HomeMy WebLinkAbout07-0726DANNY L. DAVIS, JR., IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
V. CIVIL ACTION -LAW
MARY ANN K. DAVIS, NO. V 7- 7 .? CIVIL TERM
Defendant IN DIVORCE
NOTICE TO DEFEND AND CLAIM RIGHTS
You have been sued in Court. If you wish to defend against the claims set forth in the
following pages, you must take prompt action. You are warned that if you fail to do so, the case
will proceed without you and a decree of divorce or annulment may be entered against you for
any 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 Cumberland County Courthouse, Carlisle, Cumberland County,
Pennsylvania, 17013.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS
OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO
PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL
SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
CUMBERLAND COUNTY BAR ASSOCIATION
32 South Bedford Street
Carlisle, Pennsylvania 17013
Phone: (717) 249-3166 or (800) 990-9108
DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. O l -7 4 CIVIL TERM
IN DIVORCE
COMPLAINT IN DIVORCE
NO FAULT
I. Plaintiff is Danny L. Davis, Jr., an adult individual currently residing at 8 Greenwich
Drive Carlisle, Cumberland County, Pennsylvania.
2. Defendant is Mary Ann K. Davis, an adult individual currently residing at 103
Commonwealth Drive, Bethlehem, Northampton County, Pennsylvania.
3. Plaintiff is a bonafide resident of the Commonwealth of Pennsylvania and has been so
for at least six months immediately previous to the filing of this Complaint.
4. Plaintiff and Defendant were married on September 28, 1991, in Northampton
County, Pennsylvania.
5. There have been no other prior actions for divorce or annulment between the parties.
6. Neither the Plaintiff nor the Defendant are members of the United States Armed
Forces or its Allies.
7. Plaintiff has been advised of the availability of counseling and the right to request that
the Court require the parties to participate in counseling. Knowing this, Plaintiff does
not desire that the Court require the parties to participate in counseling.
8. Plaintiff and Defendant are citizens of the United States of America.
9. The parties' marriage is irretrievably broken.
10. Plaintiff desires a divorce based upon the belief that the Defendant will, ninety (90)
days from the date of service of this Complaint, consent to this divorce.
WHEREFORE, Plaintiff requests your Honorable Court to enter a divorce pursuant to 23
P.S. Section 3301 (c) of the Domestic Relations Code.
Respectfully submitted,
Hannah Herman Snyder, Esqui e
Attorney for Plaintiff
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
VERIFICATION
I verify that the statements made in the foregoing document are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section
4904, relating to unsworn falsifications to authorities.
DATE: ; k 7 Grp
DANNY L. AVIS, JR., Plainti
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DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION -LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
AFFIDAVIT OF SERVICE
I, Hannah Herman-Snyder, Esquire, counsel of record for Plaintiff, state that a true and
attested copy of a Complaint in Divorce was sent to Defendant, Mary Ann K. Davis, at her
address of 103 Commonwealth Drive, Bethlehem, Pennsylvania, by certified mail, restricted
delivery. A copy of said receipt is attached hereto indicating service was made on February 9,
2007.
Sworn and subscribed to
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Hannah Herman-Snyder, EsquirA
Attorney for Plaintiff
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
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DANNY L. DAVIS, JR., IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
vs. CIVIL ACTION -LAW
MARY ANN K. DAVIS, N0.07-726 CIVIL TERM
Defendant : IN DIVORCE
NOTICE
If you wish to deny any of the statements set forth in the attached affidavit, you must file
a counter-affidavit within twenty days after this Affidavit has been served on you or the
statements will be admitted.
-- -?----?? awl a ur1'HE DIVORCE CODE
1• The parties to this action separated since April, 2006 and have continued to
live
separate and apart since that time.
2. The marriage is irretrievable broken.
3. I understand that I may lose rights concerning alimony, division of property, lawyer's
I`t3', fees or expenses if I do not claim them before a divorce is granted.
I verify that the statements made in the foregoing document are true and correct.
understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 1
4904, relating to unsworn falsifications to authorities. Section
DATE:
DANNY L. AVIS, JR.
DANNY L. DAVIS, JR., IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
VS. CIVIL ACTION - LAW
MARY ANN K. DAVIS, : NO. 07-726 CIVIL TERM
Defendant : IN DIVORCE
AFFIDAVIT OF SERVICE
I confirm that I did this 3(7 day of 'I iIJn , 2008, hand
deliver a true and attested copy of a Notice and Affidavit Under Section 3301(d) of the
Divorce Code, as well as a Counter-Affidavit Under Section 3301(d) of the Divorce
Code, to the Defendant, Mary Ann K. Davis, at the following address:
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COMA?ONW -rd OF PENNSYLVANIA
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DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION -LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
AFFIDAVIT OF SERVICE
I, Hannah Herman-Snyder, Esquire, counsel of record for Plaintiff, state that a copy of a
Notice of Intention to Request the Entry of a Decree in Divorce was sent to Defendant, Mary Ann
K. Davis, at her address of 103 Commonwealth Drive, Bethlehem, Pennsylvania, by certified
mail, restricted delivery. A copy of said receipt is attached hereto indicating service was made
on July 9, 2008.
Hannah Herman-Snyder, Esq ire
Attorney for Plaintiff
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
(717) 243-5551
(800) 347-5552
Sworn and subscribe to
before met is day
of , 2008
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DANNY L. DAVIS, JR., IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
V. : CIVIL ACTION - LAW
MARY ANN K. DAVIS, NO. 07-726 CIVIL TERM
Defendant IN DIVORCE
AFFIDAVIT OF NON-MILITARY SERVICE
Now comes Danny L. Davis, Jr., Plaintiff, in the above-captioned matter, and pursuant to
the provisions of 18 Pa. C.S. Section 4904, deposes and says that the Defendant in this action, to
wit, Mary Ann K. Davis, is to the best of his knowledge, not a member of the United States
Armed Services, and at such time as this action was filed and at all times thereafter, was serving
neither in any active or inactive capacity with any branch of the United States Armed Forces.
I verify that the statements made herein are true and correct. I understand that false
statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to
unsworn falsification to authorities.
Date:
DANNY L. VKVIS, JR., Plaintiff
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DANNY L. DAVIS, JR.,
Plaintiff
vs.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION -LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
COUNTER AFFIDAVIT UNDER §3301(d) OF THE DIVORCE CODE
1. Check either (a) or (b):
(a) I do not oppose the entry of a divorce decree.
(b) I oppose the entry of a divorce decree because (Check either (i), (ii), or both)
(i) The parties to the action have not lived separate an apart for a period of at
least two (2) years.
(ii) The marriage is not irretrievably broken.
2. Check either (a) or (b):
(a) I do not wish to make any claims for economic relief. 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.
(b) I wish to claim economic relief which may include alimony, division of
property, lawyer's fees or expenses or other important rights.
I understand that in addition to checking (b) above, I must also file all of my economic
claims with the Prothonotary in writing and serve them on the other party. If I fail to do so before
the date set forth on the Notice of Intention to Request Divorce Decree, the divorce decree be
entered without further notice to me, and I shall be unable thereafter to file any economic claims.
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I verify that the statements made in the foregoing document are true and correct I v 6
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understand that false statements herein are made subject to the penalties of 18 Pa.C.S a
4904, relating to unsworn falsifications to authorities. a 3 a a
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MARY N K. DAVIS, Defenda 1` z d
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NOTICE: IF YOU DO NOT WISH TO OPPOSE THE ENTRY OF A DIVORCE DECRE W 2
YOU DO NOT WISH TO MAKE ANY CLAIM FOR ECONOMIC RELIEF, YOU SHOULD NO
FILE THIS COUNTER AFFIDAVIT.
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PROPERTY AND
SEPARATION AGREEMENT
BETWEEN
DANNY L. DAVIS, JR.
AND
MARY ANN K. DAVIS
GRIFFIE AND ASSOCIATES
200 NORTH HANOVER STREET
CARLISLE, PA 17013
THIS AGREEMENT, made this 1 Say of , 2009, by
and between DANNY L. DAVIS, JR., of 417 Independence Court, Carlisle,
Pennsylvania, party of the first part, hereinafter referred to as "Husband",
AND
MARYANNK. DAVIS, of 103 Commonwealth Drive, Bethlehem, Pennsylvania,
party of the second part, hereinafter referred to as "Wife",
WITNESSETH:
WHEREAS, the parties hereto are Husband and Wife, having been married on
September 28, 1991, in Northampton County, Pennsylvania. There are three children
born of this marriage, namely Zachary Daniel Davis, born August 18, 1992, Alexis
Nicole Davis, born August 7, 1997, and Isabella Marie Davis, born July 26, 2001.
WHEREAS, diverse unhappy differences, disputes and difficulties have arisen
between the parties and it is the intention of Wife and Husband to live separate and apart,
and the parties hereto are desirous of settling their respective financial rights and
obligations as between each other including the settling of matters between them relating
to the past, present and future support and/or maintenance of Wife by Husband and
Husband by Wife.
WHEREAS, the parties hereto wish finally and for all time to settle and determine
their respective property and other rights growing out of their marital relation; wish to
live separate and apart; and, wish to enter into this property and separation Agreement;
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WHEREAS, both and each of the parties hereto have been advised of their legal
rights and the implications of this Agreement and the legal consequences which may and
will ensue from the execution hereof;
WHEREAS, Wife acknowledges that she is thoroughly conversant with and
knows accurately the size, degree, and extent of the estate and income of Husband, and
Husband acknowledges that he is thoroughly conversant with and knows accurately the
size, degree and extent of the estate and income of Wife;
NOW, THEREFORE, in consideration of the mutual promises, covenants and
undertakings hereinafter set forth which are hereby acknowledged by each of the parties
hereto, Wife and Husband, each intending to be legally bound hereby, covenant and agree
as follows:
1. ADVICE OF COUNSEL:
This Agreement has been prepared by Hannah Herman-Snyder, Esquire, attorney
for Husband. Said attorney at the commencement of and at all stages during the
negotiation of this Agreement informed Wife that she has acted solely as counsel for
Husband and has not advised or represented Wife in any mariner whatsoever. Wife, at
the commencement of and all stages during the negotiations of this Agreement has been
informed by Hannah Herman-Snyder, Esquire, that she has a right to be represented by
her own counsel and having encouraged her to seek the advice of counsel. Wife has read
this Agreement carefully and thoroughly understands each provision and therefore signs
it freely and voluntarily.
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2. WARRANTY OF DISCLOSURE:
The parties warrant and represent that they have made a full disclosure of all
assets and their valuation prior to the execution of this Agreement. This disclosure was
in the form of an informal exchange of information by the parties' attorneys and/or
parties and this Agreement between the parties is based upon this disclosure.
