.ctllnllbb.mllne1.)""""", '
2 Caul 01 good. ICIld IIld/of op..Uon. (Schedul. C-1, IIn. 8)
J Gro"plolll(IUbVaclllne2I,.mUnele)" ,",","
" Olhef Income (anachechedule) IncludulntOf8tlllrom accounts 'UCOIVlbI8, buulllun chnddnq au:ullllln,
.nd olh. bulln... accou"", Aloo Includo laI.. 01 opOl.UOnal....IlI, Boo III.vucUOn.llooklol.
5Tolallncomo(.ddlln"31nd~) ..'"'....".."1"......""""",,,,""" , " ~ II
". ~._:..:::.. :.'..-;;:"'t-~:".nv~f~m.:'.,.:::~I;-~\- ~;;n.;.:~n.?:.}.k-nc:M:-,\'{,..: :r:~~1i.':~~5:_t:~F.":;~.,.:r,~..:,,.,,_: : ,"::, . 't"'; 1.(~.~) 1::
PARTU:--.DIdUOUon. ~~lT~~'~ .. ~!~':in""'}i:t;,;;f~':;~:- :._1~"'-~'-!-.<-~,~~~,t.~'<l,-!~.1 ..<\~t'l- ~.~~< ,_, - ,;.,.,~ .(::' " '" I," '.
.i-::!.;:'j;~~h;i~"'~ili~l!~~. "~~J~-~~'4j;fl;';i~;;;l,;:~W~nli" .}~~t,J...\:<'.~.f.t,.,l<.f-:ii.i.".;..!,,".-."....,....'m" ,
0; Adv.rtislng 125 , v:rillrj(~I'I.'.;'t':'\('4'
.,.....,...........,..... .,>t'~Jr:rt~'~T;-, l~l~i'~t;~'H[
1 ArrKlIUZDtion. . ,. . . , , ,. ,.......,. .... ,*.'~ ,1~d:.i1il;~)lt.il-~-;;-~~~d:}~iI
o Il.d d.blllltom.a1.. ol..rvIcoa , , , , , , , , , 311 Wag..
9 Dink ehO/g.. , , , , , , , , , , , , , , , , , , , , ' , ,
10 C8I8ndltuck..p.n... , ," , '" " , , , , , 32 Olh''''"U"s''(I"uclly):
11 Corrnil8lonl... . . , . . . , . , . . . . . . . . . . . a
12 Oopl.Uon...... , ,,'" '" , ", , , , , , .. b
13 Ooplocl.UOn (..plain In Schaduie C-2) , , , , c
14 OuelandpubUCatkm. .i'.....,.:-....... d
15 [,"play.. ben.fl' pIDCI""" .lhlt,,,.n In lIn.11 . ·
16 rlulghl(nollnclud.don5ehaduIeC-I), ,;, ' .." ,.' ~ ' I
17 Insurance. , , . . . . . .. . ,...,.....,.. g
18lntorestonbu8lneulndebl.dnOlI II
19L.undry.ndeIOlnlnQ"""""""", 1-
20 togal.nd plolOllllonal...v\Ce1I """", I
21 Ollle88uppll.."""""" ' , , , , , , , , , k
22 ".n'lon."dp'olll~.h"lnlplt""a"lIIploy...... I -------
23 POlil8g0 . , ,. .,..",.".."".,.,.. n\ --~---
24 R."lonbulln...proporty""""""" 1 200 "
JlS Ropalr. . . . , . . . , . . . . 0
20 5uppll.. ("ollnclud.d on 5ch.dul. C-l) " 3'i9 P
';'7 T8)(08 , , . . , , . . , . , . . . . . q ----'.-
;cn lolophono .. .. , . . , ____ I -.'^-------- ---------.'
