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HomeMy WebLinkAbout02-4971 DEBORAH L. DEYO, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA v. : DOCKET NO.O;;_~?I CIVIL TERM CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant IN DIVORCE NOTICE TO DFFRNn ANn 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 are warned that if you fail to do so, the case may proceed without you and a decree in divorce or annulment may be entered against you by the court. A judgment may also be entered against you for any other claim or relief requested in these papers by the plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for the divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, High and Hanover Streets, Carlisle, Pennsylvania. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY A VENUE CARLISLE, PA 17013 (717) 249-3166 DEBORAH L. DEYO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA v. : DOCKET NO.O,.< ~ 'iCf7, CIVIL TERM CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant IN DIVORCE COMPLAINT IN DIVORCE AND NOW, comes Deborah L. Deyo, Plaintiff, by her attorney, Dirk E. Berry, Esquire, and respectfully avers as follows: I. Plaintiff is Deborah L. Deyo, adult individual who currently resides at 221 Longs Gap Road, Carlisle, Cumberland County, Pennsylvania 17013 where she has resided since September 22,2002. 2. Defendant is George F. Deyo, Jr., an adult individual who currently resides at 112 Cave Hill Drive, Carlisle, Cumberland County, Pennsylvania 17013, where he has resided since October 1996. 3. The Plaintiff and Defendant both have been bona fide residents in the Commonwealth for at least six months immediately previous to the filing of this Complaint. 4. The Plaintiff and Defendant were married on July 10, 1999 at Newville, Pennsylvania. 5. There have been no prior actions of divorce or for annulment between the parties in this or in any other jurisdiction. 6. Plaintiff and Defendant are citizens of the United States of America. COUNT ONE - DIVORCE S3301(c) - MTmJAL CONSENT 7. Paragraphs one through six are incorporated herein by reference as if set out in full. 8. The marriage is irretrievably broken. 9. Plaintiff has been advised of the availability of marriage counseling and of the right to request that the Court require the parties to participate in marriage counseling. WHEREFORE, Petitioner requests this Honorable Court to enter a decree in divorce, divorcing Plaintiff from Defendant, pursuant to ~330I(c) of the divorce code. COUNT TWO - DIVORCE !!3301(dl _ NO FAULT 10. Paragraphs one through six are incorporated herein by reference as if set out in full. 11. The marriage is irretrievably broken. 12. Plaintiff has been advised of the availability of marriage counseling and of the right to request that the Court require the parties to participate in marriage counseling. WHEREFORE, Plaintiff requests this Honorable Court to enter a decree in divorce, divorcing Plaintiff from Defendant pursuant to ~330I(d) of the divorce code. COUNT THREE - INDIGNITIES 13. Paragraphs one through six are incorporated herein by reference as if set out in full. 14. Defendant, George F. Deyo, Jr., has offered such indignities to the person of the Plaintiff, the innocent and injured spouse, as to render Plaintiff's condition intolerable and life burdensome. WHEREFORE, Plaintiff requests this Honorable Court to enter a decree in divorce, divorcing Plaintiff from Defendant, pursuant to ~3301(a)(6) of the divorce code. COUNT FOUR - EQUITART,F, DISTRffiUTION 15. Paragraphs one through fourteen are incorporated herein by reference as if set out in full. 16. The parties have, during their marriage, acquired certain property both personal and real. 17. Plaintiff and Defendant are the owners of various items of personal property, furniture, household furnishing, real estate and/or other marital property acquired during their marriage that are subject to equitable distribution. 18. Plaintiff and Defendant have incurred debts and obligations during their marriage which are subject to equitable distribution. WHEREFORE, Plaintiff requests this Honorable Court to enter a decree equitably dividing the parties property and equitably apportioning the parties debts. COUNT FIVF. - ALIMONY 19. Paragraphs one through eighteen are incorporated herein by references as if set out in full. 20. Plaintiff is without sufficient property and assets sufficient to provide for her reasonable needs presently, and after the entry of a decree in divorce, and to pay attorneys fees and court costs, and is otherwise unable to financially support herself. 21. Defendant is presently employed and receiving a substantial income and benefits and is able to pay for alimony for Plaintiff. WHEREFORE, Plaintiff requests this Honorable Court to enter an order requiring Defendant to pay an appropriate alimony to Plaintiff. COUNT SIX - ALIMONY :~~~~~~~~~ SPOUSAL SUPPORT. COlJNS STS 22. Paragraphs one through eighteen are incorporated herein by references as if set out in full. 23. Plaintiff is without sufficient property and assets sufficient to provide for her reasonable needs presently, and after the entry of a decree in divorce, and to pay attorneys fees and court costs, and is otherwise unable to financially support herself during the pendency of this divorce action and through its resolution. 24. Defendant is presently employed and receiving a substantial income and benefits and is able to pay for counsel fees, expenses and costs as well as alimony pendente lite or support for Plaintiff. WHEREFORE, Plaintiff requests this Honorable Court to order alimony pendente lite, Plaintiff's counsel fees, expenses, and costs or appropriate spousal support. Respectfully submitted, Law Office of James K. Jones, Esquire A:/~~ DIrk E. Berry, Esquire Attorney for Plaintiff 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 - ~-- VERIFICA TlON I verify that the statements made in this Complaint are true and correct to the best of my knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. ~4904, relating to unsworn falsification to authorities. DEBORAH L. DEYO, Plaintiff : IN THE COURT OF CO.MMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA v. : DOCKET NO. CIVIL TERM CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant : IN DIVORCE CERTIFICATR OF SF-RVICE I, Dirk E. Berry, Esquire, do hereby certify that on this day Plaintiff's Complaint in Divorce was served by Certified Mail, return receipt requested, and First Class Mail upon the following persons: George F. Deyo, Jr. 112 Cave Hill Drive Carlisle, PA 17013 Date: !()-((-U~ Dirk E. Berry, Esquire Attorney for Plaintiff 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 (') CJ n c: f'0 '". ~ .Jq i9. :?:'" J ~ "1:'("-:; .""") ! llJ "'"lr hI 79 0 ~ w t) f!: C\ ~ C~'i. g ."n ...... "l D <- c ..... C' (' .- :_-J 0 -.,J , -'J -n tJ -, 10 -<.; ~ Cv '-I:: ~ ~ ~ ~ DEBORAH L. DEYO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA v. DOCKET NO. CIVIL TERM CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant IN DIVORCE PETITION FOR AUMONY AND AUMONY PENDENTE UTE AND NOW, comes Debroah L. Deyo, by her attonrey, Dirk E. Beny, Esquire, and respectfully avers as follows: 1. The parties hereto are husband and wife, having been joined in maniage on July 10, 1999. 2. The parties separated on or about September 22, 2002. 3. Petitioner is without the ability to earn income sufficient to meet her reasonable needs and to pay attorneys fees. WHEREFORE, Petitioner prays this Honorable Court to order alimony pendente lite in an amount equal to the Pennsylvania State Support Guidelines and reasonable attorney's fees. Respectfully submitted, irk E. Beny, Esquire Attorney for Plaintiff 7 Irvine Row Carlisle, PA 17013 (717) 240-0296 - VERIFICA TION I verify that the statements made in this Complaint are tme and correct to the best of my knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. ~4904, relating to unsworn falsification to authorities. o c "'",.~. \:]1-,-:' n"" ;;;~~- :).',' (c-]t f;:( -.:t"~ C) I>"',) n C"J -< () -'1 .(1 :-:) DEBORAH L. DEYO, Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : DOCKET NO. 02-4971 CIVIL TERM v. CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant : IN DIVORCE PRAECIPE TO: The Prothonotary Please reinstate the complaint filed in the above matter. Respectfully submitted, iJ?1.1/ irk E. Berry, Esquire Attorney for Plaintiff 7 Irvine Row Carlisle, P A 17013 (717) 240-0296 ~~ ------ ------ o ~ -at:;:, mrr -7 "..,. ~~-:'. --- r::C ~Fs >c <J =< (:) ['\) o --fl ..... ?- 1'0 ~~C"1 r:..: .~ <:'0 DEBORAH L. DAYO, PlaintifflPetitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE GEORGE F. DEYO, JR., Defendant/Respondent NO. 2002-4971 IN DIVORCE DR# 32230 PacseS# 19410503i6 CIVIL TERM ORDER OF COURT AND NOW, this 20th day of November, 2002, upon consideration of the attached Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that th~: parties and their respective counsel appear before R.J. Shaddav on Janua11l 8. 2003 at 2:00 P.M. tbr a conference, at 13 N. Hanover St., Carlisle, P A 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 191O.11@ (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, George E. Hoffer, President Judge Mail copies on 11-20-02 to: Petitioner < Respondent Harold Irwin, Esquire Dirk Berry, Esquire " /' I . 1'- ~ , R. J. "sbadday, Conference Officer ,. (/ 1 /l l /",/ / t.. "" ,/'_._G!.L'?-L--:"-- /'\:f -#".--- ('.l ,...J ., Date of Order: November 20, 2002 YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUN1Y BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 h'j;\;'\!/\lif\S\jf\l3d t '~lr'F.-" .,,~' ~-c......~..,..,. '"' I\~I';;;' , ".'-'-",."-;I;V Su :/1 !id 02 , I' j:""U:~ \l:'.... j ,u/i-:,_, DEBORAH L. DEYO, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA : DOCKET NO. CIVIL TERM v. CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant IN DIVORCE PETITION FOR AUMONY AND AUMONY PENDENTE UTE AND NOW, comes Debroah L. Deyo, by her attonr1ey, Dirk E. Berry, Esquire, and respectfully avers as follows: 1. The parties hereto are husband and wife, having been joined in marriage on July 10, 1999. 2. The parties separated on or about September 22, 2002. 3. Petitioner is without the ability to earn income sufficient to meet her reasonable needs and to pay attorneys fees. WHEREFORE, Petitioner prays this Honorable Court to order alimony pendente lite in an amount equal to the Pennsylvania State Support Guidelines and reasonable attorney's fees. Respectfully submitted, <:/, .~ ----: irk E. Berry, Esquire Attorney for Plaintiff 7 Irvine Row Carlisle, P A 17013 (717) 240-0296 VERIFICA TION I verify that the statements made in this Complaint are true and correct to the best of my knowledge and belief. I understand that fallse statements herein are made subject to the penalties of 18 Pa. C.S. ~4904, relating to unsworn falsification to authorities. a c: 7<'" ...... '"OlT' rnrr z::r, -'" ~ ,.