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Home My WebLink About95-05500 . . .................... .......... ...... .. .., ... ... ... ... ... ...~...*.,'.*:...::....... ..... .'*;13 . - ,--- ~-~l' . . ! IN THE COURT OF COMMON PLEAS : . .. . OF CUMBERLAND COUNTY : ! STATE OF '* PENNA. : , . . . . ...RUTHANN ..NISWONGER, .. .. ... ..... Ii . _ N () ..95.,:,5500.. ................. . .: ....................... PLAINTlF~~ . . .. . . . ~~ . . .. . ...PAUL..F ...NISWONGER · .' . . .... DEFENDANT '. - ~ ; DECREE IN i ~ DIVORCE . I d AN~:";.p~Ps::P.PP. ,..eiL III.ordo:~n;: . . ecree a.. .. .. .. .. Rll'IH. ANN .NISWONGER.. .... .. ... ....... p , . and. ... . .. . .PAUL ,F.. NISWONGER.. . . ... . . . , . .. . . . .. . .. .. . . . .. defendant, . are divorced from the bondl of matrimony. W . . . . . . , ~ . lL. i . . .. .. . " . .... ........ J. ... . ProlheJnol."y" . . .. ... -:W;-_.~-;i::".*.' .... '*: -:ai. '.:'.~.~:<<: ......;.. ... iJ. The court retalnl lurlldlctlon of the following claims which have been railed of record In thll action for which a final order has not yet been entered; ~OwUJ ............. ....... ...... .," to ...... '0" ....... .......................... ............. "", ....,.. ...... ...... I...., .... ....................1.....' '::5.';( j,;/ J'fr/ /Jf~.d/z 4. rtJfd~~~ .5of Pt '7Wk /Wo'.A'w ~ 4f ..u'~wI RUTH A. NISWONGER, Plaintiff vs. : THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYVLANIA : CIVIL DIVISION - LAW : NO. 9S-SS00 CIVIL TERM PAUL F. NISWONGER, Defendant : IN DIVORCE PRAECIPE TO TRANS~IT RECOR~ TO THE PROTHONOTARY: Transmit the record, together with the following infonnation, to the Court for entry of a divorce decree: I. Ground for divorce: irretrievable breakdown under 3301(c) of the Divorce Code. 2. Date and manner ofservlce of the Complaint. November 14. 1995 by certified mail, restricted delivery to Defendant's counsel, Arthur McDennoll, Esquire. 3. (Complete either paragraph (a), (b) or (c).) (a) Date of execution of the Affidavit of Consent required by fi 3301(c) of the Divorce Code: by the Plaintil1: 4113/98 by the Defendant: 4/14/98 (b) (I) Date of execution of the Plaintiffs Affidavit required by t 3301 (d) of the Divorce Code: (2) Date of service of the Plaintiffs Affidavit upon the Defendant: 4. Related claims pending: none S. Indicate dale and manner of service of the Notice of Intention to File Praecipe to Transmit Record, and attach a copy of said Notice under t 3301 (d)(I) of the Divorce Code. 6. Date of execution ofthe Waiver of Notice of Intention to File Divorce Decree u required by fi 3301 (c) of the Divorce Co : by the Plaintl : 3/13 8i by the Defendant: 3/14/98. .( i ~ Lfl ~ c: .. "'. en ::')...-r ,~ - '3~ - on: q~ If ex> "'i0 N I~L.; ~ Cl:: <.1]1'1:1 F ~ \iiu.. ~ ~ a t.l_jmJl!!i!Y",,*...~.tl!'" . 0" '~'.~._..,~.. . ._+'\~~'_ _A,<_,'-,. < WHJIIUUlORE, the Plaintiff requn.. your Honorable Court to dec.... that the Plaintiff be divorced from the Defendant. COUNT I. MARIlIAGE IRRETRIEVABLY BROKEN 7. In ICCOrdance with Section 3301(c) of the Divorce Code, the marrille between the parties II Irretrievably broken. COUNT II. EQUITABLE DISTRIBUTION .. PIfIIfIPba I throuah 7 of the Complaint are Incorporated herein by reference u thouP lit forth in filiI. 9. Plaintiff IIld Defendant hive acquired property durina their marrille from Auauat 26, 1973, until the date of their lIparltion. 10. Plaintiff IIld Defendant hive bllll unable to II.... u to III equitable diltribution. WHEREfORE. Plaintiff reque... your Honorable Court to equitably divide all marital property . COUNT III . ALIMONY II. Parllraphl I throuah 7 of the Complaint are incorporlted herein by reference u thouah lit forth In full. 12. PlaintifT lackl luffici.nt property to provide for her reuonable mellll IIId II unable to lupport henelf throuah approprllte employment. 130 PlaintifT requirel reuonable support to adequltely maintain he,.elf In accordance with the Itllldard of Iivlna ..tabUshed durlna the merrille. I verifY that the 11IIementlln the forelllina pleadlna Ire true and correc:t. I lUldentllld that f.... llIIementl herein Ire made lubjec:t to the pen..ti'l of I B Paes 4904 relatlnl to \IIlIWOm falliftcalion to authoritlea. ~ . e;f ~~;;n~;:~/t "'1,J1 ,.:!.. 'J t .s I f. s s ~ -0 r1) l.$ Q. ~ 0 0 to " l_. 0 lJ) It) ~ 0 - .<~ 0 0 I'- @ FE '" I- V) It) It 0 f~ :.~. C , ~ 4'..:. ' , ~ <:> ~~L',::':~ V) ~ Of rf) c ~l;lC'-'. \ If) It... 'T:l. . r- -. r6 ('") t.'t._.; I 11 +l .'> ., ~ j d- ,>') "'" - ... ~ Rum ANN NISWONGER, Plalntlft' : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL DIVISION. LAW : NO. 95.5500 CIVIL TERM : IN DIVORCE VI. PAUL F. NISWONGER, Defendant I. A Complaint In Divorce under Section 3301 (c) of the Divorce Code wu filed on October 13, 1995. 2. The marrillle of Plalntlft' and Defendant I. irretrievably broken and ninety (90) days have elapaed from the date of the filing and aervice of the Complaint. 3. I conaent to the entry of a final Decree of Divorce after IlerVlce of notice of Intention to requelt entry of the decrees. I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HERBIN ARE MADE SUOmCT TO THE PENALTIES OF 18 PI. C.S. 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. DATE: #1'1/15' ~:fJ.. dh-n ~rP~z:h- Ruth Ann Niswonger. Plalntlft' ~ \lJ ?:: ",J -. ;:i- - , .. UJ~~ - 'd.J" {'i. ' ~- , :i" ..- ~[, A- :1 :"~ ..:J" '"- /t~ ~' - 1,. ,. . .~. 17:1" rG ItJfn 1\- :)CL.. F-: c:; ,. =''\ 'I. 00 0 0 C7\ , , ... ~l /J- (- ..1. 1\, ,C, .. " '''In - , .,' f. i';! '. J ~: 't. J, , .~~'j t" ~ It' ' - ) ! fIJ. . r..: , /;.:/ I 'J. & ", _I,}tL C;.) ..-.0 ;,,') Ul (J > UI .,. [~ .-I 1- ~': .. :':.i U-'C; (,).. [t' i'ii, .....~ " r - 1"-< - . =;i i. -.. Ir, - <l.p', 'f r.,:" "U: '1, ~: 'f-' '1t ~.. . '- ft~ ~ ( ", l - i -c' -..... ~ll n', ; :J(i1 'I~: u, ~'f(~ ~~ ~ (0 :'01 (J' u vs, : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY. PENNSYLVANIA : CIVIL DIVISION. LAW : NO. 95-5500 CIVIL TERM : IN DIVORCE RUTH ANN NISWONGER, Plaintiff PAUL F. NISWONGER, Defendant WAIVER OF NOTIC~ Of IND~TlON TO REOUEST lNTRY OF A PIVORCE DECREE )lI~DER SECTION 330IIC) OF mE DIVORCE CODE Ii 1. I COl\Jel\t to the entry ora final decree in divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property. lawyer'. 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 ofthe decree will be sent to me Immediately after it i. filed with the Prothonotary. I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa. C.S. 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES, DA TB: 'I ~ I J - 'I f" (a,J ~~.~ PAUL F. NISWO GBR, De ndant f " , ?" j: ~ 0\ r: It'; 1-- .. r'-' IlJh' - .~<' I'" .' ....( . ,..: , ~i, ',)t.::i r ' -... co. (...) in 'j'- ;i:. " , it b r-" j')ir] I' L ;}~ I:... "-" II CO ~::J CO tI' U ;F, ~ ,.. to r "RtmI ANN NISWONGER, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : CIVIL DIVISION . LAW : NO. 95-5500 CIVIL TERM : IN DIVORCE VI. f.' PAUL F. NISWONGER, Defendant " .'. ? ~FFI()A VIT OF CONSENT 1. A Complaint in Divorce under Section 3301 (c) of the Divorce Code wu filed on October 13. 1995. 2. The marriage of Plaintiff and Defendant I. 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 requelt entry of the decrees, I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa. C.S. 4904 RELATING TO UNSWORN FALSIFICATION TO AUTHORITIES. DATE: '1-1)- P ~ /!.uJ ~ -'/ ~V'-- Paul F. Niswonger. Defendan( n ~l, \ ~ en (.: II') ,~ .. l';: - ;"~)"l. 0,- \):J' lJ:: ' I.:);'..: r- ,'') 'i~ ~,- ~ ....... - "{'~J .~ j . .J_'" Q- j-':-: ~; u: .qttj 1,1. .... :':':"L 0 ~ ~ (J r.; ff. ",", ~l .~' I . RUTH ANN NISWONGER, Plalntlll' : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY. PENNSYLVANIA I v CIVIL DIVISION - LAW PAUL F, NISWONGER. Defendant NO. 95-5500 CIVIL TERM IN DIVORCE CERTIFICATE OF SERVICE I, John H. Broujos, hereby certify that a true and correct copy of the Complaint tiled In the above-captioned matter was served on Defendant's counsel. Arthur T. McDermott. by Certified Mail. Return Receipt Requested, restricted delivery. a copy of said return receipt evidencing delivery being attached hereto. Said setvice on November 14. 1995. /~1~ John II Broujos, Esquire '{ Attorn for Plaintiff ~ BROUJOS & GILROY. P.C. 4 North Hanover Street Carlisle, Pennsylvania 17013 717/243.4574 7171766.1690 FAX 11717/243.8227 , . v P, i! 6 6 :L3 i! -l!I2-'. .4::. Recel\: for 40 ~Oel~~~.n~ ~~!~Ig. Plovldld J .\t11r.\'l:U 00 nol un 'Of IntuIn,Uonel MliI ~ 1500 Revollol 'Uth' hJ ~ Arthur T. McDermott .~ ~ '111...1,1'''''''', SO E. Hi h Street III l>ca~li'~r;, PA 17013 . ,!;S" (. 10 1'''U~III' (:11'1,1...,11... !>lW\",- i1""~I.rf I r.. flnhl!.lt'du.-""I'.,ft'f m H.'''tllll'''ll'I'I!i''u",'''q en lu \\'1.111" '!laIr nt'''...,,] ~ /.10 110.'".., I~.., 1"1,1 !.~",,,,..\tllo \'0""''''. 1l41t. ",11 A'I,j'h~I"'" A.l,j'l'H flHAI "'1\'.I'J~ A','''' f'I\"Ifl,II~ (1' U..1I.' mtl.a"c. ..;). =1S" I'/tl/~ . ..r;IM~""".,.... ( \ , ) "- UI -. t,' c" (; r$ .. :).:, r' (0; ~:' (.:~ :- U:l,: 0:: .. 'r..:- \: I ~(" r.',J . :~.j [ilfi It: 1....-::.. rUt, .,:,,) - {in.),. I" ..., . : II, 1"'- ,.) 0 (J' I.) \:-' - ,. . . RUTH ANN NISWONGER, I IN THE COURT OF COMMON PLEAS OF Plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA . CIVI L AC'flON _ r,AW . VB. NO. 95-5500 CIVIr. 19 PAUL F. NISWONGER, Defendant IN IJIVOIlCI': :;'I'^IJ'II:; :;IILI':II' JIME: IIl"J' J V] '1'] L:i: ..-.-.----..---- " . . - ........-, -t_-'Ott.1 .I\~"'.L ,(.... ~) .",ill.... t.hi ;l~t. "'" l 'I. ,10 o,..e. 0' Dlvo..e. MAl,.... CUMBERLAND COUNTY COURT OF COMMON PLEAS 9 North Hanov,r Slre't Carllsl" PA 17013 (717) 240-6535 L ........ ...k..., II Divorce Maller ,.,..1 ... 0eIr'" Olllce MIIl.r/Repol1lr WH' ...... 697.0371 Ex!. 6535 August 20, 1997 John H. Broujo., E.quire BROUJOS , GILROY, P.C. 4 North Hanover street Carli.le, PA 17013 REI Anne M, Sh.pard Attorney at Law GRIFFIE , ASSOCIATES 200 North Hanover Street carlisle, PA 17013 Ruth Ann Niswonger vs. Paul F. Ni.wonger No. 95 - 5500 Civil In Divorce Dear Mr. Broujos and Mr. shepard I By order of Court of President Judge Harold E. Sheely dated AugUlt 18, 1997, the fUll-time Maater haa been appointed in the above referenced divorce proceeding.. The motion for appointment of Master indicates that Mr. McD.rmott repre.entl the Defendant; however, Anne Shepard hat entered her appearance in the action on July 2, 1997, but .he doe. not .tate in her entry whom she repre.ent.. con.equently, I a. a'luming that MI. Shepard represents the Defendant, and ba.ed on the entry of appearance I am sending her this letter with a copy to Mr. McDermott. A divorce oomplaint was filed on October 13, 1995, rai.ing grounda for divorce of irretrievable breakdown. No other grounds for divorce have been raised in the oomplaint. The complaint also raised the eoonomic issues of equitable di.tribution, alimony, alimony pendente lite, and cost. and expen.e.. I am going to proceed on the basis that grounds for divorce are not an issue. Based on that assumption, I am directing counsel for wife and counsel for husband to each file a pre-trial statement in acoordance with P.R,C.P. 1920.33(b) on RUTH ANN NISWONGER, I IN THE COURT OF COMMON PLEAS OF plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA I VS. I CIVIL ACTION - LAW I I NO, 95 - 5500 CIVIL PAUL r. NISWONGER, I Defendant I IN DIVORCE NOTICE OF PRE-HEARING CONFERENCE TOI John H. Broujo. Anne M, Shepard , counsel for plaintiff , coun.el for Defendant A pre-hearing conference has been .cheduled at the Office of the Divorce Master, 9 North Hanover street, carlisle, pennsylvania, on the 16th day of January, 1998, at 9130 a..., at which ti.e we will review the pre-trial .tatements previouslY filed by coun.el, define is.ue., identify witne...., explore the po.sibility of settlem.nt and, if necessary, schedule a hearing. Very truly your., Date of Noticel 9/25/97 E, Robert Elicker, II Divorce Ma.ter Ruth Ann Nllwonler Plaintiff IIN TilE COURT OF COMMON PLEAS OF :CUMBERUND COUNTY, PENNSVLVANIA VI. DOCKET NO. 9~.~!iOO Paul F. Nllwonler Defendant ...., U:> _I n ., ". I ',: ,: .).:~ ~ , ..."j ~ ' I Plaintiff Ruth Ann Niswonger moves the court to appoint a ma~ter with respect to tb~, ,'~) following claims: 'ii;J (x ) Divorce ( x ) Distribution of Projll!rtY '.-,\'" ( ) Annulment ( ) Support ~',::.j ( X ) Alimony ( x ) Counsel Fees ( ) Alimony Pendente Lite ( x ) Costs and Expenses and in support of the motion states: ,OJ ,"OTlON FOR APPO'~l'MENT OF MASTER 1. Discovery is complete as to the claims for which the appointment of a master is required; except that Defendant has refused to provide data essential for pension appraisal. 2. The defendant has appeared in the acllon by his attorney, Arthur T. McDemlott, Esquire. 3. The statutory ground for divorce Is Indignities (330\(a)(6)) and cruel and barbarous treatment (330I(a)(3)). 4. (a) The divorce action is not contested. (b) The action Is contested with respect to the following claims: alimony. distribution of property, counsel fee.~, costs and expenses. 5. The action does not Involve complex Issu of law ct 6. The hearing Is expected to take I day. , 7. Addltionallnfonnation, If any. relevant to e Date: July 31. 1997 r~ AND NOW, /1.. J r, ,/.L _,1997. f if Idt'l.LI- //tA~.-Esqulre,ls appointed m~o the following claims: alimony, distribution of property, counsel fees, costs and expenses. 7kJ;-l/ lJ. AlEO-Or-FICE OF T1~r: Ff1!)1HONOTMY . . 9HUG 18 PI-I 21 2~ CUMaEHI);xL) C:'lJl.fTY P~NNS)tWJol'II ir- (f) ~: ~m <'0.- .. :'~,~ C': _.. J ~ , )- '.' "J: I", u: c' ..;'1 [, I, ,;'J : r"i .. . " '" !t .cf;.o '-'I :f'J r...: .... ....,!l~ 15 r- ~.~ 0' 13 ._~ . .