~9 lravollndonlOftalnmonl . . . . , . . . , "'Ihll' "."UI" II' It.. tldll "1111"'"
3J ~t.dlll' III"". n" I . "I\.I"lllvln, 'PI
_~O UIJ~... .. ..... ..l.ri.?.!!. ___~~~~.,I~I~'~!.".'.."th'f'A III
J~ 111101 dudllcllon. (Idd OII1OUlII.I" colur",,"lol U"os 0 Ih"'Unh 32f),~'."IlI~1.~UI0 J.'l' ,_ ' '.': _ '_~:":"'.,.c~ __ ,_,__ __,~:.Ll. f, 2
J!l Nul profit or kJu (8ubb..1 Uno 34 hom Une &) EnlOf tulalllfllO Ind 1I1111lU 11)IIIIlI1,I.1U IIllflllll'^ 11\1111111111
118I1u\loaallllhown, l1IRlM 1I1Q bOil: and UII~~ nn '11II,,!PI_I!_~1IIDI~~!~~_I.lf_~I-~.!-1A.IR.~-I-lIlllI11 ...,..............--'.... U :l1'l
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.;,~.,.,..,tt~'~l,~l.\~ih .:ff.fi . .l'~~':i~~'~': ,,(......~..:.4.I"..:..:....,..'.~
..... '. .>." . .'1.". ,," J..,oIIV':U,.-1 "l4'f!l. 'lfrt; ...._.1.) r . '"' , . '. "..
t. J'I - ._.r. .~t...". .,.. 'II.~"',' d. ,..-. . '-, '1, ': I.;: _"
--.J ' .,'. ... .. P,::-:' .o::i:f' ~7032]']'33S. .: . " '; '"
. 6ClfEDULEC -,,,., .. '\1",1 ..... ., ~'..~'",. ,-...,
'."U~,_,;:"'''~t':i'':~T~;',r'*.t~',t.t''\L\....I'''\ ". . .. ......
PA DEPARTMENt 0; R[VENUE .... '\-- . .,.:~., ~t r~~O \l.l~~~;~ b~ .:::" . L.. '
'~""'~"l 'j!=! 't'~~'1 ~.
N.m.oIProprl.laruohownonPAla.,.tum. '.:'.,G:,:~;j\ IH "r.:'i~~l,;: '.:: .. . .,' ... Bode!5ecuIIIyNumber
B~~}'~~.~ir!c;"LOUSER< :'~~,.,' " ~;~I,.:;=;~r~~~II~dl"".'" ~",,; "1"184-38-0621
ii,.!. i'~ v {ri~-M, ~ ~ ~"l:,f'f ~ '<', , i\~~~U:
SI;;MI:Du~; , DliG ,8 , '''''1113'1 ~,.. ~'l- ." ,'.
~> "'>j"'<'~>ill:~,'-; *,,~ ~lt"i,~.hf~ I ~*i<l "ii~t~':.l::.~ ,ro l!l'....'-"'....
1 Invenlol'/ .1 beginning 01 YUl (II dln..enllromlulye....dolllnglnv.nlol'/..noch..pl.n.lIon), . , ,', , , , , : ,'" .
2 . PUlChu... - ,. ..':. ,,'..,>....,: 2. 2 500
........,.,..,.".,....""".".."'.11.....'. f'.
b Cost of Ilsrtlll wtthdrawn for pBf'BOnaJ U80 , . " ,.. , , . . , ,', . :'.' .~., . ::; 2b
e BaI.nce(.ub~.ctUne2blromllne2.) . .,:- ....,. . . 2e
.,..".",.."....,.'..111"..,.....,....".,...,...".