-1... (fJi _.c .....- ~c; ,J';'or-'. '~(~.~ ," L 7':' ::;:l ~~ o N o .;:-) -l o -n '-0 :::: . -~-1 :: ':~~~l\ l :::~ "!;S -< r::- :::> State Commonwealth of Pennsylvania Co.lCity/Dist. of CUMBERLAND Date of Order/Notice 01/15/03 Tribunal/Case Number (See Addendum for case summary) ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT l)ld. a&Jk.:J;? - 'It; 7) (! i 1// L I*Je~s. /9Ylo~-D:3~ @ Original Order/Notice o Amended Order/Notice o Terminate Order/Notice WEBSTER TRUCKING PO BOX 493 EMIGSVILLE PA 17318-0493 RE: DEYO I GEORGE F. JR Employee/Obligor's Name (last, First, MI) 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, MI) EmployerMithholder's Federal EIN Number See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 269.00 per month in current support $ 81.00 per monthin past-due support Arrears 12 weeks or greater? @yes 0 no $ 0.00 per month in medical support $ 0.00 per morithfor genetic test costs $ per month in other (specify) for a total of $ 350 . 00 per month to be forwarded to payee below.. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 80.77 per weekly pay period. $ 161.54 per biweekly pay period (every two weeks). $ 175.00 per semimonthly pay period (twice a month). $ 350.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (J 0) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate!date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. BY THE COU~ "':-~ Service Type M ~,';R() JV G:> b Form EN-028 Worker ID $IATT Date of Order: ,.~ ~ :.,j " r: f'" y [C"_-- . OMB No: 0970.()154 l'lt. .C3 ~-_._. C),f? 1(0 , ~ ''r ..ll r ~Ii'~ '..1 r.~ (~ \?f'lV!\\}E}\\N?d I ,~'n,....'~ '-1'" ,.'" ,'~~,\^ir1""\ i'Ll" \U'.) \.,.l"h::.::,t;'~ 1""; "" \ :C' I,lrl. Q \ 1'1\1',. f,'D .\ v V ~ ~ h- .J ~ ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If hhecked you are required to provide a copy of this form to your employee. If YOI,H employee works in a state that is ditterent from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reseNation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4. * ~~~i~~g ~~e .~~yda~~ of 'iNitnholdin? You must repo~ tne payd~~;~:: ~~~itnn,olding vvnen sending tl,e pay ":1ent. The paydateldate of vvlthnoldlng IS the date on vvnlel, amount vvas vvltnneld flO ,I n I 'yee s vvages. You must comply With the law of the state of the employee's/obligors principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 8333100107 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO, GEORGE F. JR 6918000195 DATE OF SEIJARATlON: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligors income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-.discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary aciion against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.c. 91673 (b)l; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at i717) 240-6225 or by FAX at (7171 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker I D $IATT OMB No.: 0970.()154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: DEYO, GEORGE F. JR PACSES Case Number 194105036 Plaintiff Name DEBORAH L. DEYO Docket Attachment Amount 02=49'7'1 CIVIL $ 300.00 Child(ren)'s Name(s): DOB o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB . . . . '. '. ... ," ".... .. ......................... "' "' ....... .......,.....,.. ........ .. .. .. .. ..,.. .. .. ..,..... .. .. . .. ..... ................ """ ..,.." ..", ",........ ",.'..,....", ..,........ ............. .... ............ ..................." .."..... "........ ......".. .............................. .................. ".....".......,.... ."............................................................. .......... .",.,..,..",.. ........... .......................................................", ........ '. .... ",.."... '... ................................................. .................. .............. .......... ...................... ............................................... ............ ....... ...... ......... ...... .................. ......... ......... .............. ......... o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. Service Type M Addendum OMB No.: 0970.()154 PACSES Case Number 433104887 Plaintiff Name DEBORAH ]~. DEYO Docket Attachment Amount 008'5"7S 2002 $ 50.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. PACSES Case Number Plaintiff NamE~ Docket Attachment Amount $ 0.00 Child(ren)'s l'Jame(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. Form EN-028 Worker 10 $IATT DEBORAH L. DEYO, Plaintiff/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA vs. CIVIL ACTION - DIVORCE GEORGE F. DEYO, JR., Defendant/Respondent NO. 2002-4971 CIVIL TERM IN DIVORCE Pacses# 194105036 ORDER OF COURT AND NOW, this 9th day of January, 2003, based upon the Court's determination that Petitioner's montWy net income/earning capacity is $856.76 and Respondent's monthly net income/earning capacity is $1,271.66, it is hereby Ordered that the Respondent pay to the Pennsylvania State Collection and Disbursement Unit, $269.00 per month plus $31.00 for arrears payable weekly as follows; $62.08 for alimony pendente lite and $7.15 on arrears. First payment due next pay date. Arrears set at $757.71 as of January 15, 2003. The effective date of the order is December 24,2002. The Alimony Pendente Lite Order is $202.00 per month, effective October 11, 2002 through December 23,2002 while the parties' child was residing with the Peititioner. This Order considers that Petitioner has an Obligation for child support to the Respondent, effective December 24, 2002. Failure to make each payment on time and in full will cause all arrears to become subject to immediate collection by all of the means as provided by 23 Pa.C.S.S 3703. Further, ifthe Court finds, after hearing, that the Respondent has willfully failed to comply with this Order, it may declare the Respondent in civil contempt of Court and its discretion make an appropriate Order, including, but not limited to, commitment of the Respondent to prison for a period not to exceed six months. Said money to be turned over by the P A SCDU to: Deborah L. Deyo. Payments must be made by check or money order. All checks and money orders must be made payable to P A SCDU and mailed to: P A SCDU P.O. Box 69110 Harrisburg, P A 17106-9110 Payments must include the defendant's P ACSES Member Number or Social Security Number in order to be processed. Do not send cash by mail. Unreimbursed medical expenses that exceed $250.00 annually are to be paid 0% by the respondent and 100% by petitioner. The petitioner is responsible to pay the first $250.00 annually in unreimbursed medical expenses. Respondent to provide medical insurance coverage. Within thirty (30) days after the entry of this order, the Respondent shall submit written proof that medical insurance coverage has been obtained or that application for coverage has been made. Proof of coverage shall consist, at a minimum, of: 1) the name of the health care coverage provider(s); 2) any applicable identification numbers; 3) any cards evidencing coverage; 4) the address to which claims should be made; 5) a description of any restrictions on usage, such as prior approval for hospital admissions, and the manner of obtaining approval; 6) a copy of the benefit booklet or coverage contract; 7) a description of all deductibles and co-payments; and 8) five copies of any claim forms. This Order shall become final ten days after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. DRO: R. J. Shadday Mailed copies on ],]7,03 to; < Petitioner Respondent Dirk Berry, Esquire Haro]d Irwin, III, Esquire BY THE COURT, J. g Co C' (..J -n ?: , -urn ~.. f'Tlf"-' - Z'j; ZC' r-:l (f.';P' 0) -:'....' r;:C - j;c " ~.:::;:C) :::- )>-c j +--' -7 1'L;oo ~ ::;. ~ Iv ~ In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DEBORAH L. DEYO ) Docket Number 02-4971 CIVIL Plaintiff ) vs. ) PACSES Case Number 194105036 GEORGE F. DEYO JR ) Defendant ) Other State ID Number Order AND NOW to wit, this JANUARY 28, 2003 it is hereby Ordered that: THAT THE JANUARY 9, 2003 ORDER IS AMENDED TO REFLECT AND CORRECT RESPONDENT'S MONTHLY NET INCOME AS $2,128.42. DRO: RJ Shadday xc: plaintiff defendant Dirk Berry, Esquire Harold I:rw:in, Esquire Edward E. Guido JUDGE Service Type M Form OE-520 Worker ID 21005 Of It;, \fIiN/il).8,'~N:Jd r I 'JI"\(.....I~~ I ~.." '-"-'I'''''f'''\ 1\,.Lj\; ;,..),) :" r'_i";~:}\;1 1....; tll; : (; .. . l,:..:' ~J ~ ~ 'J 82 N~(' SO 'l~"1 ,'''. AU "_l",,J:' ',#.... I :";'..J State Commonwealth of Pennsylvania Co.lCity/Dist. of CUMBERLAND Date of Order/Notice 02/19/03 Tribunal/Case Number (See Addendum for case summary) ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT bl!/ c2ct:1) - r971 {'ftlL IJ/r<;:f~ /106~o3(;., @ Original Order/Notice o Amended Order/Notice o Terminate Order/Notice WEBSTER TRUCKING CORP PO BOX 388 BURLINGTON MA 01803-0688 RE: DEYO, GEORGE F. JR Employee/Obligor's Name (Last, First, Mil 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) EmployerNvithholder's Federal EIN Number See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'slobligor's income until further notice even if the Order/Notice is not issued by your State. $ 269.00 per month in current support $ 81.00 per month in past-due support Arrears 12 weeks or greater? ~yes 0 no $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 350.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the follOWing to determine how much to withhold: $ 80.77 per weekly pay period. $ 161.54 per biweekly pay period (every two weeks). $ 175.00 per semimonthly pay period (twice a month). $ 350.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amounr. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: P A SCDU Send checkto:PennsylvaniaSCDU, P.o. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Service Type M ." ~ ..." ~"".?I ki ~) :",;:;,-~:.',"~~~~,,:,~':-..-- r:l PlJ) ~O-2 - Date of Order: FEB 2 0 2003 CbwdK.O l: JV t.€ Form EN-028 Worker ID $IATT No.: 0970.()154 C!&(o .. .1~- '.- ,.;;,. !: _ ,_, "of n Vl8 (J Vlj\Ni\lASN~{id U~ In;-J", ....n :'-..t~"~ :-']f';';"('\t"'\ I f\jj 1\.;0,) I,.:!\'" :~r~-''''~:'~f Iv 81] :[: ~;d ! Z 83J 80 ;j""- ::,:,,~j ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to provide a ~opy of this form to your employee. If your employee works in a state that is different from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* ~~~f~~h~ .':yd~~ of'/v'ithholdil1? You must re"o~the payd~~::I~~~;~'~l: ;hen seMdingtl,e payM:el1t. Ti,e paydateJdate of vvltJ.holdlng IS the date 01, vv!<llcM aM,ount vvas vvrth!