3. MUTUAL RELEASE:
Husband and Wife each do hereby mutually remise, release, quitclaim, and
forever discharge the other and the estate of such other, for all times to come and for all
purposes whatsoever, of and from any and all right, title and interest, or claims in or
against the property (including income and gain from property hereafter accruing) of the
other or against the estate of such other, of whatever nature and wheresoever situate,
which he or she now has or at any time hereafter may have against such other, the estate
of such other, or any part thereof, whether arising out of any former acts, contracts,
engagements, or liabilities of such other as by way of dower or curtesy, or claims in the
nature of dower or curtesy or widow's or widower's rights, family exemption, or similar
allowance, or under the intestate laws, or the right to take against the spouse's Will; or
the right to treat a lifetime conveyance by the other as testamentary, or all other rights of
a surviving spouse to participate in a deceased spouse's estate, whether arising under the
laws of (a) Pennsylvania, (b) any state, commonwealth or territory of the United States,
or (c) any other country, or any rights which either party may have or at any time
hereafter have for past, present, or future support or maintenance, alimony, alimony
pendente lite, counsel fees, costs or expenses, whether arising as a result of the marital
relation or otherwise, except and only except, all rights and agreements and obligations of
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whatsoever nature arising or which may arise under this Agreement or for the breach of
any thereof. It is the intention of Husband and Wife to give to each other by execution of
this Agreement a full, complete, and general release with respect to any and all property
of any kind or nature, real or personal, not mixed, which the other now owns or may
hereafter acquire, except and only except, all rights and agreements and obligations of
whatsoever nature arising or which may arise under this Agreement or for the breach of
any thereof.
4. PERSONAL RIGHTS AND SEPARATION:
Wife and Husband may and shall, at all times hereafter, live separate and apart.
They shall be free from any control, restraint, interference or authority, direct or indirect,
by the other in all respects as if they were unmarried. They may reside at such place or
places as they may select. Each may, for his or her separate use or benefit, conduct, carry
on and engage in any business, occupation, profession or employment which to him or
her may seem advisable. Wife and Husband shall not molest, harass, disturb or malign
each other or the respective families of each other nor compel or attempt to compel the
other to cohabit or dwell by any means or in any manner whatsoever with him or her.
5. AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS.
This Agreement shall not be considered to affect or bar the right of Wife or
Husband to a limited or absolute divorce on lawful grounds if such grounds now exist or
shall hereafter exist or to such defense as may be available to either party. This
Agreement is not intended to condone and shall not be deemed to be a condonation on the
part of either party hereto of any act or acts on the part of the other party which have
occasioned the disputes or unhappy differences which have occurred prior to or which
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may occur subsequent to the date hereof. The parties intend to secure a mutual consent,
no-fault divorce pursuant to the terms of Section 3301 (c) or (d) of the Divorce Code of
1980.
6. AGREEMENT TO BE INCORPORATED IN DIVORCE DECREE:
The parties agree that the terms of this Agreement may be incorporated into any
divorce decree which may be entered with respect to them. Notwithstanding such
incorporation, this Agreement hall not be merged in the decree, but shall survive the same
and shall be binding and conclusive on the parties for all times.
7. DATE OF EXECUTION:
The "date of execution" or "execution date" of this Agreement shall be defined as
the date upon which it is executed by the parties if they have each executed the
Agreement on the same date. Otherwise, the "date of execution" or "execution date" of
this Agreement shall be defined as the date of execution by the party last executing this
Agreement.
8. PERSONAL PROPERTY:
Husband and Wife do hereby acknowledge that they have previously divided their
tangible personal property, except as set forth herein, including, but without limitation,
jewelry, clothes, furniture, furnishings, rugs, carpets, household equipment and
appliances, pictures, books, works of art and other personal property and hereafter Wife
agrees that all of the property in the possession of Husband shall be the sole and separate
property of Husband; and Husband agrees that all of the property in the possession of
Wife shall be the sole and separate property of Wife. The parties do hereby specifically
6
waive, release, renounce and forever abandon whatever claims, if any, he or she may
have with respect to the above items which shall become the sole and separate property
of the other, with full power to him or her to dispose of the same as fully and effectually,
as though he or she were unmarried.
Husband shall provide to Wife, upon execution of the Agreement, FIVE
HUNDRED AND XX/100 DOLLARS ($500.00) in exchange for the previously sold
basketball hoop and for retaining the car top carrier, carpet steam cleaner, and draperies,
which shall remain in Husband's possession.
No later than the end of June 2009, Wife shall provide to Husband photographs
and videos of the parties' children, from the time of their birth to the date of separation.
The cost to reproduce the videos and pictures shall be shared equally by the parties.
9. BANK ACCOUNTS:
For the mutual promises and covenants contained in this Agreement, Husband and
Wife hereby waive all right, title, claim or interest they may have to equitable distribution
in their respective bank accounts, checking or savings, if any, and each party waives
against the other any duty of accounting for disposition of any jointly held funds. The
parties hereby confirm their prior equal distribution of the contents of their joint accounts
and neither shall hereafter make any claim against the other regarding the same.
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10. MOTOR VEHICLES:
With respect to the motor vehicles owned by one or both parties, the parties agree
as follows:
a. The 1996 Plymouth Grand Voyager currently in Wife's possession shall
remain the sole and exclusive property of Wife. Husband shall waive any
right, title, and interest he has or may have in said vehicle.
b. The 2006 Saturn Vue currently in Husband's possession shall remain the
sole and exclusive property of Husband as this was purchased subsequent
to separation. Wife shall waive any right, title, and interest she had or
may have had in the previously owned 1996 Dodge Intrepid.
11. AFTER-ACQUIRED PERSONAL PROPERTY:
Each of the parties shall hereafter own and enjoy, independently of any claim or
right of the other, all items of personal property, tangible or intangible, hereafter acquired
by him or her after the parties date of separation, with full power, in him or her to dispose
of the same as fully and effectively, in all respects and for all purposes, as though he or
she were unmarried.
12. REAL ESTATE:
The parties were joint owners of real estate located at 8 Greenwich Drive,
Carlisle, Cumberland County, Pennsylvania. Said property was owned in joint names as
tenants by the entireties. The property has been sold and the parties contributed equally
to funds necessary to sell said property and no proceeds were realized from sale of the
marital residence.
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13. PENSION, RETIREMENT, PROFIT SHARING:
a. The parties recognize that Wife did not have any retirement, pension, profit
sharing, etc., accrued at the time of separation.
b. The parties recognize that Husband has a 403(b) and pension as a result of his
employment with Green Ridge Village, as well as a 401(k) as a result of his prior
employment with Diakon. For the mutual promises and covenants contained to this
Agreement, Wife hereby waives all right, title, claim, or interest she may have by
equitable distribution or otherwise in Husband's 403(b) and pension plan with his current
employer. The Diakon 401(k) plan shall be rolled over, in its entirety, into a qualified
account for Wife, including any changes in market growth from the time the Separation
and Property Settlement Agreement is entered until such time as the funds are actually
received. Counsel for Husband shall be responsible for preparing a Domestic Relations
Order to effectuate the rollover of the qualified account, and a draft of said Order shall be
prepared within thirty (30) days of the execution of this Agreement.
c. Each party specifically waives any and all rights to pre-retirement death
benefits and survivor benefits under the other's pension or retirement plan(s) and each
acknowledges that the effect of this waiver is that he or she will not be entitled to any
benefits whatsoever from these contracts, plans or accounts if the other dies before or
after reaching retirement age and each agrees and unequivocally consents to the
designation by the other of any alternate or further beneficiaries at any time.
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14. LIFE INSURANCE:
Each party agrees that the other party shall have sole ownership and possession of
any life insurance policies owned by him or her, except as set forth herein. Each party
agrees to sign any documents necessary to waive, relinquish, or transfer any rights on
such policies to the respective party who presently owns such policies.
Husband maintains a life insurance policy for each of the children, Zachary,
Alexis, and Isabella, which is a whole life policy with a death benefit of TWENTY -
FIVE THOUSAND AND XX/100 DOLLARS ($25,000.00). Husband and Wife are
beneficiaries of each of the policies. Husband shall maintain these policies with Husband
and Wife remaining jointly as beneficiaries until each respective child reaches age
twenty-five, whereupon he/she will then assume responsibility of said policy and name
beneficiary of choice. The parties agree that neither will do anything to disrupt the
policies, including but not limited to taking loans against the same. Husband shall
provide Wife with statements of the policies annually until such time as the policies
become the property of each of the respective children.
Husband maintains a State Farm whole life insurance policy of ONE HUNDRED
THOUSAND DOLLARS AND XX/100 ($100,000.00), with policy # 1590-8009, and
with a guaranteed death benefit of ONE HUNDRED THOUSAND DOLLARS AND
XX/100 ($100,000.00). Husband shall retain each of the children, Zachary, Alexis, and
Isabella as equal beneficiaries of one third of the death benefit until such time as each
child graduates college or reached age twenty-five (25), whichever is sooner. As each
child reaches the aforementioned graduation or age, the beneficiary designation shall then
be at the discretion of Husband. Husband shall provide Wife with a policy statement
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annually until the youngest child has graduated from college or reaches age twenty-five
(25), whichever is sooner.
In the event of Husband's death where proceeds are distributed to children as
noted above, proceeds shall be administered by a financial institution trust officer as
designated in Husband's last will and testament. Proceeds shall only be utilized for
expenses directly related to the post secondary education of the children until each of the
children either complete their education or reach the age of twenty-five (25). At the time
each of the children reach the age of twenty-five (25), any remaining proceeds being
administered by the financial institution trust officer shall be distributed to the child.
15. DEBTS:
Except as otherwise herein expressly provided, the parties shall and do hereby
mutually remise, release and forever discharge each other from any and all actions, suits,
debts, claims, demands and obligations whatsoever, both in law and in equity, which
either of them ever had, now has, or may hereafter have against the other upon or by
reason of any matter, cause or thing up to the date of the execution of this Agreement.
In the event that either party becomes a debtor in bankruptcy or financial
reorganization proceedings of any kind while any obligations remain to be performed by
that party for the benefit of the other party pursuant to the provision of this Agreement,
the debtor spouse hereby waives, releases and relinquishes any right to claim any
exemption (whether granted under state or federal law) to any property remaining in the
debtor as a defense to any claim made pursuant hereto by the creditor spouse, and the
debtor spouse hereby assigns, transfers, and conveys to the creditor spouse an interest in
all of the debtor's exempt property sufficient to meet all obligations to the creditor spouse
11
as set forth herein, including all attorney's fees and costs incurred in the enforcement of
this paragraph or any other provision of this Agreement. No obligation created by this
Agreement shall be discharged or dischargeable, regardless of federal or state law to the
contrary, and each party waives any and all right to assert that any obligation hereunder is
discharged or dischargeable. The failure of any party to meet his or her obligations under
any one or more of the paragraphs herein, with the exception of the satisfaction of
conditions precedent, shall not in any way void or alter the remaining obligations of
either of the parties.
16. WARRANTY AS TO EXISTING OBLIGATIONS:
Each party represents that they have not heretofore incurred or contracted for any
debt or liability or obligation for which the estate of the other party may be responsible or
liable except as may be provided for in this Agreement. Each party agrees to indemnify
or hold the other party harmless from and against any and all such debts, liabilities or
obligations of every kind which may have heretofore been incurred by them, including
those for necessities, except for the obligations arising out of this Agreement.
17. WARRANTY AS TO FUTURE OBLIGATIONS:
Wife and Husband each covenant, warrant, represent and agree that each will now
and at all times hereafter save harmless and keep the other indemnified from all debts,
charges and liabilities incurred by the other after the execution date of this Agreement,
except as may be otherwise specifically provided for by the terms of this Agreement and
that neither of them shall hereafter incur any liability whatsoever for which the estate of
the other may be liable.