3 eo.lolI.bor(donollncludo.lIllypaldloyouroolf) "",..;. :;'" :.:;:::",.,.,.,..",.".."".." 3
4 Maler1l1und IUppll... .. . . ..... , " . , , .. .. " . .. , " .. " , :. " , " . " . .. .. . .. .. .. , .. . " .. . " . .. . 4
5 Olhel eO.1ll (.naeh schodule, .. , " , " " " .. . .. .. . " " " , " . . .. " , , , " . " .. . " .. . . .. . . , . .. .. 5
6 Addllne.1.2e.3.4.nd5.".... ..".. ..."....", ."" ,".."...".., ,.........,..". ",,, 6
7 Invenlol'/.I .nd 01 yell. . . .. . . . . .. . , , " .. . .. . . " . .. .. .. .. .. .. .. . .. .. . .. .. . .. . .. . .. .. , " . .. 7
6 eo.lolgood.8(lld.nd/o'op...llon.(.ub~.ellln.7lromlln.6)EnIBfhel..ndonPOIII.lin.2 ".,',...".~ 6
" :.s :'''-'',; :->':' '''''~,?:::,~~-''': :~". ':.. '.-" ", .' " >';,';*"?:" l'\:~::-~~:~~j;t.rF~r::.?~;.~,,.!':';t ~-r-},,;,:'O ',~" ;.;'.' ',.-~.. -.:,.r~.i;~:,~':~:-:!f~'>>.j: _"~~~.
SC,~~~J:fti~~~i~,;~e~~~82;t~;<_t~';i :.kj;it~it5~~~i ill1Z&~~~~L{{~;;L~;i;:~1}$a~;~~j;j~:~(:; ~'..,~.~
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1.200
2,500
3.700
1.800
1,900
Oalo eo.lor '. Oeprecl.Uon allowed or
.e~~~led Olh"!eb cllla ,. allow.bIe In plio' Y.1l1
(., Ib, leI (di
1 Tole! .ddIUonlllil81-y.OI d.plsclaUon (do nollnelud.ln lI.rm below)
2 OlhordeprecJ.lIon: '-. '..~>::~::~;:;. 'L,-~';~I2;~.g~iE:rm!~fj ttl:~:"SlC2L,;~'~S~~:;L;
Building.
Furnllurelnd ftxturo9
Tt .nsportatlon oqulpment
MaehlnlllY &OlllBl.qulpmenl
Olher(.peclly) ____U_n..
OeocrtpUon 01 plOpBf1y
M.thQliof
cornp\ltlnl
d,p'r:,.t1on
Ut.
or:~18
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Dopr9~18Uon lor
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3 Tolal. .' {t j., .\.'~ .. ..'rli n l-l<! r~ 1;2..., ..r!,:-! .....' ,
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.. Ooprecl'Uonclalmed'lnSchod~klC-1 ". '.:~. :~~.",~~PI'r1l~~~!(;'" .,>. ':. .-'
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5 Balonce(.ub~.ctflno~lromfln03).Enl.lh.'.andonP0I111.lIn.13 ~ 5
s6iti~:q~J~~il.~~:~~1~~~W~~>>if~~Iiti~i~f~~.;':~t:.,;~:f~i;lfl:;~Ill1f[:'..
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ena.. dllSCl1bed below. .nl.. Ih.llIOOunl 01 Ihd ..pen... and d08CIlbe tho kind. 01 co.ts Incun.d and Ih. bU'ln...
.n... -'>, .: Amount
,,'
II you 111ClJ,.n
UlpOBO.
A. EntOfll1nmonllsclll1y (boa~ '88011. ,anch, ele.)
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B. UvlnglCCOnmod.lIona(..r.oplm,..,loyooaonbualn...) :<.; il..,,";:
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C. Vocaflona lor youl""'l. you, Il\T'4IloyllO!l or IhoIr 18lIiI1eo. :.' ..: ,~ . '$' '~."!! :, I.