<leld fro n I 'v e. You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligors principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 0423907260 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO. GEORGE F. JR 6918000195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: .Ifyou fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10. * Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.c. 91673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O.. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATIACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (7171 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT OMB No.: 0970-01 S4 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: DEYO, GEORGE F. JR PACSES Case Number 194105036 Plaintiff Name DEBORAH L. DEYO Docket Attachment Amount 02=4971 CIVIL $ 300.00 Child(ren)'s Name(s): DOB dlf~~~~~;~'~~~~;;~~~~i;;~~i:~~~'I~~~~~il~~~~~~....<>>>>... identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB .........,............:....................................-:..................................................;.....;........'..................;...;.................;...........;......-:................-:.................;...... . ..... "' .. .................... ................................ ..................................................... ..... ........................ ........ ..... ..... .......................................................... ..,..... ...............,.....,........,.....,'......',....,......'..........,'......,'.....'.......,...............,...' '..................'..,..'.....'.........,..'........'.',..............,... ... ...... ... '.' ................... ....... ....,.. .. .......... ....... ........... . ................. .......... ......... ............ .............. ............... ....... .... o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. Service Type M Addendum OMB No.: 0970-0154 PACSES Case Number 433104887 Plaintiff Name DEBORAH L. DEYO Docket Attachment Amount 00ii57S 2002 $ 50.00 Child(ren)'s Name(s): DOB ';::::::::::::::.::::::::::::::::::::::::'::::::;:::;'.;::::::::::::':;::::;:::::'::'::.:::::::.:::::::::::::.:.::.::.::::.::::::::::::::::::::::::::::::::::::::-::-:::::--::::::.;:.:.::'.;.;:::..:-..;.,..-:....,..,-:.... tJlf~h~~ked,Y~~~~~~eq~ired to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff NamE~ Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB If checked, you are required to enroll the child(ren) above in any health insurance coverage available the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB . ..... ...... ....,. ,,' .'..... .,........................,.........,..... ''''.' ,. .,.. .............,.... ......,............ ....... ......., '......... ...................... ....... ....... ........ ..... ............... ........ ......... ...... '.' .. .. ,. .. ...................,......,..,...,. ....,. ...., ,. .....,............, .. ,. ........... ...... .. .. ..... ,. '.' .. .. . ........,...., .,... '.' ..,.. ,. ..,.. .. ..,.. '. ..,.. ..........,.. ,. .,.......,.. ...... .... .............. ...,..., ..,. ... .... ..,..... ........... ............... ............... .......... ..... .........,.. .,..... ..... ..' .....,.... ... ... ......................,.... .,....... . [j Ifch~~k~d, };~~ .~.~~~~~Ui;~t~~~;~llth~~hild(;~~)..... identified above in any health insurance coverage available through the employee's/obligor's employment. Form EN-028 Worker 10 $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT ~(i q; 0 C;O-3 ~~ Dc) - L-I Cj, I U\);) State <;:ommonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 02/14/03 Tribunal/Case Number (See Addendum for case summary) RE: DEYO, GEORGE F. JR Employee/Obligor's Name (Last, First, Mil o Original Order/Notice o Amended Order/Notice @ Terminate Order/Notice ElTiployerlVVithholder's Federal EIN Number WEBSTER TRUCKING PO BOX 493 EMIGSVILLE PA 17318-0493 y~~\ OLt&g, 2 '1 5 :/ rjO?r- 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mil See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'slobligor's income until further notice even if the Order/Notice is not issued by your State $ ____ 0.00 per month in current support $ . .0 . 0 o per month in past-due support Arrears 12 weeks or greater? 0 yes <X) no $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. (fyour pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0 .00. per weekly pay period. $ O.....Q.Q.perbiweekly pay period (every two weeks). $ . 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, dndyourfee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to:PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Form EN-028 Worker ID $IATT Dateoforder:~~ Service Type M OMB No.: 0970-01.54 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to provide a ~opy of this form to your. ~mployee. If YOl)r employe~ works in.a state that is ditterent from the state that issued this order, a copy must be provided to your employee even If the box IS not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4. * R-eporting the PaydatelDare of \r\!itllhol~i~~ ':m 1TIU5trepo:1: the-pay;~date of-#ithhold~ng-v.llen sellding the paylllent. The paydateldate of vvitl,l,olding is the date 011 ..hiel, amount was withheld fron! the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state ,of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and .return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'SID: 8333100107 EMPLOYEFS/OBUGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO, GEORGE F. JR 6918000195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law ot the State in which he or she is employed governs. 9. Anti~iscrimination: You are subject to a fine detennined under State law fordischarging an employee/obligor from employment, refusing to employ, or taking disciplinary actic'!l against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor isem'ployed in another State, in which case the law of the State in which he or she is employed governs. 10.* Withholding Limits: You may not withhold morethari the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.s.c. ~1673 (b)l ;()r 2) the amounts ~lIowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (7171 240-6248 or by internet www.childsupport.state.pa.us Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 Page 2 of 2 Form. E N-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 o C 7 '"'OeD IJ) q::! .e-- _'~ zr:;: ~~'" kC; ~D >~ c:::.., ~ o (,.Jl.) :T. 'f:-~'" ;'0 I 0-: :::>- :.l: r:- o -" :--'1 r o '-r. -n (') in ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 03/01/04 Tribunal/Case Number (See Addendum for case summary) o Original Order/Notice o Amended Order/Notice @ Terminate Order/Notice WEBSTER TRUCKING CORP PO BOX 388 BURLINGTON MA 01803-0688 W ~-;;.-t,J'171 tt/ /J!f!;f:; /9 'II o~ 1?3(., /:id, ?J':S'l S ~ ;YiJ-e:;z s 0 3/0Z; H7 RE: DEYO, GEORGE F. JR Employee/Obligor's Name (last, First, Mil 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) EmployerANithholder's Federal EIN Number See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0 . 00 per month in past-due support Arrears 12 weeks or greater? 0 yes @ no $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0 . 00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. \!l\'.! ~\'.'1 Ii ',,"",cIU'THE COURT: Date of Order: MAR 2 200'. F Oc.<J 1'frct, E 71..! lJ(o C3' Form E N-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to proville a copy of this form to you~ employee. If yo~r employee works in.a state that is different from the state that issued this order, a copy must be provided to your employee even If the box IS not checked. ,. We appreciate the voluntary compliance of Federally recognized Indian tribes, triballY-<lwned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Rq5o,lil.g tlle Pdyd~Dat~ of\V;tl.l,old;,lg. Yl)U II'uS! l~pol1 tile pAydatc/ditte of ni1LI,oldil,g vvl.G.. sel,d;llg tl,~ paYlllellt. Ti,e payJatc/datG of vvitl.I,old;,.g i311,e d.al~ 01, nl.iel, dlllOolll nIB yyitl,l.eld hulll tl,l: dllfJIOy{'{':3 vvagc;;. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #1 0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and retum a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 0423907260 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO, GEORGE F. JR 6918000195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any Questions about lump sum payments, contact the person or authority below. 8. liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10. * Withholding limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.c. 91673 (bll; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxeSi and Medicare taxes. 1 ,. Additional Info: * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. 80X 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATIACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (7171 240-6248 or by internet www.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID $IATT OMS No.: 0970-0154 Q ~ 0 c:.;.;:.~ c. C~~ "T1 ... .-4 -, ,.~;"":. :x I:n ,.-r;ll;-i "'" n'F- "'-? ...,'j ;;U ~;;:.., -o~ /". . I :'1)' (I:') N q, i":~ ~~' ! ':k:tl ~C~~; ..,., '~-- ::l: ~......("") c~ (~)m '.-1 ""1:> ~;-- "-"-'1 =< .r- ;C< a:> St;;,...~i'-~t~,~.;:.;.; ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co.lCity/Dist. of CUMBERLAND Date of Order/Notice 03/09/04 Tribunal/Case Number (See Addendum for case summary) RE: DEYO, GEORGE F. @Original Order/Notice o Amended Order/Notice o Terminate Order/Notice EmployeriWithholder's Federal EIN Number OLD DOMINION FREIGHT LINE 500 OLD DOMINION WAY THOMASVILLE NC 27360-8923 INC JR Employee/Obligor's Name (Last, First, MI) 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, MIl W. ;;ltJaI-1j97/ (}ft//L //1C~S 11<11 {!5"03?~ ,M! 73"'7 8 ~cJ. ~J9C!%S. 7'33/cwl1?7 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania, By law, you are required to deduct these amounts from the above-named employee'sfobligor's income until further notice even if the Order/Notice is not issued by your State. $ 269.00 per month in current support $ 81. 00 per month in past,due support Arrears 12 weeks or greater? @yes 0 no $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 350.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 80.77 per weekly pay period. $ 161.54 per biweekly pay period (every two weeks). $ 175.00 per semimonthly pay period (twice a month). $ 350.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sf obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at l,B77-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. , ... ~.1 tfi:'J \;::'T"! ....,.~u._!,,:i"'-';.:""'''.:''B\iqHE COURT: q :lIJ...JJ.!L..____ ,/ ". 7V. tPG orm EN-028 Worker ID $IATT Date of Order:-l4AR 1 j 2nO'. t:/)ftJ~ E (;,0 Service Type M OM6 No.