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Home My WebLink About97-01396 >' . .~ - ~ J 0- CC') . . r /,J'';:?9'.a; del t'~/J~~ -#4~t', /::l, ,d)f'.~ 71~ ,1tf&;b ~ d7f ~ i ... r . Ilo, ?J../Y;.t,.(!. .r' MARITAL SETTLEMENT AGREEMENT AGREEMENT, made this ~ day of \j).t..<- , 2000, by and between GEORGE COSTA JR., hereinafter referred to as "Husband", and MILDRED COSTA, hereinafter referred to as "Wife", WITNESSETH: WHEREAS, the parties hereto are Husband and Wife. having been married on February 13, 1971; WHEREAS. the parties hereto separated on or about March 10, 1997; WHEREAS, there were two children born during this marriage, Scot Costa, born October 26. 1972; and Charles Costa, born March IB, 19BO, WHEREAS. diverse unhappy differences, disputes and difficulties have arisen between the parties. and it is the intention of Husband and Wife to live separate and apart for the rest of their natural lives, and the parties hereto are desirous of settling fully and finally their respective financial and property rights and obligations as between each other, including, without limitation by specification: the settling of all matters between them relating to the ownership of real and personal property, the equitable distribution of such property; the settling of all matters between them relating to the past, present and futu if&- respect to the parties. It is the intent of the parties hereto that this Agreement shall create contractual rights and obligations entirely independent of any Court Order and that this Agreement may be enforced by contract remedies in addition to any other remedies which may be available pursuant to the terms of this Agreement or otherwise under law or equity. 3, AGREEMENT TO BE INCORPORATED INTO DIVORCE DECREE, The parties agree that the terms of this Agreement shall be incorporated, but not merged, into any divorce decree which may be entered with respect to them, The parties further agree that the Court of Common Pleas which may enter such divorce decree shall retain continuing jurisdiction over the parties and the subject matter of this Agreement for the purpose of enforcement of any of the provisions thereof, 4, 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 this 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. 5, ADVICE OF COUNSEL, The provisions of this Agreement and their legal effect have been fully explained to Husband by his attorney, Nora F. Blair, ~, 3 . carry on and engage in any business, occupation, profession or employment which to him or her may seem advisable. Husband and Wife shall not molest, harass, disturb or malign each other or the respective families of each other or compel or attempt to compel the other to cohabit or dwell, by any means or in any manner whatsoever, with him or her, 7, SUBSEQUENT RECONCILIATION. The parties agree that the terms of this Agreement shall not be affected by their subsequent cohabitation or resumption of marital relations, unless the parties otherwise specifically agree in writing. 8. MUTUAL RELEASES, Husband and Wife each do hereby mutually remise, release, quitclaim and forever discharge the other and the estate of the other, for all time to come, and for all purposes whatsoever, of and from any and all rights, title and interests, or claims in or against the property (including income and gain from property hereafter accruing) of the other or against the estate of such other, of whatever nature or wheresoever situate, which he or she now has or at any time hereafter may have against the other, the estate of the other or any part thereof, whether arising out of any former acts, contracts, engagements or liabili ties of the other or 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 tU-/(J _ 5 treat a lifetime conveyance by the other as testamentary, or all other rights ofa surviving spouse to participate in a deceased spouse's estate, whether arising under the laws of Pennsylvania, any State, Commonwealth or territory of the United States, or any other country, or any rights which either party may have or at any time hereafter shall have for past, present or future support or maintenance, alimony, alimony pendente lite, counsel fees, property division, costs or expenses, whether arising as a result of the marital relation or otherwise, except, all rights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any provision thereof. It is the intention of Husband and Wife to give to each other the execution of this Agreement a full, complete and general release with respect to any and all property of any kind or nature, real, personal or 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 provision thereof. It is further agreed that this Agreement shall be and constitute a full and final resolution of any and all claims which each of the parties may have against the other for equitable division of property, alimony, counsel fees and expenses, alimony pendente lite or any other claims pursuant to the Pennsylvania Divorce Code or the divorce laws of any other jurisdiction, ~-1~ 6 . him or her, 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. Further each of the parties waives and relinquishes any right, title and interest which either may have in such property acquired by the other party since separation. Should it become necessary for either party to execute any titles, deeds or similar documents to give effect to this paragraph, it shall be done immediately upon the request of the other party, 12. AUTOMOBILES, The parties are the owners of several automobiles, The vehicle(s) currently in Wife's possession shall be Wife's sole and separate property, Wife shall be solely responsible for the payment of any loan on her vehicle(s). Wife agrees to indemnifY and hold Husband harmless for and against any and all claims arising out of Wife's failure to make payments as specified in this paragraph, The 1966 Chevy Step Side Truck, the 1968 Harley Davidson Motorcycle, and any other vehicle currently in Husband's possession shall be Husband's sole and separate property, Husband shall be solely responsible for the payment of any loan on his vehicle(s). Husband agrees to indemnifY and hold Wife harmless for and against any and all claims arising out of Husband's failure to make payments as specified in this paragraph. Each party agrees to execute all documents necessary to implement this paragraph, ~ 8 . 13. LIFE INSURANCE. The parties are the owners of various life insurance policies. The life insurance policies shall be the sole and separate property of the insured. 14, CURRENT LIABILITIES, The parties have accumulated various debt during the marriage. Wife shall be solely responsible for the payment of any and all debt that is in her name. Husband shall be solely responsible for payment of any and all debt that is in his name. Notwithstanding the above, Husband shall be solely responsible for payment of the balance on the loan to Dauphin Deposit which was taken out at the time of Wife's fathers death, If either party incurs any debt on a credit card titled to both parties after the date of the parties' separation, the party making the charge shall be solely responsible for payment of the charge amount and any accumulated interest. Each party agrees to indemnifY and hold the other party harmless for and against any and all claims arising out of the party's failure to make payments as specified. 15. TAX CONSEQUENCES: The parties believe and agree, and have been so advised by their respective attorneys, if any, that the division of property heretofore made in this Agreement is a non-taxable division of property between co-owners rather than a taxable sale or exchange of such property. Neither party will take any positions, on his or her federal or state income tax returns, with respect to the adjusted basis of the property assigned to ~ 9 him or her, or with respect to any other issue, which is inconsistent with the position set forth in this Agreement. 16. TAX RETURNS. The parties agree that in the event any deficiency in federal, state or local income tax is proposed or any assessment of any such tax is made against either party in connection with the filing of a joint federal, state or local income tax return for prior years, the parties shall equally share any loss or liability in connection with such tax deficiency, including counsel fees and such tax, interest, penalty or expense associated therewith, unless and only unless said tax, interest, penalty or expense is finally determined to be attributable to misrepresentations or failure to disclose the nature and extent of either party's separate income on joint returns, in which case any and all liability, cost or expense shall be the sole responsibility of the party responsible for the misrepresentation or failure to disclose the nature and extent of separate income, 17, WAIVER OF PAYMENT OF LEGAL FEES, Wife shall be solely responsible for payment of her legal fees. Husband shall be solely responsible for payment of his legal fees, Each party waives the right to have the other party pay any of their legal fees or costs, 18, ALIMONY AND ALIMONY PENDENTE LITE. Husband agrees to pay Wife alimony in the amount of One Hundred Thirty Dollars ($130.00) per week for a period of three years beginning January 1, 2001, and ending ~ 10 . ' December 31, 2003. Said alimony payments are non-modifiable and shall cease upon the death of either party. Wife and Husband do hereby waive, release and give up any rights they may respectfully have against the other for any alimony, support or maintenance, except as stated above, It shall be, from the execution of this Agreement, the sole responsibility of each of the respective parties to sustain themselves without seeking any additional support from the other party, except as stated above, 19, WAIVER OF BENEFICIARY DESIGNATIONS, Unless otheIWise specifically set forth in this Agreement, each party hereto specifically waives any and all beneficiary rights and any and all rights as a surviving spouse in and to any asset, benefit or like program carrying a beneficiary designation which belongs to the other party under the terms of this Agreement, including, but not limited to pensions and retirement plans of any sort or nature, deferred compensation plans, life insurance policies, annuities, stock