- ...... RUTH ANN NISWONGER, Plaintiff 1 IN THE COURT OF COMMON PLEAS OF 1 CUMBERLAND COUNTY, PENNSYLVANIA 1 1 NO, 95 - 5500 CIVIL 1 1 CIVIL ACTION - LAW 1 1 IN DIVORCE vs. PAUL F. NISWONGER, Defendan t ORDER AND NOTICE BETTING HBARING TOI Ruth Ann Niswonger , plaintiff John H. Broujos , Counsel for Plaintiff Paul F. Niswonger , Defendant Anne M. Shepard , counsel for Defendant You are directed to appear 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 Hanover Street, Carlisle, Pennsylvania on the 14th day of April , 199B, at 9100 a.m., at which place and time you will be given the opportunity to present witnesses and exhibits in support of your case. By the Court, ~~ \S . Harold E. Sheely, .1udge Date of Order and Noticel 12/9/97 BYI Divorce Master IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. COURT ADMINISTRATOR FOURTH FLOOR, EAST WING CUMBERLAND COUNTY COURTHOUSE CARLISLE, PA 17013 TELEPHONE (717) 240-6200 . . . RUTH ANN NISWONGER, plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 95 - 5500 CIVIL vs. PAUL F. NISWONGER, Defendant IN DIVORCE RE: Pre-Hearing Conference Memorandum DATE: Tuesday, December 9, 1997 Present for the Plaintiff, Ruth Ann Niswonger, is attorney John H. Broujos, and present for the Defendant, Paul F. Niswonger, is attorney Anne M. Shepard. A divorce complaint was filed on October 13, 1995, raising grounds for divorce of irretrievable breakdown of the marriage. Counsel have indicated that the parties will sign and file affidavits of consent and waivers of notice of intention to request entry of divorce decree prior to a hearing to be .cheduled in these proceedings. The divorce complaint also raised the economic issu.s of equitable distribution, alimony, and counsel fee. and expenseB. Counsel have indicated that they will not be offering any testimony on the factor or marital misconduct as that factor affects wife's alimony claim. The parties were married on August 26, 1973, and separated November 25, 1995. They are the natural parents of three children, all of whom are emancipated. Wife is 41 years of age and resides at 438 1st street, carlisle, Pennsylvania, where she lives alone. She is a high school graduate and counsel believe works as a waitress at the BBQ Pitt in carlisle, PennsYlvania. For purposes of a support order entered on August 12, 1997, the monthly income for wife was computed to be $568.00 net. Wife is receiving $140,00 per week for spousal support plus $15.00 on account of arrears. Counsel are going to inquire as to whethe~ or not wife is entitled to any COBRA benefits in the event of a divorce decree to provide medical coverage and counsel are going to determine what the cost of that coverage, if available, would be. There is an issue as to whether or not wife is working up to her earning capacity and counsel for husband has indicated that she may have wife evaluated by a vocational expert. If that is done, the report should immediately be provided to Mr. Broujos and to the Master. Mr, Broujos will then be in a position to do hi. own evaluation and perhaps request an expert of his own to review the report, There is a question as to whether or not wife has any physical problems and counsel are going to inquire a. to the status of her current health. There is an issue perhaps that she has had some problems with depression, Husband is 45 years of age and resides at 655 Forge Road, Carlisle, Pennsylvania, where he lives with one of the emancipated children of the marriage, He is a high school graduate and works as a truck jockey at Roadway Express. His monthly net income was computed at the support conference I hearing to be $2,089.00. Husband has not raised any health issues. Husband is a participant in a pension with the Teamsters Union and has also been involved with a pension with Volkswagon America Inc., a prior employer. Inasmuch as there does not appear to be sufficient assets in the case to do an immediate offset of the pension against other assets to be distributed to wife with husband receiving the pension, it i. recommended to counsel that they use a Qualified Domestic Relations Order approach to distribute the pensions. Counsel for husband was going to have the pensions evaluated by an expert but if a Qualified Domestic Relations Order is used, there does not appear to be any need to go to the expense of having a pension evaluation since we do not need to have a present value. It is suggested, however, that attorney Shepard prepare a coverture formula showing the number of years that she believes wife would be entitled to as the marital portion of each of the pensions so that the fraction perhaps can be agreed upon although we at this point do not have an agreement on the percentage of distribution. Wife is in possession of a 1990 pontiac Grand Prix and counsel havs stipulated that tho value of that vehicle is $8,500.00. Husband is in possession of a 1988 Pontiac 6000 station wagon and counsel are going to attempt to stipulate to the value of that vehicle. It appears after discussion that the $8,500,00 value that has been stipulated to for the Grand Prix is a date of separation value rather than the date of hearing value. The parties owned some real estate at Fayette County, Pennsylvania, which was sold and ultimately $10,000.00 of those proceeds were placed under husband's control, Those funds were used, according to husband, to buy vehicles for the parties' three children. Wifs's position, howovsr, is that she lost all control over the accounts and had no input as to how the monies weru being expended; therefore, ehe believes that she should be entitled to a share of the $10,000.00 that was distributed from the sale of the marital residence. Attorney Shepard is going to provide verification as to how this money was spent for review by attorney Broujos. At the date of separation we have a value for the Dauphin Deposit checking account of $93.00 and a value for the Members 1st Credit Union account of $497,50. Husband apparently received the benefit of both of those accounts, There are three $100.00 face value savings bonds. Counsel are going to get a value for those bonds and according to husband's attorney, husband has no objection to wife receiving those bonds, The pre-trial statements list two Teamsters Union life insurance policies; attorney Shepard believes that only one policy exists which provides a benefit of $75,000.00 upon death and that the surrender value of that policy is around $800.00. She does not know about the existence of a policy providing a death benefit of $25,000.00. Attorney Shepard is going to provide verification as to the surrender value of the policy which she knows exists and inquire about the policy which Mr. Broujoe's client claims may also exist with a death benefit of $25,000,00, There was an American Life and casuality annuity, and according to attorney Shepard that policy paid out $1,601.00 and husband received those funds. That policy no longer exists. Apparently there is no issue with respect to the distribution and value of household tangible personal property and we are not going to use any values for that property in the equitable distribution computation. However, there is a question about the value of a rifle and a shotgun. Husband claims that one is premarital and the other was a gift to him during the marriage. In any event, attorney Shepard is going to get a value even though husband takes the position that the rifle and shotgun are nonmarital assets. The parties have no marital debt which needs to be considered and allocated, 9-19~97 Z RU11I ANN NISWONGER, PIaImlft' : IN THE COURT OF COMMON PLEAS : OF cUMBERLAND COUNTY, : PENNSYLVANIA VI. . : CIVIL DIVISION. LAW : NO. 95 - 5500 CIVIL TERM :'IN DIVORCE PAUL F. NISWONGER, Defondant ~ , I. LJST or ARSm Defindant'1 Inventory and Appral...... pI'IIIII'ed In compIIancI with Pennsylvania Rules of Civil Procedure In providlni Idditlonallnformation relative to the marital .....1, I. belna filed contemporaneously with the fiIlnI of thI1 Pre- Trial Statement and will be served upon oppoalna counaeI by npIar ftnl-dua mall, JIOIIIII pre-pald. At the time of the fU1na of the Pre- Trial StatImInt, no muitall'IIicIInce tIlisted. Howe\W, the proceedl tom the aaIe of the marital I1lIidenc:e In Fayette CouDly, Pennsylvania wu $17,000.00. The partIa Ijp'IId that ... proceed.. auppIemented by the partIa' llvinp, woulcl be used to purcbue vehidtl for their three c:hIIdren. At the time of aeparatlon, the partlea owned two motor vehideI. Neither party tranafemd title of their respective motor vehlclea to lid! other. The Plaintiff cIaImI that a 1915 Corvette II owned by Defendant, and II therefore marital property. The 1915 Corvette wu owned by Defendant'l mother. and wu not marital property. That vehicle has been sold by Defendant'l mother, At the time of separation, there were two checIdni 1C(lOUIlt1. At the time of separation, the parties were recelvilll fundi trom an annuity which the partlel had purchased at the time that the Defendant wu laid off. Defendant Is aecurina 11\ evaluation of hi. penaIon ICCXIWIt throuah VoIbwqon of America, Inc. Defendant is also aecurina 11\ evI1U1l1on of hi. penaion account throuah Central Pennaylvania Teamat.. Pension Fund. Tholl eva1uatIona will be provided upon reeelpt. It II anticipated that . Stlpu1atlon II to allltema, with the exclualon of the pension, can be reaciled. No appralaal of personal property WII ever conducted becaulll Plaint1ft' removed all pcrsona1 property from the parties' residence with the exception of an uprial\t freezer. refiiprator, bedroom suite, and Defendant'l mother'l couch, bed and television. II. IjXPJRT WITNESSES Defendant II currently havina hll penaIona evaluated by 11\ IctUIry who will praent her position II to the value of the marital portion of Defendant'a pwlona. In the event that the parties are able to stipu1ate to the value once the Defendant'. expert baa provided her report, then no expertl will be necellary relative to thl. matter. IU.~ Defendant at thl. time does not anticipate uaina any witnellel other than the parties. Upon receipt and review of the Plalntlft's Pre- Trial Statement, if additional wltDIIMI are necealll)', they can be d1ac1oled and rec:orded at the time of the Pre-Hearina Conference In thll matter, IV. J:XHIBI'fS Defendant'llnventory and Appraisement will be uled II UI Exhibit at the time of the Muter'l Hearina In thil matter. In the event that expertl are neceuary for the pension evaluation, then the Defendant's expert penalon evaluation will be uled II an 1IIlIbit. In thelWnt the pertlee ....lIIIIbIt to ItIJ111III' to the vIIueI of the motor vthideI. theltll.- &om the De&ndant'. expert II to the va1ue of the motor vthicIeI will be 11\ exhibit. The llatlllllllt II to the value of the parties' llvinp bonds II attached. A ItIteIIlInt II to the value of the chalna aceount. and llvinp ecc:ount reflected In the InVlMOly and AppraI.... will be 1lICUI'ICI. A ItIlIllllllt II to the value of the DeIindant'llIIIUity, IncIudIna a RatInlInt II to the value at the time of the parties' llIpII'Ition and the aurtIIt value, wID be aec:und. In addition, It I. aubmltted that the Defendant'. 1994, 1995, and 1996 F'" IIllXIlIII Tax rtIUmI will need to be uled II ExhlbIta, II will PIaIntlft'.. V.~ ~'I 1994 F......11lCOlllI Tax and 1996 Ptn.-.yIvanla Income Tax ntunlI ....1ltIclhed hInto reftec:tlnt the DtCtncIant'.Income. The Cumberland County Domestic Jl...,1now SIcdon In S~ of 1997 cIetermInId the PIaINIfI'.1ncome to be approxlmately $561.00 monthly and the DeIindant'IIncome to be approxlmatlly $2,019.00 monthly. IWindant II employed II a jockey for RoIdway a.-. Mlddl.nx. PennayIvanla. It Is unknown whether Plalntlll'll employed. VI. uruIII At the time of the parties' IIpII'Itlon the expenIII llaodated with rala1ni the putlea' children were belna borne by the Defendant In that the chlIdren rnided with him, III IddItIon, partla were ltlplyina Defeodant'I mother for one of the two vehIc:Iea for which she hid 1ent them the pun:hue price. VII. fD.I.WU As referellced previously, the Defeodant'I penIIona are beina appraised by Defeodant'. expert. The expert hu not yet provided her written report. That will be provided upon receipt. VIII. WIlliUL.fUI IWindIIIt aubmltl that the partla ahouId be rIIpOIIIibIe for their own (IN..... ....In this CUI. The Defendant hu been required to retain IepI counaeI \hrouihout theM prooeedlllll. The most recent COUIIIII retaIned by Defeodant Is at an hourly rate of S 100.00 JIll' hour. IX. As reIinnced previously, a penonaI property appralaaI hu IlOt been pedomled. , x. awuIAL...UII As explained previously In the expense aectIon. marital debt conaIated of a debt owed to OIfendant'I mother for payment ofone of the two marital vehIdeI. XI. PROPOSl:D USOLVOON O[.l:CONOMIC IUIlJiI In the Immedlate Ktlon, It II submitted that the p1alntift' hu an Int... In the pIIIIion of the Volkawaaon of America. Inc. and In the unveated portion ofDefeodant'. pIIIIion throuah Central Pennaylvanla Teamster, Pension Fund. The ao1e IIIItI of the lllllriaae that have not already been distributed In aareement by the parties are the pension ICCOUlltl. ""'OIU1t--''''''MImllI. .,......'..........-"1.., C!,U: ~f!lUtIuutlW!iIItl 16. 3. 7368, '/'~. 2J.. .. . H i ~'. l;~" . -. ~1.' SERIES EE 1...t-<...I' , ~, , , ! ,.~I, . ,1,~" , -..--, r,. ~~iWO~~E'los~t~{t.IlEET .~"''''':f.t CUltELLSVILLE" 'PA~~15425 H~c~.J9iV "f . ,,' I I , ,,' 1 " , : ',','~' GiV, RH&Yo~ts2nSr2til':;68 .0 ,OL67lJUI~t9iE'~"mI8 \. '", ,. .: " 3 j, r. fl. i 3 I i';,' , ' ". "" .... .' ' d I ~ ' ./ ..01,,;., '..... '. .~. _.a 0._ ...... .,' .....:" ..... ..,..".'.._..._.........., , :"\.l\':-",,~ .' ,:::::~, ,IJJ ,~,C"U_~) " J).!J;!'w:: ~ :~~~~ lbS'flt llEE' , , ,':,':' .:OOOOQ0007.:01,. OU::.?F.5....H.. ~ I l...',' . :. '~.;...~.. ,of'" ' . 'I ",:..:;~; . " 'ti, ... -. ., ,oat ~'01.III1II1R...&tI....- ........_h.............. cnti: W~~l!UIifi)f__ SERIES EE 168 38 7368 ,r'. ~ tI _ ~....1. 1988 '-;-":'---. II.. '. '" ~uwO~~E'Aos~~\ tfllEET j,' " f~fGH " , CONNELLSVILLE,PA. 15425 AP~IPU~81 1 , r.w, RNJUo ,nilsl'm"J';. -00 I J3118~UOt~~;"'''at8!~8 ~ .. :'- ;:,: ..;b~.t';'!C-l132S~~.5IfEE ; .:OOOOQOOO 7':01, . "0 l H 250551,,,1 :, 1!1W: ~'am6DIImtlWj'tV"'IIDII~ "'....u_............... Cj~tJ: W~f!\Hl.UI OOl!li.\.~ 168 36 1368 SERIES EE 06 1988 '" ~diwo~~PAos~t~~ ~tREET ' " ''';:1\1 UIHNHUV ILLE, 'PA. 15.Z5 " .Mi'~!.U.!~9i~ liil'; .' l 1-:1'- ..:, -1' , "\t. -.... ; : /~~\S,~ii R~&UOet~l'J$r~"8 -0 ;on~~!~~f.J;.,~~~.,.~...~~8'. l , .,..,..."...'.~.,.....,' 18. "'-TIJfiT-'- I ' ...,., "~J'. C l: .'-- 1111 1');'Hl~ .11" . '''.' .,;" \\'1 .r.'", 11.1 J' .' . '.~,T ,.' /Yk~lU "Cfllfb lb 112EE \.1;'. :t.\\\y(,.:OOOO~OOO?,:o.. II "~~77F. 7 l2" . . Y.. No X to lIIillund?",. ,,,,,..,,.,,.,,,. X 6lngl. Pot Pl1veey AllIIIlI r" I r _~ ""uDIIon All....... _..... 4- X Mtln.d ftUng Joint return (tv.n II only 0", hid 1_) "lrtI.. Ilh"8 "pallI. ""'lfn.lnl,t ,pol.lH'.IIN..." I. 