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to prpvide a copy of this form to your employee. If your employee works in a state that is ditterent from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, triballY-<lwned businesses, and Indian-<lwned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.* Rep6It;"g ti,e r"'ydatelDat~ ofW;lLLoldL,g. You IlIu~t leport lll~ pAydatetdate of vvitLholdil,g yvl'~11 3{.I,d;1,g ti,e P&YII'C,I,t. TLe pciydate/dblG of vvill,I,oldillg;,3 ti,e ddl~ 01. vvl,;c:1, illllOulIl nas nill.l.~ld (10,11 tI,e elllployee's m\g{.S. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 5607517140 EMPLOYEE'S/OBlIGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO, GEORGE F. JR 6918000195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10. * Withholding limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (1 5 U.5.c. ~1673 (b)1; or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your ernployee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMBNo.:0970-0154 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: DEYO, GEORGE F. JR PACSES Case Number 194105036 Plaintiff Name DEBORAH L. DEYO Docket Attachment Amount 02~ CIVIL $ 300.00 Child(ren)'s Name(s): DOB PACSES Case Number 433104887 Plaintiff Name DEBORAH L. DEYO Docket Attachment Amount 0085'7S 2002 $ 50.00 Child(ren)'s Name(s): DOB you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) above in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB you are required to enroll the child(ren) above in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. you are required to enroll the child(ren) in any health insurance coverage available employee's/obligor's employment. Addendum Form EN-028 Worker ID $IATT Service Type M OM6 No.; 097(}.()154 0 ...., 0 c:-, s= = " .c- -..... .-1 ~,~.-~ "T ::a ~-a f"il r- -0 In -"I y (5 -I CJ -0 -T- ,j (~5 :'1 C) (, , C) rn Co,) ::.:-~_l -.--! L> ,i;:~ -, U) :< $c'<ll1ned D~BORAH L. DBYO, Plaintiff ; IN TH~ COURT OF COMMON PLUS OF ; CUMB~RLAND COUNTY, P~NNSYLVANIA v. ; CIVIL ACTION - LAW ; NO. 02. 4971 CIVIL T~RM G~ORG~ F. DBYO, .JR., Defendant ; IN DIVORC~ DEFENDANT'S AFFIDAVIT OF CONSENT 1. A complaint in divorce under Section 3301 (c) of the Divorce Code was filed in this matter on or about October11 ,2002. Service of the complaint was accepted by counsel for the defendant on November 12, 2002 (see Acceptance of Service previously filed). 2. The marriage of plaintiff and defendant is irretrievably broken and ninety days have elapsed from the date of the service of the complaint. 3. I consent to the entry of a final decree in divorce after service of notice of intention to request entry of the divorce. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein made are subject to the penalties of 18 Pa.C.S. Section 4904 relating to unswom falsification to authorities. ~-2 ~ ,2004 DI!BORAH L. DI!YO, Plaintiff I IN THI! COURT OF COMMON PLI!AS OF I CUMBI!RLAND COUNTY, PI!NNSYLVANIA v. I CIVIL ACTION - LAW I NO. 02 - 4971 CIVIL TI!RM GI!ORGI! F. DI!YO, .fR., Defendant . . I IN DIVORCI! DEFENDANT"S MARRIAGE COUNSELING AFFIDAVIT The defendant, being duly sworn according to law, deposes and says: 1. I have been advised of the availability of marriage counseling and understand that I may request that the court require that my spouse and I participate in counseling. 2. I understand that the court maintains a list of marriage counselors in the Prothonotary's Office, which list is available to me upon request. 3. Being so advised, I do not request that the court require that my spouse and I participate in counseling prior to a divorce decree being handed down. I verify that the statements made in this affidavit are true and correct. understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. ~ -2- "? ,2004 ,~-- )-d4 t. - / GEOR F~, JR. 1 DI!BORAH L. DI!YO, Plaintiff : IN THI! COURT OF COMMON PLl!A8 OF : CUMBI!RLAND COUNTY, PI!NN8YLVANIA Y. : CIVIL ACTION. LAW : NO. 02 - 4971 CIVIL TI!RM GI!ORGI! F. DI!YO, .JR., Defendant = IN DIVORCI! WAIVER OE...NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCII5 DECREE ,UNDiR SECTION ~OF THE.-.DIVORCE CODIi 1. J consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that J will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. ? - j!.. .~ , 2004 ~~a GE . DE , JR. ~ ~ ~ ~ !':l Cf' g ~ -rn1J rrlr". ~"'r1 ~c: VlA-, :.r,F,,:' !20 J;C: ..... ~, ""(~ ,vC ~ Q, %:D.~ ~ ~, ~p, 9 ~'::>- :.2. -,j ::J' ~ o u:> ORDER/NOTICE TO WITHHOLD INCOME FOR: SUPPORT State Commonwealth of Pennsvlvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 04/19/04 Tribunal/Case Number (See Addendum for case summary) o Original Order/Notice o Amended Order/Notice @ Terminate Order/Notice Employer'\vithholder's Federal EIN Number RE: DEYO, GEORGE F. JR Employee/Obligor's Name (Last, First, MI) OLD DOMINION FREIGHT LINE C/O ATTN - JILL BIGGS 500 OLD DOMINION WAY THOMASVILLE NC 27360-8923 INC 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (S~ Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, MI) U! ;;ry}) _1/97/ (! t/ 111~9'<:; /'J'I/cb{)3l-fJ .J;I1 ? 5' 7 .s df' ()-;) ;JJ1~<; '/33/6 'jt?7 See Addendum for dependent names and birth dates associat,f!(/ with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). Arrears 12 weeks or greater? o yes <Xl no If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877,676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: APR 2 0 20041 . E COURT: JZ) orm EN-028 Worker ID $IATT t.CM) liK!j C Service Type M OMB No.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to provide a copy of this form to your employee. If your employee works in a state that is ditterent from the state that issued this order, a copy must be provided to your employee even if the box is not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal proc"ss under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4. * R~po,til,g tl,~ F'aydAt~Dare of 'vVitl,l,oldil,g. Yol:lllltJ~t lepolt t1,~ pAydAte'dare of n;tl,l,old;,.g HI,~II ~~lId;llg tL~ pAYIII~"l. The pa,datcldate of "itl,l,oldi"g i, t1,e date 0" ,,1.leI, 01 ,,<>u I ,t "as "itl.l.c1d flOl" tl ,e .,,,pl,,,,ce', "age,. You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5. * Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Fecleral or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all OrderslNotices to the greatest extent possible. (See #1 0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S ID: 5607517140 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO, GEORGE F. JR 6918000195 DATE OF SEIPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania S'tate law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Withholding Limits: You may not withhold more than the lesser of: 1) the amount" allowed by the Federal Consumer Credit Protection Act (1 5 U.S.c. ~1673 (b)1: or 2) the amounts allowed by the State of the employee's/obligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: * NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at LZ1Zl. 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Worker ID $IATT Service Type M OMB No.: 0970-0154 ~ .... c:::o ~ "'" .z:- :z,. ~' ;g i N ~c5 N I~ ..." :x ~fJ' ~ Q w :r, \0 -< <inned In the Court of Common Pleas of CUMBERLANIl County, Pennsylvania DOMESTIC RELATIONS SECllON 13 N. HANOVER ST. P.O. BOX 320, CARLISLE. PA. 17013 Defendant Name: GEORGE F. DEYO JR Member ID Number: 6918000195 Please note: All correspondence must include the Ml!mber ill Number. ORDER OF ATIACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Financial Break Down of Multinle Cases on Attachment Plaintiff Name DEBORAH L. DEYO DEBORAH L. DEYO PACSES Case Number 194105036 433104887 Docket Numbel: 02-4971 CIVIL 00857 S 2002 $ I $ $ I $ Attachment Amount/Freauency 300.00 IMONTH 50.00 ?MONTH I I % I I I TOTAL AITACHMENT AMOUNT: $ 350.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to auach the lesser of $ 80 . 77 per week, or 55 %, of the Unemployment Compensation benefits othe,rwise payable to the Defendant, GEORGE F. DEYO JR Social Security Number 453-94-5187 , Member ID Number 6918000195 . BUCBA is ordered to remit the amount attaehed to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant"s Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages. DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to IS U.S.C. ~ 1673 (b)(2) and 23 Pa. C.S.A. ~ 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant"s entitlement to Unemployment Compensation bmefits, under the Application for Benefits dated MAY 9, 2004 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: ~ 1 8 1.00~ ' Eow;'J-KcJ {:', JUDGE Service Type M Form EN-530 Worker ID $IATT ~!}t~~_~ ~iL () ,..., 0 ~ .::;~ ~ -n ..A -. .~ :r,:;" --~~ ...,.-\ -: r'\r":' --ndl - .- ~.~~ ,-. U) <:)C _.\ H) -V ~~~ ~\ -' t_':, --- ,,,,rn <.2 ~-) ~ ..; N ~..;.) Cf' ."" DEBORAH L. DEYO Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 02 - 4!~71 CIVIL TERM GEORGE F. DEYO, JR. Defendant : CIVIl. ACTION - LAW : IN DIVORCE AFFIDAVIT OF CONSEN1[ I. A complaint in divorce under ~ 3301 @ of the Divorce Code was filed on October 11,2002. 2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the date of filing and service of the complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and c:orrect. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904 relating to unsworn falsification to authorities. Date: b- r -tJ r/- , o c- ? -r..!65 ITir-~- ~f'q ~l;: r-: c~; '< ~ ;t;:c .L -') );Cl c: Z :< ~ = ..... <- c:: z ~ s: i~ t5:B ZO C')m -, 55 -< .- :r> :x CJI DEBORAH L. DEYO, Plaintiff v. : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : DOCKET NO. 02 - 4971 : CIVIL ACTION - LAW GEORGE F. DEYO, JR., Defendant : IN DIVORCE CERTIFICATE OF SERVlCE I, Dirk E. Berry, Esquire, do hereby certify that Plaintiff's Complaint in Divorce was served by Acceptance of Service, dated November 12, 2002, upon the following persons: Harold S. Irwin, III, Esquire Attorney for Defendant 64 South Pitt Street Carlisle, P A 17013 Date: to (<-1-0 'f ~~# Dirk E. Berry, Esquire Attorney for Plaintiff 44 S. Hanover St. Carlisle, P A 17013 (717) 243-4448 --' o ~ ri40:1' ,;?,[.