The URL can be used to link to this page

Home My WebLink About97-06139 ~. w ..( ., ~ ~. 1'1 ~, 1 ,-.( . , ,~ ,\,. I".' "'~ '1 'I I! , '" .':5 '~, !f' I ".... 'j "'~ '(';\1'-;; "..,. 'il'~ ,,~ 1,1 ' :;,~ ". . II " " , " " ),v ): J~ j'A ( '{ll", '!H;\ ,'_....J\ f(~,;! ,I i'?f:~ I' 'Ai ~ " "I ,:Il. , '..I,!.', '..Ii;!'! "1'\ , .- " -'J ',~ f ,11 ~ (_,Ii 'J'-' \'Ii) " ',j,l.i, I,-,/t,l(v ","i.,- 1.,I'!lr_~i .. Iii!.\'; ':I'I':';,w,';' 'I ~ 'iilt ,';-- j."JI'f'1 J >j,:,~\o' , 'I{'I ; IFIll ;"I}l.},i, ;,{^ " .1 ,I ',,:13 " 'It ~,tL ',H',;~ 1',"'1' ,iI' ",;'~M;,1 ;::'}It "YUi j li:;/I~'1 II I;i",?~ "'I'i)J ;1; i ' :! ,1'1 ;..Hrl , 1 "\;}~ I' I'I(~ Ii 'I\"W I" '.'i)lt ':~~ L!,"'~\'I j,r ':v 'd;' :lr :~ '-~ i1t i Il~ H 1'.1_) ,J , '1& ~Fti!J' t.'.." \ ill I, 'It\~ff "t' 1,1' d r I , ! ~ ~ . ~ ~ ~ ~ ~ 8 . * ~ * . . ~ ~ 8 8 " ~ M ' t1i~- r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ~, DECREE IN D I V 0 R C E I" "I"'" M {f\ .:t ".. ~ I'Hr. AND NOW"",.., ,~,{?,"",... "dm.", It Is ordered and AMY C, SHEPHERD I ff decreed that, , , . , , , " , , , , " " , , , , , , , , '. , ,. , , , , , ". , , , , , ". , , " p olntl , and, , , , , , . , , , , , , , , , , , ,P9,N~~P, .I'! ~ . ~!:!,E1~I;I!J:,~I:1 , , , , , , . , , , . , , , , " defendant, ore divorced from the bonds of matrimony, The court retains lurlsdlctlon of the following clolms which have been raised of record In this action for which 0 final order has not yet baen entered; No issues are outstanding, All issues have been resolved and settlsd py the .f.. "...1 " ",."..",..."""."""""",..""""""."""""" I, parties' Marriage Bettlement Agreement dated April 20, 2000, filed of record and .., ,..., I,', """ "',"'," """""" ""'" ,',",',"""" '.'""". incorporated but not merged into this Decree, ~ l~ ~ I~ J. ('" I~ II.! I~ . " ,~ ,~.:' ':.:' {t:. ':.:' .:.;. .:.;. ':+:' ':.:' .Ct:. .:.:' AUel\tl ~ 1','ulllIlIlllllll'Y . .:<<' ':.:. .:.e. .:+:' ':.:' ,:.:. ':.:' .:t:, ':.:. ,e.:. .:.:' ':+:. ~ ~ * ~ , _I. ~~;.JI '?I.'J {~(.I t/f;J1/ (/'I" ,At,t ...') 31. '](."J "'11;/ I t" "(I"7.,,'(!:'" 1'/ I.;' ,i'?-/ ';;;: Ii . , " -;(., (14 /;;:4r~ (~ , I' I, . ..r t I ,'II \, 1 ,f ,"'" -,,/1'''-'' -"" , ,I , I DIAN/! Q. RAl>C'-I"" I ArroR~~Y ^r ""^W 3448 r..ln~lt Ruad CIllJlP JlIU. Pi\. PQII t'T "'\' I, '!'/'i'''- " ,:If .'. '_-...ul .. . . . , ,f'''' I, 1/1 I ~ II" ".., \ ,1'11"\'1 I." \1 ('t-I)' '.h' " ' .1 , . . , -.... ", .. IN 'I'1,n;: COUR'I' OF COMMON 1'1,HMl ()jo' CUMB~:JH,AN[) COUNTY, lJ~:NNSYLVANII\ I\MY C. Slll!:P1W:JlP, Plaintiff I v. I NO. 97-G139 CIVIL, 'n:rlM I DONALD W. Sm:PIW:JW, I CIVIL I\C'nON - LI\W Defendant I DIVORCE: MARITAL AGREEMENT BETWEEN AMY C. SHEPHERD AND DONALD We SHEPHERD 'I' t r'11, If, I. c INTRODUCTION. . . . , I I , , . . . , , . . . . . I , . . I I I I , . . I , , , . , I , I , ~ . . . I .1 I3111C'l'IO~ I General Provisions,., .. """,""" I'" 1'..';--'....".., I 3 I3IlCTIO~ II Property Distribution Provisions, . .",.,..",.....,..", I ~.B I3IlCTIO~ III ~limonY, 'Spousal Support, Child Custody, child Support, Heal th Insurance, Educational Expenses and Income Tax Provisions...".,...,..,..,....". "'....,. II 1'1'1 I,".... 30 I3111CTIO~ IV Closing Provisions and Execution,..,., ,.., ....... ..."", 34 " . . IO THIS AGRJ!lENEN'l' madq thilJ~day of ~ , 2000, by and between AMY C. SHEPHERD ("WIIi'J!I") of 3824 MOlultain Road, Mechanicsburg, PA 17055 and DONALD W. SHEPHERD ("HUSBAND") of 224 Sella Vista Drive, Marysville, PA 17053 WIT N III S III T H I 'I , WHJll~IIlAS, the parties hereto are husband and wife, having been married on ,,June 9, 1990 in Newberry town, Pennsylvania and separated on April 18, 1999. WHIIl~IIlAS, There were no children born of thin mardage. WHJllRJllAB, diveri'll} and unhappy differences, disputes and difficulties have adsen between the parties and it is the intention of Husband -I- . . and WHo to live uepa~'i\l:(} <lilt! ap.nt j:or tile rout of thoh' natural lives, <Hld tho pal"tios hOl'oto iHO dOfJirOllS of nettling fully and finally their renpectivo financial and property rights and obligations as between each other inclUding, without limitation by specificationl the settling of all matters between them relating to the ownership and equitable distribution of '\:'eal f,lnd personal propertYI the settling of all matters petWGen them relating to the past, present alld future support, alimony and/or maintenance of Wife l:ly Husl:land or of Husband l:ly WHel and in general, the settling of any and all claims and possible claims by one against the other or against their respective estates. NOW, THEREFORE, in consideration of the premises and mutual promises / covenants and underta)dngs hereinafter set forth and for other good and valual:lle consideration, receipt of which is l:).erel:ly acknowledged by each of the parties hereto, \'life and Husband, each intending to be legally bound herel:ly, covenant and agree as follows I THIS SPACE INTENTIONALLY LEFT BLANK 'II' , .2. , I 'II . ,-.,'" SECTION I 1.01. ~~CQRPORA~;Q~ or p~I~HBHm 'l'he recital~ ~et forth in the Preaml:lle of thi~ Agreement are incorporated hel"ein and made a part heraof as .if fully set forth in the l:lody of the Agreement, 1.02. Mi~il~~lIINT ~Q7.' A BAR 7.'0 p:tVQRCm' P~OCI1lI!,lDINGfJ 'l'hi~ Agreement ~hall not be con~idered to af feet or bar the right of Husband anq Wife to an absolute divorce on lawful grounds if such grounds now ex,ist or shall hereafter exist or to such defense as may be available to either party. This/\greement if,! not intended to condone and shall not l:le deemed to be condonation on the part of either party hereto of any act or acts on the part of the other party which have occallioned the disputes or unhappy differences which have