12
18. ALIMONY, ALIMONY PENDENTE LITE, SPOUSAL SUPPORT AND
MAINTENANCE:
a. Husband hereby waives any right or claim of any nature whatsoever relative to
alimony, alimony pendente lite, spousal support, spousal maintenance, counsel fees and
expenses against Wife.
b. Husband shall pay to Wife alimony in the amount of SIX HUNDRED AND
XX/100 ($600.00) a month, in equal installments every two weeks of $276.92, for thirty-
six (36) months or seventy-eight (78) paychecks, starting on May 22, 2009. The start
date of May 22, 2009 is based on the assumption that the Divorce Decree will be entered
such that if it is not yet entered, alimony will begin on June 5, 2009. The obligation
pursuant to Docket No. 00541 S 2006, PACSES Case No. 421108402, as it pertains to
support for Wife, shall terminate immediately upon the execution of this Agreement and
any arrears shall be set at zero, and the alimony payment shall be garnished from
Husband's wages by the Cumberland County Domestic Relations Office pursuant to the
Stipulation and Agreement executed simultaneously with this Agreement.
The alimony award is non-modifiable.
19. CASH PAYMENT:
In consideration of Husband retaining the portion of the stimulus check for the
2007 tax year that was distributed in recognition of the minor child Zachary, Husband
shall pay to Wife THREE HUNDRED XX/100 DOLLARS ($300.00) immediately upon
execution of the Agreement as Wife exercised custody of Zachary for said tax year.
13
5
20. BANKRUPTCY:
The respective duties, covenants and obligations of each party under this
Agreement shall not be dischargeable by bankruptcy, but if any bankruptcy court should
discharge a party of accrued obligations to the other, this Agreement shall continue in full
force and effect thereafter as to any duties, covenants and obligations accruing or to be
performed thereafter.
21. DIVORCE:
Husband has commenced an action for divorce from Wife pursuant to Section
3301 (c) of the Pennsylvania Divorce Code (irretrievable breakdown) by the filing of a
Divorce Complaint as the parties have agreed to consent to a divorce. Both parties agree
that they shall each sign an Affidavit of Consent and Waiver of Notice of Intention to
Request the Entry of a Divorce Decree evidencing that each of them consents to the
divorce and each shall provide said document to counsel for Husband within ten (10)
days of execution of this Agreement. It is further agreed and understood that any Decree
of Divorce issuing in this matter shall reflect the fact that Husband shall bear the cost of
same in his individual capacity.
a. Each of the parties agree that this Agreement represents a complete and
final agreement as to their respective property rights which arose from the marital
relation and therefore mutually waive any and all rights they may have under Section
3501 (Equitable Distribution) of the Pennsylvania Code, Act No. 1990-206.
b. This Agreement may be offered in evidence in the action for divorce and
may be incorporated by reference in the decree to be granted therein. Notwithstanding
14
such incorporation, this Agreement shall not be merged in the decree, but shall survive
the same and shall be binding and conclusive on the parties for all time.
22. LEGAL FEES:
In the review and preparation of this Agreement, each party shall bear his/her own
legal fees, with Husband paying for the preparation of this Agreement.
23. REMEDY FOR BREACH:
If either party breaches any provision of this Agreement, the other party shall
have the right, at his or her election, either to sue for damages for such breach, in which
event the breaching party shall be responsible for payment for reasonable legal fees and
costs incurred by the other in enforcing their rights hereunder, or to seek such other
remedies or relief as may be available to him or her.
24. EQUITABLE DISTRIBUTION:
It is specifically understood and agreed that this Agreement constitutes an
equitable distribution of property, both real and personal, which was legally and
beneficially acquired by Husband and Wife or either of them during the marriage as
contemplated by The Act of December 19, 1990 (P.L. No. 1240, No. 206) known as "The
Divorce Code," 23 P.S. 3501 et seq. of the Commonwealth of Pennsylvania, and as
amended.
25. SUMMARY OF EFFECT OF AGREEMENT:
It is specifically understood and agreed by and between the parties hereto, and
each party accepts the provisions herein made in lieu of and in full settlement and
satisfaction of any and all of said parties' rights against the other for any past, present and
15
future claims on account of support, maintenance, alimony, alimony pendente lite,
counsel fees, costs and expenses, equitable distribution of marital property and any other
claims of each party, including all claims raised by them in the divorce action pending
between the parties.
26. TAX CONSEQUENCES:
By this agreement, the parties have intended to effectuate and have equitably
divided their marital property. The parties have determined that such equitable division
conforms to a right and just standard with regard to the rights of each party. The division
of existing marital property is not, except as may be otherwise expressly provided herein,
intended by the parties to constitute in any way a sale or exchange of assets and the
division is being effected without the introduction of outside funds of other property not
constituting a part of the marital estate.
27. MUTUAL COOPERATION/DUTY TO EFFECTUATE AGREEMENT:
Each party shall, at any time and from time to time hereafter, take any and all
steps and execute, acknowledge, and deliver to the other party any and all further
instruments and/or documents that the other party may reasonably require for the purpose
of giving full force and effect to the provisions of this Agreement.
28. RECONCILIATION:
The parties shall only effect a legal reconciliation which supersedes this
agreement by their signed agreement containing a specific statement that they have
reconciled and that this agreement shall be null and void; otherwise, this agreement shall
remain in full force and effect. Further, the parties may attempt a reconciliation, which
16
action, if not consummated by the aforesaid agreement, shall not affect in any way the
legal effect or this agreement or cause any new marital rights or obligations to accrue.
29. SEVERABILITY:
The parties agree that the separate obligations contained in this Agreement shall
be deemed to be interdependent. If any term, clause, or provision of this Agreement shall
be determined by a court of competent jurisdiction to be invalid or unenforceable, then
the parties agree that the Agreement may be reviewed and renegotiated in order to fulfill
as closely as possible the purpose of the invalid provision. Notwithstanding any release
contained herein, the parties intend that they may reinstate any and all economic claims
to the extent available under the Divorce Code of 1980. Further, any court of competent
jurisdiction may, under the equitable provisions and purposes of the Divorce Code,
reinstate any economic claim which was available at the time of the parties' separation or
avoid any waiver herein contained to renegotiate or effectuate as nearly as possible the
purpose of the unenforceable provision.
30. NO WAIVER OF DEFAULT:
This Agreement shall remain in full force and effect unless and until terminated
under and pursuant to the terms of this Agreement. The failure of either party to insist
upon strict performance of any of the provisions of this Agreement shall in no way affect
the right of such party hereafter to enforce the same, nor shall the waiver of any breach of
any provision hereof be construed as a waiver of any subsequent default of the same or
similar nature, nor shall it be construed as a waiver of strict performance of any other
obligations herein.
17
31. INTEGRATION:
This Agreement constitutes the entire understanding of the parties and supersedes
any and all prior agreements and negotiations between them. There are no
representations or warranties other than those expressly set forth herein. This Agreement
shall survive integration by any court into any judgment for divorce and shall continue to
have independent legal significance as written contract separate from such judgment for
divorce and may be enforced as an independent contract.
32. EFFECT OF DIVORCE DECREE:
The parties agree that unless otherwise specifically provided herein, this
Agreement shall continue in full force and effect after such time as a final decree in
divorce may be entered with respect to the parties.
33. NOTICES:
Any and all notices given hereunder shall be in writing and shall be sent
registered mail, return receipt requested:
a. To the Husband, in care of Hannah Herman-Snyder, 200 North
Hanover Street, Carlisle, Pennsylvania 17013.
b. To the Wife, at 103 Commonwealth Drive, Bethlehem, Pennsylvania,
18020.
34. WAIVER OR MODIFICATION TO BE IN WRITING:
No modification or waiver of any of the terms hereof shall be valid unless in
writing and signed by both parties and no waiver of any breach hereof or default
18
hereunder shall be deemed a waiver of any subsequent default of the same or similar
nature.
35. CAPTIONS:
The captions of this Agreement are inserted only as a matter of convenience and
for reference and in no way define, limit or describe the scope and intent of this
Agreement, nor in any way effect this Agreement.
36. AGREEMENT BINDING ON HEIRS:
The Agreement shall be binding and shall inure to the benefit of the parties hereto
and their respective heirs, executors, administrators, successors and assigns.
37. LAW OF PENNSYLVANIA APPLICABLE:
This Agreement shall be construed in accordance with the laws of the
Commonwealth of Pennsylvania.
38. SUBSEQUENTLY DISCOVERED PROPERTY PENALTY FOR
NONDISCLOSURE:
Should either of the parties subsequently discover the existence of any marital
property not distributed by this Agreement, said property shall be divided in the same
proportion as this Agreement's equitable distribution of marital property (50150).
However, if the existence of said property was knowingly concealed or its value
misrepresented by one of the parties, said property shall be transferred in its entirety to
the non-concealing party and the concealing party shall pay all costs, fees, and attorney's
fees occasioned by the failure to disclose its existence or true value.
19
• i
IN WITNESS WHEREOF, the parties have set their hands and seals to two
counterparts of this Agreement, each of which shall constitute an original, the day and
year first above written.
Witness:
Danny L. vis, Jr.
4eal)
Mary ATin K. Davis
20
COMMONWEALTH OF PENNSYLVANIA )
) SS.
COUNTY OF CUMBERLAND )
On this, the day of , 2009, before me, a notary
public, the undersigned officer, personally appeare Danny L. Davis, Jr., known to me
(or satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged that he executed the same for the purposes therein
contained.
In Witness Whereof, I hereunto set my hand and notarial seal.
MOiN?Nt MAt
141t1I t !?
#NNW A"
808011{,
?N? at"" am
i. ?/!!
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
No Public
SS.
On this, the / 7 day of AQ?( , 2009, before me, a notary
public, the undersigned officer, personally appeared Mary Ann K. Davis, known to me
(or satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged that she executed the same for the purposes therein
contained.
In Witness Whereof, I hereunto set my hand and notaria seal. (Notary Public
CONIMONwEA1,Tx OF pENNSYLVAMA
NOTARIAL SEAL
Sharon A. Kels, Notary Public
Palmer Township, Northampton County
21 M commission expires April 11, 2013
C f
??IMIII?
swoopl?
DANNY L. DAVIS, JR., IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
V. : CIVIL ACTION -LAW
MARY ANN K. DAVIS, NO. 07-726 CIVIL TERM
Defendant IN DIVORCE
PRAECIPE TO TRANSMIT RECORD
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 §3301(c)
3301(d)(1) e fthe Diyeree Code
(Strike out inapplicable section).
2. Date and manner of service of the Complaint: by restricted delivery, certified mail
February 9, 2007.
3. Complete either paragraph (a) or (b).
(a) Date of execution of the Affidavit of Consent required by §3301 (c) of the Divorce
Code: by Plaintiff: 05/15/09 by Defendant: 05/14/09
(b) (1) Date of execution of the affidavit required by §3301 (d) of the Divorce Code:
(2) Date of filing and service of the plaintiff s affidavit upon the respondent:
4. Related claims pending: none
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 plaintiffs Waiver of Notice in §3301 (c) Divorce was filed with the
Prothonotary: May 15, 2009
Date defendant's Waiver of Notice in §3301 (c) Divorce was filed with the
Prothonotary: May 15, 2009
?..cTi.?..c?G? ?,g ?w.sa e? - t?l ,.va„t? 4 _h
Hannah Herman-Snyder, Esquir
GRIFFIE & ASSOCIATES
Attorney for Plaintiff
P. I,. i 'r
U, E';x i f C
DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under §3301(c) of the Divorce Code was filed on
February 7, 2007, and service was made on February 9, 2007 by restricted
delivery, certified mail.
2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90)
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 THE FOREGOING AFFIDAVIT
ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN
ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO
UNSWORN FALSIFICATION TO AUTHORITIES.
