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Home My WebLink About95-06454 ..--.......".... , , \ : , I, . I f.;J'l7 &J. ~ J -e. aif .7i-.,..t~ 4c)'f') ~( ft';~ ~'c/.?} ~*~ . . . . l'l' .' V, \". \f~ " ~ .. en \u" - ttL' i). I .. I&i' :,-, - ." ...,) 'r f\' , ' ' I ~ ~ I "., n:\' :;1 ( r~ \,I, 1- U U 0' .. lil .. z ~ 0( ,.. ~!j ! ~ ~ I 3 mil . ~ ! ~ ~ i ~ . .' . . " ; ..t,. ~ \... .I' ~j.!i' ~ 4s4 (1.11'1 ( MARITAL SETTLEMENT AGREEMENT ll/A () l~jJ_ rills AGREEMENT, made Ihl~_ dllY of ~/ lll!lween GARV J, liERMAN, herdnllfler rdml'd 10 liS "!lU 8 ND", 1997, by Rnd IInd SUSAN S. liERMAN, hereinafter referred III as "WIFE". WITNESSETH, Ihat: WHEREAS, the parties hereto arc husband and wife, having been IlIwfully Joined In marriage on January 10, 1981. In Cllrllsle, Cumberland Cnunty, Pennsylvania. WHEREAS. two (2) children were bom of Ihis marriage: DEREK IIERMAN born May 30, 1988 and MONIKA IIERMAN bom Mllrch 1. 1993, WHEREAS, it Is the intenlion of the parties tn sellle fully and finally thdr respective financial and property rights and nbllgalions liS bel ween cach nther arising nut of the marriage relationship or olherwise, including withoUI IImillllinn (\) the sellllnllnf nil l11ullers helween Ihel11 relating In Ihc nwnershlp nf rC1I1 111111 pcrsnnlll prnpcrly: (2) thc scllllng uf 1111 l11allers between them relullng Intlw past, presenlllnd flllllre sllpporlllnd/or I11l1illlellllllcc of HUSBAND and WIFE: (3) the sellllnllnf ulll11l1l1ers bel ween Ilwl11 rcl ull nil III the pasl, prcsenl IInd flllllre sllppnrlur I11l1lntenllnce nf Iheir l11inor children, IInd (4) Ihe sCllllng nf IIl1mllllers betwccn lhcm relaling In IIny und 1111 rlghls, titles 1IlllllnlCresls, c1l1lms 111111 pnsslble c1l1hns In nr againsl Ihc cslatc nf thc nlhcr. ,}" . \t' /1 NOW, THEREFORE, with the foregoing recitals being hereinafler incorporated by reference and deerned an essential part hereof In consideration of the foregoing recitals, the mutual prornises, covenants and undertakings herein sel forth, and for good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hercto. HUSBAND and WIFE, each inlending to be legally buund hereby, covenanl and agree as follows: 1. ADVICE OF COUNSEL HUSBAND and WIFE declare thai they have each had a full and fair opportunity to obtain Independent legal advice of cuunsel of their selection. WIFE has been independently represented by Barbara Sumple-Sullivan, Esquire. HUSBAND is has been independently represented by Juhn Connelly, Esquire. Each party further declllres lhat they are executing this agreement freely and volunlarily. having oblalned such knuwledge and disclosure of they legal rights and obligations and that they acknowledge that this agreement is fair and equitable and Is not the result of any fraud, coercion, duress, undue influence or collusion. Z. PERSONAL RIGHTS HUSBAND and WIFE may IInd shall, 1II oil times hereafter, live separale and apart. Each shall be free from all control, reslrainl, interference or mllhorlty, direct or Indirect. by the olher in all respects as is she or he were unmarried, exceplos Illay he necessary to carry oUlthe provisions of this Agreement. Each mllY reside ot such place or places ns she or he mllY select. Each may. for his or her separale use or heneflt, conducl. corry on ami engage inony huslness, 2 .' .j'" '., occupation, profcsslon or employment which to him or her may seem advlsahle. This provision 5hallnot be laken, however, to be an admission onlhe part or ellher IIUSBAND and WIFE of the lawfulness of the causes which led 10, or resu\led In, the continual Ion or Iheir living apart. HUSBAND and WIFE shall not molest. harass, or malign Ihe other or Ihe respective raml\les of each other, nor compel the olher 10 cohabilor dwell In any manner wilh him or her. nor in any way Interfere wilh the peaceful existence, separate from each other. 3. pERTS Each party represents that they have not contracted any debl or lIahllily fur lhe other for I \ \ which the estate of the other party may he responslhle or liable except as otherwise provided herein, and thai excepl only for lhe rights arising out of this Agreement. neilher party wl\l hereafter incur any liability whatsuever for which the other party or Ihe eslale of lhe other party wl\l be liable. Each party agrees to Indemnify and hold hamlless from and against all future obligations of every kind incurred by Ihcm, including Ihose for necessities. WIFE shall continue 10 be solely lIahle anll responslhle for Ihe remaining halances on the marital debt Incurred on her Individually titled credit canis. IIUSBAND shall continue III be solely lIahle and respunslhle for the remaining blllances on the marital deb I Incurred on his Individually Iilled credit cards. Additionally, Wife shall pay lhe following dehls and Imld HUSBAND hannless for SlIme: \. Mastercard. Accounl No. 5329 mil 2 7204 0677, halance $-0-; 2, Discover, Account No. 6011 002.1 5H52 5616, halance $2, 124.H]. ] " ". HUSBAND shall pay Ihe following debls and hold WIFE harntless for same: \. VISA, Account No. 4800 12058201 0260. balance $\,103.00: 2. Gas charges with approximate balance of $800.00. All jolnl credit cards shall be canceled and tennlnated. The parties agree 10 Indemnify and hold Ihe other harmless from each of Ihe aforernentloned debts. Each party further agrees In be responsible for all allorneys' fees Incurred by the other In defense of any claim or suit brought agalnstlhem arising from any debl incurred during the rnarrlage. To the best of thc parlles' knowledge, the parties affirm no other joint or marital debts exist, 4. WAIVER OF APPRAISAl. AND INVENTORY The parties acknowledge and agree thaI Ihey have each had an opportunity to value or have allprBlsed any and all marital properly, and they do hereby waive a fornlal appraisal and Inventory of sarne, and no statemenl or representation by either parly as to value shall be deerned a misstatement or mlsrepresentallon In the olher or be deemed fraudulent. 5. MARITAL ANI) NON.MAR1TAL ASSETS HUSBAND and WIFE do hereby llcknowledge Ihnllhey hnve herelofore divided the non- marital assets nnd mnrltnl nssets Including hut wllhout IImllallon. huslness Interests, jewelry. clothes, furniture, stocks, bonds, pensions nn,1 other llssels wherever sltunted whelher real. 4 execution of this Agreement and the parties acknowlcdge that this agreernent Is specifically conllngent upon the occurrence of the refinance or WIFE'S obtaining his release from Ihe mortgage. 7, MOTOR VEHICLES WIFE is Ihe operator of a leased Volvo. WIFE agrees to assume the debt relaled to sold vehicle and shall save and Indernnlfy HUSBAND from the obligation on said marital debt. HUSBAND shall have sole tille and ownership of the parties' 1992 Iionda and 1980 Jeep. Neither of Ihese vehicles are encumbered. HUSBAND shall be free to dispose of these vehicles as he sees fit and WIFE shall cooperate In executing all documents necessary to effecluate any transfer. 8. PENSION Each party hereby waives any and all claims that he or she may have against the other 10 any pension, employee saving or other stock benefil prograrn of the other. WIFE specifically acknowledges that HUSBAND has two (2) pensions -- a federlll civil service retirement pension, as well as a U.S. mllilary pension. She knowingly wlIlves any claim to said pension benefits, HUSBAND specifically acknowledges tllllt WIFE has pension benefits from her employment at Capilol Health System. HUSBAND knowingly wlllves any cllIhnto said pension benefits. Also, WIFE has addilionally acquired some post-separation benefits at her current employment to which HUSBAND would have no claim. () '."'''''4""~-~}i:,,,,~.;''''~'':.'t:..,.h." L , . / 9. BANK ACCOUNTS AND INVESTMENTS Each party shall have sole possession of the hank uccounls ill Ihelr own numes, 10, INSURANCE HUSBAND shall retain sole ownership of the John Hancock Oroup Policy, as well as life Insurance policy, OL 124559-09. Sold certificale numbers 01.-614.348 and OL-750-196. Additionally, each party agrees to corry life insuronce in 0 sum of not less thot FIFTY THOUSAND DOLLARS ($50,000.00) on himself or herself wilh Ihe children named as Irrevocable beneficiary unlllthe children reach the Bge of twenty-two (22) years. This obligation Is to assist the other parent In support of the children In the event of the other parenl's death. II. STOCKS The parties have various stock holding Interests, which shull be disposed of as follows: A. The parties relinquish ul\ c1ulms 10 slock titled to son, Derek, and daughler, MonlcB, In the McDonald's Cnrporatlon and Financial Tnlsl Company. B. HUSBAND shull have sole ownership of the purtles' sixty-seven (67) shares of stock joinlly titled in Financial Trust Company. C. HUSBAND shall huve solc owncrshlp of the purtles forlY (40) shares of slock In the Disney Company. 7 \2. DISNEY V ACATION l'ACKAm~ WIFE agrees to relinquish and trllnsfer to JlUSBAND 1111 her rights, litle IImllnteresl In Ihe Disney Vacation Pllckllge. IIUSIIAND shllll he solely responslhle for 1111 costs and expenses associated with this Packllge, Including IIny pllst urrellrllge, IHlSIIAND agrees. however tn allow WIFE and the children to use this benerltlnthe event he is unuhle to dn so. IlUSBAND shall have first cholee of date and occupancy. WIFE and children sholl have the right of use of any unuscd portion of Ihis benefit on a yearly hasls as long as IIUSBAND nwns Ihe property. HUSBAND shall give WIFE at least thirty (30l days nntice of all avulhlhle time periods. However, HUSBAND shall be tOlally free 10 sell or Irllnsfer his interest In this IIssel as he so e1ecls. 13. M~~~:~ ~ A~~E~ A~~ N~~~~A:~ 01' RIGlI1'S ANI) CLAIMS C RE T IE :N.' IA DIVORCE ACT OF 1980. AS AMENDED HUSBAND and WIFE acknowledge and IIgree that the provisions of this Agreement are fall', adequate and satisfactory to them. Bolh pllrtles agree to IIcceptIhe provisions set forth In Ihis agreement In lieu of IInd In full ami rlnal selllel1lent and satisfaction of ull claims and delt1ands that either l11ay nnw or hereufter huve ugalnst the other for equituhle dlstrllJIIllon, alll11ony, ullmony pendente lite, counsel fees, costs lIml expenses Ill' other prtlvlslons for their support lInd lt1alntenunce hefore, during lInd lifter the L'OIt1Jl\Cncelt1cnt of uny proceeding for divorce or annullt1cnt betwccn the parlles. H ,~',. ,.. I". AFTER ACOUlRED PERSONAL PROI'ERTYIFllTURE EARNINGS Euch of thc pul1lcs shull hcrcufter own and cnjoy Independeluly of uny c1alrn or right of lhc othcr, all hems of personal propel1y, langible or Intangible, hereafter acquired by HUSBAND or WIFE. whh full power In him or her lU dispose of the same as fully and eHcctlvely, In all respects and for all purposes, as Ihuugh he ur she wcre unlllarricd. 15. ALIMONY. SUPPORT AND MAINTENANCE BOlh pal1les acknnwledgc and agree thallhc provisions of this Agreement providing (or equhable distribution o( marital propel1Y are full'. adequate and satisfuctury tu thcm and are accepted by thern In lieu uf and in (ull and final satlsfacllun of any claims or demands that ehher may now or hereafter have agalnstthc olher fur suppUI1. mulnlcnance or alimony. HUSBAND and WIFE fUl1her, voluntarily and Intelligently, waive und relinquish any right to seck (rom the other any payrnenl (or spousal SUPPOI1, alimony and Illulntenunce. 16. J;USTODY ANn VISITATION HUSBAND and WIFE shall have sharcd legal custudy uf Ihc pal1ics' Illlnor children. Primary physical custody of thc childrcn shall hc In WI FE. II USIlAND shall havc pal1lal physlcul custudy fur thc purpuscs o( vlshulion on ultcrnullng wcekends fmm Ilrlday 01 5:30 p,m. 10 Sunday ut 5:30 p.llloi allematlng hulldnys: two (2) weeks cnch summer and such olhcr times us the pUl1lcs cun mUlually Ilgree. 9 . 17. ~HILD SUPPORT The parties' child supporl obligation Is presenlly delennlned Ihmugh the Domestic Relations Section of the Court (Docket No. 242 S 97, DRII 26,311) by an Order of Court dated Apr\l16, 1997. 18, IiUBSEOUENT DIVORCE A decree In divorce, enlered by a court of cornpelenl jurisdiction to either party. sball nol suspend, supersede or affecl Ihe lenns of Ihls Agreement. Both parties agree to enter a Consent Decree concerning the provisions of this Agreemenl In Ihe Court of Common Pleas of Cumberland County, Pennsylvania, or any olher Court of cOlnpelenl jurisdiction, as a part of a resolution of any divorce action flied. This Agreemenl, and Ihe tenns and conditions contained herein, as well as Ihe enforcement of said tenns and conditions, shall not be contingent upon the granting of a Divorce Decree to either party by the Court of Comrnon Pleas of Cumberland County, Pennsylvania, or any olher Court of competent jurisdiction. Furthennore, both parties hereto agree to execule simultaneously wllh Ihls Agreemenl Ihe appropriate affidavits and consenls 10 secure a No-Fault Divorce as may be required by the Divorce Code of 1980, as amended. 80lh parties herelo agree Ihal Ihls Agreement may be Incorporated Into a separate Court Order bUI shall nol merge In such order In Ihe Court of Common Pleas of CumberlBnd Counly, Pennsylvllnla. 10 " i r, :~ t':~ I,' I 19, OTIIER DOCUMI~NTATION HUSBAND and WIFE covenant and agree thai upon requesl of the other party, they will forthwith execute and deliver to the other pIl11)', 111I)' IInd nil wrlllen instrumenls, IIsslgnments. releases. satisfactions, deeds, notes or such olher wrltll1gs liS mil)' he necessllr)' or deslrllhle for thc proper effectuation of this Agreement. 20. MUTUAL WAIVER AND RELEASE Ol~ RIGIITS AND Cl.AIMS IN ESTATE Each party herehy releases, waives and relinquishes any aod all rights which he or she may now have, or ma)' hereafter have, agllinstlhe olher part)' under Ihe present or future IlIws of any jurisdiction (a) to share In the estate of the other pllrt)' upon Ihe other pllrty's death and (b) 10 act as executor/rlx or admlnistrator/rlx of the olher part)"s l'stllte, 21. MUTUAL REI,EASE HUSBAND and WIFE each do hereh)' mutually remise, relellse, qullclllim IInd forever discharge Ihe other IInd the estate of such other, for 1111 lime III Cllllle, IInd for 1111 purposes whatsoever. of and from IIny IIl1d 1111 rights, title IInd Interests. or c1l1hns In or against the property (Including Incume IInd gain fmm propert)' herellfter IIccl1ling) of thl! other or against the estate of such olher. of whateVl!r nllturl! IIml whercsol!ver sltUlltl!. which she or he now has or at any time hereafter mllY have IIglllnst such olher, Ihe estllte of such other or IIny pllrt thereof, whether arising oUI of un)' fonller IIcls, cnntrncls, engllgemel1ts or IInhllltles of such other or hy WII)' of equltllhle IIISlrlhullol1, dower or cnurles)', nr c1l1ims In Ihe natul'l! of dower or courtesy of widow's or widower's rlghls, fllmlly eXl'mplllln nr shnllur III10WIlI1Ce, Ill' under II " Ihe Inlestate laws, or Ihe right 10 lake IIgalnst Ihe spouse's will, or the righl 10 lreat II lIrellme conveyance by Ihe olher as lestamentary, or all other rlghls of II surviving spouse 10 participate In a deceased spouse's eslate, whelher IIrlslng under Ihe laws uf (II) I'ennsylvllnla, (h) IIny Stale, commonwealth or lerrllory of Ihe Unlled Slates, or (c) IIny olher country, or and rights which HUSBAND or WIFE rnay have or at any time herellfler hllve for lhe past, presenl or fulure support or rnBlntenance, alimony, alimony pendente lite, counsel fees, costs or expenses, whether arising as B result of the marital relalion or olherwise, except, and only excepl, all rights and Agreements and obllglllions of whatsoever nature arising or which may arise under Ihls Agreement or for Ihe breach of any Ihereof. Each of the parties herelll further covenants and IIgrees for himself IInd herself and his or her heirs, executors, administrators and assigns, that he or she will never, at any lime hereafler, sue the other party or Is or her heirs, executors, administrators and assigns, for Ihe purpose of enforcing any of the rights relinquished lindeI' this paragraph. Each of the parties further covenants and agrees thai he or she will pennll any wlllnf Ihe nlher to be probaled and allow administration upon his or her personal, real nr mixed estate and allnw effects to be taken out by the person or persons who would have been entllled to dn sn had HUSBAND or WIFE died during lhe lifetime of the nlher. Elich of the pllrlles herehy releases, relinquishes and wolves any and 1111 right In lIet as execulor or executrix nr IIdmlnlslralnr or admlnlstralrix nf Ihe nther's estate. 12 , , " .. Ills the Intenllon of HUSBAND and WIFE to give to each other by the execution of this Marital Selllement Agreernent a full, complete and general release with rcspect 10 any and all property of any kind or nature, real, personal or mixed, which Ihe other now owns or rnay hereafter acquire, except and only except all rights and Agreements and obllgalions of whatsoever nature arising or which may arise under Ihls Agreement or for the breach of any thereof. n. SUCCESSOR'S RIGHTS AND LIABILITIES This Agreemenl shall, excepl as otherwise provided herein. be binding upon Bnd Inure to the benefit of the parties hereto, their respective heirs, executors, administrators, successors or assigns. Z3. SEVERABILlTV If any provision in this Agreement is held by a court of competent jurisdiction to be Invalid, void, or unenforceable, Ihe remaining provisions shall nevertheless continue In full force and effect without being Impaired or Invalidated in any way. Z4, ENTIRE AGREEMENT HUSBAND und WIFE do hereby covenant und warrant tbat this Agreemenl contains all of the representations, promises and Agreements made hy either of them to the olher for the purposes set forth in the preamble hereinabove: Ihat there arc no claims, promises or I.l represenlallons nol herein conlained, either omlor wrillen, which shull or Illuy be churged or enforced or enforceable unless reduced to writing ond signed by both of the porties herelo. 25. plNDlNG EFFECT OF AGREEMENTIW AIVER This Agreemenl shall rcmain In full force ond effect unless and untiltem1inated under and pursuanlto the lerms of Ihls Agreement. The failure of either party 10 Insisl upon strict perfonnance of the provisions of Ihis Agreernent shall nol be construed as u waiver of any subsequent defuullof the same or similar nature, nor shall such failure be construed as a wulver of uny other lern1, condition, clause or provision of this Agreement. 26. BREACH If either party breaches any provision of this Agreemenl, the other purty shull have Ihe righi, at his or her elecllon. to sue for damages for such breuch or seck such olher remedies or relief as may be available 10 him or her, uml the purty brellchlng this conlract shall be responsible for payment of reasonable legal fees and costs Incurred by the olher In enforcing Ihelr rights under this Agreement, 27, CONTROLLING LAW This Agreement shall be conslrued ullll governed in accordance with the luws of Ihe Commonweallh of Pennsylvunla. 14 . ~ . ' I. Gold necklace 2. 12 beer steins 3, Mal1ha Washington plales 4. Orville Wright (clark rlgure) 5, 2 cuckoo clocks 6. Grandfather's clock 7. 2 Selmshell pictures (ducks/grouse) 8, Hurnmel wine glasses (6) 9. Mickey Mouse humrnel (TO BE GIVEN TO THE CHILDREN) 10. Desel1 stonn hummel 11. Hunter hummel 12. Airplane set - Franklin Mint 13. 2 marble lamps 14, Gennan candle 15, Ship frorn Spain 16. Father's sled 17. 22 rines 18, Skis (x-country, downhill) 19. Personal belongings from the boxes in basemen I Contents of Safe: including but notllmlled to Gary's discharge papers (DD214), old and foreign rnoney from Gary's grandfalher, Elvis cards (If found). Tool Box Prints of Wood Duck, Bob while, Pheasant Power Tools HUSBAND shall have the righllo use WIFE'S canoe wllh appropriate nOlice as long as wife retains ownership. WIFE shall be under nn obllgallon 10 relurn sold canoe. EXHIBIT "A" MARITAL SETrLE:\IENT AGI{EEMENT AGREEMHNT. made IhiS~ 111 belween GARY J. lIER:\-I.\N, hereinalter referred 10 THIS 199i, by and Jnu Sl'SAN S. HER:\IAN, hereinafter referred 10 as "WIFE". WITNESSETH, Ihat: WHEREAS, the panies herelO are husband and wife, having been lawfully joined In marriage on January 10, 198 I. in Carlisle, Cumberland County, Pennsylvania. WHEREAS, two (2) children were bom or Ihis marriage: DEREK HER:\IAN bom "lay 30, 1988 and MONIKA HER:\IAN bOI11 March I. 1993. WHEREAS, it is the inlentlon or Ihe panies 10 settle lully and finally Ihelr respective finuncial and property rights and obligations as between each olher arising out 01 the marriage relationship Ill' otherwise, induding WUhllUt limilation {j) Ihe "ellling 01 all malleI'S bel ween Ihem relaling 10 Ihe \lwnership or real and personal property: 12) the sellling of all malleI'S between them relating lolhe pas!. present und fUlure support and/or maintenance of HUSBAND and WIFE: (3) the sellling of all mailers between them relating to the pas!. present and fUlure SllppOl1 or muintenance 01 their minor children, and 14) the sellling of all mailers belweenlhem relating 10 any and all rights, litles and iuten'slS. daims and possible duims in Ill' against 11ll' eSIaI,' III the olher. NOW, THEREFORE, with the foregoing recitals being herllinafter inColl'oraled by reference and dllllll1lld an essenliul part hllreof in considllralion of the foregoing recilals. the ll1utual promises. covenalllS and undertakings hllrein sel fonh. and for good and valuable consideration, receipt of which is hereby acknowledged by each of the panills hereto, HUSBAND and WIFE. each inlending to be Illgally bound hereby, covenant anci agree as follows: 1. ADVICE OF COUNSEL HUSBAND and WIFE declare that they have each had a full and fair opponunilY 10 obtain independent legal advice of counsel of their selection, WIFE has been independently represented by Barbara Sumple-Sullivan. Esquire. HUSBAND is has been independently represented by John Connelly, Esquire. Each pany fun her declares thai they are executing this agreement freely and voluntarily. having obtained such knowledge and disclosure of lhey legal rights and obligations and that they acknowledge thai this agreement is fair and equitable and is not the resull of any fraud. coercion, duress. undue influence or collusion. 2. PERSONAL IUGlITS HllSBAND und WIFE lIlay and shall. ut all times hereafter. live separale and apan. Each shall be free Irom all colllrul. restrulnl, Interference or uuthorllY, direct or indirect. by the uther in all respects as is she or he were unrnurried, e.\cept us may he necessary to carry oUllhe provisions of this Agn'elnent, Each ll1uy reside ut such place or places as she or he Il1UY select. Euch IIlUY, for his or her'iepunllc IIse or IWllent. c,lIIducl. carTY on and engage in uny husiness. ~ " occupallon, profession llr employmenl which 10 himl]r her may seem advisable, This provision shall not be taken, however, 10 be an admission on lhe pan of eilher HUSBAND and WIFE of lhe lawfulness of lhe causes which led to, or resulted in, lhe wnlinuation t)f lheir Iivlllll apnrt. HUSBAND and WIFE shall not moles\, harass. or malign the .Hher or Ihe respeclive families of each other, nor compel the other lu whabil or dwell in any manner Wilh him or her. nor In any way il1lerfere with Ihe peaceful e,\istence. separate from each olher, 3. DEnTS Each pany represenls Ihal they have nOl conlracted any debl or Iiubilily for the olher for which the estale of lhe olher pany may be responsible or liahle e,\Cepl as IJIherwise provided herein. and Ihut excepl only for the righls arising uul .]f this Agreement. neither puny will hereafter incur any liability whalsoever for which lhe other pany or the estate of the olher pany will be liable. Each puny agrees 10 indemnify and hold hannless from and againsl all future obligations of every kind incurred by lhem, including those for necessilies. WIFE shall continue tu be solely liable and respllnsible for the rl'lJ1aining balances onlhe marital debt incurred on her individually lilled credit cards. HUSBAND\ltall continue 10 be solely liable and responsihle fpr Ihe remaining halances on Ihe Illarital delH incurred on his individually litled credil cards. Addilionally, Wife shall pay lhe following deb Is and hold HUSBAND hal1l11ess ft)r same: I. MnslercanJ. Accollnl No, 5321) OOll 720.\ 06ii, halance $.ll.; 2, Dlswver, ACCOllnl No. /lOll 002,) 5852 5616, halance $2,12.\,!lJ. \ HUSBAND shall puy the following debts and hold WIFE hannless for same: t. VISA, A~count No. 4800 1205 82111 112611, balance $1.I03,1l1l: 2. Gas charges wilh approximate balance nf $8110,llO, All joint credil cards shall be ~anceled and lemlinaled. The panies agree 10 indemnify and hold Ihe olher hannless from each of the aforementioned debts, Each pany funher agrees to be responsible for all attorneys' fees incurred by Ihe other in defense of any claim or suit broughl against Ihem arising from any debt incurred during Ihe marriage. Tulhe beslof the parties' knowledge. the panies affinn no other joint or marilal debts eXIst. .j, WAIVER OF APPRAISAL AND INVENTORY The panies acknowledge and agree Ihal they have each had an opponunil}' 10 value or have appraised any and all marital property, and Ihey do hereby waive a fornlul appraisal and inventory of same, und 110 stalemel1t or represenlalilln by eilhel' part). as to value shall be deemed a misslutel1telil III' misrepresentation 10 Ihe other or be ,teemed fraudulent. 5. MAR1TAI~M'!D NON.MAHI'r,\I. ASSETS HUSBAND and WIFE do herehy a~knowledge Ihullhey huve hel'elofme divided the non. murilal assets and marital assets includlllg but Wilho<ll Iimitalion, business inlerests, jewelry. clothes, fUl11ilure, stllL'b, bonds. pensions ,<llll olhel assels wherever silllillcd whether real. .1 persnnnl nr mixed. ll\n!!ihl~ or Illlnn!!ihl~. and HUSBAND ngre~s Ihnl. except as set f<lI1h nn E.xhiblt "A" nnd incnrpnrated herein by rct"erence, all assets in the pnssessionllf WIFE shall be the sole and separate property nf WIFE: and. WIFE ,lgrees Ihnl nllnssets in the pnssession of HUSBAND shall be the sole and sepnrate property of HUSBAND. The parties agree that the Mickey Mouse hummel and 111'0 (2) Scimshell pictures to become the property of HUSBAND and shall be passed by him to the children. Each of the parties does herehy specifically waive. release, renounce and forever abandon \v halever claims. if any, he or she may have with respect to any of the above said items which are the sole and separate property of the other, Thi) document shall constitute ,I hill of sale for said sole property. 6. REAL ES'r,\TE The parties jointly own property at III East Yellow Breeches Road. Carllsle, Cumberland County, Pennsylvania, and an adjoining lot known as 113 East Yellow Breeches Road, Carlisle. Cumberland County, Pennsylvania. Said properties are encumbered with mOl1gages due and owing to Homeside Lending, Ine and Coreslate Lending Co.. respectively, Said real estate shall hecllll1e the sole pmperty Ill' WIFE. Simultaneously wilh his e,\ecutiol1 of this Agreemelll, HUSBAND shall execute Quilcl,tim Deeds relinquishing all his rigllls. title and in,terest In the property. WIFE agrees 10 assume and he responsihle for all Illortgages, loans, liens, assessments and insuranL'e I'llI' said properties. WIFE will save and hold HUSBAND harmless for said ohllgatillns, WIFE agrees 10 refinance said dehlllnlhe prnpel1ies in her name alone. WIFE has heen approved for the refinancing which Is expected to nccur shortly nfter the :J execution of this Agreement and the panics acknowledge that this agreement is specifically contingent upon thl) occurrence of Ihe refi/llll1cl) or WIFE'S obtaining his release from the 1ll0l1gage. 7. ~IOTOR VEHICLES WIFE is Ihe operalor of a leased Volvo, WIFE agrees to assume the debt related 10 said vehicle and shall save and indemnify HUSBAND from the obligation on said marital debt. HUSBAND shall have ,oil) title and ownership of Ihe parties' 1992 Honda and 1980 Jeep. Ncither of Ihese vehicles ,Ire encumbered, HUSBAND shall be free to dispose of Ihese vehicles as he sees fit and WIFE ,hall cooperate in Ilxecuting all documenls necessary 10 effeCluale any transfer. II. PENSION Each pany hereby waives any and all claims Ihat he or she may have against the other to any pension, employee saving or olher stock benefil program of Ihe olher. WIFE specifically aCKnowledges thai HUSBAND has two (2) pcnsions.. a federal civil service retirement pension, as well as a U .S, military pension, She knowingly waives any claim 10 said pension benefits. HUSBAND specifically acknowledges Ihal WIFE has pension benefits from her employmenl at Capitol Heallh System, HUSBAND knowingly waives any claim 10 said pension benefits. Also, WIFE has addilionally acquired smllc post-scparalion benefits at her current employment 10 which HUSBAND would have no claim. o 101. AFTER ACOUIRED I'ERSONAL PROPERTY/fUTURE EARNINGS Each of the parties shall hereafter own and enjoy independently of any claim or right of the other, all items of personal property, tangible nr illlangible. hereafter acquired by HUSBAND or WifE, with full power in him or her to dispose of the same as fully and effectively. in all respects and for all purposes, as though he or she were unmarried, 15. ALIMONY. SUPPORT A:'-ID MAINTD1A:'-ICE Both parties acknowledge and agree that the provisions of this Agrcement providing for equitable distribution of marital property are fair, adequate and satisfactory to them and are accepted by them in lieu of and in full and iinal satisfactlnn of any claims ,11' demands that either may now or hereafter have against the nther for support. mailllenance or alimony, HUSBAND and WIFE further. voluntarily and intelligently. waive and relinquish any right In seek from the other any payment for spousal support. alimony and mallllenance, 16. CUSTODY AND VISITATION HUSBAND and WIFE shall have shared legal .:ustody n[ the panics' minor children, Primary physical custody nf the children shall be in WIFE, HUSBAND shall have partial physical custody for the purposes of visitation nn alternating weekends frnm Friday at 5:30 p.m. to Sunday at 5:30 P,IIl,: alternating holidays; two (2) weeks each sumlller and such other times as the parties .:an mutually agree. 9 17. CHILD SUPPORT Th~ parti~s' ~hild support obligalion is pr~s~ntly d~l~rmin~d through Ih~ Domestic Relalions Se~tion of Ih~ Court lDo~ht No. 2-12 S 9;, DRIt 26,3 III by an Ord~r of Court daled April 16, 199;, 18. SUBSE~UENT DIVORCE A de~ree in divorce. entered by a ~ourt of compelenl jurisdiction to either pal1Y, shall nOl suspend. supersede or aff~ct lhe lelms of this Agreement. Bolh parties agree to enler a Consenl Decree ~on~en1ing lhe provisions of lhis .-\greemel1l in Ihe Court of Common Pleas of Cumberland CoulllY. Pennsylvania. ,Jr Jny other Coun "f compelenl jurisdi~lion. a~ a pan of a resolulion 'lf Jny dil orce a~tion filed, ThIS ,\greemenl. and llw len11S and cnndilions contained herein. as well as lhe enforcemenlof said lerms and wnditions. ~hallnol be contingent upon th~ granting of a Divorce De~ree III ~ither pany by lhe Coun of Coml11on Pleas of Cumberland COUIllY, Pennsylvania. or any olher Court of ~ompelent jurisdiction, Furthermore. bOlh panies hereto agree to execule simullaneously wilh lhis Agreemenl the appropriate affidavils and consel1lS 10 secure ,I No-FJull Divorc,' as may be required by Ihe Divorc~ Code of 1980. as am~nded. BOlh p<lrti~s herelo agree Ih'll Ihis Agreemenl lIlay be in~llrporated il1lo a separate COUll Order hUl shall nol merge in such order in Ihe ('OUIl of COml11<lll Pleas of Cumberland County. Pennsylvania. III 19, fl""IJ:H DOCUMENTATION HUSBAND and WIFE covenant and agree thill upon request of the other party, they will forthwith execute and delil'er to the other party, any and all wrillen instruments. assignments, releases, satisfactions, deeds, notes or such ,)Iher writings as may be necessary or desirable for the proper effectuation of this Agreement. 20. MUTUAL WAIVER AND RELEASE OF RIGHTS AND CLAIMS IN ESTATE Each party hereby releases. wail'es and relinquishes any and all rights which he or she may now have, or may hereafter hal'e, against the other party under Ihe present or future laws of any jurisdiction la) to share in the estate Ilf Ihe other party upon the other party'; death and Ib) to act as e.\ecutlwri.\ or adminbtrator/ri.\ of the other party's estate, 21. MUTUAL RELEASE HUSBAND and WIFE each do herehy mutually remise, release, quitclaim and forever discharge the olher and the estate uf such olher, for all time 10 come. and for all purposes whatsoever, of Jnd from ,lilY ilnd all righls, litle ami interests, or claims in or against the property (including income ilnd g:lIn frum property hereafter accming) of the olher or .Igains! the estate of such olher. of whatel'er nalllre and wheresoever siluate, which she or he now has or at any time helcatll'r nw) hal'c against such other. the estate I)f such olher or allY part Ihereof. whelher arisillg "ul of illlY fonner acts, contracts. engagements or Iiahilities of wl'h other or hy way of l''1uital,k dl,"'ihntion, dowl'r nr courtesy, or claims ill the nature of dowel ur "ourtesy of widow's 01 widll\l'cr's Ilghls, fllmily e,\emption or siulllar aIlOWIlIICl'. or undl'r 11 _~_."