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'1703211335
.,
'170J2BJ35
IRSN()TICE 974
INovemller 1996)
"
~-_..~-----~._"._...__._-
Welcome 10 Ihe 1040PC Formal lax Relurn
Thank you 100Ioklnll PAil In Olll 1040rC rlllllllll Tn. H,.luln pll'\lllln! 1111. 1040l'C Inhlll' IIffll/a Iho nccllIocy 01 0 compulor
plnpolod InlulIllhnllHS can pille".. InOlll qllickly And, don'l WililY. unlllll 0 1040l'C lulllln won'llnclooso YOIll choncos of
being audllod
1I.01l180ne 81so 1""1"1100 YOW .ollllnlw VWJ. VlltJ w.1I "n ,..k,.d 10 "Ilnlhn 1040l'C IIIhlln "nllllll nllllllnll II 10 IHS You w.1I 01.0
be ulven 0 cupy 101 YOW 111..0. "'"' VOIl IIIIIV ""IIII'nl " ropy 01 Y"1lI II,hllll In Ihn lrmlllion"1 hn 101UII' fOllllol or 0 Legend
"De.cnption" Popel II YOII pwrlm.u WnWIIll! 1IIIIIulln\l1040rC 01111 plnllllll' VOIll own 'OIUIII, ho SIlIO III sllln Ihe 1040PC leluln
you send 10 IRS ond kel!p 0 t:Opy 101 VOIJlsull Alloeh oil rllllll5 W ~ 111111 olllln od,lIIlonollnlollllollonal laqulled lorm. and
schedules 10 Iho back Ion flllnnl III "'I! 1U41l1'C on,I'"ll:III." povmonls Bllll pOYlI\llnl vlludl.l. "you hove 0 1II01llng label, u.a
II, bulll1ako sUle II doos nol !:llVnr ony Inl""'",lilll' on VOIII Inhlln
The 1040PC FUlmal Tnx Ht!hHII dllflsl1llllllho"". VillI! II" plllpnlllllll II!! l'l\lft 1/11011111111011 "ol11lr~S obout your Is. account.
You n.ed 10 fJie 0 FOllll2646 III 66211l1\ll1l1l1lll' 1'"'1"""1 P"W"I IIlallllll"'V III'IIIIIl W.. , 1111 '''nlll YOIll plepoll!lllmllnlolmalion,
You Can Choose DlrecllJepolil lor Yuur nulLJlld
1 he 1040PC relwn allows you to lIu..." Vow IUflUld dttllotJlh'd tlllf'lll" 1111" Vlllil tHlvlllU!; 01 c:IIIJl:kulU hank account II for some
reason your requ661 IOf t!ilod dHpmul wouht tll1luy YUill 'f'IUlld wn II fif'lId yllll It PUpt" dHH~k
· If 'rOll Hre fillllY U jOlllllltlUlll, Villi I it'l IIH\f'~ VIHI! Illftllllllll"Hl!illf'tl Hilt) II Jlllnl Illl'llllllllor you Bnd your spouse or 10
your own oecounl, or lu ~tHJl tilJllllMI fi HI I tJUllt
· If you and yow f;IK1USO fUn tWPi1lultt ItlhJlII!;; Villi' 11I111111111111 Iw d"11Ilhlll'd 10 your own account or 10 a joinl accounl
101 YUU olld YIllJl spUU'"
· U yuu afe il 6111'110 111m )'lllllilllllillill yOIJl IHhllld dl'lll11illl'd lit ypUI IIW!t IHTiJlHlI, but '10110 a Joint account.