DATE: 1? f? \
A Y L. DA S, JR., Plaintiff
?
Tir h
t f`,.?s
2009 N 5 } 1 Z: ;
DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REQUEST
THE ENTRY OF A DIVORCE DECREE
UNDER 43301(c) OF THE DIVORCE CODE
1. I consent to the entry of a final decree in 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 I will not be divorced until a divorce decree is entered by the
Court and that a copy of the decree will be sent to me immediately after it is filed
with the Prothonotary.
I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT
ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN
ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO
UNSWORN FALSIFICATION TO AUTHORITIES.
DATE: zZ--,
DANNY L. DOVIS, JR., Plaintiff
OF THE P '
DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
AFFIDAVIT OF CONSENT
1. A Complaint in Divorce under §3301 (c) of the Divorce Code was filed on
February 7, 2007, and service was made on February 9, 2007 by restricted
delivery, certified mail.
2. The marriage of Plaintiff and Defendant is irretrievably broken and ninety (90)
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 THE FOREGOING AFFIDAVIT
ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN
ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO
UNSWORN FALSIFICATION TO AUTHORITIES.
DATE: Coq.
MARY A K. DAVIS, Defendant
t ,r .. 1 yt I
THE
C, in i ? b
r
DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY ANN K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
: CIVIL ACTION -LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
WAIVER OF NOTICE OF INTENTION TO REOUEST
THE ENTRY OF A DIVORCE DECREE
UNDER 43301(c) OF THE DIVORCE CODE
1. I consent to the entry of a final decree in 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 I will not be divorced until a divorce decree is entered by the
Court and that a copy of the decree will be sent to me immediately after it is filed
with the Prothonotary.
I VERIFY THAT THE STATEMENTS MADE IN THE FOREGOING AFFIDAVIT
ARE TRUE AND CORRECT. I UNDERSTAND THAT FALSE STATEMENTS HEREIN
ARE MADE SUBJECT TO THE PENALTIES OF 18 Pa.C.S. §4904 RELATING TO
UNSWORN FALSIFICATION TO AUTHORITIES.
DATE: '1'?"6
MARY ANN K. DAVIS, Defendant
M LE
cu;k
Danny L. Davis, Jr.
V. :
Mary Ann K. Davis
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 07-726
DIVORCE DECREE
AND NOW, {`?av ?.? ?Of , it is ordered and decreed that
Danny L. Davis, Jr. plaintiff, and
Mary Ann K. Davis , defendant, are divorced from the
bonds of matrimony.
Any existing spousal support order shall hereafter be deemed an order for
alimony pendente lite if any economic claims remain pending.
The court retains jurisdiction of any claims raised by the parties to this action
for which a final order has not yet been entered. Those claims are as follows: (If no
claims remain indicate "None.")
None. The parties' Property and Separation Agreement entered into on May 15, 2009 is
incorporated herein, but not merged.
By the Court,
Attest: J.
I
honotary
r
DANNY L. DAVIS, JR.,
Plaintiff
V.
MARY AI N K. DAVIS,
Defendant
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 07-726 CIVIL TERM
IN DIVORCE
STIPULATION AND AGREEMENT REGARDING ALIMONY
Thi Agreement, made this -LL day of , 2009 by and between
Danny L. Davis, Jr., party of the first part, hereinafter referred to as "Husband,"
AND
Mary Ann ?K. Davis, party of the second part, hereinafter referred to as "Wife."
WITNESS TH:
WHEREAS, the parties are divorced from the bonds of matrimony, with a copy of the
Divorce D cree being attached hereto and incorporated herein by reference as "Exhibit A."
a Separation and Property Settlement Agreement, executed by the parties, is
incorporated into the Divorce Decree. A copy of the Agreement is attached hereto and
herein by reference as Exhibit "B."
pursuant to paragraph 18(b), Husband is obligated to make alimony
payments (to Wife in the amount of 600.00 (SIX HUNDRED AND XX/100 DOLLARS) a
month, beiinning on May 22, 2009, for thirty-six (36) months.
, the start date of May 22, 2009 is based on the assumption that the Divorce
Decree will be entered such that if it is not yet entered, alimony will begin on June 5, 2009.
WHEREAS, the parties agree the alimony obligation shall be collected from Husband by
Cumberland County Domestic Relations Office via wage attachment.
WHEREAS, Husband and Wife have agreed to the following Stipulation:
1. Husband shall pay to Wife alimony in the amount of $600.00 (SIX HUNDRED
AND XX/100 DOLLARS) a month, in equal installments every two weeks of
$276.92 (TWO HUNDRED AND SEVENTY-SIX AND 92/100 DOLLARS), for
thirty-six (36) months or seventy-eight (78) paychecks, starting on May 22, 2009.
The start date of May 22, 2009 is based on the assumption that the Divorce
Decree will be entered such that if it is not yet entered, alimony will begin on
June 5, 2009.
2. Husband shall be wage attached through the Cumberland County Domestic
Relations Office.
IN WITNESS WHEREOF, the parties hereto have set their hands and seals the day and
year first above written.
WITNES ED BY:
l?
U1 A, -A C11
Hannah H rman-Snyder, Es ire atD e ' DAN DAVIS, JR.
Attorney f Or Dan Davis, Jr.
511 ,79 Yz ?
ate MARY NN K. DAVIS
L. Davis, Jr.
V..
Mary l nn K. Davis
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 07-726
DIVORCE DECREE
AND NOW, May 20 2009 , it is ordered and decreed that
L. Davis, Jr. plaintiff, and
Mary inn K. Davis
defendant, are divorced from the
of matrimony.
Any existing spousal support order shall hereafter be deemed an order for
alimony pendente lite if any economic claims remain pending.
The court retains jurisdiction of any claims raised by the parties to this action
for which a final order has not yet been entered. Those claims are as follows: (If no
claim remain indicate "None.")
None. he parties' Property and Separation Agreement entered into on May 15, 2009 is
incorp rated herein, but not merged.
By the Court,
M. L. Ebert, Jr.
Certifi d Copy Issued: May 21, 2009
Date
Attest: J.
71rothonotary
a
t;
PROPERTY AND
SEPARATION AGREEMENT
BETWEEN
DANNY L. DAVIS, JR.
AND
MARY ANN K. DAVIS
GRIFFIE AND ASSOCIATES
200 NORTH HANOVER STREET
CARLISLE, PA 17013
a
¦ .
7? 11SAGREEMENT, made this /544day of Mat r , 2009, by
and between DANNY L. DAMS, JR., of 417 Independence Court, Carlisle,
Pennsylvania, party of the first part, hereinafter referred to as "Husband",
AND
YANNK. DAMS, of 103 Commonwealth Drive, Bethlehem, Pennsylvania,
party of t?e second part, hereinafter referred to as "Wife",
WHEREAS, the parties hereto are Husband and Wife, having been married on
Septemb r 28, 1991, in Northampton County, Pennsylvania. There are three children
born of marriage, namely Zachary Daniel Davis, born August 18, 1992, Alexis
Nicole D:, born August 7, 1997, and Isabella Marie Davis, born July 26, 2001.
'vNHEREAS, diverse unhappy differences, disputes and difficulties have arisen
between he parties and it is the intention of Wife and Husband to live separate and apart,
and the arties hereto are desirous of settling their respective financial rights and
obligations as between each other including the settling of matters between them relating
to the past, present and future support and/or maintenance of Wife by Husband and
Husband by Wife.
, the parties hereto wish finally and for all time to settle and determine
their
live
ve property and other rights growing out of their marital relation; wish to
and apart; and, wish to enter into this property and separation Agreement;
2
.
S, both and each of the parties hereto have been advised of their legal
rights and the implications of this Agreement and the legal consequences which may and
will ensue from the execution hereof,
WHEREAS, Wife acknowledges that she is thoroughly conversant with and
knows ac urately the size, degree, and extent of the estate and income of Husband, and
Husband acknowledges that he is thoroughly conversant with and knows accurately the
size, degree and extent of the estate and income of Wife;
N W, THEREFORE, in consideration of the mutual promises, covenants and
undertake gs hereinafter set forth which are hereby acknowledged by each of the parties
hereto, 'fe and Husband, each intending to be legally bound hereby, covenant and agree
as
1. ADVICE OF COUNSEL:
T is Agreement has been prepared by Hannah Herman-Snyder, Esquire, attorney
for Husb d. Said attorney at the commencement of and at all stages during the
negotiate of this Agreement informed Wife that she has acted solely as counsel for
Husband d has not advised or represented Wife in any manner whatsoever. Wife, at
the commencement of and all stages during the negotiations of this Agreement has been
informed by Hannah Herman-Snyder, Esquire, that she has a right to be represented by
her own Counsel and having encouraged her to seek the advice of counsel. Wife has read
this Agreement carefully and thoroughly understands each provision and therefore signs
it freely aid voluntarily.
3
WARRANTY OF DISCLOSURE:
parties warrant and represent that they have made a full disclosure of all
assets and their valuation prior to the execution of this Agreement. This disclosure was
in the f6rm of an informal exchange of information by the parties' attorneys and/or
parties and this Agreement between the parties is based upon this disclosure.
3.1 MUTUAL RELEASE:
and Wife each do hereby mutually remise, release, quitclaim, and
forever dlischarge the other and the estate of such other, for all times to come and for all
purposes whatsoever, of and from any and all right, title and interest, or claims in or
against toe property (including income and gain from property hereafter accruing) of the
other or kainst the estate of such other, of whatever nature and wheresoever situate,
which heI or she now has or at any time hereafter may have against such other, the estate
of such ?ther, or any part thereof, whether arising out of any former acts, contracts,
or liabilities of such other as by way of dower or curtesy, or claims in the
nature ofIdower or curtesy or widow's or widower's rights, family exemption, or similar
allowanc?, or under the intestate laws, or the right to take against the spouse's Will; or
the right o treat a lifetime conveyance by the other as testamentary, or all other rights of
a surviving spouse to participate in a deceased spouse's estate, whether arising under the
laws of () Pennsylvania, (b) any state, commonwealth or territory of the United States,
or (c) another country, or any rights which either party may have or at any time
hereafter have for past, present, or future support or maintenance, alimony, alimony
pendente Ilite, counsel fees, costs or expenses, whether arising as a result of the marital
relation o? otherwise, except and only except, all rights and agreements and obligations of
4
whatsoever nature arising or which may arise under this Agreement or for the breach of
any thereof. It is the intention of Husband and Wife to give to each other by execution of
this Agreement a full, complete, and general release with respect to any and all property
of any kind or nature, real or personal, not mixed, which the other now owns or may
hereafter acquire, except and only except, all rights and agreements and obligations of
nature arising or which may arise under this Agreement or for the breach of
any thereof.
They sha
by the of
places as
on and e
her may
each othe
other to c
Husband
shall
part of
4.1 PERSONAL RIGHTS AND SEPARATION:
ife and Husband may and shall, at all times hereafter, live separate and apart.
be free from any control, restraint, interference or authority, direct or indirect,
in all respects as if they were unmarried. They may reside at such place or
may select. Each may, for his or her separate use or benefit, conduct, carry
in any business, occupation, profession or employment which to him or
advisable. Wife and Husband shall not molest, harass, disturb or malign
or the respective families of each other nor compel or attempt to compel the
or dwell by any means or in any manner whatsoever with him or her.