-.:;"..".c Ihe inteslate laws. or the right 10 take againsllhe spouse's will. or lhe righl to lreal a Iifelime conVl!yance by Ihe Ilther as leSlamel1lary, or all olher rights of a surviving spouse 10 participate In a deceased spouse's eSlale. whelher arisin\! under the laws of la) Pennsvlvanla, Ib) anv State. - .' commonwealth or territory of the United Slates. or ld any other counlry. or and rights which HUSBAND or WIFE may have <Jr al any time hereafter have for Ihe past, present or fulure support or maintenance. alimony. alimony pendel1le lite, C<Junsel fees. costs or expenses, whelher arising as a result elf Ihe marital relation or otherwise. excepl, and only except. all rights and I\greements and ubligations of whalsoever nalure arising or which may arise under Ihis Agreement or for lhe breach of any lhereof. Each of the panics hereto further cllIenal1ls :111<1 agrees for himself and herselt and his or her heirs, execllLOrs. adminislrawrs .lI1d assigns. lhat he or she will never, al any time hereafter. sue lhe olher party or is or her heirs. executors. administralors and assigns. for the purpose of enforcing any of Ihe rights relinquished unlkr Ihis paragraph, Each of lhe parties furlher covenanlS and agrees Ihat he or she will pemlit any will of the other 10 be probated and allow 'ldl11inlslralion upon his or her personal. real or mixed estale and all<Jw effects to be tuken out by the person Ilr persons who would have been enlilled 10 do so had HUSBAND or WIFE died during the Ilfelime of lhe olher. Each of the panks hereby releases, relinquishes and waives any and all right tn aCI as e,\ecUI<Jr or e.w,'ullh or administrator or adminislratrix of the other's eslale, I' It is the intention Ill' HUSBAND and WIFE to give 10 each olher by the e.xcculiun of Ihis Marllal Selllement Agreement a full. complete and gencral release with respect Itl any and all properly of any kind or nature, real. personulur mixed. which the ulher nul\' owns or may hereafter acquire, except and only except all rights and Agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for Ihe breach of any Ih\lreof. 22. SUCCESSOR'S RIGHTS A~D LIABILITIES This Agreement shall. except as otherwise provided herein, be binding upon and inure 10 the benefh of Ihe parties hereto. their respective heirs, execulors, adminislrators. successors or assigns, 23. SEVERABILITY If any provision in this Agreement is held by a court of compelent jurisdiction to be invalid, void, or unenforceable, Ihe remaining provisions shallncvertheless continue in full force and effecl without being impaired or invalidated in any way, 24. ENTIRE AGREEMENT HUSBAND and WIFE do hereby covenant and warranl thatlhis Agreemenl cnnlains all of the representations, promises and Agreemenls made by either Ill' Ihem to the other for the purposes set forth in Ihe preamble hereinabove; Ihat Ihere arc nil claims, promises or l.l representations not herein ~llntained, either oralnr wrillen, which sholl or may be charged or enforced llr enforceable unless redu~ed 10 writing and signed by both of the parties hereto, 25. BINDING EFFECT OF AGREE;\IENT/WAIVER This Agreement sholl remain in full force and effect unless and until terminated under and pursuant to the lemlS of this Agreement. The failure of either pany 10 insist upon strict performance of the provisions of lhis Agreement sholl nOl be CDnstrued as a waiver of any subsequent default of the same or similar nature, nllr sholl such failure be construed as a waiver of any olher term. condition, clause or prnvision of this Agreement. 26. BREACH If either pony breaches any provision of lhis Agreement, the other pmy sholl have the right, at his or her eleclilln, to sue for damages for such brea~h or seek such other remedies or relief as may be availahle III him or her, and Ihe party breaching this contract shall be responsible for pay me III of reasonahle legal fees and costs incurred by the other in enforcing their rights under this Agreement. 27. CONTROLLING LAW This Agreemelll ,hall be ,~nnstru\:d and go\'cl11ed In ac~ordance with the laws of the Commonwealth of I'cnn,ylvanlll, 14 '"., ~.\ .'. li , II ~ 1'1 II ~ ~ ; ~ I j ~ i d ~ iil : ~ ~:\~ ! ! ; 111 i'i; l": '1. . t.~ l'~ Ill", .. 0 ~Jf ;,'~: Itr' l'r.' II' (r\, eLl i' b o- f ~.: I~' I !' .... .' , '. SUSAN S, HERMAN, Plaintiff IN mE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION. Divorce GARY J. HERMAN, Defendant No. 95-6454 CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date. 1 served a true and correct copy of the foregoing Plaintiff's Praecipe to Transmit Record, in the above- captioned malter upon the following individual by first class rnall, postage prepaid, addressed as follows: John J. Connelly, Jr. Esquire Connelly, Reid & Spade 108-112 Walnut Street Harrisburg, PA 17101 DATED:~;t arbara S mple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774.1445 SUllreme Court I.D. No. 32317 ""7';7~""'" . ........t""- " "'..... '" SUSAN S. HERMAN. Plaintll1' IN TIlE COURT OF COMMON I)LEAS CUMUEltLAND COUNTY. PENNSYLVANIA v. NO. ~!f. & 'I.1tj (~~/ -..:71", CIVIL ACTION - LAW IN IJIVORCE GARY J. HERMAN, Defendant NOTICE TO DEFEND AND CLAIM RIGHTS You have been sued In Court. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You arc warned that if you fail to do so, the case may procced without you and a Decrcc of Divorce or annulment may be cntered against you by the Court. A judgment may also be entered against you lor any other claim or rellcfrcquested in these papers by the PlalntilT. You may lose money or property or other rights important to you. When the ground for divorce Is indignities or irretrievable breakdown ofthc marriage. you may rcquest marriage counseling. A list of marriage counselors Is available in the office of the Prothonotary at the Curnberland County Courthouse, Carlisle, Pennsylvania 17013. IF YOU DO NOT FILE A CLAIM FOR ALIMONY. DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A IJIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE TIlE RIGHT TO CLAIM ANY OF TIIEM, YOU SHOULD TAKE TillS PAPER TO YOUR LA WYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEI'HONE THE OFFICE SET FORTI I BELOW TO FIND OUT WllEltE YOU CAN GET LEGAL HELP. Court Administrator Cumberland County Courthouse I Courthouse Squnre Cnrilsle,PA 171113 (717) 2411-621111 ....:..... .' " .~,~.,,,,,i,.-~_;,.' . , maintenance, and/or alimony and other rights, and thc support and malntemmcc ofthe children should the Defendant die. 13. The marital rcsldence ofthe parties is located at III East Yellow Breeches Road, Carlisle, Cumberland County. I'ennsylvanla. 14. It is appropriate that Plaintiff and the children be pennlllcd to havc exclusive possession of the marital residence. COUNT 11I_ ALlMONV. ALIMONY PENDENTE LITE. t\TTORNEV'S FEES AND COST IS. Plaintiff lacks sufficlcnt property to provide for her reasonable needs. 16. Plaintiff Is unablc to sufficiently support herselfthrough appropriate employrnent, 17. Defcndant has sufficient Income and assets to provide continuing support for the Plaintiff. 18. By rcason ofthls action, I'lalntllTwlll be put to conslderablc expense In the preparation of hcr case and thc cmploymcnt of counsel and thc paymcnt of costs, 19, The I'lulntll1'ls withuut sulliclcnt funds to support hcrsclf and to Illcetlhc costs and cxpenses of this litigation and Is unable to appropriutely maintain hcrsclfdurlng the pendency of this action, 20. Plalntll1's Inclll1\e Is not sulllclcntto provide Iilr her rcasonuble needs IlI1lI . . pay her Attorney's fees and the costs of this litigation. 21. Defendant has adequate earnings to provide lor the PlaintllT's support and to pay her counsel fees, costs and expenses. COUNT IV - CUSTODY 22. There are two children born to this marriage, namely: Derek Herman, date of birth May 30,1988, and Monica Herman, date of birth March I, 1993. 23. Plaintiff desires custody of the minor children and Is capable of giving said children the necessary parental care in 0 proper and healthful environment. 24. The Plaintiff avers that she is a l1t person to raise the minor children and that by awarding her legal custody, the best Interests and permanent welfare ofthe children will thereby be promoted. The parties' minor children have resided at III East Yellow Breeches Road, Carlisle, Cumberland County, Pennsylvania, since their births. 25. I'lointlffhas not participoted in ony other Iitigotion concerning the custody proceedings In a Court ofthis or any other stote, nor docs she know of uny person not 0 party to these proceedings who hilS hlld physico I custody ofthe children or clolms to hllve custody or visitation rights. 26. The Plolntln'requests Ihot a reasonable visitation schedule be set up by the Court regarding visltotion of the parties' minor children by Defendllnt. . . COMMONWEALTH OF PENNSYLVANIA ) ) SS.: COUNTY OF DAUPHIN ) i\FFIDA VIT SUSAN S. HERMAN, being duly swom according to law, deposes and says that the facts contained in the foregoing Complaint in Divorce are true and correct to the best of her knowledge, information and belief. ~ "..., ~"'';--.. ~ SUSAN S. HERMAN Sworn to and subscribed },r]11I before ~JJIS ~ day of L '( (,1. 1995. ~fJl ( ,)J./LL.U Notary Public ( l' Not.,1 tJ GJul K~'en ^, Sher,n, Not"l' Public M C dnlab'Jlg, O,,,pl1ll1 Coullly y e,"mlllllon Emir,. Mn'Cl1 g, "'Dll DII. ''''CilNoldl ~~-f . ,. """:J'. i'~ i~ T,Lj t; f?l ~j t': ~1 '~ ~ i<.' \ €' SUSAN S. HERMAN, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION. Dlvoroe GARV J. HERMAN Defandant No. 96.6464 AFFIDAVIT OF CONSENT 1. A Complalnlln Divorce under Sectlon JJOJ(c) of Ihe Divorce Codo wu flied on Novermbcr 13, 1995. 2. The marriage of Ihe plalOllff and defendaOl Is Irrc.rlevably broken. NinelY dlYs have elapsed since the filing and service of Ihe Complaint. 3. I consenl 10 Ihe enlry of a final decree of divorce afler service of nollce of Inlentlon 10 requesl enlry of Ihe decree. 4. I undersland Ihal I may lose rlgh.s concemlllg alimony, division of property, lawyer's fccs or expenses If I do nol claim Ihem before a divorce 15 granled. 5. I verify Ihal the stalcmenls made III Ihls nffldavll lire lrull alld corrccl. I undersland Ihal falsllslatemenls arc mnde subJecltolhc I'ennlllcs of 1111'0. C.S.A. Secllon 4904 relallng 10 unsworn falslflcallon 10 authurllle5. Dale: tJ(l97 ~ ~ ---- .'W~~;';';'''''''':"O;;"",,_''''''''V''';.J.;;'''-'''''''''__''''' ,. 1'1 Cll ,. -- ~ ~ ell r- 'r,: (oo ,. IJ. .,~ ~ r; .. . -' . ~ n C'1 I l:.. Z ~U; ,~ ." .'I'.J :J I ~ J( "J '-., 1/1 ft:, ,,- ., :.~ 'I e ~ t . : ~.~l W ~ l . - ~ " n I, , j"l. ~I ,,' '~l Z ~ ~ flY' .-, t'!':::"" ~ :J 1-' :-: ~ 1/1 . ci b r- '") ~ .. z 0' n ~ :5 0( ffi m 0:: m .: J m a ~ z ... , ';-. -' - ~~ ., . SUSAN S. HERMAN, Plaintiff IN mE COURT 01: COMMON PLEAS CUMBF.RLANI) COUNTY, I'HNNSYI,VANIA v. CIVil, ACTION. 1)lvorce GARY J. HERMAN No. 95.6454 Defcndanl w AIVE:T~~ Nonc~ OI1IN','I,l.Nl'ION TO ltEQUEST ~ OF A DIVORCE DECREE UNDER InOlCel m' ntE D1VORCI!. CODE 1. I consenllo the enlry IIf II flnll dLocrel! of divorce wilhnulnollce. 2. I undenland lhll I 11111)' IlIsl! rlghls conccnllnll 1I111l101lY, division of property. lawyer's fees or expenses If I do nol claim lhcm herON II dlvllrcc Is grallted. 3. I undersland lhol I will nol hl! divorced until II divorce decree Is enlered by the Court and lhal a copy of Ihe decree will ho scnl '11 llIe IrnmL'Illalely after II Is flied wllh the prolhonolary . I verlf)' Ihal the sllllelllelIls llIade III Ihls IIfflrln\'illllll Intc IIl1d correct. I undersland Ihal false slalemenl hcreln are IIInde suhJeclllllhe Ilenohlcs IIf III l'a.C.S. 14904 relallng 10 unswom falslficallonlo oUlhorllles. DATEI-J'4liL- G!...--c4IJ....;;- ,,~L r-- HbHAN H. IIERMAN ~ O' '>- Lr. 1-- '.' ,~ .. ." (f'~ '_l '..; " " " " n. " t., h /,'l l"'J ' ,,'~ , ,"'F \' 1:" itt) F c:? : -~u. , ::1 15 t;; "' (j " SUSAN S. HERMAN, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLANO COUNTY, PENNSYLVANIA NO. 95 . 6454 CIVIL TERM CIVIL ACTION. LAW IN DIVORCE v. GARY J. HERMAN. Defendant W~~~~~~:C~~;~~~ INTENTION TO REQUEST ENTRY pF A D fiR t 33011cl OF THE DIVORCE CODE 1. I consent to the entry of a final Decree of Divorce without notice, 2. I understand that I may lose rights concerning alimony, division of property. lawyer's fees or expanses If I do not claim them before a divorce Is granted. 3. I understand that I will not be divorced until a Divorce Decree Is entered by the Court and that a copy of the Decree will be sent to roe Immediately after It Is flied with the Prothonotary. I verify that the statements made In this Affidavit are true and correct. understand that false statements herein are made subject to the penalties of 18 Pa. C.S,A. Section 4904, relating to unsworn falsification to authorities. Date: 'I ~ ~?;-ql .~111..-'> fr. ~, r-: ~m Ir. r~': .. .1._ (') :*) :. r, .. " ~i~, C_. , :'!t.~ C\ .} r.~ [f C'J u:P' J ;0"'1 t:J iCL /"" '" ;.:s !5 ~ .'.:J 01 0 \ ~ ~~ .. - iE a !P. 0\ ;:'0 - WS! (.., ~ in 0\ ~'1 - " . '- ~ '., . _!... .' " " MARITAL SETTLEMENT AGREEMENT THIS AGREEMENT, made Ihisll~ of between GARY J. HERMAN, hereinafler referred 10 199i. by and / and SUSAN S. HERMAN. hereinafter referred to as "WIFE". WITNESSETH, Ihal: WHEREAS, the parties herelo are husband and wife, having been lawfully Joined in marriage on January 10. 1981. In Carlisle. Cumberland Counly. Pennsylvallia, WHEREAS, IWO (2) children were born of this marriage: DEREK HERMAN born May 30. 1988 and MONIKA HERMAN born March 1. 1993, WHEREAS, II is the Inlenllon of Ihe parties 10 seide fully and finally lhelr respecllve financial and property righls alld obllgallollS as helweell each olher nrlslng out of Ihe marriage relalionshlp nr olherwlse. Including without Ilmitnlion (1) the settling of all matters belween them relallng 10 the ownership of real alld persnllal properly; (2) the settllllg of nil matters betweellthem relating to the past, I'resenl and futun) support and/or mailltenallce of HUSBAND and WIFE; (3) the seullng of all mailers bel ween them relallng 10 the pasl, I'resenl and future support or malnlellance of Ihelr minor childrell. and (4) the settlillg of all matters between Ihem relaling to allY and all rights. litles amI interests. claims and I'ossible c1nims in nr agalnsl the estate uf the other, NOli'. THEREFORE. with Ihe foregoing recllals belllg hcreillufler IlIcorporated by reference and deemed all essellllal pari hereof In conslderatloll of Ihe foregoillg recitals. Ihe mutual promises, covenallts and undenaklllgs hereill set forth, and for good and valuable consideratioll. receipt of which is hereby ackllowledged by each of the parties hereto. HUSBAND and WIFE. each intendillg to be legally bound hereby. coven ani and agree 3S follows: I. ADVICE OF COUNSEL HUSBAND and WIFE declare that Ihey have each had a full and fair opportunity to obtaill independent legal advice of counsel of their selection. WIFE hus been illdependently represented by Barbara Sumple.Sullivall. Esquire. HUSBAND is hns been independently represented by John Connelly. Esquire. Each party further declares that they arc executing this agreement freely and voluntarily, having oblailled such knowledge and disclosure of they legal righls and obligations alld that they acknowledge that this agreement is fair and equitable alld is notlhe result of any fraud. coercloll. duress, undue IlIfluence or collusloll. 2. PERSONAL RIGHTS HUSBAND and WIFE may and shall, al 1111 times herellfter. live sepllrate and apart. Each shall be free from all colllrol, restralnl. IlIlerference or aUlhority, direct or Indirect. hy the other ill all respecls as is she or he were unmllrrled. excepllls lIlay be necessllry to carry out the provisions of Ihls Agreement. Elich mny reside al such I'lnce or places as she or he mny select. Each may, for his or her separale use or henefll. conducl. carry Oil nnd engnge In IIny husllless. 2 occupation. profession or cmploymel1l which to him or her may seem advisable. This provision shall not be taken, however, to be an admission 011 the part of either HUSBAND alld WIFE of the lawfulness of the causes which led to. or resulted ill. the continulltion of their living apart. HUSBAND and WIFE shall 1101 molest, harass. or malign the other or the respective families of each other, nor compel the other to cohabit or dwell in nny mallller with him or her. nor in any way interfere with the peaceful existence. separate from each other. 3. DEBTS Each party represents that they have 1I0t contracted allY debt or liability for the other for which the estate of the other pnrty may be respollsible or Iiahle except as otherwise provided herein. and that except ollly for the rights arising out of this Agreemenl, neither party will hereafter Incur any liability whatsoever for which the other party or the estate of the other party will be liable. Each party agrees to indemllify and hold hannless from and against all future obllgalions of every kind incurred by them. including those for necessities. WIFE shall continue to be solely lillble and respollsible for the remaining balallces on the mnrllal debt Incurred on her individually titled credit cards. HUSBAND shall contlllue to be solely liable and responsible for the remllinlng balallces on the marital debt incurred on his Individually lltled credit cllrds. Additionally, Wife shall pay the following dehts and hold HUSBAND hnmlless for slime: 1. Mllstercllrd. Aecoul1l No. 5329001272040677. blllllllce $-0-: 2. Discover. Account No. 6011 0023 5852 5616. balllnce $2, t24.83. 3 " HUSBAND shall pay the following debls IInd hold WIFE harmless for same: 1. VISA, Account No. 4800 1205 8201 0260. blllllncc $1.103.00: 2. Gas charges with approximate blllllncc of $800.00, All joillt credit cards shall be canceled alld lenninated. The panies agree to indemnify and hold the othcr harmless from each of the aforemenliolled debts. Each pany funher agrees to be responsible for all allomeys' fees incurred by the other in defellse of any claim or suit brought against them arising from any debt incurred during the marriage. To the best of the panies' knowledge. the panies affirm no other joint or marital debts exist. 4. WAIVER OF APPRAISAL AND INVENTORY The panies acknowledge and agree that they have each had an opponulllty to value or have appraised any and all marital propeny, and they do hereby waive a formal appraisal and invelltory of same, and no statement or representation by either pany as to value shall be deemed a misstatement or mlsrepresentatloll to the other or bc deemed fraudulent. 5. MARITAL AND NON.MARITAL ASSETS HUSBAND and WIFE do hereby ncknowledge that they havc heretofore divided the lion- marital assets und maritnl nssels Including bUI without limitntion, husiness interests, Jewelry. clothes, furniture, stocks, bonds, penslolls nnd othcr usscts whcrever siluntcd whether real. 4 I'ersonal or mixed. tangible or Intangible. and HUSBAND agrees thai. except as set fonh on Exhibit "A" and Incorporated herein hy reference. all assets In the possession of WIFE shall be the sole and separate propeny of WIFE: amI. WIFE agrees Ihat ullussets III the I'ossesslon of HUSBAND shall be Ihe sole nnd separate property of HUSBAND, The punles agree that the Mickey Mouse hummel and two (2) Scimshell piclures to become the propeny of HUSBAND alld shall be passed by him 10 Ihe childrell, Each of Ihe panies does hereby specifically waive, release, renounce and forever abandon whatever c1uims. if ullY. he or she may have with respect to any of the above said ilems which arc the sole and separate property of the other. This document shall conslitute a bill of sale for said sole property. 6. REAL ESTATE The panies jollltly own property al III Easl Yellow Breeches Road. Carlisle, Cumberlnnd County, Pennsylvallia, and all adjoinillg lot known as 113 East Yellow Breeches Road, Carlisle, Cumberland Counly. Pennsylvania. Said propenies are encumhered with man gages due nnd owlllg to HOO1eside Lending. Inc. and Corcslale Lcndlng Co., respectively, Said real estate shall becomc Ihe sole prol'erly of WIFE. Simultaneously with his exccullon of this Agreement. HUSBAND shull execule Quitclaim Deeds relinquishing all his rights. title and in,terest ill Ihe property, WIFE agrees 10 assume and be responslhle for all mortgages. loans. liens. assessments IInd Insunll1ce for suid propenies, WIFE will save und hold HUSBAND hamlless for said ohligations, WIFE agrees to refinance suid dehtllnlhe propcrties in her name alone. WIFE has heen approved for the refinancing which is expected III oecur shortly after the 5 execution of this Agreemcnl and Ihe panies acknowledgc thai Ihis agrccment is specifically contlngenl upon the occurrence of Ihe reflnallce or WIFE'S oblaining his rei case from lhe mongage. 7. MOTOR VEIUCLES WIFE is lhe operalor of a leased Volvo. WIFE agrees to assume Ihe debt related 10 said vehicle and shall save and indemnify HUSBAND from the obllgalion on said marital debt. HUSBAND shall have solc lille and ownership of the ponies' 1992 Honda and 1980 Jeep. Neither of Ihese vehicles are encumhered. HUSBAND shall be free 10 dispose of these vehicles as he sees fil and WIFE shall cool'crale In exccutlng all documcnts nccessary to effectuate any transfer, 8. PENSION Each pony hereby waives nny alld all claims Ihat he or she may have againsl lhe olher to any pension. eml'loyee saving or olher stock benefit program of the other. WIFE specifically ackllowledges thaI HUSBAND has two (2) pensions -- a federal civil service rl!llremenl pellslon. as well as a U.S. mllilary pension, She kllowlllgly waives any claim 10 said pension benefils. HUSBAND specifically ncknowledges Ihlll WIFE has pcnslon hcnefils from her eml'loyment at Capholllenllh Syslem, HUSBAND knowingly wnlves lIny cllllmtn said pension benefits. Also, WIFE has addhionlllly IIcljuired some pust-sepllrution beneflls at her currenl employment to which HUSBAND would have nil clllim, 6 ~- 9. BANK ACCOUNTS AND INVESTMENTS Each party shall have sole possession of the ballk accounts in their own names. fO. INSURANCE HUSBAND shall retain sole ownership of lhe John Hancock Group Policy, as well as life insurance policy. GL 124559-09. Said certificate numbers GL-6t4.348 and GL-750-196. Additionally, each party agrees to carry life insurance in a sum of not less thai FIFTY THOUSAND DOLLARS ($50,000.00) on himself or herself with the children named as irrevocable beneficiary until the childrcn reach the age of twenty-two (22) years. This obligation is to assistlhe other parent ill support of the children in the event of the other parenl's dealh. 11. 5:[OCKS The parties have various stock holding illtcreslS, which shall be disposed of as follows: A. The parties relillquish all claims 10 slock Iltled 10 son, Dcrek, and daughler, Monica, in the McDonald's Corporation and financial Trusl Company. B. HUSBAND shall havc solc owncrshlpof thc partlcs' slxty-scven (67) shares of stock jollltly tillcd In flllancial Tmst Company. C, HUSBAND shall have sole owncrship of Ihc parties forty (40) sharcs of stock in the Disncy Company, 7 14. AFTER ACOUIRED I'ERSONAL PROPERTY/FUTURE EARNINGS Each of Ihe partics sholl hcrcaflcr own and enjoy indepcndently of nny c1nlm or right of Ihe other. 011 items of personal property, tangihle or Intangible. hercaftcr acqulrcd by HUSBAND or WIFE, with full power in him or her to dispose of Ihc samc as fully alld effectively, III all respects and for 011 I'urposcs. as Ihough hc or shc were unmarricd, IS. ALIMONY. SUPPORT AND MAINTENA:'IlCE Both parties acknowledge and agrcc that thc I'rllvisions of this Agrccmcnl provldlllg for equitable distribution of marllal propcrty are fair. adequalc and satisfactory to Ihem and are accepled by Ihcm In lieu of and ill full and final satlsfactlollof any claims or dcmallds Ihal either may now or hereafter have against Ihe othcr for support. mainlcnnnce or alimony, HUSBAND and WIFE further. volunlarily and intclligently. waive alld rclinljuish any right to scek from Ihe other any paymcnt for spousal support. alimony and malmenallcc. 16. CUSTODY AND VISITATION HUSBAND IInd WIFE shail have shared legal custody of the I'artlcs' minor children. Primary physical custudy of Ihe children shall he in WIFE. IIUSBANlJ shall have parllal I'hysical cuslody for the purposes uf l'isitalionon alternating wl'ckends fmlll Friday at 5:30 p.m. 10 Sunday at 5:30 p,m,; allcnlllling holidays; two (2) wceks ellch sunllller and such other tlmcs as the panics cnnlllulually agree, l) ._' ...... 17. CHILD SUPI'ORT The parties' child support obligation Is presently detcrmllled Ihrough lhe Domcsllc Relations Section of the Court (Docket No, 242 S 97. DR# 26,31 J) by an Order of Court daled April 16. 1997. 18. SUBSE~UENT DIVORCE A decree in divorce. entered hy a court of competent jurisdiction to either party, shall not suspend, supersede or affect the terms of this Agreement. Both parties agree to enter a Consent Decree cOllcemillg the provisions of Ihis Agreemellt in the Court of Common Pleas of Cumberland County. Pcnnsylvanln. or any other COUlt of competent jurisdiction. as a part of a resolution of allY divorce action filed. This Agreemellt. and the terms nlld conditions contained herein. as well as the enforcement of said terms alld conditiolls. shall not be cOllllngent UpOIl the granting of a Divorce Decree 10 either I'arty by the Court of Common Pleas of Cumberland County. Pennsylvallla. or any other Court of compelent jurisdiction, Furthermore. both I'artles hereto agree to execule simuitalleously wilh this Agrcemellt Ihe appropriate affidavits nnd consellts to secure a No-Fauit Divorce as may be required by the Divorce Code of 1980. as amended. Both parties hereto agree that Ihis Agreementmuy be incorporated into u scparalc Court Ordcr hul shall not mcrgc In such order in the Court of Common Plells of Cumberland Counly, I'ennsylvllnla, III 19. OTHER DOCUMENTATION HUSBAND alld WIFE covellantund agree thut upon request of the other purty. they will f0l1hwith execute alld deliver to the othcr I'arty. an)' ,lIld all wrillell illstrumenls. asslgnmellls. releases, satisfaclions, deeds. notes or such other writings as may be nccessary or desirable for the proper effectuation of this Agreement. 20. MUTUAL WAIVER AND RELEASE OF RIGHTS AND CLAIMS IN ESTATE Each party hereby releases. waives and relillquishes an)' alld all rights which he or she may 11011' have, or may hereafter have. against the other party under the present or future laws of any jurisdlctioll (a) to share in the estate of the olher party upon the other party's death and (b) to act as execulor/rix or adminlstrator/rix of the olher I'arty's cstate, 21. MUTUAL RELEASE HUSBAND and WIFE each do hereby mutually remise. release. quitclaim and forever dlschnrge Ihe other alld the estate of such other. for all time 10 come. und for all I'urposes whatsoever, of and from any and all rights, title and interests, or claims in or against the property (Including Income and gain from property hereafter accruing) of the olher or ngainst Ihe estate of such other, of whatever nature and wheresoever sltuale, which she or he now has or at any time hereafter may have against such olher, the eSlate of such other or any pnrl thereof. whether arising out of uny fonner ucts, contraclS, engagemcnls or liabilities of such other or by way of cquitable distribution, dower or courlesy. or daims In the nature of dower or courtesy of widow's or widower's rights. family e,\el11ptlon or similar allowance. or under 11 the intestllte 11IWS, or the right to take against Ihe sl'ouse's will. or Ihe righl 10 Ireat n lifetime convcyallce by the other as testamentary, or 1111 other rights of II surviving spouse to pnrtlcipatc In a deceased spousc's eslatc. whether lIrislng under the 11Iws of (II) I'ennsylvllnia. (b) lIny State. commonwealth or territory of the United Stlltes. or (e) lIny other country. or 1I11d rights which HUSBAND or WIFE may have or III any lime hereafter have for the Pllst. I'resenl or future support or mailltenance, alimony, alimony pendente lite. coullsel fees. costs or expenses. whether arising as a result of Ihe marital relalion or olherwise. except, and ollly except. all rights alld Agreements lInd obligations of wluilsoevcr nature arising or which may arise under this Agreemellt or for the breach of any thereof. Each of the parties hereto further covenants and agrees for himself and herself and his or her heirs, executors. administrators lInd assigns. that he or she will never. at lIny lime hereafter, sue the other party or is 01' her heirs. execlltors. adminlslrators alld lISSigllS, for the purpose of enforcing any of Ihe rights relinquished under this I'aragruI'h, Each of the parties further covenallts and agrees Ihat he or she will pennit any will of the olher to be probllted and 1I110w lIdmlnistralioll upon his or her personal, real or mixed estlllc and allow effects III he laken out by the person or persons who would hllve bee II entitled to do so had HUSBAND or WIFE died during the IIfellme of the other, Each Ill' the parties hereby releases. relinquishes lInd wlIives lIny and all right tll act as executor Ill' executrix or lIdmlnistralOI' or lIdmlnistratrix of the othcr's eslalll. 12 ... -~.. It is the intention of HUSBAND and WIFE to give to each other by the exccutioll of this Marilal Selllement Agreement a full, coml'lete and gcneral release with respect to allY and nil property of any killd or nature, real, personal or mixed. which the other now owns or may hereafler acquire. except alld only except nil rights ana Agreemenls and obligaliolls of whatsoever nature arising or which may arise under this Agreement or for the breach of allY thereof. 22. SUCCESSOR'S RIGHTS AND LIABILITIES This Agreement shall. e.xcept as otherwise provided herein. be hinding upon IInd inure to the bellefh of the parties hereto. their respeclive heirs, executors. administrators. successors or assigns. 23. SEVERABILITY If any provision ill this Agreement is held by a court of competent Jurisdiction 10 be invalid, void, or unenforceable, the remaining provisions shallllevertheless continue in full force alld effect without being Impaired or invalidated in any way. 24. ENTIRE AGREEMENT HUSBAND and WIFE do hereby clll'enalltand warrant that this Agrccment conlaills all of the representalions. promises and Agrccmenls made by eilhcr of them In the other for the purposes set forth in the preamble hercinahovc: that there arc no c1nims, promises or I.l rcprescntatlons 1I0t hcrclll cOlllained. either oral or wrillcn. which shall or may be charged or enforced or enforceable ulllcss rcduced to wriling and signcd b)' both of Ihc pllrlics hcreto. 25. BINDING EFFECT OF AGREEMENT/WAIVER This Agreemelll shall remaill ill full force alld effect unless and ulIlil lermlllnted ullder and pursuallt to Ihe temls of this Agreemelll. The failure of either pany to insist upon slrict perfomll1l1ce of the provisions of this Agreement shall not be cOlIstrued as II waiver of IIny subsequelll default of Ihe same or similar lIalUre. nor shall such failure be cOlIslllled as a waiver of any other term, cOllditlon. clause or provision of this Agreement. 26. BREACH If eilher pany breaches any I'rovision of this Agreement, the other pany shall have the right, at his or her election. to sue for damages for such breach or seek such other remedies or relief as may be availllble to him or her. and the pllrt)' brcachillg this cOlllract shall be resl'onsible for I'aymelll of reasollable legal fees and cosls Incurred by the other ill enforcillg their rights under this Agreement. 27. CONTROLLING LAW This Agreement shall be constllled and governed In accordance with the laws of the Commonwclllth of PennsylvlIlIlll. I.' -. . , I , ", ~ , . .",., c) r'\ LAY! OFFlcn BARBARA SUMPLE.SULLIVAN "AU IIRIDOE STREET NEW CUMBERLAND. PENNSYLVANIA 17070.1931 PHONE C7t7l77.....,4!I FAX 17l7)77..70111 THIS 18 A TRUE CORRECT COpy OF THE ORIGINAL.. .1)..94? k " , ~_: '. --;::;--J~~'" ,,;,-: - .' _--=,~~~~A'"~~~~,",}'</.v".- " .""" r'\ ASSETS OP PARTIES ~ , Plaintiff marks on the list below Ihllse lIems IIpplicable to the case 01 bar and Itemizes the IIIllCI8 on the following pages. r' (X) 1. (X) 2. (X) 3. ( I 4. (XI 5. (XI 6. ( ( 7. ( ] 8. (X) 9. (X) 10. I I II. II 12. ( ) 13. (X] 14. I I 15. ( ) 16. ( I 17. IX) 18. (XI 19. ( I 20, II 2t. IX] 22. II 23. ( J 24. IXI 25. IXI 26. i' -~- Real properly Motor vehicles Stocks, bonds, lICCurllles and optlon.~ Cerllficates of deposil Checking accounts, CUAh Savlnjpl occounl8, muney markct and savinjpl ccrlificatCll Conlents of safe deposit boxes Trusl5 Life Insurance policies (Indlcale face vlllue, cash surrender value and current benellelorles I Annuillcs Olfl8 InherilanCCli Patenl8, copyrlghl8, invenllons, royalties Personal property oul8lde Ihe home BuslnCSl Illsl allownera, Including percentage of ownel'llhip and oflloor/dlreclor poslllons held by a parly wilh companYI Employmenl lermlnallon benefil8 . sevcrancc pay, worker's compenaalinn claim/award Profit sharing plan.