occurred or may occUr subsequent to the date hereof, 1.03. ~IVORC' ~iC~mm The partie~ acknowledge that their marriage is irretrieval:lly l:lroken and that they will secure a mutual consent no- fault divorce decree in the sl:love captioned divorce action, Upon the execution .3. . . of this Agreement, or as soon as possible unde~' the terms of Baid Divorce Code if said documents can not be signed upon the execution of this Agreement, the parties shall execute and file all documents and papers, including affidavits of consent, necessary to finalize said divorce, If either party fails or refuses to finalize said divorce or execute and file the documents necessary to finalize the divorGe, said failure or refusal shall be considered a material breach of this ~greement and shall entitle the other party at his Ii or her option to terminate this Agreement, 1.04. EPr~aT OF DIVO~Qi gia~~~ 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, 1.05. AGBiBHlNT TO e. INaOB~ORAT~D IN DIVORC~ D~CR.m, The terms of thie Agreement shall be incorporated into any Divorce Decree which may be entered with respect to them. 1.06. NON-MBRGER Thie Agreement shall not merge with the Divorce Decree, but rather, it shall continue to have independent contractual significance and each party I3hall maintain their contractual I'" .4. .,'\i , I J ~.. ,'. -', ,1"',, :,:.,:;'1 . . t'ljmodiotl as well as cO\II:t nlllwdlou MJ tile t'uUlIlt of tho ufot"osaid incorpot"utiop at" au othcrwluo ~lI:ovidtld ~)y law ot' tltatuto. 1.07. p~~~ or .lmCUTIQ~ 'fhll "date at: execution", "execution datu" at. "date of thit] Agt'eement" shall be defined as the date of oxecution by the party last executing this Agreemo/lt. 1.08. p~STRI~U~~QN DATE The transfer of property, fundrl and/or documents provided fa)'.' herein shall only talte place on the "distribution date" which shall b,e defined as the date of execution of this Agreement unless other.wise specified herein. 1.09. ADY.ICS or co~s~~ The provisions of this Agreemel1t and their legal effect have peen fully explained to the partiea by their respective counsel, William T. Smith, Esquire for Husband, LInd Diane G. Radcliff, Esquire for Wife. The parties acknowledge that they have received independent legal advice from cOunsel of their selection and that they fully understand the facts and have been fully informed as to their legal rights and obligat ions. They acknowledge and accept that this Agreement is, under the circumstances, fair and equitable .5. U'JI! . . and that it ia being entered Into f~'eely and volllntcldly ,]ftOt: havIng receIved such advice and wIth /Jllch l<Ilowledgo, and that executIon of thia I\gntomentis not the L"eault of any dUreSfJ or undue influence and that It is not the ~"mJult of any collu/Jion o~' improper or illegal agreement or agreemonta. 1.10. Ft~~C;A~ PI~C~OSVR~ The parties confIrm that each haa relied on the substantial accuracy of the f inancial disc;losu~'e of the other, as an inducement to the execution of this Agreement and each party acknowledges that there has been a full and fair disclosure of the parties' marItal assets and debts and the parties' respective incomes, which has been provided to each party. 1.11. DISCLOSURB AND W~IVBR OF PROCBDURAL RIGnTS 'Each party understands that he or she has the right to obtain from the other party a complete inventory or list of all of the property that either or both parties own at this time or owned as of the date of separation, and that each party has the right to have all such property valued by means of appraisals or otherwise. Both parties understand that they have the right to have a court hold hearings and make decisIons on the mat ters covered by this Agreement. Both parties understand that a court decision .6. . . c;onc;erning the parties I reupect i vo dghtu and obligilt iO~lU might bo different ft'om tho provisiono of thio ^groomont. , E:ach party hereby acknowledgeu that this ^grol'Jment ill fair und equi table I that ,I. t adequately provideo fot' his or het' needs and is in his or her beat interests, and that the ^greement ill not the rellult of any fraud, duress, Ot' undue influence exercised by either party upon the other or by any other person or persons upon either party. Oi ven said understanding and aclmowledgment, both parties hereby waive the following procedural rights I a. Inventory, The right to obtain an inventory of all marital and Ileparate property as defined by the Pennsylvania Divorce Code, b. Income and E:xpense Statemen~1 The right to obtain an inc;ome and expense statement of the other party as provided by the Pennsylvania Divorce Code, exc;ept in instances where such an income and expense statement is hereafter required to be filed in any child support action or any other proceedings pursuant to an order of court. c. DiscoverYI The right to have any discovery as may be permitted by the Rules of Civil Procedure, except discovery - 7 ~ " . . . . arising out of a I:lreach of this I\greement, out of allY child support action, or out of any other procsedings in whioh di/Jcovery is /JpecHioally ordered Py tho court. d. Qsl1e.rminatioJ) of MarIt<,l and NOll-MarItal Pj:opej:'tYI 'I'he right to have the court determine which property is marital and which is non-nlarital. and ~quitably distril:lutel:letwqen the parties that property which the court determines to pe marital. e, Other Rights and l~emedies I The right to have the court decide I any other rights, remedies, privileges, or ol:ll1gations covered by this I\greement, including, but not limited to, possible claims for divorce, spousal support, alimony, alimony pendonte lite (temporary alimony), counsel fees, costs and expenses. 