'ull,*", hi,... H..d of hou..hold (willi qUllllylng pt""n), (6.. pagt 13.) II q~ng ptl1Ol1ll' cIlIld but not )'Our d'ptndlllt. .ntll chUd'l nllTlt hll', . Qullllylng wldowllll willi d.ptnd.nt child (yr, tpOu" dItd.'1 ). (6.. _ 13,) W Your..". II )'Our Pll.nt (or _n. ....) can cUlm you U .Iltpendtlll on h1l/htr...} N.,.I ..... b X. .."r~.'~:~,~,~~.~.~.~.~~r.'.~.~~.~~~~.~~.2 ~~~..n" C Deptnden1l; Chk. It... , 01 Olll,r, ~t't h,.ol No. 01 V'Ol.I' If un." D."naenfl...., ,""'111 ....u.na"" lo .11 tlln chU,,.non" t NIft'It ctu", lnihll.II"i' tal, NtfIII .,. t """''', X', WhO: JULIE A NISWONGER DAUGHTER "".O.rt"~ 2 IlmorethanlillROBERT A NISWONGER SON 'O.on'II"..II" - ~,~ t. ....'n dependlnts, " ....,.IIOn.... - PIlI' '4. - "I form 1040 lIll~ ~J ...... N E.! 'IIII..nllll ... IlaotIon Call1paltn , 1 2 3 4 Filing StatUI 18.. p.gt 12,) Chtclc only ont boa. Exlmptlonl (8.. ptgt , 3,) . I lltpaMltlll of th. TreU&oly .. InItmII Rtv.nut 8.Melt U,8, IndMduII 'ncom. Tax Rllum , . IBM 1"'U"OnI t.O'...'.rtl..'........,thlt..... "'11\, arJIft. '.ON.'I. '.....f.ltl.... ,..., ,It OMa No. 1141.0074 Y- ...... --,...... 168-38-7368 ......... ...... --.... 170-48-8009 ....., ChtoIing "'t..' wi IlCIlIlllangt your tax or rtduot your ralund. MI PAUL F NISWONGER RUTH A NISWONGER 655 FORGE RD CARLISLE, PA 17013 I II 2 De""',"" on II ..'.ntlf" ..." d It ~o,,' chll~ Iheln', IIr. .llh VOU bill I, claim.. II .,0111 """tnl 11M". ,It. 'III IItttM1fll. IhM' hi,." A~~ """'Mil . T~ number of ,xern ani claimed. , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =~'::.~... 7 W...', Illanll, IIp'.llc. Aneen fotm"l W., Income 49 006 AllIth c." 10' row '-tw-I, W.aa.1IIlI ,..".... " )'OU dd not "".w.a,_ page 11. Enclo... but do not_, In\' paymtntwlll1 your rtlum, Adlultmlnta to Income CauIIon16.. In_cIonl. . . II TIIIIIIe 11lI.1.lIln_ (IN page 18). AIlach 6C1ltdult B " ovar 1400 . . . . . . . . . . . . . . . . b Tu.........lntellll (_ pg. II). DONT Includ. on In. II Ib . Dlvld.ndIncotnl.Attach Schldw.8 Hov.rl4OU. ........ ............ ...... ...... 10 TIIIbI. "'und.. cndIIs. or ~ 01_ and locaIlnoomt..... (_ page 11) ........ 11 AIltnonv rtotlvld...............................,.......................... 12 Bulln'"lnoome or ~ou), AIlach6c11tdul.CorC.EZ............................. 13 CapIlaI gain or ~Oll), If l.qulrtd.1IIICh 6chedul. 0 (IN PIlI' '1) ................... 1. Other gllnl or ~o....}. A!tIch F0IT114181...... ....... . . ........... ............. 111 Total IRA dltlltbutlonl .. ~ I b TIlIIblt amoulll 1- pg. 17) 111 T.'~..n".n....OOM~I~.. ~ b TllIIbltamoullll_pg.l7) 17 R.nta1 1.11 .ttalt. royalll.., paM.rshIpl, 6 lXlrporallonl, IN.... tlO. AIIach 6chtdult E . . . 11 Farm Income or (lOll), A1lICII6C1l.dul. F, . , , , , . , . .... . . .... ... ..... ..... . ...... 1. Unemployment compenlllion (III page 11).. ... .. .... . . ...... ...... ..... . ...... 20a 6oc111 tlCUrlty bantlltt . ~I I b TIlIIblt amount 1_ pg. 11) 21 Other Income, 22 Add the amoulll. In I'lt IlIn lXl""M lor In.. 7 tllro 21. ThIa I. 23a Your IRA d.ductlon (_ page 18). .. " . .. .. , .. .. .. ... zsa b 6pou....IRA d.ductlon (IN ptgt 18) , . , , , , , . . . . . . . .. 23b 24 Moving ..pan.... AlIach Form 3803 or 3803.F .. ....... 24 21 On.. hall of uH.tmploymantllll. ..,.,'.............. 21 . 21 6tH..mployed h.1ilh Inluran... dtduC1ion IIN pagt al).. 21 27 Keogh It1Irtmtnt plan a uH.tmploytd 6EP dtductlon . . . 27 21 P.nllty on .tr1y wIII1drawll of IIvlngl. .. , .. .. .. .. . " .. 21 21 AlImony plld, R.clpI.IlI'. 6SN. 21 r..... ,,-, . 30 Add IIn.. 23. throu h 211, Th... "' All , Or. Incom. 31 6ubtract Iln. 30 Irom IIn. 22, Thllll Hn~ NTFlr10 COP~"gf\1 'Olm, loll",,,. Only. ,It. N.ltO, Inc. "'1.1040' , folm '010 (I"'~I Amo<l::'~";I"~':U:~~~~~~~~.~~.,.................,......,. ~,68-38-7368 T.. Ua ChecIc II: 0 You welllalolclll, Olllnd; 0 .......wu laIoIdtr, 0 lind, Compu. Add the numblr 01 boll" chIdllCllbov. and II1IIl lhI IClIIl hili . , . , . . . , , . . . . Ua IatIon b II ~r parent lor _ne ....) _ dIim ~ u . dlpendll1l. chick hili. , . ., . Db c H ~ '" mamlCl tIIIl1II IIjIIIIIIIy and \'!lII' _..IfIrTU" deduOlon. 0' ~u . 33c ~"flI8I ....dull._._. _PIlIIllanil-hIII...,.,,'............... .) M Enter {........ ..........Inlm IDhedull A. I". ft. 011 } thI... ~-~!':"~~.: ~'!!.r'a'f :~=~'.t:lJ~'= " 1J1ou~;:; 110. IVur ~ard decluOlOnI. I'ro, 01 . Bln~ .. IUllO . Htld 01 hou..hoId .. .e.eoo ~ur, . MtiillClllllng jolnfy or Qulilfl'lng wldow(lI) .. 11.310 . Mtn1lC1l111ng ..partltlr .. 1lI,171 31 Subtr.atlln. 34 from IIn. 32. .. .. . .. " .. . , , , , , .. .. . , .. . .. , , .. , , , , , , , , , , , , .. , . . .. . 31 31 If In. 321. "3.110 or I.... muIlIplr 82,450 br th.,otAI numblr ot otmp1lon. elllmtd on In. It, IIl1n. 32 I. ov.r 113,110. lit th. wortclhltt on page 24 for the tmOum 10 .mll . . . , , . 37 T.......lnoomt. Subtractlln. 31 from IIn. ai, If IIn. II I. moll thllllin. 35, .nIt, .0., , , . , . . 31 T... Ch.cIe H f,om al!!l To TIbI., b 0 To RMI Soh.dul.., C 0 Clpllll Olin Tax Work. IhttI. or dO Form .,11'" PI, 1'" Amoum from Form(.) 1114.. 31 31 Addl1lonll ...... Ch.cIe H from a 0 Form 4870 b 0 Form 4872 ,,"............... 31 '"' Add IIn.. 3IlIId 31. , , . ....... , , .." , . . .."... , . . .. , .. , , , , .., , , , , , , , , , , , , , . ,. 40 41 Crtdlt for child I d.pend.m car. '"P, AIIaoh Form 2441 . . . .. 41 42 Crtdll for 111. .ld.1ly or \h. d,lIDI.d, AlIach Schedul. R. . . . .. 42 43 Fortlgn'" ortdII. Attach Form 1111..." ........... , .... 43 44 Othtr _ (III flI8I 211, Chtclc II from a 0 Form 3100 b OForml3111 coFormllOldOForm 44 41 Add Int'" through 014.........,.....,........,. ""'''''''''''''''''''''''''' "I 41 lubtrllllUntlIIfromUnt40, IIUn.lII I. mort thlll IIn. ~,Imll .0.".."."",,,,,,,,. 41 47 I"..ormom IlL Attach Schtdull BE. . . .. .. .. . . . . .. .. , .. . , . .. . , . .. .. . .. .. . .. .. ..7 41 Alltlllllvl minimum IlL AtIach Form 1211 . . .. .. .. . . . . .. , . , , , .. . .. .. .. .. .. .. . , .. .. . 41 41 Iltotptull ....., Ch..... II from . 0 Form 4211 b 0 Form II" C 0 Form 11II.. .. .. . ..I 10 BooIllltOUrt1r IIId Mldlcal.... on Ip Inoomo nlll rtpollld 10 tmpI"I'Ir, AlIach Form 4137 , . . 10 It To on qullllftlCl rtlrtmtm p1anl.lnllludlng IRAI, If rtqulrtd, _ Form I32t . , . . , . NO, , . . 11 U AdvIllCt .erned lnoomt Old PfrIIlIntllnlm Form W.2. .... .... . , ,.. .. ...... .... . , .. U U Add Inti II Ihrou 12. TIlI.1a ur ItlIIlu, ....... . . .... .... . , ".. , , " , , ,.. .. . , . '...'lIln1eme....llh"'.",ltlnrllhom"rm.I'DII,chlClI... ., .. 'armanta II 11M .-ntltd ... ~ I WIt. tpp/itd lrom 1113 ilium . II II IImtlIInMInt mill " requlrtd. 8IICh Soh, ElC (lit P8, 27). NontaxabII .amed lnoomo: trrt. I I tnd trPI . NO 17 Amo<lm pIlid ..., Form 411I (_nllon requtll) ..... . . . . . . II EaDl.._IlII1CUrt1r and RRTA ...1VIthh..d 111I ~ 321. . . II Othtrplrmtntl.Chtclcllflom ao,o...l... bU'o"""", II 10 Add anti II throu II, Thill'" ur.... " " " " " " " " ".." ".. .. . ., II lnt 10 I. mort thlll fint 13. IUbtrlllllnl 53 from Un. eo, Thill. tht tmOum ~u OVIIIMlD. U Amo<lm 011".11 ~u wllllllUUIlllD TO YOU"... , "....'..'""."""..,,... . U Amo<lnl 01 lint II ~u willi APPUID TO '.IIT. TAIl, , , . U 14 II Int 13 I. mort thlll fint 10. IUbtrllllln.eo flom ant 53, ThI. I. tht AMOUNT YOU OWL For dttllil. on how 10 par, Inllludlng whit 10 wrtlt on ~ur plrmtm. lit plgt 12, . , , . . , , , . , . II EIImtItd ... n ... I 13, AlIO Inoludl on IInl 14, " II Undt' penlllltt r IlI,JUIY, I dlClllIt thtIl hi" .lImIntd lhl. ,",urn IIId aOOOll)llllll'lng _uIIl and _ilia. and 10 OInfo~ RnOlVlottdllf Ihd balIif, Ihov lit trut, OOIr.... and oomplltl, lltCIItrllOn 01 proper.r (othtr lhan laIptyorjl. bUtd on lIT ortnallon which prtp"" hilony knOlVlldlll, ~ You,lIgnlluro 0111 You, oocupllon ,. DOCK WORKER Spo...'. oocupallon HOSTESS lIrDl'wllll lhI IRS 10 leull ~, IlL ... page 24, c...dlta (1M flI8I tI,1 Oth.r T.... 11M flI8I .,1 AIIaoh P'oImI W.1l. W.IGJ..and '011." on flI8I ,. ".fund or Amount You Ow. Illn H.... KHp I oopy 0I1hl. r,,"m for~, raoordl. 'aid P...pa...". U.. Only H'IS ProPlltr'. -II -rt1r no. 152-24-1033 Spou..'. IIgnllurt, If. JoIm Ilium. 80TH mUlllIgn, 011. Pllpartf.... lIgnalllll ,. Firm'. nlmt lor ~u " ....tmpl"l'ldl IIId eddr... N"'''' Dill 3/2/95 Chtclcll MII,om d E,I, No, ZiP ODd' D R BLOCK M J MALL LISLE PA 31 37 6 350 44 043 9 BOO 5 134 5214 5 189 17013-4113 Propertll Edl1lon C,p)'rl,t<tl """"011"1" Only. I". ~'ICI. Inc. N..,OU' ~ , COMMONWEALTtt OF PINNIVLVANIA O"'CIAL UII 1184 R.ldlrtt IndlvlduallnoolM TM AltUm PA PlUNClaTATUI: (ChlCll One) OCCUMTJIlNl o ...... VIII fllIf IeIJInnlng 11M 40R I Iln~ VOIlr OoolIPIIOn EndIna 11M 'A.OO".... J MIrrltd, filing 'lolnt rllum VOUllaOClALIECURITY NUMIER POUII'I"N ..wen It 111I,.. ..,.,.t"rJ M MIrrltd, filing llparlllly DOCK WORKER 168-38-7368 170-48-8009 T Joint 0aIm for T.. Fors;..ntll lpou.... Oocupalon 1M Nama Alii Nama. InlIII & SPOUII'I F DMMMi. Dill 'lnIIftl,,'" .1 NISWONGER PAUL r , RUTH A OH'n HOSTESS Home Adcl_ ~~IDINllV ITATUII (ChlCll Only II A Pan. V.., R.licltnt) 655 FORGE RD P ,.,tV,. ""I..lrolft ''''10 .... OIly 0' Poll OMot SIIII ZIp Cod. NAMl/ADOIIIII LAIEL OI'1'ION CARLISLE PA 17013 ;.rChMk tl.t:~f.~:~ P.'.~~~':'"" W'I VO\lDnlV '11II"110 ""11" , I 1'111 I'll 1 I U CIIIIk "'" 1111I1. II . ohInIe of I OAYTIM~ TELEPHONE NUMBER O"ICIAL UII ..... IrolIlIat weer'. ilium. 1717\ 243-4913 SCHOOl. DiSTRICT NAME I......... h... OK, ot, ,..., I SCHOOL CODE INDICUI HOW ""N'tOP SOUTH MIDDLETON 21830 IACH 'OIlU..,'CH.11 An. 'U 'I 'i-It. PI.... UII lL GROSS COMPENSATION., . .. . . .1,.. , .... , ...., ..'., l' 49,807 Your CorrtCt I of FOI11lIw.a 2 lb. UNRElMBURSED EMPLOYE BUSINESS EXPENSES,.,... lb H7 School D1I1rlCl Cod. I or IchId(l) UE --r 10. NET PI. TAXAILECOMPENSATION,...,....,..,.,."",.,..."......,..,. lc 4! I or Schlll(l) A --r a. TAlCAILE INTEREST. . , , , , . " . " " . , .. .. . " . " , , .. , , , .. . , . " " . , .. .. .. . a :illll I of8chld(1) I - 3, TAlCAILE DIVIDENDS, . , . , . . . . . . . , . . . . , . . . , . , , . , , , . . . . . . . . , , , . , , , , . , . , . 3 I oflchlll(l) C - 4. NET INCOME OR (LOSS) FROM OPERATION OF BUSN" PROFESSION OR FARM. , 4 , olllh'."l "(., NET GAlN OR [LOIS) FROM SALE. EXCHANGE OR DISPOSITION OF PROPERTY, , - I. I I ofSchldll) F I orSchId(l) C.F = ... AMOUNT OF EXCLUSION FROM UNE ao OF PI. Atllth All RlqullH !iCHEDULlPA.1............."..., ..."..'.,.... II DocUtnlntt I orSchId(l) 0 Nil 1""_ in UnI. ...., - I. IT INCOME OR (LOIS] FROM RENTS, ROYALTIES, PATENTS & COPYRIGHTS. . . I 1.'.....'10." ESTATE AND TRUST INCOME ....", ...",. "... """... ......,. '"'''' - 7. 7 I ofSchldll) II - .. GAMlUNClANDLOTTERYWlNNINGS...."...."..,."........,.......... I I of SchId(l) E TOTAL PA TAXAU INCOME IT....U... II,U, C, 1,1, 211.. DO NOT DIDUCT fLOlllan, I .! I ~ ofSchId(l) J - I. 10. TAlCUAIIUTY Multlllv Unt I bva.llI (,0211.....""",,,,..,..,,,..,,,,... 10 - n. TOTAL PI. INCOME TAlCEI WITHHELD .."...."".."... . . . "... . ..." ". " .J7 11. I!ITlMATEll PAVlAENTI AND CREOlTS 1.. CrIIIl From 1113 PI. Rllum . . . . . . .. .. . . . . . , , . , .. 121 Thll Return Mull Be lab 11M Inlllllmlll\ PlymlntI ...... . . .. . . , . , , . . . . ,. lab FtIIII On Or ItIora 110 PI)'I'IlInI wtlh 1114 Rlqu," for Exlanlion, .. "..., ,. 12c April 17, 11M lid TOTAL PAYMENTa AND CREOlTS. . .. . . . , .. . . . . , . . . . . . . . . . , . . . . .. . . . . lad 13. TAlC FORGlVENEIS FROM PI. SCHEDULE SP SH InlltUctlon. For 111 D""",nllClairnetl frOm U", ',P"IUlo'PAtch"ul'" "., 1h R.pOllng E~ 'Ib IllfIlNlil~ Inc."" lrom Ll",.,'art IV 01" ""1111I.1' ...." 1Sb T.. Crldll And C1llm1ng 110 ,...,.A.Juat..O'D..lnc.rntfr.mU"'....l1llllol'A kll..1t 130 T.. Forglv_ 1341 TAlC FORGIVENESI FROM UNE I, pan IV of PI. Schlllul. SP . . . , . , . . . , . . . . ISd I of Schlll(l) SP 14, TOTAL CREDIT FOR TAlCES PAID TO OTHER STATES OR COUNTRIES '.."".., - 14 I of Schill (I) G II. EMPLOYMENT INCENTIVE PAVMENTS CREDIT, . , . . , . .. . . . . . . . . . . , . . , , . . . , . - II I of Ichlllll) W II, TOTAL PAVlAENTSAND CREDITS ITOIII U"" 1 I, lad, 13d, 14 and 111. , . . ., , "" - II l,Jn 17. TAlC DIll SH InlltUC1Ion. fIlr paying ~ur'" du., 111.11 than 11,00, n. paymell\ II r.qulr.d, , ' """""'" 17 111 11, OYIlIPAVMlNT"",.,...,...,,,....,,,,,,,,,,.....,,.,,,............ 1. I DoubI. Chick You, MaIIl IlL Amount of Unl 11 to III REFUNDED.. .. , " . " " " , " , , . , , .. . , , " , .. , , , .. , .. " " , , " , , " '" 11. lib, Amount of Un. 11 to III CREDITED to YOUR '''' ESTIMATED TAlC ACCOUNT, , . , , . . , , , , , . , , , , , , ,. lib 110, Amount of Un. II to III OONATED to thl WILD RESOURCE CONSERVATION FUND, ,. , "..., .. , " ,. 11. 110, .Unt lito III OONATEDto\hlU,S, OLYMPlCCOMMITTEE. PI. DIVISION .."""".""" lid ~,'tn It I ':,lllIl~, .....,. mill nlv, '.""'''11 '''I' IIhlln,IMIUlt"l ICCOmpanr1ntl ten""'.. tnl '''ltIMIUt, tn. tolnt "I'" m, Nt.......'". .'h" III' ,,.., Your Slgnatur. I Dill ~.,1nalu" ~I. ~"'I1",~:,_ ..n_~ I..,....'. ..... on., 11"",,* .'n".,.tI" 81 ' ,. .......'14"". ......1'.1 ") II"" I( I( "Lal'- ,'1" I hire 8POuH"llgnaturl N JOlnl, 10TH ""'"'I8".v.nIIOnJ~one J\.tllncolnl' PrlplIlI" TIi.phon. Numlll, 1:01" .. I( 17171 243-6868 3/2/1995 ""'1 NT' f,n ~ ~a if II TAlC pi tl COJlVlllnI Fllmt lolt",,,.On1V, III. N'III, Int.. NI.'Al . .---~........ - .' ;_.",,'~'h'l'T'"'.'" ,~".. M.. UI., (1.14. ALLOWAlLI EMPLOYlIUIINIII IXPINBEI IMlllUpIyII nlllIIlMdIl..... UI., tal.... .l1Ilajll. I'ItnIOt IIUlln II . Villi..... Irnplo.......... IIII"OHGIR PAUL F ROADWAY BURlSS Villi...... ~ HlIIllIIIr ."...,.. ~ 168-38-7368 100 ROADWAY DRIVE CALRLISLB PA 17013 IlIIIltM In WIllI TWlI' ClI Joll VOY InoulllCl '"'"' IIpIlIM II."'"", kIIl"lIlm No. (11M) DOCI'WORKIR 3t-Ot92670 ,. MIlT AI UlllON DUU (NImI of union ond IftllMllll of dllll) TEAMSTERS 776 L MIlT II WOIIK CLDTHU AND UHlPOll.. (H nqWed bV ~ 1l.lpIoJlf. I _.n crI ~ ond IlOllullllllltal - (WIlIn reqlired bV ~ ......1 U I IDOI.an crI DDnlInUld ond not I 4. MIlT Dl PIlOI'UIlOHAL UCIHII 'W, MW'IlACTICI AND fllllUTV IOIIIINlUIWICa flIl11U.. u1M U 11I011 n"n crI 4. I. TOTAL MIITI A THIlOUCIH O. ..... .....1lIII.. Uno '1.. Ill' -r ... ..... .. MIlT II TMVIL. IILlAGIIIlI'IHIII ComplIIt lIlIt PIll or.... ,..., I'orm .,oa, ....... ...... .......,....... I'. TrlVtllIjlInNI tor IWIy from homo ovtmIghI bulllllll ~nCllucllllr fIIIO. 011.... ~ IIID.) .... . . . .. I'. a. luIIntII~andl""rlllnrnentexptn"I.................................. .... ..", ..... ... a. D. ,.,...,.._toIe.loClIItranaportlllonlltC......... ........................... ........... '" .., D. 14. VIhlCllt IIflIIlI" from Un" I and r bIlow or UN lhI 6\11lcIMIIMNgI RIll trom Form 1101. . . . . . . . . . . .. 