accounts, bank accounts, final pay checks or any other post-death distribution scheme. The parties by the terms of this Agreement specifically waive the rights of spouse beneficiaries established by federal or state statute including ERISA. Each party expressly states that it is his or her intention to revoke by the terms of this Agreement any beneficiary ~ 11 . designations naming the other party which are in effect as of the date of execution of this Agreement. If the other party continues to be named as beneficiary and no alternate beneficiary is otherwise designated, the beneficiary shall be deemed to be the estate of the deceased party, Not withstanding the foregoing, however, in the event that either party hereto specifically designates the other party as a beneficiary after the date of execution of this Agreement, then this waiver provision shall not bar that party from qualitying as such beneficiary, 20. MUTUAL CONSENT DIVORCE, The parties agree and aCknowledge that their marriage is irretrievably broken, that they do not desire marital counseling, and that a complaint in divorce has been filed in the Cumberland County Court of Common Pleas at case number 97-1396 CIVIL, The parties agree to have the divorce decree entered in that case pursuant to Section 3301(c) of the Pennsylvania Divorce Code, Act 26 of 1980, as may be amended (herein referred to as the Code), Accordingly, both parties agree to execute such stipulations, consents, affidavits, or other documents and to direct their respective attorneys to forthwith file such stipulations, consents, affidavits, or other documents as may be necessary to proceed to obtain a divorce pursuant to said Section 3301(c) of The Code, Specifically the parties agree to sign the Affidavits of Consent and the Waivers of Notice of Intention to Request Entry of Divorce Decree simultaneously with the ~ 12 , . signing of this Agreement. Upon request, to the extent permitted by law and the applicable Rules of Civil Procedure, the named defendant in such divorce action shall execute any waivers of notice or other waivers necessary to expedite such divorce. 21. WARRANTY AS TO EXISTING OBLIGATIONS. Each party represents that they have not heretofore incuITed or contracted for any debt or liability or obligations 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 and hold the other party harmless for 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. 22. WARRANTY AS TO FUTURE OBLIGATIONS, Husband and Wife each covenant, warrant, represent and agree that, with the exception of obligations set forth in this Agreement, neither of them shall hereafter incur any liability whatsoever for which the estate of the other may be liable. Each party shall indemnifY and hold harmless the other party for and against any and 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. ~ 13 , ' 23, WAIVER OR MODIFICATION TO BE IN WRITING, No modification or waiver of any of the terms hereof shall be valid unless in wri ting and signed by both parties, and no waiver of any breach hereof or default hereunder shall be deemed a waiver of any subsequent default of the same or similar nature, 24, MUTUAL COOPERATION, 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 ancllor documents that the other party may reasonably require for the purpose of giving full force and effect to the provisions of this Agreement. 25. LAWS OF PENNSYLVANIA APPLICABLE. This Agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania which are in effect as of the date of execution of this Agreement. 26. AGREEMENT BINDING HEmS. This Agreement shall be binding and shall inure to the benefit of the parties hereto and their respective heirs, executors, administrators, successors and assigns. 27, OTHER DOCUMENTATION. Husband and Wife covenant and agree that they will forthwith (and within no more than ten (10) days after demand therefor) execute any and all written instruments, assignments, releases, satisfactions, deeds, notes or such other writings as may be necessary or desirable for the proper effectuation of this Agreement. ~~ 14 . . 28. 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 default or breach of any provision hereof be construed as a waiver of any subsequent default or breach of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein, 29, ENFORCEMENT OF AGREEMENT. If either party breaches any provision of this Agreement, the other party shall have the right, at his or her election, to sue for damages for such breach or to require specific performance. The party breaChing this Agreement shall be responsible for payment of legal fees and costs incurred by the other party in enforcing their rights under this Agreement or for seeking such other remedies of relief as may be available to him or her. 30. SEVERABILITY. If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, then only that term, condition, clause or provision shall be stricken from this Agreement and, in all other respects, this Agreement shall be valid and continue in full force, effect and operation, Likewise, the failure of any party to meet her or his obligations under anyone or more 01 ~ 15 : ". Itl f:: po " <.; :::: '~:, , ,,'...... , , ':1 , , (''] ...... .. '..J:;? f' ,', , ~o ~. j."i.-::j .::J 2T;;5 (\. "~3 <..1 , , ~J'~ ~.1 :5 .7\ u f:'J U ~ v, : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 97-1396 CML GEORGE COSTA, JR., Plaintiff MILDRED COSTA, Defendant : CML ACTION - DIVORCE PRAECIPE TO TRANSMIT RECORD UNDER ~ 3301(c) OF THE DIVORCE CODE To the Prothonotary: Transmit the record, together with the following information, to the Court for entry of a divorce decree: I, Ground for divorce: irretrievable breakdown under ~ 3301(c) of the Divorce Code, 2, Date and manner of service of the complaint: (a) Date of service: March 27, 1997. (b) Manner of service: Certified Mail, Ristricted Delivery, Return receipt requested 3, Date of execution of the affidavit of consent required by ~ 3301(c) of the Divorce Code: (a) By the Plaintiff: December 23, 2000. (b) By the Defendant: December 26, 2000. 4. Date of execution of Waiver of Notice of Intention to File Praecipe to Transmit Record: (a) By the Plaintiff: December 23, 2000. (b) By the Defendant: December 26, 2000, 3. Related claims pending: NONE DATED: December 26, 2000 ----~ N ra . Blair, Esquire Attorney for Plaintiff , , I "~I' ,C , '~~', ) "'l' ',;{~. . . :,~ . ;">. .::.t;,:;,.. , .,), ~ , ~ I '. . ~ . .}'" .' \ .;.., _t_. . ..1\", :fj"'~, .' .'\::1,'" ~ l. [:)\' . ~;;..::l ,,;~:, : \~<:', . ~f') ,.], '. .:;f":r ".\ ',:::'1 ~~.-::~- . " <"j, ".~~ ~'-;'1' . 1,';..'..'.. ::t~_!. ~' }1\." . ':r:-'~\ .1 -.~~~ ;,.,1 _' l"'Jl" . . ~,}..~ ;./l~-. .~"?~\' :3.. ~r~J .1 :.:1-. -":.'o-,~ .' 'L_, i " -, l .' i, . .:..,' " .....;.. .;) 'h !6S '" " ~. , ~' C!: -"', j; ,,~' .......... /-,,' ,', '. 0 ~ ~ l' () .... 't' f'_ ~ --.9 ' ! ....... r--J ~ \J<::) JCS} ~ ." ;,"" f a) is c:. , 1-' .~- ; 0 c:': :3~ ~z ~ :'. z It~ ,- . ,:J,;o .0.. -', :>;-' :),:;J ~~. ... ' c.o \':~i=/j' 0: ,;J?;i lIt!.! t'o1LiJ R '" . ~ t~J 0:- x: 5 r-- :5 0'1 '(J, " \'," " .' " :.( ; , :"f. "'. .. ~'h. \,"' c " , - . ~ ... . ~". NORA F. BLAn't. ESQUIRE 11440 JaNISTOWN "OAD . poeT or'ICI BOX ea.. . .. HARRISBURG, PI. 17112.02111 (717)15."'4111 , . fi; M >- ~, ...:J Z '=-. ci:) ::l~ ~U'-. 8~ ~~, :c lL.:J. ..: ,...::i ~.- '",;;: ,--. en . -in < ~:JZ lO.';" I o:z r-!L! . c:: "'"1 u. J Co. 4'1 a.. " &J: " u. r- :.3 c., c:n u ~ N G= 2c z ,- 3"'- , . (") .:J . _"":t d,J... 0~ ';-~;.';. u: ...". r--',.;, ':I~ {~.j: '.::J ;C'U) ': .~ ; N ~lZ 1...1; n:i:'5 f~f. - c..J ~:Ju. ,- lLj I'll a.. 0::" . ~. IL 0 a 0 '.::l . - rr; N i= >;:, ':>" ,., .. t;;; i..!....! ~ " - ()- . 6~ C-:l. - 0S .... t.:"i; a.. :s ::151 " <:) '/ r....,. ~((j) '.!' C\.t .:-:~ L:..::t W '1);,0 Lt., ',' uJ 11_ r.;: '::-Iu. Cl ... 0 0 B . :>- ~ 0: ~ j::: .. :5 f'-, -:; b~ ..ltc-, '.-''''h ij;2: >< a: .." {;J;~ . C~';:.J ';"". '..0 :......(f) (} N .:12 " }jaJ , c..~ ". ld ft!a.. a .~ ;,1. e> => ';.) 0 <..> .. . . . .. " . v. : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA : NO, 97.1390 CML GEORGE COSTA, JR" Plaintiff MILDRED COSTA, Defendant : CML ACTION - DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 330l(c) OF THE DIVORCE CODE I, I consent to the entry of a final Decree of Divorce without notice. 2, I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a Decree of Divorce 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. 'ify that the statements made in this Mfidavit are true and correct. I undl'rstand that false statements herein are made subject to the penalties of 18 Pa,C,S. fi4904 relating to unsworn falsification to authorities, DATED: D c-<:.- Je, ,~JcJ J ( #A#~~ ~ED COSTA Defendant '- ~ it> (V " % , .. --:)...;: 1] " - (~)~: ." '.'J;;e (~l ~ ; I.:t... };:i 'a ;@ (',j t.., '"m L I.L; cHH:. c:; ...., -. D l':' -) I~;J U ,~ '... .. - DEe 2fi?~ GEORGE COSTA, JR., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. CIVIL ACTION - LAW : IN DIVORCE MILDRED COSTA, Defendant NO. 97-1396 CIVIL TERM ORDER OF COURT ?b f{, day of December, 2000, AND NOW, this the economic claims raised in the proceedings having been resolved in accordance with a marital settlement agreement dated December 26, 2000, the appointment of the Master is vacated and counsel can file a praecipe transmitting the record to the Court requesting a final decree in divorce. By the Court, .tw G cc: Nora F. Blair, Esquire For the Plaintiff :lfh ) Cop I ts I'1t'a. l ( ~;c... \I Esquire (J../J.~ /oD 0:, ~7\" -j\~' :") rbl." :71') -/'" :" :(:L. c I.I". .-':"'- -""t) r~\." ::~. ~:~~~-, ~ ;;.. ~~:- .. ->/ " 3..()'\ =~ '):l ~- John W. Purcell, Jr., For the Defendant RtLr1--UJ {~t- I. - , - f1-~ . vs. : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : CIVIL ACTION - LAW NO. 'tl- {'3ft (" CIVIL 19 l/VL:tJN.J.. c...:t..... ( d~~ DATE: d-uv. 'Db J <..~/t-oO 0 : IN DIVORCE STATUS SHEET fr{ " J'), ,ciJ I ~4~.Mf~!1!ett'1: ~ ". 't}'\' '~~1_ ~~ All.l I ';J.lv., '1.1K:l, d ~~4 ~l.u"d..