1.12. BA~RUPTCY The parties hereby agree that the provisions of this Agreement . shall not I:le dischargeal:lle in I:lankruptcy and expressly agr~e to reaffirm any and all obligations contained herein. In the event a party files such bankr~ptcy and pursuant thereto oPtains a discharge of any ol:lligations assumed hereunder, the. other party shall have the right to declare this Agreement to pe null and void and to terminate this Agreement in which event the division of the .8. . pin'ties' marital assets and all othe~' rights determined by this Ag~'eement shall be subj ect to court determinat.ion the sallie as if this Agreement had never been ElI1tered into. 1.14. Jj)~JUJQ~~L ij;GijTS Husband and Wife muy and shall, at all times hereafter, ,pve separate and apart. 'l'hey shall be free from any control, restraint, interference' or authority, direct or indir.ect, by the other in all respects as fully as if they were unmarried. They may reside at such place pr places as they may select. Bach may, for his or her separate uSle or benefit, conduct, carryon and engage in any business, oocupation, profession or employment which to him ot' her may setlm advisable. Husband and Wife shall not molest, hat'ass I disturb or malign each othe~' or the respective families of each other not' compel or attempt to compel the other to cohabit or dwell by any means or in any manner whatsoevet' with him or her. 1.15. MUTUAL RIlMIlIAfiUIJ/3 Except as other wise expressly provided in this Agreement, Husband and Wife each do hereby mutually r.emise, release I quitcldm and forever discharge the other and the estate of such other I for, all time to come, and for all purposes whatsoever, of and from the following I .1). a, .c.ltI.iJnfl....&JillJ)st Property or "Btatol Any and all riijht, title, interest and/or claims in or against the otIJe~' rarty/ the pl:'operty (including income and gain from property het'eafter accruing) of the other or against the estate of such other / of wlH\tevet' nature and wheresoeve): situate, which he or she now has or at any time hereafter may have against such other party/ the estate of such other party or the property of the other party or any part thereof I' whether arising out of any former acts, contracts/ engagements or liapilities of such other. p, Dower, Curt~ey! Widows Rightsl Any and all rights and claims of dower or curtsey/ or claims in the nature of dower or curtsey 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, c, Life, T~me ConveY'~1 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 (I) tl}e Commonwealth of Pennsylvania, (ii) State, Commonwealth or Territory of the United States/ or (iii) any other countrYt .10. " , d. Mariti'\l I~lqht/JI Any rights which either pnrty may have or at any t 1me hereaftex' have for past, present or future support or maintenance, aLimony, ill imony pendente lite, counsel fees, equitable distribution, costs or expenses, whether arising as a result of the marital relation or otherwise. e. j3.reach F.xceDt iOlll 'rhe foregoing shall not apply to all 1;'ights and agreements and obligations of whatsoever nature arising or which may arise under this Agreement or for the breach of any ,I provision thereof. It is the intention of HUllband and Wife to gi ve to each other by the execution of this Agreement a, full, complete and general release with respect to any and all property of any kind ox' 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 ox' which may arise under this Agreement or for the breach of any provisions thereof. 1.16. WAtVmR OR MOD~'~CATION TO BE IN WR~~ING No modification or waivElr oF. any of the terms hereof shall be val~d unless in writing 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. -II- ( 'Jllj It, 1.17 . WJ'J:J1/lL CQ.QfERA'l'IQt] Each pat'ty shall, at any, time and from time to time heroafter, take any and all steps and execute, aclmowledge a~ld deliver to the other party, any and all further inatruments and/or document that the other party may reasonaply require for the lJurpose of giving full. force and effect to the provisions of thLs ~greement. 1.18. ~GR.i~~NT BJt1D;~q O~ ~i~Ra This I\greement shall be binding and shall 'inure to the penefit of the parties hereto and their. respectIve heirs, exec~tors, administrators, successors and assigns. 1.19. I~'l'.QRATION: This I\greement constitutes the entIre understanding of the parties and supersedes any and all pdor agreements and negotiations between them. There are no representations or warranties other than those expressly set forth herein. 1.20. 9'l'HE~ DOCUNiNTA~ION , Wife and Husband covenant and agr.ee that they wIll forthwith (and within at least twenty (20) days after demand therefor),' execute any and all wri tten instruments, assignments, releases, satisfactions, deeds, notes, stock certi f Icates, or such other .12. ')1 , I!-I,' I writing~ as may be neceB~ary or deBitable for the proper effect:uation of thil!l Agree/lIent, and/ot- as their re~pective .counsel shall mutually agree, should be so executed in order to carry out fully and effectively the terms of thi~ Agreement, 1.21. NO WAJV~~ OF P~'~~L~ This Agreement shall remain in full force and effect unless and until terminated under and pur~uant 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 subsequent default of the same or similar nature, nor shall it be construed as a waiver of strict performance of any other obligations herein. 