If you dlOose direct depo~lt fOf YOllllI'hulIJ '(IJlII hlUl1ltlllW 111111111 Iflltllfl illlllulll/lll\ tIlU dnpohll to he mnde. This signalure, and
tho dhect deposit i11fOftllBtiufl hfiled (III If 1ft Ifillll'l ilIH uti Wfll\llflll III JI'III 1"i'l )'11111 ''''Illust You tfun't need to send any ploof of
occoulIl, such os 0 vUldod cltock '" dllp"'11 .1,1'
Use Ihe Voucher When You Make Your PaYlllanl
A paymonl vouchor OlOY ,,""1 WIlh Y"III 104iJ1'c "'h"" .1 YUII 1111'" "'lllllllti II PIIYlIlI",'I ho IlIlormollon pllnled onlho voucher
will ensU/e thaI your paYlIlellllo fll""rllv ""I',h'" I" VIII" Ill. '"'"11111 W.. "II"'''"I1U'' VOU 10 file your rolurn eally and send your
paymolll wilh Ihe !loymolll VUIll:h", '''I'lIloh.IV III II 1111I" "'!!lImll... ApIII15 ""0 'In I"
Call UI If You Have Any QUllllon. Aboul Your 1.. or H.lund
You ala lespolIslble 1011l1Uklll\J SIlll! 111111 V"'" 10401 't; Ill.ltlll' '" Iii,.., , ""'''IIV 111111 "" 111110 You con gol onswolslo mony lox
qu05llons, Includlnlllofulld III'l"lll"S IIV' nllll'!l "Ill ,..h. l,u 11111111"'1 1", Y"''' ""'" which Is IIslod In Ihe logular Form 1040
booklel you lecaived "you roll I ele In. 01111111 V"1lI 1I"IIII,'"IVO Vow ''''11l1 sorllllly nlllnber (or, "you mad a Joint relurn, Ihe
nn;t social SBCU/ffy nlllllber lialed). Ihe IiIlIlU sInh" oh""," on Vow I"h,," IIl1d lito ".acl lefund you are e.pecUng, Don'l call your
bank. II Telo-Tax \llYa. you. dala when we l.slIod y"ll. lohlloj VOII shollhl'orelvell wllhln a waek after Ihal dala, If you havon'l
received It by Ihen, call YOUI h,..eIIHll"If"e If 1,,10 In. ""e,nl ulve you A lolund dote, and you mad your 1040PC Format
Relurn more Ihall elUhl wuk. pllor III YOWl 611 ,,,"101.'1 YIIII! hll:IIIIRBofflcB
Paperwork R.ducllon Acl Nollee
We uk for IhelllfurmaUun (HI lite 1040PC """Inl 1.. 110hlllllo cOIrY oullhe IlIlalnol Revenue 10wI 01 tha Ul1l1ad Statas. We
need II to flgwe end collecllhe IIU/.I omollllt 01 III' YOllllllllt give III IIlla InfolmaUon to participate In Ihe program.
The eIUmol.., avereueIIIllI"eo"..110 'oPY e",",I.11I 111111 I" nil yuw relU/lllo IRS IIslng Ihe 1040PC 1010101 Is 151111nl11es,
which Islonllltnll ftllllU 1110 IrUlllol1 111111 104IJ 1111111 1 04llA. U. '01111 1040El Tho limo e.lI",alal lor Iho olher ecllvlUes Involved
III pre"ollllg youI lellJIII cell ho 101111" '" voor lOll" Ill40. rOlmlO40A. 0/ FOlln 1040EZ booklals.
" YOlJ have UlftlllWllhl nl)(1l111hn UI 1.111111 )' Ilf 1I1ul!lIt llllm (Itlllllllttm. Of stJUUf!slJoll8 fill l11aklng FOlm 1 040PC simpler, wo would
11f' hAPPV In h.ol "0111 VOII YOII'''O ","I.. 10 ,,,,11. ",,' 11I11lI1I1I1 HltVl'lIlItl COlVIe.. olld lite Olfice of Manage me III and Budgol 01
Ihe addresses shown 111 VUllllin IlfHlklulb
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~Se~~lcePltts.' 1m'
.