~~ . GEORGE COSTA, JR" Plaintiff vs, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO, 97 - 1396 CIVIL MILDRED COSTA, Defendant IN DIVORCE TO: Nora F. Blair Attorney for Plaintiff ~~ John W, Purcell, Jr, Attorney for Defendant DATE: Friday, April 7, 2000 CERTIFICATION I certify that discovery is complete as to the claims for which the Master has been appointed, OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions, , GEORGE COSTA, JR" Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO, 97 - 1396 CIVIL vs, MILDRED COSTA, Defendant IN DIVORCE TO: Nora F, Blair , Attorney for Plaintiff John W, Purcell, Jr, Attorney for Defendant DATE: Friday, April 7, 2000 CERTIFICATION I certify that discovery is complete as to the claims for which the Master has been appointed, \/~ C' -J OR IF DISCOVERY IS NOT COMPLETE: (a) Outline what information is required that is not complete in order to prepare the case for trial and indicate whether there are any outstanding interrogatories or discovery motions. . j OFFICE OF DIVORCE MASTER CUMBERLAND COUNTY COURT OF COMMOr-.. PLEAS 9 North Hanover Streel Carlisle. PA 17013 (717) 240-6535 E. Robert Elicker, II Divorce Master Tracl Jo Colyer Office Manager/Reporter West Shore 697-0371 Ext. 6535 March 8, 2000 Nora F, Blair Attorney at Law 5440 Jonestown Road P,Q. Box 6216 Harrisburg, PA 17112-0216 RE: George Costa, Jr. vs, Mildred Costa No, 97 - 1396 Civil In Divorce Dear Ms, Blair: I received your most recent filing in the Costa case, which is a notice of intention to request entry of divorce decree under Section 3301(d) with a counter-affidavit attached. Since Mildred Costa apparently has no attorney, the attachment of the counter-affidavit was necessary, However, I do not want to appear to be too technical but it seems to me that a counter-affidavit should have been attached also to the affidavit under Section 3301(d), which was previously filed on February 8, 2000, The divorce rules of civil procedure specifically refer to the counter-affidavit denying statements set forth "in this affidavit", The affidavit being referred to is the 3301 (d) affidavit. See the "notice" statement prefacing the affidavit. Consequently, I must infer from that language that a counter-affidavit should have also been included with the 3301(d) affidavit when filed. This matter will perhaps become moot if Mrs. Costa now responds to your current filing with the attached counter-affidavit. )-, (1\ r; .~ In .... M z ~~ ::>:1; 0- u:~. :t: 07 ~ ~~~ Q.. ~~ ??: r- u_ I .....z " u:1j,1 ~ ffifu :1: .c: ~a.. 1-' :t: ts 0 :3 0 u ... - . v, : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA : NO, 07-1306 CML GEORGE COSTA, JR., Plaintiff MILDRED COSTA, Defendant : CML ACTION - DIVORCE ORDER AND NOW, this day ,2000, after review of the attached Motion to Withdraw Appointment of Master, it is hereby ORDERED AND DECREED that the appointment of E, Robert Elicker, II, as the Master in this divorce matter is withdrawn and the decree in divorce shall be entered. J. GEORGE COSTA, JR., Plaintiff : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 97.1396 CML v. MILDRED COSTA, Defendant : CML ACTION - DIVORCE CERTIFICATE OF SERVICE I hereby certifY that I have this date served a copy of the Motion to Withdraw Appointment of Master on the person in the manner stated below which service satisfies the requirement of Pa.R.C.P. No. 440. SERVICE BY FIRST CLASS MAIL TO: Mildred Costa 45 Village Court Mechanicsburg, PA 17055 Date: March 18, 2000 Respectfu y submitted, .~.. .' " I ,. -. ... . - f --::;,.._~" ..-- - GEORGE COSTA, JR., Plaintiff VS. : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSL YLV ANIA MILDRED COSTA, Defendant : NO. 97-1396 CIVIL : CIVIL ACTION-LAW : IN DIVORCE CLAIM OF RIGHTS Count I . Equitable Distribution 1. Plaintiff and Defendant possess various items of property which are subject to equitable distribution by this Court. WHEREFORE, the Defendant request this Honorable Court to distribute the marital property of the parties. Count n . Alimonv 2. Defendant lacks sufficient property to provide for reasonable needs. 3. Defendant is without funds or means to adequately support herself. WHEREFORE, the Defendant requests this Honorable Court to order reasonable alimony to her pursuant to '3501 of the Divorce Code. ,. t'". ..... l:': roo; i",: , r-~~ " ~1, , , " " :~~] '.-;' , '" in C..: ~'1 :';-0: ....... C.:":. '" ~. .j ll,..,.' ~.j ...- l,_ . r... ;:5 :.::;." U GEORGE COSTA, JR., Plaintiff : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA . v. : NO. 97.1396 CML MILDRED COSTA, Defendant : CML ACTION - DIVORCE PRAECIPE TO WITHDRAW CLAIMS To The Prothonotary: Please withdraw the claims for Equitable Distribution and Alimony filed by Defendant in the above-captioned divorce. Respectfully submitted, PURCELL, KRUG & HALLER DATED: p ,. .r ,,, , .~'- .7" -'<.lJ,j " Jo p me Court ID 29955 7 North Front Street arrisburg,PA 17102 (717) 234-4178 >- G ~ C'\.' ~ ~ i: l~=-: - :::J~ i")... (?~ -- .~~ ".. 0: ": ~ " ~.) i . ')';.1 " , , ~ -~,~ ~- ( ")':1) "-~; ,~." C\I ~ ~ t_'. <...: fEz j', LO I.lJ rue.; CJ -;: ", a ::3 l.i 0 <.:l .... ~ b'; C\I j:~ ~<~ .-, ..::: :..IJ ;C'~ r,:.: -, :'1 i"~ :z:: ~)~ '..:~ <:l.. O~ (Jr.- ;'.~ lD . 'Cf) C'" N ::)2 t~ ;,'. '.t:2 u '''Lll W tD a.. CJ :cE L' <::I 3 0 0 GEORGE COSTA, JR" Plaintiff v, : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 97.1396 CML MILDRED COSTA, Defendant : CML ACTION - DIVORCE ORDER AND NOW, this day , 2000, after review of the attached Motion to Withdraw Appointment of Master, it is hereby ORDERED AND DECREED that the appointment of E, Robert Elicker, II, as the Master in this divorce matter is withdrawn and the decree in divorce shall be entered, J. GEORGE COSTA, JR" Plaintiff : IN THE COURT OF COMMON PLEAS, : CUMBERLAND COUNTY, PENNSYLVANIA v, : NO. 97.1396 CML MILDRED COSTA, Defendant : CML ACTION - DIVORCE CERTIFICATE OF SERVICE I hereby certifY that I have this date served a copy of the Motion to Withdraw Appointment of Master on the person in the manner stated below which service satisfies the requirement of Pa,R.C,P, No, 440, SERVICE BY FIRST CLASS MAIL TO: John W, Purcell, Jr" Esquire PURCELL, KRUG & HALLER 1719 North Front Street Harrisburg, PA 17102.2392 Date: March 18, 2000 Respectfully submitt~ /" t;/ /~/~-.::....... . ~~ " " /' .', . #'. . ~ .--, . ;.'- o F, Blair ~ ..:t '>- f... ,- ". , , I~_' 9 <1 '-of' uJ' . , " , , (, - I .' -.' - , L ~ " I.i_ ."\ "_1 Ci , ,', )~~ .. C'~ ~:'J , , c:~ : ~ ;-} ~~ H..: . ~ i:~ .- u. rJ ~j () c, <.) .~ ,4. . . .. ~ 5, INCOME Attached hereto is a copy of the Defendant's Income and Expense Statement, i I I I . . ! as well as her last pay stub and 1999 Income Tax Return, 6, EXPENSES Attached hereto is a copy of Defendant's Income and Expense Statements showing all of her expenses, 7, RETIREMENT BENEFITS See above and attachments, 8. COUNSEL FEES Attached hereto are copies of Defendant's counsel fees statements, 9, DiSPUTES Anticipated disputes may revolve around the value of the Plaintiff's motorcycle, and the value of the Plaintiff's retirement, It is possible that an appraisal may be needed unless those items can be stipulated to. ( . ~ 10. MARITAL DEBT The only marital debt outstanding as far as in Defendant's knowledge is a loan outstanding to Dauphin Deposit, which was borrowed by the parties just prior to separation when the Plaintiffs father died and they needed funds to attend the 1 i funeral. Defendant has made some payments on account of the loan, It is not known , , , whether Plaintiff has made any payments, and Defendant believes the loan is presently in default, Plaintiff had promised to keep the payments current, did not, and it has affected the Defendant's credit rating. 11, PROPOSED RESOLUTION . Defendant suggests that the marital property be left in the hands of the party who presently has possession of it. In addition, Plaintiff should pay to Defendant alimony in the amount of $130.00 per week for a period of three years, and all or portion of Defendant's counsel fees, Respectfully submitted, PURCELL, KRUG & HALLER BY .~ . , ASSOCIATED CARDIOLOGISTS, P,C. MONEY PURCHASE PENSION PLAN STATEMENT OF ACCOUNT AS OF 12/31/96 FOR MILDRED COSTA Employer Account . 01/01196 Accounl $ 9.640.93 Contribution 1,235.46 Investment Results 1,415.50 12/31/96 Account $ 12.291.89 Vesting Percent 100% Vested Amount $ 12.291.89 Every effort has been made 10 Insure the eccuracy of the InformaUon eonleJned In this Slelemenl of AI:coun~ however, In the evenl of a discrepancy, aclual beneRls will be delennlned according 10 the Plan provisions. " ." " . , . ASSOCIATED CARDIOLOGISTS, P,C, PROFIT SHARING PLAN STATEMENT OF ACCOUNT AS OF 12/31196 FOR MILDRED COSTA Profit Sharing Rollover Account . Accounl Tolal - 01/01/96 Account $ 10,666.86 0.00 $ 10,686.86 Contribution 1,235.46 0.00 1,235.46 Investment Results 1.572.39 0.00 1,572.39 12/31196 Account $ 13.494,71 0.00 $ 13.494,71 Vesting Percent 100'k 100'10 Vested Amount $ 13.494,71 0.00 $ 13,494.71 Every effort has been made 10 Insurolho occuracy oJ IholnlormaUon conlalne<l In Ihls Slalemenl 01 Accoun~ however, In Iha evanl 01 a dlscroponcy. aclual benems will be delermlne<l acconflng 10 Ihe Plan provisions. ..' ""1 .' .\1\',' ,~",,/ .~ ,t:J ;'\ t" I ,. " .. / / ..'/ /1'..- , :1040EZ Use the IRS label here - PrnldUlllal Election Campa/pi lSee pare 12.1 Income Attach Con B or Fo....lol W.I b..... IIIdoet. but do DOI.taplo, eny pt1III..L Note. You } mud cbeclc Yes or No. Payments and tax r- Refund Havill directly .. depooitedl See pap 20 end .. GU ID Ub. U.. Ind lid, 7172323868 JONES DALY COLDRE~ 932 P01 SEP 13 '00 B7:34 ~~~'l. ,',," '~::-~;;li:~f.:~~~..rM~"""""""""1": .-- -'-""". ~ ......---... ," Drporlaa\I 01 tho 'l'rooa\ll1-'.ouul _110 Strvice Income Tu Return for SIngle and Joint FIlers With No Dejlendents ILl 1999 ONa N. 111_76 M r;ri;;20l (},oS t./J LaM nom. - 11 :~: lOCIaJ MCUrity Dwober II. Joint rlblr\ tpCMt'. ftrtI NII'\IIt'd!nlt&! Last name ~I U 7 If ~ 8 J c1 f _oddr_~IIldwm.I""_'P.o.bOI."'1.'z. ApLno. :t..[.j2tl{.{!~l[do ~~~oddr~..._tZ. !tq/!:!f-y!.~~~g,~!:."L~~~:.: Do you want S3 to go to thl1l tund? .. Ir a Joint return. d... your .pouse want S3 to go to this fund? .. j, Total wall", salaries, and tips, Thil should be shown in box 1 at your W.2 tanneal. Attach your W.2 formlsl. 1 2 Taxable Intemt. II the total II aver $400.,au CADIIOt Ule Porm 104OEZ. II 3 Unemplo)'ZlleJlt componaatlon, quaUfied ltale tuition prosram eamingl, e.nd .AWka Permanent Fund cIIvld.ndI (lee page 141. 3 4 Add Unee I, 2, and 3. This Is your aclJu.ted p-oe. income, 4 5 Cen)'1l\l1' parents (or someone else) claim you on their return? Yet. Enter IlllO\Int No. If 1InI1e, enter 7.060.00. hill worbheet '-"'" Itllluried, &Iller 12/700,00. on bock. ......... 