1.22. BRmA~H If for. any reason either Husband or Wife fails to perform his or her obligations owed to or for the benefit of the other party and/or otherwise breaches the terms of this Agreemer)t, then the other party shall have the following rights and remedies, all of' which shall be deemed to be cumulative and not in the alternative, unless said cumulative effect would have an inconsistent result or would result in a windfall of the other partYI - 13 - ,I I iI 'I" '" "1 IL ,epeci Hc [lorl:orm<lllCO I 'rhe dght to spoci fic performance of the terms of thi~l I\greomont, in which event the non-breaching party shall be reimbursed for all reo1lsonable attorney I s fees and costs incurred liS the resul t of said breach and in bringing the action for specif ic pe~'formance. b. llaJnagesl The right to damages arising out of breach of the terms of this Agreement, which damages shall include reimbu~'sement of all attorney I S fees and costs ipcurred as the ,I I I , I result of the breach and in pringing the damage action. c. Divorce code Remedies I The right to all remedies set forth in Section 3502 (e) of tho Pennsylvania Divorce Code, 23 PA. , I I C.S.I\. 3502(e), and any additional rights and remedies that may hereafter be enacted by virtue of the amendment of said statute or replacement thereof by any other similar lawsi d. Qther Remedies I Any other remedies provided for in law Or in equity. 1123. ~AW OF P~~$JLVANI~APPLIaABLm This Agreement shall be construed in accordance with the laws " I of the commonwealth of Pennsylvania. .14. 1.24. fJ'IlJV'llJ~i\J!~H~T't r t: any te~'m, condItion, d,llH/o 0/: pr:bvil1ion Qf thirJ 1\9room~lrlt , shall pe determinod Ot: declarod to be void at" invalid In law o~' otherwise, then only that te~'m, condItion dallrJO or pr.ovision shall pe stricl<en trom this I\g~'eGment and in all other respects this Asreement shull remain valid and continllQ in full fo~'ce, effect and operr1tion. r..ikewise, the failure of eIther party to Illeet his or her obligations under this I\greement under anyone or more of the paragraphs hereunder, with the exception of tho satisfaction of a condit ion ,precedent, shall in no way avoid or ,11 ter the remaining opligations of the parties. 1.25. ~mADINGS NQ~ ~ART OF ~GRm~~mNT Any headings preceding the text of the several paragraphs and, l!lubparagJ:"aphs he'!:'eof, are in/Jerted solely for convenie'nQe of reference and shall not oon/Jtitllte a part of this Agreement nor shall they affect its meaning, construction or effect. 1.26. INOOMm T~X ~TTmRS With reapect to income tax matters regarding the parties the following shall applYI ai, Prior Returns I The parties have heretofore filed joint . 15. fede~al and state returns. Both parties agree that in the I' , it I ,( ~ event any deficiency in federal, state or local income tax is proposed, or any assessment of any such tax is made againet , either of them, each will indemnify and hold barmlees the other from and against any loss or liability for any such tax def iciency or assessment therewith. Such tax, interest, penalty or expense shall be paid solely and entirely by the individual who is finally determined to be the cause of the misrepresentations or failure to disclose the nature and extent of his or her separate income on the aforesaid joint returns. b. CUrrent Returns I The parties shall determine whether it is in their joint best interest to file joint or individual Federal and State Incol\1e tax returns for the calendar year 1999 and if a future agreement is reached to file a joint return the parties shall equally share in the costs of preparing that return, any refunds or any taxes owed as the result thereof. 1.27. PRESERVATION OF R~CQ~DS i Each party Will keep and preserve for a period of four (4) years from the date of their divorce all financial records relating to the marital estate, and each par~y will allow the other party .16. access to thollO l"O(!Ol'Un .:w may bo nJiluclIlably IlfJCIHHl.:lI:Y Cl'om time to timo. I I 1.28. ~.~ 9' GIVING ~O~~QR Any notice required by this I\gre~lment shall be sent to a party at the address listed herein, or such other address as that party may from time to time designate. 1~29. I"~CT or ~~CONCI~tA~;ON This Agreement shall remain in full for.ce and ef fect even if the parties reconcile, cohabit as husband and wife or otherwise, or attempt a reconciliation. 1'his Agreement shall continue in full force and effect and there shall be no modification or waiver of any of the terms her.eof unless the parties, in writing, signed by both parties, execute a statement declaring this Agreement or any term or this Agreement to be null and void. THIS SPACE INTENTIONALLY LEFT BLANK -)7 - " " SECTION II 2.01. FI~A~ ~9VITABL~ PI~~RIPQTIQ~ 0' ~~OP~~TY The parties agree that the division of all property and debts set forth in this Agreement J.s equitable and in the event an action in divorce has peen or is hereafter commenced, poth parties waive and relinquish the right to divide and distripute their assets and II depts in any manner not consistent with the terms set forth herein and fur.ther waive and relinquish the right to have the court equitably divide and distribute their marital assets and depts. It is further the intent, understanding and agreement of the parties that this Agreement is a full, final, complete and equitable property division. 2.02. AFTmR-ACQUIR~D PRO~mRTY Bach of the parties shall. hereafter own and enjoy, independently of any claim or right of the other, all property, tangible or intangible, real, personal or mixed, acquired by him or her, since Apri~ 18, 1999, the date of the parties' marital 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 .18. though he at' /lho wore unl1lolrded and each pnrty llC1t'eby wuivos, releases, t'e/loUl1ces and foreve~' abandons any right, titlu, interest and claim in and to said after acquIred property of the other party pursuant to the terms of this Paragraph. ,. 