14. I. TOTAL TMVIL AND MlLlAGIIXPIHIU. ADO UNlIt, 1HIlClUCIIf 14 . . . . . . . , . . . . . . . . . . . . . . . .. .. Olftlrlltnformatlon (If more than 0ftI vehlcll, ItIIoh ICIdltlonal IcIlIduII..) ICHEQULE UE.1 PA IlIfIAIITMINf 01' NYlNUI IffltIIaJl'" TI'lf"1lII No. 717 2U-9000 ,. U2 a. 250 I, MIlT CllMAU. TOOLS AND IUfIIILIU I. 65 .. D. 0. d. .. I. .. .....daltYlhicltw..plaoIdlnMMol... I........ .,.., ..... .......... ..... .... .,.,...... ... .. T.... niIIIgt fot IIalabIt vear. . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . I I . . . . .. ~ ~nilllgtfor"")'IIt.... ................................. .". .11............ ", 0. mIM mIM to "''''peralnIIgIU" (dividtUneCbyUnlb) ...................... I...... "" ........ I.... d. OI~,,_"'."UM" TOlIl --~_...-- ~"UtIlOllI~ I l VIII'" ~..... DoWOUhavtlftOllhltvthlolttorptflOl\~u""",,, .,..... .............. I...... tliyour..vetpl'OYidtvouwllhavthkllt?................ ............... I lwtt.llpIfIOftII UII""'"Jlld'...................... ...... .......... ."". 00 you hIYo ~ 10 IUppoll tht", ftgurtl entIred eDoYo? . . . . . . . . . . DlprIOIItIOn IxpIn.. VII VII VII VII No No No No h. 1I'Mr0000orDlhef bIIiIafvthiclt ......... II..... II.............. ,.... I....... ......... .... I. L I. Ie. L ~lJnIlbvthlbu....peroenllglU",fnltnUnld.. ...... ..... ..... ..... "" .1...... I .... , In'" "~lflIlhO' ""'I MIl ,,'Nn., ". 'onn.1 01" .th" ,,","'~ ...,,,. 1M'"'' ....... '" PI "",",II Ie. "'.lIIllIan OIflen. (MulllpIv UIlI) bV Une kl. ~nllIucII on UnlE4 eDoYo)...................... L AotuaIlxpln... to m. GIIaInI.oI. tIpIir'IlrnllntenanOl, etc............. .... ...1....... ...... I....... ...".... .... m. n. VehkIII tnlutlnCll. . . .... . . . .... . ..... ....... . .. ... . ..... ...... ........ . . ................. n. o. p. q. I. TCllllvthklllttnllll (whln own car orln\Ploytt'1 cat notavlllbll). .................... .... ..,.. t.. o. Vllut of empIover.provldld vtlllCll. (only" lDOl1o crI annuli IMII II InalucIId In yDIIr w.2) ............... p. TaIII UnIt m. n. 0 and p. . .. ... . . ... ....... .. ...... ...... ..... ..... .. I' . .................. Q. ~Untq~thlbu"n"peroIntlgttrornUnld..................... I... ..... ..1....0 ... " r, nnaludl.. UnI E4 1IIlov.,) MIlT " OI'FICI 011 WOIllC AIlIA Ill...... AIIIIlI ~,....... ......., NIMoII ". OeH..........,.''''...f.VI'''o''*''taIn..''.......,..,....,..remhl..'hll...MlI...'..... I v. No Fa. l.lNI work 11II11II principal p1_ whlll you pI/Iom1 tht duhl 01 yDIIr 1IIf.,Aor,"1I'I . VII No Fl. ,.lNI work 11II ulld leguII/tV and OIclutIvIIy 10 peffonn lhI d..... of ~ .11f11olm1nl'1 VII No :.er'~ vu" ~J:!:.!!!!!! lIU........ ...1IIn....1I you ___110" "" F4, . ~II;o; ;roe :'-~J: you pIIrcl1u1d lIIClIullvllv lor UN In yDIIr olloi. . . . . . . . .. F4. IlMoItblln IhI ~ bIlow the IUPpIIH you pIIrcl1uId and IhI - _'r, Fl. ClIIoI or work .,.1 ..pen....1nlIr ~ ... w-tr - .. OIprIGIIIonll (horntOWnlreonfy) .. .... I.................. I.......... to... ... ..... I.... "" .. b. R.II....tIaII... ..... ...... ,..... ...... .....,. ..... ,.1'" ..... .... .............. ..... b. 0. Mortglgtlntl,... (hornlOWntrlonly) .............,.... ...................,. ,t, ....'""..". Q. CONTINUI PAlIT , ON PAQ! 2 OF THIS BCH!DUU!. ..AUI', NTnm C.,~rI.hl ,.,"'. "".1" OnlV. ,... N,ico, I!\C. N..'AUlt Mlltl...UI.I".MI NISWONG~R, PAUL F .. .,..., . . . . . . . . . . . . . . I If' . . . . . . .., . . . . . . . . . . . . . . I . I . I . . . 1'1 . . . . . . . . . . . . . . . . . . . . , . . . . . . , , . " d. .. ~1nIutInoI.. .1......... ,". to.. ,.. to........... ," ............................,.... I. t ~ MIInlInIIlOI (dtIaltbe Ihl _1_1IId In IllIInlIinInQ 11II plOjlItlV below and 1alII) . . . . , . . , . . . .. t, ....... ..... . ... ~ ~~porlolllbll Eapenlll (dllcllbe 1III_1_1IId below IIld lOIIl), . ..... .. , , , . , ... , . .... ..... g, IfIIIIly. h. .....(~rtnIIIrI~CllIirnthlt.pen..)... .t,.....,........ to....,....................,. to... h. I. T"'(1dd U"".thl'OUQhh) ........ Ii...... II........... to.......,.... "................... I. ,. IuIInIII pilGll . crI propIfI\I, DlvidllOIIllqUIII ~ crI p/opellV ulld .. llIftcI or wOlle "" bV Ihl IIIlIlIqUlllfoollelollllllnlrepropellVlroundto2~) .."..,........,..."..,.......,......" J, 1'1. Appolllonlbll Eapen.... MuIlIplv UIlII bV Ihl pIIllI/IIIgIlrom Unl J.. . , . , . . , , , , . , , .. , .. , , , , . , , .. .... FI, 7. toTAL O"ICI 011 WOIIK AIlIA IXI'INlla. ADO UNIIPUND '1.. , . , . .. .. , , . , , , , .. , , , , .. . , .. " 7. MIlT Cll IIOVlNG IXNHIU AIIIIlI AUIlIonIIIIlIIlIII NINIlI CII. DId you WOItc lot 11II_ empoyer bIfotland _ ~ur movl? .. . .. , .. . , . , .. .. , , .. , ., [JVtilJ No Q2. Will wou requltld bV your ~ to movl from 011I ollilill worl<p110110 lIIo1hl' 011I0111 w.lJ'."'..loondIIonolemploymllll'l.,.....,.,.....,.."'.".,.,..."".,...,. By" BNO GlI. IlIdYOUrtlOVl"lIIIreq_ol~uremplOVlr? ,...........,............"...,...,., Y.. No II,.., _wnti VU "" iMe ........ ....... DOIIIInue. 04. EnlIIIIII number 01 mila: .. fnlmyoutOldhomlto~urIllWWOItcpilol....., ...... ..........,.",.."..""....,. .....,.. &. b. fnlmyourOldhOlllllOyourcrldwOllepilol. ..,... ,......,......,...,."...,....... ,...., ..... b, c. lublrIolUnebfromUllIlllld_rhlre ...... ......... ...........,....,...,..,...., ....... 0, 0Nr II UM I II MIlIIlII OI_,llOIltII_ 1111II, ,.., mer IlOIlIIIm movlnt elpllllM. CII. TlII1lpOl1llllon IIjlIIIlllln movlllll houllhold goodlllld PIIIOIIII "'- . , . , . . . . . . , . . . . . . . . . , . . , , . . .. 111, CII. TmII, nlIIIIand IodgIIIIlPplnlll in IOlUII rtlOVI from pllvIoUI relld..,.. to ~ur IlIW 'IIIa-. . , . . . , , .. QI, L toTAL MOVING IICJIINIU.ADO UNUCII....III .....,.......,....,."...,................., I, IWn' HI IIlUClATION IlCPIHIII AlIIIIl ._....1II1IlIIlI1I NINIlI HI. WMIhIIlCluDlllvn requlrld IIIIIIr bV law 01 bV wour ImpIoyIr to llllin ~r ptlllnt pHIon ..,...........................1..,...'0................... .......... to.. DVft DNa II,.., _ VII,---' HI. DId wou IlIId IhIIIdUOllon to mill "*y IIvII or m1ninlrn reqWlIllIntI to obllln wour Job? By" B No HI. WI" _ crI ~ or JlIOllIMI, " oonInUld. qUIIIIV you lor . new bullne.. or prcr/IIIIon? Y" No ""IIl1__..4 lOll ~II.." HlMd HI,...... _L._ 1M. ..... 11I"1'1111111I m-.on: ... 00ulII crI-.clr. ... TuIIonorteel:. 0" Of II 0...... .......... II............ to. ,.....................,.......... ... Hr. eour."*"*.... ............. .0................... to to to.......................... ... Hr. ... TrM~l~ I'. ..,................... .to............ to....... "". to............. II.. ... t. toTALlIlUClAnONIllNNIII.ADOu.......M7A11l..,..........,.........,..,....,.,...... I, IWn'II DPlllClAnoN THIJII THAN 1'011 VlHICW AIIllll'FlCI 011 WOIlK All AIIIIlI ~ _....1II11l11l111 NINIlI e'llIl..on 01 (I) CoIl or 0Ih., (Il) DlpIIliIMon (0) DlpllCidon (d) S~ 171 (I) Add (0) + (d) lull MIlhod Dldu'*on nil .. miIII mIIII 10. toTAL DPlllClAnoN IXJIIlIIU. ADO OOWIIII /II.INTIII MUI . . . . , , , . . . . . . . . , . . , , , . , , , , . , ,. '0. 1Wn'., lIaclUANlOUllllNHlU AlIIIIl .....lnaI.......lI...... DIIorlllIln ....In 11II..- provldId below or on IMpllIII ",",)'OUr lapenllltrom UIlI4 01 your Fldlrll Fonn a,oa 'oIIIIr IIpInIII lIIowabllto OIfIIln empIO\'IIIIOIM"lI nolllnlfll. oompItlldon 10, PI. "'rlOnllln_ TIX pUrpolll, llIIorIbI..oh 1IpIfI1I' your 0011. II. toTALllacllWllOlJIIIlI'INlD.ADOALLIXI'INIIIAIIlIlfTlII MIJIII.."...,.."",...".. U, MIlT III toTAL AWlWAlLlIUIINIU lIlI'I"U '" ADO THlIXI'INIEI FROM UNI!I, PAGE I AND PARTS ETHROUGH J . .. .. .. .. , .. . , .. , .. .. .. .. " " ,1. 13. INTEII AElMIURIEMINTI FROM YOUR EMPLOYER. INCLUDING AElMaUR8EMENTS FDA EXP. CLAIMED ON UNI I" WHICH YOUR EMPLOYER DID NOT INCLUDE AS INCOME IN 'STATE BLOCK" OF YOUR w.a, 'a, '4. IUBTRACT UNF. 13 FROM UNE '2.. .. .. . . , .. .. . , . " , , , .. .. " .. .. , , , . " .. . , .. .. . .. .. . . .. " '" '4, 7 4 7 I' UNE 131S GREATEA THAN UNE '1. ADD DIFfEAENCE TO YOUR TXBL. COMPENSATION ON UNE 'I OF YOUR TAX RTRN, IF UNE 12 II GREATEA THAN UNE la, ENTER DiFFERENCE AS DEDUCTIBLE EMPLOYE BUSN, EXPENSES ON UNE 'b OF YOUR PI. TAX RETURN, 'AUII. NTP JIll eo'W'"lhI Porm'lolh"" Onl~, ..,. N.leo, I",. H..'AUU M._ UI.I, AIIllII (toM! . ALLOWABLE BUSINES. EXPENSE' EaplnMl!of which wou nllClllllrnbullld bV your .,.po",. A\IaClh a ...... UE.. 10 torm PA.4Ol\ !of HIIh .,.po",. PII'" 01 II btlanT.alon. 1814' SCHIDULE UI.I PAllII'ARTUIN1' 01' RlVlHUE IOlIilII a-ftIV NunilaI 168-38-7368 ~ u __n on tonn PA.4Ol\ NISWONGER PAUL F , RUTH A InlfllllV'r'I NImI EmpIoyef'1 Add_ Job OIIDIIpIOIIln WhIDh "pln..1 Wlfllnaullld MIlT AI UNION DUll IN"'" and _nil A I C D I ""'T II WOIIK CLOTHlla UNlfOIIMllt r MIlT CllMAU. TOOLl AND IUJIIlUII (R ulrad ur IIlClIlCllIU MIlT Dl "'0'. UCIHIE 'HI, MALPIIACTICI! IMI. . f1DI!U1V 1011I "'I!IIlUMI TOTAL IXPIHIEI 0' PAIITI A THllOUOH D. II'OIIT ON UNI! II Of M. SCHEDULE A tmREBT "1""'11I1_11 ovlll4OO, compIlIIlhIllDhadull, Includll""lIIIltam pIlIOIlII__1UCll II uvingI_ra.llIIdII uNonl,IIVIngI andloanl uaocIllIonl, cartltlDIIII ol dlPOIiII. lie. In Pan I, In Pan II, "pan tIIIlnIIIIII u-na WOU IICIIYe II a pI/lIlIr 01 a/lIIIlIDldII. " additional IpIOIII nNClld. IIlIllh "",,- ...... PAIIT I AMOUNT NAME OF THE PAYER TEAMSTER CU P CBANI BANI 1. lutMIII..................... 0............................. .0........ .,,," ............... , PNIT II a. I......trorn partntrahlpa. from PA Sched.. RK-' ............................................... a I. InlIIIIIltam PA 8 aorporallon.. lrom PA 8Dhadulll RK. I . . .. . . . . . . . . . . .. . . . . . . , .. . . .. . . . . . . . . . . . . .. 1 4. TllIIIl""lIIIln_, Add U"" I, 2Ind 3, EnIIr hlfl and on Un" III your PA.4Ol\ .. .. .. .. .. .. .. .. .. .., 4 . SCHEDULE B DIVIDENDI If dMcIInd \nooIIW II ovlll4OO,llIllTlPIlIIlhIllChIduil, M dMdIncI I.-nllllaIaIlII In till VMII1Cl11wed 01 ndIIId. In PM I, rapOIl till _ Illlhl dividendi VOU "calVi dlrldly. In Pan II. "port lhI cIv\danCIllhII WOU 1ICIIYe" a..... OIllh111hald1f. " addltionlllplOlll nNCIId. IIIaDh ...... ...... PAIITI AMOUNT NAME OF THE PAYER ,. SubtCMII......,.............,.,...........,............................................... , PAIITII L DIvidendi tram p""'llIhlpl, trom PA Bchadulll RK.1 ............................................. 2 a. DlvIdIndl from PA 8 corporlllonl, trom PA 8chadulll RK.1. . .. .. . .. .. .. . .. . .. .. . .. .. .. . . .. .. .. . .... 3 4. TllIII DlvIdlnd Incoma, Add Unll 1, 2 and 3. EnIIr hi" IIld on Unl 3 ol vour PA.*lR .. ....... . .... ..,... 4 PAUUAII NTF "'0 COp~lII.hl Form' loft. I" OnIW, "14 N.lco, Inc. HUPAUat I CAPITAL TAX COLLECTION BUREAU , f" ~J1' IURUU" AND ".PAYU-' COptll 'LOtiO WITN , ...., .. .'MlND INVlLQIt LOCAL EARNED INCOME TAX RETURN (FORM 531) SEE BACK OF RETURN FOR PHONE NUMBER AND OFFICE HOURS I ',(1( '.II Ilil 01 III II I, ( (, I . ,," . I 'III I !411t I 1111 It \"1,111 '^l( ^11111^11"j '.~II 11<1 ""'''''''''''''''''''''''''''''''''''''"''''''''''''''___ , 1 W.2 EARNINGS (From Inlched W.2's) " " , , , " . , " , , ' " . " , . , , , ' , , . , , , , , , ' , , , ,2'201 I 2 EMPLOYEE BUSINESS EXPENSES (Anlch Fed"sl Form 2106 6 Stlte Schedule UE.l), 3 TAXABLE W.2 EARNINGS (Subtract Line 2 tram line 1) ,,' , , " " " , " "" " , , , 2 3 1'1'2,(> I 4 OTHER TAXABLE EARNED INCOME (NO INTEREST OR DIVIDENDS) Complele Sect'on B on Back, , , , " 4 5 TOTAL TAXABLE EARNED INCOME (Add Lines 3 Ind 4), "". , , , , " ' , " ' , , ' , , , , ' , , , , , " , , "'" '" 5 6 NET LOSS FROM BUSINESS, PROFESSION, OR FARM (USE LINE B FOR ANY NET PROFITS) , , , , , , , " 6 7 SUBTOTAL (Subtrlct lIna 6lrom line 5/IF LESS THAN ZERO, ENTER ZERO.. .,.. , '.. , , , ,. ,.",.... 7 S NET PROFIT FROM BUSINESS, PROFESSION. OR FARM (USE LINE 6 FOR ANY NET LOSSES). . , . , . . . 9 TOTAL TAXABLE EARNED INCOME AND NET PROFITS (Add linn 7 and B) . . . . , . . . . . ;. , . . . . , . . , . . . . o TAX LIABILITY: 1% OF LINE 9 (Mu"lplr Une B br .01).."...".........",.,..,.""....."".." TOTAL LOCAL INCOME TAXES WITHHELD (From 1"lched W,2's. Bo. 21)"""".".,.",.""",., 11 2 QUARTERLY PAYMENTS ANDIOR LAST YEAR'S OVERPAYMENT CREDITED TO THIS YEAR,. ,',' , ," 12 .' ", , . (,,,..'Z,;/J., ,,' I I 3 CREDITS FOR TAXES PAID TO PHILADELPHIA ANDIOR STATES OTHER THAN PA (ATTACH SCH, 0) ,. 4 TOTAL WITHHOLDINGS 6 PAYMENTS (Add Lineal', 12 Ind 13)""",..",.""""""""",,, 5 TAX BALANCE DUE (Subtrlct Line 141rom Line 10) PAYMENT NOT NECESSARY IF WS THAN $1.00., , 6 INTEREST & PENAL TV (SOl Instructlons) , . . , , , , , , , , , , , , . , . , , , . . . , , , . , . . , , , . , , , , , . , , , , , , , , , , , , . 7 TOTAL IIAlANCE DUE (Add Unesl5and 16) Mike checlt plrlble to 'CTCB" , , , , . . . . . . . . . . , , . , , " . , . . OVERPAYMENT (Subtract line '0 trom Line 14) IF LESS THAN ZERO, ENTER ZERO, , , .,. '" , ",.,." 17 T~...,. ".< .... 1,'.-_ 18 .-.~;'::-~': 8 9 PAYMENTTO BE REFUNDED, . , .. , , , , , .. .. , "" , " .. , , .. , "'" , , , , . , , , .. , , , , ".",,, , , " 19 ,0 OVERPAYMENTTO BE CREDITED TO NEXT YEAR'S TAX,. , .. '" .. , .... , , '. '. : ,. '....'.:. ..: 20 I "i\~ OVERPAYMENT TO BE CREDITED TO SPOUSE'S BALANCE DUE FOR THIS FILING yEAR.,....... 21 '~.' " O""ICIAL "'IE ONLY Stall PA o FISCAL YEAR FILER From to TYPE FILER (Ch.ck Only On!!, 51! MD JU 11"'.1 M""ld ".,,,.t1 'ill... """.,." ,.11... '.'""( II...."....., ........ 'r.'........ d.e...... '"II' ,tI. Ottt a alllh RESIDENCY ST"'TUS (ChICk Only On., :.