9H btck (or Cltp1anallOll. 6 6 Subtract Una 5 from line 4. IIUna 5 il1arrer than Une 4, enlet O. This il your taxable iDcoDle, .. 6 7 Enter your Federal income tex withheld /'rom box 2 of yout W.2 fonnlsl. 7 Sa EAmed income credit (see png. 15). b Nontaxable earned Income: enler type and amount below, 'l)po . 8a 9 Add lines 7 and 8a. 'These are yout total pa)l1lleD\I. 9 10 Tax. Uso the amount CD line 6 above to find yonr tax iD the laz table on pagee 24-28 at the booklet. 'Thin, enlet the tax from the table on thIl Una. 10 . 1.1a If Un. 9 illsrcer than Une 10, .ubtr.ct line 10 trom line 9. 'ThIa II your refund, l1a b Routing number o Type: d Account CllOdtl.. s...... nUmber ~ 1.2 II line 10 II Iarcer than Una 9, luhtract Une 9trom line 10. ,This is the ,amount fOU owe. See pep 21 tor c1etaill On h.-to pay,' , 'UfO .... "'. rolao.l1Il... ~ IIP!'iVl'.14oduo thallO Il. "" II., ....oWl..... Wlo( tho <<........... _ oM ........11 /Iolo ill_to .......... 0I1a....'........ 4ooi1D1lM"'__ SIgn ~ .......dp\I... lpouo'.lipa....~jaIM"......SOO.....IL here , I Keep copy lbr ' .... OCCIIpolioQ D... I SpooM'o ~pWoo ~~,~ j-5"-O~ ~~ d', ,,: ." F.... Dieol......., PriVI" Ael. IJId Plpa..Ork ReductiOQ Act Notice, - pepJl. Amount you owe 12 Spou.e'. eoda1 .ecurity number )-3 x~ ~9J A J ~ ~€Y" ,eJ-..G-- q-er B'.(J-.e- ..er-e- bl-'3 7 Ib .3 ~ J- ~ r I For II Official Use I Only L. Cot ,No. 12CtTll i;93 .e- S--e- Y93 :J-?I .f!r(!r..er ;l..?1 '16 lj 8"O? /g .Q-:e- l...e- 9'9 ;;a-e '1.9 -f)e CJq :wt!,fJ'or.. :r.OltOEZ I I I I I I ! , ! , i I I i I I ~ .~. COSTA MILDRE SSN: Pay perIod: 08/28/00 to: 09/10/00 ~~/~::,., 459-92-33,34 EARNINGS Type Hours Dollars '" ,.' . ...... TAXES Type Dollars <lo:-, , Deductions' & other pay -----------.________ ---- ____a. _________ ____ __________ ____________._.___ Gross Other Tips CashTips Subtotal Taxes Deducts 733,88 0.00 0,00 0,00 733,88 -201. 48 -7.34 Reg OT/1 OTIS Vac Sick Hol Comrn Mise Other 65.50 2.50 8.00 622.25 35.63 0.00 0.00 0,00 76.00 0.00 0.00 0,00 Net pay ---------- --------------------- 733.88 525.06 Gross pay FWT OASDI MED SWT SDI SUI SubTl 124.79 45.50 10.64 20.55 0.00 0,00 201. 48 LOCAL -7.34 -------------------------------------------------------------------------------- Year-to-date: " Gross pay SUI 1952,26 FICA 0.00.' SDI 149.35 FWT 0.00 SWT 336.97 54.67 ************ Five Hundred Twenty Five & 06/100 Dollars Mildred Costa 45 Village Street Mechanicsburg, PA 17055 09/13/00 COSTA MILDRE SSN: 459-92-3334 Pay period: 08/28/00 EAR N I N G S T A XES to: 09/10/00 Type Hours Dollars Type Dollars *******525.06 Deductions & Other pay __=_D==______a___=~= _=__ __=~__ =______=_ ____ __________ __________________ Gross Other Tips CashTips Subtotal Taxes Deducts 733,88 0.00 0,00 0.00 733.88 -201. 48 -7,34 Reg OT/1 OTIs Vac Sick Hol Comm Misc Other 65.50 2.50 8.00 622.25 FWT 124.79 LOCAL -7.34 35.63 OASDI 45.50 0.00 MED 10.64 0.00 SWT 20.55 0.00 SDI 0.00 76.00 SUI 0.00 0.00 --------------- 0.00 SubTl 201. 48 0.00 Net pay ---------- --------------------- 733,88 525,06 Gross pay -------------------------------------------------------------------------------- Year-to-date: Gross pay SUI 1952,26 FICA 0.00 SDI 149.35 FWT 0.00 SWT 336.97 54,67 .. '.":'..' '",'" ....j..:7.:vr\,.i"~;-:: ~ .''if. ':. "_'. IHCOIUl AlfD BDBHSB STATJDOIH'l' or MILDRED COSTS Employer: Jones, Daly & Coldren Pediatrics Address: 25 West Shore Drive Camp Hill, PA 17011 Type of Work: medical receptionist payroll Number: pay period (Weekly, Bi-weekly, etc.)LBI-WeeklY Gross pay Per Pay Period: $:735,00 Itemized Payroll Deductions: Federal Withholding $ 125.00 social Security $ 50,00 Local Wage Tax $ 12,00 State Income Tax $ 25,00 Unemployment $ Medicare Tax $ Retirement (401K) $ savings Bonds $ Credit Union $ Life Insurance $ Health Insurance $ Pension Contribution $ Net Pay Per Pay Period $ 523.00 -~....- . , ~;f":T~'_~~~. . ... P.':~;-t'. :M " , ,.... OTJUIR IIlCOJOla MONTHLY ANNUAL Interest $ $ (C.O. , Hun. Bonds) Dividends $ $ Pension $ $ Annuity $, $ social security $ $ Rents $ $ Royalties $ $ .' Expense Account $ $ Unemployment Compo $ $ Workmen's Compo $ $ Gifts $ $ Other: $ $ business run out of home Total $ $ TOTAL INCOKBa $ $: , -'='\,-.- .. .:~.1f~':'Z'_" Accident Health $ $ $ $ ( . other AUTOMOBILES: ( . Payments Fuel (all vehicles) Repairs MEDICAL: $ 225.00 $ $ $ $ 80,00 $ Doctor $ $ $ $ $ $ $ $ '$ . $ $ $ Dentist Orthodontist Hospital Medicine Special needs (Glasses, braces, Orthopedic devices, etc.) EDUCATION: Private School $ $ $ $ $ $ $ $ Parochial School College Religious PERSONAL: Clothing Food $ 150,00 $ 200,00 $ 20,00 $ $: $ Barber/Hairdresser .:. 1_,,~ ,;...."";~_. _..._-~.-. ........... .......... -' .._-~~' '" ..,-, ::"~;~;. -~~~. ..~..-" _.:!.,::'. .'!.'~ ..' . t...,... ~> .~ ~r'I..t' . ~ '-~-,..;,7i""t".r.-1\ _.~ - ...- ~... !.. - ,_. : '-. " '-~...{..~:~~~.~...,.. ..~._ t:..'....:.~::.t...... .:,.;'tt'~l":~! ';'f! . ~~ ';1"..' ..,.~...,~_. _.-.k1.'-'^~'J-'._'--"'~'._"~"'" . ....--~;~;.S:~;.;~,.. . .- ~"~:'?~:.>?;'::'-~"'~::"':~~,"'_: ;_..... _'~ ~'~~:~:.~... .: 'S:" credit Payments $ $ Credit Card $ $ Charge Accounts $ $ Memberships $ $ 35.00 LOANS: Credit Union $ $ MISCELLANEOUS: Child Care/Babysitting $ $ papers/Books/~agazin~s. $ 15.00 ' $ Entertainment $ 100.00 $ -. Pay T.V. $ .40.00 $ Vacation $ 1000.00 $ Gifts $ 50.00 $ Legal Fees $ 50.00 $ Charitable Contributions $ 20,00 $ Other Spousal Support $: $ Tax Preparation $ $ TOTAL EXPBNSBS $: 2636,00 $ 1385,00 . L. ~..1'" . . " ..,. '. --.,.- '.~".'" .''''~':'.--~'':r.. . . ' .. .- " , ~: 'x:: :-~,:>' {:':~f~t~frj:::t:;~ :~E~~f:~;;~/~~~::~~:-~': ~' , ... ","~':':~I~'I: ;~~.....::,~......,'O;:,. .... ., .~..~_.,,_ _~'.""'''.4'4''''~~''.''.. _:"'".:_.._..._... ,_. . ..:.~.~ ""''"- ....-..... .:~ ,..... I"'"! ,,~~~"",;oi;"o"~,. PURCELL, KRUG & HALLER 1719 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102-2392 (717) 234-4178 - FAX 233-1149 September 8, 1997 Billed through 09/02/97 Bill number C02751-10587-003 JR Mildred Costa 1127 Nanrock Drive Mechanicsburg, PA 17055 RE: Domestic =aa=a==========~==============aa========a===a=========aa==ae==== Account balance as of bill number 001 dated 06/07/97 Payments received since last bill (last payment 07/07/97) $ 351.00 $ 351,00 ---------- $ ,00 Net balance of account FOR PROFESSIONAL SERVICES RENDERED 06/25/97 Telephone conference with client re: husband, appointment, etc ,25 hrs 07/03/97 Office conference with client 1.00 hrs 07/21/97 Correspondence to attorney re: offer to settle ,35 hrs 08/20/97 Telephone conference with client re: spousal support; Correspondence to Attorney re: settlement ,35 hrs Total Fees for this bill 1,95 hrs $ 263.25 9ILLING SUMMARY John W, Purcell, Jr, 1.95 hrs 135 /hr 263.25 TOTAL FEES FOR THIS BILL ---------- 1,95 hrs $ 263,25 TOTAL OF FEES, COSTS AND EXPENSES TOTAL AMOUNT NOW DUE ---------- $ 263,25 ---------- $ 263.25 ; ".,~-. '..::-:(~:~2',/:-:~~~~~~??;~~~:€~~5~:~~~~j:;~;i~*~~~~~~~~t~;~~~;;~~~~:;:;;::}~~ "~M'_'"'_'''~'''__'~____''''''_'.'''''''''''.''~'''''''__'''__''''''''''' _ . _;-~....,,,.; ~_'. ".;.'" .'_'~'''' .._...'.. ....W......~ .,;.c".;;..-. ,'"'"..:..'....-.';.... do"~ ._..:._,~,.":'1....,,,,' .~.~J-'.~!,f~__~.;,...,_.....,~_~,.._.....~~~\1",':.,., -.',.,. . ", ,.., .<J', . . ',.' . .~. '-i' ,.,' . ... I .... " PURCELL, KRUG&:HALLER 1719 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102-2392 (717) 234-4178 - FAX 233-1149 December 31, 1997 Bill number C02751-10587-005 JR Mildred Costa 1127 Nanrock Drive Mechanicsburg, PA 17055 RE: Domestic ================================================================ Account balance as of bill number 004 dated 11/04/97 $ 496.75 A review of our records shows the following bills still due, BILL NUMBER DATE TOTAL AMOUNT AMOUNT DUE 003 09/08/97 263,25 $ 213,25 004 11/04/97 283,50 $ 283.50 TOTAL AMOUNT OUTSTANDING $ 496,75 ---------- TOTAL AMOUNT NOW DUE $ 496,75 \ " I , _.....-"'....~- ,.....-.. ..~ "'- - ............,... I.'.,.. .; pC.. . c" ,. _ ,<,~. (717) June 9, 1999 Billed through 06/09/99 Bill number C02751-105S7-012 JR Mildred Costa 1127 Nanrock Drive Mechanicsburg, PA 17055 RE: Domestic ======================================================a=aaa===== Account balance as of bill number 011 dated 03/02/99 Payments received since last bill (last payment 04/0S/99) Net balance of account $ 150.00 $ 150,00 ---------- $ ,00 FOR PROFESSIONAL SERVICES RENDERED 04/07/99 Attendance at support conference 1. 50 hrs Total Fees for this bill 1.50 hrs ,$ 225,00 BILLING SUMMARY John W, Purcell, Jr, 1,50 hrs 150 /hr 225,00 TOTAL' FEES FOR THIS BILL 1. 50 hrs $ 225,00 TOTAL OF FEES, COSTS AND EXPENSES TOTAL AMOUNT NOW DUE $ 225.00 ---------- $ 225,00 . " ".,~:::".~::-:,: "', ':'::~;..";';:~~~~t~~;~=,~~~~~~;~~;;~:i:'~;~f~~::"~i~ :t,ti~i.;f I J. ......,, ,J _...-..--.,--. . .. "... ...,.,,~~... .... 0,- -.-.....~,......'. ,";'1. '" ..: - ,- .. ....-,,,...... ~"'-'; --, .:--. .".... _.._.~":""....__.--__..."..',.--....-......~.-.._..':':'~'~. _...u_.~..:"':"...~_.._.~ ._ .... ..... ......-..... .- _ """'_....~---.-:.~.~,.~I'......I.....-.' .-.:-!---.-- ....".,. , , .'.,.."..,....... ...... 'd_. -.-.-" PURCELL, KRUG & HALLER 1719 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102-2392 (717) 234-4178 - FAX 233-1149 April 9, 2000 Billed through 04/01/00 Bill number C02751-10587-017 JR Mildred Costa 45 Village Court Mechanicsburg, PA 17055 REI Domestic ..............aaua=aa=========================================== Account balance as of bill number 015 dated 12/30/99 Payments received since last bill (last payment 03/23/00) Net balance of account $ $ $ 177.50 100,00 77 ,50 FOR PROFESSIONAL SERVICES RENDERED 03/05/00 03/20/00 File Counter-Affidavit; forward copy to Attorney with correspondence Preparation of Claim of right; File same . 35 hrs ,75 hrs Total Fees for this bill 1.10 hrs 165,00 BILLING SUMMARY John W, Purcell, Jr, 1,10 hrs 150 /hr 165,00 TOTAL FEES FOR THIS BILL 1,10 hrs $ 165,00 TOTAL OF FEES, COSTS AND EXPENSES NET BALANCE OF ACCOUNT $ $ $ 165,00 77,50 TOTAL AMOUNT NOW DUE 242,50 .'- ._..__u_~_....., ._.._n' ........ ...."_..... ..... .. .l;;~...~._..~._.;_.g;:;......-._...-...-.'R.,=_.- -;~ ',','., ~'. ~ -..,"~' ..,..: ..,..;..:.,..'~,_~,.:.::,x:.:...,~.'._',~,,'-.'_",'_~.T-,:,~.