2.03. Wb~VE~ Qf ~NijIRIT~~Cm Each of the parties hereto does specifically waive, release, renounce and forever abandon any right, tit le, interest and claim, if any, either party may have in and to any inheritance of any ldnd or nature whatsoever previously, or in the future, received by the other party. 2.04. pmRSQ~AL PROPE~TY Husband and Wife do hereby acknowledge that they have previously divided their tangible personal prop~rty including, but without limitation, to tbe following I jewelry, clothes, furniture, furnishings I rugs, carpets I household equipment and appliances, tools, pictures, books, works of art and other personal property ("the Personal Property"). Hereafter Wife agrees that all of the Personal Property in the possession of Husband shall be the sole and separate property of Husband, and Husband agrees that all of the Personal Property in the possession of Wife shall be the sole and separate property of Wife. -Il). The parties do hereby specifically waive, releaqa, renounce and foravet" abandon whatever claims, if any, he or she may have with respect to the Personal Property which shall become the sole and separate property of the other. 2.05. vmijIGHm~, ~O~TS AnD Tijm LIKm With respect to the vehicles, boats, snowmobiles, motorcycles and the li)~e owned by one or both of the parties, or the trade in value thereof, identified and values on Exhibit "A", incorporated by reference hareto, (lithe Vehicles") if the Vehicles have bF.len , sold or traded in prior to the date of this Agreement, the parties agree as followsl a. WHo' s Vehicles I It is acknowledged that Wife has no Vehicle. b. Husband's Vehiclesl the 1995 Chevrolet Suburban shall be the Bole and separate property of Husband, subject to the following terms and conditions I 1. Husband's shall make arrangements with pwayne Peimler to finance the vehicle through him in an amount of, $20,000.00 or sllch other <\mount as may be agreeable to i! Dwayne Peimler and to Advanta, who holds the lien on the said vehicle, so as to release the purchase 'pripe mortgage entered against the parties' real estate I' , .20. 'I doscdi:Jod In I'anlgraph 2,6 flQ that PWuyno poimlor elm purchase that roal estato, 2. I f Husband cannot como to torms on this f inllnce and release with Pwayne Poimler IInd l\dvanta, than HUlilband Iilhall turn the yehicle bacl~ to l\dvanta as a reposselilsion so that it may be sold and the pt'oceeds applied to the l\dvanta rlilal estate mortgage balance. c, IdentIf iaation I Ident if ication 'of a Vehicle herein shai'l include not only the Vehicle, but also the sale or trade-in value thereof if it had been sold or traded, in prior to the date of this l\greement, d. Transfell of Titles t The titles to the Vehicles shall be executed by the parties, if appropriate, for ef fectuating transfer as herein provided on the date of execution of this Agreement and said executed titles shall be delivered to the' proper party on the distribution date. e. Ii11e and Power of AttorneYt For purposes of this Paragraph the te:rm "title" shall be deemed to include "pOWer of attorney" if ~he title to the Vehicle is unavailable due to financing arrangements or otherwise, f. ,I,iens I , In the event any Vehicle is subj ect to a lien or .21. 'I I ~ encumbt'ance the party receiving the Vehiclf! as his or her property shall ta)<e it subject to said lien and/or encumbrance and shall be solely responsible therefor and said party furthet" agrees to indemnify, protect and save the other party harmlesEl from said lien or encumbrance. g. tlai~1 Each of the parties hereto does specifically waive, release, renounce and forever abandon whatever right, title and interest they may have in the Vehicles that shall' become the sole a~d separate property of the other party pursuant to the terms of this Paragraph. 2.06. REAIJ E~TATlIl The parties are the owners of a certain tract of improved real estate known and numbered as 3824 Mountain Road, Mechanicsburg, PA 17055 ("the Real Estate") having an approximate value of $82,000,00 and which is encumbered with a mortgage oWE!d to 1'" Unioh Bank, having an approximate balance of $27,000,00, a mortgage owed to Advant~, having an approximate balance of $38,000,00, and a mortgage owed to Household Finance, having an approximate balance of $6,500.00 ("the Mortgages"). The parties are in default under the Mortgages and foreclosure action(s) have been instituted. The parties further acknowledge that there is no equity in the Real .22. i"":- J;:state that ilil Iilllbjact to distribution. 'rhe partielil further aclmowledge that they have agreed with Dwayne peimler fOl" him to purchase the Real ~:state fOl" certain reduced balances owed on the Mortgages as may bEl agreeable to l)im and the lElnders of the Mortgages and that upon said sale, Wife shall be renting a portion of the Property from Dwayne paimler. 