~..nl N~n~g'"l '''I~j;! ",1.."1 Inlll Ih,lIme VOU .." ".. ".III."t: from to NAME OF SCHOOL DISTRICT SOUTH MIDDLETON 6CHooL DISTRICT CODE 21830 ~'QA~,IH"DO'L T,. FD Finol Revtow oIIlh1 P/lp~ntod Infarmotlon on your lobol ond p1_ h In tho nomo ond oddro..II... MIll. ony -rv corllCllon. to your Iobol ond chock1hl6SN/NAMEJAODRESS Chongo baa boIow. II _,,",hIM. .... _oIllnlormallon. nt. YOUR IOCIAL IECURITY NUMBER SPOUSE'S SOCI...L SECURITY NUMBER, ..."" rill.. ,."".,.,, 168-38-7368 Lul NImI FIlii f\IfIW ond InI1IoI . Inoh...IpOU.... _, II ftllng JolntIJ NISWONGBR, PAUL F HamoAdclIlll 655 FORGB RD ClIv 01 Poll oIlIoI CARLISLB Il!I IIMWIIIAIIIlIlEII CHANGE I' ANY'! ,,,...,,In'.I,,..llOnl' cutt"T"llro," waul lHI PA t&ll "Mn, checll'''I, 101. If lour add'... c".,.eel, -'10 ,,.,1.. h, nImI-" II, co...r 'htd ~.lo*n'"IP.lMlrough or ""-'NCIPlII1V ",hll' )'ou IIv II on tll~"". NImI ZI Cad. I. OrouCoqlonlMlonIlomW.2Iofl'f\londOlhIfW.lllIl.llmlnta.."".,........,.,.. I. lb UnrolmburllClEmployHBulin...Expon...IIomP...Schodul.UE,....,...,....,.", Ib 10 NIlPA TIIlIIliIComponIllon. Sublr..U.. ,bllom'n.,. .........,............,.,................... I. I PATIIlIIliII_lComploloondIlllchP...SchodullAKOVIr".llOOl .,...........,..,.",............,.2 I P...TIIlIIliIDlvtdInd.lComplltlondIlllchP...Schodul.BNllYor".llOO)..............,...,..............3 4 NIlIIlOClllllOl[LoM)1Iom1hl0p0rlllanol.Bulin....Pratollion.rFann................................... I NIlOllnOl[LoM)IIomIhlSoII.ExchongaOlOllflOllllonolPraporly......,................".",.".,., ,5 Ia AmountolOlinEx..udodlromPASch.dul.P....,8..........,...,..........,..,. .5. I NIlIIlOClllll 01 [Loaa) 110m R.nta. Royalll.., P.nta ond Copyl1ghtl .............,..,.,................... 5 , EoIoIaondTrulllncoma ,..,...,....,.....,....,...,..,..,.....,.,......,...,.,....,........... 7 I OImbIngond~ryW1nnlnll....,....,.....,..,...,..,........,......,........".....,........1 . TOTAL'A TAXAILIINCOMI Add Ilnll 1 C, 2t 3. 4, I, e. 7 and 8. Do nol lubl'.la (ta"l 'lpo,l.d on one 0' mo"Une. 8 'tOM Ih, ,ro'II.I..... Dr non.... oth.r Income II,.... Ho, CM 1001.1'" orr.., each olh.,..lnco......1n4 PO....I..,.n I' on Ih, NtN line. ZIp Cod. 17013 ,. AI_" rwtW."O""". lb th"'YI"IIl".'WOUf 'ItUm. 10 2 I . I a. Donol..~orll.4uc'"ne" , I , I , 10 " laa lib laa 110 lIb 110 13d I. II II " TAIlUAIIUTY MuIlI .... 2,1'110 0,021 .""""",.."""",.""""...,."",.,.".,..10 10 ToIIiPAT..W1lIlhaldIlomW.2Iofl'f\l,lto, """".....,.."........,.....,.....,.,.....,.,."""" , " C""tlr.",'MI'ATp"tlum I 0 12c P,)'menl_lll'lltHEa'ln..on .............., SHUt. t_l,tlrfll'.. 'I..mentl 0 l2d NOnlltld.nl Tu WlIhhtld ham P,lchldul.. NRK.' Instrucdonl ToIIiEllln*odP.ymontaondCrldlll...ddUn.. 12.. 12b.12.ond 12d ,...."..".,.,.,., "",.,.,.,....12. 12. Hou..holdMlmbeflftomP"'Schodul,SP.PIIIII,Un..."",."..".,..",., ,,'... 13. 13. Youmullft..~ YOurEllSlbllltylncomoIlomP...Schodul.SP, Pili 11I,lIn. 2 .,.."....."".."",.,., 13b 13b AprII1I, I..,. Your TotoIIncomo110m P'"Sch.dul.SP.PIIIIII,lIn.1 ....,...,...,...,.",.,.,.,.,'3. 13. f1lulFly,llyouOlll. T..F......CrIdltFramP...Schodul.SP.PIIIIII.Un.7 ,..,.",'.'.,'.'.,.,."...,...',."...".,. .13d 13d ToIIiClldlllorT..HPlidtoOthorS..,...rC.untrl..tromP...Sch.dul.(.IG..".,.",.....,.."".,.",." 1. I. ~ntlncan1lv.P.ymontaCtldhtramP"'6chodul.W "., ..'...'.' '..,'.,..",.,...",.,....,.. .15 IS TOTAL'AY..HTIAIIlCREDITI...ddllnlll" 120, 13d, 1.,ondls ,""',",',,',,',' """""',',' II , IS 'ATAIlDUEUnI1010morolh.nlln.,5 .,'.'""".""""....""""""" .17 17 SlIlnI1lUClI.n.f.r M.k.chlCkp. .bl.toPADIPT.OfREVENUI US!YOURPA.V. HOWTOP"'Y OVIll'AV_NTUnl teII morlthan Iln.10 ....................................18 18 ChlCIla.1wourcllclllluonl IMPOIITAHTI Thltotol.t1ln. 18. through HId mull .qull Un. la, "- d. ....II'.....'.... lI""'d .."II""h ./1.. Amountollln. 'lyouw.nUIIR.lundChIokmallodl.you """""'''''''''''''''''''''''''''''''' 19. 18. AmoumctNn.,lyouwontCr...ltHtoyourl997Eltlm.t.dT.....ccoum """.""""""""",.."". lab lib Amount 01 Un. II you wanl10 Donlllltolh.W1ld RllourCl Con..rv.tion Fund '''''''''''''''''''''''''''''' IIlo lllo Amountollln"1 u Wonlto Donllllt. lh. US 01 p1cCornmiItll,P"'OIvlli.n"""""""""""..", ..lid lid . "dlr l\III~j' of II \I' I "'llIng ,omUWOI d"Iat""'11 ew', "av' "MIlnad'hll "t\lrn, Including All aceompanVlng "h,Ow"."O tll""""II, Ind 10 'h. II YourS X lpou....Slgnalu.. (lIftlngJ" X D~T".phon.Numbor 717) 243-4913 BEBUREYOU IIlYOURlPOUI SION Your Occuplllon DRIVER Spau..'IOccupatl.n fIIr.,.,.,,, Co",""V "1fN, 0lh,r Ih." IUPIVIIIII. bll'" 0" tlllnlolfnallo"ot ..hleh lh, P"PI"f hll InV Ilno.I'd". H AND R BLOCK 17013 NEXT YEAR, you will 1110 b. Ibl.to mok.. d.n.tion 01111 or p.rt clyour .v.rp.ymomlo tho OROAN DONOR"'W"'RENESS TRUST FUND, 'A.4O 1'11I) P"'40.1V 1.4 ~OIm 10 t.", CoPVfllhlllH HIA Sloell TIA '"..Ie", Inc. MllTI. Certlnlldano'!llelblllty, IeotIon All'lllnt. 1.1I",1e lH M, Mlrrled 'IIIng 81...,_ R.turn. 1. 0 I cenlfythe! 1 pe'lOnally pravld.d .tilllt on.. hili of my own Talal Suppan .nd lem .1Ig1bl. '0' t&l farglv.n..., II filing.. M, .nt.. you, Spou..'.N..... IIldSSN ,llIpouHfillng.PASchedul.SP? 0 yeS :I. 0 I cenlfythe! lem. d.pend.nt of. perlOn who I. 1II1g1b1.la't&l 'arglv.n..., lem b.ing clalmed'lI d.p.nd.nt on the PA t&l 'IIumol:N..... IIldSSN . Yau....ynot.lllmd....ndenla. IeotIon I, PIUnt.~, MerrIed '11Ing oIoInlly, IIlCIC1IImln, T.. flHglv_..oIoInlly :I. 0 InmvapoUM cenlfythe!w. ...eMh 1II1g1b1.'art&lIo'glv.n.u .nd .1.cIto fil. . joint PA Sch.dul. sp, AI.o u..thl.llltu. Wyoufil. loI~, but only one 'POUM quallft.,'a, t&l fa'glv.n... end Ih. oth.. .pau..I.. d.p.nd.nt wKh no t&lablalncame, IeotIonC. PIllng. ",llIe 1'111II PA Rllum '0'. d.....eeI 1nd1.1eI.... I cenlfy the! I h.v. ra.d th.lnltructlan. fa, till. filing IlItu. .nd!hlt the dICed.nt n.......v.l. .lIglbl. ,., lax I."lv.n.... .. Th.dlClCl.ntllln11I1 bl. claimant or en III bl. d.p.nd.ntf.,t&l for v.n... ur aH', AIIT II. NllmIIer ofHouMhoIcI Member. lor T.. 'a'glv.n... Pu'po.... Enl..lh.lnfarmallan 'or yau".K. you..pau.. .nd IIch d.p.nd.nt child, Uatllll d.p l....nl.hlld'....lf you... not marri.d .nd h.v. no d.p.nd.nt., go to Pan III, HoullholdMember.Io,T..f. Iv.n... A. SSN TOlalln..m..fram 1. Vour Nemel S .. Nemel S . Neme I I R.letlonlhl SSN ur SP Wark.hul.lln. 2 I lem clalmn .pauH, SpauH I. filln ..p..lI11 TolaIInc.m..II an . Who I. clalmn IIch d.p.nd.nt child? S lem M Spau..l. S lem M S au..l. S lem M Spau..I. I S lem M Spau..l. S lem . , M Saau..'. 4. HouMholclMomberl. Vau, you, .pauMIK filing jointly or If you, d.p.nd.nll .nd .nly Ih. d.p.nd.nt chilorln you ... clalmn anlhi.PASch.dul. SP, Ent..h....ndanlln. 13.of aurPA.40arlln.a.of aurPA.40EZ. 4. PART III. CeIoulettng You, T.. '.'glv.n.1I C,edltl 00 NOT USE CENTS, ROUND TO WHOlE DOLlARS 1. TOTAL tNCOME from IIn. 21 of tho SP Warklhllt.1I marri.d .mll the JOINT lIlUlunllv.n K filing "p"'I'Iy, Ihlngll, UMVOURl1I\Oun\. Em..TOTALINCOMEan IIn. 13.ofPA.40a,lIn.acofPA.40EZ ,..".,...",..,... " 'I .. ~OUR ELlGIIlUTY INCOMl!.lIfilln~Slnol' 0' Mllri.d Allng S'PII.llly, u..th.emau'rtf,.",lIn. 12 of YOUR C.lumn of P WO'hh....llftllilg. Joint Rllurn au ind you"pou.. aI...ch .lIgibl.) u.. th.lIlUlunt Irom IIn. 12 allh. JOINT S olumn 01 you, SPWartc.h.... Ent.. "'lIldlln. 13bolyau,PA'40o'lIn.llbofyour PA'40EZ ,....'.."..",,'.. 2, :I. PATAXUAIIUTY',omllnIlOofyourPA,40a,lIn.aofyau,PA.40EZ """""""....,.."."..,...,.", 3, , 4. L1!11RI!IIDENTCREDIT from IIn.11 oIyour PA.40, Thl.cradKdallnallpp'yfarPA,40EZ ..""".."",."" I, , .. NETTAXUABlUTY.Subtr.cllln.4fromlln.3.nd.nt..h... """"""""""""""""""""'" a, , .. PERCENTAGE o'TAX 'ORGIVENESS from Ih. E1lgiblll1ylncom. Tobl., U..lln. 2 f.amlhl. p.n .nd Ih. Hou..h.ld Mamb.ra'ram P.n II. Enl..th.p....nllg. hll. "lo .ndlh.d.cimol.qulvollntDnlln.a . , , , , " a, 7. TAX 'ORGIVENESS CREOIT I,.m PA Schedule SP. Mu~ply IIn.B by IIn. a .nd .mll hll. .nd PA.m~~'llia.qtYOU'PA'loarlln.adof,fA'O't~M~~;4 ' "" , ,'," " " , "",.""""""., """"", ,', 7 ;o,m loll.i" C::~1l8t" 11M HIR Blocll Ta. 1$.''11,,,, Inc. PA.40CheQUat ...m.(.) W.I _ PA SchecluI.(.) A A PA Ichlelull(') B T PA Icheclulll.) C I PASohedul'I.)C.F o PA Schedull(.) 0 H PA Scheclul.(.) 0.1 A PASchlelul'I') 0,71 t PASchlelulll.)PA.,g PA Schedul.(.) E ~ PA Schedul'l') F a PA Schedull(') Q " PA Schlel""'(.) J o PA Scheclul.(.) NRK.' R PASchlelulll') NRH ~ PA S.hlelul.(.) RK.' PASchlelulll') UE.l H PASchlelul'I.)UE.2 E R PA Scheclullll) W E fldtrll Schlelul.l.) K.' FIdtrIlSchecluII(.) aloe _ Cllhe,_ ~H.. "'''101.11) UU~~~l~~~m~IfIt"", .. :I. ...UE.IID....' NISWONGER PA SCHEDULE UE.2 168-38-7368 .. aE"""I"'O' RIVI"UE ALLOWABLE EMPLOYEE BUSINESS EXPENSES N.... oIT..p.yor Claiming EApenll" Social Socurl1y Numb.. Employora NImI Employe". Addllu T.I.phano Number O'IC"be Ih. dull.. of Ih. job In which you Incurr.d th.....p.n... DO,HOT UBE CI!HJI. " ROUND TO WltDLI! DOLWlI PART A: Union 0..... UIt Union nem'(I) .nd l1I\Oum(.) Plld, Enllltotal, AlIIch .ddlllanal .hUII, Knlld.d, A' --r --r PART B: W.rtc Clollle..,d Unl'lHm.. R.qullld II' condlllan 01 your .mploym.nl.nd not IUK.bl.far.v.ryd.yu.., ,','" """""""""""""" PART C: llfnIIl Tool.IIlCISuppl.... R.qulrad II. condlllan of yourlmplDylT\Olnt IIld nal pravld.d by tho amployo, """,,',"', C, PART 0: Prolllllonlll UcolnH ,.... MllIp'ICIlc.ln.uronceand 'Id.llty land Pr.mlum.. Roqulrod ... condlllan of youllmpla nt 0' PART E: T,.v.h,nd Mile.... UH your Form 21oe, i1c1lim1n .cluol.. nHI,com IIt..PASch.dul.UE., Total Employee "line.. Eapen.... Add PII1I A Ihraugh E, Entll hllnnd.n IIn. I b 01 u, PA t'"elurn ..,.,... PA Schldulll UE mull be iliad K you hlv, moll then on. occupllllan andlo, II UII UH 1110 Incurl unrlimbu...d ampl bulln.u ..penH', I Before vou can comDI'llttll'lctltdull. YOU MUST comDletlthl SPWORKSHEET B' ES lb' DOIDTUlaCINR.'", IIOUHO TOWMCu"Olt.... ,... IIOCI&lleCUIllW NumM, o NO o D 'I o o II IUlln... Ex nil. 111I SOCIIl Securtty Number. 168-38-7368 Employe'" EIN 34-0492670 EmpIoye(. Tllaph... NumbIr 717 249-9000 It .......... MUlt 1M i"MlllIe.'.'"'' OCI lIof\. I ",.. mUll tn. ,. ,.t. UllchtdulU. DO frtQTU"ClNTI...oua.O TO*ttO&.IOoIJ.MI A. lInllIlI Dull. UIl UnI.n 1IIITlt(.)1Ild l/'IlClunt(.) plld, EntI,'GIII, A\tICh Iddlll.nlllhMl." needld. TBAMSTBRS A. . WOlllOcllhtlIlld UnIIorml, Raqulrtd u ...ndltI.n "~u'lmplaymentllld n.._.Ia'.....rydly u.. B. . IImIIITOCI.llldSuppll... Raqulrtdu...ndltl.n"~u'lt1lplaymentllldn"pravldldbylh..mploye' "..... C. I ProfMIIonII Uotn.. '"1, MllprlotloeInauranceI Fldlflty Bond Prtmlume. "'.lIlled II IcondltlOn of rour ''''''oylTllnl O. . TrIVIIAndMh",. 'rom',fmIIOlo,Ucl."",...h.....,.n...,compt'I'P..tI belOlf Md.nll' th.wnounl fromune.l, . .. E. . .ull.... Ea n..., Add PW A th,.u E, EntI' h... IIId an Hn. I b.. u, PI. I....lllm I b, I _. V.u mull_I. ..pan... alalmId.n.n. 4 .. F.nnZloe In P&I1J ..1111. _ul., If. T.....upan....wlylramhllfTll..arnlghlla'bulln....lnalud.ladglng:II"III:.....ntaI.Ita.""""..".., EI.' la, .uaIn_llIIII.llld.ntlnalnmant...y"amhllfTll....nlghlla'bulln... .." """"""" ,.., , , ,.. , , ," E2.. P. Parldl1llfila; 1alI.; IacIIltlllapalllllan (bu.; aab: Itlln, Ita,) Cammullng I. n"lIlowabl. ..'....'".,'.,.".." E3, I 14. AaluaIVahIaIIEapanllL AddUn"llIldqbalaw.'u..lI1lSland..dMlI..IlIR.."amF.nnZloe.."...,.,.,. E4.' II, TGIIIT.....IIldMllHglEapanllL Addn...EIII1,.ughE4, Enta'h...llld.nUn.EIbav.....,.. Ea,' ........ ~"'-P' 11." _lhM _ ........,................... IlI)Naf uu OIlit1;llll\lloo 'IOW_ a. llIIIvwhlallwu_rldlnta..rvI..: (month/d.y/ye..) b. TGlllmIII: mliII: .,bulln...mI1." mil." d. 1uaI__paroan!l8l,lllvld.Un..bybllldroundl.Zdoalmalpl....,."..,."",...."...",........ d. ., Da~hlvllI\lIthIl..hlalefol~u'pa...nllu..?."".,..."..,.""".,.,,,,,,,..,...,........,. I. llIdyou,ampIoye,p'avlde~uwllh...hlal.? ,,,,,.,,,,,,.,,., ,."".' """"'"'''''''' "...... " .. "\III, llperaanal u.. parmltlld? .. .. .. . . , , .. , .. . , .. .. , . . . . .. . , . .. , , . , , , . , . .. .. . . . " . .. .. . . . . . . . . h. DayouhlvllUpparllngdacumantaM.nla'th.mll..g..ntar.dlba.'?"", "., " ",'.' '...,., ,......... IIl,rr I'~ n........ U..any IlIn..IIly....p11d method .,th._meth.d.n ~u, F.nnZloe, I. EnIIr_.'athI'bllI,"~u,..hlcl. , ,..,....' '....". ,.., ,.,., ",.,.,., "".,..,..., , ,.,...... I. '.1 I, Mulllply...lbylhlbull....u..pa'..ntagI"amlln.dlba...nd.ntarth....uHhar.."..".,..",......... j, , k, Inllrthelllllllally....plldd.p'oaI.ti.nmeth.dulld IIIdth.p....ntagI ... k, I. ~..pan..,Mulllplylln.lbyth.pe'cen\lgl.nUn.k, Entllh...llldlnclud..nlln.E4,.......,....., I. .1 ,.... MIuIII,,, "... 11\ a......,aII,r_.....hlcl.ln.u'ance,II.."amKn.Z3..F.nnZloe .".",...,."",.,...,..,..,.,.,.., m, . n. TGIII.ahIaII..nIII.wh.n~u'own..h1a1..r.mploye"...hlal,wlln".vlll.bI. , ,.,..." .,.,.' , ,.,.,...., n, I ., VII...alamploye,pravld.d..hlallOnlyN l00'llo..th.annuall....I.lnaludldln~u'W.Z'.nn ., '..,...,.,.... 0, I p, TGlllalnnllm.nllld.,.".."""..,.."".,."""",.".""""".""",."""."".,., p, . TGlllAaluIIIEa n....MuItI Un.pb th'Pllcenta l,amlln.d,Ent..hll'IIIdlnalud..nlln.Ehbo.. q, . P. 0llIeI Or W.... ANtI .....-. Y.u mull .n'.1I ALL th'H qu.lli.n.., ~u, ..p.n... will be dll.llo..d, ". lloH~uramplaya'raqul..~utamllnllln..ultAbI.wo'kll...w.y".mth.lt1lploya,'.p..m1...? ".'"",.., ~ YES ~ NO Fa, I. thl. w.rk 1II.1h1 p~nclpll pi... wh... ~u padonn the dull.... Y.u, Implayment?, , , . , , , , , . , . , , , , , . , , , . , , VES NO 1'3. I. thl. w.,k III' ulld regul.rIy IIId ..clull..ly t. p.donn the dull.... Y.u, amplaymant? I YES NO If Well ___ YI... ALL lhl'M ......lIon.,.antln....1I y.u ."._Id NO to."y ......lIon. ~u may n.f.lllm .11I.. 0' wo,k "'''IIfIIIlML MtllII OllIeIer WOlll "'.. IlqIan.... Emil ..p.n..' for the .ntira yalt .nd th.n cllcul.1I the bulln... porti.n. . a. OIpraallti.nEapan..(HClfTlIOwnlrl.nly) ",.""",.""",."""""""""",."",."""" .. b, RHlI!IIIIUI T.... ... .. , .. " .. " .. , , .. " " , , " .. " , , " , " , ' " ' " " " " ' , " , .. .. , ' .. , .. . , , " b, . .. M.fllIIllI Int...1l (HllfTlI.wnarl.nly) ,..,....",..,,,,,,,,,,,,,..,....,,..,,,,,,,.........,,..,, c, . d. UM.. .,.......,.. .. ......... ..... .., . , " .,." .. . , . . ,. , , .. , .. .... ......., . .. .. . . ... . . .... d. , ., Propal1\'ln,u'III" ,., ".",...', " , " "'" ' , ",' , , , , , , , , , , "" " ,'" " ""., " ",' , ' ., , , , , ., ., . ,. P'.pel1\' Malntan.n.., "amllI the ....p..nd amount 01 mllnlln.nc...p.n...lncu"ld: f. . Allow.blt E 1o\~$r''''NImI EmpIaya,'.Addra.. I ROADWAY BXPRBSS PO BOX 471 AKRON till a..... "lhIlob In which you Incurred IhIIIllpln... DRIVlR A I'AIlT ., I'AIlT O. I'AIlT D, I'ARTI. T GIll g, Other Apporti.nabl. Eap.n..., ItlmllI the ....p. IIId amount" th...., p.n.." g, I h \. J, k. \, R'nl(R.nta".nIy) "., " ,'.,,,.....,.,....' ",'..', , , , , " " "',' "., '.....",."" , ,," , ,..' h. . TaIII,Addun...th'.':,j'hh,Entarth.IClIIlhll....",."""""".""""."""..".,..,..""... I. . lulln... P....ntalll P'.parly, Dlvld. the totll Iqulr.,.atlg. of ~u, w.'k.... by the IaIII I, IqUII.laatIga"~ur.ntI..p'.p.tly, Round taZd."mIi pl.... ' , '" , , '" " "."" '" " , ".', , ,.,.,... I Apporll.nldE.p.n..., Mul1lplylln.lbylh.percent'llI.nlln'J ".""""",."",."""""""