stz?fg ?"47 COMNIONWEALTH OF -- 2 DEPARTMENT OF STATE . is, BEFORE THE SECRETARY OF THE COMMONWEALTH ,7 Commonwealth of ?2 Bureau of Commissions, File N04 14-99-09803 Elections and Legislation vs. Lisa Marie Deeley, Notary Public Docket N0: 0040'99'17 Respondent CONSENT AGREEMENT AND ORDER PARTIES The Commonwealth of Department of State, Bureau of Commissions, Elections and Legislation ("Commonwealth") and Lisa Marie Deeley, Notary Public (?Respondent?) stipulate as follows in settlement of the above-captioned case. APPLICABLE LAW. . 1. This matter is before the Notary Public Law, the Act of August 21 1953, PL. 1323 .1-22. 1, as amended, 57 RS. 147-169 the Uniform AcknoWledgement Act, Act of July 24, 1941, PL. 490, as amended, 21 RS. 291.1?13 ml! 2. This matter is before the Secretary of the Commonwealth ("Secretary") purSuant to the Notary Public Law, Act of August 21, 1953, PL. 1323, No. 373 as amended, 57 RS. ??147~169 (Law) and/or the Uniform Acknowledgement Act, Act of July 24, 1941 PL. 490, as ,atn?nded, 21 RS. of 1953, PL. 1323, as amended 57 RS. 147-169. 3. At all relevant and material times, Respondent held a commission to practice as a notary public in the Commonwealth of ID. number 103 7012. 4. The Respondent admits that the following allegations are true: 1 Respondent holds the following commission to practice as a notary public in the Commonwealth of Notary ID. 103 7012. h. Respondent's current oommission was issued on February 8, 2015, and expires on February 8, 2019. 0, Respondent was previously commissioned as a notary public in the Commonwealth of at the following times: (1) February 8, 1995, to February 8, [999; (2) February 8, 1999, to February 8, 2003; (3) February 8, 2003, to February 8, 2007; (4) February 8, 2007, to February 8, 2m 1; and (5) February 8, 2011, to February 8, 2015' d. At all times pminent, Respondent held a commission to practice as a notary public in the Commonwealth of e. Respondent's last known business and home address on file with the Department ofState is: --, Philadelphia, PA 19152. f. On or about April I, 2010, Respondent notarized the alleged signature of Lynda Costello on a spousal waiver form. g. A true and correct copy of this spousal waivm' form is attached as EXHIBIT A and incorporated by reference. 11. Lynda Costello did not sign (his spousal waiver fonn. i. Lynda Costello did not appear before Respondent. jn On or about January 24, 201 1, Respondent notarized the alleged signature of Lynda Costello on a second spousal waiver form. k. A true and correct copy of this second spousal waiver form is attached as EXHIBIT and incorporated by reference. 1 l. Lynda Costello did not sign this second spousal waiver form. in. LyndaCostello did not appear before Respondent. n. During the investigation into this matter, Respondent was interviewed byBureau of Enforcement and Investigation (BEI) Professional Conduct Investigator Jessie J. Bennett (PCI Bennett). 0. During herinterview, Respondent stated she did not ask the individual who came intoher of?ce for identi?catiOn. p. Respondent provided portions of her notary register to PCI Bennett. q. A true and Correct copy of Respondent?s notary register is attached as EXHIBIT and is incorporated by reference. r. has failed to record in her notary register the character of the act, amount of fee collected, and either the date of the act or the date of the s. Respondent'asserts in mitigation, and the Commonwealth neither admits nor denies, the following: (1) Re3pondent at all relevant times co'operated with the Secretary of the Commonwealth into the inquiry relating to this matter. (2) On April 1, 2010, a person known to Respondent as Charles ?Chuck? Costello personally appeared before Respondent and identi?ed the af?ant as his wife, Lynda Costello. (3) At the time of the execution of the notarization of the spousal waiver form, Respondent had no reason to believe that the af?ant was not the af?ant, Lynda Costello, and Respondent believed based on the above that she had satisfactory evidence at the time of the identity of the person purporting to be Mrs. Costello. (4) On or about January 24, 201 1, the purported husband of Lynda ?Costello, Charles ?Chuck? Costello, appeared in person with the person he identi?ed as his wife, who executed a second spousal Waiver form that Respondent notarized. (5) No notary fee was ever charged or received 'by Respondent regarding Charles ?Chuck? Costello or the person represented at the time to Respondent as Lynda Costello; t. Respondent agrees, understands and acknowledges that the acceptance of the stipulated sanction imposed 'on Respondent?s notary commission by the Secretary of the Commonwealth constitutes public discipline. ALLEGED VIOLATIONS 5. Based upon the foregoing factual allegations, the Secretary of the Commonwealth may, for good cause, issue a Written reprimand, impose a civil penalty, suspend or revoke the Respondent?s commission, and/or order the Respondent to attend additional educational courses under the authority of Section 22 of the Act, 57 RS. ?168 because: a. Respondent failed to know through personal knowledge or have satisfactory evidence that the person appearing before her was the person described in and who was executing the instrument, in violation of Section 12.1 of the Law, 57 PS. 158.], by notarizing the signature of Lynda Costello on two occasions when she was not present. b. Respondent failed to maintain an accurate notary register, in violation of Section 15(a) of the Law, 57 RS. 161(a), by failing to record the character of the act, amount of fee collected, and either the date of the act or the date of the instrument. PROPOSED ORDER - 6. The parties, intending to be legally bound, consent to the issuance of the following Order in settlement of this matter: a. Based upon the foregoing factual allegations, the Secretary of the Commonwealth may, for good cause, issue a written reprimand, impose a civil penalty, suspend or revoke the Respondent?s commission, and/or order the Respondent to attend additional educational courses under the authority of Section 22 of the Act, 57 RS. ?168 because: (1) Respondent failed to know through personal knoWledge or have satisfactory evidence that the person appearing before her was the person described in and who was executing the instrument, in violation of Section 12.1 of the Law, 57 PS. 158.1, by notarizing the signature of Lynda Costello on two occasions when she was not present. (2) Respondent failed to maintain an accurate notary register, in violation of Section 15(a) of the Law, 57 PS. 161(a), by failing to record the character of the act, amount of fee collected, and either the date of the act or the date of the instrument. VOLUNTARY SURRENDER b. Respondent agreesto PERMANENTLY AND VOLUNTARILY SURRENDER Respondent?s notary commission. Respondent will submit to the Bureau Respondent?s notary seal, notary embosser, and notary commission (or af?davit of loss or destruction), along with a signed copy of this Consent Agreement. (2) Within thirty (30) days of the Secretary?s approval of this Consent Agreement, Respondent will deliver Respondent?s notarial, register to the of?ce of the recorder of deeds in the proper county. (3) The acceptance of the stipulated sanction on Respondent?s notary commission by the Secretary of the Commonwealth constitutes public discipline. (4) Respondent agrees that Respondent will not apply for a notary commission at any time in the future. (5) Nothing in this Order shall preclude the Prosecuting Attorney for the Commonwealth from ?ling charges or the Secretary ?om imposing disciplinary or corrective measures for violations or facts not contained in this Consent Agreement. This case shall be deemed settled and discontinued upon the Secretary issuing an Order adopting this Consent Agreement. ADMISSIBILITY OF CONSENT AGREEMENT IN FUTURE PROCEEDINGS 7. Respondent agrees that if Respondent is charged with a Violation of an Act enforced by the Secretary in the future, this Consent Agreement and Order shall be admitted into evidence without objection in that proceeding. ACKNOWLEDGMENT OF NOTICE AND WAIMER OF HEARING 8. Respondent acknowledges receipt of an Order to Show Cause in this matter. knowingly and voluntarily waives the right to an administrative hearing in this matter, and knowingly and voluntarily waives the folloWing rights related