'l'herefore in consideration of the premises and with respect to the Real Estata and the Mortgages the parties agree as followsl \1) " a. ~9nveyancel Supject to approval by the holders of the Mortgages, the parties shall make, execute and deliver all documents in the usual form conveying, transferring and granting to pwayne Deimler all of their right, title and interest in and to the Real Estate, and the parties agrees that they specifically waive, release, renounce and forever abandons all their right, title and interest therein. The deed of conveyance therefore shall be executed by the parties at the signing of this Agreement and held in escrow by Wife's attorney's pending the financing arrangements being made by Dwayne D~imler and the holders of the Mortgages, at which time I , the deed shall be delivered to Dwayne Deimler for recordation. b. Li~n8 and EncumPrancesl The said conveyance shall be subject .23. ,J '.,1 I to all lien/3 and enclllllbrancQs including, but not limited to, the lien of the Mortgages ilnd furt!l(H;' shall be under and subject to any covenants and restrictions of record. c. Foreclosure Salol In the event Dwayne Deimler is unable to secure the refinancing and release, then the Real Estate shall be sold at foreclosure sa III and the parties shall remain liable for any deficiency alllounts owed on the Mortgages after I , i :j I that sale. 2.07. ~~TIR~~mNT AND P~NSIO~ ~LA~~ Each qf the parties does specifically wa,iye, release, renounce and forever abandon all of their right, title, interest or claim, whatever it may be, in any Pension 'Plan, Retirement Plan, IRA Account, Profit Sharing Plan, 401-K Plan, Keogh Plan, Stock Plan, Tax Deferred Savings Plan, any employee benefit plan and/or other retirement type plans of the other party, whether acquired through said party I s employment or otherwise, (lithe Retirement Plans"). ijereafter the Retirement plf.Ins snall become the sole and separate property of the party in whose name or through whose employment, said plan or account is held or carried. If either party withdraws any sums from the Retirement Plans distributed to him or her pursuant to the terms of this Paragraph, that party shall be .24. liahle fo~' any and all ,taxos and penalties repulting frOll1 that withdrawal. 'l'he foregoing notwitlwtandirlg the parties acknowledge and represent that lleltho~' party had any retirement Plan in existence as of the date of thei r mad talpeparat ion which WOl,lld be subject to equitahle distrihution hetween them. 2.Q8. B~~ ~Cco~e/s~oa~/LIFm ;~~~~~Nai The parties aclmowledge and agree that they have previously divided to theIr mutual satisfaction all of thF.!ir hanl< accounts, certificates of deposit, honds, sharGs of stock, investment plans and life insurance cash value ("the Accounts"). Hereafter Wife agrees that all the Accounts held in the name of Husband shall hecome the sole and separate property of Husband, and Hushand ag,reee that all the Accounts held in the name of Wife shall hecome , th~ sole and separate property of Wife. 8ach of the parties does specifically waive, release, renounce and forever abandon whate~er right, title, inberest or claim, he or she may have in the Accounts that are to become the sole and separate property of the othe~' pursuant to the terms hereof. 2.Q9. T~X P~OV;SIONS The parties helieve and agree that the division of property made to be made pursuant to the terms of this Agreement is a . 2S . ! .1 I " I" 'I non-taxable division of propet'ty between (:o-ownors rather than a taxable sale or exchange of such pt'opert y. E:ach party J;lromises not to take any position with respf.!ct to the adjusted basis of the propflrty assigned to him or her or with respect to any other issuo which is inconsistent with the terms of this paragraph on hIs or her aJ;lplicable federal or state income tax returns. 2.10. ~IFE'~ DEBTS Wife represents and wat'rants to Husband that since the parties' marital separation she has not contracted or incurred any debt or liability for which Husband or his estate might be responsible. Wife further represents and warrants to Husband that she will not contract or incur any debt or liability after t;he, execution of this ~greement for which Husband or his estate might be responsible. Wife shall indemnify and save Husband harmless from any and all claims or demands made against him by reason of debts or obligations incurred by her. 2.11. "U~BAND'S P~ijT~ ,Husband represents and warrants to Wi fe that since tha, parties' marital separation he has not contracted or incurred any debt or liability for whIch Wife or her estate might be .2(, . I ';1,1', ..Ii ,Iii '\'1 ,>i) responsible. Husband fUl'thel' repl'esonts and wal'rants to Wife that he will not contract Ol' incur any debt or liability after the execution of this Agl'eement fOl' which Wi fo Ol' her estate mig/'lt be responsible. Husband shall indemnify and save Wife harmless from any and all claims or demands made agaInst her by reason of debts or obligations incurred by hIm. 2.12. ~~If~~ D~BT During the course of the marriage, Husband and Wife have incurred certain pills and obligations and have amassed a variety of debts ("the Marital Pebts"), and it is acknowledged that except for the Mortgages set forth in Paragraph 2.06 herein, all marital dePts were previously discharged in a bankruptcy proceeding filed jointly by the parties. The foregoing not with standing the parties agree as folloWSJ a. Wife's DebtsJ Wife shall pe solely responsible for the any and all other debts, liabilities, obligations, loans, credit card accounts, and the like illcurred in Wife's sole name, and not otherwise provided for herein. b. Husband' s Debts I Husband shall be solely responsible for any and all other debts, liabilIties, obligations, loans, credit card accounts, and the like incurred In Husband's sole name .27. " I" I .28. and not otherwise provided for. herein. c. rndemnH icat ion I Sach party sgrefls to hold the other harmless from any and all liability which may arise from the aforesaid bills which pUt'suant to the terms herein are not the iesponsibility of the other party. d. CaQcellption of Joint Debtfil Any joint debt shall be canceled so that neither party can mal<e any further charges thereurlder, and if said charges are made in violation of this Agreement, then the party incurring said charge shall immediately repay the same. e. N'on-Disclosed l.labilitYI Any liability not disclosed in this Agreement shall be the sole responsibility of the party who has incurred or may hereafter incur it, and the party incurring or having incurred said debt shall pay it as it becomes due and payable. f. No Further Joint Debt I From the date of this Agreement, each party shall only use those credit card accounts or incur such further obligations for which that party is individually and solely liable and the parties shall cooperate in closing any remaining aCCOlll1ts which provide for joint liability.. .' 