~ Pension plan.I(lndlcRlc employee conlrlhulion and dale plan vClIlIIl Relircmenl plans, Individual Reliremcnl Accounls Dillllblllly paymenL~ Lltlgallon claims Imalured and unmatured( Mllllary/V,A. hcnelil8 Edueallon benel1ll1 Dcblll due, Includlnllloans, morlll"ges held Household furnishings and personnlty (Include us a 10101 calegory and allach i1emlzed Ustlr dlstrlhulion of such IIssels Is in dlspule) Olher -- I'"' NON-MARITAL PROPBRTY Plaintiff IlSL, all properly In which II spnu"e hIlS II legal or equitahle Interest which 18 claimed 10 he cxcluded from marllal properly: Item Number Dclcriplion of Properly Nlmca of All OWDCrI 16. McDonald's Corp. Slock Parties' Chlldrcn 17. Financial Tru.~l Cmp Slock Parties' Children ""'"" - LIABILITIES llem Dac:rlplion NlmCl of Nlmca of Number of ProperlY All Crcditnn All Debton la. Marital RIB Hnmc.~ide Lendlnll. Inc. Husband & Wife lb. Marital RIB Corcstate Lendinll, Inc. Husband & Wife 18. Credit Cards: VISA (MIOO 1205 821lt) Maslcrcard (5329 11012 72114 (677) Discover (61111 11023 51152 5616) JC Penney 19. Costa for L11Igalion, etc. Pension Appralsors Wife Appolnlmenl of Ma.~lcr Wife Real Estate Apprlllsals Wlfc 20. Allorncy fees Barbara Sumple-Sulllvan Wife 21. Disney Vacllllnn Disney Wifc (Credit to Wife) Paekallc . . IUMMAIIY OF IALlEIIT FUTUIE. llubIIclMhu III YELLOW BRUC/lES /10, lI(IIIOlIcf\IIIon BOOK/PAGE 32R/1071 CIy ~RLlSLE CoIdy CUMBERlANO .. PA lfCodt 17013 CnllI TIEl 127 ",1lM1ce NONE ~Pm D*oI6i1 . EVALUATION N/^ IonOWlII CIIIC ltlIlIIr /lERMAN /lERMAN. SUS^N ... (., ftII) 1.941 Pm l*_ F1lOl . 92,74 lDcIIb1 SU9URBAN/AVE "" 8 CendIb1 AVERAGE TlQI Room. 7 WOOl11I 3 811I1I 2,5 AjlpI- 0* 01 AjlpIIiuff V" OONALO R, STEELE AUGUST 3, 1990 ri1alhllmal,ofVoIu, , 180,000 rUlm 850 - 'lO'Al2ooo 'UI Wk.luw.' ~lllIoI'oIIUnWN' liy a Ia III"'~, .." - 1,800,ALAMOOE F R '''110, II IYlI LO r-.- ....... '" OW BRf.f.CIIES Rll, ~ CARLIsLE !:IIIIrA li1l Codt 11013 .OO","AGE "nJ 071 r;;;-...o; -CU I ~ 0I",.,107,02B _ ..,juYeI US/90 R,E, TIIII~1lIC1II .. ~ 1_ r';I.~...n.MI MML ' ~ n T..... r 1_ [)<IF~IIII"",,"U - r.UiN1Tvl~ I I pun I-I HOAl N'^ -, C^I.I SCINK Mill Relellnca NONE Cnul TI.:I 127 1"_ .~U.i.TlON O..oI6*N/^ .- OUQ,ljl\lm'lil.J!!lm oll...n chalo.liconCII~onllo bt lltId bv ItIIl! N/^ .tERuur SUSAN ~.!l!.SAME ^S ADOVE 1l0NAIll R, STErLE MJ,m Oil HSENIIOWEIl DI.Vll, 1100 P^, 170S 7 lacllkln I:::) UtbWl VI Suburbl/l I"! RUlaI Pftdomlnlnt ~' Imlly 1tI~~r P....nt land u..'" Lind IM.[5 .. up ] Ovel 76", 'J 2s.76", J UOOilr 26", OCCllpln<y rl Onefl/lltj 40 Gl Not II<IIi L lblt 0IGWth '" J RIpIJ L~J S1able I] Sbw f' J OWl1IIr 100 lew 0 2,. fl/lltj lJ In plDCIU "'_ vlllutl ..;] IncrusiJJ ~ Slable ] Oocli1lng , Terlarl 2S0 Ii;'" ~~ulHI/llIIi To: OImnl'auppIf R ~rtage ~~ In balancl I~ OVlIIUPlI~ 1:1 ~::,"IIOS'I : "'.'i:fPltoomnn Commercial -, UNIo,inllll, ;'1 ',8 mo. 'i Over 0 nlOl, !tlm!ll\1 190 S VACANT 60 ..... .... ... lito ,ocl.1 .._'11.. .'11to ..lth..'....d ." n.' .""11111..,.,,, ~boundallel mchllaclal"'~I: SEE ^TTACIIEll LOCATION MAl' FOil NEIGIIBOIIIIOOll DOUNllMIES, facloll thllllllc:llha m.ketabllly oIlhl plopeltleS klthll1llighbolhood (plolimly 10 Imllloymeri m amenlles, employmeri llallllly.ljl(lUIto mllket. Ite,): SUBIECT IS 1.0C^TED IN ^ np,c^,. SUOUIlMN ME.\ Wll'lI SIMII.M STYl.E ^ND ^GE 1I0MES LOCATED IN OICKINSON TWSP, WIT'I EASY ACCESS TO ALL ^MENITIES, NEW CONSl'RUCTION IS ON GOING IN TIIE^IlEA, TilE NElGIIBOIlIIOOD IS WElL MAINT^'NED ANO SIIOULO OfFER AVEMGE MARKET^OILlTY, Make! eondlilna klthe aubjoctl1llighbolOOod (including lupputtlor lha above eonclu,kllls "laIed 10 lha btlKl 01 plopolly vlllutl, demnl'IUpplf, end m.ketklg line -lUCh . dIU en elll1ljlOllln plopetliel lot aale kllha neJghberOOod, deser"'lun of tha plevalence of sales II1d lk1ancklg eoncasmns, a1c,): DATA INDICATES TIIAT TilE GENEMI. MAIlKET CONDITIONS ME GOOD WITII TIlE AVEMGE MARKETING TIME BEING IN TIlE LOWER ENO OF H UONTlIS MNGE ^ND TIlE ^VEMGE !.ISTlNG SEl.!.ING FOil 07,90'1 OF TilE !.1ST PIlICt. IN ^DDr...oN TIlE AVEMGE SETTLW-"RICE S"OWS ^N INCIlEASE Of N" OVER l.I\ST YEAR, FINANCING IS I'REDOMINANTLv CONVENTIONAL WITI' fIlAN^ REPIlESENTING ONLY 17" OP T"E TOT^L WITll SEHER CONCESSIONS BEING TilE EXCFPTION IlATIIEIl T11^N TilE IlUI.E, ""'"' Inlonutlen I" PUOI (II_IIIIe) , , Iltha deuloper/buildelln eorilol of Iho Home OWI1IIII' A,soelallun (HOA)? U Yes ~ No AjlplolllnuH lolIIoombtf 01 unb klthe ,ubject project N/A Applolim~e tolal numbar of unlllollale klthe lubject project N/A I n:.;..,,,. rom I ..... 'ocrelllenallacRIes: NJA DmnIons ISO X 291.67 X 300 X 291.67 Topoooaphy I.EVEl. Sbllll 43.7S0,S SF COll1llllot I] Ves [~.J No S~e AVERAGE SjIIcIlc 1lri1 elassllclllon II1d descri>llon RESIOENT'AL Shajle RECT^NGUl.I\R lot*1g compIRe ~ legal rPleoal oonce",'!']klg IGI....~halod uso) I] 11'oQ~ [J NOlonlng Dr. ^PPEARS ^DEOUATE I ........ ' ,1 PI05Mlllse Olhor UII lellllalnl N/ A VIew ^VERAGE ..... Pubic Other OIf....lmpr.Vlm.ntl Typ. ""bile PI~aie lll1dscepk1g ^VERAGE EfIctr~ly 12J Shoel MACADAM l~J I] Or~ewl)' Sortacl MAC^Il^M 0. BWEl.L CUIWgulter NONE LJ [] App.... ._iU STNO UTILITY W... Silew. 8RICK LI ~J FEMA Spoclll Flood HUlld AIN 0 Yes -~ No Srirt lOwer 1"'1 SEPTIC -- Sheelllgtls NONE H R FEMAlOl1ll S MapO.. 4.20,79 F1 A"v NONE 0, 42IS00 ComI11OfU (ljljIIIeri ~lIse Il5Omlril, encroachmenll, lpeclal..so..mlril, slide Bleas, illegai UlleQai r'"lCo"OImklg Inning use. lie.): NO A"PARENT EASEMENTS ENCROACIIMENTS,OR ^DVERSE CONIJITIONS WEllE NonD GENERAL OE6CRIPnllN EXTERIOR DESCRIPIION FOUNDATiON BASEMENT INSlUIION No, of Unb I Foundallun BLOCK Slab 0'1 AIOaSq, FI. 1091 Roof 0 No,oISlOIIes ~ EJrtelklfWaDs BRICKJWD lAP Clawl Space 0" " lkishad 0" Ceirl,j 0 TIP' (!let/An,) llET^CIIED Roo/Sullacl COMPOSITION Basemlnt 1000; Ceirl,j 2XI0 W. B DnIQn (Slyle) COLONIAL GU8111 & OWnspll, AI. Sump Pump YES WaDs BI.OCK 11oOI Elllltlnit'Prope&O<l EXISTINO WnIow Type nil VNL Oampl~" !'lONE NOTED 11001 CONCIlETE None ~ Aoa (Yla,) 0 S10il1l'Scloens NONF,lVNL S.1I~mOld NONE NOTED Outside Emy YES Unlrllown Isw..iII. A" ,IVII,\ 0 anutacluled louse -NO Irrl..til1lon NONE NOTEIl WINDOWSJDOORS ROOMS Invor JtkL -'1!!!00 Klci!!L Uen .1am!l1llnL nee, Rm, IRldrooms 'Ball~ 1~I~lnI OIhar Ar.. Ro, I'. 1091 llovtlll I I I I I ,S I 1091 I LIVIll' -- -- -- -- -- 3 2 OSI Ilea Ibov. lIlade eonlalns: 7 Rooms' 3 O.dloo",I,): ~,5 Oalh"I' 104~ SlUal.I"'nfG,n..'~ImAlla INTERIOR Mallllal!l'Cor<lllon HEATiNG IOTCHEN EOOIP, AtTIC AMENITIES CAR STORAGE: 110011 l'INE/CrT /VN~/A'!L. Tyl~ JlLL __ n.lllgollllur [,j Ilune '-I Ik'l'lace!,)'_UI [;] NOI1ll I-I W.1Is .llW (r:, v-"________ lu.1 .!1!!JH&<: UdlVJ'V'OVr.1l [ I Glails II P~kJ __,____1.1 G~age ,00elll Tllnl'Flnlsh WOOD/AVE ~Qnd~lu~ VE ..___ Ol'IKl'~ I I 0101' GlaIr ld Oock Ll Attached Bllhlloor CI'T/VNL/AVE --, COOliNG OI,hn,l~r I,) Gcullle POlch 3 COVEIlEIJ [;] Oolachad ~. Bllh WaIoscof NONE Cerdl~ III' liVI1100rl I.' FIooI LJ Fence II Bu..ln 00011 SOUll 6 1'^NE6'A VE Oll~r __, M~lUwave 1-) If.llIld 1=1 Pool -II Carpert Condillun AVE Wasl~rlOlvnr i i 11nI,I~d Or~ew'" Addlllonalleaiulls ('l'oclalonell1l etl~~ri I.ms, ole,): SEE ^ IL~!!tpA!mICNIlA" Condllon 0I1I~ rnl"ovemIOi~I;;;Ci.ik,n (111~~k~-:I;r~i;;,;j,-Bl.j'~I,i1lo1ij:i'I'~I~ r~;;~;Cqu~ii'~j con.h.iZikJ~ Iemode~lIilll<lilons, ele: Ti'E SUBIECT IS MAINTAINEll IN AVElIAOE CONllITIOliJY.!I!lliQl'IIN1\k!J~LPlIlJJ~~Jr:,INIENANCE, TIIEIlE IS NO ~!EA~!!J\!\BI.E LVlllENCE Of fUNCTION^L .Q11J~KrrnNAI. ODSO~E5CENcL,_______". ____________ __ _ _,_______ _.._ ,MSEIl.91LU!rE f.xJ'j:fI!'lti~LQ!'!iQn^'IS. IlJlc)IHtAININ(; ITllNOMIC UIE IS S~ \'tAilS Advel" o",kunmeri~ eundillons I.ueh &', Inll rlll 1m";' tu, lI.u",IoII;W"I;;, lukic ,uh;i~~'-,: Ilc-)rrl;;;jt,;il~Ir;;I;,u;.m.Oi;:-orlil~'Ie:rn-il;Ii;------- Immedale Y~lnfty of II~ lubllclIIlUpelly,: Nll MlVEIlSE INVlflONMIN rAI.l llNlllTlONS MlE KNOWN TO EXIST ON TilE SITE Oil IN TilE IMMElJIATf. VICINITY Ill' TIlE SIlIIIl.ci'--- ,--- -" "-,,,-,,- . - -, _________..___w_____..___'______ . OUOAN APPRAISAL SERVICES 17l 7) 93H360 . urn ORM EIIDENTlAL APPHAIIAL REPORT rr~M""IUlm70 1\!9J I'Alil 101 1 "nm "^2 -- '\(I1AlIUOU hn 1'111'\'"" ill'III,''',U ,,,ltw,", lIy a 1,1 rnul~, I~, ,-- Htoo AIAMOO[ Fannie Mill fUlm 1004 1\Ill3 UIORM REIIDENTIAL APPRAIIAL'PORT 0 _ 1 40.00Q. CornmerlJ on Colt AppIu.:h (lUCh "Wet ~ toll.... III v... aqu..luol cllcullllln 11'II'" HUll. VA 11'II FmHA.lhIlIhIItd ~ ecOfl)l1llc"~lhIpllJllIIIY): S A cIao K C llllENllU 0 SUE OaT C Cll 0 S, COS ^ fROM MARSIIALI WII'T OU II OCA CONTM 0 5, UlNO V^LU IS KEN ~OM M^RKET V LIlE. ECO 0 C LI E S CAI.CU TFJ> IE^G M 00 fOlt IlEl' ECIA 0 , no 6l1t VAlUE fltllAnO IIlPROOUCllOH COST.HEW.Of 1MI'R0VlMENTS: ~ 1.94ISq,f1,@L,!LlL-1 11110391 09 Sq, f1,@1 11.30 u 12,394 C CIESEe. - 12,SIP! llIrtgt'Capllll 590,25 Sq, f1, @I 2387 - ___!932 TolII EIl*nIltd Colt New - 1--.-li8,S28,78 _ I'tt(slcll Fulltlllnal hlelnal llIpIlICIIIb1 21,\321 0IpeclIIId v.. ~ ImpIlJ'IIl1l1Rl 'AI'" V" ~ SIIlmplOVlf11l/'l1 A U IY APPROACH ITEM IU8JECT III YELLOW BREECIIES RO, CARLlSI.E _I 21,1l2 _I 137.390,78 .1 5,000 _ 182,390,78 Cll'oIPAIlABlE NO 1 10 AAI'UANO W^Y CMLlSI.E ." ",/,:,".,~.!;;i'!); I BLOCK 1 EV^LIlATION' "",:',;~"H 92,74 " L 83,07 .,. ': t"')'""""~;' INSI'ECTlON D^T^ RANK COURT 1I0USE COURT 1I0USE OEICRIPTllXl OEICRIPliON " CONVENTlON^L NONE 10/95 ' 78 paM SUBURBAN/^VE : FEE SIMI'LE ,94 ^ ^VEAAGE EQU^L BRICK AL ^ VE NEW AVEAAGE : : ~ : 81l1hs : 2,5 B; 4 : 2,S : , I. 2,30B S<l,n,: EQllAI. : "fiN : ^VEAAGE FltA/IIP EQU^L 2^O COV POR/IlECK IFRPI. NO E NONE SUBllRBAN AVE fEE SIMPI.E I ^ ^ VEAAGE COLONIAL BRICK/WO/AVE' 8 ^VEAAGE 7 : 3 : 1941 FULl. 0" ^VEAAGE II^ III' WIND'" 1l00RS 2 PG 3 COV PORCIIES IfRPL NONE NONE Cll'oIPARABlE NO 2 49 SANPY BOTTOM RP, CMUSI.E ,2S MILE t 9B 700 :. ilh~JH~~ ~ ,'. I','.:: 79,79 ~.1 " Il^T^ BANK ... COUltT 1I0USE 'I-JlAdIU~ OEICRiPnlXl CONVENTIONAL NONE II 95, 28 POM SUBURBAN/^VE FEE SIMI'LE 1.1 ^ VERAGE E UAL .4 000 BRICK VN AVE '2,500 I ^ VEAAGE Totll :B~ml; 81l1hs : 8 ; 4 ; 2,5 i .10,075 2 2S0 . EQUAl. " 'IN A VEItl\GE FilA Ill' mu I. UO .. ,000 COV l'OR/IlECK IFRI'L NONE NONE ~, .2000 . 000 .2500 8 : 4 : 2.5 '787S 'I072S '1.000 I 2 5 ..!,ill, 5375 if+<',.., . 188525 'i'!" "" 17462S ConimIIU on 5*s Compailen (ilckMi'Q lhIlubJecI p10porty'l cemplll~1ly 10 lie nelghbOlhood. elc,): LI. TIIREE COMPS LOCAl' ON AND EREFORE GIVEN E UAL WElGIIT, TIIESE CO~tpS ME TIlE BEST ^VAllABLE ANO ME ^CCU TE IND CATORS OF MARKET LIlE, ALL OTl ER COMPS RE INFERIOR TO E ONES CI OSEN ^ND AltE DEEMED LESS ^CCUAA E NDICATORS OF V^LUE. FOR T IE MOS R CO I' AABl.E PROPERTIES TO TIlE SUB ECT ^RE NEW CONSTRUCTION WITII VEItY fEW PROPERTIES 01' SIMIlAR DESIGN PP~L AND U^L1 Y TO 1'1 E SUB E ME SIIOWINO UP AS RESAW. ""- .......OO'-~l """"'", NONE SEE ^BOVE SEE ABOVE IlAT^ BANK, snBS IlAT^ AANK, STEBS lisal MLS ML5 AnatiIiI of 1fT( CUllerlllll'eomerl 01", uptkln. OIl,lIl1g oIlubloCl ",nve'l)' aOO anaIt,b ot 8/1Y ",kll .. ~ subJecI 1M cornpaablea wli*1 one yell oIlhe dIlII of 1fIlIl4"': TilE SUBJECT liAS NOT BEEN liSTED I'OR SME ^NIJ 15 NOT CUllIlENny UNDER ^NY ^GREEMENT OF SALE OR OI'TION TIl^T 11M BEEN RE/'ORTEll TO ^NY llAT^ SOURCES 1'IIAT AilE ^VMJ\DLE TO TIlE ^1'1'/lAISEIt, IHOlCATlD VALUIIY ULES COIlPARION APPROACH A DVALUIIY INCOIlUPPROACH I able ellmllled Mokel Re~ ,x 10 - ThIs epprlisllls mD' 'as Is' lubJocllo the "PMI, alllalklns, mpeclklm 01 collllklns isletl beluw _ lubjacllo complellJn pel pin & 1jlIC11c1llonl, Condllon..IApj1I,lsaI TIIEllAT^ 15 TAnN 1'1I0M I'F,IISoNAI.INSI'ITTlnN, STFn nFl'OIITSJI!'IP M~S DATA RANK ANll IS I'Rf5UMED I\CCUI1i\..IL SIIOULIJ PM^ LONH'[~JJ!!hMlJSLJlI..bL^Jl!JJ!QlII\Lt:!~LIJ~~!l!!,!11lJ -------, FNI Recentllllkln: MOST WElGIIT GIVEN_TO TIIEMAI!~!J_~\!~t1~IIISON.^l11LqA.nl. NO V^LllE GIVEN TO TilE INCOME ^PPROACII DUE TO CK Of IMIJ D^lA ^lI, SAtES USF)> ^RE snnw ^S OI:JlAlI.5ltl!lKA 1'.0 Cll'oIPAIlABlE NO, 3 , 110000 The pUlpo&l otitis IIIlpllisal b lu eslinale lie mllkel value otllellallllupelty Ihalls lie &UbjllCl otll.. lepolt, based on lie t1Jove condolklns III1lllle clI\l~e1kll\ corllngerl II'IIlmliJJ cnRllIons, III1ll m.kel valut tlelkllkm llia1l11e .Ialltlln lie a1laclmd Ii,,~'" Mac fOlm 43!l'rNMA 101m 10048 (Rovl&ltl 0/93 ), 1(WIIIIT1llATI THE MARKET VALUE, AI DUINEO, OF TRE R~L PROPERTY THAT IS THE IUBJECT OF THIS REPORT. AI OF AUGUST 3, 1990 (WHICH I THE OATE OF INSPECTION AND THE EffECTIVE OUE OF THIS REPORn TO BE 1 __.H!!.!!!!L_,_ =,~ER: C; ..::~Lf~'~~~~~_h _________._ :~=I:ISO~~~RE~,.O::(;fL i.WJ>kl [JDklNol NII11t OONALI> II S)!!lL __ __ _ _, !llllnL!!Y5.5.m, 1I05.I.Elt ~ Inspecl PIOpelly Dele RePl!ll1\mL-'\!I~Y_H 7, I~?~ _ _ P!I!JteJKlll~~LAUGUST 7. 1990_ m~~!lkm'_._ SlalL SI"eCIII!~a1kln' IH,,000970'1. 01 ale k II!., 1 71114 1-1 SI,llll'^ "olsi.i;-~.;;'ei'N^---'---- lielUe Mac fOlm 70 1l'll3 l'AGl 1 Of 2 IUll1lllAl- 'llllAll000 Iw W..luw,' 1IIIIIIaI,. ,ollw., liy' Ell11ulle, 'Ie, -1,8IXlAlAMOIl[ ~--~---~-_._._------_..._----_. Sllle P^ Sial laMIe Mae 101m 1004 8,93 . . SubJect Photo Page ftl!llllwellClo'" IIUIM^N_____________,_ -----,-,----- P.tmllY ~ddoeSI 111 Yf,1.\.U\'L\mtLqll,~.!l!l--- ,----- -- ,- CIY CARum ___________C2YntYS!lllilml~Nll- endllr IIf.lIM^N SUSAN . _..__..____ __ n~"'_' ___ _. _._u.___~_.____._____- --. -- ..----..-. ...-~------_.._. - --+----------- _ ___~I~I! j'!\.____________J\I-C\l!JO--FOIL-- Subject Front III nu,OW Illln,C1I1'.5 IIll S,lies PileI I.VAI.IlAl10N UtA 1.941 101~nllUl1is 7 101~ Be<lims ) 101~ B~llIms 2,5 lllC~~n SUllUlIll^N/AVE Vlnw A VIJI^GE SID I A r-, BlIa!dy IIIUCK/WU/AVE+ A~ 8 Subject Re.r I i I I I I 1 \ I I r==:::--= Subject Street Innll I'IC,"O 511 ___ '101AI1l1(K) '''' Wir,k'WI'lIl'jlliU,,,1 M,lIw,1I1 IIY a LlI1101\<!, II~, - \.600 AIAMOlIl . Building Ikltoh . I~="--'. - CUMBER~ND ShII P^ nJCedI 17013 LMno Room IIolh IW/I CloMI J J Both Ilodroom I2BoI~ DIning C - Kitchin IIodIoom Den Bodroom BKETCH CALCU~TIONB - 1_ ., ---- -] ~~--- -"---_.._._-----~-----_._-_.__.- -.----.-. AI: 21,0.,8.5- IU : 33,0. 4.B _ A3: 41.0.7.5- M:29,0.4,B- AS: 21.0. 7,5- :141.8 I",B 307,B 130,B lB7,B Flrlt Floor IlllIO,B A8:21.0.40,B- B5O,B .. BlCond Floor B5(J,B !~1~1_1I~1~~ ~r~..~,__.~ ____,___ n.__ 1941,0 fOlm SK10kJS~- 'TOIAl2000 101 W"JoWI' '1',,101,01160110&. ~V a~ ",otl!, Inc. - l,eoo,ALAMOOE J ~ i " ' ,~. ., '''r.!.~_ ,., -, ~', _~\"a~f DIP..II"OI OP MAIIKET VALUE: Tte most probobllllH~e wlich a 1H0pelly aoouij brlrQ ~ I competIM rd open malll urdel II COIdIln "I'W'" ..... 10 I falr .., IhI bllylf I'd .., each ICtIrQ pludlrily. koow~1y I'd &UUmlrQ U. ilia 1II/1llllllctld by UIDlIlll11iM, ImpIcl ~.., 'll\!~ dIllnIIon 1111I ~ 01 I .. as 01 I II*liod dale I'd lhe J'IISi1g of 1111I Ilorn .. 10 blflll undlf COIdIln wtwIby: (II bIIyIf rd .. n'; ;'f~' ~ molIIat (2) bolh patin lie WII Wormed Of well1lt;bed, I'd each acllrQ In whi he CenskllMI his own bell Hel1If; (3) I IUIOI1IbII tnllIlIlMl :.~ lei ...... ~ U. open mill: (.) payme~ Is m In Ielml of cash In U,S, WLvI 01 ~ lelml III IlnRiII 1I'lI1gII1lIIts c~1II1e II'Ilslo; rd (5) u. IRe . ..... III 00111III conalJellllon lor the propelly 50ij uMfeded by special III cleal~a 11M1cD,j 01 An conclSliona' grmd by IITjIlflIlIIOCiIIId wIh ...., . . . . " '''~iIIbMIU to the comp.vobles musl be m. 10' Ipeclal UI cleal~e lilM:lrQ ur .. conclSliona, No "ullmetU lie necesuy 101 U- cesIs wlich III OOImllti pal by ..lele 15 a resu. ul hlMl4lon ur law ~ a malll IIU; IheII cells lie luJIi kllrlllsble Ii1ct the ..1Ier payl the.. costs In vktually all laIIIS hansacllons, Special or crealIYe Iiw1cIrQ "ullmetU c.. be male to u. C1lI1lp.1ablll p1opet1y by compallsuns 10 1f1anc1rQ lelm. effeled by a Ihlrd pally ",'lullonal Ierder IhII Is /Ill alrWj kwoiYed In U. plOpelIy III hansacllon, AIT( Ik\uslmerl I,",UU nol be cal:ulated un a mechan~a1 oollar 101 wLv co., 01 the IInRIrQ or concession but the 00k lWllOUnl of any Ik\ustmm shlukl apploJdmale II~ m~kel'l reacllon 10 lhe lInanclrQ 01 concessions based on the apptalsel'a judgemerl, STATEMENT OF L1MITINO CONDITIONS AND APPRAISER'S CERTIFICATION COIITINOENT AND LIMITING CONDITtONS: T1~ applalser's clll!~a1lon ilia! appe~1 In U. apptlisal report Is subjecl 10 U. lollwlrQ condIions: I, n. apptalser wi 001 be lespons~1e lor maltell of a legal natule Ihal all,,1 .ftI~r II~ plOpel1y b.1ng app,aIsed or II.. IIIe 10 I, The appraiser assumes IhII the lIIIls grJOd rd mlll<ttablll am. lheretore. wi nol relller atrJ opklion. abuullhe 1111I, The plOpel1y Is appraised on II.. basis 011 b.1ng undlf respenslJle oWllll$hlp. 2, n. apptise! has plovkled a sketch ~ II.. appraisal "pori 10 soow approxlmale dimensions ol Ihe Improvemenls rd lhe skelch Is Inckllled only to asslsl Iha rWer 0I1l1l repod ~ vlsualzlng IlIl propeily rd underslmlng lhe applalsel'S delermlnatlon of Is size, 3. n. apptalser has lllII11iled lhe lI'aIIab~ lIood mapa Ihal III provkled by II~ F.delal Emerll'ncy MiNIl'merl Agency (or olillr dala SOutc..) rd has IIlled ~ liIlapprlisal report Whelhel the subjecl sle Is kJcal.d In an klenl.led Special Flood 11a/lld Aiel. Because Ihe appraiser Is noli surveyo'. he 0' she makes III QIlII....., IJIpress or Impled. lell.1I11ng II;' delelmlnallon, 4, n. apptalser wi 11I1 gIIe l.stlmolT( 01 appeal In COUll because he or she m. an Ijlp'aIsaI oIlhe properly ~ quesllon, Unlesl spec:1~ IIrlllQlllTll," to 00 50 11M been m.. belerehllJj, 5. n. apptise! has estimated IlIl value of lhe land In the cnsl approach al Is h~'",1 and besl use rd U. knplovamarll II 1iIl~ conlrlJuloIy VU. n.se IlPllIIe vak/atlons 01 the land rd Improvemern musl nol be used In co~uncllon wlh any 0111I1 appraisal rd lie kHaId I they In so used, 6, n. apprise! has /Illod In IlIl appraisal repllrt atrJ adverse cor<lllons (such as. meded Iepalra, depreclatlol\ U. plasenr:e 01 hallldoul wastes, Ioxlc &Ubstnes. lie,) observed lllllrQ IlIl "'pacllon of lhe wblecl plOpel1y or IhaI he or she became IWlle 01 durlrQ U. IIllIIIII ,_ch lnvoiYed ~ perlotmlrQ the appraisal, Ur*ss otherwise slated In lhe applalsallepor~ II~ appraiser has no klllw~dge 01 III/ hWen or u~erl CIlldIons 01 the property 01 ... env~OI1I11II'lal coOOlbns (~dJlllng lhe presence 01 haz~oous wasles, loxlc subslances, elc,) IhII wouij m"" U. plnperty mere or less vakllble. rd has I\$umed IhII IlIlre lie no such cordllons rd mid.es III gUllantees or wllrant~s, express or knplied. ,eganllng lte cOlXlIun of the property, The apptlisel wi not be lesponslblll lor any such condnlons thai 00 111,1 0' lor atrJ eng....rlng or le,'1rQ IhII mijt be rllJlkod 10 discover wheIheI such cordluns elllsl. BecllJse Ihe appraiser Is IllI an expo,l In lhe llekl 01 .l1Ywonmenlal hazllds, IlIl appraisal report must not be consklered IS .. eMOIY\1ll,.a1 assessme" 0I1l1l propelly, 7, The appraiser oblalnedthe lriulmallo~ ..Ilmales, m opklions lhat were eXj1lessed In lhe Ijlpralsalreport 110m sources IhII he or she consklers 10 be lelIble rd believes lhem In be hue rd conec\. The appralsel does nol assume IIsponslbllly lur II~ accUlacy 01 such lema IlIaI Wele fumlshed by otheI petties, 6, The appralsel wi not dls<:lose lhe cnnl.rn of II~ appraisal Ieport e"epl as PIOVkled lor In II~ Unllolm 51and.1I1s 01 Plolesslonal Appraisal P'lClk:e, 9, n. appraiser has bMed hls or her appraisal IIpIl,l and valualiun cuncluslon lor an applalsal lhi Is subjecl 10 sallslacluly completlll1. lepalrs, 01 Ile,atlons on lhe assumpllon IhaI complellon oIlhe ImplOv.menls wi bn pe~U1med In a workrnanlilul manner, to, 1h. appralsel must pruvkle ,"5 or ,,, plkJl WI!len CUI",nl ""U," nil 1e,,1e1/c1.nl SlllClled In lhe IIlprai'a1 Iepull can tlslllbul. Ihe 'IlluaIsaI repoll (lnclutlng cnncluslons aboul II.. propelly value, II~ IIllualser's kleln,l, 11.1 plUlosslonat iIes~natlons, and ,et"ences 10 any prul.sslonal apptalsal o'pUallons nr lhe lim wlh wh~h lhe appraiser Is associated) lu anyuno ull~r Ihan II~ borrower; the mortgagee or Is succeSlOlS and assigns; the mortgage Insurer: cOl15ulanl.; p,of.sslonal iljJplalsal orgarilallons; any slale 01 lellelallt '/IPIOVed fiIM:laI "'llullon; or any ditPIlImenl, agency, III Insbumanlllly 0I1i1l Unled SlaIes or any slale or 1111 D",I~I DI Columbia: .xcepl Ihalll~ Iendel/cllenl may tlsh~ute lhe propeily desc,,,,lon secllon Dllhe report edt 10 dala colecllon or reporllng selVEe(s) wlhoul having 10 oblaln II~ apP'Wsel'S l'llor wlltt,n conserl, The appraiser's wllten conserl aOO approval must also be oblalned before Ihe 'I'pralsal can be conveyod by ~~U1~ lu II~ publE IIxough etiYelllslng, public ,ela/Ions, "'ws, sales, or oIhef milia. Fre<Me Mac Form 439 0,93 Pol{JO t ul2 llllUMI APPRAISAL fir IIVICES (117) 0399350 rutm ACII - 'TOTA\. 2011O IUI Wlnduws' 'IIII/a.~ .ullw~e by a Ll mOlle, Inc, - HlOO'AlJiMODE FIM~ Mae Furm 100.B 6.93 " t ~ .. . . t "' .. ,.,::i, , : "j. I ~ " . ~:.':.l' .-, t .' ,LJ~i I' ~;~, , '~\lhl.t F.I't.'., . 'j .'..\. 1. I 11M ItIUlcl1ld U. aublec:lll1llkelllN nl 11M _led I mlninum d UVlle 1m ... d ~..,.. i~ ' lof conakIItiiln I1Ite ... compllilOn WtIIa nl havl mu I WIaI -1ullmWC whan ~~i~.II~ vOllen, . I N,1lIcIl1lIem In I comPllab~ p1opef1y If suplflx Ie. 01 I1lOIlll'lllllb~ thII\ Ite aubject pIOjIIl\'!llMillil!iil . Ite a1IIIIId ... pia 0I1ha compllab" nl, . I aQnIIcn lem 11 I compllab.. p1op11ty ~ knllx .,. III leu tMnIlla .., "I' ' lposII'/e-1I11lJn11'1Iek1cI_Iha-1u.led"'p1~aolIhaCOl1lpllab~, " :, " ';I'.ii~,1'f<'ij:;),l\l9i , , rIp' ';. .,.... ,M, . .; :,. _, "., " n'l.-. 1" , 2, 111M laken'" coll5llellllon Iha laclelllhll 11M III inpacl on valul n my dmllpmeri d IhI aatin* 0I1IUlIat vall h......_ knowklgly wllftlllllt sl;rli:1I1l Wolmalkln 110m Iha appcWlleport llIld I ballev~ 10 IhI beat d my lmwlldgl, ll1II II lIlIIImaID:ml appclllNllapohlbuelllldwnecl. , ' . .. ,.;,\!~ ~ ..:(: - ti 3, \ stlI1d n lht appclllNlleport 0Itt my own 1'01101III. uooWed, llIld pllllllSlonal wltlls. opi*>ns, mI conclo5lorl. which al aubjtct ontt ., Ite mllrnIkY.I condlklrupecllld I1l1is 101m, .: '1 : ,~l', 4, I 11M 00 plllIf( UI plOlpllClIvl kUllIl n U. plOpIfty IhlI b Iha .ubl"lto lIis Illpcll~ mil havl 00 pi...... Of ploljllCtivl 1*_ Herlll Of bill will, lapecllo lht pIItIc\lW n Iha bnacllon, I lid 001 blSt, elllIIl palllat( 01 compleltl;. my en.Yt515 nl'Of Ite esli1IIlI 0I1IUlIat va 11 lht appnki fIlIClI\ ~~, OI1lht lace. collf, IIIgIon, 5OlI, hnkap, leli lllIus, 01 naIilnal Ollgln oIllhel IhI plo,pecllvt ownerl Of IlCCUpaU 01 U. aubject pIIIlIIIty Of d U. pl1IIIII' '\i owners Of occupaU of U. plnpertm n lht v~Wy of lht aubjecl ploperty, ' ., '" .~ J!::l . ,-~ .PPIAI.III" CIIlTlPICATIDN: T'- Apprilel ctdJiIlI nl ~IIS 11111: 6, I 11M 00 pill" 0' clllCempWed IuIUII Weltsl n lht subjecl plopel1y, lid ..u.r my CUlIenI Of Mull employmll1l 001 my COf1lpIIl5lilln IOf pedoImi'G ItiI IppIIIINI b co~on ltelflllllalsedvtlue oflte plnperly, 6, I WD oolllllJlitd to report a plldtlelmkld va Of lh:1iln 11 va Ihi IIVOIlIha Cllll5e d Ite clll1l 01 flit ItIal pa1y, Ite 1lIlO\l~ 01 U. va ....... U. IiIIIm1IIi 0I11pIlClk: IlIUI, Ollht IlCCUlIlIlCt d I subseque~ eve~ i1 Olde, 10 lecatle my compensll1on nl'OIl1111jl1oyrnert tor pertorml1g Ite 1ppI", I lid 001 blSt U. appclllNlltpol\ on Irequeslld mi'inum valolllon. Ispeclk: valoilon. Ollte need 10 apprOVI a speclk: 111<l/lgIgIl1olll, 7. I pedonnId IJjs appraisal In codolmly wlh lht U,'OIm 5IandIIds 01 Ptoleasklnal ApplaIsal Plactlct IhlI well UlpIed mI plomu9led by U. Appr" 6lIIldada Board d The ApprIllNl FeundlI10n nllhi wetl 11 plata lIS 0I1hI e11llCltIe diIlI ~ lIis apprlllNl, wlh U. uteplIon ~ Ite depaturl pcovlsiln 0I1lIlM 6tnlIrda, which cIlIs not~, lecknondge Ihi III aslinala ~ a IIasonablt lime 101 elCpcllUII n IhI open make! Is I cordiln n u. dtli1Ilon d I11IIktl va ml U. tslinIIe I dmIoptd II consIstenl wlh U. I11IIketI1g line ooled n Iha IIllghbodJlOd secliln 01 thII Iaport. Ilnlllu I 11M oIterwIse slIIId 11 U. leconclallon section. 6. I 11M JlIIIOIlIIIII1specIed Iha Werlol lid em.1x ... of Iha aublecl PlOjJO'ty IIdt'- Idllkll of II prnpertilll isIed D wl11Plfablts 11 1hI1ppI" fIlIClI\, I tw1htI ctdJy IhlII 11M ooled lilt appIIt~ 01 known Mil coOOllona n 1'- aubjecl inplovemll1lt, on U. subject &Ie. 01 on flit III wlhillte ~ vkWy 0I1te aubltcl properly of wlich lam awal nl have mu ~uslme~s 101 1"'11 llII;lllI clllklllons n my aW;Ils of IhI plopefIy va Ie U. IlllIIi thai I hat I11IIket evldell;llo IUpport them, I haYIIlIse commerled about 1'- eIIecl oIlhe adillSI condllons on 1'- mlkelablly of Iha Iubject ploptl1y, 9, I peIlOl1Itj plepaed II conc~skms lid opijlns about IhI II~ esl~, IhaI well sol 101111 11 1'- apprlllNl repolt. . I IIIed on slgnli:" prdluiJnal IS8itlI1Ct trom /flY ~kllal 01 Rlvlduals n IhI pedOlf1\lllCI oIlht IIjlprals~ 01 II. plli'.~kln 01 U. apprlliul,eport, I havl I1I11Id such ~i(s) ml decklIed Ite 1pIClk: laW perlolmod by IhIm i1lht leconcillilkln secllon d lIu. BPIMaIs~ llport, \ cert/y IhII lilt ~ldui &0 I1I11Id b quilled to perform U. 1Mb, I 11M rill aollIlIlzed IIIfOI1O to make a char9t 10 IlTIlem i1lh1leIJOd; l"'lefole, 111I unauthorized char9t Is mu Ie lht appriullaport. I wi lake 00 IlSpclI'IlIlly lor I, IUPIIlVIIDIIY APPIlAIIEIl" CEIlTtFICATION: "I .UpeIVI.OIY appraise' .Igned IhIljlplalsalllpor1, '- 01 she cllllilll mI ~IIS thai: llbctly supervlst Ite appcilel woo plepllld 1'- applalsal llpoll, have mlewed II. applals~ "pol~ lIQI" wlh Iha slalemelts mI conc~.lons of lht appr..., "'" Ie be bound by Iha appI""'s tllllk:alklns ",mbe,ed 411110ugll 7 above, IIdlll11laklng luU le.pons~1Ily fOllle IIjlpralsal aM 1'- appralsi leport, ADDII.II D' PIIOPEIITY APPIlAIIED: III lTlLOIV Ool;~CIIES IUl, J. IUPEIlVI.DIlY PIlAt.EIl (onl, II requlredl: MAY 31. 1998 SIgnaIUIt: . k<l ~jJ Name: nUSS~LI. L, 1I0SLEl\ Oat, Slgr~d: AUGUST 7. 1990 Sial, C'III~~kln 1/: oL.000970'1. __._ 01 SI~ll~'nse 1/: N/^ 51alt: . PA _. Eljlu~ion Oi, 01 Ce,lI~atlun OIlk:ense: In] 0i,1 [: J Oklflol "'IIOCI PIOllOlty NQILt1~A/ . .Maa,Felm4398'03 '. Page 2 of 2 flmlt M. Felm 10048 8-03 ~P~';~l,-' :,_:,p, ,.I l cq,ttlj~'h \iI;~ I, < .hJ~Olm AC~,;,,'lOl^\2lXX!lor WnklWI' ~lpral5allOftwlIl ~11~~::~,- Hll~AlAMODE ~J:~l~ l'lll..lf"...,t'... "" ',;' -'.;.'" ,".41'1;'.)-; 1 _:.!'-~~t~~-:{L\;IA~~i~ ! ."'1 ' . . . ;';\~r~1t0;,t'; ; ',I . ~ , Oft " <r! G i' , ,: I. 't . . . " ......n. or 1IA..n V.LU.1 l11IllIOll JIIobm~ JIIIc. wtich . JIIlljlIIly iOOuk! blR,j n . tCllllplllM end epan IMliIl undIf II l.'GldbII .... kl . III ... .. bujIf end '*, IICh _ JllUIIdf. kmwlldgem~ end IlUUmR,j It. plitt Is nll lIIeded by INIlM atkmU, .. n .. ...., II .. ___ ~ . .. . ~ . II*IIId dlIIend It1e paIilQ oflltlllom .. to blljll undIf tondll:N1a wtny: (I) bll'jlf end '* n ~ 1lIIIlII1Ied; 121 belh ,.... n weI WoImed III welldvIsod, II>l u:h IIC1Ilg n whal hi toneklot. Nt own bat l'MIl; (3) . ..--.. IhIII iklwId IaI .... n .. epan 1MliIl: (4) JlIl'I11Il1l ~ mlile n Iotm. of to,h it U,S, IMM. Of n 111m. of filn:1II 111'- toI1lfIIIlblIlhoItIo: end (5) tho pilei ..... .. IIllf11III tonekIotlltln lllI !he JIIlljlIIly IllkI ul1llltcted by 'JllCIat 01 Clyt<e liln:lrQ Of ... centtlllnnl' ,_ by qoIW 1IIOC'*l will ...., 'A~ to !he tompllmill mull b. mlilo tol 'IJltIal 01 Clealt;. linaneR,j Of .... tooCII.Ilns, No "ullrntrb .a I1IttIUY lllI lt1eII toItI wtich II' oolm.... pIkl by...... u . "sui of IH"lIl1n 01 law n . mllkel 1111; IhIiI t.... .. ,'''' kIorftIabll em !he .. pay. 1'- coil. n v.lu.... II ... Ilwaclillns, SIJltIal UI tlaalt<e liloIltR,j "dllmlrU tl/\ be m to !he tompIIabII JIIOjIIlly by tomplllsons to lilolltR,j 111m. oII11ed by . Ihlrd pMy I15Ilulillllli ~..- lhII ~ not aIll11tt kMlIIed n !he pllljlIIly III bll1lltllm, AIT1 "u,'merl iOOukl 001 ba talculat.d on . mec:lwlIcol 00Iar 10f oolar tosl ~ Iho liln:R,j III cllflttIIlon but Iho IMM wnourl ~ IlI11 "uslmerl IIIluk! lIflllIulirnal. lho mllk.t'. "aclilln 10 the lInnR,j III tont~ blled 00 Iho 1jlJlI....ludll.m.nl. STATEMENT OF lIMITINO CONDITIONS AND APPRAISER'. CERTIFICATION CONTtNGlNT AND LIMITING CONDITIONS: T1~ lIjlplalsll" c'llIlcalilln Ihal '''''eM! it lho IIjIplalsal leport Is subjecl to !he lotlwktg COI1lIIlnI: 1. l11IljlJlI" wi oot b. IlSjIllI1Ill~ tol maltll' of . IogaI nalUI. Ihal aIlecl ell~I lho plOjlOrty bokJg wabod 01 Iho tltIto., l11IlIPJlI" _ thII tho .. II good end mllbllble IIKl. thollllllf., wi oot lelklll IlI11 opmn. aboullho 1I1e, Tho prOjlOrty Is lIPJlIlIsod 00 Iho bills ~ . btktg IlII<llIIIIIpIlI1IIIII o~, 2. l11I 1jlJlI" his plOl'lled . sblch it tho Wallll leport 10 slllw IPPlolirnale d1menskJns of lho mplO\'tlmerl. lII1d Iho sbtch Is k1I:klded onIi to ... Iho IIIIlII ~ Iho lIpIld 11 vlsualzR,jtho prlljlllly end ulkllli1Mdfv,J IIlIl appraisal" dolelmlnallln of 15 lb., 3, l11IljlJlIiIIf hIIlXIItIk10d tho avllabll Illod mlljls lhallI. plovldod by 1I~ fedolal Emelgeney Mwgomerl AlJOI1Cy (Ill oIhol dallIOOICII) end hII ootid 111ho 1jlJlI'" II(lOIl wI1IlIhof It1e .ubjecl I.' Is kJcliod n an Idonlllod Special fillorl iiI/aid Ale.. Because tho appraisal Is oot . IUIVlYOl. IlIl Of Iha maMa III gu...... .....1lI knplld, ,./fno lhls dotoImlnalkJn, 4, l11IW" wi oot Vie taslirnlln'I Of lIpprI. it toud becaull IlIl 01 sho made an IIjIplalsal of tho prOjlOrty it QUO$Iilll\ url... IJllClIe IIli1V'/1111D to 00 10 11M btIn m bafoIehlII1d, 5, l11I 1jlJlI" his eslInaltd tho valut of the Iinl it lho cosl II'ploach aI ls IJioI~11 lnl besl UII 1M !he mprOVl/1lllrla II IhK torlrllulory v...., Tholl ..... vall~ ~ the land end ktlplO'llmed' musl 001 b. used In conjunelilln wlh IlI11 nihil apprllsol IIld .. kwlil r thoy III 10 UIId, e, l11I..... ha noIod n the IflIlllIsaI "port .., 11I<.,11 eondlillns (,uch IS, IIlOdod lepai., depIocilllln, the pr_. of hazllibls w..... Ie* aub*ItII, lit,) obsmd 001R,j lho Inspotlilln of It1e lubjltl ploperty or I"" IlIl UI sllll becl/11O aWII' of oo'R,jtho IlOfmli '....th kMlIIed it IJIIIom*v .. lipJlIIIsIi, !WIll oIhoIwleo Illiod it Iho appralsol "potl, lho appralsa, has 00 kmwledgo of any filiIn Of Ul\lljlpllerl tordlonl of Iho prlljlllly III .. I/1IIktlrvnarIIi tordllns (lnckHlng tho p,ellne. of hazlldous WIlSIII, 10Jdc: subslancll, .Ie,) IhaI wouk! meb Iho property mor. III .... valuallll, end ha .umed lhII IhIlI III 00 .uth condillonl end make. 00 OUIl....... 0' WIlI....IeS, e"P"" 01 mpiod, l'llIIdilg Iho tordiln ~ Iho PfOllIdy, l11I IjlJlIiIIf wi 11II be lesponsI>le 101 IlI11 luch eoMlillns lhaI 00 eids' 01 101 any ena1noolR,j 01 101lR,j lhaI m~ be requDd to lIIcO'III wI1IlIhof IIICh tondll:N1a .~, Beclllll the appralsol Is 001 an alllld In t1~ 11e~ of envuOMlerlal hail/dB, lho apPlallll IlpIld must oot be COI1IilIIId . III 1IIRomIanl1i....1I1IInI ~ tho Ploporty, 7, l11IW" oblslnld lho Irtolmlllnl\ 8$llmallS, lnl upmns Ihal WII. e"Plossed In t1~ II'Plelsal "pod 110m IOUICII lhII ho Of II1Il cDI1Ildn lo be *lIend btleve& them 10 b. hue and tOllecl. Tho 'PPlaIsoI doe. 001 ..sum. "spons~lIy 101 tho aceullIt'f ofauch 10m. thII WOIIlllIniIhod by olhef ,...., e, l11I Walsal wi 001 lIstllll IIlIl corl.nll of lho IPPlaI.aI !l11U11 exc'fll .. fllovklod tOI In t1~ Uniform SIanda/ds of PlofllSillnal Appl'" PtEllc., Il, l11I 1ppI" has bssed hll Of hll IPPlalsol lopoll and valolllln conelll.lln lor an II'lualsol Ihal II ,ubJetI 10 .llll1aclory tomplatill~ 11pIi., 01 .~ on Iho _~ Ihll tumplolilln oflllll mpruv.m.rI. W. b. podolm.d In . wUlkmanllkl mannel, to. lh8 1J111tal$1l1 nllllll IllUyklft hhl Of hnl Illltl WI.llm (,u/I!'Iel. lll!lutll 111ft MlI~\t!rf\:hll'. hllflL:dintJ H\ 1I11 af11llalsal 11I1I()It can tlisllU,ule II. 8pfIlalsal lepolt (lnckHlng eonelJ.llns aIJoul 1I~ prU"Olly vlliuo, t1~ II'fIIwr'. "lolMIy 1lI>>1 plOlmllnal do,lgnaIllno, and loI.lenee. 10 .., protlllilnol IpplIiIIi llIgIIValklne 01 tho lim wlh with t1~ ap",aIsoI II ISsoclal.d) 10 anyone ulh" Ihan t1~ bUllowel; lho mortgagoo 01 II .ucmsol, and 1S11gnI; tho morlllllJll l1Iurlf: tonoulllU; pr~'"lnnal lIPJlI"'oI ollll/lllalllns; any .laI. or IIIlelllll1 .""lOved Ilnanclal Inotlutlnn; 01 111'/ dopll1merl. IglIney, 01 nuul11llUly ~ It1e Urjed Stain Of .., IlaI. or IIlIl DIsIIIcI of Collmbla; excolM IhaI t1~ lendel/Cierl may dlillllul. lho prOpolly dooclilllnn SOtlilln of the lapod o~ to daI. toIIcttln Of IIpIlIIR,j lOI\'k:a(s) wlllllll havR,j 10 oblaln t1~ ."PlallOl" IIIVI wl~.n consenl, T1~ II'Plalsol" Wilton tonsorl lnl appruvli mull IiIO be oblDd bolo" t1~ IIjIpralsal can bo tonveyed by anyone 10 t1~ puhlk: lIuuuQh IlItveltil~, pubic "Willns, new., saIo., 01 olhIll milia, flerUe Mac Form 410 0 03 1'~JllI 011 Fanllln Mill Form 10040 e.93 III1I1AN Al'l'lIAISAll,llIVICl 517111 u:m 0,1,11 111111I ACII- '101Al11ulO hll W"klw,' ~111I,li',11 ,"I1.M.I,V .1.'"11,,101, kv ,-- Ill{ul AI AMIIIlI' .' . LAND APPRAISAL REPORT . IonoWII IIERMl\to/, SUSAN ______ _,... CenmTIICI.il7 ,0 I'rel*tY MhA 113 YEU,OW BREt:<:lIf.5 Rll _______..___. ctt CARLISLE COUI~ SJ,IMll!1!!AIjJ1__ Glale l'..L- 1" Code 0 3 lIgeIDeIcf\6ln BOOK/ PAGf, 03)/1188 .____,__ _._ ,. "1'Ib1 N/A DaleotSlltl N/A loan Telm lYt'_ yll, Plollelty RijD Appuaed [:;;j Fte AduIIRNlE..T_1 ~07 !III loancharoeslobellaldby..n." _lYL-_OII.'uIesconcessklns N/^ lIndIf/CIeIt SUSAN ItERMAN Ad..m 111 nu.OW PREECllf.5 110" CARLlSU;, I'^ 17013 Occ~ VACANT AfIIlIelsef Ilolla[!!JLSI.'!!.______ Ill!illOCI~nsloAIIP,aIsol lVAl.\!MlQ1'I Ulball . Suburbarl RIII~ I I Ove115'4 . J 25'4 lu 15'4 11I11l~1 25\ [] fuly Dev, r I Rapij 'J SI..,~ I Slow [~ ]lnCleaslnO 1 1 Slab~ I OedllllnQ I I SOOrlillJO t. J In 8~ar<e 1 Ove""pp~ [I Undel3 Mos, VJ 4-8 Mus, I I OvelB Mos, -i9.'41 fam'" _'42.4famlli _UIIls _'4Col1llo__'4CommelCl~ _'4lllluslllal-.!!.Q\Vacanl '4 ___ Chqekli'le5lrHaMU5I r;J Notlle~ -tllll.e~ (') I I Tal.InQPlJca (') (')ffom _.