}; ~~ ~f~, ):>c' id c 2: ~ <.n - ~ ~ ~ ~:n : ~~, ::JI: 0 -,. = am :;-{ ,= :-.0 ~ .' G"JL/r11 MARRIAGE SETTLEMENl: AGREEMENT THIS AGREEMENT made this rday of JUnE!, 2004 by and between GEORGE F. DEYO, JR. (hereinafter referred to as "HlJISBAND") and DEBORAH L. DEYO (hereinafter referred to as 'WIFE"). WITNESSETH: WHEREAS, HUSBAND and WIFE were lawfully married on July 10, 1999; and WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the parties and it is the intention of HUSBAND and WIFE to live separate and apart for the rest of their natural lives, and the parties hereto are desirous of settling fully and finally their respective financial and property ri~lhts and obligations as between each other, including, without limitation by specification; the settling of all matters between them relating to the ownership and equitable distribution of real and personal property; the settling of all claims and possible claims bl' one against the other or against their respective estates and equitable distribution of property and alimony for each party. NOW, THEREFORE, in consideration of the promises and the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally bound, hereby covenant and agree as follows: 1. The parties intend to maintain separate and permanent domiciles and to live apart from each other. It is the intention and pUrpOSE! of this agreement to set forth the respective rights and duties of the parties while they continue to live apart from each other. 2. The parties have attempted to divide their matrimonial property in a manner that conforms to a just and right standard, with due regard to the rights of each party. It is the intention of the parties that such division shall be final and shall forever determine their respective rights. The division of existing marital property is not intended by the parties to constitute in any way a sale or exchange of assets. 3. Further, the parties agree to continue living separately and apart from each other at any place or places that he or she may select. Neither party shall molest, harass, annoy, injure, threaten or interfere with the oth'er party in any manner whatsoever. Each party may carry on and engage in any employment, profession, business or other activity as he or she may deem advisable for his or her sole use and benefit. Neither party shall interfere with the uses, ownership, enjoyment or disposition of any property now owned and not specified herein or property hereafter acquired by the other. 4. The consideration for this contract and a~lreement is the mutual benefits to be obtained by both of the parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained is stipulated, confessed, and admitted by the, parties, and the parties intend to be legally bound hereby. 5. DEBTS: It is further mutually agreed by and between the parties that the debts be paid as follows: A. The HUSBAND shall assume all liability for and pay and indemnify the WIFE against all of his debts, including but not limited to the debt to Ford motor Credit on the step-van and the debt to CitiFinancial, and he will assume responsibility for any amount owing to Waypoint Bank for WIFE's overdraft on the joint checking account which occurred at or near the time of separation. . B. The WIFE shall assume all liability' for and pay and indemnify the HUSBAND against all of her debts. C. The parties agree that they have no joint debts other than as may be listed above. 6. Except as herein provided, the parties agree that they have previously divided their personal property to their mutual satisfaction. No payment shall be made by either party to the other as a result of the division of property contained herein. The parties agree that this division is fair and equitable, ancl is voluntary and made without duress by or upon either party. The parties further agrEle that henceforth, each of the parties shall own, have and enjoy independently of any claim or right of the other party, all items of personal property of every kind, nature and description and wherever situated, which are now owned or held by or which ma}' hereafter belong to the HUSBAND or WIFE, with full power to the HUSBAND or the WIFE to dispose of same as fully and effectually, in all respects and for all purposes as if he or she were unmarried. The following division of specific items of pHrsonal and real property will be equitably distributed as follows: A. PERSONAL PROPERTY: 1.) Motor Vehicles - The parties hereby release to the other any motor vehicle in the possession of the other party. 2.) Bank Accounts - Each party shall retain their respective checking and savings account free of any claim by the other party. The parties have already closed any joint accounts. 3.) Employee Benefit and Retirement Plans - Each party shall retain all of their own employee benefit, savings and/or retirement plans' proceeds free of any claim by the other party. 4.) Other Personal Property - The parties agree that they have divided all of their remaining personal property, including, but not limited to furniture, household goods, appliances and personal belongings to their mutual satisfaction and each release to the other all such personal property as now divided. 7. INCOME TAX RETURNS: All future income tax returns will be filed separately and the parties will each retain any refund due to them. 8. SUPPORT AND ALIMONY: Both parties hereby waive and forego all future financial and material spousal support from each other and agree not to request or seek to obtain alimony or spousal support before or after any divorce which may be granted. However, HUSBAND agrees to continue to payoff any support arrearages such as exist as of the date of this agreement. 9. DIVORCE: The parties both agree to cooperate with each other in obtaining a final divorce of the marriage. It is agreed that the marriage is irretrievably broken, that more than ninety days have passed since the service of the divorce complaint and that simultaneously with the execution of this agreement, the parties will execute and file the consents and waivers necessary to obtain the divorce. 10. BREACH: In the event of the breach of this agreement by either party, the non breaching party shall have the right to seek monetary damages for such breach, where such damages are ascertainable, and/or to seek specific performance of the terms of this agreement, where such damages are not ascertainable. All costs, expenses and reasonable attorney fees incurred by the successful party in any litigation .' to obtain monetary damages and/or specific perforrnance of this agreement shall be recoverable as part of the judgment entered by the court. 11. ADDITIONAL INSTRUMENTS: Each of the parties shall from time to time, at the request of the other, execute, acknowledgEl and deliver to the other party any and all further instruments that may be reasonably required to give full force and effect to the provisions of this agreement. 12. VOLUNTARY EXECUTION: The provisions of this agreement and their legal effect have been fully explained to the parties and its provisions are fully understood. Both parties agree that they are executin!;1 this agreement freely and voluntarily. HUSBAND's legal counsel is Harold S. Irwin, III, Esquire and WIFE's legal counsel is Dirk Berry, Esquire. 13. ENTIRE AGREEMENT: This agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 14. APPLICABLE LAW: This agreement shall be construed under the laws of the Commonwealth of Pennsylvania. 15. PRIOR AGREEMENTS: It is understood and agreed that any and all property settlement agreements which mayor have bee," executed or verbally discussed prior to the date and time of this agreement are null and void and of no effect. 16. WAIVER OF CLAIMS AGAINST THE ESTATES: Except as otherwise provided herein, each party may dispose of his or her property in any way, and each party hereby waives and relinquishes any and all rights Ihe or she may now have or hereafter acquire, under the present or future laws of any jurisdiction, to share in the property or the estate of the other as a result of the marital relationship, including without limitation, dower, curtesy, statutory allowance, widow's allowance, right to take in intestacy, right to take against the Will of the other, and right to act as administrator or executor of the other's estate, and each will, at the request of the other, execute, acknowledge and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights and claims. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. Tv~ ~~ H L. DE 0 (SEAL) ~ '1V I/L s. . . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :SS: PERSONALLY APPEARED BEFORE ME, a notary public for Cumberland County, Pennsylvania, this -p- day of June, 2004, GEORGE F. DEYO, JR., known to j me (or satisfactorily proven) to be the person whose name is subscribed to the within agreement, and acknowledge that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereun 0 set my hand and official seal. NOTAAIAlSEAl HAROlD S.IRWlN, III, NOTARv PUBLIC CARLISLE BOROUGH, COUNTY OF CUMal!lUAND MY COMMISSION EXPIRES OCTOBER 22, 11006 COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND PERSONALLY APPEARED BEFORE ME, a notary public for Cumberland County, Pennsylvania, this c;-fJ, day of June, 2004, DEBORAH L. DEYO, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within agreement, and acknowledge that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. 1ukb~A ) No ary Public: ~OMMONWEALTH OF PENNSYLVANIA Notarial Seal Kathleen K. Shaulis, Notary Public Carlisle Born, Cumberland'County My Commission E:<pires Dec. 22, 2007 Member, Pennsvlvania Association of Notaries (") ~ ;:gf";i 5fj;~~'f ~~ ~,r; ~f5 ZC) j;~O c- -7 ~ ...... = = or- ~ ~:!] ~~ ~~ 62 "'" 55 -< C-.. fi2 - .r :>:0- :11: c.n DEBORAH L. DEYO, Plaintiff THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA vs. NO. 02 - 4971 CIVIL GEORGE F. DEYO, JR., Defendant IN DIVORCE ORDER OF COURT AND NOW, this I f.I; 1"1. I day of ~ the proceedings having been 2004, the economic claims raised in resolved in accordance with a marriage ,;ettlement agreement dated June 7, 2004, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. BY THE COURT, Geo:t: cc: Dirk E. Berry Attorney for Plaintiff Harold S. Irwin, III Attorney for Defendant ''jU<-<> Il~ {,/Il >f}'I ~. \ilt<'//YVS: ,!~'.! ':;d AJJ\!nC('] ('; ,>.. ':"-~:~]/\JnC) ,8 :2 Hd 91 Nnr ~UOZ ;'J,I"'W},' 'u.'U J :JIll -'0 \~J # ~~:I~l" i1.l Q(.."r .;/ 30i:l:io-cJ31I:l DEBORAH 1. DEYO, Plaintiff IN THE COURT OF COMMON PLEAS VS. GEORGE F. DEYO, JR., Defendant CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION 02 - 4971 NO. CIVIL TERM PRAECIPE TO TRANSMIT RIECORD To the Prothonotary: Transmit the record, together with the following information to the court for entry of a divorce decree: 1. Ground for divorce: Irretrievable breakdown under 93301 (c) ~~ode. (Strike out inapplicable section). 2. Date and manner of service of the complaint: Affidavit of Acceptance of Service d,lted November 12 2002, hy H:>rnJ,j" Trwi", TTJ OIl. bc:half Ilf D@f8lulant. 3. Complete either paragraph (a) or (b). (a) Date of execution of the affidavit of consent required by 93301 (c) of the Divorce Code: by plaintiff June 9, 2004 ; by dElfendant March 23. 