to that hearing: to be represented by counsel at the hearing; to present witnesses and testimony in defense or in mitigation of any'sanction that may be imposed for a violation; to cross-examine witnesses and to challenge evidence presented by the Commonwealth; to present legal arguments by means of a brief; and to take an appeal ?om any ?nal adverse decision. ACKNOWLEDGMENT .OF RIGHT TO ATTORNEY 9. Respondent acknowledges that Respondent is aware that Respondent has the right to consult be represented by, private legal counsel of Respondent?s choosing and at Respondent?s expense when reviewing, considering and accepting the terms of this Consent Agreement. To the extent that Respondent is not represented by legal counsel, Respondent has knowingly elected to proceed without the. assistance of legal counsel. WAIVER OF CLAIM QF COMMINQLING AND OTHER CLAIMS .10. Respondent expressly waives any constitutibnal rights and issues, such as commingling of prosecutorial and adjudicative functions by the secretary or the Secretary?s counsel, which may arise or have arisen during the negotiation, preparation and/or presentation of this Consent Agreement; Respondent speci?cally agrees that if the Secretary rejects this agreement, it may assume that the facts and averrnents as alleged in this Consent Agreement are true and correct for the limited purpose of recommending a sanction, based on those assumed facts. that would be acceptable to the Secretary- before hearing the case. In the event thatthe Secretary does assume the facts and averments as alleged in this Consent Agreement are true for purposes of making a recommendation as to an acceptable sanction, such action shall not constitute commingling o-f prosecutor-la] and adjudicative functions by the Secretary or the Secretary?s counsel, and the Respondent expressly waives any constitutional rights and issues related to alleged commingling, bias, or violation of due process rights to have an unbiased and impartial adjudicator in any subsequent hearing. If a hearing is Subsequently held, neither this Consent Agreement nor the proposed terms of settlement may be admitted into evidence and any facts, averments, and allegations Contained in the Consent Agreement must be proven at hearing. unless otherwise Separately stipulated. This paragraph is binding on the participants even if the Secretary does not approve this Consent Agreement. NO MODIFICATION OF ORDER 11. Respondent agrees, as a condition of entering into this Consent Agreement, not to seek modi?cation at a later date of the Stipulated Order adopting and implementing this Consent Agreement without ?rst obtaining the express written concurrence of the Prosecution Division. AGREEMENT NOT BINDING ON OTHER PARTIES 12. The Of?ce'of General Counsel has approved this Consent Agreement as to form and legality; however, this Consent Agreement shall have no legal effect unless and until the Secretary issues the stipulated Order. EFFECT OF REJECTION OF CONSENT AGREEMENT 13. Should the Secretary not approve this Consent Agreement, presentation to and consideration of this Consent Agreement and other documents and matters'by the Secretary shall not prejudice the Secretary from ?irther participation in the adjudication 'of this matter. This paragraph is binding on the participants even if the Secretary does not approve this Consent Agreement. NTIRE AGREEMENT 14. This agreement contains the whole agreement between the participants; provided however, that the captions printed in the various provisions of this agreement are for ease of reading only and, are not to be interpreted as forming any part of this agreement. There are no other terms, obligations, covenants, representations, statements or conditions, or otherwise, of any kind whatsoeVer concerning this agreement. AGREEMENT DOES NOT PREVENT ADDITIONAL DISCIPLINE BASED ON OTHER COMPLAINTS 15. Nothing in this Consent Agreement or the Order based upon this Consent Agreement shall preclude the Prosecuting Attorney for the Commonwealth ?'om ?ling charges or the Secretary from imposing disciplinary or corrective measures for violations or facts not contained in this Consent Agreement. VEBIEIQATION OF