~_ To__ PreOOmInd Occupancy I') Ownel ---rJ Tenanl _J!L'4 Vacanl SiVeFII11lyi'llceRllI1Qll , 100 10' ~50 Pletlomln.~jValue' 190 SiVe FII11Iy AOS ---!!. V", lu --1I. V", Pledomlnant All' 5 yll, Good Avg, fll Poor LI (,(J [Ill [I ;"J IJE-I IJ J ] ] IJ -~ I] [] IJ J 0 [] [8J [J 0 0000 B~BB B~8B 0000 LocallJn BulUp Grov.1hRalI PropeIly Values Oemn\I&Jpp~ MaketklgThle Pr......lMl U5I Empklyrnanlsta/J1Iy CollYenl1nce 10 Empioyrnenl Convenlenca 10 6\JlpjlWJ COllYenlence to StOOels AdatlUacy of Pubic Tllnportallon Recfeallonal facllles Adequacy of Utillel PIOpa'ty eorn".a>1Iy Ploledlon ',orn Oetrmenlal Concllons Pub aM fie P,olectlon Genelal Appalllml 01 i'lopertlel Appeal 10 Mmt Cornrnenls itcloding 10051 laclnll, lavolab~ 01 unlavolab~, al1ecllnO marketabHiIy (e,D- public parks, 6Choob, v~w, mise): TIlE SUB E IS I.OC^TEO IN YPICAL SUBURBAN AIlFA WITII VARYING STYLE ^NIJ AGE 1I0Mf.5 ON 1.0TS AI'I'1l0XIMATELY I TO 2 ACRES LOCATED IN OICKINSO TWSP, W EASY ACCESS TO ALL AMENITIES, TItE NEIGIIBOIlIIOOO SIIOULD olHIl AVEIlAGE MAIlKE ABILITY, TitER IS STEAOY OE/otAND FOR LANO FOR NEW CONSTRUCTION AND TIlE IlEMANIJ FOR 1I0MF51N TilE I SOK TO 250K I!ANGE IS BEING FILLED MOSTLY WITIl NEW CONSTRUSTION Dnensklns ~91,67X 157,44 X241,07XARC g ~00B3 Sq,A.o,Acres CorMiLol lcxq classllclikln RESIDENTIAL Pre5lnllmplovernanls ['j do 0 do 001 conlolm to lcxq I~ HlPst Ir1d ba.1 U51 -[~ Plt5lnl 051 J ,QLIJe! (~Iy) Pubic 0100 (Descllbe) OFF SITE IMPROVEMENTS Topo -"EVEI. [XJ SlIeftI Acces. Ix] Pulllic L:J Pllvale Size AVERAGE o Surtace MACADAM Shapa !!UlEGUIAR [) TO DE WELL Malnlenance 1.1 Public r.;] Pllvale VIew AVERAGE o TO BE SEPTIC IJ Slolm Sewel [] CUIb/GulIer DlaJnaoa AilE UATE lSl Undelground Elect & Tel. [:J SIde~!Ii__,_O .~lIeelllJll' . Is Iha ploparty Ioceled In I HUD Idantnled Speclsl Flood Huud Allll NoOV, Comment. ~1V1lII~' Ilf unl"v,,"~' Including '"V'pp"ent Id,er" ...em.nll, encroachment', 01 olh" Id,m, COOOlUonl}: No a a",n' adverse or IInravorable ellement' or encroachment' noted. The undenlgned his ,ected Ihretl,ecenl.aIes of plOpart'es mo.1 .IrnHar aM ploldmale In .ullleel aM has consldeltd 111851 In lite market iIIWIsls, TIte descl~ itclodes_ ckU "UItrnenl reIIectIng mllket leactlon 10 loose lems of .~nlkanl varlallon belween lite .ubleel SlId comparabla plopalllas, " s.lgnIIcanllem kl8te comflllallle projIeIty II SOf*Io! -. or more 'evorolllall1lll8te .ubject plOpaily, a mlnos (,) ~uslm.rI b made IIws IIduclnO lite ildkaled value of .ubjecl; I a slgnllcanllem kl lite comflllallle Ie i'Ietb Ie or leu lawrlbll 111III the aubject p1npaily,_ pills (+) ~u.lm~ b made IIws IocleaslnQ II,. i1dicaled value 01 II,. subject ITEM SUBJECT PROPERlY COMPARABLE NO.1 COMPARABlE NO 2 COMPAlIAILE NO, I A~... 113 YELLOW BIlEECIIESIlO, lOT 3B SANIlY BOTTOM Illl, LOT 50TltRUSIt OR, !.DT 17 ROCKWELLfARN5 CARLISLE CARLlStE CAIlUstE CARLISLE BU oun 0, o u ,25 MII.E I MII.E 3 MILES I I . . . . I · , A"lIAln,,'. O'''''''OA''OII ThI Aj1pI.... certlilsll'd lIQIaeslhll: 1. 111M_chid.. subject m.1eI MU MId 11M .Ied a mklinum of line lec.nI Illes of p10petltes Il10II HnIiI MId poidmllllO .. sobject p1- lor caneIdslsllon ., .. ... compMlsen .. MId 11M midi . illla/ ..,uslmenl when IppfIll'fID 10 lelIect .. tnllket IIdon to ltuM IIemI of ~ ~nIon. . allgnllclri hm kl a CempIIlble p1Dj11/tj Is .opetklllo, 01 mOlltal'll/lble 1hMl. lhe subiKt pluperty. I hM ma a neg6I ~ to ItcU:I .. I4U*I ... plica of the compIfallle ri I a ~n I.m kl I complllIhle p10petty Ie H'lklIln, 01 1m tlYlllallle u... the subjld p1_, I hM tnIIIs a poeIM Idjul1mllt to "r_the Idjusled'" pice of the compll/able, 2, I hM ..., Ho consldllllill1the tltlll/I IhII 11M III mpltl on ~aJu. kl my deVtlkJpmenl of the Islmall of m.ket ~alut ., the lfl1IlI-.ell!pIlrt, I 11M not ~ wIti1Ild "'i slgnllc.... HolmalkJn hom Ihe epprlisal 111'l11 and I bsllevl, to the b"t of my knowledge, thal II e111ernn. MId HIlImatton kl Ihe IIlPfIUlIlplllt n true II'd COllect 3, IIt*l klthe ~r-.el1lpOl1 0Itt my own penooaI, unbiased, II'd plofesskJnaI anaIvsle, Opk1kllll, II'd ConcklWIlI, wNth .1 subiKl 0Itt to Ihe c~ MId ImIkv condIklnIlplClled ., thle 101m, 4, I hili no pIIMIi 01 prospectlit Harllt kl the p1Dj11/tj Ihllle II. subjecllo Ihls "port. end I 11M no pr...... 01 ",0II*IIiI peIIOIIi HIlIIl 01 bile will 11II*I to the pd:1pllI'I1 ., lhe IlnltlXln, I lid no! b..., elher pl/tlelly or completatj, my wttsls W'<\'OI the ee1male 01 m..... ~.. ., the 1IlPf" IIplIl on .. ra, tokH. IIIgiln. au. hnlcep, IJII\Ial eIalul. or nalkJna1 Ollgln of .Ihet lhe p10SlllCltie OWI1III DI occopm 01 the subjld pDjll/tj Of of the flItIIl'I 0W11III 01 occupm of Ihe p1opert1u" lhe v1c1nly 01 the lubjecl plOpelty, &, 111M no pIIMIi 01 corlemplaled tuturl ihrest klthe subjecl plOpolty, andl1llhar my cun.nI or tulo" employmerll1Of my toI1IpIIlWlIton tol pertolnq ItiI "",.. II ~ on the 1llPf-.ed~" of the p1Dj11/tj, &, I w. notlsquked 10 I!pIlrt I p1ede1armi1ed ~1kJe 01 rIIeclkJn il ~aJue IhII1av011 the CIllII of the cieri or "'i lelated pM1y, .. llI110IInI of the ~.... --, .. ....... of I IjIICIk: 1IItII. 01 the occunem 01 I subsequerl war/In ordel 10 lece~. my comparAiln 1IlIl'0I empq.merI fllf pertorrnkIg the "",.., I lid not NM" ......rlplll on arequeeled milinum vlktalkJn. a'plCllc ~alullllon. 01 the I1IlId 10 1ppf0Vtl'1jlIC1Ic rnoI\gIgIlollII, 7. I peIlonMd lhIa Ippf" kl cormrmly will lhe UnIolm S1W1dll1ds 01 Proflsslonal Applelsal PrIl:ti:I IhII WIll DlIlled MId plonwIg8I by .. Aw" ..... IOIfd of ThI AppIeIIII foundllim MId thal WII. kl plac. .. 01 the effecl~. dale oflhillppfilll. YIIh the __ of .. deplI1ln pIOViIIon of ... ...... wNth doll not eWi, Iltknowtedga thallWllllinal. 01. "lISOnable 1m. tOf 'lpOIU" ., the IlpIlII mDllle a toI1lIlon"" clIlktIon of mDI~" MId .. ... I dMklped Is conslsterI wlh the m.....1ng 1m. oot.d In lhe nekjlbotlllOd sectkm 01 lhIa report. urlla I hIVI olI'nIeI IbIed ., .. NCOlI'''1IlI1Itllon. I, I hili pII1OI1IItj PjJethd the ihrlor MId uterlor .... oIlhe lubjecl Ploperly andlhe .dlllol 01 II p1opert1ea bled .. tempIIebln ., the "",.. II(lOfI. I we. CIIlIy thIIl hIVI nolId "'i eppwerI ur known m.. condlllons illhe subjecl mplOVtll11lnll, en the IUbjecI .... Of en "'i ... wIhilthe .,.... _ of .. IlIbject propII1y 01 wNch In awn lI1d 11M midi 1dIu&lmenll tOf lhe.. m.. clIIdIonI kl my .. of .. propII1y va 10 the IIIIIIt thII I hIllllllllri MImr to IUfIlIOIlthem. 111M.. cOI11II1IIUd Ibool the ""ecl of lhe Iltier.. cordlolll on \he mlllblabll1 of the IlIbject propII1y, t, I pnonltt pnpnd II concWlnl MId epk*lnI ebool the 1Ia1 eslall IhII WIll III 10M ., \he 1flIIlIIuI1!pIlrt. . I reIed en IlgnIIcIri ..' . .11I IIIIiIIlI1CIInlm "'1 nt/kkIII 01 idvklIeIs ., \he parlormlllC' oIlhe eppralsal 01 the plapl/lIIIon of lhe eppr-.al report. I hIVI nned euch ~.) MId dIedoIIId .. I\*IlC \lib petfooned by them ., .. lItonclllllon secllon of IhIs eppralsalllplllt, I cetlly IhII "'i nt/kklll1O nned II queIIId to .....,. ......, I hIVI not ilIAIIlItled rff/OIlIlo make I ~hnJe 10 II11lern In the llpoll; IheIlIOl', I 111 unautOOtlzld chII1ge II midi 10 the ""'''1IpIIfl. I wi" no I1IPOf1IIlIIYfllf I, 'U"""IO'" A"IIAIII"" CI""I'IOA"ONI "I supelVlsory IjIprallll signed !he IllPfIlsel /IfIllrl, he 01 Ihe tdleI MId ... thII: I cktIt IUpIIYM the eppr"r who prepaid the Ippfalsalllpllil, have levlew.d II. epplalsalrlplllt IIQIII YIIh the eIalemItU MId concWlnl of \he "",... ..to be bound by \he epp!alsIf'l cll1IIcllllone IIImbelld 41hiough 1 abOVI, II'd 111I taking Iull1lpondJly lor the Ippfalsal MId the "",elllllIpIlIt, ADD"'I' O' '''OPI''" A""AIIIDI .ll1.Y!i1J,OW UREECIIES UIl, A"IIA..''', 691M: ~~ €" ~.J7 Nnt: ~~~::;I Oels69led: ^"IUI17, 1998 6tallICertllcllllon ,: Of6tallllanee': RS,170141.l 6tallI: PI. hpi6ln 0... of Cartll:lllkm urllclllll: 5,31.98 IUPI"V"O~~P"AIII" (D~!r II requlred)1 .._--~= ~:~II~U~ ~t~~~:./!I ./ ;c;:j~ _.......__ DaI. Sigrlld: AUOUXT 7. 1996 Sial. Celllicallon': 111..000970,1. .___ OISlaI.llc.IlI.': S1a1e: ~A tJpielkJn Oal. ot Ceotlicallon OIllclflllll: nO.97 11 O~t r;1 Ok! 'lot Inspecl PlOpelty Irlllle Mill 'ulrn tlO 6 63 l'iI\JII1011 ElII1nIe Mill EOIm 10048 6.P3 IUlln ACI\... 'tmAI1lKK) 1"1 WMlw,' "I'llIid\~ ,ullw~. hy a I.t 1Il0>1tl. kM: - ll1OO.A1AMOIIE ill ~wil ~ II I~ ~ WI WI 191 lJ !1 ill ~ 51 I J , I I I I , I I I , , I I I I , I I ! , I I ! I I ' i ~ I , I ! ; I ' I ~~ I I ill, !IIl .., " ~~ II i! Ie ~ I~ ~ ,e ~ ~ ~ ~ ~; !ll~ j ~~i I~~ ,:a ~ '~ i' ~ : ! ~ ~ ;; ! I I!w ,I ~ · ~ ~ ~ ~ S Z !=~l" S IS ' I' , ~ ~ 'I:~! :f [e! ~ ~ l f ~ ~ ~ ~ , 115t1 - C t; R ~ ~ ... Ij ! ~ I I ,I ~ 10 . ~ ~ ~ '. - - - ~ 17 'I": Ill: f f Ii ~ i f ~ ~ l~~~!: I I ~ ~ ;"I~~ 13 ~ ,: F-I'~ f; 1L"\.l ~, , I r'" I . f I I ~ I;" u.. Cl I _...~ V" -Q - gl.oO ,..kD "'1/'1 'Q"~ ~ a g ~ a:" ~ I ~,~~ 8' ~ ~ '" i ill g i : ~e ill ~i ~, .1.~1 ~o 11 ~o . iV" ~ :: .. ' ~;: I \ Jsb\9 J; ., ~ .. ~ ~"' _ ~ ~ 1il' I s ~ .~1~r'~~~.::: I:' .1;: ,I;:~l~ ~~Ul 1;:1H~~ .:!: I e ..., I c; .... ,...I JE~ IS'" M ~ .. .... M~.... ~M .... .. SM ~ i ~ ~ ~~JHFl~"'~e ~~~ ~ '-~8(G1 -~~ ~81-~81 ~ -~sl-~~I ~:< ~B j'"t: ~ ::.; gai' ~~ ~' l!lil ~' ~al, 13_ \!l . ~~ ~~ 8~ 3..:. ~~ ~! I ~~I i ii ~~, ~~ ~~ ~~ ~ I ~~ ~- ~i f! ~~ ~ I :~ ~! ~i ~~ ~t i~ I ~:: I * I i; I 8 81 ~ ~ I ~ I ~ I tit ! a I a I I I I I I , i I ! ~, ; i i I ! ' I , I I I I I r EO 'd . , I ! , 1 I I ISOEI8G~06 'ON X~~ I I I : \ I ' ! : ' : , ' \ ONI DNION31 301S3noH ~d SG:60 OHl L6-91-N~r I ' 1 NEW CUMBERLAND .'EDERA" CREmT UNION P,O, BOX 6~8 . NEW CUMIlERLAND. I'A 17070 (717) 774.7706 . 1 (800) 716.2328 PAY OFF THOSE CHRISTHAS HARGES WITH LOAN PLAN 10- 10-10 . tlOOO AT lOX APR OVER NEXT 10 HONTHS. CALL 717 774 4633 FOR DETAILS. GAR V J HERMAN SUSAN HERMAN III E. YELLOW BREECHES ROAD CARLISLE PA 17013 Joint Own.rs SUSAN HERHAN ACCOUNT NUMBIII 041281 SOCIAL IICUIIITY ft 191-46-3426 STATEMINT '111100 From To 1201 PREVIOUS BALANCE Sl-PRIHARV SHARES 12138 6 1213 PAVROLL DEDUCTION 022 12388 6 DAO-CL CHARLESTO/FED SALAR PAVROLL DEDUCTION 022 12638 6 DAO-CL CHARLESTO/FED SALAR 1231 DIVIDEND 12672 0 ANNUAL PERCENTAGE RATEI 3.25 ANNUAL PERCENTAGE VIELDI 3.30 1231 NEW BALANCE DIVIDEND IS CALCULATED 12672 0 USING A DAILV BALANCE HETHOD. TOTAL DIVIDEND VEAR.TO,DATE 322.12 _ TOTAL FINANCE CHARGE VEAR.TOOATE 'or .11 NY'''' ..clp' IRA IIvln,.. I for IlIlotn.. DlvldtndllhoWl\,lf over '10, will bt 'lPor11d 10 Ih. Intlrnal 1I..,nu,S,..I.. '0' lhl. NOTICEI 511""/11 lidl for Impo,tlnllnformIUon, calendar VII'. 'INDICATEI EFFECTIVE DATE 0.00 ,'""" -. '" loIj ~ g ... t1 lU Lt ~ ... ~ .,' 1II ;:, '.' .o~oo4 00. lIO Cl "'~O'l~ c!. .004 ~ '" OOJ.... "'.. 0 r- 004lU CO I .L~ '" ... ....0 m UI -I'" , ... ... a: lU o 0,.. lIO 00 "'~mmm "'''''''004''' OONCII...... 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" .. .. .. ~ ... ...004...... .........N~ '" "':'" l4. - ""''''411 ..411411_ 411 411 .. ,':) u. w 0 ::I Z 0 ... 0 ... ~ z ... u '" u - ffi VI .J! Q. 0- l!s~a: .0 ~ .. oo)~ . ,~ a: l4. ...c ..."''''...''' "'~~"'II\ .o"'COOOo :Qlil~'S S .u O-llll 004 ...... ...oo4......lI/ Z zo>- ~ u lU lU'" ~~ : dl l4. III 0 ..... ! lU cc ... -l ... ':I ~ :) III a: .I: 0 ~ U ~ VI Z ~_... " ,.\. I o o ... " UI ." <IS I- 0: D. ::I 'ONI- ....01-0 en 0' Q'\ .... I ..... cC ... cr' I D. ......... D 0 'U I I u. ..... N....m t,!) ....~N ,: <u ell ~' @ 1...1 0 ,. .... IU -: ~ IL' () => 1- VI ~ U - U > ;:; .. .... u..l..... It.. .....:~u c: 1- ::'l LU ;~ ., "7 k.. ~ IU ~~. "or U. ..J c..) I-J c.I .u Q.. <I; 100",ooN 0"''''1''4''' O'Nllloo", .. . . . . N"'''''''''' ............... UJ D.U ::I:!: I <IS Oa: ....::1 Cllll D.Z ... 00...10.0 \/1......"'0 ","'00 ...... "'O'NllON 0' 11\ 010 0' "'IOO'NIO .. .. .... .. .........NN oil ...11I...... 'J) oJ :'J ..J ct > 11, "? "J ..J III o<l I- ... C :l:W ..JIIl::l ::ICl.... IIIU4 C > I- 00.0000 OOQ!II\N ..... iiif;!s ...N ...... co I- '" 0\ ... I-"'IJ''''O ... .'. ~~i$~ ............... 000\0\0,.. 11\011\"'''' . .f . . · ..0"'10"'''' ell N'" lDN ooO"'N'" ~ . .. .. . ~","'1"'4 .........411 .I " 71 . ... l- i<. ..) U - '1\ I- ,.. 'l- I) r '.J " 11.>- ,:I U ,>: ...c C"l ..J IJJ %~>- <'. D. -, r_ -4N"''''1O .' ;a ,.. III Q\ 01 ... N '" ... '" "of\ ............... .. , " ,~ . ) ~ ' .J '1 -..,,__. ... ..,...1.......- .-~~,,~.U-........l. 1-...11I1-0 Q),..","'N "'.00\...... .. .. .. .. .. ....,....11\10 lII4II4II...... \i "'.oO\NIO 0"'00"'1- ..... ...ENN'" ob .o"'>Q 11\ 000... .. .. .. .. .. .........NN 411......"1'" >Qr~ 'I) '" r.:l ... ...0-4N a tJ ~ '" 10 ,., .,. ... . '=' ... "'1I\1I\lJ' U'\N a') I'f'\ 1<'\0-40\.... " '" t- o<! ..J .. .. .. .. ..0"''''''' In ..-.""'^~ (~ ;:; " ... ,~ ", t>' -.I ~" >- f" ,P -5 .,. ... '" ,,' ,,) (J'O\IO-t ~ .... <I ;\!\ll~ ~ <u ;j.olll..:l J .. .. .... ~ N M..t In U. """"4'" .,,- tI\ 0 ":) If) rj rJ 'f"l 0 tJ 1- ,.J UJ I,ll ca 'Oo') ,i, !J.. .. '. " 1- I"" 1 '-, .:f :') ,- ,,' ',' " r.. IL <.:l .. D. . ,. " o o o .. ill '1: '" ... I I i ~ ~ "'"\ ,'-"" , ' INSURED GARY J HERMAN 1 512 OZO POLitY NUMIER TAILE OF GUARANTEED CASH, LOAN, AND NON-FORFE1TURE VALUES WHOLE LIFE PAID UP AT 65 SUH INSU~Eo 15,000 AGE Z 2 MALE END OF CASH DR PAID-UP EkTENDEO INSURANCE POLitY YEAR LOAN VALUE 1 NS. VALUE YEARS DAYS q 'I 1 I .00 . 0 0 0 Z ' .00 0 0 0 3 25.05 90 1 332 4 13.60 215 6 186 S 143.15 480 11 ZZ 6 Z05.15 610 14 208 7 Z69.65 855 17 62 .1.>'1 ~ 1,035 19 48 9 Z.70 loUD 20 228 10 4n.00 1,315 21 287 11 '10 543.30 10555 22 253 12 616.55 l,no Z3 147 13 691.TS 1,180 23 349 14 761.90 2,035 24 137 15 847.95 " 2,190 24 252 16 921.80 2,340 24 336 ti 1,011.40 20465 25 28 1,095.70 2,625 2S 61 19 1,111.65 2,760 25 75 ZO 1,269.25 2,895 25 n 160 2,971.60 4,595 21 66 162 J,lI'~OO 4,755 20 352 165 3,521.05 5,000 PAID-UP NON-FORFEITURE FACTOR 1 TO zo 'tEAIlS 66.56105 THERUFTER 60.40690 .. WASHINGTON NATIONAl. INSURANCF. COMPANY -. I'" INSURED GARY J HERMAN 1 .'11 292 POLICY MJ HaER TABLE OF GUARANTEED CASH, LOAN, AND NON-FORFEITURE VALUES WHOLE L I FE SUII INSURED 110,000 AGE 11 HALE END OF CASH OR PA I o-UP EkTENOEO INSURANCE PUL ICY YEAR LOAN VALUE I NS. VALUE YEARS DAYS I . 30.~0 . 130 1 ., 2 112.60 ~50 ~ 232 3 196.90 760 I 123 ~ 213.60 1,070 12 TI 5 372.70 1,170 15 30~ 6 ~6~.'0 1,660 18 217 7 "a.90 1,950 20 250 B 656,20 2,2~0 22 106 9 756.30 2,510 n 18a 10 B59.30 2,790 2~ 161 II ,. 965.10 - 3,050 2' 69 12 1,073.90 3,310 25 270 13 1,185.70 3,560 26 56 H 1,300.60 3,110 26 163 l' 1,"18.60 ",050 26 23.. ---~ 16 1,539.BO ",290 26 27.. . 17. 1,66~.10 ~,520 26 287 " 18" 1,791.~0 ~,T40 26 2TT 19 l,921.7O.i- ~,960 26 21,9 20 2,0''',70 ',110 26 203 860 5,341.60 1,270 18 77 i62 5,660.20 1,,"0 11 110 ;65 6, 11 7.~0 1,670 15 336 NON-FORFEITURE FACTOR 1 TO 20 YEARS 97.59610 THEREAFTER 9".24720 WASHINGTON NATIONAL INSURANCE COMPANY "11"' 1(19201 rAt;! 1111" 1""'\ ,......... '1\ . PENSION APPRAISERS INC. P.O. Box 4396 . Allentown, PA 18105.4396 1.800.447.0084 ' Fax 610.770.9342 January 7, 1997 Barbara Sumple-Sulllvan , Esq, 549 Brldge Street New Cumbarland, Pennsylvania 17070-1931 RE: Pre.ent Value ot Garv J, Herman'. Detlned Pension Benefit FlJe No. 12-96-73-2708B2 Dear Attomey Sumple-Sulllvan: We have determined by the PBGC Actuarial and Mortality Table Method the present value of Gary J, Herman's defined pension benefit of $1,378.62 per month payable at age 60 adjusted for a hypothetloal Social Security pension benefit of $621.12 per month payable at age 62 to be $36,849.57. This calculation was derlved from the following Information and facts: BIRTH DATE: August 8,1954 MARRIAGE DATE: January 10, 1981 VALUATION DATE: December 18, 1996 SEX: Male PENSION PLAN: Civil Service Retirement System DATE EMPLOYMENT STARTED: July 1, 1974 (Assumed date pension holder began participation In the plan) DATE BENEFITS STOPPED ACCRUING: August 31, 1994 (Assumed date pension holder ended participation In the plan) ASSUMED DATE MARRIAGE ENDED: August 31,1994 AGE WHEN BENEFITS COMMENCE: 60 Vears "Valuators of Defined Pension Benefits for Equitable Distribution" f. J . ~ January 7, 1997 Gary J, Herman . File # 12-96. 73.2708B2 Page 5 ESTIMATE OF HVPOTHETICAL MONTHLV SOCIAL SECURITY BENEFIT Step #1: Calculate theTotallndexed Earnings for determining the Hypothetical Social Security Benefits, MAXIMUM EARNINGS COVEREO BY XEAB SOCIAL SECURITY 1955 $4,200,00 1956 $4,200,00 1957 $4,200,00 1956 $4,200,00 1959 $4,600,00 1960 $4,600,00 1961 $4,600,00 1962 $4,600.00 1963 $4,600,00 1964 $4,600.00 1965 $4,600,00 1966 $6,600,00 1967 $6,600,00 1966 $7,600,00 1969 $7,600,00 1970 $7,600.00 1971 $7,600,00 1972 $9,000,00 1973 $10,600,00 1974 $13,200,00 1975 $14,100,00 1976 $16,300,00 1977 $16,600,00 1976 $17,700,00 1979 $22,900,00 1980 $25,900,00 1981 $29,700,00 1982 $32,400,00 1983 $35,700,00 1984 $37,600,00 1986 $39,600,00 1986 $42,000,00 1987 $43,800,00 1988 $45,000,00 1989 $48,000,00 1990 $61,300,00 1991 $53,400,00 1992 $55,500,00 1993 $57,600,00 1994 $60,800,00 1995 $61,200,00 1996 $62,700,00 Tolallndexed Earnlnga ESTIMATED EARNINGS HISTORY $0,00 $0.00 $0,00 $0.00 $0.00 $0,00 $0.00 $0,00 $0,00 $0.00 $0,00 $0,00 $0,00 $0,00 $0.00 $0,00 $0,00 $0,00 $0,00 $4,924,28 $10,520,01 $11.415,33 $12,310,65 $13,205,97 $17,085,69 $19,323,99 $22,159,17 $24,173,64 $26,635,77 $28,202,58 $29,545,56 $31,336,20 $32,679,18 $33,574,50 $~5,S 12,80 $38,274,93 $39,841,74 $41,408,55 $42,975,36 $30,142,00 $0,00 $0,00 1996 FACTOR 7.1948998 8,7245495 6,5226129 8.4656568 6,1604673 5,9278310 5,8123134 5,5351470 5.4026552 5,1905308 5,0987245 4,8100037 4,5562105 4,2632005 4,0302846 3,6397353 3,6560316 3,3297163 3,1336449 2,9578184 2,7521435 2.5744954 2,4269254 2,2502333 2,0692202 1.8962384 1. 7246321 1.6346414 1.5587063 1.4721676 1.4120067 1.3713066 1,2690954 1,2285860 1.1817941 1.1296154 1.0890320 1,0356702 1.0268391 1.0000000 1.0000000 1.0000000 ESTIMATED INDEXED EARNINGS $0,00 $0,00 $0,00 $0,00 $0,00 $0,00 $0.00 $0,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0,00 $0,00 $0.00 $0,00 $0,00 $0,00 $14,565,07 $28,952,58 $29,386,71 $29,901.65 $29,716,51 $35,354,05 $36,681.54 $38,216,42 $39,515.23 $41,517.40 $41,518,93 $41,718,59 $42,971,54 $42,128,58 $41,249.16 $42,323,36 $43,235,95 $43,368,93 $42,885,60 $44,126.78 $30,142,00 $0,00 $0,00 $779,498,56 """I ('. January 7,1997 Gary J. Harman. File #12.96-73.2708B2 Page 6 ' Step #2: Divide the Total Indexed Eamlngs by 35 to determine Average Indexed Vearly Eamlngs, Analysis: $779.498,68 = $22,271,39 35 Years Step #3: Divide Average Indexed Yearly Eamlngs by 12 to determine Average Indexed Monthly Eamlngs. Anaylsis: $22.271.39 = $1,855.95 12 Months Step #4: Determine the Hypothetical Basic Monthly Social Security benefit payable at Full Retirement Age. Formula: (A) Multiply the first $426 of Average Indexed Monthly Eamlng by 90%. (B) Multiply the next $2141 of Average Indexed Monthly Eamlngs by 32%. (0) Multiply any remaining Average Indexed Monthly Eamlngs by 16%. (D) The sum of (A), (B) and (C) Is the Estimated Basic Benefit payable at Full Retirement Age. Analysis: $ 437.00 x 0,90 = $1,418.95 x 0,32 = $ 0,00 x 0,16 = Monthly Benefit $393,30 $454,06 $0.00 $847.36 Step #6: Determine the Hypothetical Basic Monthly Social Benefit payable at age 62. Formula: 0,733 % of the Monthly Benefit Payable at Full Retirement Age. Analysis: 0.733 x $847,36 = $621.12 - - - p .' ... .-;;;:-., !""'\ I \ " ,\ I rJ I I I I' ~ P 0 BOlt 2340 .,Fen Wayne Indiana 46801-2340 February 25, 1997 Susan SHerman RE: 97-5628971 Dear Ms Herman: I'm writing in response to your request to value your account as of August 4, 1994. Due to the nature of your request, It was more time consuming than originally anticipated. We apologize for the delay. The valuation of your account as of August 31, 1994 was 54020.38, I beHeve this all the infonnatlon that was requested, Again I Apologize for the delay and hope It was 1101 to much of an inconvenience for you. If funher assistance is required feel free to contact me at 800-348.1212 xS167. Sincerely. ct~S.~ Johnny S Parrott Client Consultant Lincoln Life cc: 7511 Copeland UnwIn N.Hnlll'II.lh'III~'Ir.lllll' toll 1\.' 11.111111111111I"1"" 111,,,..11',.... : 1040 O""I"'~1 ollhl T,...\"',.I",..,,,I At,,,,,,, a"..lce c{1a5\93 :. U.S. Individual Income TalC Return U~ 'Of Ihl r",.Ian t.Dte 3t. 111),.' 01"" I'. "" ..,tnnlt\l , '"), -^'lftt Llbll u.. Ill. IRI Ilb.l. Oth.tYfII', pl.... p~nI Oll'jp', Pr..ldentlel ElocUon CIIIl Filing 8111uI Chock only ani boa. E.lmpllonl Incoml Alllch Cop, . 01 your F""". W-I, W-IG, IrId 1011-R ...... II you dld not g.t. W-2,... p.go 10. II you II' .lIIchlng . choclc lit maney oldlt, pol" on lap of 'IIY Formo W-2, W-20, lit loge-R, Adjultmlnll 10 Incoml 1 Hm I'" w.. .""...0. 1'101 ..1It., ,lilli, '" Ihl, u",. I II OM' ..... "41.00" You, "''''lnwlII, numilt 191-46-3426 IpouI", 'oc*' '''''rI'f """'"11 GARY J, HERMAN SUSAN S, HERMAN 111 E. YELLOW BREECHES ROAD CARLISLE, fA 17013 00 you w.ntl3lo go 10 IhI. fund? """""" II nt r.turn, dOli ur I au.. wanl 53 to 0 10 this fund? Slngl. X M.nl.d filing Joinlllturn (.v.n " only on. h.d Incom.) M.nl.d filing IOPIl.t. llturn, Entor 'POUII'. SSN .bov. .nd lull namo hor.,. HH tWllh qYIUI,In"'''Of'II. Illht "utili! p.llon I, "hlld but nol '0111 c1.p, ,n't' IhUa', nam. h", ... Ouall n widow If with d. .nd.nt child I.' I DUI. di.d... 18 III Your..1I II 'OUI P.'tnIIOI ,omlon. .In, can claIm WOU.I. dlp.nd.1'lI on hll 01 ''''1'1 IIIIIIn, do not " """'1'" clllcl tlOI I. But be ...,.tn''''U lnl hn.I)I'lIl,.~ nil nnOlql ~ ............t1M. .....:.; ~.~ 1~~~.:~~,I'I'~ .~~~_ hI' I -, I II t',h.,.lt.,t.___. w.._"_" ,.._..,~~_ __.:.-:..-.........,... tit.. '1. "IiU lU -H - n~~ ~UUU'l'.Ut 194-42-9049 For Prlv.., Aclond P.porwork R.cIucUo" Ael NoUe., ... plIO 4, V.. No Not.: Chu.w,........ "HI nol 't1ang. roy, 1'.0' "dun rOUI ,,'und. ,.,.,..,... ........ ,'..j i I.~ B fII0. 0' bo... cllle..d on I. ,.. II, ',_ .' ...,..,........ ...... . ...... .'jh 'l'ft'1 . "'4,n II" "Un WO\Id",.lo dl,o'c.o' up...llonll" p.", 111 O'Plndtnl, on'c nal.nlll.d .lto.. AddnWtllllf, tnl"llIon 11n" alI.'I" -~- :l II I'WDUIChlld dldn', II.,. .lIh roultl.llll clalm.d II "our d.p.ndlntund".pl.-III"lJ'llm.nl.chIU nil. .. 0 . TOIII numbor 01.. Uon. claImod . , , , , , , . , , , . , , , , , , , , , , , .._ _,.... oc,_F"""'IIN-Z ________________________ ------------------------------------------------ . . T......lntor..t Incoma, AlIOCh Sch.dul. B " ovor S400 .T......mpl InlltHt Incoma, DON'T Includ. on IIn. 81 I Dlvld.nd Incomo, Atllch Sch.dul. B " ovor 1-400 10 Taubl. rofund., crodltl, 0/ oItIotI oI.lIt. .nd loclllncoma w... . 11 A1lmony,ocolv.d """.,.."""". 11 Bu.ln.ulncomo 0/ (1001), Alllch Sch.dul. C 0' C-EZ 13 Capitol goIn 0/ (lOll), Alllch Sch.dul. 0 14 Copltollllln dl.~lbu1lono not ropOf1.d on IIn. 13 11 OtnOl goIn. or (IOO'H), Alllch FO/m 47g7 , , , , " . 11 aToIIIlRA dl.~lbu1lon. . . , ~ I b T...bl. .mount 17 . ToIII p.n'lon. .nd .nnulti.. O!!J b Taubl. .mount 11 R.nlll ,..I "111., ,oyol1l.., p.nn.llhlp., S corporotion., ~u.II, ltC, Alllch Sch.dul. E 11 Form Incoma 0/ (lOll), Atllch Sch.dul. F , , , , , , , , , , , , III UnlfTllloymont ellfTll.nution ""."'.."""""."",,, 11 . Socl.1 .ocurlty b.noflll ,. l!!!.l I b T...bl. .mounl " II Otnorlneoma, ________________________________________ Ib ------------------------------------------------ 13 Add th. .mountaln tho for II ht column lor IIn.. 7th.ou h 22, Thl.l. our Iot.ollncom. 14 .Your IRA d.duc1lon ",.., 240 bSpou..'. IRA d.duction ,.",.." Ub .. On.-hllf of 101f-.mployment W. U II SoII-employ.d h..1th In.urone. d.duc~on " 17 K.ogh ro~'om.nt pl.n Ind .oII..mploy.d SEP d.duction 17 a P.nllty on oorly wlthdt.w.1 ofuvlngo ",','," 21 a Alimony p.ld, Rocipl.nt'. SSN. 21 ------------------------------------------------ :10 Add IIn.. 24. throu h 21, Thu. or. au' total Id u.tm.nt. 31 Subtract IIn. 30 from Ilnl 23. Thil II aur ed uI'ld rOil Incom.. 7 .. 84 340. 471. . 10 11 11 13 14 15 lib 17b 11 It ZO lIb 56. 128. 8. IZ 13 85 003. :10 31 85 003. Form 1040 {1VV31 C"OI' tOIO.,,3 CLIENT'S COpy , . -\ -. Form 1040 '1le3 GARY J, " SudAN S. HERMAN a Amount horn Un. 3t(.dju.1Id groa.lncome) "",,"""""""" a a Chock If: 0 You w... 65 01 aid.., 0 BUnd: 0 Spou.. w.. 65 01 older, 0 Blind, 191-46 -3426 P. .2 32 85 003. ------------------------------------------------- Addlln..54throu h59, Th....1I ourlotal . m.nl. """"',.,"""'~ eo II Iln. 60 I. mort than Un. 53, .ubUctlln. 53 ham IIn.l5O, Thi.l.lh. .mounl you OVERPAID ~ 61 Amounlollln.6'youw.nIREFUNDEDTOYOU ."""""""""" ,~ U Amlo'"..lIy...."'IAPPLIED TO YCJUR IBM EaTIMATED TAX ~ 13 II IIn. 53 I. mor'lh.n Iln.l5O, .ub~.cllln. 60 ham Iln. 53, Thl.I. Ih. AMOUNT YOU OWE, FOI d.toU. on how to p.y, Including wh'llo wrlf. on your p.ym.nL ... p.go 29 "",' II Eolimlt.d tax p.n.tty, Al.o Includo on IIno 64 """'," IS Sign Unci., p.nalll.. 01 '.'11.1".1 dt,Ia/I,",tl tl.~. ..."untd Ihll ilium and Iccompllly,ng utl'dul., and l'I'lml"I"."lIlo Ih, b... 01 mr 'nO"itd,. and H b'Il."It\.~ "I"UI, co""t, and compl".. OICia..Uon 01 Pflp''''lalhlllhan 1..p....'ll. blud on IlIlnlormlUonol .hlch PllP'''' hlllll)' knowledge. ere ~ YDUI,lra1uf. Dill You, occup.Hon Kllp, copy,. ILITARY ollhll"turn .pou.... 11"'111'''11' 101111'111,11", BOTH mUll alrl 0... llll your I1C00dl. TIX Cornpu- llUon n you w.nl tho IRS 10 figure your lU, .11 pag. 24, C,.dlll Olher TI..I a:a 14 Plymlntl II Anach For".. W-2, W-2G, .nd 100000R on tho hont eo Rlfund or II Amount IZ You Owe 13 14 PoId Prep...,la U.. Only lCfio..t "'la..~ J4 Add th. nul!'bll 01 bo... chockod .bov. .nd onler th.loial h..o . . , , '. ,~ 33a b It your pallnl (01 .omeono 0111) c.n cl.lm you a. I depondont, chock hero ,~33b 0 o It you '" marrlod filing 'OP"'"1I1y .nd your opoulllllmlZll doduc~on. or you .11 . du.I-.tolu, .1I0n, ... p.go 24 .nd chock h.1I , , , , , , , , , Enl.. Itomlz.d doducUon. ham Schodulo A, IIn. 26, OR th. SlIndald doducllon .hown bolow lor your filing .tolu., BuIll you chockod Iargol lilY bu. on IIn. 33a 01 b, go 10 p.go 24 10 ftnd YOUf .tondard dOducUon, of II you chockod bu. 330, your .tondard deducllon I. 'Of 0, . Slnglo--I3,700 _ Hoad 01 houllhold--IMI5O . M.rrlod filing loInlly 01 Ou.llly1ng wldow(II)--I6,200 o M.rrlod IlIIng IIpar'"ly--13, lOll Sub~.clllno34lramlln.32 , , , , , . , , , , , , , , , , , " , , , , , , , , , , , , , , , 1I11n, UI,III,UOOlltl"muluCl1W lI.nOtly In,lolll"lImb" ol'''/rlPlIon,cIU'"ldon IIn....lllln. 321' 0\'1' '.I,UO....It".o'Uh..lonP...21follh.amounllo."t.' .....'...,....,..,.,. Tulble Incom.. Subtractllnl 38 from IInl 3&. 1111n36i.mol.lhanlnn.I,,11I ~O.I ......,. Tax. Chock II horn alii Tu T.blo, b 0 Tu R.to Schodul.. cD Schodulo D Tu Work.h..., 01 dO Form 1I61~, Amount ham Form(') 6814 ~ 0 Addlllonal tax.., Chock II tram aD FOIm 4970 b 0 Form 4972 Add Un.. 38 ond 39 , . , , , , , , , , , , , , , , , , , , , , , eredit lot child and dependent car. ..p.n.'.. erodillOllho .Idorly OIlho dlllblod, Attach Sch R FOlllgn IU cr.dlt. Attach Form 1116 "',',' OIh.. clldill, Chock If ham. 0 Form 3600 bO FOfm 1396 cO Form 8601 dO Form (.pocilyl 44 Add Un.. 41 through 44 "."",.""""", , . . , , , , , , , ., 45 Sub~'clllno 46 from Iln. 40, It Ilno 46 I. mall th.n IIno 40, on!or -0- """""'" ~ '" Solf-omploymentlU, AlIach Sch.dulo SE, AI.o, ... IIno 25 . , , . , , , , , , . 47 A11l1n.tiuomlnlmumlU,AnachForm62~1 .""",."""",."" '" Roc.plulltaxH,Chockllhom aOForm4265 bOFo'm68l1eOForm8626 "" 4. Soclalo..u,tty and Modlcall tu on Up Incamo nOlllpon.d 10 omployor, An FOfm 4137 eo Tax on quallflod rlllllmont plan., Including IRAt, II roquUod, onach Form 6329 ~I Adulnc. oarn.d Income clldrt p.ymonta ham FOfm W-2 ."",.." U 925. 1.0 763. ,~ 330 o 34 1.6 707. your: :15 :II 37 31 :15 68,296. :II 9 400. 37 58 896. 31 1.1. 688. 31 40 1.1. 688. 31 40 41 42 13 44 4' 42 43 ~ 925. 45 41 47 41 4. eo II U AddU;;;' 4iiii;c.;Qii i27fhii ii-YDur iCi.rtAi --7777:-:-:-:- :-:-- - -- - -,-,-,-, -. -'-'-'.. 13 ""lncomt,...llhh,ld. 1I101l,chtc.... 0 14 11 581. llIlI3 HtlrNlod Iu p.ymonto ond .mounllppUod ham 1992 IIlurn 1.0 763. .. EI,nod Ineorn. cllcIlt Anach Schodul. EIC , , , , , , , , 17 Amount paid whh Form 4861 (o"'on.lon IIqu..l) , , . , . . ... Eac... IOClallocU'tty, Modlc.II, Ind RRT^ IU whhhold b Doronal of .ddltlonal II1l13 tax.., AlIach Form 884t II Othll paymonta, Chock IlIrom aD Form 2439 bO Form 4138 IS II 17 III SIb SI 11. 581. U8. U8. 14 fI'epa,,,'1 172-36-0048 Pltpa",.. ,aclaJ lecU'll, na. ~ 11r-lu" FI,m', nama la'VeNI" 1I,.Ir.,mpIOY'"1 anll 11I111'" GREENAWALT ~ COMPANY, P.C. 400 WEST MAIN STREET MECHANICS BURG PA 23-2405297 liP.... 17055 Schedule A (FOIm 10401 O,,"IMttllo' I"'. T,...""" 'n."natA.,ItlU..",ICt """.",,,,."''',''''" lOCO GARY J. . SUSAN S. HERMAN c.uUonl Do nollnclud. ..p.n... "imbur..d or p.ld by olh"l, MIdIcIJ .nd d.nlll'''IIOnlll ._____________________ M.tIcal 1 and Donlal E.,.n... 2 , 4 1 Tun You 1 Paid 7 1 lnt.,.., II You Pald b NolIl PlrlonaJ int....III not d.duotbl., 10 11 12 0111._ " Charily 14 11 11 C.luaIlv 17 Mo.ln. 11 Job 11 Eapan... and Mo.l ll1har III Mill- .lIanlOu. Doduc1- Ion. 21 a a 24 OtIIor za MIM. 111_' Doduo1lon. TolII . lI.mlNd Doduc1lon. ......., r-. Schedule A--Itemlzed Deductions aUI No. '14'''00'' ~O A'llel'l",.." "'wt"U No. 07 YOl.II 'OC'-IU'\lIII, num..f ~ A11ICh 10 FOIm ,040. ~ S.. In.tructlon. '0' 8ch.dulo A IFo,m 1040 , .-----------------------------------. .------------------------------------ 191-46-3426 1 , ,~ 4 1 3.372. 1 1.787. E~; ~;;;;u~ j,;;F';; ~cMo~;;'; 32- ~ ~ ~ TiT -- - -8-5-.-0-0Y: Muhlply IIn. 2 .b.... by 7,&'4 (,on) Sub~.clllno 3 kom IIn. ,. III... 'h.n '''0 ontl' -0- Slit. .nd locaIlncomo tIllII R..I ..1111 tIllII OIhor tIllII, Ull--lnclud. plllanal plOplrty lilli, ~ _ _ _ _ _ _ _ _ _ __ p~~-----------------------------~~-- 7 A~;H~;._;7h;a~.;;;;-----:--:------------------,~-- " Homo morlQlo.lnll"ll.nd palntl "port.d 10 you on Form 1008 .. Homo morIgIgo Inl""1 nal "port.d 10 you on Form 1008, II paid 10 th. porion kom whom you boughl tho homo, Ihaw th.1 porion'. name, Id.n~no no" .nd .dd,,", ~ .____________________ .-----------------------------------.. 20. ,~ 1 9.920. 5.179. .------------------------------------ . Pain" not 'lport.d 10 you on Form 1008 . , '0 In"",,,,", 1"'''"1 l' Add Hnn.. thtau";ll--:-_:__:__:__:_:-:-:-:-:-:-:-:-:-,-,-.-.-,-.-.-.~-:', ,~ 12 Conlllbullo", bycalh or chICk ____________________. IWlC_._ _~OJtt'JWlJr;t'.xP.mL _ _ _ _ _ _ _ _ ___ _6~.L Add Hnn 10 .nd 20 ' . , . , , . . , , . , ',' , " . , , E",.ramount.om Form 1040, Un. 32 , , , 1221 85 003. Muhlply Un. Z2 .b"". by 2'4 (.02) , ' . Z3 1 7 0 0 . Sublllcllln. 23 kom IIn. 2l. II '''0 or I.... .nlor -0- , ~ 24 Oth". Ulltyp. .nd lIl10unl ~____ ________________________ _ _______ ------------------------------------- " Oth" th.n calh or ChICk, II ..." asoo, you MUST .lIIch Form aaa3 14 Carryovor .om pllor yaat ,.. " " " Add Ilnll 131h/ouoh 1& ealuallv or Iheft 1011(111, Alllch Form 4Il&4 M...lng 'lIl.nall, Alllch FOIm 3003 or 3003F ' , UrVllmbull.d If11l10y.. '''p"--Iob lllvel, union dUll, lob Iduc, .Ie, ~ ,JUVlJUlOj______________________JL~8~__ _____________________________________ lD Oth" 'Ilp.nlll--Ulttypoand .mount~ ________________ :wt ~JW'.AJl.AU.QH..1.MJl_ _ _ _ _ _ _ _ __ _ .":'-0__ ____________________________________. 20 21 9 920. 629. ,~ " ,~ 17 .. ,~1I 629. 2.489. 190. 2.679. 979. --------------------------------------------------- --------------------------------------------------- Illho amount on Form 1040, IIn. :12, mor.th.n "08,4&0 (mo" Ihln 1&4,22& II "..,,11d finno 11p1l.l1ly17 } . NO, Your d.dUC1lan II not Ilmltld, Add IInll 4, 8, 12, '8, 17, 18,24, .nd 2S, , oYEa, Your d.dUC1lon may b.llmilld, SII .10' A-& lor th. .mounllo .n'or, 3H773 Fa, PlpOrworll A.duCllon Acl NoUc., I.. Fo,m 1040 Inltructlon.. CFI1I711/,IIU ~za , ~ II 16.707. 8ch.dulo A (Fo'm '040) '"' .-., I'"' OMI~. 1"1..00,. Pa 2 OU'UC"I"c",lIl, "","_If GARY J. ~ SUSAN S. HERMAN Schedule B-Intere.t and Dividend Income 191-46-3426 Alllohm.nl S.qu.ne. No, 01 'Addlhttmounlaonlln.e ,.",.,..".."" 7 CApilli gain dl'Ulbu1lon., Enlor hor. and on Sch.dul. C', 7 , Non....bl. dIIUlbu1lon., (SII Ih.lnlt fo, Form lQo1O, IIn. g,1 , , Addllnll7and8 ",." , , . , , , , , , , , , . , , . , ' , , , ,. , , , , , , " . 10 Subuacllln. g trom IIn. 8, Enl.. Ih. rllun h... and on Form 1040, IIn. g .".",.. 10 a If you roetlvtel capltallllln dllUlbu1lon. but do not n.teI Sch.dul. C 10 rtporlany olhar Inl Of 101ltl, III Ih.InlUuc1Ionllor Form 1040, IInll 13 and 14, It you had ov.. f400 ollnloralt or dlvld.ndl OR had a fortlgn account Of w..a a Il'anlor of, Of a Uanlfllor la, I for.1 n trUlt, au mUlt c lltl thl, art. l1a AI any time during 11183, did you ha.. an Inlorlll In or a .Ignalurt or Olhll .ulhorlly ov.. a ftnanelaiaccounl In I fortlg" country, luch .1 . bank Iccount, lecurttl.. Iccount, or oth.r IInlnclll account? S,. plU' 8..2 lor tac.ption. and tiling rtqulramonla fo, Form TO F 110-22,1 ",."""",."""""" b It "VII," Inl" Ihl namo ollhl fortlgn country .________________________________. 