5.1 AGREEMENT NOT A BAR TO DIVORCE PROCEEDINGS.
Agreement shall not be considered to affect or bar the right of Wife or
a limited or absolute divorce on lawful grounds if such grounds now exist or
exist or to such defense as may be available to either party. This
is not intended to condone and shall not be deemed to be a condonation on the
party hereto of any act or acts on the part of the other party which have
the disputes or unhappy differences which have occurred prior to or which
5
may occur subsequent to the date hereof. The parties intend to secure a mutual consent,
no-fault divorce pursuant to the terms of Section 3301 (c) or (d) of the Divorce Code of
1980.
6.
divorce
AGREEMENT TO BE INCORPORATED IN DIVORCE DECREE:
parties agree that the terms of this Agreement may be incorporated into any
which may be entered with respect to them. Notwithstanding such
this Agreement hall not be merged in the decree, but shall survive the same
and shall
binding and conclusive on the parties for all times.
7. ? DATE OF EXECUTION:
"date of execution" or "execution date" of this Agreement shall be defined. as
the date upon which it is executed by the parties if they have each executed the
on the same date. Otherwise, the "date of execution" or "execution date" of
this Agreement shall be defined as the date of execution by the party last executing this
8.1 PERSONAL PROPERTY:
and Wife do hereby acknowledge that they have previously divided their
tangible ?ersonal property, except as set forth herein, including, but without limitation,
jewelry, clothes, furniture, furnishings, rugs, carpets, household equipment and
pictures, books, works of art and other personal property and hereafter Wife
agrees th t all of the property in the possession of Husband shall be the sole and separate
property f Husband; and Husband agrees that all of the property in the possession of
Wife shad be the sole and separate property of Wife. The parties do hereby specifically
6
waive, rtlease, renounce and forever abandon whatever claims, if any, he or she may
have with respect to the above items which shall become the sole and separate property
of the other, with full power to him or her to dispose of the same as fully and effectually,
as thous he or she were unmarried.
shall provide to Wife, upon execution of the Agreement, FIVE
AND XX/100 DOLLARS ($500.00) in exchange for the previously sold
hoop and for retaining the car top carrier, carpet steam cleaner, and draperies,
which shall remain in Husband's possession.
o later than the end of June 2009, Wife shall provide to Husband photographs
and vide s of the parties' children, from the time of their birth to the date of separation.
The cost to reproduce the videos and pictures shall be shared equally by the parties.
91 BANK ACCOUNTS:
the mutual promises and covenants contained in this Agreement, Husband and
Wife herby waive all right, title, claim or interest they may have to equitable distribution
in their respective bank accounts, checking or savings, if any, and each party waives
against flie other any duty of accounting for disposition of any jointly held funds. The
parties hereby confirm their prior equal distribution of the contents of their joint accounts
and
shall hereafter make any claim against the other regarding the same.
7
.
Q. REAL ESTATE:
parties were joint owners of real estate located at 8 Greenwich Drive,
as
10. MOTOR VEHICLES:
ith respect to the motor vehicles owned by one or both parties, the parties agree
a. The 1996 Plymouth Grand Voyager currently in Wife's possession shall
remain the sole and exclusive property of Wife. Husband shall waive any
right, title, and interest he has or may have in said vehicle.
b. The 2006 Saturn Vue currently in Husband's possession shall remain the
sole and exclusive property of Husband as this was purchased subsequent
to separation. Wife shall waive any right, title, and interest she had or
may have had in the previously owned 1996 Dodge Intrepid.
11. AFTER-ACQUIRED PERSONAL PROPERTY:
E ch of the parties shall hereafter own and enjoy, independently of any claim or
right of * other, all items of personal property, tangible or intangible, hereafter acquired
by him o her after the parties date of separation, with full power, in him or her to dispose
of the sa e as fully and effectively, in all respects and for all purposes, as though he or
she were
Carlisle, Cumberland County, Pennsylvania. Said property was owned in joint names as
tenants b the entireties. The property has been sold and the parties contributed equally
to funds ecessary to sell said property and no proceeds were realized from sale of the
marital
8
I p. PENSION RETIREMENT, PROFIT SHARING:
sharing,
account
and
The parties recognize that Wife did not have any retirement, pension, profit
, accrued at the time of separation.
The parties recognize that Husband has a 403(b) and pension as a result of his
with Green Ridge Village, as well as a 401(k) as a result of his prior
with Diakon. For the mutual promises and covenants contained to this
Wife hereby waives all right, title, claim, or interest she may have by
distribution or otherwise in Husband's 403(b) and pension plan with his current
. The Diakon 401(k) plan shall be rolled over, in its entirety, into a qualified
Wife, including any changes in market growth from the time the Separation
Settlement Agreement is entered until such time as the funds are actually
received. I Counsel for Husband shall be responsible for preparing a Domestic Relations
Order to effectuate the rollover of the qualified account, and a draft of said Order shall be
prepared {within thirty (30) days of the execution of this Agreement.
benefits
acknow;
benefits
after re
c. ? Each party specifically waives any and all rights to pre-retirement death
survivor benefits under the other's pension or retirement plan(s) and each
that the effect of this waiver is that he or she will not be entitled to any
from these contracts, plans or accounts if the other dies before or
retirement age and each agrees and unequivocally consents to the
by the other of any alternate or further beneficiaries at any time.
9
1 4. LIFE INSURANCE:
party agrees that the other party shall have sole ownership and possession of
any life ?nsurance policies owned by him or her, except as set forth herein. Each party
agrees to sign any documents necessary to waive, relinquish, or transfer any rights on
such policies to the respective party who presently owns such policies.
band maintains a life insurance policy for each of the children, Zachary,
Alexis, and Isabella, which is a whole life policy with a death benefit of TWENTY -
FIVE TI?OUSAND AND XX/100 DOLLARS ($25,000.00). Husband and Wife are
of each of the policies. Husband shall maintain these policies with Husband
and Wif? remaining jointly as beneficiaries until each respective child reaches age
whereupon he/she will then assume responsibility of said policy and name
of choice. The parties agree that neither will do anything to disrupt the
policies, including but not limited to taking loans against the same. Husband shall
provide Wife with statements of the policies annually until such time as the policies
become t?e property of each of the respective children.
114sband maintains a State Farm whole life insurance policy of ONE HUNDRED
DOLLARS AND XX/100 ($100,000.00), with policy # 1590-8009, and
with a g4aranteed death benefit of ONE HUNDRED THOUSAND DOLLARS AND
XX/100 ($100,000.00). Husband shall retain each of the children, Zachary, Alexis, and
Isabella * equal beneficiaries of one third of the death benefit until such time as each
child
child
be at the
college or reached age twenty-five (25), whichever is sooner. As each
the aforementioned graduation or age, the beneficiary designation shall then
of Husband. Husband shall provide Wife with a policy statement
10
until the youngest child has graduated from college or reaches age twenty-five
(25), whichever is sooner.
the event of Husband's death where proceeds are distributed to children as
noted above, proceeds shall be administered by a financial institution trust officer as
in Husband's last will and testament. Proceeds shall only be utilized for
directly related to the post secondary education of the children until each of the
either complete their education or reach the age of twenty-five (25). At the time
each of I the children reach the age of twenty-five (25), any remaining proceeds being
by the financial institution trust officer shall be distributed to the child.
5. DEBTS:
as otherwise herein expressly provided, the parties shall and do hereby
remise, release and forever discharge each other from any and all actions, suits,
debts, claims, demands and obligations whatsoever, both in law and in equity, which
either of them ever had, now has, or may hereafter have against the other upon or by
reason 0 any matter, cause or thing up to the date of the execution of this Agreement.
the event that either party becomes a debtor in bankruptcy or financial
ion proceedings of any kind while any obligations remain to be performed by
that party for the benefit of the other party pursuant to the provision of this Agreement,
the deb?or spouse hereby waives, releases and relinquishes any right to claim any
(whether granted under state or federal law) to any property remaining in the
debtor 4 a defense to any claim made pursuant hereto by the creditor spouse, and the
debtor souse hereby assigns, transfers, and conveys to the creditor spouse an interest in
all of th4 debtor's exempt property sufficient to meet all obligations to the creditor spouse
11
as set fo#h herein, including all attorney's fees and costs incurred in the enforcement of
this paragraph or any other provision of this Agreement. No obligation created by this
shall be discharged or dischargeable, regardless of federal or state law to the
contrary, and each party waives any and all right to assert that any obligation hereunder is
or dischargeable. The failure of any party to meet his or her obligations under
any one or more of the paragraphs herein, with the exception of the satisfaction of
itior?s precedent, shall not in any way void or alter the remaining obligations of
either of Oie parties.
1 WARRANTY AS TO EXISTING OBLIGATIONS:
party represents that they have not heretofore incurred or contracted for any
debt or liability or obligation for which the estate of the other party may be responsible or
liable ex?ept as may be provided for in this Agreement. Each party agrees to indemnify
or hold the other party harmless from and against any and all such debts, liabilities or
obligations of every kind which may have heretofore been incurred by them, including
those for necessities, except for the obligations arising out of this Agreement.
11. WARRANTY AS TO FUTURE OBLIGATIONS:
ife and Husband each covenant, warrant, represent and agree that each will now
and at all times hereafter save harmless and keep the other indemnified from all debts,
charges and liabilities incurred by the other after the execution date of this Agreement,
except as may be otherwise specifically provided for by the terms of this Agreement and
that neithIcr of them shall hereafter incur any liability whatsoever for which the estate of
the other inav be liable.
12
alimony,
expenses
1$. ALIMONY ALIMONY PENDENTE LITE, SPOUSAL SUPPORT, AND
Husband hereby waives any right or claim of any nature whatsoever relative to
alimony pendente lite, spousal support, spousal maintenance, counsel fees and
against Wife.
b.? Husband shall pay to Wife alimony in the amount of SIX HUNDRED AND
XX/100 $600.00) a month, in equal installments every two weeks of $276.92, for thirty-
six (36) months or seventy-eight (78) paychecks, starting on May 22, 2009. The start
date of ay 22, 2009 is based on the assumption that the Divorce Decree will be entered
such that if it is not yet entered, alimony will begin on June 5, 2009. The obligation
pursuant to Docket No. 00541 S 2006, PACSES Case No. 421108402, as it pertains :to
support f r Wife, shall terminate immediately upon the execution of this Agreement and
any arrears shall be set at zero, and the alimony payment shall be garnished from
Husband's wages by the Cumberland County Domestic Relations Office pursuant to the
Stipulati n and Agreement executed simultaneously with this Agreement.
alimony award is non-modifiable.
19. CASH PAYMENT:
consideration of Husband retaining the portion of the stimulus check for the
2007 tax year that was distributed in recognition of the minor child Zachary, Husband
shall pay to Wife THREE HUNDRED XX/100 DOLLARS ($300.00) immediately upon
of the Agreement as Wife exercised custody of Zachary for said tax year.
13
20. BANKRUPTCY:
The respective duties, covenants and obligations of each party under this
Agreement shall not be dischargeable by bankruptcy, but if any bankruptcy court should
discharg a party of accrued obligations to the other, this Agreement shall continue in full
force an effect thereafter as to any duties, covenants and obligations accruing or to be
thereafter.