2004 (b) (1) Date of execution of the affidavit required by 93301 (d) of the Divorce Code: (2) Date of filing and service of the plaintiff's affidavit upon the respondent: 4. Related claims pending: The parties incorporate, but do not mer~e, their Marriage Settlement Agreement dated June 7, 2004 5. Complete either (a) or (b). (a) Date and manner of service of the notice of intention to file praecipe to transmit record, a copy of which is attached: (b) Date of plaintiff's Waiver of Notice in 93301 (c) Divorce was filed with June 14,2004 the Prothonotary: Date defendant's Waiver of Notice in 93301 (c) Divorce was filed with the Prothonotary: March 26, 2004 ~t/~;7 , Attorney for Plaintiff / DGh..,.J...Rl-. "'"' = = ~- (- c z o 'TJ :r! rl1:r) r- -orn 259 @~ "'~O om :::'-1 ~...J -< ct:) -0 ::tt: Ul N . . . . . . . . . . . . . . . . . . . . . . . . . ~,.,:+: Of. Of. . .. '+';fi;!;:f.'f.:!i ;+::f;;+:;+::t: :+::+::+:;+::+:;+:~;+:'f.'f.:+:'f.:+:'+' :+::+: ;+: 'f.'f.'f.;+:'f.:+:'f.;+:'f.;+:+:+:+:+:+~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ++++++:+:+:+:+:+:'f.++++++++++++++:+:? . IN THE COURT OF COMMON PLEAS OFCUMBERLANDCOUNTY . . . . STATE OF . . . DEBORAH L. DEYO, . . . . Plaintiff No. . VERSUS . . GEORGE F. DEYO, JR., . Defendant . . . . . . . . . DECREEINI DIVORCE . . . . . . . . . . 'J~ ~ ,,, AND NOW, DECREED THAT Deborah L. Deyo . . AND George F. Deyo, Jr. . . . . . . ARE DIVORCED FROM THE BONDS OF MATRIMONY. PENNA. 02 - 4971 Civil Term eJrl/, '/S".,I/ . ~IT IS ORDERED AND , PLAINTIFF, , DEFENDANT, . . THE COURT RETAINS JURISDICTION OF THE FOLLOWING CLAIMS WHICH HAVE YET BEEN ENTERED; BEEN RAISED OF RECORD IN THIS ACTION FOR WHICH A FINAL ORDER HAS NOT The parties incorporate, but do not merge, their Marriage Settlement Agreement dated June 7, 2004 ATTEST: ~~~2 , ~- .. . . .. :+::+: 'f.:+: +;+; :f.'+':+:'f.:+:'f:+. J. PROTHONOTARY ~f70 %~~~ ~ifJV ~?:-~~~,:.~,? -/0/ , , .\..-. ,. t.. ...::: ~.' .- - //t::7 E-e. 9 /,O,['C . If'] - / In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARUSLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: GEORGE F. DEYO JR Member ID Number: 6918000195 Please note: All correspondence must include the ME~mber ID Number. MODIFIED ORDER OF ATI'ACHMENT OF UNEMPLOYMENT BENEFITS Plaintiff Name DEBORAH L. DEYO DEBORAH L. DEYO Financial Break Down of MuItiDle Cases on Attachmenl P ACSES Docket Case Number Numbel: 194105036 02-4971 CIVIL 433104887 00857 S 2002 Attachment Amount/Freauencv $ ! $ $ ! $ 31. 00 IMONTH 50.00 jMONTH / / ; '/ / / TOTAL ATTACHMENT AMOUNT: $ 81. 00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $18.69 per week, or 55. 0 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, GEORGE F. DEYO JR Social Security Number 453-94-5187, Member ID Number 6918000195 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Coun for suppon and/or suppon arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Coun or Couns for suppon and/or support arrearage, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.C. ~ l673(b)(2) and 23 Pa. C.S. ~ 4348(g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation blmefits, under the Application for Benefits dated MAY 9, 2004 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Coun. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Coun. Date of Order: JUN24.. BY THE COURT ~~ "EDtL/J4,iA 1;', 0&/[)?J JUDGE Service Type M Form EN-034 Worker 1D $IATT -S'I'Z: ,=In!tTt~'.:df " ......, = c.~ ..<.- , :;= ~ o 'J --I ,. m;2~ -om :{:)Cl r-, I ~() !~~~ .'--, rll ~:.~ ,,~.:::; ~~~ r-., - -0 ::J:: Co.) a ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/24/04 Tribunal/Case Number (See Addendum for case summary) RE:MC CORMICK, WILLIS J. II Employee/Obligor's Name (last, First, MI) o Original Order/Notice o Amended Order/Notice @ Terminate Order/Notice ErnployerM'ithholder's Federal EIN Number HARRISBURG PROPERTIES SERVICES PO BOX 1224 HARRISBURG PA 17108-1224 W dt)()3 - '100/ f! tI Pi4-e.S,fS $J15IQ5"J'i')-;;;- Dt:.f ~5<J S ;;'003 PI'\CSlS 937/D.~Co&d- 183-52-7460 Employee/Obligor's Social Security Number 4144101191 Employee/Obligor's Case Identifier (See Ackkndum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'sfobligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per month in current support $ 0.00 per month in past-due support Arrears 12 weeks or greater? Oyes @ no $ 0.00 per month in medical support $ 0.00 per month for genetic test costs $ per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 0 . 00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of lhe paydate!date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to lhe laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sf obligor's aggregate disposable weekly earnings. For the purpose of lhe limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: cf}tt.)I9ft?L,j -~' t~, / "Z;- Form EN-028 Worker ID 21205 DateofOrder:~ Service Type M OMS No.: 097().{l154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If ~hecked you are required to prpvi(le a ~opy of this form to yoWemploye". If your employeefworks in.a statehthat ieds ditterent from the state that issued thiS order, a copy must be prOVided to your employee even I the box IS not c eck . 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and indian-owned businesses located on a reselVation that choose to withhold in accordance with this notke. 2. PrioriCy: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separateiy identify the portion of the single payment that is attributable to each employee/obligor. 4.* R~pOlt;'lg tl,~ PAydat,efDa~ of'Nitl.I,old;,.g. YOtJ 1.IIH! leport t1,~ po.ydateldate of n;1.hholdilrg nl'~11 sel,dillg t11~ "arnie,,!. The paydatc/dat. of "itl,l,oldil,g;' 11,. date 0" "I,;d, an,oullt "as "ltI,I,.ld ffo", tl,. ""ploy..'s "ag... You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must impiement the withholding order and forward the support payments. 5. . Employee/Obligor with MulCiple Support Holdings: If there is more than one Order.'Notice to Withhold Income for Support against this empioyee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #1 0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and retum a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 8545100182 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: Me CORMICK, WILLIS J. II 4144101191 DATE OF SEI'ARATION: 7. lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. Anti-discrimination: You are subject to a fine determined under State law for discha~:ing an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law govems unless the obligor /s employed in another State, in which case the law of the State in which he or she is employed govems. 10.' WiChholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.c. ~ 1673 (b)1; or 2) the amounts allowed by the State of the employee'slobligor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxesi Social Security taxesi and Medicare taxes. 11. Additional Info: 'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (71 7) 240-6225 or by FAX at LZIZ1]40-6248 or by internet ~,.childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID 21205 OMB No.: 097(H)154 (") r:~ :;:/.".f..':-.,.~'!1!'L'!.'!1',~~" r-' = ~ _0:- ,- l':::: ('.) ;- , .. :J -0 Sf. .->, -r..,., rnr~ -ern -uSJ ;-) (i ~-f, -,- -f" Q(') -;.'_:::,f1"\ ~:<\ -,'~ _c.. ~: ~)j :.< ~, - ORDER/NOTICE TO WITHHOLD INCOME FOIt SUPPORT State Commonwealth of Pennsvlvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 06/24/04 Tribunal/Case Number (See Addendum for case summary) RE: MC CORMICK, WILLIS J. II Employee/Obligor's Name (Last, First, MI) o Original Order/Notice o Amended Order/Notice @ Terminate Order/Notice EmployerNVithholder's Federal EIN Number BOSLER FREE LIBRARY 158 W HIGH ST CARLISLE PA 17013-2924 183-52-7460 Employee/Obligor's Social Security Number 4144101191 Employee/Obligor's Case Identifier (SH Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, MI) 'JiJ ~3 -VOL! r!-// f?k!.(,P; I?ISI65~;l- j)tf t. '9 S di'Z;3 PI4;C.c,'i"1:.:, 997/(;/7&&;;;- See Addendum for dependent names and birth dates associat.i!C/ with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'sfobligor's income until further notice even if the Order/Notice is not issued by your State. $ 0.00 per monlh in current support $ 0.00 per month in past-due support $ 0 . 00 per month in medical support $ 0.00 per month for genetic test costs $ per monlh in other (specify) for a total of $ 0.00 per month to be forwarded to payee below, You do not have to vary your pay cycle to be in compliance with the SUPPOlt order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how mut:h to withhold: $ 0.00 per weekly pay period. $ 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). $ 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sf obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). Arrears 12 weeks or greater? Qyes @ no If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1-877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: ~ E CC'u JUJ),{,P Form EN-028 Worker ID 21205 Date of Order: JUN 2 4 200r e/,)w~~ Service Type M OMB No.: 0970-0154 ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS D If ~hecked you are required to p,!>vide a Copy of this form to your. employee., If your employ~ works in.a state that is different from the state that issued this order, a copy must be provided to your employee even If the box IS not checked. 1. We appreciate the voluntary compliance of Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority, l!there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4. * R~poll;lIg tl,~ PA)'dAtefDate o(W;tl.l.oldil,g. YOl:. '"US! l~pOlt ti,L P3.rdateldAl~ of nitl,I,old;llg nnel. sel,d;lIg ti,e pa,II1~IIt. Ti,e pard.le/d.te of nitl,l,oldir,g;. II,. dale 01, nl,;d, '1110UI,1 nO> nitl,I,.ld hun, tl,. ~I"plor',e's ..all"'. You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 5.' Employee/Obligor with Multiple Support Holdings: If there is more than one Order/loJotice to Withhold Income for Support against this employee/obligor and you are unable to honor all support OrderINotices due to Fed"ral or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #1 0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and retum a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 2313810070 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: Me CORMICK, WILLIS J. II 4144101191 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9. AnCi-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment. refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Withholding limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (1 5 U.S.c. 91673 (b)l; or 2) the amounts allowed by the State of the employee'slobligor's principal place of empioyment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. AddiCionallnfo: 'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at i7171 240-6225 or by FAX at lZlZl..240-6248 or by internet ~childsupport.state.pa.us Service Type M Page 2 of 2 Form EN-028 Worker ID 21205 OMB No.: 0970.0154 ,,~ <.::...'"") 