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In preparing your tax return, we have ensured that:
o Your return is CIll11plete and all inClll11e has been reponed, including:
1"x.,Nrll,1/r ,'rJim'/ I"x.,h/,' ,o"al J/'amly brl/t'jifJ al/ olh..,. illwolt
tllxuhle PI'11.IWW Jump.ww diJrrdm/lfmJ
o All appropriate ,bluttiu", .1I1d .,djustl11etm to inUll11e hill'l' been c1ail11ed. including:
u/ft'f!l/,/oJmml ',1.\ .hll'i1J);J Ir;rlJi/,..Itl'.III'OMb} f11l1"0)1.'I.' bU.li,It'JJ t'.\jJaJJfJ
frlln'1!lt'1J/ . 111.\"(,,1 I,I'\" ,.t'/UnJ 'Wt1'i/r,,'I;IJlI Fe
,,/iII/Oil) p.,i'/ .I"//laibl, IIllrnll I1l1nlll/rlll 'X/,fIIJt'J
mOl'ing e:xpr1/.ltJ ,-b.,n/.,ble (o1l1UbllllOllJ Jhmd.1rd Jfdllfl;01l
o"dicaIU'III,,1 Cal/lallyilhr}i loml ,.W/llpliom
o All relevalll credits and payments have been identified and claimed, including:
chi/J/d,pmdtlll .a'" bUJillw mdill p,io,.-year ampaYII/'1lI
IlderlyldiJabltd adopliall paymelll u'ilh ,x/fmioll
foreign lax uilMaldillg excm SS and RRTA
larlled illcam' fJ/ imam
o Your sme/city return has been carefully prepared to your best legal advantage,
o Selected items have been ,delllified for review by anmher Ljualified tax professional:
P',I/'e of MlIld 1'0/111 2.555, Illv. ",' JO.jI!Nl? IIlbr,.:
Sd'r,It"r K -I 'r""'1Il "II/ploy,', rxpfllJt'1 IO'dl hllm:
Commellls/Tax Tip:
Our service doesn't end here. \Xle also:
o Provi,]e infillmation abuut tax law changes that apply to yuu:
'.'/Iildl g.lI/IJ eJ/I""iall mAJ
J.tlr of bOil/I' ,bt/'/ m'/if olbfl'
o Offet additional, related products and services such us Bluck Will Kits, College financial Aid Kits,
and l'taa of Milld,
o Explain what happens next with your return and answer all your Ljuestions,
o Describe how Hal'id Hcfund works for }'ou,
o Plan for the refund you want lIext rear, Ihrough estinHlles or )'IlOr Form \V-4,
o Provide Tax Hecord Books alld Tax Hecord Cards ilS appropriate to rour situation,
o Explain where }'ear.mund 'l'rV1Ce is .lVadable alld desmbl' our guarantee,
o (,ive rou a husiness card, l'xpl"illthe Send-A-Fril'nd ll,rtili,att', and ask rOil to recoll1mend us to
Odll't!
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THE LAW FlAM OF
KILLIAN & GEPHART
OR1GlNALD cc8QT 1 5 1998 \UL
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HARRISBURG, PENNSYLVANIA 17108.0888
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'1. 11I1lil1'1 I Ill' 1"'lio<l ul ilhll'tivily, Plaintill WilB not
I lnilll<'Lllly ,lid., I" 1111011 izl' 111<' no tdull <liVOICI',
Il,
AI pIP/lI'nt. 1'1,1 i III 1 I I III
lndlwially abl., to move fOI- il
no laull divol"l' dnd lI.w lelju"lJlI'd lIill .II!01'lWYIl to finalize tllill
llIat t p) .
'J, Jl"/Io1ul ion 01 tllill mal 11'1' would bl' bellt eflectuated by
dlluwin<J I'lilil1lill 10 111l1Vf' 10) il 110 fault divon:", aB oppoaed to
dil3l11iHllilllJ il lOll want "I iwtivily, hpl'dulle P1aintifl 0)' Defendant
would I,,' Il'ljllill'd 10 IiII' il ae,'llnd Complaint in Div'))'ce, thus
plulullllinlj IlIe mal 1'1') 101- at lealll anotllel- ninety (90) days,
WHEREFORE. I'lainl i If Inaya tlliB 1I0nol-able Court not to diamiss
tllia mattel I())' wilnt of activity, thlneby allowing lIim to move fOI-
d 110 fault divolce.