~_~J:'::,',~,',.,.,',~,,~,;;,:O.',,::_:.,... ~~ "" ......~u...t........... ._;.........~ f _' _. '7 _.......J.:...~ . .....~.--:;.-. 'rr;if..:;;;~ . _ _ ,"'~". _ __"r:~i:.:.; ~:'. " :::;.+r!!-..;~:+c:-#~:.~;;:i!~..ct~~.~1ty~t~.~~~~~~'i . .... '.',.'....,' . _'".' ...".."...; .:..~..-.....,-;!;",.;t'....h ..'._........t'::'~;_....~..,..:.:. ....~ _. ...._.....-.~---....___...:-'".........._..." "'A'~_""'_""_".''''~'. .... -..~__~~~-..._. . _ _~.,;.. '. .._ ..._;...~'. ,.......... ~-..~!...;:;~;';::-~.....-.....::- "''''~'T'"':.......':';' -. ~-... ..-=--:~_...,.,...":~::'!::-'='~;T."l'~~'''''''''-'-':-rl-' PURCELL, KRUG & HALLER 1719 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102-2392 (717) 234-4178 - FAX 233-1149 June 2, 2000 Billed through 05/31/00 Bill number C02751-10587-018 JR Mildred Costa 45 Village Court Mechanicsburg, PA 17055 RE: Domestic ======aaa=============================================a_a=a_aaa_ Account balance as of bill number 017 dated 04/09/00 Payments received since last bill (last payment 04/18/00) Net balance of account $ $ $ 242.50 25.00 217,50 FOR PROFESSIONAL SERVICES RENDERED 04/06/00 Review of Court Order; forward copy to client with correspondence ,35 hrs Total Fees for this bill ,35 hrs 52,50 BILLING SUMMARY John W, Purcell, Jr, .35 hrs 150 /hr 52,50 TOTAL FEES FOR THIS BILL .35 hrs $ 52.50 TOTAL OF FEES, COSTS AND EXPENSES NET BALANCE OF ACCOUNT TOTAL AMOUNT NOW DUE $ $ $ 52.50 217,50 270.00 INCOKB AND BXPENSB STATBHBNT OP MILDRED COST A Employer: Jones, Daly & Coldren Pediatrics Address: 25 West Shore Drive Camp Hill, PA 17011 Type of Work: medical receptionist Payroll Number: Pay Period (Weekly, Bi-weekly, etc.): BI-weekly Gross Pay Per Pay Period: $.' 735.00 Itemized Payroll Deductions: Federal WithhOlding $ 125,00 Social Security $ 50,00 Local Wage Tax $ 12,00 State Income Tax $ 25,00 Unemployment $ Medicare Tax $ Retirement (401K) $ Savings Bonds $ Credit Union $ Life Insurance $ Health Insurance $ Pension Contribution $ Net Pay Per Pay Period $ 523.00 Accident $ $ Health c $ . Other c $ . AUTOMOBILES: Payments $ 225.00 $ Fuel (all vehicles) c 80,00 $ . Repairs $ $ MEDICAL: Doctor $ $ Dentist $ $ orthodontist $ $, Hospital $ $ Medicine $ $ special needs $ $ (Glasses, braces, Orthopedic devices, etc.) EDUCATION: Private School $ $ Parochial school $ $ College $ $ Religious $ $ PERSONAL: Clothing $ 150.00 $ Food $ 200,00 $: Barber/Hairdresser $ 20,00 $ .. ~..... .0~;: Credit Payments $ $ Credit Card $ $ Charge Accounts $ $ Memberships $ $ 35,00 LOANS: Credit Union $ $ MISCELLANEOUS: Child Care/Babysitting $ $ Papers/Books/Magazines, $ 15.00 $ Entertainment $ 100,00 $ Pay T.V. $ 40.00 $ Vacation $ 1000,00 $ Gifts $ 50,00 $ Legal Fees $ 50,00 $ Charitable Contributions $ 20,00 $ Other Spousal Support $: $ Tax Preparation $ $ TOTAL EXPENSES $: 2636,00 $ 1385,00 COSTA MILDRE ssN: 459-92-3334 Pay period: 08/28/00 EAR N I N G 5 to: 09/10/00 Type Hours Dollars .___a_a__._.________ _S:lII:U:::1 =_alllla_ ...._~_._ID_ Gross 733,88 Reg 65.50 622.25 Other 0,00 OT/1 2.50 35,63 Tips 0,00 OTIS 0,00 CashTips 0.00 Vac 0.00 ---------- Sick 0,00 Subtotal 733,88 Hol 8.00 76.00 Comm 0.00 Taxes -201. 48 Misc 0.00 Deducts -7.34 Other 0.00 ---------- --------------------- Net pay 525.06 Gross pay 733,88 T A XES Type Dollars Deductions & Other pay ____a_a___aa____a_ a__m _.a___IIII:::II::n:1 FWT OAsDI MED sWT SOl SUI subTl 124.79 LOCAL 45.50 10.64 20.55 0.00 0,00 -7.34 201.48 Year-to-date: -------------------------------------------------------------------------------- Gross pay SUI 1952,26 FICA 0,00 SOl 149.35 FWT 0.00 sWT 336.97 54.67 .*........** Five Hundred Twenty Five & 06/100 Dollars Mildred Costa 45 Village Street Mechanicsburg, PA 17055 COSTA MILDRE ssN: 459-92-3334 Pay period: 08/28/00 EARNINGS to: 09/10/00 Type Hours Dollars -======-============ -=-- ==-==1:1= =---=-=-= Gross 733.88 Reg 65.50 622.25 other 0.00 OT/1 2.50 35,63 Tips 0.00 OTIs 0.00 CashTips 0.00 Vac 0.00 ---------- Sick 0.00 Subtotal 733.88 Hol 8.00 76,00 Comm 0.00 Taxes -201.48 Misc 0,00 Deducts -7.34 Other 0.00 ---------- --------------------- Net pay 525.06 Gross pay 733,88 09/13/00 ..*....525,06 TAXES Type Dollars Gross pay SUI 1952,26 FICA 0.00 SOl Deductions & Other pay aaa= a====Il:II__=;::;:t FWT OAsDI MED sWT SOl SUI subTl -====--=====-=-=== 124.79 LOCAL 45.50 10.64 20.55 0.00 0.00 -7.34 201.48 Year-to-date: -------------------------------------------------------------------------------- 149.35 FWT 0,00 sWT 336.97 54.67 " .'! v ,m' I ,."J .~. ,~ t. \'. , ,. . . '" / ~/ ,..,,- . 1.040EZ Use the IRS label here - Pruldtllllal ElecUon CampalJII lSee PIC1l 12.1 Income Attach Copy B of Fo.....CI) W,. here, EndoH. but do DOI.tapll, any plYIIlonL Nole. You } mud check Yes or No. Payments and tax J--- Refund Havill dirtdly ~ d'pooitedl See JIIP200nd ~ filllD llb, 1I..lnd lid. Amount you owe 71 72323868 JONES D~LY COLDREN 932 P01 SEP 13 'e0 07:34 ;;.-... __.....,----... '-.:. :.:~ :,;;;".t.f~gi{~:~i.itt,,~~i~cf;r.!i ' I, y D,ptIlmCn& ollh Trtuury-lnlullll Ren.o.. Strvic, Income TlIJl Return for SIngle end Joint FII~rs With No Dependents III 1999 M~ld;ZdOM (!,fJS t./J IlIJoI""...... ._'.1Im O\IIM "'" l/l"eJ La" name OMB No Ilt~71 - Your .ocla! eocurily Dumber LIS. naml 4;"7l7;~ "'"i"';/'~ * "'1.12. ~I. no. Clrt,_..U_......~P_,~..~9'tOdo......._tl. !:I!c~,~!.q:ll~~g, ~uf!:, rtLt~~~.d. Do you wont $3 to go to thla fund? ~ It a Joint return, do.. your spousc want $3 to go 10 thi> rund? ~ 1 Total wogee, ..Iarie., and Up', This should be ahown in box 1 of your W,2 fonn(a). Attach your W.2 fonn(.), 1 2 Taxable Inl.erelt. If the total is aver $400, you cannot uae Form 1040EZ. 2 3 Unemployment eompenaatlon, qualified stale tuitlon PfOil'llll earnings, and Alaaka Pennanenl Fund dlvld.nds (eee page 14). 3 4 Add linee I, 2, and 3. Thie Ie your aclJuel.d grGsa ineome. 4 6 Can your parents (or someone else' claim you on their n!turn? Yes. Enlu IIIlO\IDl No. It sIn,le, enlu 7.000.00. &.1m workahut ~ Irmarrlecl, onlAlr 12//00.00. on bock. ........ St. badt ror oxplano\lOJl. 5 6 Subtract line 5 from line of. If line 5 i.larger than lin. 4, enter O. Thi. II your taxabl. income, .. 6 7 Enter your Federal income lax withheld rrom box 2 oC your W.2 Corm(.). 7 Sa EArned income credit (see poge 15). b Nontuable earned income: enler type .nd omount below, Typo S 8a 9 Add linea 7 a.nd Ba. Th..e an! your lolal payment., 9 10 Tax. Uso the amount on ll.ue 6 above to find your tax In the ta:s lable on paget 2......2B of tbo booklot. Thin, enler the tax from the lable on thi. Une. 10 ' 11a It line 9 i> larger lhan line 10, lubtract lin. 10 from line 9. ThIe II your refllDd, b Routinr number a Type: Cht<k11lJ Savill.. 11. 12 IrIine 10 i> larger than line 9, subtraot line 9 f'ram line 10, Thia is the ,amount )'OU 0...., See page 21 for c1etai1e OIl how to pay,' . I u.. .... .... nl... _ pooo!lIee oIL'!'lV7,14tdaro Iblla..,.. 0/ _, _, ood \olio( 1M ....... ll1NO, _... ........111lo1a 011 _....... _ ello....._... ioilo'... IU r-. v.....lIIM... "...... lip...... ,rjolol....... s.e pose II. I d AccoWll nlimber ~ 12 SIgn ~ here , ~f:=l: ' ..... OC<U~~f;.. Do" I SpoaH'o _patioo , ~~_. For DioololUl'l. PriVI.Y Atl, ancl PlpuorOrk ~uctlo" Act Noli... _ pip 2J. If ,j- 9 r ~ 8 J cJ If SpOUR'. .oclal .ac:urlly number X It. )...3 ~9J I e- ~(Y -eY.b' .er.e- B' .e-.e .er=e- 7'3 lj93 /.t;r 7 .e- 5""-er .e-.er Ib ~lj3 1...8- :3 ~?I 9'9 .f;rffr..e- ~.a 3 ;t? I r1 J- 'f~ If -tJ:ff rtO? c;q . r I For 10NiClal I Us. I Only L CooL No. 12S171l 1~~~ FOrM lD~DEZ I. I' ... VERIFICATION I verify that the statements made in the foregoing Income & Expense Statement are true and correct, I understand that false statemell1S herein are made subject 10 the penalties of 18 Pa. C.S. ~4904 relating to unswomfalsification to authorities, lJate: September 14 2000 l/JtU4 ~- MILDRED COSTS CERTIFICATE OF SERVICE 1,'John W. Purcell, Jr., Attomey for the Defendant, hereby certify that a true and correct copy of the foregoing was served on the Plaintiff by forwarding said copy to his attomey at the following address, by first class U,S, Mail on September 19, 2000: Nora Blair, Esquire P,O, Box 6216 Harrisburg, PA 17112-0216 GEORGE COSTA, JR., PLAINTIFF V, MILDRED COSTA, DEFENDANT : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA . : 97-1396 CIVIL TERM AND NOW, this ORDER OF COURT ~ day of April. 2000, the motion of George Costa, Jr., to withdraw appointment of master, IS DISMISSED in that the sole reason for filing the petition was that defendant has not filed any claim for economic relief which defendant has now filed on March 20, 2000. Nora F, Blair, Esquire For Plaintiff Edgar B. Bayl J, (\ A:.Ll ~ lA"" ~.b~~':J John W. Purcell, Jr., Esquire For Defendant :saa DIANE LOUISE ROSEN (TOKACH) PLAINTIFF V. JEFFREY ROSEN DEFENDANT IN Tim COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA 97-1326 CIVIL ACTION LAW IN CUSTODY ORDER OF eOlIRT AND NOW. this 28th day of November, 2000, upon considcration ofthc attachcd Complaint, it is hereby directed that the parties and their respective counsel appear before Hubert X. Gilroy, Esq, ,the conciliator, at 4th Floor, Cumberland County Courthouse. Carlisle on the 21st day of Deeember, 2000 ,at 9:30 a.m, for a Pre-Hearing Custody Conference. At such confercnce, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to dcfine and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older may also be present at the conference. Failure to appear at the conference may provide grounds for entry of a temporary or permanent order, FOR THE COURT, By: /5/ Hilbert X. GilrOJl. Esq ~ Custody Conciliator ~ The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the eourt, please contact our office, All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conferenee or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 170 \3 Telephone (717) 249.3166 I: i. I : DIANE LOUISE ROSEN (TOKACH) Pllllntiff/Respondent : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY,I'ENNSYLV ANIA : No, 97.1326 CIVIL TERM : CIVIL ACTION - LAW : IN CUSTODY v, JEFFREY ROSEN, Defendllnt/I'etllloner PETITION FOR CIVIL CONTEMPT FOR DISOBEDIENCE OF CUSTODY ORDER AND NOW, comes Petitioner, Jeffrey Rosen, by and through his allomey, Jacqueline M, Verney, Esquire and represents the following in support of his Petition for Civil Contempt: I. Petitioner is Jeffrey Rosen, who resides at319 S. River Street, Harrisburg, Dauphin County, Pennsylvania 17104, 2. Respondent is Diane Louise Rosen Tokach, who resides atl4 Russian Road, Ellers, York County, Pennsylvania, 3. The Petitioner and Respondent are the parents of Kyle R, Rosen, bom January 2, 1995, 4. A Custody Order, dated September 15,2000, entered by the Honorable J. Wesley Oler, Jr. is presently in effect. A true and correct copy of the Order is allached hereto as Exhibit "A", 5. Respondent has willfully failed to abide by the Orders in that: a, Paragraph 5 of the Order provides for the Father to have custody of the child when the child is off from school, provided Father gives Mother two days prior DIANE LOOISE 'roKACH (formerly ROSEN), : Plaintiff IN THE CXlUR'l' OF CO>IMOO PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA . . vs. : NO. 97-1326 CIVIL TERM : JEFFREY ROSEN, Defendant : CIVIL ACTIOO - LAW : IN CUSTODY au>ER OF CXXlRT AND taf, this J ~ day of ~, t~A } CalSideratial of the at~stody Cone li tion Report, and directed as follows: , 2000, upon it is ordered 1. 