0 C'> ~.t'- -1/ u c_ -I .S:-.,; ,- i1',:!J -~ r'- N -ej'" - :':'10 S~~ I~) ,,, T :-", ...c_~ '~--', "-1 ~":) ;~:~g ~ '~;~J . ') C , 5c:, anne'~j In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DEBORAH L. DEYO ) Docket Nwnber 02-4971 CIVIL Plaintiff ) VS. ) PACSES Case Nwnber 194105036 GEORGE F. DEYO JR ) Defendant ) Other State ID Nwnber ORDER AND NOW, to wit, on this 29TH DAY OF JUNE, 2004 IT IS HEREBY ORDERED that the support order in this case be 0 Vacated or OSuspended or ~Terminated without prejudice or 0 Terminated and Vacated, effective JUNE 9, 2004 , due to: THE PARTIES' MARRIAGE SETTLEMENT AGREEMENT OF JUNE 7, 2004. THERE IS A REMAINING BALANCE OF $1380.15 AND THE BALANCE IS TO BE PAID IN FULL WITHIN THIRTY (30) DAYS UPON RECEIPT OF THIS ORDER. DRO: RJ Shadday xc: plaintiff defend a nt Dirk Berry. Esquire Harold Irwin, III, Esquire BY THE CO (' Service Type M ,.c.FJ!u~ED Edward E." JUDGE Form OE-504 Worker ID 21005 FrQffi:IRWIN LAW OFFICE 717 243 8200 06/15/2004 13:50 #136 P.002l008 MARRIAGE SETTLEMENT AGREEMENT THIS AGREEMENT made this 1!day of June, 2004 by and between GEORGE F. DEYO, JR. (hereinafter referred to as "HUSBAND") and DEBORAH L. DEYO (hereinafter referred to as 'WIFE"). WITNESSETH: WHEREAS, HUSBAND and WIFE were lawfully married on July 10,1999; and WHEREAS, diverse, unhappy differences, disputes and difficulties have arisen between the parties and it is the Intention of HUSBAND and WIFE to live separate and apart for the rest of their natural lives, and the parties hereto are desirous of sett~g N fully and finally their respective financlal and property rights and obligations a~e!!, ~ each other, including, without limitation by specification; the settling of all ma~f~~! 3iJ ~iI1 between them relating to the ownership and equitable distribution of real an1f!so~ ~g property; the settling of all claims and possible claims by one against the otl1l@r::: fi& against their respective estates and equitable distribution of property and ali~Y €r 1f" " J,.- .- each party. --<: NOW, THEREFORE, in consideration of the promises and the mutual promises, covenants and undertakings hereinafter set forth and for other good and valuable consideration, receipt of which Is hereby acknowledged by each of the parties hereto, HUSBAND and WIFE, each intending to be legally bound, hereby covenant and agree as follows: 1. The parties intend to maintain separate and permanent domiciles and to live apart from each other. It is the Intention and purpose of this agreement to set forth the respective rights and duties of the parties while they contlnue to live apart from each other. o vVlC;DI <<303 From:IRWIN LAW OFFICE 717 243 8200 06/15/2004 13:50 #136 P.003/008 .- 2. The parties have attempted to divide their matrimonial property In a manner that conforms to a just and right standard, with due regard to the rights of each party. It is the intention of the parties that such division shall be final and shall forever determine their respective rights. The division of existing marital property is not Intended by the parties to constitute in any way a sale or exchange of assets. 3. Further, the parties agree to continue living separately and apart from each other at any place or places that he or she may select. Neither party shall molest, harass, annOy, injure, threaten or Interfere with the other party in any manner whatsoever, Each party may carry on and engage in any employment. profession, business or other activity as he or she may deem advisable for his or her sole use and benefit. Neither party shall interfere with the uses, ownership, enjoyment or disposition of any property now owned and not specified herein or property hereafter acquired by the other. 4. The consideration for this contract and agreement is the mutual benefits to be obtained by both of the parties hereto and the covenants and agreements of each of the parties to the other. The adequacy of the consideration for all agreements herein contained Is stipulated, confessed, and admitted by the parties, and the parties intend to be legally bound hereby. 5. DeBTS: It is further mutually agreed by and between the parties that the debts be paid as follows: A. The HUSBAND shall assume all liability for and pay and indemnify the WIFE against all of his debts, Including but not limited to the debt to Ford motor Credit on the step-van and the debt to CitiFinanclaJ, and he will assume responsibility for any amount owing to Waypoint Bank for WIFE's overdraft on the joint checking account which occurred at or near the time of separation. From:IRWIN LAW OFFICE 717 243 9200 06/1512004 13:51 #136 P.004/009 B. The WIFE shall assume all liability for and pay and indemnify the HUSBAND against all of her dabts. C. The parties agree that they have no joint debts other than as may be listed above. 6. Except as herein provided, the parties agree that they have previously divided their personal property to their mutual satisfaction. No payment shall be made by either party to the other as a result of the division of property contained herein. The parties agree that this division is fair and equitable, and Is voluntary and made without duress by or upon either party. The parties further agree that henceforth, each of the parties shall own, have and enjoy independently of any claim or right of the other party, all items of personal property of every kind, nature and description and wherever situated, which are now owned or held by or which may hereafter belong to the HUSBAND or WIFE, with full power to the HUSBAND or the WIFE to dispose of same as fully and effectually, in all respects and for all purposes as If he or she were unmarried. The following division of specific Items of personal and real property will be equitably distributed as follows: A. PERSONAL PROPERTY: 1.) Motor Vehicles - The parties hereby release to the other any motor vehicle In the possession of the other party, 2.) Bank Accounts - Each party shall retain their respective checking and savings account free of any claim by the other party. The parties have already closed any joint accounts. From:IRWIN LAW OFFICE 717 243 9200 06/15/2004 13:51 #136 P.005/OO9 " 3,) Employee Benefit and Retirement Plans. Each party shall retain all of their own employee benefit, savings and/or retirement plans' proceeds free of any claim by the other party. 4,} Other Personal Property. The parties agree that they have divided all of their remaining personal property, including, but not limited to furniture; household goods, appliances and personal belongings to their mutual satisfaction and each release to the other all such personal property as now divided, 7. INCOME TAX RETURNS: All future income tax returns will be filed separately and the parties will each retain any refund due to them. 8. SUPPORT AND ALIMONY: Both parties hereby waive and forego all future financial and material spousal support from each other and agree not to request or seek to obtain alimony or spousal support before or after any divorce which may be granted. However, HUSBAND agrees to continue to payoff any support arrearages such as exist as of the date of this agreement. 9. DIVORCE: The parties both agree to cooperate with each other In obtaining a final divorce of the marriage. it is agreed that the marriage Is irretrievably broken, that more than ninety days have passed since the service of the divorce complaint and that simultaneously with the execution of this agreement, the parties will execute and file the consents and waivers necessary to obtain the divorce, 10. BREACH: In the event of the breach of this agreement by either party, the non breaching party shall have the right to seek monetary damages for such breach, where such damages are ascertainable, and/or to seek specific performance of the terms of this agreement, where such damages are not ascertainable, All costs, expenses and reasonable attorney fees Incurred by the successful party In any litigation From: IRWIN LAW OFFICE 717 243 9200 06/15/2004 13:51 #136 P.006/009 to obtain monetary damages and/or specific performance of this agreement shall be recoverable as part of the Judgment entered by the court. 11. ADDITIONAl,,~: Each of the parties shall from time to time, at the request of the other, execute, acknowledge and deliver to the other party any and all further instruments that may be reasonably required to give full force and effect to the provisions of this agreement. 12. VOLUNTARY I!XECUTION: The provisions of this agreement and their legal effect have been fully explained to the parties and its provisions are fully understood, Both parties agree that they are executing this agreement freely and voluntarily. HUSBAND's legal counsel is Harold S. Irwin, III, Esquire and WIFE's legal counsel is Dirk Berry, Esquire. 13. ENTIRE AGREEMENT: This agreement contains the entire understanding of the parties and there are no representations, warranties, covenants or undertakings other than those expressly set forth herein. 14. APPLICABLE LAW; This agreement shall be construed under the laws of the Commonwealth of Pennsylvania. 15. fBIQB~: It is understood and agreed that any and all property settlement agreements which mayor have been executed or verbally discussed prior to the date and time of this agreement are null and void and of no effect. 16. ~Qf CLAlM~ AGAINST THE ESTATES: Except as otherwise provided herein, each party may dispose of his or her property in any way, and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire, under the present or future laws of any jurisdiction, to share in the property or the estate of the other as a result of the marital relationship, including From:IRWIN LAW OFFICE 717 243 9200 06/15/2004 13:51 #136 P.OO7/009 ~. without limitation, dower, curtesy, statutory allowance, widow's allowance, right to take In intestacy, right to take against the Will of the other, and right to act as administrator or executor of the other's estate, and each will, at the request of the other, execute, acknowledge and deliver any and all Instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interests, rights and claims. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. AL) From: IRWIN LAW OFFICE 717 243 9200 06/15/2004 13:51 #136 P.008/OO9 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :ss: PERSONALLY APPEARED BEFORE ME, a notary public for Cumberland County, Pennsylvania, this ,1- day of June, 2004, GEORGE F. DEYO, JR., known to -,' . me (or satisfactorily proven) to be the person whose name Is subscribed to the within agreement, and acknowledge that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereun 0 set my hand and official seal. ........