12 W,," you Ih'll'anlor 01, or Un.foror 10, atorllgn UUII Ihal talll.d during 11183, whtlhor or nol you ha.. an b.nlllclalInlorlllIn It? It "VII," u ma havalo fill Form 3ft20, 3ft20-A, or g211 ' , . , , , , , , , X for Papt.wa.k Raductlon AcI HoU..,... fo.m lQo1O In.tJucUon., c.alll ",' 1,12 6chadullll (fo.m 10401 1M Plrl' Inl.rlll Incom. IS.. pagll 18 andB-q Ho'a: It you racllvtd a Form lm-INT, Form lm-OIC, or lub.lltull ,lIl1monl hom a b.ok..agl tltm, lilt Iha ftrm', name II the PlY" and .nter Ih. lollllntarall shown on thai form, ParI II Dlvld.nd Incom. IS.. pagll 17 and B-1,) Hole: It you ,actlvtd a Form lm-ClVor lubllltUII IlItaman! hom a b,ok..aga ftrm, III ilia fttm', name.. Ihl payor and .n'" ilia total dlvld.ndl .hown on lhatlorm, P.rt III Foreign Accounl' .nd Trult. (S.. a I B-2, Hm 4 Ho't: It ou had ovor 1400 In l&lIabll Inlorlll Income, u mUllal,o C 1111 P.rllll, Inl,,"llncoma UI' nama ol pa",., It any Inl""' II horn .lIlor.ftnanc.d morlgag' and Ihl buy.. u.teI Ih. p.optrty a. a p...onal '1IId.ne., It. pagl B- 1 and 1I.llhI. Inlllll' filii, A110 .how lhal buyar'. ,oclal.oeu.1ly numbor and addrlll ._ _ __ _ _ _ ____ ___. . _C~l'_:J;.,T_l\k .m:MJJLSXS_T_E_I@__CJtPjpj:.1_JOO;.Oli.________. .1tfil'!. _CJOOll:'R.L.1tN!t l'_EP_E.R.It.. _G.ItEP_I_T_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Amount ---------------------------------------------- ---------------------------------------------. ---------------------------------------------- ---------------------------------------------. ---------------------------------------------- .--------------------------------------------- ---------------------------------------------- .--------------------------------------------- .--------------------------------------------- ---------------------------------------------- 2 AddlhttmounlaonUnal ,."""""".,.,.""".,."" 2 3 E.cludablalnlorlll on IIrlll EE U,S, IIvlngl bondllllu.d ahor 1989 from Form 881e, IIn. 14. You MUSTattach Form 8811110 Form 1040 .."""""""",.., 3 4 Subtllellln. 3 trom IIn. 2. Ent.r thl r..utt hi" and on Form HMO, lin. 81 ....,..,.. 4 HOle. II u had ovorl4llO In 011 dlvldlnd' and/o, OIhor dilUlbu1lona on Itock, ou mUll allo com 1.1t Pan III, Olvld.nd Incoma . Lilt nama ot payor, Includ. groll dlvld.nd. and/or OIhor dIIUibu1lon, on Itock hor., Any capilli gain dl,trlbu1lon. and nonl&llabll dl,Ulbu1lonl will b. dlduc1.d on IInll 7 and' . .l'JJUYt~~1tU~Y_S91W________________________. .--------------------------------------------. ---------------------------------------------. ---------------------------------------------- I ---------------------------------------------- -------------------------------------------.-- ---------------------------------------------- ---------------------------------------------- ---------------------------------------------- ..........,. . I 220. 251. 471. 4'1. Amounl 56. 56, 56. v.. Ho X ,.... I"'" Schedule D C.plt.1 a.ln. .nd Lo.... 0'" ..D. '....00,. (Form 1040) ~~93 . Alllch ,A FOIm 1040, . S.. In.~uc1Ion. fOl Sch.dul. 0 (FOIm 1040), DItt"IIII"'l""" .,,,'w,, Alii'"'''''''' '"llfNl""""" '"vlll . U.. Un.. l!O .nd 22 flll 11101' 'P.c. to iii' ~.n..ctlon. fOl Un.. \ .nd g, ....ueftuNo.11 .."".".h.w"., ,.U" ~o_.o S. HERNAN I 'W'DUI'OCIaJ neu'll, """'"' GARY J. . SUSAN 191-46-3426 I PIl1I I short-Term C'DI... O.ln. .nd LOIl8l-,A..... H.ld On. Vllr or L... ~O"II.IIDn.' IblD.lt ItID'I..old ,cI'laln "In l'IC.,loI ",LOll lalaAIN ,'.I,.,llllmPlt: 'I...lr., lIlAO.,;',." t lit. p.,. D-~I 011111""1' 1'11'I,moltlhll\,III. 1I1dlll"'Olll"""II. IOOth,IYICe.1 IMD.....','f_1 'U'Il'.' 0-.)1 ."bh.clla' homltl I"."lellll flDm IIU 1 I Enllr your .hOll-'arm to1al., " .ny, horn U",2' .,...,..,..,...."., . I 3 T.1aI .holl-1I,m "'.. p,lo. amoun'., Add column (dl of Un.. 1 and 2 ....... . 3 4 ShOll-'"m IlIln horn F"'"" 2\ ,g .nd 8262, .nd .hOI1-'"m IlIln 1Il (lOll) hom FlIl/!W 4084, 8711, .nd 1124 .....,.........,. . .' , 4 8 NII.hOll-lIrm galn lIl(IOIII ham p.l1nl..hlp., S corpor.tion., .nd fiduclarl.. hom SchodulO('1 K-l ,......,...... , " , 5 . ShOll-'"m capllalloll carryovll from '992 Sch.dul. 0, IIn. 38 " , , , , , , , . 7 Add Un.. 1, 2, and 4'hrough 8, In column. (f) .nd (g) ... . .... . " , ... , 7 . IMlIhert-larm ~ 0,110111. Combln. Column. (').nd (;1 of Iln. 7 """",'.'" .,., . . I PII1III Lana-T.rm Itll O.ln. Ind Lo....-A..... H.ld Mor. Th.n On. Y..r . PllfANCIAL COJ 08130/93 8. 8. 10 EnIIII ~ur lonu-lIIm tOlai., " .ny, horn 1",113 ..'.....,....,..,.., . 10 11 T....Ion.._ ..... """ amount., Add column (d) al Un.. 9 .nd '0 ...,., . 11 8 11 GaIn hom FDlm 4797: long-'.rm galn from Fa,,,,, 21\9, 2439, .nd 1282: and long-111m galn DI (10111 ham FOI"" 4084, 811" .nd 8B24 ..,. , , , , , ." . 11 13 Nlllong-'"m galn 1Il1101l) ham p.~nll.hlp., S co'por.tion., .nd "duelarl.. tom Schodult(a) K-' " , ....,.." . ... , , , , , 13 14 Capllal galn dlo.lbu1lon. ....".,. . ., , , , , , 14 15 Long-11Im eapllall..1 carryovlI hom 1992 Soh.dul. 0, IIn. 4B " , , , " , 15 11 Add In.. I, 10, and '1 Ihtough 1I,In column. (II and (g) , , " , . , " , 11 .. 17 Net long-101m .MlllllllOln or 110111, Combln. oolumn. (fI .nd (01 allln. 11 ....... . " , .,.,.,. . 17 I. I PII1II1I summlrV 01 P.rt. I .nd II 11 Corrilln. Un.. land '7, II . lOll, go 10 Iln. ,g, II. IlIln, .n,., Ih. IlIln on FDlm 1040, IIn. '3, Nol., II bOlh Un.. '7.nd 11 art galn., ...th. Ich...1a D Tu Work.h.., on p.g. 0-4 ,.......,.. . "...... . 11 8 . 11 Ill", IIl1a (1011), .n'" hll. .nd II a (10111 on Form '040, IIn. '3, th. .mall., at th...lo....: . Th'IIOll) on Un. II: or II (",000) 1Il," /!Wnl.d tiling ''Par.'lly, (",1001 ".,... , ""...""., . .....,.. . 11 ( ) H.l.: e..'h. c.. L... C"'lfonl wo,II,hl,1 on 11"1 O-'lIlhllal' on IInl II Inlld.lh,IDI' on Un' I' 0,11 'DIm IO.O,IIn, 3111 II... H77:1 'ol...,.,...,rlIl1....lIon A.I NoUoa,... form 1040 In,"uoUon., CFIUO 11111/'3 ..h..... D tform 1040) 1113 5 ,..., r- "0" 2441 Child .nd Dependent C.r. Ellpen... . AII8eh.. Porm lIMO. llfoI, N., "'1_ ~~93 AtlKhIMfIl .....""...... ., ,.., ...... ''''''' """"., 191-46-3426 0.....'....1" I~. "M"", Inlll.......'III'llII..,"'. t/MIIII .~Ift Mfl au J, . IUIAN S. H. You IlHd 10 und...land tho I"owlng 111....10 cOIJlllllllhl. lorm: o.,on"'I C.I '-flII,I.""~ 1110_, au.Hfte4I......M., Ind aull'Vlfttl'orlGll('l. 8M IIftlIOI'InI T_. on plgo 1 01 thl Porm 144' I....~, AlIa, H vau had I child born In IIllI3 .nd lno U 01 Form 10olO11 10M lhan tu,OIIO, 'M A ClJan.. To ..... on pago I 01 tha I..auctlon., P"lonl ar Orlllnlutlonl Who Provldld thl CII"-Vou mU'I cOIJlllllllhll Plrt. b [fiffi (I) Call provldll'. nama ABC DAY CAli HARIII lualJ HOSP 81THIL HURIIRY (~I Amount pald 23-0675330 570, 055, 4 6 5. I Add Iha IIIlOUnIIln column (dl at Pnll ."""."."....,.".".,.""""." . ~ Enteflhanumbor oI"'MI">.nt"'HII' CIIacl lor In IIllI3 , , , . , , , , , , , , , , . , , , . , , , , , . . , ,. [i] DId vau IIC.... .......lIIlIl...lIeMlllI' NO VEl . COIJllIIIt onll' Pili II bllOw. . CO/T'fllIII Pili III on PIlI" I now, I pen jll Cr.dlt far Child .nd Dlplnd.nt Clrl Ellpln"l I EnlII lIlIamount oI.'llIft.~ .......M. vau Incurlld Ind paid In IIN, DO NOT _ marllllln 11.400 lor on. q.ng plI.on or t4,11lO for two 01 marl P"'o", U vau cOIJllIIII PII1I11, .nlll thlarnount"ornlnall .......,....",.,...... I .. 4 . EntlrYOUA........... .... i. . . . .... . . . .. . . . . ,. . . H nwrlad ling . )DInt 'lIurn, lIIIor YOUR 8POU8E'S IIInad I.-na (PIludanI 01 dIIablad, 1M 1""uctIonol; II Dlhorl, 111\1I thelrnDUnltrornlMl .. I . , . . , . . . . . . . . . . . , . . . . , .. . 4 625, 54 633. 29 707. ., EntIlllllllllr1nl oil"" I, e, or e , , , , , , , . , . , , . , , , , , , , , , , , , . , . . . , , . . , , , ,. ., us, I EntIlfllll'llOuntlromForm 1040. InUI ".""",..."" I 85 003. . EntIl on lnol th. dlClmallIIlOUnI .hown bllOw thai app"'lO th. .mount on Nnl . ltllM 11.- IlIIlnloI II H"" III- IlNlmal .... not MMIlIlt IIll""I _I Ovor Ivar I. Ovor IVor I. 10- 10,000 ,30 110,000-12,000 ,21 10,000-11,000 ,IV 12,000-14,000 ,13 . x,20 11,000-14.000 ,II 14,000-11,000 .12 14,000-11,000 ,17 18.000-11,000 ,21 11,000- 11,000 ,10 1I,00000No Unit ,10 1I,00000ao,ooo ,25 10 MuIIpIy lno 7 ~ Iha dIClrNlll'llOunl on Pno I, EI1\II thl 'NuIt. ThIn, III Ihl Intvuctionl for th.ameunt 01 0I1Cl11 to "nItr on Form I04O,lno41 """"""""""""""" 10 Caulllftl " vau pald 110 or _. In . cII.ndar quill.. 10 . plI.on who workld In vaur hcmo, vau mutt 11I1 .n ,""Ioymont III ,elurn, OIIP_Ml~~, Hm Por '..rworIIIlIMllon All......, _ ..,.,IIIIn.lluoHonl, 925 FOIm 1441 (1113) 6 cuno 0Ii.'1'13 ~ ,-.., fill! 1t!11l~ tJ, . IVI... I. ..1IIWf lJIwtllJ DIp.....nt Cer. "nt'",~ IllIt pill elII~ N you recllvlel 1IIIt. b.n...., II .nlIr...", ~ of il.ln..... 1ft ...... you rectl.1eI 101 IIt3, ThillII10unt lhoold be .....n In lIDa 10 of YO'" W"IoIm(I), 00 NOT Include _nit that -""'P1lIttd to you II .....In II. , 01 ~0Im(11 w.a " ""',.,"",.""""""""".", Ul.U.uU ...... ,. E,..,....,..".fartMId,lfanv .,.",....",...... ," .,. .. '" . . . ... '" 'I 1...1". la hm In. I I .,""""""'"",.",.""",."""." 14 EnlIr "'101II_11I of ,.IItR'.IlOflIII..llnaUIIIeI In 1113 101"'011' 01... qUllilwt"ll p..ton(ll "',.",'.."""" '4 II EnlIr... ""* 01 UIlI '101 14 , , , , , , , . , . , , , , , , , , , , " II II InlIrVOUR.....,__ .,""'""."""""" II 17 II nwrtId tlIncl. jIInt III",n, _ YOUR lPOU8E'8 ..rnlel 1- (H IIucItnl 01 ......11d, I.. "'. Unl llna~uctlanl), It nwrtId tlIncl. ......... IlIurn, III "'.Inaructl.... 'O/Ih. _la -I .. eIher., .ntIt "'"mount ~am In. II """'" 17 'I InlIr........."oI.n.II, 11,0117 ',.""".".""" II II rllllu.. Mnlll_, IntIt hII."'......... of Ill. ....._Ing: . TIll ~ "'om.... II, 01 } · II,OOO(II,IlIllHlIlIIIlldtlllnglllpll''''IIU1n , , , , , , . , , . . , , , , , , , , , , , - you -. IICI'*1d to .ntIt yout 'PaUII'1 MlIlId InaOlN on .... In 10 T......... IA.., 'ulllrlelllll ""'om In. 13, AlIa, Includ.lhlIlII1Ount on FOIm 1040, .... ,On........, I". IlIIl\ 10 1in17 _rlll'llQI' ,."..,..."""""..",."" To oIIIrn lhIahlld .nd dep.ndlnt 011' O/ldIt, 001\11111I InN .,.alll..., .nd UIlII 4.10 On "'. tant 01 thIIl.,m, " .nlIr.......... qUllllled ........ you !na1ll/1eI.nd pM! In '113, 00 NOT Include on .. w"'W' T flU". bInIIII ahown on n1. ,... . . . . , . . . . , . . . , , . . . , . . . . . . , " It .. 1_81.4lIIl184_HIw0., mar. qlllllf\i"llp.......) , . , , , . , , , " .. a ..........."1111.11I11 1.,'..."............. . a 14 ......11II Uhm In. U, It '''0 ., ...., ITllI', You cannO\ 1IIlI. the o/IdN, lu.,...,., If WOU pIld ,. ..._In '113, III Ill. In. ID lna~uclla", ..,.,."""",.,.""", 14 .. r_ ....... 01.... ., ., 14 hit. Ill. en In. 4cn Ill. Iront 0/ "'II 101m ..,'".""""" It C'"" ","," \ '~m 6251 """' I"'"' Altll'nltlve Minimum Till - Indlvldulll O""t""",.'I"lt"..,,,, lnl"MI ""..... ""III Ham.",. ....... 1tffIl' . A....h 10 Form '040 or Form I04ONR, . OWl H.. '...-0..' ~t@93 .11'1"""1'11 .. tnI. NI. OUf .OC~ IUl,IfllW num ., GARY J. . SUSAN S. HIRMAN 191-46-3426 I PII1 t I AdJu.tmtntl Ind Prt'tr.nct. I "you ltImI.ed dedUClion. on Schill'" A (Form 10401, go 10 IIn. 2, II you did nol hemlll d.duction.. .nt.. yo'" ...ndold deduction ~om Form 1040, Un. :\4, .nd .klp 10 IIn. I """", , . ,'. , , , , , , , , , I M.......ndd.nl&l."".n..."""",..""""""."","""""'" 3 T.... Entll th. amount ~om Bch.dul. A, Un. 1 """"""""""" ","',' 4 CorI&In Intll"1 on . homo mortllllll nol u..d 10 buy, build orlmpro.. your homo ' , , 5 .oIan.ou.llonilld deduction., Enlll tho .mount ~om Bch.dul. A, Un. 24 ,',' ' , , , , , , . Rolund of IIln, En"r .ny "'"lund ~om Form 1040, Iln. 10 or 22 "",." , , ' , , , , . 7 In.ntmonllnlll..l, Enlor dlflll.nc. botwnn "guilt III .nd AMT d.duction ,,'.' , , , , , . , , . POIt.'1lIIl d.oclalon, Enl.. dIflor.nc. botw..n r.gular... .nd AMT doproc:i.tion ' , . , , , , , . , , . Ad/Ultod IJIIn or 10", En..' dIfl...nc. b.tw..n AMT .nd rogullt ... goln or lOll """"".".' , 10 Inc.nII.. .tock oplon., Enl.. ..c... of AMT Incomo 0... rogular ... Incomo "" , , , , , , , , , , . , , , I P.IIiv. activlti., Enl.. dIflor.nc. botw..n AMT .nd rogular ... Income or 101. ' , , . , . . , , , , , , , , , II e._I" oI....t.. .nd ~uIII, Entll tho amount ~om Sch.dul. K.IIForm 1041), IIn. I , , ' , , , . 13 T.....~t1n101..t Irom prlv...acti.1ty bondllllued .nor 1/7/11I """""".",.'"" '4 O\hll, Enlll tho amounl, ".n ,lor Hch 11Im .nd .ntll tho total on IIn. 14, a Chatll&ble oontrlbulonl . Long.tllm con~ac1l " . Clrcula,"" Illfl.ndhuro. h LOll IImI..tion. . Dilplollon .""" I MlnlngeOlIl .,.,.. tI D._Ion (p,,' '11I7) I Pollution con~oI l.cUiU" I lnetollmonllll.. k RnNleh/.""orImontal I InI&/1QIIlII drllIIng COlli I T.. Iholtll 111m .C1IvIti.. m Rllatod .djultmonll " 14 II T.... A ........11 MtI '"IeI_., Comblnllln.. "luau h '4 ""."."""""" 11 I 0 0, l!iiJI] A11lf'ft1l1vt Minimum TI.1b1t Incomt II I_ tho amount from'_ lIMO, line ... III... tI1an '0<0, Int.. .u (10111 """"""", ~ 17 NIl opII.I.._ dldldon, " Iny, from Form '040, Un. 22, Enlll .. . pOlIll.. amount .."",.", II "form '040,11IO 12,10 "".. 1'01,450 I""" 114,225 01 mar,led IIlIng .iIpll....yl, .nlll voul1lllmllld deduelonl Ir!*lon, " .ny, from Un. . of tho worlllhoot lor Bohodul. A. IIn. ze ' , . , , , , , , , , . , , , , II Combine Unoo '''!vaugh II .....",....".",.""""".",.""" ~ to Aller..... III ntIl op...lno 101. deduc1lon .""".""""".".",.,.",.,' I' MlnIlIlum T....... lno_. BubUc1l1n. 20 ~om IIn. '0 """"",""""" IpII1 1111 EXlmptlon Amount Ind Alttrn.llvt Minimum T.. II ........... "-n1. II your'" ._.1'1 Blngl. or held of hou..hold Mlrri.d 111111{,I jointly or quaMtyl.. wtdowlll) 150,000 45,000 Mlrriod ling .",It.toly 75,000 22,500 Bull_oat .no U from IInl ." 11.110 or IHI, .nt.. .0. hll' .nd on Iln.. ze .nd 21 ' , , , , , , ,~ "Un. 23""75.000 orIH.I"7,1OO or I..." mar,l.d IIl1ng loplI.loIy), multiply IIn. 23 by ze% (,211 ,,'" AIler.....ninlmum...lorolgn...cr.d" """"""""""".."""",,' T.""... ninlmum"', Bubroot Un. Ie ~om Un. 24 ' , , , , , , . . , , , , , , , , , , , , , , , , , , , . ~ Entll yOU/ill ~om FOIm '040, Un. 34lplul .ny .mount ~om Form 4g10 Includ.d on FOIm 1040, IIn. 30), ninuunv lorolgn tax orod" ~om Form t04O, Un. 43 """"""""""".""., U AIIemMIv. ......"'um T.., Bub_oat In. 17 hom Un. ze, 11.110 or 1,,", .nlll .0., Enlll h... .nd on Form '040 1".41 ",.,."",."".""""""."",,"""',. H773 'or '..-k R...otlon All No1Iel, _ ......... 1.,"ull1lonl, Antill.. II I. not OVI" 1112,100 Inlll on Ilnl II. 133,750 } U 14 U n 17 8 C'II" '0,11,,, \ I 3 5 179. 4 5 979. . 128. 7 . . 10 11 II 13 11 17 . " " 10 II 326. II 45 000 II 2 326 14 7 5. u . 1125, 17 11 688, II 0 Form""I'"31 "......, 'oom 2106 I'" Emplov.. Bu.ln... Ellpln... . .. ..,.,Ila In..,uctlon., . AltMh 10 r_ lIMO. . 1 O.,.'IINnI" thl "talWI, Inlt'''''...''''''.."w... Vo\"ftM'l. OMI HD. 11....01:1. .DC~ ",uI1l11'U"'~tI ~~93 AlI..h",.,,1 .. It utn.. ND. .. Oc''''IIIOft In ."1'" ..,....... .," "'''''fI' IRMAN 91-46-3426 MILITARY E"'fIloV" Bu.ln... ElIfI.n... .nd R.lmbu".m.nt. STEP 1 Ent.r Your ElIfI.n... I V.hIcIt'IlII.III.&omlln.Uorllne28 ".", , , , . , , , . , , , , . I Plltclng I..., loll., .nd ".n.pOl1ltion, Including ".In, bu., .tc" th.t did not Inv"v,ovllnight".vll """"""""""""'" 3 Tr.vll '1lII"1II. whll. ,w'Y kom homa o..!nlght, Including lodging, allplan., cllllnlal, aIC, Do nol Includl mill. .nd Inllrlalnmanl 4 aualn... 'llII.n... notlncludld on Un.. t through 3, Do nollncludl II*Ia .nd .n_lnmant """""",."""""" . MeaIa.nd.nIInIlnmant..p.n... . , , , , , , , , , . , , , , , , , , , , . r.... .........., In Column A, .dd Unn , lIvough 4 .nd Intll Ihl lI.ull. In Column e, Inllt thl .mounl kom Iln.. """""""'" Column A Colllllln e Othll Th.n Mill. Mill. Ind .nd Entll1Alnmlnt Entlrlalnmant 515. I 3 4 1 563. . 140. . 2 078. 140, Nelli" VOU Wit. not ,almbu'"d lor .ny 'llII.n... In SI.p 1, .klp IIn. 7 .nd .nl" thl .mount kom Iln. 0 on Un. 8, STEP I Ent.r Amount. Your Emplover On. You lor ElIfI.n"l Llltld In STEP 1 , I.... _nil VOU' ~IOVIIlIllVl VOU that Wit. nol reportld 10 you In boa I 01 Form w.a, Includ. .nv amount 'eportld undlt cod. "L' In boa 1101 III Form W.l '""""",.""".."" 7 I ......elln.nomUnaO """""""""""'" . 1 821. NellI I' ..... Hlumn. 01 Un. . II' ,ltO, ..... her.. II Column A I. 11II than IIIe, report th. .mount ..Incoma on Form 1040, IInl 7, .nd _ ..(). on In. la, Column A. . En\Ir lO% (,101 01 Un. I, Column 8 , , , , , , , , . , . : , . , , , , . " I 10 In Column A. .ntII th. amount "om Un. I, In Column 8, .ubvlct Ilnl 8 komln.' ",..."."""""""."""." 10 1 821. 1 I Add Ill. amounta on IIn. 10 of both column. .nd InI" 1h.10II1 hll', AI.. an", ""1011I on "hldul. A (Film lCMO), Uno II. (Ouallfi.d parforlling .......nd Indlvldull. Whh dlMblUlln. ... th. In."...U"""OI tcl.lrulnonwh".lo.ntltlh.lotal """".,."""..""" ,. Hnl For "..,wo,k ".ducMon ADI Holle., _In.vucUon.. STEP a 'ltur. bp.n... To D.duct on Schedul. A (Form 1040) 9 ef".1 OI/..tl 257. 140, 28. 112. 1 933. FOIm 1101 (111031 .-... ...... " O. you (or yoU/ ap.UII) hlvo Inothll vlhlell Ivallablt for p..I.na1 purp.lln 1U-U-3tal Peat . ~ Vthlole I miltl mil. miltl mil. '4 % mil.. mi. mil.. mil. mlltl mIIH alIVH ON. OV. ON. all Not tppllcablt OUy OS. .IJMAN Form.IOIIIII3) I Pitt II I V.hlcle EIp.n... (...1n.1ruttIon.10 nnd oul wlIlch _lIontlo oomplow,) lellon A. - Inlra nlorm.llon t Vthlol. 1 II EnIIIlhtdalt .thlctt WlI plactd In 'IIvlet """',',,', II 04 06 87 1~ TlllAlmlltav_wt.drlvtnd",lng 1"~ ..", , , , , , , , ,,13 15 000 14 BUlln_ mil. Includtd on Int 13. , , . , , , , , , , , , , , , , ., 14 1 840 15 POIctnt 01 bullnMl utt, Olvldt Unt 14 by Unt 13 , , , , , , , , . ,,15 1:Z . :z 7 15 AvOll1ll dilly r.und trip comnutlng cIIIltnct , . , , , , , , , , . ,. 11 17 CllIlITIII1Ing mIlta Includtd on Int 13 """"""",. 17 11 011I01 pOl..na1 mlIH. Add Un. 14 Ind 17 Ind lub~lcl th. IllItlfromln.13 "",."".""""""""" 13 160 10 11 your ~ICJytI p,..ldtd you with I vthlelt,l. p....nll u.. during oH duty h.ulI p"mlHtd? III 11~ O.youhavIOYkltnot'.lupporlyo",dtdUC1lon? .."".",.,.".."".". 11"V,'lath...ldtnolwrllltn? , , . . . , , , . , , , . , , , , , , , , , , , , , ' , , , , . , , , all Vt. 0 No all Vt. 0 No Sletlon . - Standard MII"ol RI'I IU.. thl. ..ellon on Iv II yOU own thl vlhle'I.1 12 MuIIIolv Int 14 bv 21 etnltl ,151. En'OI tht rHuh h..t Ind .n lint 1, IRur11 ma,l cirri..., ..tln..uction.,) , , 112 I 1515. Slellon c. - Actu.' ElDin... (1\ Vthlel. 1 Ibl Vlhlel. I n GlIoIIno, 1liI, rapalrl, .thlel. .Insuranc., nc ........, , " , n III Vthklt't~1 .......,... . 140 b IncluaIon amount .......... . lib . SubrleUnt 14b from 240 .,... , .!!!. IS Vllue 01 ~1oyar-p'OYIdtd vthIcIt (appa.. .nty " 100% 01 Innuallaa.. valut WII Includtd on FormW.a) ............ . .!!... .. Add Inta 13, ala, Ind as ...... . A- 17 MuIIIply lnt lIll by tho pOlClnltgt on lne 15 .............. . .!L .. Oopr-.on, EnIII amount from lno :II below ...,.,...... . A- .. Add 1_I7.nd II. EnItr 10ItI hart Ind on Inl 1 .,........ . .. S.ctlon D. - pur.clallon 01 vanlel.. IU.. thl. ..ellon onlv II YOU own th. vlnlcll.1 III V.hlole 1 I~I Vthlole I 3lI EnIII ...t 01 alhOl bllll ...... . 3lI 31 EnlII amount oIlta11on 178 dad_ 0........,.... . 31 3Z MuIIIply lnt 3lI by lnl 15 (8H lnaluctlona " you IItc1td tho lta1Ion 178 dld....on) . . , , . . , , . 31 :13 EnItr dop'....n mtlhod Ind p","ntagt ...... I....... :13 :sa MuIlIply lnt 3Z by tho POlCtnltgt .nlnl:13 ....,..,.,.... . 1L :t5 Add in.. 31 Ind :sa ... I.... " :15 :II EnIIIlht ImIIaVon amount from tht IIbIt In Ill. Int 31lnlrUC1l.n. ., , :II 37 Mullply Inl 31 by tho ptlctntagt .n lno 15 ...,.......... . 1L :II EnItr lht........, oIlnt 35 01 Unt 37, Ala. _ lilt amount on Int 21 Ibovt , :II LO C,.14, OI')0/1! , . -.. 11 r- Employee lu.ln... Ellpen... . .....,.... In.tnlItIon.. . AlIMlI.. r_ 1040. OM' "'I. ".I~III ~~93 All.."",,,,, If U."., HI. .. OIC~'I"'1n wl'llll'l '''In'" .", ~".1I 'M~ 2106 . :I D.,.,tlMftlef 11'1, fr..." 1ft.....""""" .... Veu'NIM 1..IIIUCUfllr """'i" 8U I Part tl 8. KIRMAN 94-42-9049 NURSI EmployH BUllnal. EllJIln"l .nd R.lmbur.lmlntl STEP 1 Entlf Your EllJIln..1 Column A OIh" Than M..I. .nd Emtr1alnmam Column' MNl. .nd En~nmant 1 VaIlIeIa..p.n.."amln.Uarln.n "".",.""""" 1 Patldllll ra., ...., .nd lr.naparlaMon, Including Iraln, bu., till" thai dld not lmIo1veOVllnlghtlr.vtl .,.."..,....""",..."" I I TI... aop.... whlla IW'V "am hama ov'lIllght, Including lodging, alrplIne, OIIli1l111l. till, Do nollncludl "",II .nd .mlllllnmanl I 4 .utI__ "",'nHI nDllnclud.d on Un.. 1 Wough 3, Do nollnclud. ........ndlnlll1llnmonl .,."""""""",..,." 4 556. I MIIIt.ndlnlll1llnmtm."".n.H """""""""'" . . TIIIIIlIlI"'.... In Column A, .dd InH 1 Wough 4 .nd .ml/lIl. 'Hull, .lnColumn.,......tIlIl/lllIum"amUn.. ",.",."""", I 556. ....., "you __ noI ,tlIrilU/lld lor .nv '""lntH In 611p 1, .klp Iln. 7 .nd .mlr th.l/lllIum "am Iln. . on In. e. STEP I Intlf Amountl Your EmploV.r a.v. You lor EIlJI.n"l Lilted In BTEP 1 7 .... __ VOIll IIl1lIoVIIlllvl vou ""1 WII. n.' ,eparlld to VOU In .... 1 DI Farm W-I, Includ. .nv l/lllIum 'eponed undl/ Codl "L.'n .... 11 DI Form W-I ,..,......"",,,,,,,,,,, 7 ITlP I ''''" IllJIInl.. To D.duct on Ich.dul. A (Form 10_) . lubteIllnl7tornlnel I.'............,... " , . .. . .....'If... __I DlI... I "I 1110, ..., ...., II CoIurm A II .. ""n 11I0, ,aport Ill. _mlllncOllll on Farm 1040, Unl 7, .nd ...... -0- on .... 10, CoIurm A- I E... ~ (,10) of Nnt I, Column 8 . . , , . . . . , , , . . , . . , . , " . 10 In Column A, ...... till l/lllIum "am Un. e, In CoIurm 8, .ublrlCl IIn. a 556. frombl .. t . , . . . . . . . . . . . . . . . . . , . . , . . . . . ,. 10 556. l' Add the __ on I... 10 of both columna .nd Intl/thl lotII hll', AlIO anlOf "" ...... on ......." A tf- IlMO), ... II. (OuIIItlad pllfarmng ...... Ind Individual. wllh diubllftlH, 1M Ill. IllIlrucllont lor aclaI ,..... on wh".lo .nlllth.I""1 ,."",.""""",."", ,. 11 11m For r.-ilIIlItl R"',llon Act NotIce, _In.llucUonl, 556. FClIm 1101 (1llV3) Ll CF,Ut OI/JO/I) "'" 1"', SUIAN I, HIItIIAN FOIma'llI1U1I31 I Part II I Vlhlcll Eap.n... (...In.lructlon. to nnd oul which ..lIon. to .ompl'''.1 Slctlon A. - Gln"l Inlorm.llon . Vehlcl. , 11 Enter the delo .ehIcl. w.. pllcod In ....!c. """,'.,.,. 11 13 TlIIaI mIIH ..hIcl. w.. drl..n doting 11183 """"",,'. 13 I. BUll.... milIIlnoIuded on Un. 13, , , , , , , , , , , , . , , , , " I. II P....n101 bUlln... 01', DI.ld. Un. 14 by Un. 13 , , , , , , , , , " II 11 A...IIII dIlIV round lrlp .ommu1Ing ell."... . . , , , , , , , , , " 11 17 C_ng rnI..lncludod on Un. 13 ".,."""" 17 11 00.. p...ol1ll mil.., Add Un.. 14 .nd 17 .nd .ub~.ellh. ,011I from Un. 13 """""""",'."", 194-42-9049 PIIIII ~ Vehicle I rmll mlllI % mil.. mil.. mill' mil.. % .!!!I!!.. mlllI 11 mil" mill. 11 00 vou (or VOIll 'POUIO) hi.. .nothot .Ihlcl. 1.lllabll for por.onal purpo...? o VI' III No 10 If VOUf """Ioyer pro.ldod VOU with I ,"hlcl", I. plroonll UIO du,lng oft duty houro permlltld? o VII 0 No III Not .ppllclbl. 1,. 00 VOU hI.1 ovIdl..I'O .upport vour dlduclton? lIb If "V.. '10 tho ovld.nel wrl1lln? .....,..,................., , III VII 0 No o VII II No Slcllon I, - Itlnd.rd MI"'II~ R~I~ 'IU~~ ihl~ ~~~tio~' on'l~ i, 'v~~ 'o~'n' tj,~ 'v~hl~i':I' , Z2 Mulliol.lln. 14 b. 21 clntol.211. Enler 'hi ,"un herl .nd on Ilnl " IRurol moll clrrll", IOlln.~uction..l ' , I 12 I Slcllon c. - Actu.' ElDin... III V.hlcl. 1 (~l V.hl.lel 13 aulllno, III, ropalr., .Ihlell lnourane.. 010 ....,.. """ 13 I.. V_r_ ...,.. I.'.,. lie ~ InclUIlon amount ........., . 111I . 8ull1rlC1lno 111I from 2... ..... . .!!! 18 Voluo of """loyer-provided .-lopplIoo only II 100% of Innuollouo vol.. wlllncludld on Form W-II ....... j,.,.. .!!.. . Add ..... U. 140. Ind II ..,... , ..!!.. 17 MulIplv lno . by thl porclnll;1 on lna " .... """"," ..!!... 18 DaprICllIon, EnlII amount from Ino 31 boIow .....,..... " .!!.. . Add .....17 Ind II, Ent.. 1011I hart IncI on Ino 1 ..".,.... , . Slcllan D. - D-ICllllon 01 VI CII"U .1 thl. .Icllon on Iv II vou own thl Vlhlcll.1 III Vlhlol. 1 I~I Vehicle I iIO EnlII ..., or oth.. bllll ,., ".. iIO 31 Enter amount of ....on 17; did..... II" '" "".. " 31 3Z MulIplv.na iIO bV Un. 1118" lneructlonl II VOl' tlICl\od the ItoIon 111 deducfonl ' . . , , , , , , 3Z 33 Enter doprlClllon "*"od and P..OI""III ,."...,.,.,. . 33 :II MuIlIplv Inl :Ja bV thl p..el""at on lno 33 ,....,......., . ~ 31 Add Unoa 3 I Ind 34 "..,..., , 31 31 EnlII thl IImIIalcn lII1Oun' from 1111111>11 In the lno 3lllnlllucfonl '. , 31 37 Mullply Inl 31 bV the p..clnlllll on Unl tl ...... I.'...... ~ 31 EnlIIthe IlMlltf of Unl 31 or Inl 37, AlIo .nlIIlI1. lII10unt on IInl 21 Ibo," , 31 l:a ef'''' 01,)0/11 '" I'"' Me.l. & Entert.lnment Exp.n... 1993 1191-46-3426 Form 2101 bUY is. HI 8UDDortInD 8chedule 1._lntry..... . 1 De """""" rOOD AHD NlALS UO. , , Tot.' UO. . IHJ ICI/C""",I. L3 C,,"1 0,,11/11 ~ f""'. Other lu.ln... Ixp.n... 1993 1 ~ UNIrO.... UNIrOIUl IClIlIT_urel 'Hon eONTZMUID IDveATZON 'lor'..ZONAL DUI' 81, 588, 288. 57S, 30, .'MlIO"O_11 L4 1 563, 0'",1 Olllllt! Oth.r Bu.ln... Exp.n... 1993 I 194..2-90U Form 21M SUSAN S. KIllIAN S llna Schedule .,........... . 2 III ~ UNIrOItll IlAINTINANCI "3, PRor.ISIONAL DUIS 50, CONTIHUlD IDUCATION 33. . , , Tol.' 5U. I') ,-... . IH) ICI/C..,.. L5 C'IOII O./11/IJ -.. : "040 Olp"lmen' of Ih, '1""I'I~1 An.nu. '.n'le. .;1((5)94 ~ ,'I u.s. Indlvldulllncome Till Return U;W Llb.1 UII \h. IRS 1oIlol. Otherwl.., pl.... p,'nl orlyp', Prooldontlol Eloctlon Com AI Filing StltUI Chock only an. bo.. Exemptlonl II mo.. th.n Ila dep.nd.nto, "' p.g. 14, Incom. Altlch Copy . 01 you, Form. W-I, W-IG, ..d 10000R her., II ycu did not g.,. W-2, III p.go1!, Encloll, bu1 do not .ttach, .ny p.ymont with your return. Adjultmentl to Income C.ution: Soo Inl~uC1lonl ,~ 1 H773 ,-. IRS loIU onlV.Oo not ""11. 1011 1111I11 1ft Ihlt IPIU. 'Of 'fl, W'" Jen I-D,c. 31, IIt4, Gr olh,'I,. Y'" blQmnlng .11I4,.ftdlnl ,10 0,.,.. No. 'l'I..OQ14 'tOUI .OCIaIUCUIIIW nul'll"" GARY J. HERMAN SUSAN S. HERMAN 111 E. YELLOW BREECHES 191-46-3426 spou.... 'OClIlUcuIlly numb.' ROAD 194-42-9049 CARLISLE, For P".ICY Acl end Pep.rwork R.ductlon Acl Notlc., '" pogo 4, V.. No Not.: Ch.UInQ "V.... wlllnol chltlOt you, ".01 ,.dun YOUt ,.Iund. PA 17013 .. 00 you w.nlS3 10 go to Ihillund? """"""""" ,. If oint r.turn, dOl' our. aUII want 53 to 0 to thlt fund? Singl. X M'I/I.d filing jOlnl liMn (ov.n II only on. had Incom.) Married filing IIparate faturn, Entll 'POUII', SSN abovI and full nama her. ... I 2 3 4 ! e. b HOH IWllh qUIII'Wlngpll.anl.lf qUII P"'DI'lI" child b",t nol rou' alp, ,nl,' chUa', nama ... auaull" wlclawl."...UI1 d'o.nalntchlldl "',p~"cll.d II ... II Yountlt. II 'tour o."nllO' .om.on. "u,can cl&~ you It. alp,nda"t on "., 01 hll 'I. 'lh,lIn, dO nol II s u.. ~tI~C~~O~~,.O~I~'.'U.fI.1C1.C~'~1I.1h.'~O~~~in~~:I~O~~'~'~. : : : : : : : Dependent.: 21Chlell ,3111'g' 101 ola". ,.. Dlp,na'nl" it unda, dlp.nd,n,', ,oelal IlINaml,lInl."'.IIaI..ndla,tnaml' , II 'ICU'" numb., No. at bau. chlclI,d on" analb No. 01 WCKJf c:hlld"non 6c .1'10: . liVId wllh you . cllan'tlin wl1h )'DUlIu'to dlvoruor .lpI,.lton,,,. P'g' toll Caplnd,nll on Ie not .nt'''d abo.,. Adctnurnb", ."I".don Imn,bovI a III No 01 mo. IIVldin)'OUf homlln 1194 ""lIon,hip 10,ou DEREK J. HERMAN MONIKA T. HERMAN 99-72-6556 81-74-1246 ON AUGHTER 12 12 d II 'tour child dia,n IIv. WIth you bul II c1almea.1 'tOUI d.penaenl unae,. ple-Iln agreemenl, ctl.U tie" ~D . Total numb.r 01 .XI tiona claimed . , . . .. ............ 7 W.g.., IIlarloo, tiPI, .tc, Attach Fo,m(l) W-2 .______________________. ~---------------------------------------------_. 7 .. 96 732. 268. . . T..oIIl. Inlar.atlncom., Attach Sch.dul. B Ilovor 1400 b T......mpllnlor..t. DON'T Includ. an IIn.s.a , , , , , , , " Ib . Dlvld.nd Incom., Attach Sch.dul. B II ovor 1400 """,' 10 Taxabll IIlundl. crldita, or ohlta 01 atat. and locallncom. IDII 11 A1lmonyroc.,..d """",.,."."" 12 BUlln,"lncomo or (1011), Allach Sch.dul. C or C-EZ 13 Capilli gain or (lOll), If raquil.d, .ttach Sch.dul. D 14 Oth.r galnl or (101100), Allach Form 4797 , , . , , . , , , , , , , , . , , 18 . ToIIIlRA dllillbutionl . . , ~ I b T...bl. .mount 18 . TolIl p.nllona .nd .nnul1lOl O!!J b T...bl. amounl 17 R'nlll rill 01111', roy.'till, p.rtnorahIPI, S corporationl, ilulto, .tc, Allach Sch.dul. E II Film Incoma or (lOll), AlIIch Sch.dul. F , , , , , , , , , , , , 11 Un.mplaym.nt comp.nlltion ",'..'"'.'"",.'""",,, 20 . Socl.llocurlly b.n.fito '. l!!!!J I b T..abl. .mounl " 21 Othor Incom., . 10 11 12 13 14 llIb lib 17 \I \I 20b 75. 131. 22 Add Ih. .mounts In th. III " ht column lor llnal 7throu h 21. Thllll ur 10'" Incom. "~ 13. Your IRA d.duction ."""""" 1310 b SpoulI'IIRA d.duction """"'" 2311 24 Moving ..p.nlll, Allach Form 3903 0' 3903-F 24 U On.-h.1f Olloll-.mploymanllla , , , , , . , U " S.II-.mploy.d hoohh Inluranc. d.duction ' , " 'D K.ogh lltillmanl pl.n .nd IIII-.mployad SEP d.ducticn 'D 21 Plnalty on IItlV wlthdtlwal or living. ,..... 21 21 Alimony p.ld. Roclpl.nl'l SSN~ 21 21 22 97 217. :JO Add IInOl 231 lh,ou h 29, Th... "' 31 Subuct IIn. 30 "0m IIn. 22, Thl. II ur total Id Itm'nll ur ad u,"d olllncaml,. 30 31 CUENT1S COpy ~ ~ 97 217. FOlm 1040 (12941 CF201' 11/II,U -1.. -1.. 11. Add intI ~ throu h &;, Thl.. a.. ur lolal manll """"".",.'" ,. IIllnl eo II mo.. thin IInl 1l3, lub~lclllnl 53 trom IInl eo, Thll II thl Imounl you OVERPAID . A""""",... .",1 REfUNDED TO YOU , , , . , . , , . , , , , , , , , ' , . . , , , , " . A"'I."".II iou.""APPLlED TO YOUR '"I ESTIMATED TAX. Il3 If Unl 5311 mo..thln Ilnl eo, lubtrlcl Unl eo from Unlll3, Thll Ilthl AMOUNT YOU OWE, For dllalll on how 10 p"y, Including whlllo wrlll on ~our plymlnl, "" plgl 32 , , , . , , 15 Eltimllld Iu plna 1111 I 33), Allo Includl on Unl ~ '" IS Unci" ,.",IU...I p"tu't. I cltell,.lhll' h.... ,.&mmed Ihl, "Iu,n and .UDmPlIlyln, uh.cluln anll '1IIemtnl., ",'la Ih, b.,I.1 my '"Owlld,. and It,ll", lhtr "llIuI, co".,I, and compltl" Dul.,.Uon 01 pltp.'" lalhll Ihan 1..paYIIII. b.ud an ,lIlfl'Oltnlllon of which P"P'''' hll."y ,nO..l1dat. H.r. ... You, ,lrlluII alii You' Getup.llon Kllp &copy,. ILITARY of this r.turn ~ 'POUII', IItnlhH1 1l101f'l11l1uf". BO H mu'l fliP' alII tor your rtcOfdl. " k~ 3Z 33a /'.. , Compu- t.Uon IS" plgl 23.) II you wlnt lhl IAS to figure your Iu, III plgl 24, 38 40 41 4Z 43 44 IS.. plgl 24,) 45 II 47 II 48 IlO 51 1511 plgo 25,) IIZ Credit, Oth.r T.... p.ym.nt. Alllch Fou", W-2, W-2G, Ind l099-R on thl hon\. 10 R.fund or .1 Amount IZ You Ow. 13 14 Sign 34 GARY J. " ~AN S. HERMAN ,.-... Amounl hom Unl 3111dlullld 1lI0..lncoml) """""',,',"','" Chock II: 0 You WI<I 55 or oldl<, 0 Blind; 0 SPOUII WII 55 or oIdl<, 0 Blind, Add Ihl numbl< ot bOllochockld IboVI Ind IntI< thllotll horl , , , , " ,. 334 b II your plllnllor lomeonl 1111) can ctalm you II I deplndlnt. chock horl ,. 33b 0 o It you all marrlld tiling Ilporltlly Ind your IpOUll1loml1l1 dlductionl or you I.. I dual-ltatulIUln, III plgl 23 and chock hili .."" , , " ,. 330 Enlor {Ulmlnd doducUonl t,om Schldull A. Uno 29, OR Iho Slandlrd doducUon Ihown bolow lor your ftllng IlIluI, BuIll you ohlcked IlIlI" any baa on IInl 334 o. b, go to pili' 2310 ftnd your IlIndord dlduction, of If you chockld baa 330, your ltandard dlduction II zoro. your' I Slngil--I3,800 I Hlld ot hOUllhold--I5,800 , I Marrlod tiling jalntiy or QUlllfylng w1dow(or)--I5,360 . Marrlod r~lng IIplrllolYnl3, 175 SubUlclllnl 34 horn Ilnl 32 , , , , , , . , , , , , , . , , , , , , , , , , , , , , , , , , , , 11111I. U I, IU.'!OOII""mulllpl, 12,410 bV lhtlolllnumbll 01 ",mpUon. &11,",ld on hn, ...11 lint nil 0_" IU..ao....UI.WO'.."..IOl'lp.'.2.,otlh.""aunIIO."lll .,........."........ Tuabl.lncom.. Subtract Un. 38 Irom IInl 3S. II In 3111 11'10" than In 31, '1'1111 .0. ....... Till, Chock II tram I 1BI Till Tobll, b 0 r.. Altl SChldulll, c 0 Capilli Olin Till Wo,k- IhlOt, or dO Fo'm8815, AmounllromForm(l) 8814. I Additionolllllll, Chock II trorn a 0 Form 4g70 b 0 Form 4g72 AddHnll38lnd3g . , , ,. . , , . , , , ,. , , , , , , , , , , Clldlf tor child Ind dlplndlnlcl" "'plnlll " Crldlt tor Ihl oldolly or 'hi dloablod, Attach Sch R "'" Forolgn Iu C"dll Alllch Farm 1116 """."", Othor c"dlta, Chock If horn a 0 Form 3800 bO Fo,m 6396 cO Form 8801 dO Farm (Ipoclty) Addllnll41lhroughaa , . . . , , , . , , . . , . , . , , , SubUlclllno 45 from Ilno 40, IIl1no 45 II more lhan Ilno 40, onlor -0- Solf.lmploymant Iu. AlIIch Schodull SE , , , , . , . , , , , , , , AI1ornltivomlnlmumlu,AlllchForm5251 ..,..,..""""." Aocapluro lull, Chock If ~om . o Form 4265 bO Form 151100 Form 1525 Social locurlty Ind Mldlcl" Iu on tip Incomo nol reporlld to omployor. An Form 4137 . , , Till on qulliftod "ti"mont pllnl, Including IAAI. If rlquuod, IlIIch Form 5329 Advlncl oornld Income c"dll plymlnta hom Form W-2 ...""", 38 38 37 38 41 4Z 43 ,. 960. 44 a Add~;'4eWQ:Vh~~T~T.vow~~-~--~::~~~~~~----------~~~~~ 14 FldInCDm,t...llhh,ld. II 'O..,CII"II.... 0 14 13 785. 55 1884 lltimalld Iu plymanta Ind amount IPPUld ~am 11183 "turn 55 III E.,nld Incoml c"dlllf "qullld, llIach SChldul1 EIC (110 plgl 27), Nonlulbll ..rnld Incomo: amounl . Indlypl. ' , . . , , . , , , , , , , . . . . . , , , , . . Amount plld with Form o\888llldonllon "quill) , , , , , , E.cI.. loclalllcurlly Ind AAT^ IIll withhold (I" plgl 32) Othor plymonta, Chock If horn .0 Form 243g b 0 Form 4138 III 117 III 58 117 III 58 PoId Prop.,.,'1 Uoa Only P,.p'''f' .... "pluII ,. ~ "r",'tnam. 101 ,DUll, .... """_...,1.",, ,. GREENAWALT " COMPANY, "'........ 400 WEST MAIN STREET :lHIII e..... 1111I,.. MECHANICS BURG PA P.C. Iud, 191-46-34:l6 PI12 3Z 97 U7. o } 34 19 438. 38 77 779. 38 9 800. 37 67 979. 38 14 093. 40 14 093. 45 960. 13 133. ,. 47 . IlO IIZ 13 133. 13 7S5. 652. 