1be prior o:ders of this Court dated March 2, 1999 and Noverrber 16, 1999 are vacated and replaced with this order. 2. 1he Mother, Diane Louise Takach, and the Father, Jeffrey Rosen, shall have shared legal custody of Kyle R. Rosen, born January 2, 1995. Each parent shall have an equal right, to be exercised jointly with the other parent, to make all major non-emergency decisions affecting the Child's general well-being including, but not limited to, all decisions regarding his health, educatial and religion. 3. 1be Mother shall have primary lXlysical custody of the Child. 4. 1be Father shall have partial lXlysical custody of the Child in accordance with the following schedule: A. 1he Father shall have custody of the Child frcm saturday, 5epterrber 9, 2000 at 9:00 a.m. through Monday, 5eptember 11, 2000, when the Father shall transport the Child to school, and frcm saturday, september 23, 2000 at 9:00 a.m. through Monday, 5epterrber 25, 2000, when the Father shall transport the Child to school. B. 1he Father shall have custody of the atild frcm saturday, October 7, 2000 at 9:00 a.m. through Monday, October 9, 2000, when the Father shall transport the atild to the Mother's residence no later than 10:00 a.m. C. Beginning Friday, October 20, 2000, the Father shall have custody of the Child al alternating weekends frcm Friday at 8:00 p.m. through SUnday at 8:00 p.m. D. BegiMing 1bursday, October 5, 2000, the Father shall have custody of the Olild every 1bursday frcm 11:30 a.m. until 7:00 p.m. 6>( ';4 ,I 5. When the Olild has a day off school and the Father is available, the Father may have custody of the Child for any part of the day upon providing at least 2 days advance notice to the Mother. 6. Each party shall be entitled to have custody of the Child for 3 weeks (with no ll'Ore than 2 weeks to be scheduled consecutively) during each year upal providing at least 30 days advance notice to the other party. ihe Father shall be entitled to have custody of the Olild for an additional 3 days during the sUlllllE!r 2001 to make up for a missed period of custody over Father's Day weekend in 2000. ihe Father shall not schedule his additional 3 day period of custody to exceed the two week I1'aximun for a single continuous period of custody. 7. The parties shall share or alternate having custody of the Child on holidays as follows: A. QlRIS'J!IAS: In every year, the Mother shall have custody of the Child fran Christmas Eve at 12:00 nOCXl until Christ:rna.s Day at 12:00 noon and the Father shall have custody of the Olild fran Christ:rna.s Day at 12:00 nOCXl through December 26 when the Mother ,returns fran work or as otherwise agreed by the parties. B. mANKSGIVING: In every year, the Mother shall have custody of the Child on ihanksgiving DaY,until 2:00 p.m. and the Father shall have custody of the Child fran 2:00 p.m. until 8:00 p.m. C. NBW XEARS: In every year, the Father shall have custody of the Child fran New Years Eve at 5:00 p.m. until New Years Day at 8:00 p.m. D. EAS'l'ER: In every year the Mother shall have custody of the Child on Easter sunday. E. MIKlUAL DAY/JULY 4~ DAY: In even nuntlered years, the Mother shall have custody of the Child on Memorial Day and Labor Day and the Father shall have custody of the Olild at July 4th. In odd numbered years, the Father shall have custody of the Child on Memorial Day and Labor Day and the Mother shall have custody of the Child on July 4th. F. l'IV:!:'WSl('S DAY/FATBER'S DAY: ihe Mother shall have custody of the Child every year on Mother's Day and the Father shall have custody of the Olild every year on Father's Day. G. CHILD'S BIRTIJI).\Y: Both parties shall be entitled to have a period of custody with the Olild on his birthday at times to be arranged by agreement of the parties. B. ihe holiday custody schedule shall supersede and take precedence over the regular custody schedule. 8. In the event the Mother requires care for the Olild for a period of 5 hours or ll'Ore during her periods of custody, the Mother shall make a reasonable effort to provide the Father with an opportunity to provide the DIANE LOOISE mKACH (formerly ROSEN),: IN TfIE COURT OF CXlMMCXi PLIlAS OF Plaintiff : CUMBERLAND COUNTi', PENNSYLVANIA vs. . . : NO. 97-1326 CIVIL TERM JEFFREI ROSEN, Defendant . . : CIVIL ACTIOO - LAW : IN CUSTOO:i PRIOO JUDGE: J. Wesley Oler, Jr. Cu::,....\AJ~ cx:NCILIATI~ &HlARr REPCRr IN ACXXIUlANCB WITH atoIBERLANo CXUf1Y Rm.E a! CIVIL ~ 1915.3-8, the undersigned CUstody Conciliator submits the following report: 1. The pertinent information concerning the Child who is the subject: of this litigation is as follows: NAME DM.'E a! BIR1'B January 2, 1995 a:IRRIlNTr.Y IN ~""un a! Kyle R. Rosen . Mother 2. A Conciliation Conference was held on September 5, 2000, with the following individuals in attendance: The Mother, Diane Louise Takach, with her counsel, Marcus A. McKnight, III, Esquire, and the Father, Jeffrey Rosen, with his counsel, Jacqueline M. Verney, Esquire. 3. ihe parties agreed to canply with Dr. SChneider's recarmendation that they identify a neutral third party to provide them with a forum to address issues concerning their Child and resolve disputes. ihe parties were not: able to select: a mediator at the Conference and counsel agreed to contact: the Conciliator within two weeks with a list of potential counselors. The Conciliator will submit a supplement:al proPOSed Order at that time identifying the mediator selected by the parties. 4. The parties agreed to entry of an Order in the form as attached. 5, f'~ -kA Date ca~~ Dawn S. SUnday, Esqu CUstody Conciliator 7. ~f\ , ---*--~~*~_*_*_***ID__)~~:*______"~ ._...- ___ ......__-....-_r...-.. _....._________.. ,', ~ ~ ,.' ~ ~" 8 $ ~ w ~ ~ ... ~ ~.' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ~ STATE OF PENNA, ~ ,.' ~ '.~ !i! '.' ~ '.' $ ~ ',' ~ '.' v. " ..~ ~ ~ ',' ~ ',' ,', * ~ ... ,', ~ w. ',' ~ I~ ~ '.' ,''; ~ ~ ',' 8 ~ ~ ~.~ ~ ~.~ ~ ~ ~ w. '.' ~ ~ j~ )* ~ * ~ Dy The Court: ," (t ~ I~ .~ I~ M, Allest: J. ( : '4; ~ IV ~ '~ . P I $\ rollonolnry ~ I~ .! '... ~~;;-;:.--:.:. .>>:. -:.;. .>>;. .:.:. .:.:.~:.::-::'::-::;;.""::;::-,:.:.~.:.:. .:.:. ::.:.'.:.:.--.:;:.'-::.:.~",:.:: ::~::'.:.:: ::.:. .:.:. .:.:. .:.:. .:~t ~ ~.' l~ ~ ~ ;;, ~ " .., s ~ ~ '.' GEORGE COSTA JR, .... . -.......-..... ........ ...,. H..H,HH....HPlaintiff ..'H...... II NCl, ...".......1396 ....CMLllJ 97 ~ ~.' ~ <:> V CI':H1~ ~ ... MILDRED COSTA ....... ..... .. ~ '.' Defendant ~ '.' ,i ..; W <:> ~ ~.' DECREE IN DIVORCE ~ '.' ,', * ~ ~ ~ ~ ~ AND NOW, ' .... ... . .. .. .. ... ... . .. . .. '. 19......, it is ordered and decreed that ... q~Q~.G1ii GO.~'fA,..n", . . . ... . . , . . .... . . . .. , . '. plaintiff, and. . . .. . .MU..:[n,~p GO~'fA. . . . . . . . .. . .. . . .. . . , .,. ., . . . . . ., defendant, are divorced from the bonds of matrimony, ~ ~ ~.~ ~ <:> ~ The court retains jurisdiction of the following claims which have been raised of record in this action for which a final order has not yet been entered; ........ ............ ................... ................... ................, .. ................ ............. .................................... .... ... HlllL1I1 AlY.1H1 lXll.O<1Y C u.A'16'-/'t. L AND 1. NAME (Fnr) ~ntC#PlNNSY\.\lAHlA DI,ARNEHTCWtEAUlt V1TALRI!CORDS RECORD OF DIVORCE OR ANNULMENT {WI} 2.. DATE OF BIRTH &.Ie 4. PLACE OF '" / BIRTH 7. USUAL OCCUPATION ~ o (CHECK ONE) HUSBAND (lh:kfe) 3. R~ENCE 0/)'.""""''"'', """"'" ./~r.. " 8. MAIDEN NAME (F"nr) 10. RESWENCE SIrHf '" A.D. Vr.. 1 NUMBER OFTHIS 1 MARRIAGE 15. PLACE OF (C<>>>1y1 THIS MARRIAGE ,-tf~ 17A. NUMBER OF BER OF DEPEND OiLDREN THIS atlLDREN UNDER 18. 0- MARRIAGE 20. NUMBER OF HUSBAND WIFE CHILDREN TO 0 0 CUSTODV 01= 22. DATE OF OECREE 1- 1"'" 24. SIGNATURE OF TRANSCRIBING CLERK (Mdcfe, WIFE 1....0 """"'" SUII I (SII"",FMIQlJCountryl 18. PLAINTIFF HUSBAND CY SPUT CUSTOOV OTHER ISpeaty) o OTHER I_I o STATE ALE M.lM8ER STATE ALE DATE I...."" M r.' 1sw....F....",CDun"l'1 1-"" (Oq) (Y..., ( S-r) {SII" 01 FotIoIgl'I CountlyJ C {lIonth} i- S. DATEOF THIS UAARIAGE 8. DECREE GRANTED TO HUSBAND .QO 21. lEGAL GROUNDS FOR ~ORCEOR~ENT o (Yell' 23. OATE REPORT SENT TO VJlAL RECORDS I......) Cl..t:' (08,) ..., 13 ? WIFE o ?THER IS...~I o rr.." Hllll.II7NV.H1 COUf1Y 1. NAME 3. REBmENCE 5. NUMBER OFTI<IS MARRIAGE II. MAIDEN NAME to. RESIDENCE 12. NUMBER OF THIS t.lAIIIllAOE 1&. PlACE OF THIS MARRIAGE 17A. NUMBEROF CHI.OREN THIS MARRIAGE 2- ... NUMBER OF CHlDAEN TO CUSTODY OF 22. DATE OF DECREE 24, SIGt&ATURE OF TlW<SCIlllllNQ CLERK ~1lt"'I'lHNS't\.VIJM DI.,.lftNlHT Of teAL TH VITAL RICOROl RECORD OF STATE RLE NUUBER DIVORCE OR ANNULMENT STATE ALE DATE ~ (CHECK ONE) 0 HUSBAND CAldcl.) (....0 2. DATE ''''''''1 'Dlyl (V0IIl OF BIRTH CIIy.-...Tlop. c-oy 4. PLACE rS/Mt..Fngn""""'Y) OF BIRTH 7. USUAL OCCUPATION WIFE CMdcl., '....0 t. DATE ,....11I rCoy} (V'I<) OF BIRTH CIIy.-...Toop. c-oy SUI. 11. PLACE ($"",,_,,- OF BIRTH 14. USUAL OCCUPATION (- ........R.D, '''''0 M1= $..., 01 RD. - 78. NUMBER Of DEPENDENT CHILDREN UNDER II. HUSBAHD WIfE o 0 r.......) rCoy) ./)- 111, PLAINTIfF H\JSIlANO a. DATE OF THIS MARRIAGE t. DECREE GRANTED TO HUSBAND .eg (- WifE o OTHER I_I o WIFE o .J3{) (Coy) SPUT CUSTODY OTHER (S9<<dYJ 21. LEGAL GROUNDS FOR DIVORCE OR ANNUl.J.tEHT o cr.." o 2:1. DATE REPORT SENT TO VrTAl. RECORDS r....") (/lfIy) (V00Il OTHER (8_ o /Y.., . ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonweallh 01 Penmvlvanla Co.lCity/Dist. 01 CUMBERLI\ND Date of Order/Notice 09/29/03 Tribunal/Case Number (See Addendum for case summary) Employe"Wilhholde,', Fede,.1 fiN Number SOCIAL SECURITY ADMINISTRATION C/O LYNN SHOPP DISTRICT MANAGER 555 WALNUT ST HARRISBURG PA 17101-1925 kE: COSTA, o O,igin.l O,der/Nolice o Amended Orde,/Nolice o Terminate OrderlNotice GEORGE JR EmployeelObligo,', N.me (l.'l, Firs., Mil 039-32-8441 Employee/Obligo,', Soci.1 Securily Number 2213000027 E mployeelObligo,', c... Idenlifie, IS.. Addondum lor plalnrlff ""mel ."ocI.red wlrh r.... on .ttachmenr) Cu~lodlJl Parent's Name (lasl. First, MI) J:J! 1997 -18?t C'IJI/'- /lkS1.t; (N.?O~Od').Y 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 CUMBERLI\ND County, Commonwealth 01 Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's!obligor's income until further notice even lIthe Order/Notice is not Issued by your State. S 563.33 per month in current support S 43 .33 per month In past-due support Arrears 12 weeks or greaterl 0 yes (X) no S 0.00 per month in medical support S 0.00 per month for genetic test costs S per month in other (specify) lor a total 01 $ 606.66 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 (ollowing to determine how much to withhold: S 140.00 per weekly pay period, S 290.00 per biweekly pay period (every two weeks), S 303 .33 per semimonthly pay period ((wice a monlh). S 606.66 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 01 this Order/Notice. Send payment within seven (7J working days of the paydateldate 01 withholding. You are entitled to deduct a fee to defray the cost 01 withholding. ReIer to the laws governing the work state 01 your employee lor 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 (ollowing Information is needed (See # lOon pg, 2). II remitting by EHIEDI, please call Pennsylvania State Collections and Disbursement Unit (SeDU) Employer Customer Service at 1.877.676.9580 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106.9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date 01 Order: SEP 3 0 2003 Service Type M 7. O\'B No.: 0'110.01 is orm EN.028 Worker 10 $OINC . ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o If checked you are ,equired 10 '''pvil'e a ropy of Ihi, form to you, employee. If YO\" employee works In a ,tate that Is dille,enl from Ihe 'Iale Ih,1t i.-u.. th, onler, il ClJI'Y mu,1 he provi,lecf 10 your emp oyee even rllhe box 15 not checked, 1. We appreciate Ihe volunlary compliimce 01 F..Jer.1I1y recognized Indliln tribes, t,ibally-owned bu,ine.-es, and Indian-owned businesses located on a rcselViltion lhal choose 10 withhold in ilCcorrlancc with (his nolice. 2. Priority: Withholding under Ihis Order/Notice ha, priority over any other legal process under Slale law against Ihe same Income. Federal tax levies in effect hefore receipt of this onler have priorily. If Ihere a,e Federal tax levie, in effect plea,e conlact the requesling agency Ii,ted below, 3. Combining Payments: You can combine wilhheld amount, lrom marc than one employee/obligor's income in a ,ingle payment to each agency rclluesting withholding. You must, however, separalely identify Ihe portion or Ihe ,ingle payment Ihal i, allribulable to each employee/obligor. 4. "Repol1int'he-PaydatelDate'ofWithholding~You must".port thepayt!ateldate of wilhholdingwhen'1ending1he'payment~he- paydateldale olwilhholding.;,thedat"on whichnmountwas withheldlromtheemployee's'wag",; You musl comply with the law ollhe stale ollhe employee's/obligor's principal place or employment with re'pectto Ihe lime period, wilhin which you must implemenlthe Wilhholding order and IOlWard the support paymenls. 5.' Employee!Obligor wIth Multiple Support Holdings: Illhere is more lhan one Order/Nolice 10 Withhold Income for Support against lhis employee/obligor and you are unable 10 honor all support Order/Nolices due to Federal or Stale withholding limits, you must follow lhe law ollhe state 01 employee's1obligor's principal place of employment. You mu,t honor all Orders/Nolices to Ihe greatest extent possible. (See #10 below) 6. Termination Notification: You must promptly notify the Requesling Agency when the employee/obligor is no longer working for you. Please provide Ihe inlormation requested and relurn a copy 01 this Order/Nolice to Ihe Agency identified below. WITHHOLDER'S ID: 9593100092 EMPLOYEE'S/OBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: COSTA, GEORGE JR 2213000027 DATE OF SEPARATION: 7. Lump Sum Payments: You may be re<luired to report and withhold lrom lump sum payments such as bonuses, commissions, or ,everance pay. II you have any que,lion, aboullump sum payments, conlact Ihe pe"on or authority below. 8. Liability: If you lall to withhold income as the Order/Nolice directs, you are liable for both the accumulated amoun! you should have wilhheld Irom the employee/obligor's Income and olher penahles set by Penn,ylvania Slale law. Pennsylvania Slale law govems unless Ihe obligor is employed in another Slate, in which case the law olthe Stale in which he or she is employed governs. 9. Anti-discrimination: You are subject 10 a fine determined under State law lor discha,ging an employee/obligor from employment, refusing to employ, or laking disciplinary aclion againsl any employee/obligor because 01 a support wilhholding. Pennsylvania Stale law govems unless the obligor Is employed In anolher Slale, in which case Ihe law 01 the Slate in which he or she Is employed governs. 10.' Withholding Limits: You may nol withhold more than the lesser 01: 1) lheamounls allowed by Ihe Federal Consumer Credit Protection Act 115 U.S.c. ~ 1673 (b)l; or 2) lhe amounls allowed by lhe Stale 01 Ihe employee's/obligor's principal place 01 employment. The Federal limit applies 10 Ihe aggregate disposable weekly eamings (ADWEI. ADWE is Ihe nel income lell aller making mandalory deductions ,uch as: Stale, Federal, lorallaxes: Sorial Security laxes; and Medicare laxes. 11. Additionallnlo: 'NOTE: II 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 slate that issued this order with respect to these items. Submilled By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 24()'6225 or P.O. BOX 320 by FAX at (717) 24()'6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Service Type M Page 2 012 Form EN-028 Worker 10 $OINC n"'BNo:1I'J71l-01H :- 0:01 cr' ?; ~ u: lIJ~~: .. =:; ~?,: L~ ;::)~( ~; '. :5~ ~\ ~ ~- . "..}:.:i r,;o 'I "0 I '~I% ,; ,.. .~._, Ifl..ra j:'. t...; ,tit C ::.0- :" ::;-.., G ;.j P03UI.J P ~S ....:: U '>- CI ~ h: .;...~ ,. \. ~i 11,(0, !.;~ " <1; <_17 (). ::r: \ " ...., fi:' c.. .~~ , ~; ~ ,,, <;I; " ~:.. ';:;~ ., .-- j;'(u .. ::".)'1... t:.> ::5 ' ~- ,,? '.) ,,::' U .. . ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvania Co.lCity/Dist, of CUMBERLI\ND Date of Order/Notice 12/18/03 Tribunal/Case Number (See Addendum for case summary) RE: COSTA, o O,iginal O,de,lNoIire o ^mended O,derlNoIice (8) Terminate Order/NOCice GEORGE JR Employee/Obligo,', Name lLa.l. Firsl, Mil 039-32-8441 EmployeelObllgo,', Social Secu,ily Numbe, 2213000027 Employee/Obligor', Ca..ldenlifie, (See Ad<hndum lor plaintiff ""mel assoclared wllh rale' on attarhmenr) Cuilodial Parenl', Name ILail, Firsl, Mil Employer/Wilhholder', Federal EIN Number lPaq {)OO {)dY t17,139&; ~ OVERNITE TRANSPORTATION CO · 1000 SEMMES AVE RICHMOND VA 23224-2246 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TION: This Is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLI\ND 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. So. 00 per month in current support So. 00 per month In past-due support Arrears 12 weeks or greaterl 0 yes (X) no S 0.00 per month in medical support S 0.00 per month for genetic test costs S per month in other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: S 0.00 per weekly pay period, S 0.00 per biweekly pay period (every two weeks). $ 0.00 per semimonthly pay period (twice a month). S 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven m working days of the paydateldate of withholding. You are entitled to deduct a fee to defray the cost of withholding, ReIer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 5S'Io of the employee's! obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following Information is needed (See #10 on pg. 2). If remilling by EHIEDI, please call Pennsylvania Stale eollections and Disbursement Unit (SCDU) Employer Customer Service atl.877.676-9S80 for instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106.9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. Date of Order: ::r:> ~. 2-1 J Service Type M Form EN'()28 Worker 10 21205 O\l8No_:()lI1O-015~ " ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o II checked you are required. 10 prp~llle a 'OilY or Ihls form to your. ~mployee. I( your employeclworkbs Inla slate lhal ~~ dilferentfrom Ihe slate thalossued 111 ,order, a ,opy must be prowled to your employee even 0 Ihe ox s not checkL'U. 1. We appreclale the voluntary compliance o( Federally recognized Indian Iribes, Iribally-owned businesses, and Indlan-owned buslnesse, located on a re,ervalion thai choose to wilhhold In acconlance wilh this notice, 2. Priority: Withholding under Ihls Orne,lNotlce has priority over any olher legal process under Slate law agalnstlhe same in,ome. Federal lax levie, In elfect before receipt olthls orner have priority. 11 there are Federal tax levies In effect please contactlhe requesting agency listed below. 3. Combining Payments: You can combine withheld amounts lrom more Ihan one employee/obligor's Income In a single payment to each agency requesting withholding. You must, however, separalely Idenlify Ihe portion of the single paymentlhal is auributable to each employee/obligor. 4. '-Reporting1he-Payda~Elate-ofWithholdlng:-YotMl1,"l~rt the.paydateJdate 01 wilhholdingwhen~endin8.thepayment:-The- paydateJdate 01 "ahholding-~thetlatelln"Whiclumoun~withheldlmmtheemp\oyee',",.ag",: You must comply with the law olthe state ollhe employee's1obllgo~s principal place 01 employment with respect to the time periods within which you must Implement the withholding orner and lorwarn the support payments. 