-- NOTAAIALSEAL c';:AFloLO S,IRWlN, III. NOTAI'!Y PUBLIC RLlSLE BOROUGH, COUNTY OF CUMSeRLAND MY COMM'.sSION EXPIRES OCTOOER 22. 2006 - - From: IRWIN LAW OFFICE' 717 243 8200 06/15/2004 13:51 #136 P.008/008 ,', . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :89: PERSONALLY APPEARED BEFORE ME, a notary public for Cumberland County, Pennsylvania, this c;-fJ, day of June, 2004, DEBORAH L. DEYO, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within agreement, and acknowledge that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. '-rj(rLddt~~{L-I ) N'ojary Public C F PENN Y lI. Notarial Seal Katblnn K. Shauli$, NolaIy Publio CarIlsII Bon>, Cwn6orWllfCoIlllll' My ConunIaion &pIns 000, 22, 2007 M...ber, Ponnl'llvenla Aoloc1.llon 0' Nollrieo '~-:t t'" !~ '!_.2! Pl,~\ji j-'" _<. C"" (.J. "'> C';':) C'_:' .,L'" o ., ...... ffl'J r- "\"'11 'v , (.'J C" C~I ,~l ('") r-,,) ;11 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwpalth of ppnn.vlvania Co.fCity/Dist. of CUMBERLAND Date of Order/Notice 08/30/04 Tribunal/Case Number (See Addendum for case summary) RE: DEYO, GEORGE F. JR Employee/Obligor's Name (Last, First, MI) @Original Order/Notice o Amended Order/Notice o Terminate Order/Notice Employerf\Nithholder's Federal EIN Number E U TRUCKING 601 POTTS HILL RD LEWISBERRY PA 17339-9594 MI fJA (!SEt::. ,#p). _ '/971 (l't/ /1W~~O~(..' 453-94-5187 Employee/Obligor's Social Security Number 6918000195 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (last, First, Ml) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'sfobligor's income until further notice even if the Order/Notice is not issued by your State. $ 0 . 00 per month in current support $ 50.00 per month in past-due support Arrears 12 weeks or greater? <XJyes 0 no $ 0.00 per month in medical support $ 0 . 00 per month for genetic test costs $ per month in other (specify) for a total of $ 50.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 11. 54 per weekly pay period. $ 23.08 per biweekly pay period (every two weeks). $ 25.00 per semimonthly pay period (twice a month). $ 50.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydateldate of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee'sf obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg. 2). If remitting by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SCDU) Employer Customer Service at 1_877-676-9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SfCUR/rY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. ~ ~tld)t? :JV Form E N-028 Worker ID $IATT Service Type M OMB No.: 097(}..O154 _ ADDITIONAL INFORMATION TO EMPLOYERS AND OTt-IER WITHHOLDERS o If ~hecked you are required. to pr9vi~e a copy of this form to your. employee. If your employee works in.a state that iSd ditterent from the state that ISSUed this order, a copy must be provided to your employee even If the box IS not checke . 1. We appreciate the voluntary compliance of Federally recognized Indian tribes,tribally,{)wned businesses, and Indian-owned businesses located on a reservation that choose to withhold in accordance with this notice. 2. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 3. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 4.' ::~~~~g~,~ ~~l:~~~~: ofW;tl,!.oldi"g., Yoo '^u,'~ ,;~~,~t~~.i.~~~~ ~~ :~I,?ld;"g ..I,." ""di"g li,. pa,,,.'c,,L TI,. pa, [ .. I, , tl,e dat" 0" ..!.Ie!. .",0",,[,,", ..ltl,I,.ld f,o", II,. c",pl<>,.e, ..ag<'. You must comply with the law of the state of the employee'slobligor's principal place of employment with respect to the time periods within which you must implement the withholding order and fo!Ward the support payments. 5,' Employee/Obligor with Multiple Support Holdings: If there is more than one Order/I_otice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee'slobligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #1 0 below) 6. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. WITHHOLDER'S 10: 0930000036 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: DEYO, GEORGE F. JR 6918000195 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 8. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9, Antkliscrimination: You are subject to a fine detennined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 10.' Withholding Limits: You may not withhold more than the lesser of: 1) the amoun'!s allowed by the Federal Consumer Credit Protection Act (15 U.S.c. 91673 (b)l; or 2) the amounts allowed by the State of the employee's/obllgor's principal place of employment. The Federal limit applies to the aggregate disposable weekly earnings (ADWE). ADWE is the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Security taxes; and Medicare taxes. 11. Additional Info: 'NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at 07) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Form EN-Ol8 Worker ID $IATT Service Type M OMS No.; 0970-01 54 ADDENDUM Summary of Cases on Attachment Defendant/Obligor: DEYO, GEORGE F. JR PACSES Case Number 194105036 Plaintiff Name DEBORAH L. DEYO Docket Attachment Amount 02~ CIVIL $ 50.00 Child(ren)'s Name(s): PACSES Case Number Plaintiff Name DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB you are required to enroll the child(ren) in any health insurance coverage available through the employee's!obligor's employment. o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's!obligor's employment. Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name, Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's!obligor's employment. o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's!obligor's employment. PACSES Case Number Plaintiff Name PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee'slobligor's employment. o If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's!obligor's employment. Addendum Form EN-0l8 Worker ID $IATT Service Type M OMB No.; 0970-0154 2 ....., = ~ -= ~}~ x- 2: =:1 ".., fn:D -7 ~~ ..c_ c..) CO r" ~<;( ~:::.: ~E:, ~ ("):!:l ::>: zC> c <.f! Om ~ ,-< .c- ~ .c- -< {'-' ,.. i'.-(i"" t;}:C1. In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DEBORAH L. DEYO ) Docket Number 02-4971 CIVIL Plaintiff ) vs. ) PACSES Case Number 194105036 GEORGE F. DEYO JR ) Defendant ) Other State ID Number Order AND NOW to wit, this AUGUST 30, 2004 it is hereby Ordered that: THAT DEFENDANT WILL MAKE PAYMENT ON THE REMAINING BALANCE OF $1380.15 IN THE AMOUNT OF $50.00 PER MONTH UNTIL THE BALANCE IS PAID IN FULL. DRO: RJ Shadday xc: plaintiff defendant BY THE COURT: ('- '- - Edward E. Guido JUDGE M a..... ... 'U" ~"'~) Service Type M Form OE-520 Worker ID 21005 \~ l; :--01'_-' -.....-., 2~( (;.;' ~( ~~! ...,. "J :< ':-', j:\-,sc;: n S; ~.~. ..... g: .s:- ".. c: G") c.> ~ ~, :!l 0,- ~~ ::r.!"T; S~~ ~ ?i5 -< 1:> :::: <a .s:- w In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Defendant Name: GEORGE F. DEYO JR Member ID Number: 6918000195 Please note: All correspondence must include the Member ID Number. ORDER OF ATTACHMENT OF UNEMPLOYMENT COMPENSATION BENEFITS Plaintiff Name DEBORAH L. DEYO PACSES Case Number 194105036 ~ (~ e:;;> c- ".s:' -,'"' -;;''' Attachment Amoun~~hency6 (1 ' l " ~ ....:::. $ 50.00 I~H \ I ~:",\c ~ $$ /1 " :~~.: ,{' ~.' ! ~;;. S~ $ /':i Financial Break Down of Multiple Cases on Attachment Docket Number 02-4971 CIVIL TOTAL A'ITACHMENT AMOUNT: $ 50.00 Now, by Order of this Court, the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), is hereby directed to attach the lesser of $11 . 54 per week, or 55 %, of the Unemployment Compensation benefits otherwise payable to the Defendant, GEORGE F. DEYO JR Social Security Number 453-94-5187 , Member ID Number 6918000195 . BUCBA is ordered to remit the amount attached to the Department of Public Welfare (DPW). DPW shall forward the amount received from BUCBA to the Domestic Relations Section of this Court for support and/or support arrearages. If the Defendant's Unemployment Compensation benefits are attached by another Court or Courts for support and/or support arrearages, DPW may reduce the amount attached under this Order so that the total amount attached does not exceed the maximum amount subject to garnishment pursuant to 15 U.S.c. ~ 1673 (b)(2) and 23 Pa. C.S.A. ~ 4348 (g). This Order shall be effective upon receipt of the notice of the Order by the BUCBA and shall remain in effect until the Defendant's entitlement to Unemployment Compensation benefits, under the Application for Benefits dated OCTOBER 17, 2004 is exhausted, expired or deferred. BUCBA shall comply with this Order, unless it is amended or vacated by subsequent Order of this Court. All questions, challenges or obligations to this Order shall be directed to the Domestic Relations Section of this Court. BY THE COURT Date of Order: N' Oil '( ;:,; ~ ~::: - toUW~ i:. .' - JUDGE 2004 Service Type M Form EN-530 Worker ID $ IATT ~ ~--n rnf':: ~o8 :'9 1- 0, C) :;~ ~~ c'5-~":' 1,-,,(. ,f.- rn 9'\ :J:;'" ....... .' <'j) c.'J :.-4. ;;:- In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION DEBORAH L. DEYO ) Docket Number 02-4971 CIVIL Plaintiff ) vs. ) PACSES Case Number 194105036 GEORGE F. DEYO JR ) Defendant ) Other State lD Number Order AND NOW to wit, this APRIL 18, 2005 it is hereby Ordered that: THAT THE BALANCE OF $1058.65 OWED TO THE PLAINTIFF IS REMITTED, PURSUANT TO HER REQUEST TO REMIT THE BALANCE. BY THE COURT: ORa: RJ Shad day xc: plaintiff defendant Dirk Berry. Esquire Harold Irwin, Esquire ~ Edward E. . G~dO JUDGE Service Type M Form OE-520 Worker lD 21005 n t"_:1 C'; c:::'J ':-:- c'" --0 . ("f\ T..r:~ -;.., :;:;-~) - 0) -.::J :~: t":'? C~) {,'L.J '-'" In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION 13 N. HANOVER ST, P.O. BOX 320, CARLISLE, PA. 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: GEORGE F. DEYO JR Member ID Number: 6918000195 Please note: All correspondence must include the Member ID Number. ORDER TO VACATE ATTACHMENT OF UNEMPLOYMENT BENEFITS Financial Break Down of Multiple Cases on Attachment Plaintiff Name DEBORAH L. DEYO PACSES Case Number 194105036 Docket Number 02-4971 CIVIL Attachment Amount/Freauencv $ I $ $ I $ 50.00 /MONTH ; I I I ; I I TOTAL AITACHMENT AMOUNT: $ 0.00 The prior Order of this Court directing the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), to attach $ 0.00 or 50 % per week of the Unemployment Compensation benefits of GEORGE F. DEYO JR , Social Security Number 453-94-5187 , Member ID Number 6918000195 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE COURT Date of Order: APR 1 9 2005 c;~ r;j)u)/H!.lJ 5. ti cJ 106 JUDGE Service Type M Form EN-035 Worker ID $IATT ::::.J '---:} ,7..n -ji \..c :r~ _I... (~;J :-1'. 'c..,) (.'J