Respectfully Submitted,
Killian? GePhart'----_
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, Paul lIe]vy, Eaqu' e
218 Pine Street
1',0, Box 81lG
lIalTiabUlg, PA 1'/108
(717) 232-1851
Attorney I,[), 1153148
Dated. October Il, 199B
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~HI ~AW FIRlA OF
l<ILLIAN 8c GEPHART
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IN 'l'IIE COURT 01' COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
RICHARD L. CLOUSER, I
Plaintiff I
I
v. I No. 2908 CJvil 95
I Civil Action - Law
BONNIE M. CLOUSER, In Divorce
Defendant
PRAECIPB OF Al'PBARANCB
'fO 'l'HE PROTHONOTARY I
please enter my appearance as attorney for the defendant,
BONNIE M. CLOUSER.
DATE I (, /11 '.5"
~" 1!. WAbU;
Debra K. Wallet, Eequire
24 N. 32nd street
Camp Hill, PA 17011
(7171 737-1300
1.0. H239B9
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\\{\'J I \ "KILLIAN.. GEPHART
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HA"""llJI'IO, P,NNIYLVANIA 17101,O,,1l
ORIGINAL
CERTIFIED COpy
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IN TilE COURT OF COMMON PLEAS
CUMBERLAND COUNTY , PENNSYLVANIA
RICHARD CLOllSER.
Pluillliff
v.
No, 95.29ll11
IN D1VOI{CE
BONNIE M, CLOlISER,
DctCndalll
I'ROOF OF SERVICE
I, Dchm K, Wallcl, Esquil'c, hCl'chy cCl'tify Ihat nn Dcccmhcl' 11. 19911. I sCl'vcd II copy
of mWENUANT'S COUNTER-AJiFIDA VIT lJNUEll SECTION 33111 (d) OF TIm
IHVORCE COUE hy lil'sl dass mail. postagc pl'cpaid, addl'csscd In:
J, Paulllclvy, Esquil'c
KILLIAN & GEPHART
218 Pinc Sll'cct
1',0, Box 8116
HlIl'l'ishul'g, PA 171011
tJAJ/lL ~. u.......-
Dchl'll K, Wallcl, Esq,
24 Nnl'lh 32'" SlIccl
Cumpllill,PA 17011
I.D,II239119
(717) 737-I3IHI
AIIllt'ncy fill' I>cfcndanl
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IN TilE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
IUCltAIW CLOUSER,
PIlIintiff
v,
No, 95-2908
IN DIVORCE
BONNIE M, CLOUSER.
Defel1llllnt
ANSWER ANI) COUNTEltCLAIM
Defendllnt. Bonnie M, Clouser, hy her 1I11onley, Dehl'll K, Wallet. Esq.. respollds 10
Ihe COl1lplllilltas follows:
Answer
I. ADMITTED,
2. ADMITTED in pllrl, DENIED in pilI'\. Defendllnl is IIl1l1duh individual. who now
resides al 2470 VlIlley ROlld. Marysville. Pennsylvllllia. 17053,
3, ADMITTED,
4, ADMITTED,
5, ADMITTED,
II, ADMITTED,
7, ADMITTED,
Ii, ADMITTED,
Counterclaims
Equitable Distribution
9, Plaintiff amI Defendalll arc owncrs of various items of pcrsonul pl'llperty. furniturc.
and household furnishings. as wcll as intangiblc propcrty such as IIn illlcrcst inPluillliff's
pcnsion and rctircmelll accounts, all of which havc bccn acquircd during thc marriagc IInd
which are suhject to equitable distrihutilln,
10, Plaintiff and Dcfcndalll have incurrcd ccrtain dcbts and obligations during tll':ir
marriage which are subjecttll cquitable distribution,
II, To date. Plaintiff and Defendant havc hccn unahlc to agrec onthc division of this
property and these dchts,
WHEREFORE. Dcfcndalll rClluests this I1onorahle Court to cntcr a dccrcc equitably
dividing the parties' property and cquitably apportioning thc partics' dchts incurrcd during
thcir marriage,
Alimony and Alimonv Pendclllc Lite
12, Defcndalll docs not havc sulticicnt incomc and funds to support herself and her
minor child cithcr to providc Iill' thcir rcasllnahlc nccds or to maintainthc standard of living
dcveloped during the marriage with Plaintill.