FACTS AND STATEMENTS 16.? Respondent veri?es that the facts and statements setfo'rth in this Consent Agreement are true and correct to the best of Respondent's knowledge, information and belief. Respondent understands that statements in this Consent Agreement are made subject to criminal penalties of 18 Pa. C.S.A. 4904 relating to unswom falsi?cation to authorities. Andrea L. Costello Prosecuting Attorney WOW 10 Qi Lisa VMarie Deeley, NotanLP?'blic Respondent DATED: Ines C. Crumlis 1, Esquire For the Respondent DATED: lilection For ?..Withholding of State Income Taxes ?ndings Sumfaymrents andlt?o?arers atone-Roth money to a Roth?i'A} andatory for 'hle rollovfer distributions applicable withho . AR. CA .- E. IA. Note: Some states require mandatory ederal NE, 0 VA or deducted automatically. unless an election; nut is a' licable (see belo Withholding if federal income taxis withheld ?'om the guibu?on. ?M?EMyresident state is All(for NE and VA. election out is allowed for . sissyments from ile only) and I donut want state income tax withholding deducted them my {An election out of All, KS, MB, NC, or- VA state tax is not allowed for eli hie rollover distributions, subject to 20% mandate federal withholdin .1 Immutable remote residents, Eran elect not of ME you must or have elected out of federal Waiting, tit-have no Maine State taxliabi'lityin thepriorercnnentyeam. .. El resident state is one of the fallowhi on. 01:, ?yr and vritlrhol is aired if federal mcgme trait is withheld some? to 20% mgandatory federal-Mthhol 131135 132m out of state withholding. 'ch - box Iain electing out of state withhol ?An election out is 'not anewed for eli ionover dismbuttons appropriate box below. lfstate income taxwithholding is - B. Volmmafmte Withholding?l?iease Check the ta . you may be allowed to ?nest state tax Withholdin?nif your state of not man tory in yoru- 7 residence is not listed, or if you choose a method of WI aiding that is not altered your statexwe v: t" om Smtammuewme tax'g or no ohm mm ?Iresideitmneofthefot I. ?dun. wt 0 statesz . .. -. . i. .. $1?.le (min-Bl "?ble rollover distributions MIN. 3&0. MT.- ND. NJ. NM. NY. 01L RI. SC, 111', WI. and state v?vithholdoag issvolnntaty for payments from only) and would like state income tax Withheld. (Specify a percentage or dollar amount to be withheldreside in one of the voluntary withholding states listed above and'l do not want state income tax withholding deducted from my dishibntiOn. . C. No State Withholding: Some states do not havestate income taxwithholding. . . rasidentstate is one of the folio . All, FL, ill, NV. NH, SD, TN.- WY th .D stgteginc'ome taxwithholdinf. wing TXan? there is no state income tax withholding on non-periodic (single sum) My resident state is payments. - . iam the participant's spouse. understand that I am entitled to a spousal death bene?t under the Plan or . ed based on the participant's account balance at the time of his or her death. I understand that this spousal ?is bene?tis in the form of a joint and survivor annuity? or QJSA, an explanation of the QJSA and upon other- paymentoptions was provided to the participant; .I realize that the participant cannotwaive this Spousal spousal bene?t and'Obtain a distribution in the form requested by the participant Or obtain a loan unless i Wm, consent. 1 acknowledge that the transaction requested by the participant'may reduee?or eliminate any ("rem bene?t otherwise payable ?to me. Ihave reviewed the paperwork associated with theparticipant?s request enablers and con?rm that it identi?es{an requested by the participant and any non-spouse ?up! 3151' .bene?dal'y. I vollmta?iy consen - - . - aiver orioan Wine? and acknov'vledge that thiswm authorize?the requeSt. - .. graham . -. ZOIO gap . pansessigna - - - .. - Date _Ll_ -. (S ouse's ustbe witnessed and 'publico authorized an're entativethe year - - - - "State of -., one?" I Couhtyi'if mnlissi - I GOMMW or I P) onexpires: at! my . 7W Nomhwranne I ,u . . 