5.' Employee/Obligor with Multiple Support Holdings: II there Is more than one Orner/Notice to Withhold Income lor Support against Ihis employee/obligor and you are unable to honor all support OrnerlNotices due 10 Federal or Slate wilhholding Iimils, you must follow Ihe law 01 the state 01 employee's1obligo~s principal place 01 employment. You must honor all Orne~Notices to the greatest extent possible. (See #10 below) 6. Termination Notification: You must promplly notify the Requesllng Agency when the employee/obligor is no longer working lor you. Please provide the Inlormation requested and retum a copy olthis OrnerlNotlce 10 the Agency identified below. WITHHOLDER'S ID: 5404812360 EMPLOYEE'SIOBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: COSTA, GEORGE JR 2213000027 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to report and withhold lrom lump sum payments such as bonuses, ,ommissions, or severance pay. II you have any questions about lump sum paymenls, contact Ihe person or aUlhorily below. 8. Liability: II you (all to withhold income as Ihe OrnerlNotice directs, you are liable (or bOlh the accumulated amount you should have wilhheld from the employee/obligo~s income and olher penallies set by Pennsylvania Stale law. Pennsylvania Stale law govems unless lhe obligor is employed in another Stale, in which case the law ollhe Slale in which he or she is employed governs, 9. Antkllscrlmlnatlon: You are subject to a fine determined under State law lor discharging an employee/obligor lrom employment, re(uslng to employ, or taking diSciplinary action against any employee/obligor because of a ,upport withholding. Penn'ylvanla Stale law govems unless the obligor is employed In another State, in which case the law 01 the State in which he or she is employed govems. 10.' Withholding Limits: You may not wilhhold more than the lesser 01: 1) the amounts allowed by the Federal Consumer Credit Protection Act (15 U.S.c. S 1673 (b)1; or 2) the amounts allowed by the State 01 the employee's1obIi80~s principal place 01 employment. The Federallimil applies to the aggregate disposable weekly eamings (ADWE). ADWE i, the net income left after making mandatory deductions such as: State, Federal, local taxes; Social Secu,ily laxes; and Medica,e taxes. 11. Additlonallnlo: . NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. Submitted By: II you or your employee/obligor have any questions. DOMESTIC RELATIONS SECTION contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (7171 24()'6225 or P.O. BOX 320 by FAX at /7171 24()'6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Service Type M Page 2 01 2 Form EN-028 Worker 10 21205 OMB No: 0976-(115.1 I ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsvlvanla Co.lCity/Dist. of CUMBERLAND Date of Order/Notice 12/10/03 Tribunal/Case Number (See Addendum for case summary) R[: COSTA, a O,lglnal Orde,/Nolirc o Amended O,de,/Nolire @ re,minale OrderlNOIice EmployerfWilhholde,', Fede,.l EIN Numbe, GEORGE JR [mployee/Obligo,', Namella.., Firsl, Mil 039-32-0441 [mployee/Obligor', Social Secu,i1y Numbe, 2213000027 Employee/Obligo,', C...ldenlifier IS.. Ad<hndum lor plaintiff mmel assocla/ed wlrh ralel on arruhmenl) CU'lodlal Pa,enl', Name Il.", FlrsI, Mil SOCIAL SECURITY ADMINISTRATION C/O LYNN SHOPP DrSTRICT MANAGER 555 WALNUT ST HARRISBURG PA 17101-1925 JJ;j. 111'l .139(" (' t/ jJJK!.r;["~ &-d-'1CJ{)OO,}-V See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMA TlON: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLI\ND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee'slobligor's income until (urther notice even if the Order/Notice is not issued by your State. So. 00 per month In current support So. 00 per month in past.due support Arrears 12 weeks or greaterl ayes @ no $ 0,00 per month in medical support $ 0 . 00 per month for genetic test costs S per month In other (specify) for a total of $ 0.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: S o. 00 per weekly pay period, S 0.00 per biweekly pay period (every two weeks), S 0.00 per semimonthly pay period (twice a month). S 0.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. 5end payment within seven (7) working days of the paydateldate of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount, The total withheld amount, and your fee, cannot exceed 55% of the employee's! obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #10 on pg, 2). If rerr.illing by EFT/EDI, please call Pennsylvania State Collections and Disbursement Unit (SeDU) Employer Customer Service at 1.877.676-9580 for Instructions. Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106.9112 IN ADDITION, PA YMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. . 0 .... BYTHECOZ7T: .-2-/,zl:..{~p.2 [ ---- v, . . . 0;..10/. ~(€y tx. Date of Order: Service Type M I. 0."'8 No: Oq70-01~" 71., 40e Form EN.028 Worker 10 $OINC " ~ I ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS o II thccked you are required to prp~lde a copy 01 this lorrn to your employee. II your employee works in a state that Is dllferentrrom the state Ihall,sued this order, a copy must be provided to your employee even If the box 15 not checked. 1. We appreciate the voluntary compliance 01 Federally recognized Indian tribes, tribally-owned businesses, and Indian-owned businesses located on a reservation that choose to withhold In accordance with this notice. 2. Priority: Wilhholding under this Order/Notice has priority over any other legal process under Stale law against the same Income, Federal tax levies In ellect before receipt olthis order have priority, Illhere arc Federal lax levies In effcct please conlact the reque,tlng agency listed below. 3. Combining Payments: You can combine withheld amounls from more than one employee/obligor's Income In a single payment to each agency requesting withholding. You must, however, separately Identify Ihe pan ion of lhe single IJayment that is auributable to each employee/obligor. 4, '-Rl!pOlting-the-Paydlllel6a1~ithholding;-You-mult~.th~paydateldale 01 withholdlngwhen~ending.th~"aymenHhe- paydatelda~thholding1sth~ate onwhiehllmount-waswilhheld-from-the employee's-wagcs; You must comply with the law 01 the stale of the employee's1obllgor's principal place 01 employment with respect 10 the time periods within which you must Implement the wllhholdlng order and lorward Ihe ,uppon payments. 5.' Employee/Obligor with Mulllple Support Holdings: II there is more than one Order/Notice to Withhold Income for Suppod against this employee/obligor and you are unable to honor all suppon Order/Notiees due to Federal or State withholding limits, you must follow the law 01 the state of employee's1obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent pos,lble. (See #10 below) 6. Termination Notlficallon: You must promptly notify the Requesting Agency when the employee/obligor is no longer working lor you. Please provide the Inlorrnation requested and return a copy olthi, Order/Notice to the Agency Identified below. WITHHOLDER'S 10: 9593100092 EMPLOYEE'SlOBLlGOR'S NAME: EMPLOYEE'S CASE IDENTIFtER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDRESS: COSTA, GEORGE JR 2213000027 DATE OF SEPARATION: 7. Lump Sum Payments: You may be required to repon and wilhhold lrom lump sum payments such as bonuses, commissions, or severance pay. II you have any questions about lump sum payments, contactlhe person or aUlhority below. 8. Liability: 11 you fail to withhold income as the Order/Noliee directs, you are liable for both the accumulated amount you should have withheld Irom Ihe employee/obligor's income and olher penalties set by Pennsylvania Slale law. Pennsylvania State law governs unle,s the obligor is employed in another State, in which case the law olthe Slale in which he or she is employed govems. 9. Antkllscrlminallon: 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 suppon withholding. Pennsylvania State law govems unless the obligor is employed in anolher State, In which case the law 01 the Slate in which he or she is employed govems. 10.' Withholding Limits: You may not withhold more than Ihe lesser 01: 1) the amounts allowed by Ihe Federal Consumer Credit Protection Act (15 U.S.c. S 1673 (bl1; or 2) the amounts allowed by the State 01 the employee'slobligor's principal place 01 employment. The Federal limit applies to the aggregale disposable weekly earnings (ADWE). ADWE I, Ihe nel income left after making mandalory deductions ,uch as: State, Federal, local taxes; Social SccurilY taxes: and Medicare taxes. 11. Addillonallnfo: '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. Submilled By: If you or your employee/obligor have any questions, DOMESTIC RELATIONS SECTION contact WAGE ATTAeHMENT UNIT 13 N. HANOVER ST by telephone at (7171 24().622S or P.O. BOX 320 by FAX at 17171 24()'6248 or CARLISLE PA 17013 by internet www.childsupport.state.pa.us Page 2 01 2 Form EN-028 Worker 10 $OINC Service Type M OMB No.: 097(}.{)1S" In the Court of Common Pleas of County, Pennsylvania CUMBERLAND DOMEbTIC RELATIONS SECfION 13 N. IIANOVER ~T, P.O. BOX 310, CARLISLE, PAr 17013 Phone: (717) 240-6225 Fax: (717) 240-6248 Defendant Name: GEORGE COSTA JR Member ID Number: 2213000027 PI.... 0010: AU cOl'l'fJpondo.... must Inrludo Ih. M.mber ID Number. ORDER TO VACATE ATI'ACHMENT OF UNEMPLOYMENT BENEFITS ...> ('1 g~ r: ,;-- Financial Break Down or Multiple Cases on Allachmenl -.. <:!,. Plaintiff Name MILDRED COSTA PACSES Cue Numher 629000024 ',; , .' ;-.:, ~ . Amchmenr AmoumlFrtOuenc:r' 563.33 lMONTll 7.'''(' c....;' 7 " J ==::..a Ul I -<: - 1- ~ I Dock'l ~ 97.1396 CIVIL $ ! i $ TOTALAITACIIMENTAMOUNT: $ 0.00 The prior Order of this Court directing the Department of Labor and Industry, Bureau of Unemployment Compensation Benefits and Allowances (BUCBA), to attach $ 0.00 or 50 % per week of the Unemployment Compensation benefits of GEORGE COSTA JR , Social Security Number 039-32-0441 , Member ID Number 2213000027 is hereby vacated. This Order to Vacate shall be effective upon receipt of the notice of the Order by the Department and shall remain in effect until a further Order of the Court is filed. BY THE COURT Date of Order: _ \ 1\)U~" JUDGE . .i>\ . - 'J. Service Type M Fonn EN -035 Worker ID $IATT '- ~.. :: .. - o '11 ::l .I.~ plP;: -r1 r~. .,flY I-":ICJ :;j..", ~; ,::1 .- l"' ~:~.nl ;; I c..~ i , f i I' I f I ! i: Ii -.