...,. k, . TaIII 011I.. SupplllI, IlImll. .uppl.. you purch.lld ..alull..ly fa, ullln you, office., w.rk ..... Enta' the taIII T....OIIIGearWOlll"'..Ea n....AddUn..h.ndl 43 to VES VES YES YES NO NO NO NO 8 '110 o '110 o F4, I, . F4,I NOT U'E CINT" IIOIINO T. _"Ol.f *\"". "'.UI., If'" PAUel.IVl.31 ~.;ml.fl*"" CdVli.hll... HI" 810c_ TlllltlyIU'. II'IC, NISWONGBR, PAUL F 16 -38-7368 MMI' .UI.l 00 HQTUHCINTI.IIOUND10 WIIOL.OOLLMI Mltvlnt "'1...... You mull Inlw.r ALL thrll qu.llIon. or your lapen... wm be d1J111owld, QI. llIcIyouwOltlIolIh...",.employerblfor..ndlhrmovlng?" .....""........,.................. "DYES 0 NO oa. WIf. you requlrtd by your employer 10 move Irom on. oIlIdll duly ltaIIon 10 anoth.r UlOOldonolyour~.....,.....,......,.".....",.,..................,........, 0 YES On NO 01. llIcIyoumovllllhlrllqu.llolyourlmflloyer? ,...,.,...,.."",..., ".,.,....."",..".......... 0 YES NO llWOU ___ YlllIIALL 1Il_ ......IIon.. oonJIn....1I WOU M'''' NO... MY q....lIon. you may nololalm movlne ..pen.... .. EnIIrlhlnll1ll-llolmll..ITomyouroldhomtloyournlWworkpl... ....""....,...,.."..."".. mil.. b, EnIIrth.numblfolmll..lromyou,oIdhomtloyouroldworlepl.ce ......".,.."...,...""".,.. mil.. 0. .ublr.....lllbIromUn..and.n1.rth.difllrence,.....,....."" , , ,.,....,,,...,..,, , ",..", mil.. II..... .......... _, ....-nue.11 no"llIIIl. ""lei. you mer notolllm movlne .1Il*l.... 114. TrllltpOllllon 'aplnlllln moving houllhold good. and pellOnll_ """.,.....",.,.,.".,.,...,. 04,' 01. Tr.....mHI..ndlodglng...ptnl..du~nglhllOlUllmov.,romyourold hOllll to your nlW homt , ,,, . , .. .. , . .. 05,' ell. T'" _Add Un..G4 and G5 Oa.. I'IIlH. ""M' llapln-. You mull anlWlI ALL Ihlll qUllllon.oryour..ptnlllwW bI dINllow.d, HI. WulhI.lduoatlon requlred byl.w or b'/you, lmflIoye' to 'ItIlnyou, pre"l1I polltlon orJob? "".""",.,... 0 YES 0 NO lfWOU __ YlI, oentInue.lI you M'''' NO, WOU mer notolalm lducMlon .1Il*l.... HI. OIdyoulllldlhl.lduoatlontoll\llllhl.nttyllVlio,mlnlmumrequlflmlnl.toobtllnyourJob? .,,'....,...,.. 0 YESj NO H3. WIIIhlIIdUCllllon.progremo'ooufMohtuclyqullilVyoufoJlnlWbulln...orprol.Jlion?,....".".,...". 0 YES NO =--- NOlIIlIolh quelllon. HUnd HJ, DOnlIn.... II WOU _... YEI......... q....lIon Ha.. H3, you mer not .lIIm uo8llon .. NlmloIooIIIgI, univllllly OIId~lIlnllllMon b. eou...oIl1udy 114. TuIIIonot....... . . .... . . .. .... ..... . .... . .. . . . . . I . . , , .. . . . ................................ 114,' HI. eou...~. ....................................."............................,...".. H5,' HI. TrlVll~ .....,..........,....,.,.,...,....................,..........,............. He,' H7. T"''''"''ln __ Add Un.. H4through He ,I H7.' -L 00 nDllnclud. v.hld..lu..1Wl El and oIIIce or worle ..../u.. Pili F) "' n.... (I) Dllcrtpllon (b) COil or (c) IlIpflCilllon (d) IlIprlCilllon (.) S.eIIon 118 (~ uptnll oll'IO-.... OIherball. Mllhod Doduellon u-n.. Addrdl.,.1 I I I . . I I I . . I . . . . . I . . . I I . . I . I I I . I . . . . . 11. T.... DI'....I...., lapin.... ToIII Column l~ and .nllI her. ...".""""..." ..,..".."".'".., III. . I'IIlJ. ....IIIIII..U.IIpen-.lllmll.th.lyp. and omounlof lIeh lap.n.., Indud.ltllOunlllromlln. 4 of Fonn2108 Inthl. p&Jt . . . . . . . . . Jl. TolIl..--...u.bpen...,...............,.."..,....,."....,...,.......,.",.,........ Jl. I 1'IIlK. T.... Alia....... ,.,."."...11 !mploW-Iu"1II1I EapIn.... Add th. lapen,,,'rom .och P.n. You mull 0110 lCCOunl for fIlmbUlllmlnll. W any. In Illl. P&Jt KI. TotaI..ptn...lromPlnaAlhroughJ .,...".....,...'....., ." "....., ,......' "",.".,.,... Kl. .1 Ka. En1If rlimbu'''''''n11lrom you, employer.lndud. rlimbullllT\lnl. which your emplllylr DID NOT /lporl UtallAlll.w..onyourW.2Iann ".."..,.,..,..,.."...",.,..,..........,."...,"',.,... K2,' IU. 1ulInoI....K2ITornIlIlllKl..,...., ....,...,..." , ,.,.., "."""..., , ,....."",.",.,..,. K3. I 73U "'01 K21. MOllE than IIn. Kl, Includ. tho differ.nceln IIn. t., G,O.. PA Comp.n.llIan of your PA I&Il /lturn, ".n. K I II MOllE than IIn. K2, .nllr th. dlff'/lnce on IIn. 1 b, Un/llmbur..d EmplaYII Bulin... up.n... an your PA!Ix ,"urn. I'A.UE.1I1tll) pAUEI.2V 1.3. form latt.~. CoPWn,hl tlU HIR 810cll ra. SIl'~lc.', Inc. DOHClTUHClN1"I"H AOVN,D TOWHOIloOLt,lilj' 010U6 17 OMl NO, 1545-130' n., 1040PC FORMAT U',S, INDIVIDUAL INCOMB TAX RlTURN PAGI 01 0' 01 I PAUL '<NISWONGIR I I I 655 FORGI RD I CARLISLI PA 17013 I I I t PPIC' N sPlcr FS 4 6A-SBLF X t DBP RlS 01 6D-TOTAL 02 DBPD INPO 'Cl--ROIBRT A<NISWONGB -R---------------- 'C2--------203-66-2619 IC3--IOI-------------- IC.-----------------12 1040 PAGB 1 ,----------------40850 11.----------------801 I 22---------------41651 2'"--170-48-900'--6000 2'----------------&000 30----------------&000 31-------~-------35651 1040 PAGB 2 32---------------35651 3.----------------5900 35---------------29751 31----------------5100 31---------------24651 31----------------3701 TOTAL INCOMB LINB 22 TOTAL PAYNlNTS LINB 58 I 4t----------------3701 . 48------------------80 I 51----------------3781 1 52----------------7159 1 S4---HO--------------- I 58----------------7759 I 59----------------3978 I 60A---------------3978 t t t I I t I t t t I I t t t I t PRlP-JOHN L BOWBRS---- FIRM-a AND R BLOCI---- ADD--30 S HANOVBR ST-- CSI--CARLISLB PA 17013 --3306------------ SSNP-------186-30-7236 PIIN--------25-176'631 poce-DRIVER----------- FORM 5329 - 29 NAH--PAUL F<NISWONGBR- 8SN--------168-38-7368 1------------------801 3------------------801 4-------------------80 41651 7759 TOTAL TAX RBFUND 168-38-7368 50 I I ADD INFO I PDI---------I000010000 1 811------------------- 1 SC------------------03 t t t I t I t t I t t I I t t t I t t t LINB 51 LINB 60A 3781 3978 Under penaltie. of perjury, I deolare that I have examined thi. return and aooo~anyinq .chedule. and etatement., and to the be.t of my knowledge and belief, they are true, correct, and complete, Declaration of pre parer (other than taxpayer) i. ba.ed on all information of which preparer ha. any knowledge, Your Signature Date Spou.e'. 8ignature Date ~~'f- -'- 020297 IRS U8B ONLY parer'. S gnature Date PAGB 01 or 01 'or Paperwork Reduction Act Notice Statement, ..e Taxpayer Notice 974 010196 17 -RETURNB'" APRIL 151 1997Tc;----C;.l{0\96 APITAL TAX CC;>UECTION BUREAU U fW s. ~UCV[1l Sf.. !U I1f 102 LOCAL EARNED INCOME tlLULIE, PI 11013-3]]6 TAX RETURN (FORM 531) to CON""Utl"OOI Of 't.....G, ,... ,A.PAUI, COI' WI' II W If 'HI IUItUU to May, 'OUI eMf "auO"ID" MAIL _n_ IU.tAU' AHa fll'.". . CO,," 'LO~O WIT" & ilL' . ""'OIN'llLOH SEE BACK OF RETURN FOR PHONE NUMBER AND OFFICE HOURS I ',( It ',I ( '41 l (.) I ',I It ',I ( '41 I ,,' '. l.".," ""I "1,,, I Id,l" .....IH lA_I AllIIIA111)f4',MII,lltl , I' , ' ,I', 1.IIUI411, "41' ".H I Ii I tj II Illnllllll , W'Z EARNINGS (From a"ached W'2I) , , , ' , , , , , , , ' , , , , , ' , , , , ' , ' , , I EMPLOYEE BUSINESS EXPENSES (Anach Ftdt,a1 Form ZI06 & Slalo Schodulo UE'Il, TAXABLE W.2 EARNINGS (SubIIlC' Llno 21,om Uno I) I OTHER TAXABLE EARNEO INCOME (NO INTEREST OR DIVIDENDS) Complele SocI'on B on Bock, ' 2 , ,., ' , 1 I... 3 'i 'to 4 0' NET lOSS FROM BUSiNeSS. PROFESSION. OR FARM (ATTACH FEDERAl OR STATE SCHEDUlE), , ' SUBTOTAL (Subtrac1 Uno 61rom Una 5)IF LESS THAN ZERO, ENTER ZERO, , , , , , , , , . , , , , , , , , , ' , , , , 6 '~()lIr 11f . o. ",I,f ',t. ;; ~~.. TOTAL TAXABLE EARNED INCOME (Add Linn 3 and 4J ' , '",,''''''''' 5 7 '~.._... -' -, . . . . " t' ...--..,'-........ ...~,....:..--- TAX LIABILITY: 1% OHINE 9 (Multiply Una 9 by ,01)" , , , , . ' " , , , , " , , ' " ' , TOTAL LOCAL INCOME TAXES WITHHELD (From anoched W,2'., Bo. Zl), ~UARTERLY PAYMENTS ANDIOR LAST YEAR'S OVERPAYMENT CREDITED TO THIS YEAR 0: 'lOll': If ., I ",,,.,.' .., -..... ';' .,.,' ,"~', ' . 10 .~'<.~,fl,'\'...~I' , t.f,~'.:-,.~t=1'#l.~..V ,~~ " Yol:!). : ,.!(, I': , ' 12 01 13 01 I ' 14 WI"/l 15 16 17 .....-.'..-...... ! '!, NET PAOFIT FROM IU8lNIESS. PAOFES8lOH OR FARM (ATTACH FEDERAl OR STATE SCHEDUlE), , . 8 TOTAL TAXABLE EARNED INCOME AND NET PROFITS (Add Line. 7 and 81" , ' , " , ,. , ,'" " "" '.,. :. CREDITS FOR TAXES PAID TO PHILADELPHIA ANDIOR STATES OTHER THAN PA tATTACH SCH GJ,. TOTAL'WlTliHOCOINGS & PAYMENTS tAdd L,no."I: 12 and 131 ' TAX BALANCE DUE (Sublracl Line 141rom Line 10) PAYMENT NOT NECESSARY IF ~ THAN $100, INTEREST & PENALTY ISeeln.l,uC1lon.I TOTAL SALANCE DUE IAdd L,no. 15 and '61 M..e check payable 10 'CTCB' (,1,. .. ',', "," 'I, PAYMENT TO BE REFUNDED OVERPAYMENT TO BE CREDITED TO NEXT YEARS TAX OVERPAYMENT TO BE CREDITED TO SPOUSE'S BALANCE DUE FOR THIS FILING YEAR, ' , , , , 1B , : 19 OVERPAYMENT lSublracl L'no 10 Irom Line 1411F LESS THAN ZERO, ENTER ZERO , 120 ~<:\J ,.. .. r llllU T'J"< '~II ("IIJ ).J'( J - 'I U J I 1OC.....CUNT't....~ 0 16d)~ 1)b'! ~_.CUIIITV_ @ TA.IlOF'tCE uSE OHL. V a!YCCJDO...........~tqLC1..~.Cl Cl~~]61J6~~f.Ol~11r. YOUR HAUl llAST. 'IAIT, "II POUIll~ ~ (LAIl, 'IMT, MI, ~;fswrp,(il'P PUll " 01 00.. "'. f' .... ' -- 1111 7 SPOUSE S OCCUPAtIONIONl't' If ALSO "L'NQON t~IS 'OAM, -- ff,PMSNAUf. IOAENTEA "S'E "IF SElF EUPlO't'EO, _._.L. , mm_.,_J P"D POE...EO_5 PHONe HU"". w EMPLOYER'S N~ME CUE flolll'l;)'(OCI,A,W; h..\ UI '(l" 1 'A<;U '0' EMPLOVER 5 LOCAL ~DDRESS 1------- ,.--- GROSS E~RNINGS S S ;------. -~..__.._- ~-,-- -*_..~"-- ----_._--- .-~- ._-------~ ~~I.~ OTHER !f-.y_~)~A~~.ED INCOME", W P~YMENT FOR tWORK OR SERVICE PERFORMEDl RECEIVED FROM tPAYOR) .i ~~'. ...... . ,_".', ~ . X,'~. '..< . _ ."....~! \_ ,.~......;i".\,i~''''';f~~ t#. . . ~MOUNT s , . '/ .t,' . . , '. SEC~.C:-MOYINO INFORMATION (/lyou~IiftItJ~1D ~. a/:'O~I~..SdonA~'1:~"""(I' It')"l PERIOD LIVED HERE M~ILING ADDRESS CITY' BOROUGH I TOWNSHIP TO ;URRENT ~DDRESS I ( Jf O,"fArH' rHAIoI ) 1"'!HliNl A80ve __.___.___u ~_._.______._ __u___._____.__._~ - ----- RUTH ANN NISWONGER, Plllnllrr v IN TilE COURT OF COMMON PLEAS OF I CUMBERI_AND COUN1Y, PENNSVLVANIA CIVIL. DIVISION. LAW PAUL F, NISWONGER, Derendant NO, 95.5500 CIVIL TERM I IN DIVORCE Plaintiff Ruth Ann Niswonger by her allomeys Broujos & Oilroy, P.C. sets forth the following pursuant to Pennsylvania Rule of Civil Procedure I 920.33(b): I. The marital assets of the parties are as follows: A. 1990 Pontiac Orand Prix H&W $8,500 B. 19RR Pontiac Stationwagon H&W unknown C. Cash at credit union (proceeds from sale of house) H $ 10,000 D. U.S. Savings Bond, H&W unknown E. Life Insurance through TeamHters" H $75,000 F. life Insurance through Teamsters"' H $25,000 G. Pension from Volkswagon of America, Inc. H unkno\\lI H. Pension from Teamsters H unknown 2. The parties have no Joint debts 01' other debts which must be disposed of through the Master's proceedings. 3. The parties separAted November 25, 1995, And have remained separated since that date. 4. nle parties entered into various IIegotiation8 since filing of the complaint, to no avail. 5. Husband Is currently believed to be employed by Roadway Express, 100 Roadway ;;".<c' J.",,,,:,~.,.,,"-,' . , ,_",',',' ~",-j,,",.::'-i';""~-iri.:_"';;-H4i,''';ii?:.@'..".t;;'t~~,{;~f<:~{~L-~,' . ,"-,..............Jo--.~'~'.: _" ," ,_ ,.. Drive, Carlisle, PA 17013. 6. Wife had been employed by Bob Evans. She has recently started a new job and will provide employment Information. 7. Wife claims allomey's fees, since she has been unemployed for various times due to injuries for which she received workmen's compensation and/or unemployment compensation. On the other hand, husband has been employed regularly at a wcll-paying job with Income as of AUlust 13, 1997 in the net amount of $2,089 per month. 8. Wife also claims alimony and requests that the Master direct that alimony be detennlned by the Domestic Relations Office in accordance to regulation. RESPECTFULLY SUBMITTED, BROUJOS " GlLROV, P.C. . Br 'os, Esquire I.D. 06268 4 N. ano Street Carlisle, Pennsylvania 17013 717/243.4574 717/766.1690 FAX 717/243.8227 lrt en "..... L f-_ ., , "~-I :r.: tl_ '" '" .., " ~.. I- ~, .~) , '" t..~ ':;tl ,\'.1.. :-..... '-' ,.. :1,:: @ VI, : IN THE COURT OF COMMON PLBAI : OF CUMBERLAND COUNTY. : PENNSYLVANIA RUTH ANN NISWONGER, Plaintiff PAUL F. NISWONGER, Defendant . . : CIVIL DIVISION. LAW : NO. 9S.SS00 CIVIL TBRM : IN DIVORCE TO THE PROTHONOTARY: Pleue enter my appearance In the above captioned mailer. RelpecllUlly aubmllled, GRIFFIE" ASSOCIATES ?i; (lJ c .J.. ..:: '" .. " 1-" - ~lJ,. ~; , Ie, -, .. ~ II' (',J '_'l 1" l' I '. .. ~ rLI" I ..~(~ If":'1 ,:. =1 ~' H. 'J. b; j L) .......a.-. ........QIMt A.-........ ..... .... ....... GIIMR ... ........ GRIFFIE & ASSOCIATES Attol'Dl)'la.d Couuelon At Law ..... ........... ~,,, I"'" (717) ..... ....,... 'All'IU" RIf - . ......'TMI..... .... - I. ........... - . ~'AI,.. (717) ... ... III CIIIIIIo \. Sept-- 19. 1997 E. Robert EIIcbr, U, Esquire Dlvoroe Muter 55 Will C1aarcb Street CaIt*. PA 17013 0: N1swonpl' VI. Nlawonpl' No. 95-5500 Civil Term Dear Mr. ElIcker: EncIoIed pIeue ftnd Defendant'I Pre-TriaI Stltlllllllt INl Inventory and AppnIIIIIIIIIt In the above-captloned matter. Very truly yours, GRIFFIE a: ASSOCIATES &ft~ J AMSljml EncIoIIUI'II cc: John H, BrojouI, Esquire AR!ilI:TS OWITRIl, Paul P. NiIwonp', Defendant, marb on the Hit below tho. ItImI applicable to the CUI at bar and Itemlu the .....1 on the foUowina JIIIes. ( ) I. ReII Property (X) 2. Motor Vehicles ( ) 3. Stocb, Bondt, Securities, and Options ( ) ... CertifIcates of Deposit (X) 5. Chlc1dna Account.. Cub (X) 6. Savinp Alx:ounta. Money Market and Slvinp c.tlflcates ( ) 7. Contentl of Safe Deposit Boxes ( ) 10 TnaItI ( ) 9. uti InIunnce PoUcies (indicate face value, cub IUITIIIlIer value and current beneficiaries) 0010. Annuities ( ) 11. GiftI ( ) 12. Inheritancel ( ) 13. Paten... Copyriahtl, Inventlolll, Royalties ( ) 14. Penonal property outside the home ( ) 15. Bualneuea (LIlt all owners, lncIudlna percenllp of ownership and officer/director, positions held by I party with company) ( ) 16. Employment termination benefits-severance pay, workers' compenutlon c1a1m1lWard ( ) 17. Profit Slwina Plana Paul F. NllWOlllW. Defendant, marb on the Uat below tho.. Items appUcabIt to the 011I at bel' IIld ItemIaI the IlablUtla on the foUowlna papa. SECURED ( ) I. Modppa ( ) 2. IUlfammta ( ) 3. Uena ( ) 4. Other Secured UabUltla UNSBCURBD ( ) 5. Credit Card bal.