652. II IZ 14 liP""" ,oel,l"cunt, no 17:l-36-0048 :l3-H05297 17055 / / ,.IiIedule A ,,(form 1040) Oeo"lmenl at "" r""UI., Inl,,~ ",,"'UI ..,~Ict ,"I "II\"ItCII '''0''" on Dim 104Q GARY J. M.dlc.1 1 and D.nlAl Elptnll' 2 3 4 I Tutl You I Paid 7 I Inltrtl' You Paid NOlt: P,rlanal Inlertl,l. not d.ductibll, Olnl to Chorlty II WIN mid.. gillandlOl1 .,",rulorll, 1. I" p..' ",..3. 17 'I II to ca.uolly Job Elp.nll. and Mo.' 0\11" MIIO- .nan.OUI Otdue\- Ion. 11"""1 A..' lo,...",n". IOd,duel h.".1 0\11" MIIO- .lIl11tou. Otcluellon. Tolll IIlmlnd Otduellon. ""'\ /""', Schedule A--Itemlzed Deductlona ~ AIIMh '0 form HMO. ~ S.lln.lrucllon. lor Behldull A (form '040 , & SUSAN S. HERMAN Clullon: Do nallnclud. "pin... "ll1'llurlld or plld by alh.lI, Mldlclllnd dontalllpln... ______________________ . 10 11 \ E~I;r ~;;;;u~lfr~,;; ;;;i;O, u;,; 32 - ~ ~ ~T Z T - - - -9Y,-2-i7-: Multiply IInl 2 IbavI by 7,1% (,0751 3 SUbUI.tllnl 3 tram IInl 1. IIl1nl 31. marllhln IInl 1 Inler -0- SIIII Ind lacllln.aml tax.. ,. I Reel I.tall taxo. . , , I POllanl1 praplrty taxi' ,. '. 7 Other taxtl--U.tlypl .nd Imaunt ~________ __________ ~_EJl~~llCllEp___________________~~~~__ _____________________________________ I Add IIn.. I thrauah 8 " , . Haml mar1gegllnltrtlt.nd paints "partld 10 you an Farm 1098 \0 Haml martgegllnlertll not "partld to you an Farm 1098, II plld 10 thl plllan kam wham you baughtlhl haml, .ee plgl A-3 Ind .haw thll per.an'. "'mtI,ldlntit;lng no" .nd Idd,," ~______________ 9.946. 3.441. 2,365. 1 085. \2 \3 \4 \I _____________________________________ 11 ~a1nts natl,aartld 10 you an form 1098 12 .. "..,. A.. bl .pICII IUI.. nvtlvnenllnlertll 13 Add Ilntll0thraugh13-------:--:------------------ 011II bycllh or chock__________________________ ~cal_________________________J~~__ ~I~_~~L~~_Oy~___________________~~__ _____________________________________ \I Other Ihln cllh or chock, II aver 1&lO, you MUST lnach Farm 8283 11 CarryoVII kam prior yeti 17 Add Ilnee Illhraugh 17 . . , . , . . ca.ua/tv arthln lallltl). Anach Fa,m 41184 Umlll1'llu,"d 1f1lllayel I"".--jab uavII, union dua., jab Iduc, IIc. ~ ,_OJYt~_~O~______________________~JL~~_ 1 075. 21 12 to I' 3,245. 225. Tax preparation f," . Other IIplnll.--LI.11yp1 .nd .maunl ~ _ _____ _________. Z3 14 l5 U Z7 U .____________________________________ 12 Add IIntl 20 through 22 ., " ,. Z3 3.470. Enlll amaunl kam Farm 1040, IInl 32 ~ 97 , 217 . Multiply IInl 241bova by 2% (,021 , , l5 1 944. Subl1ac1l1nl 28 Iram tinl 23, IIl1nl 281. maralhan IInl 23, Inlor -0- U Moving Ilplnll.lnourrld bllaro 1994, Anach Farm 31lO3 or 31lO3-F Z7 Othor, U.tlypo and amounl ~____________________________________ III I. Farm loaO, Ilnl 32, avor III 1,800 lavor 188,110O " ""rrlld IIIIng IOperlllly)? NO. Your ".ducllDt'l1l noIIItrlUt.. Acldlhlamounllln 'h,," IIIhl CClk;m" IDf lln., 4lhlDUg" I'. } AIIO, tnlt' Dtl ,.,"' 10'0, II". ~4, IhI "'"., DI thl, wnounl Of WCM.tl ,lanllal. ...ducllon YES. Vaur dldu.tian mev ballml1ld, all pagl A-8 'OIlhl amount 10 Inlor, 3 H713 fa, paptrwork Illducllan Act Nallet, ... form 1040 In.lruellanl. eFI'" OI/U,1I OMU No. 1141.00,. ~~94 Alllchm~1 IIqutnu No. 07 YOUI loclaj "CUflI't numb" I 191-46-3426 4 . 6.891. 14 9 946. 11 11 1. 075. 1.526. u ,~ III 19.438. Schedull A (farm 1040) 11M ~ / , . ule D Capital Gain. .nd Lo.... CMI No. II".OOH 1040) ~~94 . Alllch to Form 1040, . SII Inlttucdonl lor Schldull 0 (Form 1(40), 0""'''''''1 ollnl T1'.,u" Alllen",.". Inlt'ne' A...nut ""leI 1111 ... U" Un.. 20 and 22 '01 moll .pac. to Ult tllnaactionl tot Un.. , and D. ..!tUt".. No. 12 '!.MI.'llhe." on form lOCO S. HERMAN I Your IOC..lucuIltynumlll' GARY J. r. SUSAN 191-46-3426 I Part II Short-Tarm C.olla' Oaln. .nd Lo.ae.-A...l. H.ld On. Vllr or L... III Otn'lpllon 0' (blOllt ICIO,I"Old Idlbl"p'leI IllCallor tlILO.. IIlQAIN p1OOlflylElamplt: ICqul". (Mo"liIlt.yr.1 t..,ptgtO..31 oln,'b_"t 1I1"I,mo"th"'ldl. Illdlllmo,tthanCtl, 100 th. XYZ CO.I (Mo.t aty, y") 1",p11l,O-31 lubtr'Clldlhom'tl IllblflClltlr,omcdl 1 2 Ent., your Ihot1-tllm totall, If any, from Unl21 ................ . ... . 2 3 Total Iholl-Illm ul.1 prlc. amounll. Add column (dl 01 Unll 1 Ind 2 ,...... . 3 4 ShOll-tllm gain kom Formo 2119 and 82~2, and Ihort-tllm gain or (10111 kom Formo 4684, 8781, and lI824 ................... . , , , , , , , , 4 5 Net .hort-Ierm gain or (lOll) from partnership.. S corporations, e.ta''', and ttuIIl kom SChldult(l) K-l ........................ . . . 8 . ShOll-tllm capital I..a callyovar, Entll tha amount, K any, I,om Una 9 01 you, 19113 Capilli ~"" CarryovlI Worklhllt ...... . , , ...... . ,. , ,. , 8 7 Add Unll 1, 2, and 4 tlvough 8,In columna ('land (gl ..... . " , . , 7 ) . N.llholl-I.rm capital lain or (lOll). Comblna col"mnl (II and (g) o'lInl 7 ............. . ., , . . I Pert III Lona-T.rm C.allal O.ln. .nd Lo....-A...l. H.ld Mor. Than On. Ve.r I 8/29/94 FIN TRST CORl' ITARIOUS 11 11. 10 Entll yoUllong-torm totall, K any, kom IIna 23 .......,..,..,... . , . 10 \I Totallonl-I.rm aal.a prlc. amounla, Add column (d) of Unll 9 and 10 ... . " , 11 11. 12 GaIn kom Form 4797: long-tarm gain from Formo 2119, 2439, and 112~2; and long-111m gain or (lOll) kom Forma 48lI4, 8781, and 11824 ..... , ,....... . 12 13 Nit long-tllm gain or (lOll) kom partnlrshlpl, S co'poradonl, lltatll, and ~UIIl kom Schldula(l) K-l " , ,.,. . , . . , " , , , , , , . 13 14 Capital gain dllttlbuUonl .,...... . ...,....., , , , " . 14 15 ~ong-Illm capital lOll "'ryovor, Enlor thl amount, II any, kom IInl 14 01 your 1993 Capital ~"" Carryovor Worklhllt ..... . ... . ,. , ." . , , " , 18 II Add Iln.. g, 10, and 12 through 18, In columnl (II and (g) ...,.,.. . , , , , " , II ) 1l. 17 Nit lona-term _Ital all" or 110..1, ClllNllna columnllll annlal o'lInl 18 .....,. . " . ,,,,,,. 17 11. IPert 1111 Summ.rv 01 P.rt. I and II II ClllNllnalnaa 8 and 17, "a 1,,", go to Unl 19, "a gain, antor the gain on Form 1040, Unl 13, Nol., " both Un.. 17 and 18 III galnl, III thl Capital Gain Tax WorkahHI on plga 2~ . , , , ........ . 1. 11. II "Unl 18 II a (1..1). antll hora and al a (lOll) on Form 1040, IIn. 13, thl Imallar of th...lolI.., . Thl (lOll) on IIna 18; or b (13,000) or, H marrlad filing IIparatlly, (11,500) .........,..,....,......,.....'.. , II ( I """I t"'I Not.: e..,hl e... LOll c., ,wove, ",",o,..hlll on Pili 0-' I' 'h~ la.. on Ilnl 'I In..d. thlla.. on Ilnl 1101 II Falm 10..0.1.".31, ,. 110'1, H773 For P....r_rk naducUon Aal NoU.., ..a Form 1040 Inlllu.Uonl. c...aa Ill/I "" Sch.dull D (Form 1040) 1914 4 -. ,....." , ,.,.. 2441 Child and Dependent Care Expenses ~ Alllch 10 Form 1(140, 0J.48 No. 1.....001. D.p.,lm..,1 at .". TI",uI, In'''natA.wenu.l"vlce tll' N""~'I'''o.n Dr'l aIm 0.0 ~~94 AII.ehment ."uenceNo. 21 You, 'OClel..CUII1V numb" GARY J. " SUSAN S. HERMAN 191-46-3426 You nlld to underetand the following terme to complete thle lorm: Qualifying Pereon(a), Dependent Care Benellte, Quellfled Expen..e, end Earned Income, S.. Important Terme on page 1 01 the Form 2441 Inltructlonl. I Plrt II Perlonl or Orglnlzatlonl Who Prov/dld the Clre-You mUll camplltl thll pill. " U nl.d mort I lei UII thl bottom of . . 2. (I) CIII pravldll'l (b) Addreu name numb.r, .trlll.. L no., . ltatl, and ZIP cod. ABC DAY CARE ~_lBQ6T_~~BI~~_______________. HARRISBURG HOSP ISBURG PA 23-0675330 BETHEL NURSERY .tla_UQ~~X_~~~~_______________. ARLISLE PA 23-1982986 (d) Amount plld 5 137. Z Add thl Imountllln column (d) 01 IInl I "",',..".,..",.....""..".,..", Z 3 Entll tho nurrbll aI qualifying pa"onl corod for In 1994 , , , , , , , , , , , , , . , , , , . . , . , , , , , , ~ [iJ 1 240. 6 377. Old you roellvo depandenl carl bonoml? NO YES . Camploto only Pin II bolow, . CamplOlO Pin III on pogo 2 now, I Plrt III Credit for Child and Depandent Care Ellpen..1 4 Entll tho amount aI ""IUnod o.pan..o you Incurrod ond plld In 1994, DO NOT Ontll moro thon 12,400 fOl one qullllylng pOllon or 14,800 '01 two 01 moro plllonl, If you camplltod Pin III, ontll thoomounl~omlln028 """"""""""""" 4 4 800. I EntllYOURo.nodlncomo ...,..,.""."."""" 8 I It II1IIrlod tiling I Joint rOlurn, ontll YOUR SPOUSE'S ollnod Incomo (It Itudont 01 dl,"blod, "0 tho Inltructionl); ",I othoro, ontll thoamount~omlln08 ,."",.""",..".""". I 60 870. 35 862. 7 EntorthoomallOlI alllno 4, 8, 016 . , , , , , , , , , . , , , , , , , , , , , , , , , . , , , , , , , . , , " 7 4 800, I Entlllho Imount trom FOIm 1040, IIno 32 ..,..."....,... . I 97 217. . Entll on IIno g tho doelmal amounl .hown bolow thlt Ippllll to tho Imount on IIno 6 IIltnl III. Doclmol IIl1no 111- Doclmal Bulnot amount aulnol amount Ovor oy.r II OVI' Dve, II 10 - 10,000 ,30 SZIl,ooo - 22,000 ,24 10,000 - 12,000 ,29 22,000 - 24,000 ,23 . x.20 12,000 - 14,000 ,28 24,000 - ze,ooo ,22 14,000 - 18,000 .27 28,000 - 28,000 .21 16.000 - 16,000 ,26 26,000 - No limit ,20 18,000 - 20,000 ,28 10 Multiply Ilnl 7 by tho doelmolomount on IIno g, Entll tho relult. Thin. "0 IhoIn.trucUonl 101 tho amounlolcrodllloontllonFOIm 1040,lIn041 """"""""".,."",.", 10 960. CouUonl1l ycu pold .150 01 maroln I colondll qUlnor to I pOllen who workod In your homo, you mull filo In omplovmont taJc rlturn, Oot FOIm 1142 fot dotalll, Hn3 For Poperwork RoducUon Act NoUco, ..0 10pOlllO InlltucUonl, FOIm 2441 (Igg4) 5 CFIHC 10/10114 ,/ . / ./.,: 6251 '""'\ ......... AUernatlve Minimum Tax - Individuals oua No, lus.aur alPlllm,nl of lh, r''''I.IIW Inlt.",,1 A..tnuI '''''IU HIMII" ,hO*" on Fa,m 1040 ~ Ansch to Fo,m 1040 ot Fo,m 1040NR. ~~94 "!llCtlm,nl B. u."U~o. YOUf ,aCIIIUa.l111r numb" GARY J. & SUSAN S. HERMAN 191-46-34~6 I Plrt II Adjultmentl end Preterenc.. I I' you It.mlz.d d.duction. on Sch.dul. A (Fotm 1040), go to IIn. 2. II you did not It.mlu d.duction., .nt.. you, .tand..d d.duction from Form 1040, IIn. 34, and .klp to IIna 6 ....... . . . . . 2 Mldlcal and d.ntal. Ent.. tha .mall.. of Sch.dula A, IInl 4, or 2 Im~ of Fo,m 1040, IIn. 32 3 T..... Enl.. Ih. amount 'rom Sch.dul. A. IIna 9 ................ 4 Cafl.lln Inl....1 on a home mot1gagl not ulld 10 buy, build or improve your home 6 MI.clllanoous 1I1m1..d d.ducllon.. Ent.. Ih. amount 110m Sch.dul. A, IIn. 26 I A.fund 01 ...... Ent.. any... ralund from Fotm 1040, IIn. 10 ot 21 7 Inv"lm.nt Inta...L Ent.. dlll...nc. b.twlln ragular ... and AMT d.ducllon . . Poat-lllII d.prlClation. Ent.. dlll...nc. batwlln rogular ... and AMT d'prlClallon . Ad/ull.d geln or lOll. Enler dlffer.nc. b.tw..n AMT and ragular IIll gain or 10.. 10 Inc.nllv. .Iock opllon.. Ent.. exc... o. AMT Incom. over ragular ... Income ... \I Pa..lv. activlti... Enter dill...nc. b.twlln AMT and ragular lAx Incom. or lOll . . 12 B.n.fielarl.. oI..tat.. and ~u'lI. Enler Ih. amount from Sch.dul.K-I (Form 1041), IIn. 8 13 T..-exempt Int'''"t from privet. activlly bond.l..uad after 817188 ............ 14 Oth... Ent.. tho amounL II any, 'ot IIch h.m and .nt..lh. total on IIn. 14. . Charltabl. con~lbutionl h lo,"lImltallonl b Circulation exp.ndUu,.. I Mining co'1I C Depletion ....... J Pa~on'l adJu.tm.nt d D.prlClation (pra- 1987) k Pollution con~ol f.cUIIl.. . Inllallmont 1.111 I A....rch'..p..lm.ntal Intanglbl. d,lIl1ng co.1I m T.. .hlller farm activlll.. II long-t..m conlracta n A.let.d adJu.tmenll 14 11 Tala/Ad Ibn.nta andPr,'er.nc,". Combln.lln.11 throu h 14 .................... . 16 8 ~ 86. I Part III AllerneUve Minimum rlxable Income \I Ent.. tho amount from form 1040, IIn. 36. II I...,han zero, .nt.. II a (10") ........,.... . II 77 779. 17 N.t operating 10.. d.duction,lfany, from Fotm I04O,lIn. 21. Enta.... po.ltivllmount ..... 17 II II Form 1040, IIn. 32. II over 1 I I I ,BOO (ov.. 166,900 II marrl.d filing IIpar.t.Iy), and you lI.mllld d.ductions, .nl..lh. amounL II any, from IIn. g 01 the work.hall lor Sch.dul. A, IIn. 26 ..... \I \I Combln.lln.. 16 Waugh II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. \I 86 065. ZO Ahernstiv. ... nil oporlting 10.. d.duction ................................ 20 II Altarnatl.. MinImum Tulbl.lncom.. Sub~act IIn. 20 from IIn. 19. (II ma"l.d filing IIparlt.ly and IIn. 21 Ia mo.. than 1\66.000, ...In.~uction. .................................. II 86 065. Ipart 11I1 Exemption Amountlnd AlllrneUve Minimum rex II E..mpUan AmaunL (II thlllorm la lor a ehlld under agal4, a,,'nltrucUonl.) II your nllng llalulll' And IIn. I1II nal ov." Enter on IIn. 22: Slngl. Of h.ad 01 houuhDld ........ S"2.600 . 133,7SO } Mlrrlld filing jolntiy ot qualllylng wldow(er) . lSO,OOO . . . 46.000. . . . . . M.rrlld filing IIparalaly . . . . . . . . . .. 76,000... 22,600 II IIn. 2111 over thl amount thown abov. 'or your flllng ltatul,,"lnllructionl Z3 Sub~aet IIn. 22 from IIn121.11 zero ot 1III,lnler-O- hall and on IInll 26 and 26 . . .. 14 IIl1nl 231. 1176,000 or I... (187,600 or ,... II mlfrlld filing IIperat.ly), multiply IIn. 23 by 26% (.26). Otherwl.., multiply IIn. 23 by 28'4 (.28) and .ub~act 13.600 (11,710 If ma"l.d filing IIperat.ly) from thl '.Iult .......,.....,.,..............,..,.......,.. 26 AlternallY. minimum'" loralgn'" clld" . . . . . . . . . . . . . . . . . . . . . . . . . 21 Tentativ. minimum.... Sublle' IIn. 26 from IIn. 24 ............................ . 'C1 Enter your IIIl Irom Form t040, IIn. 38 (plu. any 'moun' from Form 4970 Includ.d on Form 1040, IIn. 39), mlnullny .or'lgn ta. clld" 110m Fotm 1040, IIn143 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ZI AlternaU.. Mlmlmum Tu. (If Ihl. fo,m I. lor a ehlld under ag. 14, 1I.ln,uuction..) Sub~act IInl 27 I,om Un. 28. If I.ro or "", .nter -0-. Enlll hlr. Ind on Form 1040 IIn. 48 , . . , . . . . . . . . . . . .... H773 Far Pap.rwork R.dueUon Aet Nodc., "' IIpar.,. In.trueUon.. 7 Cfllfl 10/20'1. I 2 3 6 891. 4 6 1 526. I 131. 7 . II 10 11 12 I~ II 45 000. Z3 41 065. 24 10 677. Z6 21 10 677 . 'C1 14 093. ZI O. FOIm WI (19ll4) ~06 'l r"' Employ.. Busln..s Expenses . ... .'P....,n.lrIIellon.. ~ Allaeh 10 farm 1040. OMaH,. ".'.DIU .. 1 D,,"lf11ltftl"lhl ""''''V IftltlMl ""tf'lUl ."..lel 1111 'rou,,,,,,,, loc'" ..CUIIl., nwfl." ~~94 AlI..n"',"1 .. . ..,uHa. V"9 OcC"PIUon In which 'IJI"'''' .". ,"CUll'" GARY I plI1'l J. HBRNAN 91-.6-3.~6 MILITARY Employee BUllne.. Expenle. .nd Rllmbur.ementl STEP 1 Enter Your Expen.e. Column A Oth.. Than Meall and Entlf1alnmont Column II MaaIa and Entorralnmont I Vlhlcl..ap.nl.frotnUn.22otllnI2ll ........ . . . . . . , . . . . I Parking ,_, talll, and tr.n.pott.ltion, Including ~aln, bUI. Itc., thai lid nal Involv.ovltnlllhlravol ,................ . . . . . . . . .. 2 , Travel up.naa whil. away frotn home ovltnlllhL Including lodging, akplan., car rantaJ, ate. Do nollnclud. milia .nd .nlortalnmanl 3 4 BUlIn". lap.na" not Includad on Un" I thtough 3. Do nOllnclud. moalaand.ntorralnmant .,.....,........ . . . . . .. 4 682. 2 223. I MeaIo Ind Inlarulnmont .apln..o .."..,.... 6 311. . Tala/.."..,..., 'n Column A. add IIn.. I through 4 Ind .nt.. th. rllult InColumnB,.ntltth.amounlfromllnl6 ................. e 2 905. 311. Nala' If you wor. not ralrnbur..d lor any lap.nlllln St.p I, .klp IInl 7 .nd Int.. the amoUnlfrotn Un. a on IIno I. STEP 2 Enter Amount. Your Employer Give You lor Expen... LI.ted In STEP 1 7 Enter amouflll your employer IIIVI you thaI w... not reparl.d 10 you In box I 01 Fotm W-2.lnclud. any amount reportad und., cad. "l"ln box 1301 Form W-I ......................... 7 ~91. STEP 3 Flgurl Expen.ee To Deduct on Schedule A (Form 1040) I Bubrae1 Una 7 Irotn Un. I ,..................... ," . ~ 614. 311- Nola, If ...... aolumn. 01 Unl I are ..,0, Ilop h".. II Column A II '- than .ltO, report thl amounl II Income an Fotm 1040, IIn. 7. I In Column A. .nlor the amcuntfrom IIn. 1(11 ...0 or ,,,", .nl.. -a-).In Column B, muhlply thl amount on IIn.' bY'60% (.601 ...,., . e ~ 614. 156. 10 Add thl amounll an Un. g ot both eolumna Ind ont" th. totol h.". Al.o, .nlar III. lola/ on leh.dul. A (farm 1040), Una zo. (Qu.lIfI.d plrlormlng artilll.nd Indlvldu.11 wnh dlllbllltill, "" th.lnltructionl 'ot acIaI rul.. an whit. 10 .nt.. th.lotaJ .,..........................,...... 10 Hm far Paparwark R.ducUan AeI NaUe., "" In.llueUan.. 2 770. Form 2108 (18841 8 C'lt41 till"" I I' . IJ. HBRHAN .,;,{:,~ { 111I41 /1' Part II I Vehicle Expln.el (s..InltrueUanl10 nnd aut which laeUonl to eompl.t..) Section A, - Glnlrlllnlormltlon a V.hlcl. 1 II Entor th. dotlVlhlcl. w.. placed In IIrvlc. . 11 02 06 91 'I Tolalmllllvahlclawlldllvandu,lng 111I4 .. II 25 113 13 Bu.ln... fTilallncludld on IIn. 12. . . . . . . 13 2 352 14 P"cant of bu.lnl.. UII. Dlvldl Nno 13 by line 12 14 9 .37 15 Avorag. d.lly round ~Ip cotMmullng dl.lancl . . II \I Corrrnuting mil.. lneludod on IIna '2 II 17 Othor p."onaJ mIlII. Add linn 13 and 15 and .ub~acl tho tOlallrom IIno 12 ...................... """" r'I 17 22 761 191-46-3426 Pallll b Vahlel. I mil.. mil.. mllol mil.. 'J(, 'J(, milD milD mlllI mil.. rRI.. mll.1 III VII o No III V.. ONo o Notappllcabla 11 00 you (ot your .pouu) hlv, onolher vohlcla Ivallabl. for p."onai pu,po...? 11 II you, omployer p,ovldld you with a vlhlcll,l. p."onal UII du,lng off duty hourI pormlnod? 20 00 you hava avldenc"o luppan your daduction? III V.. III o No o II II "YD'-lithO avldone. wrtaan? ................................,.... . V.. IN. 8ectlon 8, - standard elgl Rite IUle thl. Ilctlon onlv II YOU own the vehicle,) II MulIIlllv Una 13 bv 2lI c.nll i.Zlt Enter tho ralull h..a .nd on IIna I. fAu,a1 mall carrlorl, ..lln..uctionl.) . . I II I 682. Section C, - ActuII EllDlnl.. lal Vahlel. 1 Ibl Vahlel. I Z3 Guolln., 011, ,apm, v.hlcll Inlurancl, .ta . I.. ... . .. . . . Z3 14a Vahlcla rental. ..... . .. . Z4I b Inclullon amounl ..., . .. . 14b e Sub.leI IIna 24b from 24a " . 1140 II Valuo aI emplcyar-p,ovldad v.hlcta (.ppiol only 11100% o. .nnUIII.... valu. WII includ.d on Form W-2) .......... . ~ II Add Unn 23, 240, and 2S .... . ~ Z7 Mul1lply Uno 26 by tha pereonllgo an Ino 14 .......,..., . c..!!.. a Depracladcn. Entor amounlfrom in. 31 below ..,......,. . ~ O. O. a Add In.. 27 and 21. Enter total herllnd an Un. I ...,..... . ZI . Section D, - DeDrlclltlon 0' Vlhlcle. IU Ie thle Ilctlon onlv II YOU own the vehicle,) lal Vahlcl. 1 Ibl Vahlela I 3D Enter eOlI ot oIher b..11 . . . . 3D 31 Enlor amount a1laction 17V dlduction ......... . . . 31 3Z Mulllply IIn. 30 by IIna 14 (SII In.~uctionlll you .Iocted tho .action 179 dlduction) . . . . .. . 3Z 33 Enter dapraclaUon method Ind percantag. .......,. . .. . 33 34 Mulllply IIno 32 by tha porconlag. on Hnl 33 .......... . .. . ~ 31 Add IIn.. 3\ and 34 ..,..',. . 31 31 Entar Iho IIm1laUon amount hom thl tablo In tho IIn. 3Ilnltructionl . . 31 37 Muhlply IIno 31 by tha porcenlag. on IIno 14 ,....,....". . r.1!... 31 Ent..lhe omallor oIlIn. 35 or IIn. 37. A1lo. .nl.( thl, amount on IIn. 28 abov' 31 O. O. H773 9 C'IUJ If,tI'14 -.. 1""'\ r"" , - Other Bu.lne.. Expen.e. 1994 8USAN 8. R.RJIAH Inlry NuonHr . 2 194-42-9049 BUllnel1 Expen.e. Stll.m.nt De Amount UNIPORM MAINTENANCE 475. Tot.1 475. -.., I I I i Fonn I n. I iN I '.. I f!l I ! K I I I I I I !'" : - I A . " " , "J j)'" ff ~f b~'" q ~ ,[ ! >1 :.a.... e.~ - ... ... ~ ... f \f b' l:.l I ...~ ,~ j ,f . [~.. ~i :) ,) ;; iiJ . ~ ,,.I ,~ .' "','1 ~J 61 i.'J I ,. ... ~ J ~ ,.. "'111 f.j ~ ~'''~l I ~ ::I I i v, ;) ... t,l :t jt,! ~ 1~r B Ai ~ .. n '1 i .=. 1 3 ... . I '" : '$ ~ , I : - . . ::tlr , : :-' I II .. Il' .(}\ .. - . .. .. .. - :w -If .~I : r f i r ~ ;-of .~( lar . - f J;3 :lJ ~. I! : . , ( .(" :~i ~ Fl :'t ~ ~~ I rJI i I I a ~l ~t : I -If "I 1.1 0 ! ...... a if; 7:li ii - :", ~ iI - . . . .. fll 0 '.a Ul ,;; i I f I f ( ...! ' ,'" " r'f : ~ I at !l I ... i fi ~i 81 II !IJ ... i ~i . I' Zl I ~I cti . f ~I 5 31 ,;. i 11 I - . .'1 '~I'I I: I I f a , f r f l10M . LIbel = :::... O\harW1II, pIMH print Ol typo. F1llngllltul a.ck only _ boll. ExemptIon. II men tt.n 6 dooIndInt., _Irwtr1 Income ~...!.. . fiUt,!. ~l did gila .2.," InItn.dlanS. EneIaH Wdonol .lIochY"" payment and payment \'OUCtwI. Adultm.nt. to Incom. ---~,...... Deportment of It. Tr~ - Intimal AI...... SaIV..' U.I,lndytttulllM Hax ""11m fOlIt. l'Iar Jan , ' Ole 31. lege. Ol oItwI t.. 1'111 bealnnlf'lll l- ) MlMtMJ-Pt...........m. .lm. .ndlf'lll .If. I. 1995 ,....FINIlI"'" GAV . ............,......,....,..,. "I UtI "'"" Y............ .... 191..6.3.26 -.....-.., 192..2-90.9 ,.~Ad ='~lIaU", _l~. 17013 V.. Ila _....= )( "",,''''''' -,....... X,........ J oil HER"AH ....- SUSAN HER"AH .......... ~........ "......... D. ",, "'Ill~ III EAST EL OW BREECHE RO. CIr. T.... ...,... OIl\cII.'''eII HIve.'.... ........... "'........ __No lutI lP CoM PA CARLISLE Do you want S3 to go 10 lhis find! " .. If. int r.ttJ'n doH I went 1 Slngll 2 X Morried IllIng joint III\.n (I"" If only 0111 had Incoml) . MorTied filing _"tl rtn. Enter 'pouIl'. SSN lbo.. & full nom. hall ' ' · 4 He.d of tnaah>1d (with quslifylng pelOon). II tha quslifylng polOon .. . chlld t>..I not Y"" dependent, ent.r uu chkfl rwm. twrt "... .. Duall w_ er wllh de ndent ctNld II I I died. 19 V....u. II you: pallnt (Ol .omeone 11M) con clllm you II . dependent on his or twll.. mum, .. naI chock box 60. aA III '\11 10 chock tha box on In 33b on PI 2. to ttN. I\nd! I. .......... r=-" 2 (4).... ......_ .,....- -.. .. ,.. .....: 12 ":='- 12 (11_ - .... Cl) ~. .....1 _..-x_ ift'''.MlIIltlr\K1IIMII 199.72.6556 1111-74-1246 C 1'-....1. ...: ,. ... l", ftIII1t OEREK J HER"AH "ONIC" T HER""H 2 50n Dauahter . ...,Iwt ..... f... ........, ......... . . , ' -.. .....- ...,. ......' IoM_ -.. 1-- II .,.dMW.IIlIl'........r-WtlclunM..pvl~vftHf. ,..-,.. ",","",lochKk"'" . Totll nunbtr of e.em tlonS claImed 7 WlgeS, IIlanes, tIPS. etc. Attach FOfm(I) W.2 . I. T.......lnI....tlncome. AlIlch SChedull B If 0'" $400 II Tu..-.,llnt""l. Dan' Include on line Sa ' . Dividend Incoml. AlIach SChedull B If 0'" $400 · 10 Tlklble ref\ndS, credits, or offl,ts or Itlt. .nd locallr\Come 1aiel 10 11 Alimony '''"ived, , . 11 12 Bum... Income or (Ios.). Alloch Schedull C or C,EZ 12 \I Capll.1 glln ot (Ios.). II reQUIred. Alllch Schadull D " ,. Ott'e, gal"' ot (los.IS). Aitach Form 4797 . .. .,.. .. ' I. "a TallllRA dlSl"bulIOllS ",lllal_ I b Taxabl. .mount .., lib ,.. Tal pensIonS & aMUlhlS ' , . , . [iliL II Taxabl..mount. "II 17 Atn'.1 ,..1 "t.t,. royalties, partnershtps, 5 corporahons. trust" Ilc. Attach 5th E . 17 11 Finn Incom. or (lass). Attach Schedull F JL. II UnemploymlnlCompensohon .",... ,..", . " .", " II lOa Soclll '''\llly benefit. " ~!.l_______J b T..obll amount., lOb t1 Ott'er Incoml "_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - -' 11 II Add tha Imount. In the 10' I col""n lor line. 7 . 21, ThIS "talallncama ,. Z2 U. YOlI IRA deduction. . . . , . , Ua II 8pouse'. IRA dedUction, . , lib Z4 MoVing IXpens... Attlch Form 3903 or 390H Z4 II One.hall 01 ..1I,lmploymlnt t.. . , II II s.II..mployed t'ell1h Ins\llncl dlducllon 21 Z7 IlIojII!1l"hTllIo)od 5EP p~nl II SEP, thod< ~] Z7 II Penalty on ..rly wlUnlwal oll8VlngS a. II AI_HId Roc~""f1 SSN. II 7 la 99 3 B, IU. I.bl. 114, ] 99 596, ;-; ,;c~~!. ':,' ,i.f~~ ',-l:-.,. .. Add lines 23a t 29. ThaSllf8 talal ad uatmonta . .. .. 11 99,596, Ao"Ultel d 11 ...actwlO"""'....a2, Tw.l.wo...........,...hte... Hit.. ,.......,Jllfdr~1WM t'OIl "come MfI,., (It.. ~UJO H. rftIld1ldrl1/1vt ...~. ... fMNd ....~~-~!.!!!.!~!~"'" . . . 1M Form 1040 (\995) 'D....OIII 11m... 'llf'!' '''Il~ T. Camputetlon II )'OIJ want Ihi IRS to IIgln )'Ill.r IaIL*. InaUUClIonS. Cmltl other T..I IWlllIntI Attaell Forms W.2,W.2q, and 1000.H an page I. ltefund or Mount You 0.. SllIn .... I<aap a copy of thI relum fer yo<I rlCCldI. Paid P"~r'. U.. Onl~ GARY J . SUS""'ttER"AN r-, . Amount from line 31 (odlUltad grcaa 1nCDmI) """""""'"'''''''''''''''''''' Ua Clledl ~ 0 Y. _151_. 0 Blind, 0...... .,IS/oidof, 0 Blond Add It. runbor of bo... checked abo.. and ant.. tt. 100al t.1I ."".,. . . . .. lIa loll )'Ill.r parent (ot _ alii) can claim you II I dependent, ck t.re ' . ,. 1110 e II you are morrlad hllng IIplrellly and )'Ill.r spousa ItlmlZII dIduc1lon1 CI you Ire I dual.atllUl IlIln, III Inslruc110N Ind ct-eck t.1I. , , ... En'" ~1IamI_ ~DM from Schedule A, I,ne 28, or r:.. - ..........hown below for )'Ill.r I,l'ng Ilalus. But II YGU ckd III any..... an line lie or 10, _ 'nstrucllOOS 10 t'nd )'Ill.r lIaf1da'd ""'" dlel, It you checked 1101 lie, )'Ill.r .llndard doducllon .. zero. I Single - 13,900 . Haad of houslrold - 16.750 . MImed "lIng jo,nlly ot Quallfylng "Ido"ler) - 16,&50 I Married "ling Itpllllely - 13,27& . Slblract line 34 from line 32 . 99,5 t. · lie 0 " i~~ .".' ~,'i' ... 20603, . 78 993. If In 32 11186.025 or 1111. mlillply 52,500 by the totl' no. of ..emptlonS claimed on In 61. If In 32 II om S8610~, 1M thl InstrtJCllons for the emDU1t to enter . ,. 17 T.......I_ SWIre.! In 36 hotn In 3&. II In 36 .. mCla Il10n In 35, Inter .0. " , , . Tal. Chock It fromaOO TI. Tabla, 100 T.. AlII Scheelulll. cO Cap,lal OI'n T.. Workstwet, or, to Form 8616. Amcu1t ham Form(.) 8814 ,.., . a . AddltlDnlllaxo. Chock" ham ., ,aD Form 4970 100 Form 4972 . . . , . , . . . . .. Add II_ 38 Ind 39 . 41 Credit for chid Ind dep care "p. Attl.h Form 2441 4Z Cred,t for I'" IldIrly or t'" dllabled. Anlch Sch A 41 Fotllgn t.. credrt. Atllch Form 1116 .. 1M Ott.r clOd'''. Chock " ham a8 Form 3000 100 Form 8396 eO Form 88)1 d Form ('PIC) ___ 1M .. Add lines 41 lITough 44 . SlbIrlct lint 45 from line 40. II hne 45 II mm. than line 40 enter .0, 117 Sall,"mploymlnt tax. Attach SCt'edul1 Sf .. Ahlmallva minim"" ta.. Attech Fotm 6251 ., . . . , , , . . . . . .. Roclpt... laxo. Cl< 'f ham aD Form 4255 100 Form 8611 cD Form 8828 10 SSIl'<l...'....luonl1p"""""notnporledlo.....""",AltacHorm41l1. 11 rax CJr1 q\JIIIlfltd rwllr.m.nt plans, InchAlng lRAs. If reqUired, .n fOfm 5329 . II AdvInc. ..med tncom. crldlt PI)'fT1tntS from form W-2 . U HaUlarold employment taxo. Allach Schodull H . .. Add 10.16 . U Thll " 1III1t.. , .. r..I......Iu_~ Itlllr II homrorn(l) 109'l, d'<<tl , II 199!lllllmstld I.. Plymlnt. and Imount Ipplled frotn 1994 ilIum ' 17 to.... ""-._ Attach 5,"''''10 lit rt IW "'" . qUllofr"'ll tMd. Honllubllearned ~ .rrount . .. 1I'<I1ype..... N AmUll'lI paid ",Ih Form 4868 (exllnslon roquell) II ExCIII .oclal.lClOily Ind RATA lex ",llTeld . 10 Ott.r paymlnl.. Chock " ham aD FOIm 2439 100 Form 4136 11 Add line. 55 . 60. Tho.. ..a total nil. '1 II If I.. II II """1lIon I", 14. l""hlCll", 14 hom I... 'I hll..Iht""""'IWOwo"lkI... ...., 12 U Amountofllne62)W".."L..l.........toY . .... . . .,... .,.... , ~ ., .. Amtolln62)WwantAppUotI "UItTal. ,.~_____ N If In 541. mOlllhon In 61, .WlIICt In 61 hotn In 54. TIn I. 1110 Amount You OWe. Fot dellll. on ro" 10 PlY Intlud'ng us'ng Form 1040.V, Plymlnt VlXJthor. III Instr , H II Estimated ,.. nelt, Also inch.de on line 65. II ,j. '. ,r;;."y-;" \WIIr........., peojtIly.l....1'I ".. , hh. ..'""* Ill.,.,... 1M HumpltI)"'" wtIMlIiI. INlltI~. ,till.... Mlt II"" ~!Mtt IrIII1 1leW..., '''hI, ~.1/IIll c........ DtclattMftof!"PI"" (oIitl.....II'-.,.,,,,,,.......1N 1fltomvtlotl.,....lChptt,.~ hit 'II, ~ . " 10 000, 68 993, . .. . .. 14,243, 14 243, 41 G 41 960. .. ~ ... 117 .. .. 10 11 IZ II .. ... 960. 13 283. 13 283, . H 14 597. II 17 N Sf 10 14 597. , . 1.314, '.U:":i'::"," y...,.,,,atul'l D... YOIlfOecvpaboll . '''''''''' "MWI' .. Jair.I "~_ lorn hlltll-ii9".~-.-_.._---- b.I'---U -.--------.- .poII....OUltp...." . P""""'hc~'tc"rttr"'< ~Y'S7..2- D... Chee'" L(//.3/r;C ............. ~=. ,""'" NMtI l:ll::: · ...~ ---- -. -~"------------- -?,..,.. .. ./ . "'1 ,..- Ut ~ (.1' / -_~?i....~.:b..~.._,. "L-4-~U:"'----_u __..b_>j_~_L~L_~ -~.- -.----."---~.I.It'.Jr~OI11" ~r"'~....---.--_._-- tpC~_.L...::z ~ ;' IcIl..1JI1 A ~ Schedul. A - Remind Dtductl,.... _Ila, ''''all. .-'11I) 19H ' , ~"~a:J.04O, t~d~!'.l.~ lWl · ... IIlr A(F_ t04O~ 07 ___""...1010 ,;--..--- GARY 1 ~ SUSAN HERHAN 191-46-3426 ... CaulIaft, 00 /HlI ""/udf _... ",mburIod., plrd by IlIhIn '~I;;, .. 1 Medical and dlntal axpensa. .. T21 . . . , , . . . , 1 2 Enlor _nllrem rorm H)lO, line II , '-'ol' .'. J t.\1lbply II.. 2 above by 7,5l4o (.075) ..... . 4 Subtract II.. 3 lram II.. I. " II.. 3 01 mora 1I11n II.. I Intor .0. " . . =r V... . Stall and Iocallncomo ta.al .. .... I 3 547. ;;.'~ . Aeal altala ta.11 , . 2 144. 7 Pallonal property ta... . 7 . Other Ia..a - llat typo Ind ornount . " Other 591. 8 591. . A~"~i5~~~8~-------------------- . . . . . . , . ,,,.. .. . 6,282, ==. 10 tbna rnorwlntwost end polntl reported to... on Fo,m 1098 , 10 9 524. ),. 11 Hama == Inlml not Itpottad to)'O. on rarm t098. II paid 10 till palOft WI1am ... bar/9lltlll hOn'J ItI InI~ctronJ end l/'ow . .. lhatpalOll'I_IdoinII!ylll9numblf, add'..1 . .,., ..,., =~ ------------------------------- ------------------------------- not 11 deductible . ------------------------------- 12 POlnls not raporlld 10 you on Form 1098 12 11 Inveltrnlntlntorest. II required, Ittach Form 4952. (5la instrucllons) '" 11 1. Add llnas 10 1I1rough 13 """ ". ....." I. 9,524, = 11 Gilts by cash or chIck. II you mIdI Iny gilt 01 $250 Dr more ..a Instructions "". .,."",. " '" , ""'"'''''' " 11 1 930. II f! made 1. Other than b~ cIsh or chICk. "any gilt 01 $250 or more, Sl. I . Md InstructiOns. , over $500, you M...t attach Fo,m 8283 ..,... ~ a banalll I' It,_ lrwhlctions 17 Caff)'Over from prior )'lor . " ",..., .. 17 1. Add llnal 15111rough 17 ., .... . I' 1 930. m:: 1. Cllualty or thalt 101l(IS). Attach Form 4684 , . . , , . . . . , . . . . . . " 11 ~: ao lkYalmbursed amplo)'ll a'penslS ;J: trlval, unton dUlS, job aducatlon, ItC. "requ""d, you lt1ach Form 2106 or .. 2106.EZ . -------------- ~~{ J!'!te!!'ltl'\.t_ KH~ ~l!..P_ _ _ _ _ _ _ _ _ _ _4" R4~ 20 4 624, 21 Ta. praplrallon to.. . , ". 21 235, a Other "'pens.. - Inve.tment, saIl dlpoSlt box, ItC. . (Sea list typo and amount. --------------- lrwtrucbons 1o"::I::nsll ------------------------------- to do uct ------------------------------- a hare.) 2. Add llnel 20 through 22 ,. .... ..". . 2. 4 859, Z4 En'" amI f,am r.,m 1040, line II " (241 99 596. ., 1 2ll Mulllply line 24 lbove by 2l4o (.02) .., . . . . . ,. .... 2ll 1 992. 21 Subtractllna 25 from line 23. " line 25 Is more 1I1an line 23 Inter .0. .... .., ',.. · 21 2 867. ... " Other - from 11.1 In 1111 Instrucllons. List typo and amount. ------------- ------------------------------------------ · Z7 21 II Form 1<)40, line 32, over $114,700 (over $57,350 II ma"OId tiling .lpa,alely)1 .. a No, Your d.duct,on IS not limited. Add 111. amounts In 1111 far 'ahl column lor J line. 4111rough 27. Also, Inter on Form 1040, line 34, 1I1a rgar of 1I11s 603. lmount or your stondord dlductlon. . 21 20 a V... Your dlducllon mlY be IImltld. See Instrucloons tor \hI Imount to Intor. --'~'.l Aillllllfflllil~'iij!llK' 11M Far r....._"" ""'<1lan Act HalIea, _Inolnlctlana. Schedull A (form 1040) 1995 f[JI,A.OJOI IOJ19," ,_ _1. "'"""I ,-... .hlld .nd Dependent C.re Expe,. . _ No '11'_ ~~~ . Aftach.. r_llMl1. 1_ 21 ,--.....- .. ... GARY J . SUSAN HERMAN You ne.d to underltand "'e IolloWlng ta,mllD completa ""llorm: 0uaIlIlIlM 'anM(a~ D......n' CaN........., Quill.. EIqIlna.., .i1d rimiII___:SIIIJl1,.11allt t_ In tha I..truc~ns. IClII1KiI fie,"", or Oraanlllllon. Who Provided the CI... - You IIlIlIt compll" "'II pari. ~ ~,~u netd mo.. 'ipac., ..t lha bo~m 01 P'lI" 2.) 1 (a) Car. proVKler'1 nome (II) Add.... (c) Idlntlly'ngnumbe' (no.. .~..t, apt no., City. Ita... Ind ZIP cod.) (SSN" or EIN} CHILD DEVelOPMENT CENTER C~I!LJ.H.l !l~fUlj~Kj_ _ _ _ _ _ _ _ __ CARLISLE PA. 17013 SEE PAGE 2 YOUTH SERVICE CENTER CARLISLE BARRICKS C^RUSlE-p~-iim3-------- (II) Amount p.1d " 592.00 2 736.25 I Add lha amounllln column (d) oll,ne 1 2 1 328. I Entar lha numbe' o. ~aMtwlne panant clred lor in 1995 · 2 Old ~u ..Clive '11 ...ot ... toanalllo, No YH . Complllo only PlrI II below. . Compllla PlrI III on pall" 2 now. !iI[[J C....t lor Child Ind Dependent C.... EIlpen... . Enlar lha amount 0'= atqIIMH ~u Incurr.d '''U"id in 1995. Do . ....nta' mo.. than 2,400 10, one quali ng paroon 0' BOO 10' two 0' mo.. 1'1"0". If you compl.t.d P.rI III, enter "'. Imount ~om line 25 . 4 800. .i:;~. I Enlar WOW .......Inc_ B 60 118. . If marrtad filing a:nt return, .nt.a::........... ..'ned Income (lIotud.nt a, dllabled, u, InI~UCtIOns); _. .nter "'. .mount from line 5 ' . . , 39 200. 7 Enlar lha --... of line 4, 5, or 6 . 7 4 800, I Enta, lha amounlfrom Fo,m 1040, line 32 ' I 99 596. ',', I Enta, an I,"" 9"'. d.clm.1 .mount ohown below "'.1 .ppll.o to "'. .mount on line 8 IIUn.lll- lll1nalll- DKIIIIII But no' llmounl Over _ I, SO - 10,000 .30 10,000 - 12.000 ,29 12.000- 14,000 ,28 14,000 - 16,000 .27 16,000 - 18,000 .25 18.000- 20,000 ,25 Doclmal ~mounl .24 .23 ,22 .21 .20 - . - . . - - - - But no' Over aver $20,000 - 22,000 22,000 - 24.000 24,000 - 25.000 26,000 - 26,000 28,000 - No limit I ,,,, /ii. 'JI~~' ,I," 10 Multiply Una 7 by"'. d.clm.1 .mount on line 9. Enter "'. ,.oult. Th.n, 0" "'" instructiOns tor the .mounl of credit 10 enter on Form 1040, line 41 10 CaulIan, If you paId e "",.on who wolked 111 you, home. you ",.y have to p.y e",,/Dyment I.... 5,. the rllJlruc',on. for Form 1040. ',ne 53 1M 'ar'...<NiIIlMucllcn Act Nalk:., _oopera'tlnllnlctlant. Form ""'I (1995) frxAJ2I2 11<<)11'9' 0.20 60 Form 1101 a e:=~~~ (99) v.._ U~burstd Imploy..lutln... ~.n... . AtwhIoFormlCM9orFormlD4D-T, _No,I"I.'Ml Y HERMAN fiIDm GtMrlllnlormlllon YIllI" _........ OIllW"" at... foL..L.. ","' a You ar1I an amploy.. d1ducbng axpensla at1llbutabll 10 your job. a You ;a1lll4 gal ralmburlld by yoU' Imployer lor any a.pens.. (amounts your employer Includld In box I ot YO'" Form W.2 are nol canaldarad ralmb\.namants). a/l you ara Claiming whlcla expensa, a You own yoU' own whlcll, and IlYou ara using tha standard mileage rate lor 1995 And also uoed II tor thl year you first placId the vehicle In IIrVlce. ~ FllIllre YOllr Expen... -....- 191-46-3426 1995 54A Oca4l.lon W\ 'iIhdt ElJIfM''' tncunM HI L1TARY Vahlcle expellllluslng the standard millage rate. Complete Part "land mulbply line Sa by JO' (.JO) 1 360, a Parking loll, lolls, and transporlllllOn, Including baln, bus, ltc, thaI did not onvolw owmlghl bawl 2 I Tra..laxpensa whlla away from homa o\lernlghl, InCluding lodging, airplane, car rental. Itc. Do not Includa maala and enterllltnmlnt .......,...,..... , .......,......., .. , ,. ..,.,..". I . 8ullness a.pens.. not Included on lines 1 through 3. Do nallncludl meals and Interllllnmenl . 2714, . Mula and antarllllnmlnt ..pens..: S X 50% (.50) e . Yllr.l:.:' Add 111101 1 through 5. Enter I"re and on Ilna 20 01 Schadule A ~orm lIMO). or form I.:r f till rulll ~n -::.. (g>:~l:rd,:,,:,,:::;~~. artISts ~nd 'r<l'Vlduals\01th dlsabllba., slllnstructlOns . , fiiI2llnformlllon on Your Vehlde, Complltl IllI6 part On~ It you a.. elelmlng \Iehlcle expense on tine I. 3 074. 7 When did you place your \IehlCl1 In SlrVlce lor buolness purposls7 (monlll, dey, year) · ::1.1I../C;I. . . 01 tha total number of mile. you dftl\le your whlCle during 1995, Inter Ille number of mil.. you uold your vehicle 'Dr: a BUllness 1,200 b Commuting cOther 12,300 !BJ YH 0 No ~ YH 0 No !BJ Yn [] No .. .[Rl Yn DNo Form 2106.EZ (1995) . Do you (or your .poUOI) haw enother \IehICII aVlllabl1 tor personaluoe1 lD W.. your \IehlCle a",leble for uoa dunng off,duty hour.1 . . lla Do you ha.. tha aVldence 10 suppo,t your deducliDn1 II /I 'Vaa,' Is tha eVidence wrltten7 1M For"Flll1.Atlllalluc1lan AdNollea, _ separalllnslnH:tlanl. FllIA1~1 tWlm Sche.... A U.... 20, 22,1:1 , MI~I.neous "tmlud Deductions SIIttm.nt 1995 . Anach 10 relum (after all IRS lOon{ " Statement ~ NamaCa) lhown on lltun GARY J . SUSAN HERMAN EmpIo~ Bullnlll ExpenH' (Sullj.ct to 2% Unit.llon) Social Sac"'lly !'Unbar 191-46-3426 1 Deductible expenses from Form 2106, line 10 less deductions for per/ormlng artists and handicapped employees claimed elsewhere 1 3,074.00 2 Other unrelmbursed employee business expenses: . Union and prolessional dues 20 45.00 b Professional subscriptions , b c Uniforms and protective clothing , c 1. 220.00 d Job sealch costs d . Other: a J~~lH~~______________________________ 285.00 ------------------------------------- ------------------------------------- 3 TOtIl unNlmbumli -einPliiift bu-.rn.a. .....1.... erii Sch-A~ ~ne -20) . M.CIIIlneou. ExpenHI (Subj.ct to 2'~ Unitlllon) Ch<<k 1M box In In""/llment column If an Inveslment expense Investment Expense · " Depreciation and amortization deductions .. 5 Losses Irom casually or then of business property, Irom Form 4684 6 Losses from casually or then 01 business property, Irom Form 4797. 7 REMIC expenses, Irom Schedule E ,. 8 Investment expenses related 10 dividend Income. , Expenses related 10 portfolio Income, from Schedule K.l 10 Miscellaneous deductions, Irom Schedule K.I 11 Excess deductions on termination, from Schedule K.l 12 Other deductible expenses: I Investment counsel and adVISOry fees . b Certain anomey and accounting lees . c Sale deposit box rental fees d IRA custodial lees . , . Other: .....mX .. X ... X ~ ------------------------------------- ------------------------------------- 13 Toiifrriic-a.pen.-'..-Comtiine lines '4 -: 12. (To Sch- A. Tine -22)- - -. oth.r MI.cell.nloul D.duction. Not Subj.ct to 2% Umll.llon 1" Federal estale tax paid on decedent's Income reported on this relum 1" 15 Impalrment.related expenses 01 a handicapped employee, Irom Form 2106. 15 16 Amortlzable bond premiums on bonds acquired belore 10/23/86 16 17 Gambling losses 17 18 Olher: 18 19 TOt"OIh.r-~a-c c,;d-uC1lon.~ Combin; ~n-;'s f4-.19.-cTo-S~h A,line- 27) . 19 3 4,624.00 X X X X X X " 5 6 7 8 9 10 11 120 b c d . 13 . """" "..... .----- --...--- ------- ----- -- --- - .---- --- - _. ,. . 'I r' I " I C~lroI numt~r Copy C For EMPLOYEE'S RECORDS (m Noll.. on bact) f.4 No I 01. 8 b EmpIOYI"IId.nllhcallon number 1 Wages, Ips, Dlhe, ~bon 2 Federal income !all Wllhheld 'I " N. 0 ")0:'1'1 3 Sociallecunty wages 4 Sooal .ecunly !all Wllhheld 'm n ? 'I f. 5 Medicare wages and lIps 5 Medicare tall: WIthheld 3<1 IflQ."4 I 5ti'l.Vl 7 Social secunty tips e Allocated lip. 8 Aavance EIC payment 10 Dependent care benefJIs 11 Nonqualifled plans 12 Bonellts included in boll: t 13 See lnsltl, lor 00113 14 Oltle, l'~lJr. - ~3. J2 c Employer', nlme, addr,.., and ZIP cod. \kn: IlCJ:O :,'<J;;,ll:' l'!'yzil:J..llIr" Ft: l~,ju Gc..c,i 'ZetA:" 1"-",,d j,~cl~, P^ 1;~~5 d Employ.." toclal IICUtlly numbe, ':v- ....-.ill!n · Employe,'. name, addre... and ZIP code 3lJO~1~ H(~r~r. lli L.;JHI: ~el!Or; IJr"I.'C", /1 :lCilt: Cut 1 L1h.!, fl"l liCd':; 11 S&aII Employer'. Ila'810. No. ." I ......................... 5 SI.1I.1Oll o.:..Md P'~IOII lfQIl '"1JIO)" pli~ rftl -,,, _u"" H.... ..... 17 S.~..l" 1\>.. 1') 1~''l. '... ...r......... 11 SlllelllComelll 1 :)1')7.'i" ...1........ 18local.ry name 20 lOCAI.ag.. ''PI ,I( ~.~1 '1<1 1'1". "'. .......... .............. 21loca1irWntw . ~.".~\r:'0.... 'I lWII2 Oepartmenl ollhe Treasury -Inllrnal Revenue Service Th.. Infolmallon IS bel"9lurlllshed 10 Ihe Inlemal Revenue Servin II ~ou I'. required 10 Ide a laa f"urn, a negllgftnee penally or other IAnellon may be impoled on you I' thll Income i'la._ble and you la~ 10 'eport 11 Wege end Tex Sletemenl 1995 -___w- \ I :1 , J ""'" TEL:717-732-9241 ,-.., . GOOD HOPE FAM, PHYS, .11P40 L.be1 (tee ....N.,'.) Uta the .11....., OtI1erwiae, plall4 pnnl or type. elMntlll ..\Ian JIll.., (hi"""".....". filing Statile cnact< only one boJC. ExemptlDna II ",ola111111 6 daplnalnlll, ... thl H ~ttu~. tionllor IIno 6c. Ifteome AllaCh c."hl &rf~o.ra.'. \Oii.i ...., " yoU did not 51. W.2, oae . ,"atructiona """ /, Enelo~o. bul do no. .neeh. eny ;::1111. AloO, I.... ."ele.. ormltMO-V (lIa 111. II1IlruC. 60nl lor Ilnl 62), AdllI.ted Gte.. Income 1111".3110 under $28,49!l (under Ill,SOO II il child Cllo nol II.. WlII1 you), ..a lI1a lha~uc' tion. for Ilnl 54, lip r 18' '" 7 o.,ltttn'\eflt.f '" '''''''''t - Ir'l&lrTl~ A~. ""-u U.S. Indlvldulllncome Till Retum For lI11 yeer jen 1 . Dlc JI , 1996, or Diner I.. YI.r OeQ'Mlna 11:04 No,OO~ P,06 1996 IRQ "t. fW\Iy - 00 ,..1 ""fII.'" UIIl1e Itl _.. 'n.,.. ,I9OO,Ina,ng ,19 ~tw,. Yowr,nl"'1tIu. II U'l"'~ HERMAN Ln' HI_ SUSAN I" ,IoInIPelJn. """""'11\11111'" II V", itcllt ....'" "t. 194-42-9049 ,,.... tlecJII ............ 111 E YELLOW BREECHES c,~. TOftf' rw Put! OMct. If Veal Hh" "9fI!"" AotrtM, Set '""M"'" .;.w...IN. For hal IIndl"9l1r~- InltN~Onat .eI - - natNcllanlln the ""okla!. YH No )( CARLISLE 00 you wan' $3 to 90 10 In,. IUnd! . . . · "I o,nt relum, dllll our 1ll0Ule went $3 to 0 10 thIS Wd! 1 ~ 5.",11 2 Married flhntJ JOIMt reun (a.on II only onl had InCotnl) 3. MII,,"d IiIlnQ .aparoll rlw",. Enter spOil..'. ~SN e!lOVft & fUll nomij ne.. .. 4 ;X. HeaU 01 110",,"nold (W,th quallly'ng p""on). (5.. ,nstNc1lons,) II tn. quahlylng pellon II . cn'ld ~ul nOl YOlK d,plndlnl, Inlel trl,""hiId'. nama hera .... Quell n WIdow Ir W1~ d. Indent .i,ild YouraaIl. II your p.ront (or .omaone .111) cln ,Iaim you M' . dependenl on hla CI her 1M' r.lufn, do not ch.Ck bOI 60 ,.,........ . . ...... . . . ' b["l ._......'...... .. C Dh-'N1an'",' 12l0tl*ldlflrll'elll ....... *""lynuIlIDer,1I born In o-cor lit&. ..Inllnlen,n. 1 -6S56 1 1-74-1246 "4ome Add,.... (nwmf* 1M ....1'- lI"1'ou )Il... .'0 Do., Snlntl\lcw' e"" l1P Cod. PA 17013 ... a....... Y'I'MII1tU',,,,, ,aM'" ,"""". 19fIt....h\tf .~~~- LISt naml (I) D.pendlnll rllobonan,p to you Son Oau ter 1- ........... ...... ... ... II..' . .. _,....1 - "."'.' 11UIf... II (')No" ..IC_, II1cnthJllvtd m )'Jur tlQ~ ......... '" 1996 loll....... ... roe ill II 12 -...- I ==:.l.':. 2 -- ..-t----" tt.."":."':.. ........ .... a"_II ,:::-.:. . II- dTolll number ol..am bonl clllmaa . 7 WaQII, lOIar'lI, liP'. etc. AllaCn form(.) W.2 ,... '1 TlulIIllnl""1. Al1lIen Sen.dula B II over ~ . , b T.........pllnl....1. 00 1lO'lnCludO on III" 81 . . . . : : : : : W . Dividafld inco,"e, Anaen Scnodula a It over $400 , , , . ' . . .' .' 10 T..abla "IYnd.. crldll>, or oltollo ol.~la Ind local incoml to,". (see 'n.~uc"onl) 11 Alimony ,."vlvad . ,.. ........ 12 Business ,neeml Dr ~o..). Allacl1 Schedule C or C.EZ 11 Cep.tel g.,n or (lOll). It reqUlrld, .tllIen Scnudul. 0 14 Other glln. nr (10....). Al1lIcn FOlm 4797 . . ,.. .. . . ". lB. Total IRA dlstrlbuholl' ,...' ,W I b To..bl. amounl (sv. Inltrs) 1.. 10111 penllo", and ..'''IllS ..,.. [J!!J b ro..bll amount (all Ino11.) . 17 IIlfltal rul ut.tl, loyalolS, porlr1l"nlp" 5 corporabo"" \rUllo, .Ic, Anlen SCh E l' Farm ,"come or QOII). Ahacn Schecul. F . l' Un.nl~luyment complnubon .,..", . , .. ,'.. 20a Social lOtur,ly b""',11 . . . ~ 21 Oll1er incom., ~ilt Iype end amo\J'\t - .ee ,n.bucbona i'b T"eb;~ ~O\J'\1 (sel InstrO' Incoma , -- ...- 7 'al 4 U Add'tl,; ;m;,u"Tain-th-. jar ri htcOlumn io'-lIiiii 7 :-2;.11;"1'1 'Our i'aiallnciml - - --. 231 Your IRA Ulductlcn (sle IM.bucllon.) , Sa b 5poull.. IRA CleduCUon (.~v inltructiono) , , . . ., . 21b 24 Mo'MQ upln,"". Al1lIch fotm m3 or 3903.F ,..', 24 2ll ene'h.1I 0' .ell..mplo~."llll.. Altoch Son'dule SE 2ll 21 Sell.employld hlllll1 inlUlanee dldlJction (te. InstNc1,on.) at 27 KIOQh and "1I.",pl.rod ~U' pl"l, II SU'. cIioek ..". -n 27 21 Plnalty on aorly ."thdrawll 01 ....ng. . 21 at A1i"",n, Plld.lloclpl..t1 SSN . . . .. II II Add linea 231 . 29 "., , , .. . .. . . . .. .. .. " " Suctracllln.:lO ~ anlllnl 22. Th" 's lust. .~lIJII'rl'''_'__'~ r.r-....vt".,.II!tl~IftI".,._I'.."--l,_. I I '()lAD"1 It.W1)I . 10 11 12 11 1. lBbl "llbl 17 ,. 11 20bl 21 '1 U' 41. 3, 4 II . 11 43 87S. \I"I'.I~ .---------------------------------------------------- I'" GOOO HOPE FAM, PHYS, ........ TEL:717-732-9241 Apr 18 '97 form 1040 \ ~:"putlllon SUSAN HERI1AN II hnaunt from line ~1 (IdiUStld QtO" ",com_). ..,.,. ......",,' II. Oleo~ II: [l ,. "'" U'oldor, r I lI~d; L I .......... "'01". 0 11,04 ...~~ \t1e numller of 00..1 ohacked Iibova and .ntar Ina total here. ' . . . . . . .' ~ "I 1111 yOU ara marrlad Iillng Hparllaly and your IlpOul1 ItemlUl dlducUDI" I I or you ware . dual'lta"" allen, HI ",.lrucIJona and ch.Cl< hera .., . . ~ SIb M~'" -Gilncl tIaiuctIona from Seneaula..., line 28, Or } rear ,,.,..,,. tladucllan aho.... Dolow lor your nliflQ altlul. IuI Oil 111. o ,",~UCllona II you chacktd lily bok on llna 33. 0( b ..1OI111."a """. can claim yOU as . aapanaanl. t Blngl'" $4,000 . Mlfllld filing loln<<y or Oualllylng VOIdow(er) - $6,700 . Hatll 01 household - '5,900 a MIrTle. tlllllg Hparetely - $3,3!<l . Sl,lbtrtctllna34fromllna32 ........................... . ........ .......... .. . Ifllnl 3Z 11.115 or In~ mulUglr I2.SlO br lhllelal number of _t,onl cllimed CI\ IInl 6d. " lint II II 0'0W 1SI.4R ItIlhlworkl'-I'n lhllnJ1tucllOnllor thunounllD""'.. .. ... ...... .. . , f7 T.....Incam., Subtract lint 36 nom line 3!5. II line 36 II more lI1an line 35, Int., ,0. . TI.. S.. n1JUC\lons. Chtcll \I total ,"Cludll any t.IJc from I 0 Form(.) 81114 II 0 FormMl72 ........ ............ ...... .... ... .... . Otdlllor ctuld IIlillllCllllCl..1 ~II _1tI. Attach Form 2 I.... . 40 Ctedll fat Inl .lderly or Inl Clubl.d. "'Men 5cn A .,. 40 4t furllgllallo:radlLAttacnForm 1116 ..................... .. 41 4Z OIIle,. ChICk.1 from." ..,.,. 8 Form 3800 II I J Form 83g& e n Form IllKlI 1I farm (IPIC) __ 4Z AS AlllIlr..1 39 thrauQll 42 ....... .............. ....... ............... .u ... lSuIllr.ct 11n. AS ',um \"'" 3lI. \I linl 43 ,a mora IIOIIllna 38. ""tar .0, ~ ... 41 :loll..mploymtrllllw. ...l1ach 8l.'t\ooul. HE. .. . . . .... . .. .' .. .. , . . , ., <III 41 "'Ilt,nallva mlnrmum Iak....l\KlI Form 6251 ,........'.,. .,......,. 41 47 as eM Madkn tar 011 lip IllCDIM !IOI rtpl'ltd Ia tmglorw, AltIdr 'I,m 4111 .. .......,.. .., 41 T.. on ~llIlId tlllllmant plana,lnclU<llng IRAI, II rtqJltla, .ttaCh Form r.:l29 . 41 41 AdVonc. aarnad Incom. o:raml p'rm.nll from Form(l) W,2 . . . . . . ., " 41 10 Houlahold tmploymanllallll. AllIch Schadule H .........."...... ....., ..... . .. " 10 11 AddIltIU.!&l TIlIIII ...111. ..... ................. · II U F-*a11_luwilNllkllromFormlW,lInd11M ......,.. U 5 953, II -~ lI~want III IRS to ft.,... yOU' \IllLII! Ina 1ns1fUOUona lur I.... 37. ere." S4 025. . 850, . 7 650, 17 ..~ . . 23. Other TUN 'evmentl 19!1Ii eltim.tad IIlk paymtntllll'1d amounl appliad from 1995ra\ll'n ....... ...... ..............'. ..... 14 I.... __..... AIlIctt SctrIdult llC rt reu 1M . Qual""II8 ctnld, Non"uIl~ .1IIl1_r I_nl . .. . . ~ eM\IPt,...~ ______________________ 14 II Am...." paid wt1h form 4IliIl (,."".tlo, e_on) , , , . , ' . " · 81 Ewca"socl. aacur.1y and RATA t.IJc VOIlhtrald (..a Ins".) ...' 81 11 Other paym,nll. CheCl< "!rom .... I J F .fln 2439 11.,[.1 Form '\36 .........,.. ..,..........,.......... .. 17 II Add lmel e2 . 57, Thal..tI ur IoIaI - " .. .. .. .. A.lund It If Imo 1111 mort lhan \,,111, subtlletll" lllrom llnall TIIIIIlIhI I/nI)U11I rcu Ororfll. Htva It IInl 10. Amount or line 69 you want IltlUndtllla You ... .........,. ...... ..... g::lc~~:rsaa ~ IIRou\1llQ runbar .. cTypt: 1I ChecKIng Ina....tiona and "II ~ II Account ",,"bar .. In 6Ob, 0, and d. ., Am6",,' of II,. &t UW..t fa 'IIr'''' lllllllllal Tu ..... ,. .1 Amount You II II Iina 6111 motl lItan IIna M1lllbti.ctllna ell from IIna 51. Thill. tla Amounl Yau Ow., OWl For dalalll on new to p.y ana usa r_ID40.V, H.lnalructiOf\l,."....",.. .""" ~ . Eattmalltd till tnol . AI.. Inc\udl an line 62 ........,. u nit'" '" ....~,;n"Mnii~.Jt.........,r"r... ~1 . YOl.lf~"'Dn I -,- . AIltch Forml W.2'W!r' and \ .R 10 peg. . .... lit II lOa 5 953, 2 6 9, 2,679i ... LI ~eVII'9' Ka~ . copy I .... 0111\11 'tturn pi lor your racorao, ~ Do" P,.,.,Iff', "Ill s.wntr 'lid p,.,.,....~ ~"I J ~.,.u. ........ ~"P!I'tr'. ,Imt'........ Se\f:oreoare .. Only ~' ~ '" -~ IJP.C'" rowU1I 1111"" " ."'"'\ I~L:717-732-9241 ,"""" ,GpOD HOPE FAM, PHYS, SchetkH A "_1140) ~~:"'(99) ......., ~.,."' 10&0 USAN HE PIAN ..... =- ~:r You ='ct:onl.) =:rJc. (Sae "'llNct,onc.) It:n.t 12 _ellla ,. not oeclJCIlDla, 14 == 15 IIVC!l1mada ,. E'ftnl ellenafit lit ... 17 INellOlll. 11 ~ " ibr.r.t- III ===:'" 21 22 (S.. lnalNctlona lor '''I"nlll 10 dI<t.lct hara,) =- Total =- Api 113 '97 11:06 ND,006 P,08 _No. ,1414)7. Schedule A - itemized o.ductlons 1996 07 ,... IIdII "'.,......., 194-42-9049 . AltachlD FCll1I110e0, . ... Ine\nletI_1or IchtillIe A (FamI 1~ Clluflaru 00 no/inclUde .""ena.. rembu"aa or pllld by Olh"l, 1 Maulcl' and aenllll ..pana.. (Ie. Ins~uC~onc) ....... Z EnlarsmoIlllIIromFormIDlO,I".32.,.... 2 4387 . a MJjtlply line 2 abova by7Sl4o (.075) ...... ... ........ ..,.. a 4 Sub~lCtllna 3 Irum 11n. I, 111I"a 3 II more Ill," liMe 1, entar.o. ..... 5 Slate If"J locailncoml t.... ,..................... ........ I . A.ai .alale 'awII (eaa Inahleoens) .. ........... .. .. .. .. .. . 7 Paraonal propar1y tax.. ......................... 7.. I Oll1er ta..a, ltll lypa ana omount . 9SQ~_ll~~t_________~.________V)~ I . AddllnelSllu I..... ............. ............. ........... 10 Ham. mortollll.nllmt and polnlsr""llId 10 IOU on Ferm 10iI ..... .. ... 10 1 1 521. 3 291 4 1 1 U9, 313 .. ...... ... ...." I 4 698. 0, 3,127. 11 I'oma met\GIOI.nllrlll MOl f1lIOlrlld 10 IOU on form IDIllII paid 10 till pnon Iroin WI'4m "'" beu;lt tl1I homt. ..1"IIruCllonllMClltml Ihll\*1on'a "MIllo kIInt,""O numllcl, .vId Iddflll · .----------------- -----------~- _.------ ----------_.._----~---- 11 Pe~li ";1 ;;i;.t Iv-rou ; r;,;, 'ioa -~ \;.;;uii,Oniioi' ';;'al,;itI.~ .~.~ 1 I Invll!ment Inlll..l, II r~qulred, allach Form AQS2. (8.. .,.trucllana,) ......... ...................... .......... " AdtJ llne& lU thr 13 ... ..."...... ....,..,.......... Gifts by oath or cn.ck. 11 you mad. any gin 01 $260 Dr more, ..elnltrucll..,... ..,........ ............. ....... ,. 14 4,698, 200. 0111'" than by catII or cheel<, III!1lY gift Dr SC'!iO or moro, ..a lnI~uetron.. 11 0'" I~. you 1111II attach fo,,,, 12a3....,............................,..... ..,... ,. Carryover ~om prior ya., . .. .. . .. .. ' , .. .. . . , , .. ' . ' .. , . , .. 17 Add I'"'' ID II1r 17 ......".. .................. ...... '" 11 2 Ca",al or thefllo... II . AttaCl'l Form 4684. .. IntlNellona. Unmburaad tmploy.. .lIPtnan - loll "val, union aual, lob aducatlon, tle. II required, you lliat attach Form 2101l or 2106.EZ. (Saa InstrUchona.) . J!!!I1.\.!lYt~ fY,SJ!1Il\.5_ ~l1Pi!.!-tej_-:_-_-:_-_-:~'Ui.. zg Taw preparation rill""........,............"., ....'." 11 011111 a.pan..a - In,"tment, till. depoo" bO', .te, lilt typa and "",0..,1 . 11 510, ---------------------~--------- 22 ZI Addil;'; 20 -a.oi:Qi; '22-.:-. :-.:- ~ ~ ~ .~.~.-.~.~.~.:.~~.:-.:-.:- ~ 2S 5 \ Z4 Enlar .nount Irom Fo<m IDlO, line 32 ..'.. 24 43 875, II Mut1IpIy line 24abovUy 2~ (.02) ........ ..........,"..."... 2!l 878. n Suhtract lint 25 from IIn. 23. IIlIn. :IS Ie more Iftan line 23 anlar .0. , V OII1er - from lIat In the InltrucQorw. List typ. and 1m00000t. _ ~ _ _ _ _ _ _ _ _ _ _ _ n 0, - ... ... - - - - ... - - - - - - - -., . - - - - - - - ... - - - - - - - - - - - - - - - r1 U II Form 1040, line 32, over S117,9'""o (over '58.975 II marri.a IiIlng leporelely)! No, Your d.ducllon 10 not 11m, Ita. Aad tha amounll '" tnl 'If "111' uulLllln lot Ilnaa 4 ttvouon 27, AIIO, ""lor on Form 1040, liMe 34. th...... 01 UIII amount or your otandard daductlon. V.., Your delllct,on may be IImltad. See In.truCII,,", tor lI1a amo,,",t to Inter. 1 aM ror PtpatWDrto IIeducUon Ad NoUea. '" InollUc\lona. , ,CXAOJOI 1011." Scheaull A (Fotm 1Q.40) 1996 I I Godo HOPE FAM, PHYS, '""".:717-7-2-9"_41 A ,-t8'97 1108" 00- P y- : . ,0. " ,12 P.nnlylvlnlllncome T,x Retum Cr:Ti1 -...u..o.r, - YOIIlIIluItFU. by Midnight Tuaaday, April I!, 1.7- 1~ c....-.....IP_.~.... 1996 'AOoo._.,_ O:PA..!O (O9.96l RavllW all 1111 preprinted inlurmll10n on yuur lobe I Md Pl..e 'tin tnl neme and aU<kIU .ee. Meke eny nleeaaary co"ve~o'\G to your libel end cnlek Ihe 15NmlmalAdclrln ClIanga DO', "you. do not have a ~ntaollalMl, ant., .lIlnlormollan a_ nt. 'f'H'................. ........ a.clal.....-......, E'ttnll'~ elp..,,,,,, 194..2-9049 LN' NtmI. "lit, N."" and 1n."1 -I,cl... ................",... J..... III E YELLOW BREECHES ....~Vn'u.._ ..tkR LI S L E o IINIltamalAdllml Chll1lIa " Ally of t/lIabM Inf,rm.I,on is diffnnl h,m lOur 1995 P",..,Iv..~ ,tturn,lhack lllIa _,It '"u, I'Jdll" clWlQ1d, 01.. p'O'I~.11le nMllUM n~ Cod. 01 I'" ell" I....sh'p, bolO""n 01 munlClpz 1~-l)OU lived ,n IZlll/96. ~~ ~C_ 1. Groll compenul1on Irotn W.2 lu,ms ond otfler w&Q' '\llemenll , ., .., I. lis UrvalmDurlld ,,"~Ioyee bu.,neas expense' ',om PA Schedule UE ", I b le Nat Pennsylvo,"a 'euble comp.nSl~on. 5ub~oclline lb !rom IIn. 10 ., 2 Pe""aylven,. t"ODle inte,.,l (complele III1d anlch PA Sch,CUII A 'lover $1.CXlO) a Pemeylvanlo Ia.eble dlvidond, (comp'e'l Ind ottoch PA SCI1Ir1llo B " over $1.000) . Nalrneoml cr (Ie..) !rUin lI1e operal1on 01 a bUllne.., prol....,on or flllm .' I Nil ~a'n or (10") from tfle .a'e, ..chlnge Dr dllllOllbOn 01 property ,... ' . . Sa Amoun' Dr gain I.e'udad!rotn PA Scnedule PA.19 .." """"" la I Nit ,ncome 0' (Iu,,) ~om ,en"', royallll', pltenlS ana copyrlgllil . , . . . , . Ii 7 Ell... Ind lru.llnr.ome " " . , " " . " ' 7 . Qlmbllng ana lottery Wlnnlny. "...."" . "" .. "... '''. ..." . I Tal" '"1ltf1'1111l1 T...~llln""I. Add IInlS It, 2. I, I, ~ , 7 .ndl De IlalIllMrKh (Iou) ,.,.IIt. Ill'" or ' , II... Mlho ,,"',10_" II. al . alhlf 1_ ~... Nor e.. 11IIII.1t1lIlhar', iIlrMo ifill 10111. an 10 , anlaTuLI~1 . Multi I line 9 b 2.8" .0 10 11 olal Plmaylvanll II. Wlll1n,,~ "om W.2 forms, atc ..."."..,. "..",.....,'. '.', " 121 Q1d111rem 11195 PA IAl "lurn E EI lZc Pa)"'anl Wll/l t996 1.10nG'aM, . ,L 121s 1!IiIl ""metod pa,""'" ... . _ 12d NIl Iu w,il>ilIld f,cm PA Schldul.. NRl(.1 1 120 Tet'IIIUm.led payment. and cre.,ts. ACd lin.. 12a, 1211, 12c and 12<1 ,., ,.,. ." ."". Ua HoulanOId memborlfrom PA Scnedull 51', Part II, 111'114, '" , ",.... '" l'ls Your IlIglblllty ~coma flllm PA Schedula SP, Port III, line 2. .,......' lib 11. Your total VlComa from PA Schldule Sp, Port III, Iina 1 ". ... .. .... lie 1111 T.. forg,van... ,"vdil!ronl I'A ~th.dUla SP, PilI III, Un. 7 14 Tolll credit lor I.... paid 10 otfler ,totes or coun~'e. from PA Sch.dUII(I) G 18 Employmorll,nclntlve plymln'" cr'd't from PA ScnedUlI W . ,.. II ToIal'" _andC,...II..AdUh"..1I 12e 13d. 14anc 15 17 ',"Myl..". T.. Due. Line 10 II more lI1an line 16 . . ' , '" . . . ... . . . MIlkI chock. Ie to '..,nl anla I' Overpayment. L~c 16 " more than II'" to Im"""..1t Thl tOI,1 of linea Ilathrough 19<1 mu.t lqualllna 18. I" Amount 0' llno 18 you want e, . ,.Iund ehacli milled to you ...", lib Amounl 01 line 18 Y'''' wont cl1ldllad te your 1997 IIUmlled tal accounl lie Amount 0' IInl 18 you wanlto donatl to 1111 Wild RIICLVtI t:onllrvaeon FlI1d 1111 Amounl 0' 11"1 18 u wanl to dana1e to the U.S. 01 ,. Com I ee Pema 'va'''o Olvlllon ~'vur"~rm~Vl!IIIU"_\oI..t:~I~wnl'.II~~I"V"III_I:hd'~I"'_."IIII'lrftnllU1l.r.\W,...rn:I.-cIIIYIllollI~\o""I'~ e .au'" and , Iteml ,tnC 10 the be I m (our) I I," true, eorrl.' a cmpl.te. y............ 0111 't'....Ocwp.t.ert ....... ......." Of..".."". .... 0.'- GP/I.4.'.OU\lpatlorl X NURSING . It i'UI1 You (and Your Spcuu) III n, Chack"AlI Math. AttacI1 All Schad..... _ form.. "...,., Of ComHfl, HIIN,"'" Nil ..p....rC.)....Md 01' .11 tnlot"'I1ion 01 whid'lhe ,,.,.,., hit .n)' ~"dft ~!~~f~~![~_A_______________________________ HERMAN, SUSAN -- ___QIf' I.. PA 17013 .. - - - - - -...... - - - - - - - - - - - - - - - . - - - - - - -... - -... - _...- w riocal Ya., '111; F..... .. TY"'fU'r. (C""OIlr 0111 , SiX M '! J r "."g'. t.I.rMd F'doltg Mi,n.4 !tCl"'~r 'ltlnO)o.n1 II tNtllJnO bot' tl~.. ... ...,..... II dtc....., Itfl'" '" "" r Ii.." IIHldancy Stalul (CMe'''''' c..) R~i ~I' HR[I~. p~..i ~'l&.l' tn_ fl. b~.,., ..re. P..\,,,~.,.... ,.Wen!: ~.... 11M.. I III Nama oISehool Dlalrlct CARLISLE School DltlnC1 Coda [ran lor .1tt7looldlt Ie ".,.... ",I""". f';:J P.MI)tvIN f.. e..-. ...... ....Id.......,.. flJ '!nlt 21110 4 51 Ie 2 3 . 5 51 I. 2 a 4 ,- . DI...144"_I... . 7 . . 41. 121 Soolhl,n.lruet,.n. 12. You mUlt nra 111 April I!. lt17, Fila aarty, If you can. 1.d 14 15 I 2 7, 1. Sea w:."'I:t~~ lor C,*hll ""'11I'""' 131 In .)3c 13d I' 11 1fi 17 01 meT. .... r-ll"'~H ...p.,.', T"~ul. NwI\b4, ...., "...,JI'U...WU.IDU--'C"faD1mlUlHlu".....\ianlJUUI W\lIrall~I""" tml'Y~ .narp1llyITI'Il'IIl.t.......'......ftoFVI'Y' lItw....__IJ'VW(' MI,.. ~.,lDlJI .. GQOO HOPE FAM, PHYS, TEL:717-732-9241 CAPiTAl.. TAX COLLECTION BUr""""J i U ~~.., "T · l'~ 10> I LOCAL EARNED INCOME . S "A"OVEII · II ~U < · TAX RETURN (FORM 531) '.LISLE. P' 11013-3336, ' I I Apr 18'97 11:10 No,006 P,14 /""""^:'~"'D I"~I~CWI SEE BACK OF HETURN FOA PHONE NUMllEA AND OFFIC~ HOURS 1;1, 1,2 1~~.1 t.....w;lrAM1tlGS1FiomUtcIlld'W.~'.I...,..,.,......, ",', ::.. :,': :;.,': ...,;,',::.. :::......,..... '11~r. a eMPLOYEE BUSINESS EXPENUES (Anach Fed.,al F.,m 2'06 & Slala S~~edul' UE'II ' .... . , ... . . , ., , 2, ?o 3 TAXABLE W.~ EAANINGS ISublr.cl Line 21rom Un"l .. ...... :. :'!':';...... .. . .. .. ..... ..... J 4 OTHER TAXABLE EAANEO INCOME (NO INTEREST OR OIVIDENDS) Compllll Section Bon BICk. . . . . . ~ . 6 TOTAL TAXABLEEAANEO INCOME (Add Llno. J and A) ... ........ ...~.. .... .,.. .. ..,.. .. .. .. ~!i II NET lOSS FAOM BUSINESS. PROFESSION, OR FARM (USE liNE 5 FOR ANY NET PAOFITSI. ....,., i ~ 7 SUBTOTAL (Subuact line 8 'rom Line 'I IF LESS THAN :ERO. ENTEA ZEAO . . . . , . . . , . , . . . . . ,I. ,I , 'I I I o " 'I!" " .r ~ I I '::'4- I" .. NET PAOFIT FAOM BUSINESS, PROFESSION, OA FARM (USE LINE I FOA ANY NET LOSSES) TOTAL TAXABLE EAANED INCOME AND NET PROFITS (Aoo llnll7 and 6)., . . , . .. ..,. .. . .. ' . ,. ,.. 9 TAX lIABILIN: 1% OF liNE 9 (Mul\lply Una 9 by ,01).. ............'...........,.............,.. '0 TOTAL lOCAL INCOME TAXESWiTHHELD (!'rom al\lc~ed W.2'.. Bo.21)...... .."..,.. .. .. .'. .I~ "....- OUAATERlY PAYMENTS ANDIOA LASTVEARS OVERPAYMENT CREDITED TO Tl'IS YEAR... .. .. ~2 CREDITS FaA TAXES PAtO TO PHILAOELPHIAANOIOR STATES OTHEA THAN PA ,ATTACH SCH (II. , 11:) TOTAL WITHHOLDINOS & PAYMENTS (Add linu II, 12 Ind 13).. ...... . .".,. ............,... 14 e. . . ..,,.," TAX BALANCE DUE (Subtract Lln. 141'oml!na 101 PAYMENT NOT N~CES'SAAY'IF LW THAN 11.00 . l'li INTEREST' PENALTY (Sa. Inllruc\lon., , . . , .. ...,...............,....,.................,.. '6 , I , . I it ,:; .I 12 13 14 18 III 17 II " lID . !.~, . ;.4' ~ ~f' . ,"t . I .: ,:~ I ',. I :.,;. " . I :.: I TOTAL BALANCG DUE (Add lln.,15 ond 16) M.ko cheCk payabl.10 "CTCB".,... . ..,.. . . ... .' .- blracl Un. 10 from line 1A) IF LESS THAN :EAo,,€NTER ZEAO. . .. ........, ...... I . PAYMENT BE AEFUNDE . ......... .....................,.........". OVERPAYMENT TO BE CREOITED TO NEXT YEAR'S TAX. .. . . ;.,. , . . .. . . . .. . . ' , , . . \ tor . OVERPAYMENT TO BE CAE CITED TO UPOUSE'S BALANCE DUI! FOR THIS ~lllNQ YEAA . , . . . ." d7 .. IlOt ~.. \Q '/ ..'.1 A, r'18 '97 GOOD HOPE FAM, PHYS, ~:717-732-9241 .------ - . . -t:C1I1Uot rn.H1lL.I~' 11:02 No ,006 P,02 -----......- ~D ~. 1146-0008 Copy C For EMPLOYEE'S RECORDS (a.. Nollel on bIcl) b EmplOytf" IC'IfIlmJflUlIOl1 'hIIlUle1 2~1~a~S15 c r"'l'InyfW'lt r.."., lMJar,.., and ZIP cOW Good Itqle f'.n11y IPnGtJ.ca 1830 aocx! Nope Ill*1 Sno1., Pl 17025 G (moloyee', IUC"" uc:umv I"!Un'lHf 1~4-4a.90~\I .. Ef"'ploys.... name. ICdrllW, AM ZIP ;04' Swum JltIrrlloll'l 111 Ii: Y.11<71{ Brec!_ carli.1lr PA 17013 II "'P EJ1IP~'" ,11111,0, No'. IT .......N...... .....I'j\l............. ............. 4~1.1J,\,.~.~... J W.2 W"I Ind TI. Itltement 1996 I W09R. tip'. 0"* r.otl"fl.lIllr..on , FH1".1 inca.". tAl wnht'lllCl '.~fl~1 ,:!~ ~r'\~~,'YI s Social MC\luty WIQII . Soi:..d ~1~."ry1&a \..ll'itltln 4'3831.22 2717. ~4 I Ml.Vjl;',' Yfl;e.",d tipt . MNl:.r.:'ltl tal w,Ultl.IG 431:131.21 (,.1~.~~ 7 $oe1l1 ucunt) Up, I A.1<<,*1 tiP' . ACl'tanc. EIC J.kl~",.nt 10 I H1f*'1dlnt Ute' e.,.,fIt. II NonqUMIiliW pltn. .2 BI'I,fot, ifl\,;I~I,\(1 Ir Dell , 10, 11M Inl'''. far bar 13 14 Ol'ler . :',\UC ... 24.r!!j "1'flIt. ~T;C1'N1,.n 1.llahdOtV 1tt"W 'tft&lOI\ U~I "V"O ""'l~ ,11II It' IF:1I ..JL 1. ftwaitlClll'11 "I,' l' Locality net"" 10 w..lleWM I.;. II', '1 .tell t1;tj'll fl. 1.-, .. . . I . _ ,. '~n.,)'t:l..... .... . %..... ..kii:;I.\..?,L. ..!t:\I,I..R.... CIl O.ptll'\lI,lttl ul tl" T.IIW'Y...lntI'lFn"t nlh,nu. SO,,"'CO , Tl'Illlln'Drmll1UUlll$ ~na turl'\l&h.d 10 Ihe Internal A.__.nuc 8CMCl't. It VOU l"IlIN~ltd to lil. III". 'Illurn, . n,ulflJr.nr~ (UtnAIty or uther ,,,nrUM mI~ btllmpO,~ en ~ou II \IllS 1'lCQm8.. tultM 1V'tt1 yeu rill to fWPJr1 n. ~'" I'""' ~ OtpartMnl olh T""",,ry - Inl,mal Rh'nuI 5.",lU , I 11 1 040 U,S.lndlviduallncome Tax Return 1996~ I"S",,,",,-Oo~I"",,,..~,"In',,,,,,," For the year Jan 1 . Dee 31, 1996, or other talt year beginning ,1996. emMlJ ,19 Itiftt1!r.. CARLISLE .. Do you wont $3 to go to thIS lundl If 8 OInt return does our 5 Quse want $310 0 to U,'s fund? 1 Single 2 Married filing JOint return (e\len If only onB hod Income) 3 X Mer"ed Illlng .eperete return. Enter .pouse's SSN ebove & lull nomo here ~ SUSAN SHERMAN 4 Head or household (With quahfYlng person). (See Instructions.) II the qualifyIng person 16 a child but not your dependent, enter this child's name here ... OJah In widower With dependent child Yourselt. If your parent (or someone else) cen cl8lm you 85 a dependent on hIS or her t8X return, do not check bolC 6a 5 au.. Label (6.. ...,lNtbon' ) UI. thl IRS I.bel, Otherwise. pleo.e p"nt or typl. pr:.ld.nUal E action Campllgn (S.. .,.tM:taon. ) Filing St.tus Check only one box. Exemptions II more then 6 dependents, see the instruc. tlons for hne 6c. Incom. Allach Copy B 01 your Fonn. W-2 W.2G,1 loii.R h.... If you did not get 0 W.2, .el the Instructiofl& 'or line 7. Encloll. but do not attach, any poymlnl. AI.o, please ,"!=Iose Farm 1040.V llee the I"strue. Ion. for line 62), Adjustld Gross Incom. II line 311. undor $28,495 (under $9500 .1 o child did not live WIUl you), loe thllnstruc. tlons lor hne M. 'YOoIIfnlNlml .. luttl,me GARY If. ktnIRI!lJm, Spouu', fnl Name ItERMAN l"lt~..m. J MI Hame Add,." (number 1f1d .bnt) II Tau tl.~.. P 0 80r, 5.. In\INelll.ln' "'Plllf1\II'lINo III E YEllOWBREECHES RD C.ty, to\llln or Po,t Ottw:t. If YC1I H", . Forl'9" Add..... S.. 1l"lnKtJO"\ Sl.t, llP Cod. PA 17013 'fll" 1ee1.II,nfl" N,. 191-46-3426 .,.......IKI....uritr No. 194-42.9049 For hllp IIndlng IInl Instructlon.,IH Inllructlonlln thl baoklll. V.. No X N." Otfd.."9 'y..'"",tw;l"~ rout I.. ",... .......w ..~...l~ b c Dlpandlntl' (2) O.pendent', IOc131 seculIlynumber, II boln In December '996. see ,"struchons (3) Dependent'. relabonr.hlp to you 22 iidd the amounts ~n-th-e fat ,7 ht colu;n~ fu'-hncs 7 .- 21.-ThISIS- ow toiilin~ci"ni. - - - - ~ 23. Your IRA deduction (see Inr.tlucllons) 25. b Spouse', IRA deduction (see InstllJctmns) 23b 24 MOVing ..pln.I.. Attech FOIm 3903 01 3!J1IJ F 24 25 One.hall 01 6elf.employmL I trill. Altach ~r.hec1ulo Sf 25 _.______ 26 Self.employed heallfl1115urance deductIOn (sell lnf,lrlH.;llom;) 26 ___._..._~_.___ 'l7 K"'9" end Itll,mplortd SIP pl.lI. II SIP, cher, ~ I lL ____ ___ 28 POf1elty 011 early WIthdrawal 0158'111195 J.l!_ ____u_____~__ 29 Allmonr p.'d RlClp"nl', SSN · 29 30 Add I,nl. 23a ' 29 11 Subtlact line 30 trOfll_~X2-:l!!~~_~i'2~j~ ..~Ju.l~d~ir~.~.!~(;om! IlJ01l1f'arrrl.....'" ~"'.."d r.p'W'....ul k'1fItIO!IIBmAtfNml""",~lu'l. I I I OIA.11112 12JUJ/% (1) F".t naml Lest name d Total number or eKem lions claimed 7 Wege., ,010"IS, tiP', Ilc. Attach FOIm(.) W,2 8. T...bll interest. Attach Schedule B If o.or $400 b T...I..mpt inloro.1. Do not Include on line 8a I 8bl 9 Ol'lldend Income. Attach Schedule 8 if o,er $400 10 Tauble refunds, credits. or olfsets of stale end local Income taxes (see Inslruclions) 11 Alimony received 12 BUSlne.. Income or (loss). Attoch Schedule C or C.EZ 13 Capital geln or (loss). If reqUired. attach Schedule 0 14 Other geln. or (losses), AUoch Fo,m 4191 151 Total IRA dl&tllbutlon&.. .L!~_~~ I b TOJ;aule amount (see Instill) 16. ToL11 penllons and InnuIlles [!!!r--~- -. --, b TOkable amount (set Instrr.) 17 Rental real estate, royalties. partnerships, 5 corporatmns, trusls, etc. Attach 5ch E 18 Ferm Income or (Io.s). AIloch Schedule F 19 Unemployment compensation . . . 20. SOC:I.IIKulIlybenetlls .' L~~L-__________I b To.able amount (see Inslr6) 21 QUler Income. list type end amOllnt - .ee Insl1uctlon6 1- N...l~... elite,".. II... ..... - No..' ,.., ellllll'.... (4) No 01 hot Ie ..., months Irved 1ft )'Our heme · "w'.\II rell 1ft 1996 . .....1.... .",,"11I110'0 IIII.D'Uff ..,. ,n""", IlItl'IIC.OII.. I Ott...... ." ".Icul 0"1"....... Ai'.,....." Oll''''t:: .. I ""... 0, 7 69 048. 8. 322. 9 41. 10 11 12 13 14 15b 16b 17 18 - 19 20b 21 22 6 4 30 _ ~ 91- -----691-4.11. 1lIII'I10Q,19'J6l Form 1040 T.. Computallon II you wenl lI1ilRS to "gure your lex a.. lI1e In.ln'ictlon. lor line 37. C...dlt. Other T.... Peymentl Attech Form. W.2, W.20, end 1099.R 10 pege 1. Wt Keep e copy 0111111 return for your records. Plld P...p....r'. U.e Only """ GARY J HERMI\N !12 Amount from hne 31 (edlu.led g'o.. ,ncorne) , ,. , "" O1eck ,I 0 Ye..... Wold.., 0 Blmd. 0 5poull WaI Wold... [1 Add lI1e number of bo.ea chlcked ebove end enle, lf1e lolel here. . b II you tire mauled fIling 6eparalely end your spouse IlernlleS deductions 'xl or you were 8 dual'italus ellen, lee InstructIons and chock here.. .. 33b ~ !14 f..n}II {tlmlled deductlonl ~om Schodull A, line 28, Or 1- 1171,. r Standlrd deducllon .ho"" below fa, your filing .I.h.., But .ee Ihe 01 Instructions If you checked ony box on hne 330 or b or someone ~ur can cl81m you 85 a dependent. I Singl. - $4,000 . M.r".d IIIlng ,oll,lIy or Qu.llfylng Wldow(e,) --$6,700 a He.d 01 hou.e"old - $5.900 I M.",.d flhng .ep.'.llly - $3,350 S!l Sub~.cl hne 34 from line 32 . 1I6 II hn! 32 II $88,115 or 1m, mulhply 12.550 by Ih.lo,.1 numb., 01 ",",pho", clOlmed on Iln. 6<1, 111m. 32 Is over $88,41~ ,..,h. wo'k,h..11n lhe InllrUtI"", fOllhe .mount 10 1111.. .. . . . J7 T...btllncoml. Sub~.cllln. 36 from hne 35, If hne 36 I. more th.n line 35, enler .0. 38 Tax. Sleln.~ucUon.. Check II lotel,nclude. eny Ie, ~om a 0 fo,m(.) 8814 b Form 4972 .., 19 CtedlllOl child snd d.pendll1l call ''P'"'" AIl.1ch form 2441 , .eo Cred,l for lI1e etde,ly or the di.ebled. Mech Sch R 41 foreign te. crldll. AII.ch Form 1116. ,..,., ". .., 42 Other. Chick If !rom '" ,.. a 0 Form 3BOO b 0 Form 8396 c 0 Form 8801 d [] fo,m (.pIC) ol.! Add hnes 39 If1rough 42 ' 44 Subtract Une 43 from hne 38. If line 43 IS more lhan line 38 enter .0. ol.! SIIf'employment Ie.. M.ch Schedull SE , 46 A'llrnehve ml",mum t.,. M.ch form 6251 47 5S snd Molltar..... on lip In",m. notr.porfed 10 .mployer. Altath form 4137 48 Tax on qualtlled retirement plans, Including lRAs. II required, attach Form 5329 . 49 Advance earned Income credit payments from Form(s) W.2 . BO Hou.ehold employment t...., M.ch Schedule H BI Add In. II . 