2.13. IHQIHn;'~Cb1~QN Any party assuming an obligation J;lursllant to the terms of this Agreement shall indemnify, protect and hold the other party harmless from and against all any and all liability thereunder, inclUding, but not limited to, any attorney's feen and costs incurred by the other party as the result of defending against the obl,igation and/or enforcing the provisions of this indemnification. THIS SPACE INTENTIOijALLY LEFT BLANK . .29. . I I' ; , " , I '\'1"'_\ , </i"i ,i", "~I ':'''''j'' '..' :,,',-;,1 I ",,'~j:"iirll '1"iI'I,C/if , '" k'llI /1"!;"fj'J r ,', ;,'1\".,' ; ", c)'!:\ I ' " \',1"\ ,\ ':\l~ ", (illl~ t 1"l",~I\U' I " SECTION III o ~TOD~ , CHII,P ..mlFPOR'1', MA1lJ'H ~MBYRAHQ~. EPUCATIONA~ E,XP~ijB~~ ANP- 1NCOM~~X PROVI~~O~ I ! , ~. I ',. 3.01. Wb~V~~ 0' COVNSIL '~.S The parties hereto agree and do hereby waive any right and/or claim they may have, both now and in the future, against the other for counsel fees, costs and expenses. 3.02. ~IMOwY AND SV~~QRT With respect to alimony, alimony pendente lite, and spousal support, the parties agree as follows I " a. A.EI..I The existing Alimony Pendente Lite Order dated March 13, 2000 in the amount of $100.00 per week in the APL action docketed to No. 97-6139 CIVIL TERM, pacses No. 868101247 shall remain in effect until the date of the entry of the decree in .30. divorce between the parties. Upon the entry of the divorce decree that order shall terminate, at which time the order shall be converted to an alimony order in the above captioned case. Any remaining arrears on the spousal support order ,I shall be added to the alimony order. b. 1\limony I Husband shall pay Wife alimony in accordance with the following terms and conditions I 1. Commencing with the date the divorce de,cree is entered between the parties and continuing thereafter until October 4, 2001, or until the death of either party or Wife's remarriage, whichever shall first occur, Husband shall pay Wi~e alimony in the an~unt of $100.00 per wee~. 2. I f any arrears exist as of the date Husband's alimony obl igation terminates, then, Husband shall pay those arrears at the rate of $100.00 per ~eek until paid in ,I I i I full . 3. The alimony shall be reported by Wife as inccme on her applicable income tax returns and deductible by Husband on his applicable income tax returns. For all purposes, I', including income tax treatment purposes, the payments 'I shall be deemed to be a periodic payment of alimony between Husband and Wife associated with a dissolution of their marriage and pursuant to a written marital ,'I agreement. 4. The alimony provisions set forth in this Paragraph shall 'I .31. "I , , not be uubjllL:l: to IJludl,I1<1oltluII by I.illl court or the rnl:tiu~1 ilbul/nl: II\Ul:Uill. wrl UOII! 1111I:I/ollIllJlll:, c, PaYII\entl IIllullalld llillll.l pitY tilo II/UI'ollil101 ill.llllony olnd spOllsal llu/;1port obli\Jut~h)'HI I;Q IIlId I;hr'>lll/il I)UII\'/lJl: Ie: Holi'lUona Office of CI1lI\Pot:land Counl:y, P^ JllIl,'llllillll. t;1l II C:lJlI/:l: ol:d,n: previously entoL'lld or' to bu lJlIl:IIl'od /"11' l:htll JlilYlIIlllIl: ilnd Ilus~and' swages shall bo attnched t,~ \junl'lllll:y l:hlltpaYII\'JIlt, 3.03. UI~uTU I~~YJANgJ '1'11', Collowlll'J uili.\ll ilpply l:LH'JiII:dl.l'I'1 honlt)l .insurance I 1'1, 11001 ~ tb Illullrill!.IJ.lL,.LJJ.:..JlI.lJJl.IJJUI Ihu'IJlllld IIhnll cont .inue to provide healtll inIlUrnll'J<J ')I:)Vor,l\Jo J:OI' Wl.fo, nt tile current level of cover'age Ullt II ()otql)[lj.' 'I, ~Ol)(), On Oul;oPOI: 4, 2000, Huspand's obli~jnt; lOll Le,) pl'QvldlJ lln,II,l:h Illlllll'/IUCO for Wife shall , , \:erlllilli'lto i.\lld WHo uhnl.L bn nnl:.ltlod t() oloct continued Cobra covet'ag'j lllldol' lIulIlJ,lnd'll lJlllploYlllont poLley .in accordance with and IJubjllut \;0 J'llCltn:,ll t'l11.11ll nnd t.'o\julnt.ionlJ provided that: he or Ilho uhllll 1)1) /lol,l.Ily bu 1:'Wpollu.lble for the payment of the ooat!! thor'of')I', b, He[\ltlL,.lllllJ.U:i.Ul.iJU~IJ.IJ,\lJ..lJJJ!.lllJ.;.il..ti!;ml Any party required to have health 1nlJUr,'llluo ':OVOI',IIJU Oil tho othor party shall provide the othol.' pal.'ty wl.th ,\11. ,jQc:\lll\ollti\Uon pertairting to the insurance .:\2. including, put not limIted to, medical insurance cards, benefit booklets, claim supmission forms and all atatements pertaining to the determination of insurance coverage as to each claim made thereunder. THIS SPACE INTENTIONALLY LEFT BLANK .33. ~~....",..,j ;h", SECTION IV il I BY SIaNI~a TaIS Aa~.B~.NT, BAcn PARTY ACKNOwumPGms HAVING ~Bf\D ANP UNPIIl~STOOD THill BNTI~1ll AG~lllml'llllNT I /\NO mACH PARTY ACMOWlIBoaBS TIfAT '/.'1I1ll P~OVISIONS OF TaIIl AG~Ill111l'lmNT SJlAlIlI BB AS BI~INa QPON Talll PARTIlllS AS IF Tamy wm~lll ORDlll~mD BY TaB COU~T A''/.'.~ A rUlIlI a.A~ING. IN WITNJIlSS WJlJIlRIlOF, tl\(J parties hereto have set their hands and HllUls tlw d"y ilUd YOln' first above written. WI'L'NJ;;SI3I 'j 12 ) ",., I .,._._ fLM\Ij' :J7~!.!-"-.