- ( ) 6. Pun:hueI (X) 7. Lou paymentl ( ) .. NoteI PlyabIe ( ) 9. Other upW\II'ICI UabUltla CONTINGENT OR DBFEIUlED ( ) 10. Contract or Apementl ( ) 11. PromIaory Not. ( ) 12. Lawaultl ( ) 13. Options ( ) 14. Tax. ( ) 15. Other contlnaent or deferred UablUtla ~ Paul F. Nlawonaer, Defendant, Uatl all nwital property In which either or both apoulel have IlepI or equitable Intemt, IndJvidually or with any other person, u of the date that this action wu commenced: 2. (I) Deleript10n ofPro~ 1990 Pontiac Orand Prix Names of All 0wnIn Ruth A. N1lwonaer Paul F. Nlawonaer Paul F. Nllwonaer Dat. of Acq~llitJon Item Numlw- 1992 (b) 1988 Pontiac 6000 Stltlon Waaon 12/11/91 5. (I) CheckIna Account Ruth A. NIawonaer 1991 Dauphin Deposit Bank Paul F. Niawonaer Account II 031300834.10-48250-99-1169 (b) Members United Federal Ruth A. N1lwonaer Credit Union Paul F. Nllwonaer Account 1166718410, Member 111152300 6. U.S. Slvinp Bondi (3) Paul F. Nllwonaer Face Valu. SIOO 10. American LIf. &: Cuualty Paul F. Niawonaer Insurance Company AnnuIty Accountll1N272777CD 18. (I) Volkawagon of America. Inc. Plul F. Nlawonaer (b) Central Pennsylvanll Paul F. Nllwonaer Teamlters Pension Fund 1911 03/02119 IImnl 1990 Colt or Value Coil or Valu, 1- M ofDelt of M ofDllt of 30 Dlya Prior IfIDbIr .~.iIiI,IaD ~...tlnn To ...... 5. <I) -0- (b) .0- S 93.00 6. 1150.00 ~:l4.00 10. 2,401.53 .0- II. <a) -0- (b) -0- 21,9:19.96 Paul F. NIawonI<<. ))e(endant, lIatJ III property In whlc:h a spoull baa JepI or equitable interelt, whlc:h II c:Ialmed to be excluded from marital property: Item Description Names of Date of tJt........ ofPnlpertv AIIllwnIn ~ 25. (a) (b) 300 Savap rl8e I2-puae Rem1naton Sbotpm Paul F. Nlawona<< Paul F. Nlawonp' 1961 durilli IIlII'riap 7. <a) AIllOWlt ofLlab1Uty DIll IncurrId . (JI\ Ad10n wu CftM........... S <a) 6,000.00 (b) 3,000.00 Date BaIanc:e laDue PIriodic .. ................ Item N......... Paid 011' S1OOl1llOllth RUTH ANN NISWONGER, I IN THE COURT OF COMMON PLEAS OF plaintiff I CUMBERLAND COUNTY, PENNSYLVANIA I vs. , NO. 95 - 5500 CIVIL . I PAUL F. NISWONGER, I Defendant . IN DIVORCE . ORDER OF COURT AND NOW, th'o J { "" do, 0' , 1998, the parties and counsel having entered into an agreement and stipulation resolving the economic issue. on April 14, 1998, the date set for a Ma.ter's hearing, the agreement and stipulation having been transcribed and subsequently .igned by the parties and counsel, the appointment of the Master is vacated, and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY THE COURT, er, P.J. eel John H. Broujos Attorney for Plaintiff Anne M, Shepard Attorney for Defendant ~~4- m'-~ +/, sJ q 8'. ..& ,p. , . IN THE COURT OF COMMON PLEAS OF ClmBERLAND COUNTY, PENNSYLVANIA NO. 95 - 5500 CIVIL RUTH ANN NISWONGER, plaintiff I va, . . PAUL F. NISWONGER, Defendant . . . . I IN DIVORCE THE MARTER I Today is TUesday, April 14, 1998. Thia ia the date set for a Master's hearing in the above captioned divorce case. Present in the hearing room are the plaintiff, Ruth Ann Niswonger, and her counsel John H. Broujoa, and the Defendant, Paul F. Niswonger, and his counsel Anne M. Shepard, A divorce complaint was filed on October 13, 1995, raiainv vrounda for divorce of irretrievable breakdown of the .arriave. Attorney Shepard haa adviaed that yesterday she filed with the prothonotary her client's affidavit of consent and waiver of notice of intention to request entry of divorce decree. Mr. Broujos has provided me with the same doou.enta which have been signed today by his client, which the Master's office will file promptly today with the Prothonotary. Therefore, the divorce will be able to be concluded under section 3301(C) of the Domestic Relations Code. The complaint raised the economic claims of equitable distribution, alimony, and counsel fees and expenses, The parties were married on August 26, 1973, and separated on November 25, 1995, They are the natural parents of thr.. childr.n, .11 of whom are .mancipated. Th. Ma.t.r has been .dvi.ed that aft.r n.goti.tion. the p.rti.. h.ve re.ched an agreement with reepect to all the economic i..u.. raised in the proceedings. counsel are going to pl.c. the agr..m.nt on the record in the presence of the part i.. .nd the agr....nt a. .t.t.d on the record will be con.id.r.d the .ub.t.ntiv. agr....nt of the parties not sUbject to any change. or modification. except for correction of typographical .rror. which .ay be made during the transcription. counsel and the part i.. .r. going to return later this morning to r.vi.w the dr.ft for typogr.phical errors, make any correction. .. r.quir.d, and then affix th.ir signature. to the .gr....nt by way of .ffirm.tion of the t.rms of settlement that h.ve been placed on the record at this time. Aft.r the agre.ment has been reviewed for typogr.phical .rror. and signed by counsel and the parti.., the Ma.ter will prepare an order vacating his appointment and th.n coun.el, upon r.ceipt of the vacation of the Master's appointm.nt, will be able to file a praecipe transmitting the r.cord to the Court requesting a final decree in divorc.. The Master has been advised that there will b. two Qualifi.d Domestic Relations orders prepared in order to co.pl.t. settlement on the pension issues. Those orders will be able to be presented to the Court subsequent to the entry of a divorce decree as part of these proceedings and to complete the ..ttl...nt .gr....nt aa provided herein. Ms. Shepard. MS. SHEPARD I 1. Th. agr....nt between the parties shall be that th.re will b. 60/40 diatribution of the ourrent pension., Th.r. are ourr.ntly two pensions, one Volkswagen of ~.rioa Ino" whioh had been aold to GE capital and i. Policy No. P4083, and Roadway Express Inc., which ia through the T.a.sters Union. Ruth Ann Ni.wonger shall reoeiv. 60' of the marital portion of said pensions. The marital portion shall be that which was acquired before the date of final ..paration. The date of final separation was Novemb.r 15, 1995. Th. cov.rture fraction for Roadway Express Ino., i. 65.8' and Ruth Ann Niawonger's intereat in that amount .hall be 39.48'. The coverture fraotion for Volkawagen of ~.rioa Ino., or GE capital, is 60'. a, Ruth Ann Niswonger shall not receive any alimony. 3, Paul r. Ni.wonger shall pay $1,000.00 of Ruth Ann Ni.wong.r's counsel fees related to this divorc. dir.ctly to Broujo. . Gilroy, P.c, ~aid payment shall be .ad. no lat.r than Jun. 15, 1998, This paragraph is enforc.able by conte.pt proceedings with the right of Broujo. · Gilroy, p,c" to enforce it through court proce.ding., .hould the $1,000.00 not be paid by end of bueine.. on June 15, 1998, inclUding counsel fees and expense.. 4, spouaal support shall end upon the entry of a divorce decree. 5, Each party shall retain all personal property currently in their possession without any claim by the other party to said personal property inoluding any bank account. or any other items of household tangible personal property, 6, Ruth Ann Niswonger shall convey all right, title, and interest she may have in the 1988 pontiac station wagon to paul F. Niswonger. Paul F. Niswonger shall convey all right, title, and interest he may have in the 1990 pontiac Grand Prix to Ruth Ann Niswonger. Eaoh will exeoute, aoknowledge, and deliver any and all instru..nts neoessary to transfer said title to the oth.r party within two (2) weeks of today's date. 7. Exoept as h.rein otherwise provided, eaoh party may dispose of his or her property in any way and .aoh party h.r.by waives and relinquishes any and all rights h. or sh. .ay now have or hereafter aoquire und.r the pr.s.nt or future laws of any jurisdiotion to share in the prop.rty or the estate of the other as a r.sult of the .arital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the oth.r, and right to act as administrator or executor in the other's estat.. Each will at the request of the oth.r .x.out., acknowledge, and deliver any and all instru..nts which .ay b. neo.ssary or advisable to carry into .ff.ct this .utual waiver and relinquishment of all suoh int.r.sts, rights, and claims. MS. SHEPARD I Mr. Niswonger, you've heard m. r.cit. this .gr....nt? MR. NISWONGER I Yes. MS. SHEPARD I And you were present at the time that the agr..m.nt was being recited? MR. NISWONGER I Yes. MS. SHEPARD I And do you understand what this agr...ent is? MR. NISWONGER I Yes. MS. SHEPARD I And do you agree with this agr.em.nt? MR. NISWONGER I Yes. MR. BROUJOSI Mrs. Niswonger, have you been here during the time that that information was diotated? MRS. NISWONGER I Yes. RUTH ANN NISWONGER, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY, PENNSYLV/ III vs. NO. �5 - 5500 Civil Term mw PAUL F. NISWONGER, : ACTION IN DIVORCE Defendant . CIVIL ACTION - LAW c-a a_r Ica --4 cn JOINT MOTION FOR ENTRY OF DOMESTIC RELATIONS RDER< 1. Defendant/Participant is Paul F. Niswonger, whose address is 53 Monarch Drive, Carlisle, Pa. 17015. His social security number will be provided in a separate private document, to the account holder. He is self - represented. 2. Plaintiff /Alternate Payee is Ruth Ann Niswonger, whose current address is: 1823 3rd St., South Conellsville, Pa 15425. Her social security number will be provided in a separate private document, to the account holder. Her counsel is Jane Adams, Esquire. 3. The parties were Husband and Wife and an action in Divorce was filed under the above - captioned number. 4. The Decree in Divorce was entered on May 5, 1998. 5. Husband has an annuity account with G.E. Capital Retail Bank, a company which purchased his Volkswagen America Inc. account, which was referenced in the parties' original settlement agreement. 6. Pursuant to the parties' settlement agreement, the parties agreed that Wife should be awarded sixty. percent (60 %) of the monthly retirement benefit should be transferred to Wife. 7. The transfer cannot be made without a court Order. 8. Both parties agree and request that the attached order be entered to effectuate the transfer. 9. This matter was previously assigned to Judge Bayley. WHEREFORE, the parties jointly request entry of the attached Order. Witnesseth: ne Adams, Esquire 17 W. South St. Carlisle, Pa. 17013 (717) 245 -8508 ATTORNEY FOR PLAINTIFF titk oirvvy‘ 71A..suAY;Yie--.) Ruth Ann Niswonger, Plaintiff Date: — 1J — 7`-i' Paul F. Niswonfendant Date: c./r F--/Y RUTH ANN NISWONGER, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. : CIVIL DIVISION - LAW ...a= ...- m' ,.. r-, -r) PAUL F. NISWONGER, : NO: 95-5500 CIVIL TERM cr)P :473r..) Defendant : IN DIVORCE --<> cn r- <c) ..e, ›c--) = zc, QUALIFIED DOMESTIC RELATIONS ORDER This cause coming before this Court for the purpose of entry of a Qualified Domestic Relations Order under the Retirement Equity Act of 1994; the parties being in agreement; and the Court being fully advised in the premises; THE COURT FINDS AS FOLLOWS: A. On May 5, 1998, this Court entered a Judgment of Dissolution of Marriage (hereinafter, the "Judgment") which approves and incorporates the parties' Marital Settlement Agreement dated April 14, 1998 and which resolves between the parties the issues of property distribution and maintenance pursuant to the provisions of Pennsylvania Domestic Relations Act (23 Pa. C.S. §§3501, et seq.). Said Judgment further allocated to RUTH ANN NISWONGER certain retirement benefits of PAUL F. NISWONGER, her former husband. At the entry of the Judgment herein, PAUL F. NISWONGER, had a fully vested interest in the Volkswagen of America, Inc. Pension Plan. Prior to the entry of the Judgment herein, said Volkswagen of America, Inc. Pension Plan was terminated and a single premium group annuity contract No. P4083 was purchased by Volkeswagen of America, Inc. from GE Capital Assurance Company (formerly United Pacific Life Insurance Co.). Said Pension Plan is hereinafter referred to as the "Contract." Said Marital Settlement Agreement provides in Section 1 that sixty (60%) percent of the monthly retirement benefit of PAUL F. NISWONGER under the Contract shall be transferred to RUTH ANN NISWONGER. C. Said Judgment incorporates by reference the findings and orders set forth herein, which are intended by the parties to constitute a Qualified Domestic Relations Order under a Retirement Equity Act of 1984, providing for distribution to RUTH ANN NISWONGER sixty (60%) percent of the benefits regarding PAUL F. NISWONGER'S interest in the Contract commencing upon the payment of benefits to PAUL F. NISWONGER. D. No portion of any benefits of PAUL F. NISWONGER under the Contcact is required to be paid to any other alternative payee under any other qualified domestic relations order, and no such order has ever been entered relative to any such benefits to PAUL F. NISWONGER under the Contract. E. The address of RUTH ANN NISWONGER, the alternate payee under this Order is 1823 3rd St. South Conellsville, Pa 15425, and her social security number will be provided in a separate document. RUTH ANN NISWONGER was born on July 30, 1956. The address of PAUL F. NISWONGER, the annuitant in the Contract, is 53 Monarch Drive, Carlisle, Pennsylvania, 17015 and his social security number will be provided in a separate document. PAUL F. NISWONGER was born on October 12, 1952. IT IS HEREBY ORDERED AS FOLLOWS: 1. The right to receive sixty (60%) percent of the vested benefits of PAUL F. NISWONGER and all the income, dividends or interest earned on said income since the entry of the Judgment of Dissolution of Marriage, May 5, 1998, under the contract is hereby assigned to RUTH ANN NISWONGER, former wife of PAUL F. NISWONGER, to be received by her commencing upon the payment of pension benefits to PAUL F. NISWONGER. The measuring life for the payment of pension benefits to the alternate payee shall be Iflfl)!±C nt , the {Annuitant or Alternate Payee}. 2. The Contract administrator shall pay such benefit to RUTH ANN NISWONGER. 3 PAUL F. NISWONGER shall forthwith execute or cause to be executed such documents and/or shall perform such acts as are necessary to provide RUTH ANN NISWONGER with the right to receive the distribution of her benefit in the form set out in paragraphs 1 and 2 above. 4. With respect to PAUL F. NISWONGER'S interest in the contract, as described above, PAUL F. NISWONGER hereby waives and is now barred from electing any distribution options or alternate payees or from taking any other actions which would in any way impair RUTH ANN NISWONGER'S right to receive the above-described distribution, provided that said waiver and bar shall have no application with respect to PAUL F. NISWONGER'S remaining interest in the vested benefits under the Contract. 