50 Ihll I' urtohl tll .. e2 fed..al "com. tllwlihheld hom form, W,2 and IIl'l'J . U /""'0. Blind . 1h 191-46-3426 !12 6 P. a 2 4 !14 7 985. 85 61.426. 1I6 2 550. J7 58 76. ... 38 14,191. 119 .eo 41 42 52 10 928. 1996 ..t,meled I.. p.ymenl. end emount epplled I,om 1995relurn ....,..., ..... ....... . Il4 Eamld Incom. ".dlt, Allach Schedul. [Ie II you haYS. qUlllfY"i child, Nontnabll earned income: amounl . , .. andtyp.. . ___ ________ ____ _ ____ __ 55 Amounl p.id With Form 4868 (reque.1 for e.ten.ion) .. H E.ce.. .oclet .lcu,lly end RRT A ta, withheld (.ee In.~.) B7 Olf1er paymenl., Check If I,om ,a 0 form 2439 bO Form 4136 , Be Add hne. 52 . 57. The.. a.. ou,lolll I mlnll, Relund B9 II line 58 II mor.than hn. 51. lubhzclline 51 from hne 58 Ih" Illh. amount you O,"p.ld Heve II senl lOa Amounl 0' fine 59 you wanl Rlfundld to You, dlreclly to your . b Roullng number benk eccounll See In.tructlon. end 1111 · d Accounl number , In 6Ob, C, end d, Bl Amount oil". 59 . wanl A lI.d \0 You, lHI EsIIm.I.dTlI ... 61 Amount You 62" hne 51. I. more then hne 68, .ubl,eclllna 68 from III,e 51. Thi.lslf1e Amount You OWl. Owe For delelll on how 10 pay ena usa Form 10411.V, ... Instructions,. ,., .. " ,. 62 61 Eltunated tax enalt, Also Include on line 62 63 1 09 .im}J,~W*~;~iif'" . .lItII'IIIIftIll~"""''8If1_tml~_'"t"ft~.\.\.uonp.''r~I'WI'II1m"",,"I7m'''''r'''m9IrllJlM\'''''''., "".1, ~'r '1' In.I., COIIKl, .nd comr'e', O.d.r.bon QI r"r"" 10'1., 'l.n tI'j'r"} I' bl\.d on 'u tnrorm.boll 01 Milch r"r'IIl h" .nr "",",IIdI' Ywr 8~n.i.l" 0.1 I YWIOetup.bon B3 64 B5 B6 B7 cType: [J Checking ....... [J Sevlng. . &ptlJII', Slgn.a.,. II I JOI1I1Rrt,~nll.t4161I1n ~ CIVIL 5ERV1CE PIIU,,',Ocr;up.bon . ~"Plr.f' l.,n'kl1t .. Fltm',N.mt (0I~,,1l .eU,mploytd) IndAdd,", ().I. CJllt(.kil ..lltm to-I'd _..sin -ll.repi! red~-- . E'N i'!PCodt 1010\0112 lI/1?!)/':16 43 .44 45 46 47 48 49 eo · BI ",. ell n eo. Plt"r,,', Bocill&'CUrltyfill 4 4 19 . 10 928, =1i:.:,,,,,~,::"" (99) "'mt(t. IhcMn on , orm 10t0 GARY J Madlcal ~:ta' t.....,..1 11 Hom. mOltt,: Int.",1 nol ,eporled 10l"lJ on rOlm '098. II PI'd 10 the pinon rom Whom )IOU bouQhllhe hQm~ lei Inllrucllons and show (See that p'ISon', name, klenhlrsnQ numbtl', In addltu .. Instrucbon..) ------------------------------- ------------------------------- ~.. ------------------------------- 11 .,aCnll 12 Points nol repolted to ruu on Form 1098. See inslructlonl for special rules 12 Inter..! II 11 Investm.nt Int.r..l. If r.qu".d, .tt.ch Form 4952. not daductlbl.. (S.. Instruction.,) 15 14 Add lines ID through 13 G1l1ato 15 0,", by ca.h or ch.ck. II you mM. .ny gilt 01 $250 Dr mOil, Chari" "' I"'tructions . ..., ' .. ,. 15 It y<>u mid. 11 Oth.r th.n by cosh or ch.ck, If '12ll gl" of $250 Of · N'" and ~O a b.nelit more, .... Instruction.. It over $ , you MUlt or II, HI .ttach Form 8283"" , ,..,., ...,.. 1& In.tmchona. 17 Carryover from prior year, 17 11 Add lines 15 throu 17 No. Your deduction II not limIted. Add UUt amounls In the fef fight column for Ilnl.4 through 21. AliO, enter on form 1040, hne 34, tfle I.ru., of UIIS ,mount or your Itandord deduction. YM. Your deduction may bellmltod. See Instructions tor the amount to enter, 11m! 1M Far I'lpIIWorll Raducllon Ac' Nolin, IlIln.trucllon.. I Schedule A (FamI 1040) Tu.. You I'ald (S.a Insructlons.) Inlamt Yaul'a1d ~~:: 11 Jab 1.....,_ 20 and 110I, Other MIscall........ Iladucllana (See Inslructlonl for Ixpenlll 10 deducl her..) other "'KelllnlOu, 004v""," Tatll "amlead Ileducllanl '" ".. Schldule A - Itemized Deductions _No 1&4111074 - A"ach 10 Form 1040, - Sn Inltrucllanl lor Schedul. A (Form 1040). 1996 07 ,..., '.dal'te''''' N.....' 191-46-3426 HERMAN elution: Do nolmctude e"'pen,'u!s reimbursed Of paId byelflers 1 MedlClI and don'al e:~penlel (tiee InstructiOns.) 2 [.1. .mount "om rOlm 1040. lin.ll LLI S Mulllply lin. 2 obov. by 7.5'110 (,075) 4 Subtract line 3 trom line I. II hne 3 II more Ulan hne , enter .0. S Slota and 'oc.llncom. t.x.. 6 Reel ..1.1. I.xo. (0.. In. ructions) 7 P.rson.1 prop.rty I.... . 8 O\her tax.a. list type .nd .mounl - ~!~~_ta~~~___________________~8~~ . Add linel 5 through B ' 10 Hornl mortglQllnl..,'.nd polnllreported 10 rou en rorm 1098 14 4,698, 230. 18 230. Casual or theft 1011 el , Attac~ Form 4684. See instructions. 11 Urveimbur,.d employee expenses - lob trs\lel, union dues, job .duCttlon, etc. "required, you MUlt attach Form 2106 or 2106.EZ. (Sa. Inotluct,o,,",) - J!!!I1.\Jly~lt ~\!~..1.D!1ts_ ~lUJio-tej_- _- _- _- .:-_- _-_-716; 20 21 T.. p,.perallon flea. 21 22 Other ellpenses - Investment, lalo depOSit bo)!;, ole. list type end amount ~ 730. 22 2S 730, 2S Add \in.. 20 through 22 24 E.I..""".I horn Form 1040, \ine II . .l1U 69 , 411 . 21 Mulliply Iln. 24 .bove by 2'110 (,02) 26 21 5ublrecl lin. 25 hom line 23. III,n. 25" ,"0'. \h.n Iln. 23 .nlll ,0, Z7 QU\lf - from list In the Instructlons. lUit type end amount.. _ _ _ _ _ _ _ _ _ ._ _ _ _ 388. 21 0, ------------------------------------------ 27 28 II Form 1040, line 32, over $117,950 (over $58.975 .1 married II lIng I8poralely)? rOlAOJOI 101141lM Schldul. A (Form IQ.1O) 1996 I f.PMI . DonIld II. lla.l. 1l!I.... Approl.a' SeMen .11 ....nhower t1vd, ~lddl'lawn, PA 17057 10: IIl:l1MAN, 5U~AN III YELLOW IRUCIIES RD. CARLISLE, PA 17013 III YELLOW BREECIIES RD., CARLISLE ' FUll lIMR FORM APPRAISAL I , I , , , I , , , , I , , ! , . . , , , , I . , I I I I , , i , , , I I , , , , , , , , I , , I , , , , , , , , , , I , , , , I , , , I , RECEIVED FROM CLIENT 1150.00 8ulJIotal Lat. Fit TOTAL TIIAHk \'OU 1'011 YOUR BUSlN...1 OI/DAtI ^f'I'MlllAl S!RVlC18 (71719390350 [DIm Nll- 'I01^l2lXllllor Wlnclow.' ~111f~'~ lohw.. by a II mocl.. k~, - 1.800,^lAMODE 150.00 '150.00 ~ I""' Il PENSION APPRAISERS INC. P.O. Box 4396 I Allcntown, PA 18105.4396 . 1.800-4-47-11084' FRl610.770-9342 E-~IAIL: I'Cnlll'I'Iiill'Cn81onlll11lrlllecn,coIII ""\'WI hlllll//Ww\\"llcnllonolll'roI8cn,clInt December 23,1996 Barbara Sumple.Sulllvan, Esq, 549 Brldge Street New Cumberland, Pennsylvania 17070.1931 INVOICE For Professional Services Rendered: Detennlnatlon of the present value of Gal}' J, Hennan 's defined pension benefit Boclal Security Cola Offset Report Fee: Payment Received: Balance Due: $160.00 , 95,00 $ 65,00 Our File No, 12.96.73-27088 Thank you, Pension Appraisers, Inc. .Va/uators of Defined Pens/on Benefits for Equitable Distribution" ~ "... EXHIBIT "e" 1""\ ,.... 3 p.r.on. In hou..hold. Support r.qu..t.d for Wlf. and two (21 Chlldr.n. INCOME: 1888 Ora.. VTD = .43,831.22 t3816.10 Ora.. Monthly. FT (S.31 388.00 S8 278.58 St.t. 101.22 Local 38.16 NET Monthly 2832.18 EXPENSE8: MONTHL V S.1f Chlldran Home: Mortgage 1094,00 Maintenance 80,00 Utilities: Electric 120,00 011 66,00 Trash Removal 16,00 Telephone 100,00 Beeper 16,00 Cable 36,00 Yard care 10,00 Alerm System 146.00 House Cleenlng 80,00 Employment: Lunch 80.00 33,33 Insurance: Disability Health/Dental Automobile: Reglatretlon 2...QQ ..2..QQ Fuel/Maintenance 100,00 100,00 Insurance 46,00 46.00 Leese Peyment 361,00 Medlcel: MOTHER a DEREK Doctor Dentist 26,00 OptomotrlBt 13,00 Optlclen 26,00 Medicine 36,00 Therapy Ii..OQ ~ "..., EXPENSES: MONTHLY S.1f Chlldr.., Education: Darak 110,00 Monica 32B.00 Chlldcare Sefore\After School (Derek) 100,00 MUllc Lellons BO,oo Personal: Clothing 60.00 160,00 Food 600,00 Credit payments: Credit card (31 300.00 Charge accounts 160,00 JC Penneys & Bon-Ton Loans: Mllcellaneous: YMCA Mambership 26.00 Entertainment 20.00 20.00 Gifts 26,00 100,00 Legel feel (on going) Charltlble contributions 17,00 Vlcetlon 100.00 Perlonll Care 60,00 Total Expenses: .3663,00 .1193.33 PROPERTY OWNED: Owner.hlp Dtlarlptlol1 ~ H W J Checking acots. X Savlnglaccts, X INSURANCE: Cover.g. · ComDlnv Pollav No. H W C Hospital: *H"'Husband; W",Wlfe; J...Jolnt; C...Chlld . -- SUSAN S, HERMAN, : IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v, NO, 96.6464 ;! GARY J, HERMAN, CIVIL ACTION - LAW IN DIVORCE Defendant CERTIFICATE OF SERVICE I hareby certify that I have served e true end correct copy of PLAINTIFF'S PRE- TRIAL STATEMENT, INVENTORY & APPRAISEMENT end INCOME AND EXPENSES STATEMENT document upon ell Individuals to this action, by United States mall, postege prepeld, addressed as follows: John J, Connelly, Jr" Esquire Connelly, Reid '" Spade 108-112 Walnut Street Harrisburg, PA 17101 Dated: May', 1997 E, Robert Elicker, II, Esquire Divorce Master Office of the Divorce Master Cumberland County 9 North Hanover Stree~ Carlisle, PA 17013/ ;1.." S"mpl..S" Attorney for Plaintiff 649 BrldgB StreBt New Cumberland, PA 17070 (7171774.1446 Supreme Court 1.0, 1/32317 BUSAN S. HERMAN, Plaintiff fN 'fHE COURT OF' COMMON Pl.li^S OF CUMBERLAND COUNTY, PENNSYl.V^NI^ CIVIL ACTION - I.AW VB. GARY J. HERMAN, Defendant NO. 95 - 6454 CIVIL 19 IN IHVOIlCE STATUS SHEET DATE: - - 1lidL1 . ~lA1lirftrofj 01 vE. 6/ IJ,Q1. 0 ~ lM;tryCth'l t'l!bl'V.2flh.1vft{J ~1 01 ~ I~ 1 q ~ ~()__ 1.1. ")- c{~ 'L~~ .ftc<1.I...~:tD ~ Iq ~D C'-:f1 oX" b f,I . . . tI.. t' ,<[,Jr12u.....~et+~ Y'\A',) 1-(f-' ~ fff U i~.J.)OJ ;/ ......11' \JJ ,1'''( · r '..." . t " I . .,~ 111,1 ..1" r:<ii....\{/(~'~ t,1 <,,11.t/,1 ./ I" r,,/. 0 J" .11...~~/., /)ll..L...... rt.1'1',.,...l'.\L.;/ 1,~1,q1 .~.--- ,- ~/l/h 1 -' OFFICI OF DlVOIICI .ITIII CUMBERLAND COUNTY COURT OF COMMON PLEAS 9 North Hanover Street Carllale, PA 17013 (717) 240.6535 .. ......" .Ioker, II DlYorce Mulal TrIlOI ... Colfer 0IIIce Mln8llll/Repoltll w.., ...... 697-0371 Ext,6535 November 20, 1996 John J. connelly, Jr'r E.quire CONNELLYr REID' SPADE 108-112 Walnut street P.O. Box 963 Harrisburg, PA 17108 Haria P. cognetti Attorney at Law P.O. Box 689 Harri.burgr PA 17108-0689 REI susan S. Herman vs. Gary J. Herman No. 95 - 6454 civil In Divorce Dear H.. cognetti and Hr. connelly: By order of court of president Judge Harold E. sheell dated November 13, 1996r the full-time Ha.ter hat been appo nted in the above referenced divorce proceedings. A divorce oomplaint was filed on Noveaber 13r 1995r rai.ing grounds for divorce of irretrievable breakdown of the aarriager indignitie'r and adulterl' The coaplaint al.o rai.ed the econoaio i.sues of equitable d stributionr alimony, alimony pendente liter and counsel fees and expenses. I aa unable to determine from the pleadings whether or not the parties are willing to consent to a divorce or ifr in the alternative, they have been separated for a period in excess of two year., however, I will assume that grounds for divorce are not an issue and will proceed with the directive to file pre-trial statements. In accordance with P.R.C.P. 1920.33(b) I am directing each counsel to file a pre-trial statement on or before HondaYr December 16r 1996. upon receipt of the pre-trial statements I will immediately schedule a pre-hearing conference with counsel COMMONWEALTIt OF PENNSYI.YANIA COUNTY 01' CUMIlERLAND SS: SlJSA.N S. IU!RMAN. IN Tim COURT 01' COMMON PLEAS OF CUMUERLAND COUNTY, PENNSYLVANIA PlalnlllT v. GARY J. URRMAN. TERM,1995 NO. 95.6454 Defendant l"OTION FOR APPOINTMENT OF MASTER AND NOW, October 28, 1996, comcslhe undersigned allomey for Ihe plaintiff and certlnes 10 the Court thallhe above acllon In Divorce Is at Issue; that no Issue hll5 becn direcled by the Court 10 be tried by jury, and therefore respeclfully moves the Court for appolnlmenl ofa Masler. The following mailers are at Issue between the plainlllT and the defendanl: (X ) Grounds for divorce; (X) Alimony Pendenle lite, ( ) Support; Counsel fees; (X) Alimony: ( ) Paternity; (X ) Equitable distribution of ( ) Custody; property: ( ) Other Service ohhe complalnl was accepted by defendant's counsel, John J. Connelly, Jr., Esquire on December 11.1995, An appearance on behalf of the defendanl has been entered by John J. Connelly, Jr, Esquire. llte followln8 allomeys have been Interested In other mailers arising between the plaintiff and defcndanl: nla. Contesl Indicated. ANDNOW,.1YWV \ -}:> ,199(-' , r' Ai ~yv( FLt (J.!.~ , Esq., Is hcreby appolntcd Maslcr in this proceeding to hcar the tesllmony and relum the record and a tmnscrlptto Ihe Court together with report and recomn1endallon. UY TilE COURT: JJ u "U- J~L)/ " 1/ .n r.J. V,-.,!;,,"""'1'1 II ,I ,l. .,< ,,'i_. . ., , ' ~, ""\ ,a,ltt,'\I" c. , ,- Gllt\lti'i 'II (. ': , ,,'..1,1 ;J LAW OPPIOBH BARBARA SUMPLE.SULLIVAN 114VllHIDlIIl BTHUIlT NIlW OUHIIIlHI.ANP, t'IINNSYI.vANIA.'O'O.1I101 l'IIl1NS 1'171 ....'.....ft "AX 1'''1 """"ftU July 25, 1997 E, Robert Elicker, II, Esquire Dlvoree Master 9 North Hanover Street Carlisle, PA 17013 Re: Hermln v, Hermlln No. 95.6454 Dear Dlvoree Master Elicker: Please be advised that the parties in the above-captioned action have resolved all outslandlng Issues concerning their divoree action pursuant to a Marllal Selllement Agreement dated July 25, 1997, Please cancellhe pre-trial conference scheduled In this mailer for August IS, 1997 at 9:00 A,M, Thank you for your allentlon in this maller, Very truly yours, 'vdlj"lA ..t~ - ~. Barbara Sumple-Sulllvan BSSllwz cc: John J, Connelly, Jr, Esquire Susan Hennan -~fr~ 'i 0 'J/:LB. __. CJ /) . (VI/t/ \1..0 (:~t-l()I~1 '},~ . ,. \- \. ~1I~t~'~\' C\s,?Z ~ '{\ ." J , ~{l~t(~~S;!~';~~\>ci?))~~..~.tP""r~li~:;!~'~~~~.n!r,!.'Y~;:h~~r.t_f-;;(/~';?:l~ 'ii!,,,~,,.,,' ,.'.'".......~.~'I".j ',... i ,.... ""'''\ ,,," ;,;.;~;,if~ty:.t~:~',~C\.: :'~ .~Ail:~ ""..~;; '. u,;~;, """~ji~;~';~,i~;:, v, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, I'ENNSYL VANIA : NO, 95.6454 CIVIL TERM SUSAN S. HERMAN, Plalntin' GARY J, HERMAN, Defendant : CIVIL ACTION - LAW : IN DIVORCE PRAECIPE FOR WITHDRAWALlENTRV OF APPEARANCE 10 THE PROTHONOTARY: Kindly withdraw my appearance on behalf of Susan S, Hennan, the Plaintiff in the above- captioned matter, " if6' , MARIA P. COON I. ESQUIRE Sup, Ct. I. 0.1127914 200 North Third Street, Twelfih Floor p, 0, BOll 689 Harrisburg, PA 17108-0689 (717) 232.2103 DATED: December 4, 1996 Kindly enter my appearance on behalf of Susan S. Hennan, the Plaintiff In the above-captioned matter. / /' ~,// ///' , / (.(. (~,~ / . ",,J Barbara Sumple-Sulllvan, E8qulre 549 Bridge Street Ncw cumberland, PA 17070-1931 (717) 774.1445 DATED: December /(J ,19% rr. 0\ .- .:J 1*- e' ',," t". r .. ::% N r :c to'"", " t~,~ 0- .;] ,- I' . ,/} I ;J Ii:" c . '\1 r' b' !tJ.. ,;.. It ." :l L) l~n L) (t; "'l'_ 'O? 'D''tI SUSAN S. HERMAN, Plaintiff v, IN THB COURT OF COMMON PLEAS OF CUMBBRLAND COUNTY, PBNNSYLV ANIA NO. 9.5-64.54 CIVIL TERM CIVIL ACTION - LAW IN D1VORCB OARY J, HERMAN, Defendant DEFENDANT'S PRE-TRIAL STATEMENT Dlte of Marrlqel Date of SeparalloDl Divorce Complaint 011111 datel January 10,1981 September I, 1994 November, 199.5 I. ASSETS A. Marltll Property MII./Loan Bal. Present Value. 1. Marital Residence $98,000.00 $180,000,00 2, Lot $4,200.00 $37,000,00 3, Volvo Unknown To be determined 4. 1992 Honda $6,600,00 .5, 1980 Jeep cn $1,000,00 6. Pension (WIfe) To be determined 7, Pensions (Husband) $.5.5,346,6.5 8, Disney Vacation Timeshare $8,198,00 9. 67 Shares Financial Trust Stock $2,800,00 10, 40 Shares Disney Stock $3,200,00 Mtl./Loan Bal. Present Value. 11. NOAUS Life Inl. Polley (W) 12, Credit Union Account (Marital Portion) 13, SOLI Term Life Ins, Polley (8) 14. NOAUS Life Ins, Polley (8) To be delermlned $7,000.00 $0,00 To be delennlned 15. Travelers &. Lincoln Life Annuity (W) To be delermlned 16, Bank Accounts (W) Unknown 17, Miscellaneous Personal Property (See Exhibit . A. of Inventory) B. Non-marital Property I. Oerman Beer Stines (H) $500.00 2. Oak Cuckoo Clock (H) :$150,00 3, Marble Lamps (H) $200,00 4, German Candle (H) $50,00 5. Ship from Spain (H) $100,00 6, Drill (H) Unknown 7, Grandfather Clock (H) $2,500,00 8, Dry Sink (W) $300.00 9. Wooden Sofa (W) $100,00 10. Monumental Life Ins, Polley (H) To be determined ($10,000,00 Whole Life) B. Non-marital Property Present Valuc 11, Monumental Llfc Ins. Polley (H) ($5,000,00 Wholc Llfc) 12, Credit Union Account (H) (Represents non-marital portion) To be dctermlned $6,000.00 2. EXPERT WITNESSES Defendant knows of no cxpcrt witnesses at this tlmc, Howcvcr, Defendant reserves thc right to supplcmcnt this answcr should such becomc avallablc, 3. NON-EXPERT WITNESSES Defendant knows of no non-expert wltncss at this time with cxceptlon to thc partlca, Howevcr, Defcndant reservcs thc right to supplemcnt this answcr should such become avallablc, 4. EXHmlTS (a). Defendant's Inventory and Appralscment. (b), Defcndant's Incomc and Expcnse Statement, (Exhibit" A"). (Exhibit "B"), 5. NET INCOME A. Defendant - See Incomc and Expcnsc Statement, (Exhibit "B"), B. P1alntlrr - See Plalntlfrs Incomc and Expense Slalemcnt, 6. EXPENSES A. Defendant. See Income and Expensc Statement, (Exhibit "B"), B. P1alntlrr - See Plalntifrs Income and Expense Slatement, 7. PENSIONSIRETIREMENT A. PlalntUf. To be dclermlned B. Defendant. To be determined .. COUNSEL FEES N/A ,. PERSONAL PROPERTY DISPUTE See Proposed Resolution below, 10. DEBTS None except u let forth herein, 11. PROPOSED RFSOLUTlON Each party to receive fifty percent (50") of the value of the marital estale with Wife retalnln, the marital residence u . portion of her fifty percent (50") distribution, Respectfully submitted, Dale: CERTIFICATE OF SERVICE I, lohn 1, Connelly, lr., Blqulre, of Connelly, Reid, &. Spade, attorney. for Defendant, hereby certify that I have on the date shown below lerved . copy of the fOl'Clolnl Pre- Trial Statement upon the followlnl and In the manner Indicated below: FIRST CLASS MAIL, POSTAGE PRE-PAID Barbara Sumplc-Sulllvan, Blqulre 549 Bridle Street New Cumberland, PA 17070-1931 Date: EmmIT "A" ASSETS OF PARnES D.f.nd.nt I1lIIrk. on the lI.t below tho.e Item. eppllc.ble to the cese at bar .nd It.mlz.. the ....t. on the following pege.. If en Item haa been appral.ed, e copy of the .ppr.I..1 r.port I. .tt.ched, Ixl 1, Re.1 proparty Ixl 2. Motor vehicles Ixl 3. Stock., bonds, securltle. end options II 4. Certlflcete. of Deposit Ixl &, Checking .ccounts, cesh II 6, S.vlng. accountl, money market II 7. Content. of .efe depo.lt boxe. II 8. Tru.t. 1111 9. Llf. In.uranc. pollcl.. IIndlcat. f.c. velue, ce.h .urrendar v.lu. .nd current beneflclarle.1 Ixl 10. Annultl.. 1111 11, Gift. II 12. Inheritance. II 13. Patent., copyright., Inventions, royeltles II 14, Personal property out.lde the home II 1&. Bu.lne..e. lII.t ell owners, Including percentage of owner.hlp, and officer/director po.ltlon. held by a party with a company I II 16, Employment termlnetlon benefits - .everence pay, workman's compensation clalm/8ward II 17. Profit .harlng plan. Ixl 18, Pen.lon plans IIndlcete employee contribution and date plan vests I Ixl 19, Retirement plan., Indlvldu81 Retirement Accounts II 20, Disability payments I I 21. LitIgation claims Imatured end unmaturedl II 22, Mllltery/V.A. benefits II 23, Education benefit. II 24. Debts dU8, Including loans, mortgages held Ixl 2&. Household furnishings and personalty IInclude e8 a total category and attach Itemized list If distribution of such e88et8 Is In dispute I II 26. Other ~, t , MARITAL PROPERTY , Defendant Ulta all marital property In which either or both lpoUICI have a 1ep1 or equitable lntereat Individually or with any pcrIOn u of the date of aeparaUon: .-,,: I' ITEM NO,..l3... DESCRJPI'ION: $200.000.00 SOLI Term Life Insurance Policy lH\ CASH VALUE: $0.00 DATE OF VALUATION: NON-MARITAL PORTION: AMOUNT/NATURE OF UEN(S): ITEM NO..J.!., DESCRlPI10N: NOAUS Life Insurance Policy lH\ CASH VALUE: To be determined DATE OF VALUATION: NON.MARlTAL PORTION: AMOUNT/NATURE OF UEN(S): ITEM NO...!L, DESCRlPI10N: NOAUS Life Insurance Pollc:y CWI CASH VALUE: Unknown DATE OF VALUATION: NON-MARITAL PORTION: AMOUNT/NATURE OF LlEN(S): ITEM NO....l6..... DESCRlPI10N: Travelen '" Lincoln Life Annul\)' CWI VALUE: To be determined DATE OF VALUATION: NON-MARITAL PORTION: AMOUNT/NATURE OF LlBN(S): ITEM NO, -!..' DESCRIPTION: Fumlll'#. AMOUNT OF PRESENT DEBT: $2,200.00 AMOUNT OP DEBT AT SEPARATION: DATE DEBT INCURRED, INmAL AMOUNT OF INDEBTEDNESS AND PURPOSES OP DEBT: AMOUNT PAID BY DEBTOR SINCE DATE OF SEPARATION: ITEM NO. -L, DESCRIPTION: Cllr Il\lln AMOUNT OF PRESENT DEBT: $305,00 AMOUNT OP DEBT AT SEPARATION: DATE DEBT INCURRED, INmAL AMOUNT OP INDEBTEDNESS AND PURPOSES OP DEBT: AMOUNT PAID BY DEBTOR SINCE DATB OP SEPARATION: ITEM NO...L' DESCRIPTION: Mortrare. Marital Residence AMOUNT OP PRESENT DEBT: S98.000,OO AMOUNT OP DEBT AT SEPARATION: DATE DEBT INCURRED, INITIAL AMOUNT OF INDEBTEDNESS AND PURPOSES OP DEBT: AMOUNT PAID BY DEBTOR SINCE DATE OF SEPARATION: Plgl 2 EXHIBIT WA" - PERSONAL MARITAL PROPERTY IIEIlI VALUE t7&.oo t2oo.oo ., ,000.00 13,&00.00 t2oo.oo t2&O.oo 1300.00 130.00 Unknown .'00.00 .&0,00 t2oo.oo t7&.O t2oo.oo ., ,000.00 37. Hummel Silt/Pepper 38. Hummel Nur.. 39. Chine DI.h Set 40. Olnlng Room Set 41. Llzy Boy (Bluel 42, TVNCR 43. Olvld Winter Houle. (& each) 44. Plplr Cutting Prlntl 4&. Bllnket Chait 48. Wooden Che.t 47. Print. In Plrlor (2 8ach) 48. Frllzer 49. Cllrk Figure &0. Kitchen Chair. &1. Sofl In Plrlor EXHIBIT "B" IN THE COURT or COMMON PLEAS or CUMBERLAND COUNTY SUSAN S. HERMANr Plaintiff v. GARY J. HERMAN, Defendant No. 95-6454 CIVIL TERM HI' 1'011I MV'I' .1 rILLID OU'1' (If you are aelf-e.ployed or if you are aalaried by a buaineaa of whioh you are owner in whole or in part, you .uet alao fill out the Supple.entel Inoo.e state.ent whioh appearl on the laat page of thia Inoo.e and Ixpanae stata.ent.) I.COIII &lID .11'.... 'I'A'l'1IIlU'l' or. GUY J. ....U lIICOII. -.ployers Penneylvania National Guard &tareaas 75 Muatan9 AlleYr Middletown, PA 17057 typa of Works Airoraft Maintenanoe Officer 'ayroll lUmbar. 1.14.J4.. 'ay'.rioa Cweekly, biweekly, .ta.). Biweekly Gro.a 'ay per ,.y 'eriods $2r182.40 It..l..d 'ayroll DeduatioDa. Federal withholdin9 $346.61 social Security N/A Local Wage Tax stat. Inco.e Tax $61.11 Retire.ent $152.77 savin9a Bonde Credit Union $250.00 Life Ineurance $10.75 Health Insurance $18.63 Medicare $31.64 charity $5.00 lIet ,.y per .ay .erloa. U,UI... 1I0ll'1'llLY y...,,,y (Fill in appropriate column) MIlD I.eml. National Guard (Net) $539.00 $6,468.00 Dividend. pendon Annuity Social security Rent. Royaltie. Ixpan.e Account. Gift. Une.ployment compo Workar'. compo AU.ony Child Support N'l'AL 11ft I.COD tl,I..... t.., UI ..1 ........ Ho.e Rent $450.00 $5,400.00 Maintenance $30.00 $360.00 Lot $305.00 $3,660.00 Utilitie. Elactric $137.00 $1,644.00 Ga. oil Telephone $70.00 $840.00 Water/Sawar $34.00 $408.00 bploymant public Transportation Lunch $97.00 $lrl64.OO MOIl'l'IILY Y...LY (Fill in appropriat. colUlln) Taxa. Raal I.tata (Lot) $75.00 $900.00 par.onal Property $15.8J $190.00 Inco.a (Local) $58.33 $700.00 In.uranca Hoaaowner. Autoaobila $179.90 $2,158.80 Life $30.00 $360.00 Accidant Haalth other Autoaobile payaant. Fuel $125.00 $1,500.00 Rapain Medical Doctor Danti.t $8.33 $100.00 orthoclonti.t Ho.pital Medicine Special Nead. (9la..e., braca.r orthopedic devica.) Education Privata school $41.67 $500.00 Parochial School Collava ReUqiou. Per.onal clothing $75.00 $900.00 Food $540.00 $6r480.00 Barbar/Hairdre..er $15.00 $180.00 Credit Payment. Charga Accounts Hallberahips Loans Cradit Union Hiscallanaous Household Halp Child Cara Papars/Books/Hagalines Intartainaant Pay TV Vacation Gifts Legal Fa.. Charitabla contribution Othar Child support Ali.ony Pa~ents 1I0llTBLY (Fill in appropriate $100.00 $16.67 ya.-r.y column) $1,~00.00 $200.00 $350.00 $4,~00.00 $50.00 $30.00 $50.00 $33.33 $100.00 $8.33 $850.00 $600.00 $360.00 $600.00 $400.00 $lr~OO.OO $100.00 $10,200.00 MIl... 'IO'l'AL IUIII.I. '3,171.31 ...,10.... IIOID'l'Y OIIIIIDI OWnarahiD* D8.criDtion Value D Jf i1. Chacking Accountl Farmers' Trust $2r500.00 x Credit Union $13 rOOD. DO' X (Savings Acct.) stOCk/Disney 40 Shares $3r200.00 X stock/Financial Trust 64 Shares $2,800.00 x Raal Istata Marital Residence $180rOOO.00 x Othar Lot $37,000.00 x Disnay Vacation Timeshare $8r198.00 X $7,000.00 marital portion; $6rOOO.00 non-marital portion. %..tm.~.1 Covm-&aII* Co.nanv Policy No. B I( , Ho.pital Blue Cro.. Health Aaerica HMO 1000010001 Medical Blua Shield Other Heelth/Accident Di.abU. Inco.e Dental, viaion Other *(H-Hueband, W-Wifel J-Joint, C-Child) x .ut.LIUlft'AL I.COIII .'a'....., (A) Thi. fora i. to ba filled out by a per.on (check one)t (1) who operate. a bu.ine.. or practice. a profe..ion, or (a) who i. a .e.bar of a partner.hip or joint venture, or (3) who i. a .hareholder in and i. .alaried by a clo.ed corporation or .iailar entity. (B) Attech to thi. .tate.ent a copy of the following document. relating to the partner.hip, joint venture, bu.ine.., profe..ion, corporation or .i.ilar entitYI (1) the .o.t recent Federal Incoa. Tax Return, and (a) the .o.t r.c.nt Profit and Lo.. stat..ent (C) Na.e of Du.in...l Addl....l Tel.phon. Numberl (0) Natur. of Du.ine.. (check one) I (1) partn.rahip (a) joint venture (3) profe..ion (4) clo..d corporation (5) other . (I) Na.e of accountant, controller or other per.on in cher;. of financial racord.. (r) Annual inco.. fro. bu.in.ee. (1) How often i. inco.e received? (a) Oro.. inco.e per pay period. (3) Net inco.e per pay periodt (4) sp.cified deduction.r if anYI ,1 . SUSAN S. HERMAN, Plaintiff v, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO, 95-6454 CIVIL TERM CIVIL ACTION - LAW IN DIVORCE GARY J. HERMAN, Defendanl DEFENDANT'S PRE-TRIAL STATEMENT Date or Marrlaae: Date or Separation: Divorce Complaint flUna date: January 10,1981 September I, 1994 November, 1995 1. ASSETS A. Marital Property Mla./Loan Bal. Present Value. I. Marital Residence $98,000,00 $180,000,00 2, LoI $4,200.00 $37,000,00 3, Volvo Unknown To be delennlned 4, 1992 Honda $6,600.00 5. 1980 Jeep CJ7 $1,000,00 6, Pension (WIfe) To be determined 7, Pensions (Husband) $55,346,65 8, Disney Vacation Timeshare $8,198,00 9, 67 Shares Financial Trusl Slock $2,800,00 10, 40 Shares Disney Stock $3,200,00 Mta./Loan Bal. Present Value. 11. NOAUS Life Ins, Policy (W) 12. Credit Union Account (Marital Portion) 13. SOLI Term Life Ins, Policy (H) 14, NOAUS Life Ins, Policy (H) To be determined $7,000.00 $0,00 To be determined 15, Travelers & Lincoln Life Annuity (W) 16, Dank Accounts (W) To be determined Unknown 17, Miscellaneous Personal Property (See Exhibit "A" of Inventory) B. Non-marItal Property 1. Oerman Beer Stines (H) $500,00 2, Oak Cuekoo Clock (H) $150,00 3, Marble Lamps (H) $200,00 4, Oerman Candle (H) $50,00 5, Ship from Spain (H) $100,00 6, Drill (H) Unknown 7, Grandfather Clock (H) $2,500,00 8. Dry Sink (W) $300,00 9. Wooden Sofa (W) $100,00 10, Monumental Life Ins. Policy (H) To be determined ($10,000,00 Whole Life) ASSETS OF PARTIES Defendant marks on the list below those Items applicable to the case at bar and Itemizes the assets on the following pages. If an Item has been appraised, a copy of the appraisal report Is attached. (x) 1. Real property (x) 2. Motor vehlclas (x) 3. Stocks, bonds, sacurltlas and options ( ) 4. Certificates of Deposit (xl 5. Checking accounts, cash ( ) 6. Savings accounts, money market ( ) 7. Contents of safe deposit boxes ( ) 8. Trusts (xl 9. Life Insurance policies (Indicate face value, cash surrender value and current beneficiaries) (x) 10. Annuities (x) 11. Gifts ( ) 12. Inherltancas ( ) 13. Patents, copyrights, Inventions, royalties ( ) 14. Personal property outside the home ( ) 15. Businesses (lIst all owners, Including percentage of ownarshlp, and officer/director positions hald by a party with a company) ( ) 16. Employment termination benefits - severance pay, workman's compensation claim/award ( ) 17. Profit sharing plans (x) 1B. Pension plans (Indicate employea contribution and date pion vestsl (x) 19. Retirement plans, Individual Retirement Accounts ( I 20. Disability payments ( ) 21. Litigation claims (matured and unmatured) ( I 22. MllltarylV.A. benefits ( ) 23. Education bane fits ( ) 24. Debts due, Including loans, mortgages held (x) 25. Household furnishings and personalty (Include as a total category and attach Itemized list If distribution of such assets Is In dispute) ( ) 26. Other ITEM NO. i. DESCRIPTION: $S.OOO.OO Whole Life Ins. Policy (H\ VALUE: Unknown DATE OF VALUATION: REASON FOR EXCLUSION: Pre-marital asset AMOUNT/NATURE OF LIEN(S): ITEM NO....1L. DESCRIPTION: New Cumberland Fedeml Credit Union Account VALUE: NON-MARITAL PORTION: 56.000.00 DATE OF VALUATION: REASON FOR EXCLUSION: Acquired Post ~pamtlon AMOUNT/NATURE OF LIEN(S): EXHIBIT "A" . PERSONAL MARITAL PROPERTY IIEM VALUE 1. Welhlngton Dishes 2. Clerk Figure Orville Wright 3. Green German Wine Glasses 4. Cuckoo Clock 6. Scrlmlhew Pictures (duck/grouse) 6. Hummel Wine Glasses 7. Hummel Desert Storm 8. Hummel Hunter 9. Hummel Mickey Mouse 10. Franklin Mint Acft 11. Oek Rocker 12. Lazy Boy (Toni 13. Coffee Pot 14. Tool Chest 15. Crosl Country Skis 16. Downhill Skis 17. Picture of Bobwhites 18. Picture of Wood Ducks 19. Picture of Pheesants 20. Brass Floor Lamps 21. Bedroom Suit 22. Scrimshaw Jewelry Box 23. Hummel Jewelry Box 24. Canoe 26. Foreign and Old Money 26. Elvis Cards 27. DD214s 28. Refrigerator 29. Washer/Dryer 30. Stove 31. Wooden Duck 32. Wooden Figures (3 eaoh) 33. Kltohen Table 34, Wooden Plates from Germany (5 each) 36. Nordlo Track 36. Hummel Spice Set $100.00 $76.00 $50.00 $160.00 $100.00 $150.00 .200.00 $200.00 Unknown $700.00 Unknown $60.00 $30.00 .50.00 Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown $200.00 $300.00 $200.00 $75.00 $300.00 Unknown $300.00 $700.00 $200.00 EXHIBIT "B" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY SUSAN S. HERMAN, Plaintiff v. GARY J. HERMAN, Defendant No. 95-6454 CIVIL TERM '81' rORN HU'T .1 IILLID OUT (If you are self-employed or if you are 8alaried by a business of which you are owner in whole or in part, you must also fill out the Supple.ental Inco.e Statement which appears on the last paq. of this Inco.. and Exp.ns. state.ent.) I.COMI DO 11....1 'TA'1'IKIKT or. auy J. BIRHAM I.COMB laploy.r. Pennsylvania National Guard A44r..s. 75 Mu.tang Alley, Middletown, PA 17057 '1'"e of Work. Aircraft Maintenance Officer '.yroll Muaber. 1.14..4.. .., '.rio4 (weekly, biw..kly, eta.). Biweekly aro.. ..y per .ay 'eriot. $2,182.40 It..i.e4 ..yrall Detuation.. Federal Withholdinq $346.61 Sooial Security NIA Looal Wage Tax State Income Tax $61.11 Retirement $152.77 Savings Bonds Credit Union $250.00 Life Insurance $10.75 Health Insurance $18.63 Medicare $31. 64 Charity $5.00 .et .ay per .ay 'eriot. U,UI... HOKT8LY YIlULY (Fill in appropriate column) MIl.. 1.0011. National Guard (Net) $539.00 $6,468.00 Dividends Pen. ion Annuity social Seourity Rent. RoyalUe. Expense Aocounts oift. Unemployment compo Worker's Compo Alimony Child support lO'1'aL .1'1' I_CONI ti,...... ...,u.... 1.....1. HOlle Rent $450.00 $5,400.00 Maintenanoe $30.00 $360.00 Lot $305.00 $3,660.00 UtiliUe. Eleotric $137.00 $1,644 .00 Oa. Oil Telephcne $70.00 $840.00 WaterlSewer $34.00 $408.00 Employment Public Transportation Lunoh $97.00 $1,164.00 ~*,,::j.''''-;' ;rt~.~::,;:;-"t."f;~..: j,';n, "~.""" Taxe. Real E.tate (Lot) Personal Property Income (Local) In.urance HOlleowner. Autollobile Life Acoident Health Other Automobile Payments Fuel Repairs Medioal Dootor Denti8t orthodontist Ho.pibl lCedioine special Needs (glasses, braces, orthopedio devices) Eduoation Private Sohool Paroohial school College Religious Personal Clothing Food Barber/Hairdresser Credit Payments \ .....'"'- MORTBLY YUIlLY (Fill in appropriate oolumn) $75.00 $15.83 $58.33 $900.00 $190.00 $700.00 $179.90 $30.00 $2,158.80 $360.00 $125.00 $1,500.00 $8.33 $100.00 $41.67 $500.00 $75.00 $540.00 $15.00 $900.00 $6,480.00 $180.00 IRO'BRTY OWNEDI Checking Aocounts Credit Union (Savings Aoct.) stock/Disney stocklFinancial Real Estate other Disney Vacation MONTHLY YBaRLY (Fill in appropriate column) $100.00 $1,200.00 $16.67 $200.00 $350.00 $50.00 $30.00 $50.00 $33.33 $100.00 $8.33 $850.00 $3,875.31 DescriDtion Farmers' Trust 40 Shares Trust 64 Shares Marital Residence Lot Timeshare $4,200.00 $600.00 $360.00 $600.00 $400.00 $1,200.00 $100.00 $10,200.00 ''',504... Value $2,500.00 $13,000.001 OWnershiD* H Ii il. Charge Accounts Memberships Loans credit Union Mi.oellaneous Household Help Child Care Papers/Books/Magazines Entertainment Pay TV Vacation Gifts Legal Fees Charitable contribution other Child Support Alimony Payments OTHBRa TOTAL 81'IN8I:8 x x $3,200.00 x $2,800.00 x $180,000.00 x $37,000.00 x $8,198.00 x $7,000.00 marital portion; $6,000.00 non-marital portion. . IK.UIlUCB. Coverao.* CompanY Poliov No. H H ~ Hospital Blue Cross Health America HMO 1000010001 Medical Blua Shield Other Health/Aocident Disabil. Inoome Dental, vision other *(H-HuBband; WaWife; JaJoint; C-Child) x 8UPPLIKIlNTAL IKCOMI ITATIKIlNT (A) This form is to be filled out by a person (oheok one): (1) who operates a business or praotioes a profession, or (2) who is a member of a partnership or joint venture, or (3) who is a shareholder in and is salaried by a olosed corporation or similar entity. (B) Attaoh to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, oorporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss statement (C) Name of Business: Address I Telephone Number: (D) Nature of Business (oheck one): (1) partnership (2) joint venture (3) profession (4) closed corporation (5) other