2'. DIVORCE:
H sband has commenced an action for divorce from Wife pursuant to Section
3301 (c) f the Pennsylvania Divorce Code (irretrievable breakdown) by the filing of a
Divorce Complaint as the parties have agreed to consent to a divorce. Both parties agree
that they shall each sign an Affidavit of Consent and Waiver of Notice of Intention to
Request ?he Entry of a Divorce Decree evidencing that each of them consents to the
divorce Od each shall provide said document to counsel for Husband within ten (10)
days of e ecution of this Agreement. It is further agreed and understood that any Decree
of Divorc issuing in this matter shall reflect the fact that Husband shall bear the cost of
same in his individual capacity.
a. Each of the parties agree that this Agreement represents a complete and
final agr ement as to their respective property rights which arose from the marital
relation and therefore mutually waive any and all rights they may have under Section
3501 (Equitable Distribution) of the Pennsylvania Code, Act No. 1990-206.
b. This Agreement may be offered in evidence in the action for divorce and
may be i corporated by reference in the decree to be granted therein. Notwithstanding
14
such incprporation, this Agreement shall not be merged in the decree, but shall survive
the same and shall be binding and conclusive on the parties for all time.
LEGAL FEES:
the review and preparation of this Agreement, each party shall bear his/her own
legal fee4, with Husband paying for the preparation of this Agreement.
2$. REMEDY FOR BREACH:
either party breaches any provision of this Agreement, the other party shall
have the ?ight, at his or her election, either to sue for damages for such breach, in which
event thel breaching party shall be responsible for payment for reasonable legal fees and
costs inc*ed by the other in enforcing their rights hereunder, or to seek such other
remedies Or relief as may be available to him or her.
. EOUITABLE DISTRIBUTION:
It
equitable
Divorce (
amended.
25
It
each partsatisfactio
is specifically understood and agreed that this Agreement constitutes an
distribution of property, both real and personal, which was legally and
acquired by Husband and Wife or either of them during the marriage as
by The Act of December 19, 1990 (P.L. No. 1240, No. 206) known as "The
" 23 P.S. 3501 et seq. of the Commonwealth of Pennsylvania, and as
SUMMARY OF EFFECT OF AGREEMENT:
s specifically understood and agreed by and between the parties hereto, and
accepts the provisions herein made in lieu of and in full settlement and
of any and all of said parties' rights against the other for any past, present and
15
future claims on account of support, maintenance, alimony, alimony pendente lite,
counsel fees, costs and expenses, equitable distribution of marital property and any other
claims of each party, including all claims raised by them in the divorce action pending
between the parties.
20. TAX CONSEQUENCES:
this agreement, the parties have intended to effectuate and have equitably
divided t?eir marital property. The parties have determined that such equitable division
to a right and just standard with regard to the rights of each party. The division
of existing marital property is not, except as may be otherwise expressly provided herein,
intended lby the parties to constitute in any way a sale or exchange of assets and the
division is being effected without the introduction of outside funds of other property not
a part of the marital estate.
MUTUAL COOPERATION/DUTY TO EFFECTUATE AGREEMENT:
party shall, at any time and from time to time hereafter, take any and all
steps and execute, acknowledge, and deliver to the other party any and all further
and/or documents that the other party may reasonably require for the purpose
of giving full force and effect to the provisions of this Agreement.
281. RECONCILIATION:
parties shall only effect a legal reconciliation which supersedes this
by their signed agreement containing a specific statement that they have
I and that this agreement shall be null and void; otherwise, this agreement shall
remain in
force and effect. Further, the parties may attempt a reconciliation, which
16
action, if not consummated by the aforesaid agreement, shall not affect in any way the
legal effect or this agreement or cause any new marital rights or obligations to accrue.
. SEVERABILITY:
parties agree that the separate obligations contained in this Agreement shall
be deem?d to be interdependent. If any term, clause, or provision of this Agreement shall
be determined by a court of competent jurisdiction to be invalid or unenforceable, then
the parti?s agree that the Agreement may be reviewed and renegotiated in order to fulfill
as closely as possible the purpose of the invalid provision. Notwithstanding any release
contained herein, the parties intend that they may reinstate any and all economic claims
to the extent available under the Divorce Code of 1980. Further, any court of competent
may, under the equitable provisions and purposes of the Divorce Code,
reinstate lany economic claim which was available at the time of the parties' separation or
avoid any waiver herein contained to renegotiate or effectuate as nearly as possible the
purpose Of the unenforceable provision.
. NO WAIVER OF DEFAULT:
Agreement shall remain in full force and effect unless and until terminated
under ano pursuant to the terms of this Agreement. The failure of either party to insist
upon stri t performance of any of the provisions of this Agreement shall in no way affect
the right f such party hereafter to enforce the same, nor shall the waiver of any breach of
any prov?sion hereof be construed as a waiver of any subsequent default of the same or
similar nature, nor shall it be construed as a waiver of strict performance of any other
obliizatiofis herein.
17
3 1. INTEGRATION:
Agreement constitutes the entire understanding of the parties and supersedes
any and all prior agreements and negotiations between them. There are no
or warranties other than those expressly set forth herein. This Agreement
shall survive integration by any court into any judgment for divorce and shall continue to
have independent legal significance as written contract separate from such judgment for
divorce a?d may be enforced as an independent contract.
32. EFFECT OF DIVORCE DECREE:
parties agree that unless otherwise specifically provided herein, this
shall continue in full force and effect after such time as a final decree. in
divorce may be entered with respect to the parties.
33? NOTICES:
Arty and all notices given hereunder shall be in writing and shall be sent
registered mail, return receipt requested:
a. To the Husband, in care of Hannah Herman-Snyder, 200 North
Hanover treet, Carlisle, Pennsylvania 17013.
b. To the Wife, at 103 Commonwealth Drive, Bethlehem, Pennsylvania,
18020.
34, WAIVER OR MODIFICATION TO BE IN WRITING:
Nod modification or waiver of any of the terms hereof shall be valid unless in
writing a4d signed by both parties and no waiver of any breach hereof or default
18
-t • r
shall be deemed a waiver of any subsequent default of the same or similar
nature.
3$. CAPTIONS:
captions of this Agreement are inserted only as a matter of convenience and
for refer?nce and in no way define, limit or describe the scope and intent of this
nor in any way effect this Agreement.
36. AGREEMENT BINDING ON HEIRS:
Agreement shall be binding and shall inure to the benefit of the parties hereto
and their respective heirs, executors, administrators, successors and assigns.
3' . LAW OF PENNSYLVANIA APPLICABLE:
Agreement shall be construed in accordance with the laws of the
of Pennsylvania.
3?. SUBSEQUENTLY DISCOVERED PROPERTY PENALTY FOR
either of the parties subsequently discover the existence of any marital
property not distributed by this Agreement, said property shall be divided in the same
as this Agreement's equitable distribution of marital property (50/50).
if the existence of said property was knowingly concealed or its value
by one of the parties, said property shall be transferred in its entirety to
the non-concealing party and the concealing party shall pay all costs, fees, and attorney's
fees occasioned by the failure to disclose its existence or true value.
19
of
WITNESS WHEREOF, the parties have set their hands and seals to two
of this Agreement, each of which shall constitute an original, the day and
year first 4bove written.
Witness:
Danny L. avis, Jr.
Mar nn K. Dav s
20
COMMgNWEALTH OF PENNSYLVANIA )
-I, ) SS.
COUNT X OF CUMBERLAND )
O this, the 15*6 day of _ W , 2009, before me, a notary
public, t e undersigned officer, personally appeare Danny L. Davis, Jr., known to me
(or sati
y proven) to be the person whose name is subscribed to the within
and acknowledged that he executed the same for the purposes therein
Witness Whereof, I hereunto set my hand and notarial seal.
II"A1yM1 am
OVA HM
Now has
ift
public,
(or
In
. OF NO,?7N 14 h' y11z1,4,17e, ?&)-
STWEALTH OF PENNSYLVANIA
Not ub
lic
SS.
this, the day of 1?14Y , 2009, before me, a notary
undersigned officer, personally appeared Mary Ann K. Davis, known to me
proven) to be the person whose name is subscribed to the within
and acknowledged that she executed the same for the purposes therein
tness Whereof, I hereunto set my hand and notarial seal. //
otary Public
,owAoNWFALTH OF PENNSYLVANIA
NOTARIAL SEAL
Sharon A. Kels, Notary Public
21 Palmer Township, Northampton County
M commission expires 111, 2013
,?;
.,,- .- ? , r , ? ? « ,., -.
t _ ??;'_
% MAY z,d 2009q j
DANNY L. DAVIS, JR., IN THE COURT OF COMMON PLEAS OF
Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA
V. CIVIL ACTION -LAW
MARY ANN K. DAVIS, : NO. 07-726 CIVIL TERM
Defendant IN DIVORCE
ORDER OF COURT
AND NOW this ??
day of K" , 2009, upon consideration of the
attached Stipulation and Agreement, it is hereby ORDERED as follows:
I. Husband shall pay to Wife alimony in the amount of $600.00 (SIX HUNDRED
AND XX/100 DOLLARS) a month, in equal installments every two weeks of
$276.92 (TWO HUNDRED AND SEVENTY-SIX AND 92/100 DOLLARS), for
thirty-six (36) months or seventy-eight (78) paychecks, starting on May 22, 2009.
The start date of May 22, 2009 is based on the assumption that the Divorce
Decree will be entered such that if it is not yet entered, alimony will begin on
June 5, 2009.
2. Husband shall be wage attached through the Cumberland County Domestic
Relations Office.
By the Court,
DRO:_1 . Shadday
?Dan L. Davis, Jr.
./1VVtary Ann K. Davis
--<anrnah Herman-Snyder, Esquire
lip
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of Pennsylvania
Co./City/Dist. of CUMBERLAND
Date of Order/Notice 06/05/09
Case Number (See Addendum for case summary)
Employer/Withholder's Federal EIN Number
421108402
541 S 2006
RE: DAVIS, DANNY L. JR
07-726 CIVIL
OOriginal Order/Notice
OAmended Order/Notice
[Terminate Order/Notice
OOne-Time Lump Sum/Notice
Employee/Obligor's Name (Last, First, MI)
441-80-3677
Employee/Obligor's Social Security Number
PRESBYTERIAN HOMES INC 2089101681
C/O WOODLAND RETIREMENT HOME Employee/Obligor's Case Identifier
STE 201 (See Addendum for plaintiff names
1 TRINITY DR E associated with cases on attachment)
DILLSBURG PA 17019-8522 Custodial Parent's Name (Last, First, MI)
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's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 1,250.00
$ 0.00
$ 0.00
$ 0.00
$ 600.00
$ 0.00
$ 0.00
$ 0.00
per month in current child support
per month in past-due child support Arrears 12 weeks or greater? Dyes ® no
per month in current medical support
per month in past-due medical support
per month in current spousal support
per month in past-due spousal support
per month for genetic test costs
per month in other (specify)
one-time lump sum payment
for a total of $ 1,850.00 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:
$ 426.92 per weekly pay period. $ 925.00 per semimonthly pay period
(twice a month)
$ 853.85 per biweekly pay period (every two weeks) $ 1, 850.00 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 #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS 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. .. y
BY THE COURT:
DRO: R.J. Shadday
Service Type M OMB No.: 097"154
. L • L,J?1. 1. , lJl . ?
Form EN-028 Rev.5
Worker ID $IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
If hecked you are required to provide a opy of this form to your mployee. If yo?1 r employee works in a state that is
dihenrent from the state that issued this order, a copy must be provided to your employee even if the box is not checked.
1. 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.
2. 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.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from 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.