5. Nothing in the Order requires and this Order shall not be construed to require the Contract to provide PAUL F. NISWONGER and/or RUTH ANN NISWONGER with: a. Any type or form of benefit not otherwise provided under the Contract; or b. Any increase in benefits to which RUTH ANN NISWONGER is not otherwise entitled (determined on the basis of actuarial equivalency.) 6. This Order is applicable solely to the GE Capital Single Premium Group Annuity Contract. 7. RUTH ANN NISWONGER shall report any retirement payments received on any applicable tax return. The Contract administrator is authorized to issue a form 1099-R on any direct payment made to RUTH ANN NISWONGER. 8. This Court retains Jurisdiction to amend this Order: a. For the purpose of establishing or maintaining this Order as a 'Qualified Domestic Relations Order; b. To revise or conform the terms of this Order so as to effectuate the express provisions of this Order, of the parties' Marital Settlement Agreement dated April 14, 1998, and/or of the Judgment of Dissolution of Marriage entered in this cause on May 5, 1998. c. To revise or conform the terms of this Order so as to effectuate the parties' intentions as expressed in said Agreement and in the Order. 9. A copy of this Order shall be promptly submitted by RUTH ANN NISWONGER or her counsel to the Contract Administrator of GE Capital Assurance Company (formerly United Pacific Life Insurance Company). DATED: T as A. PlaceV. Comm n Pleas Judge e., ESTA re— rfr Flott4C-F ckv 1 “Nswbr19.ersi De-e-fracxvib RUTH ANN NISWONGER,.. : IN,THE COURT OF COMMON PLEAS Plaintiff _ : OF CUMBERLAND COUNTY, PENNSYLVANIA vs. : NO. 95 - 5500 Civil Term PAUL F. NISWONGER, : ACTION IN DIVORCE Defendant : CIVIL ACTION - LAW QUALIFIED DOMESTIC RELATIONS ORDER In accordance with the agreement of the parties, this orc?es dis_neses of 1 or a portion r, f the i -'a ticipant's benefit in the central Pennsylvania Teamsters Retirement Income Plan 1987 (the "Plan"). 1. Participant Information: Name: Paul F. Niswonger Address: 53 Monarch Drive, Carlisle, Pa. 17015 Date of Birth: 10/12/1952 Social Security No. To be provided separately to the plan, in writing. 2. Alternative Payee Information: Name: Ruth Ann Niswonger Address: 1823 3rd St. South Connellsville, Pa 15425 Date of Birth: 7/30/56 Social Security No. To be provided separately to the plan, in writing. 3. Date of Marriage and Separation/Divorce: The Participant and. Alternate Payee were married on August 26, 1973 and were separated on November 15, 1995. The final divorce Decree was entered on May 5, 1998. 4. Assignment of Benefit to Alternate Payee. Alternate Payee is hereby assigned a portion of the Participant's account balance under the Plan. The Fund is to make payment of the Alternate Payee's benefits directly to the Alternate Payee. 5. Method of Dividing Participant's Benefits: The Plan shall pay the Alternative Payee a portion of the Participant's vested accrued benefit under the Plan. This Alternate .Payee shall receive $32.83..7.55 from Participant's irterest in the Plan as of the date this Order is signed, and the Alternate Payee shall be credited with net income, loss, or expense from the date this Order is determined to be a QDRO until the date the Alternate Payee receives the awarded benefits. The Fund shall separately account for the benefits awarded in this Section as soon as administratively possible after the Order is determined to be a Qualified Domestic Relations Order. 6. Form of Payments. The Alternate Payee may elect to receive payment from the Plan in any form in which benefits may be paid under the Plan to the Participant (other than in the forni of a joint and survivor annuity). 7. Beneficiary. The Alternate Payee may select a beneficiary to receive her benefits by filing a beneficiary designation form with the Fund Office. In the event the Alternate Payee should die prior to receiving all of the assigned benefits, the Plan shall pay the benefits to the beneficiary selected by the Alternate Payee on a beneficiary form provided by the Fund Office, or if no beneficiary is selected, to the Alternate Payee's estate. 8. Date of payment. The Alternate Payee may elect to receive payment from the Plan at the Participant's earliest retirement age, or, if earlier, at the earliest date permitted under the Plan. For purposes of this paragraph, the Participant's earliest retirement age means the earlier of: (a) the date on which the Participant is entitled to a distribution under the Plan; or (b)The later of either: (i)the date the Participant attains age 50; or (ii)the earliest date on which the Participant could begin receiving benefits under the Plari if the Participant separated from service. 9. Construction. This order is not intended, and shall not be construed in such a manner as, to require the Plan Administrator: (a) to provide any form of benefit option not otherwise provided under the terms of the Plan; (b) to require the Plan to provide increased benefits determined on the basis of actuarial value; or (c) to require the payment of any benefits to the Alternate Payee under another order which previously was deemed to be a Qualified Domestic Relations Order. 10. Federal Tax Reporting. For federal income tax purposes, the Alternate Payee and not the Participant shall be treated as the distributee of all benefits made by the Plan to the Alternate Payee pursuant to this order. The Fund will issue a Form 1099-R to the Alternate Payee with respect to each calendar year in which the Alternate Payee receives benefits and will report such income to the IRS under the Alternate Payee's name and Social Security Number. 11. Continued Jurisdiction. The Court shall retain jurisdiction over this matter to amend the Order if necessary to establish or maintain its qualification as a Qualified Domestic Relations Order under applicable law. 12. Qualification. The Order is intended to constitute a qualified domestic relations order within the meaning of Section 414(p) of the Internal Revenue Code of 1986 as amended, and Section 206(d) of the Employee Retirement Income Security Act of 1974, as amended, and shall be interpreted in a manner consistent with such intention. WITNESS: WITNESS: G1nwm- 9,744w Ruth Ann Niswonger, Altte ate Payee Date: `r - Paul F. Niswonger, Participant Date: g ^ r %y SO ORDERED, this2(7 day of , 2014. cc: ✓ Jane Adams, Esquire, for Alternate Payee Hannah Herman. Snyder, for Participant e tes 0 Common Pleas 1 _ (lige RUTH ANN NISWONGER, : IN THE COURT OF COMMON PLEAS Plaintiff : OF CUMBERLAND COUNTY, PENNSYLVANIAN, vs. : NO. 95 - 5500 Civil Term rn PAUL F. NISWONGER, : ACTION IN DIVORCE -<> Defendant : CIVIL ACTION - LAW cz) C-) CPI JOINT MOTION FOR ENTRY OF DOMESTIC RELATIONS ORDM! :Ns.) c.) 1. Defendant/Participant is Paul F. Niswonger, whose address is 53 Monarch Drive, Carlisle, Pa. 17015. His social security number will be provided in a separate private document, to the account holder. He is self -represented. 2. Plaintiff/Alternate Payee is Ruth Ann Niswonger, whose current address is: 1823 3rd St., South Conellsville, Pa 15425. Her social security number will be provided in a separate private document, to the account holder. Her counsel is Jane Adams, Esquire. 3. The parties were Husband and Wife and an action in Divorce was filed under the above -captioned number. 4. The Decree in Divorce was entered on May 5, 1998. 5. Husband has an annuity account with Genworth Life Insurance Company, a company which purchased his Volkswagen America Inc. account, which was referenced in the parties' original settlement agreement. 6. Pursuant to the parties' settlement agreement, the parties agreed that Wife should be awarded sixty percent (60%) of the monthly retirement benefit should be transferred to Wife. 7. The transfer cannot be made without a court Order. 8. The entity with which the account is held, was previously incorrectly identified as "GE Capital" and Genworth Life Insurance Company needs an updated Order which correctly identifies the company to divide this asset. 9. Both parties agree and request that the attached order be entered to effectuate the transfer, and have indicated so by signing the Order. Date: 10. This matter was previously assigned to Judge Placey. WHEREFORE, the parties jointly request entry of the attached Order. Respectfully submitted, Adams, Esquire est South St. rlisle, Pa. 17013 ID. No. 79465 (717) 245-8508 ATTORNEY FOR PLAINTIFF RUTH ANN NISWONGER, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY - PENNSYLVANIA VS. : CIVIL DIVISION - LAW PAUL L. NISWONGER, : NO. 95 - 5500 CIVIL TERM Defendant : IN DIVORCE QUALIFIED DOMESTIC RELATIONS ORDER This cause coming before this court for the purpose of entry of a Qualified Domestic Relations Order under the Retirement Equity Act of 1994; the parties being in agreement; and the Court being fully advised in the premises; THE COURT FINDS AS FOLLOWS: A. On May 5, 1998, this Court entered a Decree in Divorce, (hereinafter "Decree") which approves and incorporates the parties Marital Settlement Agreement dated April 14, 1998 and . which resolves between the parties the issues of property distribution and maintenance pursuant to the provisions of the Pennsylvania Domestic Relations Act (23 Pa.C.S. s3501, et. seq.). Said Decree further allocated to RUTH ANN NISWONGER certain retirement benefits of PAUL F. NISWONGER, her former husband. B. At the entry of the Decree herein, PAUL F. NISWONGER had a fully vested interest in the Volkswagen of America, Inc. Pension Plan. Prior to entry of the Decree herein, said Volkswagen of America Inc. Pension Plan was terminated and a group annuity contract was purchased with Genworth Life Insurance Company, (hereinafter "Genworth"), with a certificate number 1P4082683. Said plan is hereinafter referred to as the "Contract." Said marital Settlement Agreement provides in Section One that sixty (60%) percent of the monthly retirement benefit of PAUL F. NISWONGER under the Contract shall be transferred to RUTH ANN NISWONGER. C. Said Decree incorporates by reference the findings and orders set forth herein, which are intended by the parties to constitute a Qualified Domestic Relations Order under a Retirement Equity Act of 1984, providing for distribution to RUTH ANN NISWONGER sixty (60%) percent of the benefits regarding PAUL F. NISWONGER'S interest in the Contract commencing upon the payment of benefits to PAUL F. NISWONGER. D. No portion of any benefits of PAUL F. NISWONGER under the Contract is required to be paid to any other alternative payee under any other qualified domestic relations order, and no such order has ever been entered relative to any such benefits to PAUL F. NISWONGER under the Contract with Genworth. E. The address of RUTH ANN NISWONGER, the alternate payee under this Order is 1823 3rd St. South Conellsville, Pa 15425, and her social security number will be provided in a separate document. RUTH ANN NISWONGER was born on July 30, 1956. The address of PAUL F. NISWONGER, the annuitant in the Contract, is 53 Monarch Drive, Carlisle, Pennsylvania, 17015 and his social security number will be provided in a separate document. PAUL F. NISWONGER was born on October 12, 1952. IT IS HEREBY ORDERED AS FOLLOWS: 1. The right to receive sixty (60%) percent of the vested benefits of PAUL F. NISWONGER and all the income, dividends or interest earned on said income since the entry of the Judgment of Dissolution of Marriage, May 5, 1998, under the contract is hereby assigned to RUTH ANN NISWONGER, former wife of PAUL F. NISWONGER, to be received by her commencing upon the payment of pension benefits to PAUL F. NISWONGER. The measuring life for the payment of pension benefits to the alternate payee shall be the alternate payee and she shall have the right to receive the actuarial equivalent of 60% of PAUL F. NISWONGER'S benefit as long as she lives. 2. The contract administrator shall pay such benefit to RUTH ANN NISWONGER. 3. PAUL F. NISWONGER shall forthwith execute or cause to be executed such documents and/or shall perform such acts as are necessary to provide RUTH ANN NISWONGER with the right to receive the distribution of her benefit in the form set out in paragraphs 1 and 2 above. • 4. With respect to PAUL F. NISWONGER'S interest in the contract, as described above, PAUL F. NISWONGER hereby waives and is now barred from electing any distribution options or other alternate payees from taking any other actions which would in any way impair RUTH ANN NISWONGER'S right to receive the above-described distribution, provided that said waiver and bar shall have no application with respect to PAUL F. NISWONGER'S remaining interest in the vested benefits under the Contract. 5. Nothing in this Order requires and this Order shall not be construed to require the Contract to provide PAUL F. NISWONGER and/or RUTH ANN NISWONGER with: a. Any type of form or benefit not otherwise provided under the Contract, or b. Any increase in benefits to which RUTH ANN NISWONGER is not otherwise entitled (determined by an actuarial equivalency.) 6. This Order is applicable solely to the Genworth group annuity contract, certificate no. 1P4083683. 7. RUTH ANN NISWONGER shall report any retirement payments received on any applicable tax return. The Contract Administrator is authorized to issue a form 1099-R on any direct payments made to RUTH ANN NISWONGER. 8. This Court retains Jurisdiction to amend this Order: a. For the purpose of establishing or maintaining this Order as a Qualified Domestic Relations Order. c. To revise or conform the terms of this Order so as to effectuate the express provisions of this Order, of the parties' Marital Settlement Agreement, dated April 14, 1998, and/or of the Decree entered in this matter on May 5, 1998. d. To revise or conform the terms of this Order so as to effectuate the parties' intentions as expressed in said Agreement and in the Order. 9. A copy of this Order shall be promptly submitted by RUTH ANN NISWONGER or her counsel to the Contract Administrator of Genworth Life Insurance Company. STIPULATED BY THE PARTIES: iilkahalyvy\-)AkaAfr"cktA. 444 ten Ruth Ann Niswonger, PIgntiff Paul F. Niswonger, De endant Date: SO ORDERED. Date: 7-.iY—/y cc: ----Jane Adams, Esquire, for Plaintiff Paul F. Niswonger, Defendant Copes wailed 10/,3