0R Author?edphanrepz?senta?ve ssignat'we Hm lg mommy 'hnnemtrermauonmtt?euedoa uterus-mien; Plan number: 767472 4?3? . . .n A. Mandatoryftate Withholdin . If. an reside in a state where state income tart withholdingis mandat . a" w? he - ?iv. t; - I am the artici pant' 's nose. I understand that I am entitled to a spousal death bene?t under the Plan Married based on earticipant 5 account balance at the time of his or her death. I understand that if this bene?t is? in form of- a ?quali?ed oint and survivor annuity? or" QJSA, an explanation of the IQJSPagfiald to the pa'rtici ant. I reahze that the cipantI caniiot waive this Participants otherp ent options was provide spolrsala ene?t and obtain a distribution in the form requested by the particrpant or obtain a loan miless I Spousal consent. racism Ie that the hansaction guested participantnia areduee or eliminate any beWe?t othemise paya to me. I have review the paperwork assouated w_i_ the partiapant?s request - 7-. nested by the parti' dany non-spouse clinowledge that this will - mfg: mm lliatit?ldenti? the :r unableto bene?aai?lvoluntar?yconstto - . . loanrequ'esta'iia ?3 authorize ereqi'iest. 3}ng Spousessi?gnam - .. Date 1 '21 20 am 'ssignatur mus edba to it unauthorized lair resontaliVeS Seal) m?gjlnust sign dotteb the at ?lejsame timg'a'iidbn thesamedate dang. Billedamsmust pouse and Subscribed and sworn before methis__. day of JCOU . I 2?13 ?l Staleof -- Countyof . Mycannissionexpeeso? 2/2/20 II Nomi; signature on 1' I .Your [underslandthat inaccurate assertionormisrepresentalion mayjeopardize theab'ihty myenet'mployertoolfer the- lanaiid se'veran?co from employiir willbe resp forits Authorization may subject are to' disciplinary action.in accuracyinthe eventanydisputeanseswithres tothetransac?on. cerhfy'alotherdistiibillions (other than hardshi distributions) and non-taxab loans have been obtainedcertify or sought and any loans which are available will cdluse further hardship. therefore this hardship disbursement' is necessary. [havereadtlieexplanaiion ofthe that was provided and I know thatl have the righttoreceive my bene?ts as a joint and survivor annuity if I amniam?ed the revoke the waiver at any time below my payments begn. I have at least 30 days to decide whether or not to Waive the annuity payments. By consenting to this distribution. I understand I am waiving my light to a life annuity. If there are investment options available through your retirement account that are subject to the fund' Is market timingpdicies, you may be subject to restrictions or incur fees if you engage in excessive trading activityinthose investments. You maywish toreviewthefund prospectus oryourretirement accounts to silbinitling this transaction request. If a fee applies to the transaction, you will . . .r a is processed by logging on to the retiremeniinternet site at Ed. outmzoil .mm-i CharlesJ Costello 767472 -- - u-l vhf! .n . 4/77/17 Jam {77/th .. ., 77/35? 7 17%3" J, .. ?/7777 Dec/7472777 777m/ 3777/ K7 - F. 4 47/099775 6775774170 r, I game/Sm 65/ Q47 77 371/1"; 574716.: 5752155 . 7 Z. 4/9/57. . A M711 pe??M Ill/?1507 I I. 75?7"? 6D. 57175 bin/?772; 6777645 .. ,5 a ?ax-7 75m Ida/?62? #76 517735 . 7777717770775777 7477597?) 3 1/9757?; - . .17 Mag/Wu, 137,407ng ., - W47 40 ?a?eld A701- .. In] F.- F. 42., hi - 3 7/5 \17/777 .. 5) ?4 (7727307) Jong??oq- . I - .. -.-. (We .. 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A513.- a - - sum.- . 1 11- 3611111 V111 11411 1117111272 4?11 .9 .1- COMMONWEALTH OF DEPARTMENT OF STATE BEFORE THE SECRETARY OF THE COMMONWEALTH Commonwealth of i Bureau of Commissions, File N03 14-99-09803 Elections and Legislation vs. i Lisa Marie Deeley, Notary Public i Docket 0: 0040'99'17 Respondent ORDER 3 AND NOW, this?? day of 2018, the ACTING SECRETARY OF THE COMMONWEALTH (?Secretary?) adopts and approves the foregoing Consent Agreement and- ineorporates the terms of paragraph 6, which Shall constitute the Secretary's Order and is now issued in resolution Of this matter. This Order shall take effect immediately. BY ORDER: ACTING SECRETARY OF THE COMMONWEALTH Honorable RObErt- Torres . Acting Secretary, of the Commonwealth For the Commonwealth: Andrea L. Costello, Esquire 2601 North Third Street P.O. Box 69521 Harrisburg, PA 17106-9521 For the Respondent: James C. Crumlish, HI, Esquire Elliott Greenleaf, P.C. Date of mailing: my, 8 925 Harvest Drive Blue Bell, PA 19422