13, Plaintiff docs havc suflicicnt incomc and funds 10 support thc Dcfcndant during thc
litigation and aftcr the clllry Ill' a divorcc dccrcc,
WIIEHEFORE, Dcfcndant rcqucsts Ihis I10nllrahlc Conrt to clllcr a dccrce awarding
Dcfcndant alimony and/or alimony pcndcnlc lilC,
l \!UlIsl'll"ccs.J.\!H~J!!!!U~!!.:Illi:~
14, !,Iaillllll has 1II111111l'IIl'cd Ihis divolcl' acliollagaiml Ikli:lldalll allll .1> a ICMIII of Ihc
al'lioll, I klclldalll IIlIISI l'llgagl' alld pay all allolllcy 10 dl'klld hl'l,
15, As 1\ fUllhcl II:slIll 01 Ihb aclioll. Ikkllllalll 1l1li'1 haw l'cllaillplopclly apprubcd OIl
1111 cxpcmc which ,hc CIlIlIlOI atloid Oil hCI nmclIl illllllllC,
16, l>elclldalu i, ullahlc 10 plovidc 10101 atlonl hCI l'IIlIml'l kc" cxpcmc" IIlld lIIsls
dlllillg Ihl' pl'lIdclIl'Y of 11m aclloll alld Ihrough ils Icsl1ll1l1l1l1,
17, !'llIilllilf. whl1 b Pll'Sl'lllly l'lIlpll1Yl'd alld Il'l'l'lVil1g 'lIhslalllial illllllllC alld hl'lll'fils.
is IIhlc 10 pay 101 l'lIlJIIScI kcs, l'XPCllscs, alld lIIslS 1111 l>elclldalll.
WI 1I",HEI'IlIU" , Iklclldalll ICljUl'SIS Ihis 1Il1lll1rahlL' 1'111111 111 l'llll' I all OldcI ICljuil'ill1!
!'lailuillll1pay DclclllllllII's cl1ullscllces, cxpellses, alld l'IlSIS 0' Ihe divoIl'e liligalion,
lll'spel'lflllly suhlllilled,
_~J.m..1tdJ~ .
Dehl'a K, Wallet. hlj,
24 Nmlh 32"" SlIeel
Camp I Ii II. !'A 17011
II), /I 2WII'I
17171737 DIKI
AllolIIl') '0' Delendalll
Dale: I>cl:cmhcr 11, 199M
II' PINE .1~ln
ORIGINAL
FES 0 4 2000 b!J
C~RTIFII!D COpy
fHE L~W FIRM of
KILLIAN 6: GEPHART
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tiARRISBURG, P~NN5YLVANIA \1108,0886
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RIl'IIAIW I.. l'IllllSl'lt
1'luinlimPclilhlller
: IN Till' l'Ol 'In OF l'OMMON 1'1.I:AS Ill'
: ('l fMIII:ltIANI> l'IlIINTY.l'l'NNSYIVANIA
v,
: No, 1)5 - :!I)O!l t'idlTerlll
III INNII'. M, t'I,I)( ISI 'It
I kll'ndant/ltespollllenl
: l'IVII,AlT1<IN-IAW
IN IlIVIlIHT
OIWElt
ANIlNnW, ",;, r ~ ",,',,' ~
, 2000, pllrslIanltolhe ullached
Petition, Ihe appoinllllenlof'!', Itohertl'.lider. II as 1Ji\'OI'CC Musler in the ahovc,cuplioned
ucliol1 is herdl)' revoked,
11'1' Till,: ClIl fin:
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