4.* 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 #9 below)
5. 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. 2313814040
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ID
EMPLOYEE'S/OBLIGOR'S NAME:DAVIS, DANNY L. JR
EMPLOYEE'S CASE IDENTIFIER: 2089101681 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT-
NEW EMPLOYER'S NAME/ADDRESS:
6. 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.
7. 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.
8. 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.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65"/o if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA 0 5 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. 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.
11. Send Termination Notice and
other correspondence to: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST by telephone at (717) 240-6225 or
P.O. BOX 320 by FAX at (717) 240-6248 or
CARLISLE PA 17013
by internet www.childsupport.state.pa.us
Page 2 of 2 Form EN-028 Rev.5
Service Type M OMB No.: 0970-0154 Worker ID $IATT
ADDENDUM
Summarv of Cases on Attachment
Defendant/Obligor: DAVIS, DANNY L. JR
PACSES Case Number 064110890 PACSES Case Number 421108402
Plaintiff Name Plaintiff Name
MARY ANN K. DAVIS MARY ANN K. DAVIS
Docket Attachment Amount
Docket Attachment Amount
07-726 CIVIL $ 600.00 00541 S 2006 $ 1,250.00
'
DOB
Child(ren)'s Name(s): DOB s Name(s):
Child(ren) 08/18/92
ZACHARY D. DAVIS
VI 08/07/97
S
ALEXIS N. DA 07/26/01
ISABELLA M. DAVIS
PACSES Case Number PACSES Case Number
Plaintiff Name Plaintiff Name
Docket Attachment Amount Docket Attachment Amount
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
PACSES Case Number PACKS Case Number
Plaintiff Name Plaintiff Name
Docket Attachment Amount Docket Attachment Amount
$ 0.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
Addendum Form EN-028 Rev.5
Worker ID $IATT
Service Type M OMB No.: 0970-01 54
ALED-OFFiCE
OF THE , . ?H!,x\,tr)TARY
2009 JUN -8 PM 3: 0 9
ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT
State Commonwealth of Pennsylvania
Co./City/Dirt. of CUMBERLAND
Date of Order/Notice 09/23/09
Case Number (See Addendum for case summary)
Employer/Withholder's Federal EIN Number
PRESBYTERIAN HOMES INC
C/O WOODLAND RETIREMENT HOME
STE 201
441-80-3677
Employee/Obligor's Social Security Number
2089101681
Employee/Obligor's Case Identifier
(See Addendum for plaintiff names
1 TRINITY DR E associated with cases on attachment)
DILLSBURG PA 17019-8522 Custodial Parent's Name (Last, First, MI)
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's/obligor's income until further notice even if the Order/Notice is not
issued by your State.
$ 973.00 per month in current child support
$ o . oo per month in past-due child support Arrears 12 weeks or greater? C )yes (X) no
$ 0.00 per month in current medical support c
$ 0
00 per month in past-due medical support
$ .
600.00 per month in current spousal support <<l ? ."
`n
$ o . oo per month in past-due spousal support o N
$ o . oo per month for genetic test costs x
'ji
$ o . oo per month in other (specify)
$ one-time lump sum payment r.;>m
for a total of $
1,573.00 per month to be forwarded to payee below. C:D
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:
$ 363.00 per weekly pay period. $ 786.50 per semimonthly pay period
(twice a month)
$ 726.00 per biweekly pay period (every two weeks) $ 1, 573. oo per monthly pay period.
REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten 0 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 #9 on page 2).
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is
ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has
a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections
and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE
42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown
above as the Employee/Obligor's Case Identifier) OR SO / L ;PITY NUMBER IN ORDER TO BE PROCESSED.
DO NOT SEND CASH BY MAIL.
.3 00
BY THE COURT:
F.10F, 1,
DRO: R.J. Shadday
Service Type M V OMB No.: 0970-0154
421108402
541 S 2006
07-726 CIVIL
0Original Order/Notice
@Amended Order/Notice
oTerminate Order/Notice
QOne-Time Lump Sum/Notice
RE:DAVIS, DANNY L. JR
Employee/Obligor's Name (Last, First, MI)
, Jr.,
Form EN-028 Rev.5
Worker I D $ IATT
ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS
o If hecke? you are required to provide a opy of this form to your. mployee. If yo r employee works in a state that is
di erent from the state that issued this o er, a copy must be provi?ed to your employee even if the box is not checked.
1. 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.
2. 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.
3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The
paydate/date of withholding is the date on which amount was withheld from 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.
4.* 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 #9 below)
5. 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. 2313814040
THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : O THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0
EMPLOYEE'S/OBLIGOR'S NAME:DAVIS, DANNY L. JR
EMPLOYEE'S CASE IDENTIFIER: 2089101681 DATE OF SEPARATION:
LAST KNOWN HOME ADDRESS:
LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT-
NEW EMPLOYER'S NAME/ADDRESS:
6. 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.
7. 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.
8. 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.
9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit
Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of
employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social
Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is
supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is
increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may
deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section.
Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the
employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts
allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of
the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the
CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health
care premiums in determining disposable income and applying appropriate withholding limits.
10. 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.
11. Send Termination Notice and
other correspondence to: If you or your employee/obligor have any questions,
DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT
13 N. HANOVER ST by telephone at (717) 240-6225 or
P.O. BOX 320 by FAX at (717) 240-6248 or
CARLISLE PA 17013
by internet www.childsupport.state.pa.us
Page 2 of 2 Form EN-028 Rev.5
Service Type M OMB No.: 0970-0154 Worker ID $IATT
ADDENDUM
Summarv of Cases on Attachment
Defendantlobligor: DAVIS, DANNY L. JR
PACSES Case Number 064110890 PACSES Case Number 421108402
Plaintiff Name Plaintiff Name
MARY ANN K. DAVIS MARY ANN K. DAVIS
Docket Attachment Amount Docket Attachment Amount
07-726 CIVIL $ 600.00 00541 S 2006 $ 973.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB
ZACHARY D. DAVIS 08/18/92
ALEXIS N_ DAVIS_ 08/07/97
ISABELLA M. DAVIS 07/26/01
PACSES Case Number
Plaintiff Name
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):
Service Type M
DOB
Addendum
OMB No.: 0970-0154
PACSES Case Number
Plaintiff Name
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
Form EN-028 Rev.5
Worker I D $ IATT
CF T}7
2099'S EP 28 F ' 0
DANNY L. DAVIS, JR., : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
V. CIVIL ACTION -LAW
MARY ANN K. DAVIS, : NO. 07-726 CIVIL TERM
Defendant IN DIVORCE
STIPULATION AND AGREEMENT
By and between, Danny L. Davis, Jr., Plaintiff, and MaryAnn K. Davis, Defendant,
WINESSETH:
WHEREAS, the parties, intending to be legally bound and waiving their right to be
present when this Agreement and Order are presented and signed by the Court, hereby stipulate
and agree that the Court may enter the attached Order of Court.
IN WITNESS WHEREOF, the parties, intending to be bound by the terms and conditions
of this Agreement, execute this Agreement by signing below:
Hannah Herman-Snyder, Es4i
Attorney for Plaintiff
ti
Danny L. D 's, Jr., Plaintiff
MaryAnn . Davis, Defendant
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Betsy Kovalovsky, Notary Pubik;
Bethiehern Twp., Northampton County
My Comrnissia , Eyirsrs Oct 22, 2011
i ember, Pennsyivania?Association of Notaries
Cr' } - r
p
,
"
1
AIR 1 S Z010
DANNY L. DAVIS, JR., : IN THE COURT OF COMMON PLEAS OF
Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA
V. CIVIL ACTION -LAW
MARY ANN K. DAVIS, NO. 07-726 CIVIL TERM
Defendant : IN DIVORCE
QUALIFIED DOMESTIC RELATIONS ORDER
1%% to X14.
AND NOW, this day of _I?1` , 2009, it appearing to the Court
that:
1. The parties to the Divorce Action. The parties to this action are Danny L. Davis,
Jr. ("Participant") and Mary Ann K. Davis ("Alternate Payee').
1.1 Participant's name, address, social security number and date of birth are as
follows:
Name: Danny L. Davis, Jr. :! -..
V
651?;
-
.
Address: 417 Independence Court
Mechanicsburg, PA 17050
4
4
_
Soc. Sec. No.: xxx-xx-3677
Date of Birth: July 22, 1966
1.2 Alternate Payee's name, address, social security number and date of birth are as
follows:
Name: MaryAnn K. Davis (^ )
Address: 103 Commonwealth Drive
Bethlehem, PA 18015
Soc. Sec. No.: xxx-xx-0336
Date of Birth: December 22, 1965
The parties were divorced by Order of this Court (a copy attached hereto) on May
18, 2009. The Decree has not been amended.
2. Plan. This Order applies to the Diakon 401(k) Plan of Danny L. Davis, Jr.,
Contract Number 60520. The administratm.responsible for determining whether
the Order constitutes a Qualified Domestic Relations Order as described below is
L.R. Webber Associates, Meri Lightbody, P.O. Box 593, Hollidaysburg,
Pennsylvania, 16648.
3. Interroretation and Construction of Order.
3.1 The parties intend this Order (the "Order") to constitute a "Qualified Domestic
Relations Order," within the meaning of Section 414(p) of the Internal Revenue Code of 1986, as
amended (the "Code") and Section 206(d)(3)(B) of the Employee Retirement Income Security
Act of 1974, as amended, ("ERISA"). The provisions of this Order shall be administered and
interpreted in conformity with Section 414(p) of the Code and Section 206(d)(3)(B) of ERISA.
3.2 Nothing in this order shall be construed to require the Plan to provide:
3.2.1 Any type or form of benefit, or any option, not otherwise provided under
the Plan.
3.2.2 Benefits to Alternate Payee (as defined in Paragraph 4) in an amount that
exceeds the amount of benefits that the Plan would be required to pay with
respect to the Participant.
3.2.3 Benefits to Alternate Payee which are required to be paid to another
alternate payee under another order previously determined to be a
qualified domestic relations order.
IT IS ORDERED, ADJUDGED, AND DECREED as follows:
4. Alternate Payee. This Order creates or recognizes the existence of the right of
Alternate Payee (as hereinafter defined) to receive all or a portion of the benefits
payable with respect to Participant under the Plan. For purposes of this Order,
Alternate Payee is:
X 4.1 Former Spouse
5. Amount of Distribution and Form of Distribution to the Alternate Payee The
distribution to Alternate Payee contemplated by this Order shall be made in the
form of a transfer of the entire amount of the account as of the date of distribution
from the aforesaid Diakon 401(k) Plan of Danny L. Davis, Jr., Contract Number
60520, to a qualified account on behalf of MaryAnn K. Davis.
6. Distribution Date. The distribution to Alternate Payee contemplated by this Order
shall be made as soon as administratively practicable following the Company's
determination that this Order is a Qualified Domestic Relations Order.
7. Death of Participant or Alt?.ate Pavee The death of Participant before all
benefits to which Alternate Payee is entitled under this Order have been paid shall
not affect the right of Alternate Payee to benefits from the Plan as described in
this Order. Should Alternate Payee die before benefits have been distributed to
her, Alternate Payee's designated beneficiary shall receive any and all benefits
remaining to be paid, with her estate receiving any portion not designated
specifically by her.
8. Continuing Jurisdiction. The Court shall retain jurisdiction to amend this Order
for the purpose of carrying out the intent of the Parties as reflected in this Order
and to establish or maintain the status of the Order as a Qualified Domestic
Relations Order. Either party to this Order may apply to the court for such
amendment.
IT IS INTENDED that this Order shall qualify as a Qualified Domestic Relations Order under
the Retirement Equity Act of 1984. The Court retains jurisdiction to amend this Order as might
be necessary to establish or maintain its status as a Qualified. Domestic Relations Order under the
Retirement Equity Act of 1984.
By the Court,
1?kl'
J.
INCOME WITHHOLDING FOR SUPPORT ` 1 u
O ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO)
0 AMENDED IWO 4-111 U 4 o:? C N-1 I
O ONE-TIMEORDER/NOTICE FOR LUMP SUM PAYMENT
Q TERMINATION OF IWO 5+1 S a_oo S° Date: 06/05/12
? Child Support Enforcement (CSE) Agency ® Court ? Attorney ? Private Individual/Entity (Check One)
NOTE: This IWO must be regular on its face. Under certain circumstances you must reject this IWO and return it to the sender (see IWO
instructions htt2://www acf hhs gov/programs/cse/newhire/employer/publication/publication htm - forms). If you receive this document from
someone other than a State or Tribal CSE agency or a Court, a copy of the underlying order must be attached.
State/Tribe/Territory Commonwealth of Pennsylvania Remittance Identifier (include w/payment): 2089101681
City/County/Dist./Tribe CUMBERLAND Order Identifier: (See Addendum for ordeddocket Informalton)
Private Individual/Entity CSE Agency Case Identifier: (See Addendum for case summary)
PRESBYTERIAN SENIOR LIVING*
STE 201
1 TRINITY DR E
DILLSBURG PA 17019-8522
Employer/Income Withholder's FEIN 231381404
Child(ren)'s Name(s) (Last, First, Middle)
Child(ren)'s Birth Date(s)
RE: DAVIS, DANNY L. JR
Employee/Obligor's Name (Last, First, Middle)
441-80-3677
Employee/Obligor's Social Security Number
(See Addendum for plaintiff names
associated with cases on attachment)
Custodial Party/Obligee's Name (Last, First,
Middle)
NOTE: This IWO must be regular on its face.
Under certain circumstances you must reject
this IWO and return it to the sender (see IWO
instructions
/
http://www.acf.hhs.gov/prggrams/cse/newhire
employer/publication/publication.htm - formal. If
you receive this document from someone other
than a State or Tribal CSE agency or a Court, a
copy of the underlying order must be attached.
2313814040
See Addendum for dependent names and birth dates associated with cases on attachment
ORDER INFORMATION: This document is based on the support or withholding order from CUMBERL AND Cd{unty,
Comm onwealth of Pennsylvania (State/Tribe). You are required by law to deduct these am
e/
ountf?* the empsD
obligor'
s income until further notice.
171 ___
C= _ r -
$ 973.00 per month in current child support
$ 0.00 per month in past-due child support - Arrears 12 weeks or greater?
y%
$ 0.00 per month in current cash medical support
$ 0.00 per month in past-due cash medical support mac)
$ 0.00 per month in current spousal support r?
$ 0.00 permonth in past-due spousal support
$ 0.00 permonth in other (must specify) `
for a Total Amount to Withhold of $ 973.00 per month.
AMOUNTS TO WITHHOLD: You do not have to vary your pay cycle to be in compliance with the Order Information.
If your pay cycle does not match the ordered payment cycle, withhold one of the following amount:
$ ,9224-,S+perweekly pay period. $ 486.50 per semimonthly pay period (twice a month)
$a}q.,.fl5?per biweekly pay period (every two weeks) $ 973.00 per monthly pay period.
$ Lump Sum Payment: Do not stop any existing IWO unless you receive a termination order.
REMITTANCE INFORMATION: If the employee/obligor's principal place of employment is within the Commonwealth
of Pennsylvania (State/Tribe), you must begin withholding no later than the first pay period that occurs en 10
working days after the date of this Order/Notice. Send payment within seven 7 working days of the pay date. If
you cannot withhold the full amount of support for any or all orders for this employee/obligor, withhold up to 5°0 of
disposable income for all orders. If the employee/obligor's principal place of employment is not within the
Commonwealth of Pennsylvania (State/Tribe), the employer can obtain withholding limitations, time requirements,
and any allowable employer fees at http://www acf hhs gov/programs/cse/newhire/employer/contacts/contact_maa
htm for the employee/obligor's principal place of employment.
Document Tracking Identifier
OMB No.'. 0970-0154
Form EN-028 06/12
? Return to Sender [Completed by Employer/Income Withholder]. Payment must be directed to an SDU in
accordance with 42 USC §666(b)(5) and (b)(6) or Tribal Payee (see Payments to SDU below). If payment is not
directed to an SDU/Tribal Payee or this IWO is not regular on its face, you must check this box and return the IWO to
the sender.
Signature of Judge/Issuing Official (if required by State or Tribal law):
Print Name of Judge/Issuing Official -
Title of Judge/Issuing Official:
Date of Signature:
If the employee/obligor works in a State or for a Tribe that is different from the State or Tribe that issued this order, a copy of this IWO
must be provided to the employee/obligor.
? If checked, the employer/income withholder must provide a copy of this form to the employee/obligor.
ADDITIONAL INFORMATION FOR EMPLOYERS/INCOME WITHHOLDERS
Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an eI%trQnijpayment method if an employer is ordered
to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of
two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and
Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00
Make Remittance Payable to: PA SCDU
Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 1710166.911112
IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as
the Empbyea A13ipllW's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT
SEND CASH BY MAIL.
State-specific contact and withholding information can be found on the Federal Employer Services website located at:
http://ww 1.acf.hhs.gov/12Mg M§tQW,new mlemRigyar/contacts/contra i map.htm
Priority: Withholding for support has priority over any other legal process under State law against the same income (USC 42
§666(b)(7)). If a Federal tax levy is in effect, please notify ttae sender.
Combining Payments: When remitting payments to an SDU or Tribal CSE agency, you may combine withheld amounts from
more than one employee/obligor's income in a single payment. You must, however, separately identify each employee/
obligor's portion of the payment.
Payments To SDU: You must send child support payments payable by income withholding, to the appropriate SDU or to a
Tribal CSE agency. If this IWO instructs you to send a payment to an entity other than an SDU (e.g., payable to the custodial
party, court, or attorney), you must check the box above and return this notice to the sender. Exception: If this IWO, was sent
by a Court, Attorney, or Private Individual/Entity and the initial order was entered before January 1, 1994 or the order was
issued by a Tribal CSE agency, you must follow the "Remit payment to" instructions on this form.
Reporting the Pay Date: You must report the pay date when sending the payment. The pay date is the date on which the
amount was withheld from the employee/obligor's wages. You must comply with the law of the State (or Tribal law if
applicable) of the employee/obligor's principal place of employment regarding time periods within which you must implement
the withholding and forward the support payments.
Multiple IWOs: If there is more than one IWO against this employee/obligor and you are unable to fully honor all IWOs due to
Federal, State, or Tribal withholding limits, you must honor all tWOs to the greatest extent possible, giving priority to current
support before payment of any pest-due support. Follow the State or Tribal law/procedure of the employee/obligor's principal
place of employment to determine the appropriate allocation method.
Lump Sum Payments: You may be required to notify a State or Tribal CSE agency of upcoming lump sum payments to this
employee/obligor such as bonuses, commissions, or severance pay. Contact the sender to determine if you are required to
report and/or withhold lump sum payments.
Liability: If you have any doubts about the validity of this IWO, contact the sender. If you fail to withhold income from the
employee/obligor's income as the IWO directs, you are liable for both the accumulated amount you should have withheld and
any penalties set by State or Tribal law/procedure.
Anti-discrimination: You are subject to a fine determined under State or Tribal law for discharging an employee/obligor from
employment, refusing to employ, or taking disciplinary action against an employee/obligor because of this IWO.
OMB Expiration Date - 05/31/2014. The OMB Expiration Date has no bearing on the termination date of the IWO; it identifies the version of the form currently in use.
Fnrm FN-07R na/19
Employer's Name: PRESBYTERIAN SENIOR LIVING' Employer FEIN: 231381404
Employee/Obligor's Name: DAVIS, DANNY L. JR 2089101681
CSE Agency Case Identifier: (See Addendum for case summary Order Identifier: (See Addendum for order/docket information)
Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection
Act (CCPA) (15 U.S.C. 1673(b)); or 2) the amounts allowed by the State or Tribe of the employee/obligor's principal place of
employment (see REMITTANCE INFORMATION). Disposable income is the net income left after making mandatory deductions such
as: State, Federal, local taxes; Social Security taxes; statutory pension contributions; and Medicare taxes. The Federal limit is 50% of
the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting
another family. However, those limits increase 5% - to 55% and 65% - if the arrears are greater than 12 weeks. If permitted by the State
or Tribe, you may deduct a fee for administrative costs. The combined support amount and fee may not exceed the limit indicated in
this section.
For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers/income
withholders who receive a State IWO, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which
the employer/income withholder is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)).
Depending upon applicable State or Tribal law, you may need to also consider the amounts paid for health care premiums in
determining disposable income and applying appropriate withholding limits.
Arrears greater than 12 weeks? If the Order Information does not indicate that the arrears are greater than 12 weeks, then the
Employer should calculate the CCPA limit using the lower percentage.
Additional Information:
NOTIFICATION OF EMPLOYMENT TERMINATION OR INCOME STATUS: If this employee/obligor never worked for you or you
no longer withholding income for this employee/obligor, an employer must promptly notify the CSE agency and/or the sender by
returning this form to the address listed in the Contact Information below: 2313814040
Q This person has never worked for this employer nor received periodic income.
O This person no longer works for this employer nor receives periodic income.
Please provide the following information for the employee/obligor:
Termination date: Last known phone number:
Last known address:
Final Payment Date To SDU/Tribal Payee: Final Payment Amount:
New Employer's Name:
New Employer's Address:
CONTACT INFORMATION:
To Employer/Income Withholder: If you have any questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at 0717240-6225, by fax at (717) 240-6248, by email or website at: www.childsupport.state.pa.us.
Send termination/income status notice and other correspondence to: DOMESTIC RELATIONS SECTION, 13 N. HANOVER ST.
P.O. BOX 320 CARLISLE PA 17013 (issuer address).
To Em loot' ligor: If the employee/obligor has questions, contact WAGE ATTACHMENT UNIT (Issuer name)
by phone at (717) 240-6225, by fax at (717) 240-6248, by email or website at www.chil
IMPORTANT: The person completing this form is advised that the information may be shared with the employee/obligor.
OMB No.: 0970-0154 Form EN-028 06/12
ADDENDUM
Summary of Cases on A chmntt
Defendant/Obligor: DAVIS, DANNY L. JR
PACKS Case Number 421108402 PACKS Case Number
Plaintiff Name Plaintiff Name
MARY ANN K. DAVIS
Docket Attachment Amount Docket A11achment Amount
00541 S2006 $ 973.00 $ 0.00
Child(ren)'s Name(s): DOB Child(ren)'s Name(s):
ALEXIS N. QAVIS 08/07/97
ISABELLA M. AVIS 07/26/01
PACSES Case Number
Plaintiff Name
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
DOB
PACSES Case Number
Plaintiff Name
D cM Attachment Amoun
$ 0.00
Child(ren)'s Name(s):
DOB
PACKS Case Number
Plaintiff Name
Docket Attachment-AmouLnt
$ 0.00
Child(ren)'s Name(s):
DOB
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