__ ~ ( SSAL) ~.,J 'J ~_9-(s"L1 , 0 ALe W. SHJ;;PHE D 'I' .34. COMMONWE:Al:m-l OF PE:NNSYINAl'lIA SS. COUNTY OF CUMSERLAND On this the t.tr~day of G~ , 2000, pefore me the undersigned officer, J;lersonal1~eared; AMY C. SHEPHE:RD, known to me (or satisfactorily proven) to be the person whQse name is sltbscribed 1,:0 the within Agreement, and aclmowledged that AMY C. SHE:PHE:RD executed the same for the purposes therein contained. IN WITNESS WHERE:OF, I hereunto set my hand and notarial seal. ~( Expires~ COMMONWEAL'rH OF PE:NNSYLVANIA COUl'/TY OF Cld()4/'; r " t~ /J_ r') On this the ;)7 lday of ;..yJHX , 2000 I before me the undersigned officer, personally appeared, DONALD W. SHEPHERD, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement, and acknowledged that PONALD W. SHEPHERD executed the same for the purposes therein contained. SS. Notarllllll.1ll C Dlanalol S' RldCllffJ'lola~PUbllo I H oro, Curnb. Coo MV 3WmmlaalOO E~pl",. j ,t 1.1fo~4 ~,P8Mlytl1llla~anoMt/'l0Ill/ifl. IN WI'I'NESS WHEREOF, I have hereunto set my hand and notarial seal. My - 35 . ..AllY STAMis 3" ~orMYW: HARRIS URG 0 UP IN COU IY MY COMMIS I N IRE sm. , ,I IN nm COURT Of" COMMON I'L,r:MJ OF CUMUWU,MP COlIN'I'Y I pr:NNSYLNAN LA AMY C, SHE:J?Hr:Hp, Plaint i ft NO, 9'1-61.39 CIVIL, 'rJ;;r~M v, CIVIl, I\C'l'ION - I.,flW IN DIVORCE: PONI\I.,D W, SHJ;:J?IIE:RP, Pefendant PllMC I P/.\ 0[0' 'I'RI\NSM IT R/.\CORD To the Pl'othonotary I Trancmit the record, togother with tha following infol'mat(on, to the court for Bntry of a divorcB decreel 1. Ground for divoroe, Irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. pate of tiling and manner of .ervioe of the oomplaint, pate of filing of Complaint I 11/5/97 Manner of cervice of Complaint I Acceptance of Service Date of Service of Complaint I 11/10/97 by Attorney a. b, c. 3. Pate of e~eoution of the affidavit of oon.ent required by Seotion 3301 (0) of the Pivoroe OOde, a. Plaintiff I 4/26/00 b, Defendant I 4/27/00 QJl Pate of exeoution of the Plaintiff'e affidavit required by Seotion 3301(d) of the Pivoroe Oode and date of eervioe of the Plaintiff'. 3301 (d) affi~avit upon tile Pefendantl a. Date of execution I n/a b. Date of filingl n/a c, Date of aervice, nla .. Related oleim. pending, No iccuea are pending. All iaauea have been reaolved purauant to the Marriag~ settlement Agreement between the partiea dated April 20, 2000 which Agreement is to be incorporated into but not merged with the Divoroe Decree. II. Pate and mallner of .ervioe of the Notioe of Intention to Ule Praeoipe tq Tranemit Reoord, a oopy of whioh i. attaohed, if the deoree ie to be entered under Seotion 3301(d) (1) (i) of the Pivoroe Oode. a, Date of Service In/a b. Manner of Service I n/a QJl Pate Waiver of Notioe in Seotion 3301(0) Pivoroe was filed' with the Prothonotary I a, Plaintiff'a Waiverl 5/~2/00 b. Defendant'a Waiverl 5/22/00 "I "(, / RADCLI' " ESQUIRE indle Road Camp IIi 11, l1A 17011 Supreme Court 10 " 32112 Phonol (717) 737-0100 (" ", 'I _,I' "r"",','" ,,"' '" I, " " 1,- r, !"":" '.;'.ill """/ . ",,' , , i Il~' , ....;!;'1111i j"~ i, :i:;::'Ji 'I , if V If , I' I I,', 'I' , I I' " I 1]\, I'i' ;, , , 1;1. ~ I, I (~ ) , .,., , j :") (,: ) ';1 '. i." ,~ _,J ,,-,I,? I'J " ,)7 ) , 11'11 1,\ -d Il :_,1"1' ,"I' , )~. ~J . ,,) t'. ~ I J::- .. ,.... '''' , ,1 . VR. IN TIll': tOllllT (W ('OMM(,N I'/./';A/I ()II' ClIl\'Jlll':IU,ANII ('()llN'I'V, l'I':NNSn,VANIA 'I NO, If 'I. I. (H (Jt~~.~ '71,," ~ AMY C. SHBPHB~P, l'llll,,111T pO~A~P W. S~B~"BRP, 1)~'~IIdll,,1 CIVIl. AC'I'ION -I,AW IN UJVOlln: ~O'l'JU;-T!UmEEl'H>..A~D_(.'.LAlM IUCIJIIIi Y IIU hllve heen slIed III COlin, I f you wls', 10 defend IIgllln"llhe cllllms scllimh In Ihe lilllowlng PllgcS, YI'1I mUSllllke prlllnplllc\lon, You lire wumcd Ihul If you lblllo dll so, Ihe ellSc mllY prllcccd wltholll YIIU IInd U decree III dl VI)ree or UlllJ\lhllenl /lIUY be enlered IIgulllsl you hy thc CI)url. ^ JlIdgll)e'll mllY IIlso be enlcrcd 1I!!""lSI Yl/U 1'1)1' "IlY olher CllljJll or ,'ellcr rellllcNled I" these pllpers hy Ihe PllllnlHr, yml I)lOY ll)se moncy or pruperly 01' I)ther rights lmpl)l'llllllll) you.lllcludlng cuslody or vlsllll\lollll/,your chlldre'l, Whell the !!rl)Ullds n)r dlvlJl'ce IIn: Illdlglllllcs ur lrrelrlevllblc brellkdnwll or Ihe Il)llrJ'lllge, Yl)\l I)JIlY rellllesl Il)lIrrlllgc cl"IIlselln!!, ^ IIsl uf mOrl'lllge cuu"selurs Is llyulIllble llllhe Ornce ()flhe I'l'olhollulllry ul: om~1! I" ll'l! 1"'IIlhl/lllllnrY C"llIhl!rln"d CO""ly Clmrt Ill/""I! O'IC Crl"rlllli""c /lllunrc ('lIrURle, l'cm,"ylvnlllll, 1701.' IF YOl! no NOT FIJ.l( A CJ.^,M FOR ^,"MONV, 1>IVISION or PROPERTV. I,A WYHRS FHJiS, OR liXI'I(NSHS. llliFORli A UIVORCH OR ANNULMENT IS , ClMNTEJ>, YOl! MA Y I,osli '1'1 IIi HI(II IT TO CLAIM ANY OF TIJESE, YOU SIlOl1l.J) TAKli TIllS PMlilt TO YOIJlt LAWYliR Nt' ()NclI, IF YOll DO NOT IJA vn A LA WYIiR OR CANNOT M'F<IIm ON/,i, (]O TO. OR TELEPIIONE TIlE OFFIcE SliT FORTI Illlil.OW TO FIND OUT Willi/Hi YOl! ('AN (JET LliCJAL 11m,!', Crlurl AtlllIh~I".r"h'r C1Hllhl!rlnnd Cr/llJlly CI,urlllou"e 110urlh r"llmr Olll! Courlhou"c NllnArc ('IIl'II"le,I'A .70p-.HK? 717-240-(,200 /' MY C. SH2paJ!lllp, I IN 'l"'fl (!Olllt'l' oJ" COMMON Jl~,FlI\S l'J,I\UI'l'JIi'Ii' I ClJM,mIH,!\N1'I ClJIIN'l'Y, JlfJNNflY~NflNll\ I Vll. I '1/ ~ t.IJ1 ell V H. I\Q\:Icm t 'r/.~ J)Q~"J,P .,. SJJl'lPJJJ!lRP, I /lflli'mmWl' I HI 'HVQIlCPI cq~II'>J.1\I ti'rJ!U>IVOllCg COIlN'I' I I\NO ~O" oomen the Jllnintl~~, Py I\ttoPIOY .7/1MI'lS M. /lI\C/I, nnd nverll an folloWlll I' 1. Jllninl:i~~ in AMY C. Slllill'H2~0 , who ou~renl:ly rell~den at _.3824 Ml:. View Road, Meohanionburg, P/\ 17055. 2. Defendanl: ill ourrently ~ellidoll DQNI\J.rP Jh_ SHEPHERO , who al:n!n q~ prinoosQ Blvd., MeQhaniosburq. 1'/\ 17055. 3. Jllai>>l:U~ and Defendant have peen honn fide ~elJidetll:n in the COlllmonweall:h ~or at least six months immedial:ely previous to the fi 1111'./ of this Complaint. 4. 'he Plainl:iff and pe~endant were marri~d 0>> 6-9-90 5. 'l'here 'lave bee'l llCl p~ior ao!:lone of divoroe or anllulmenl: between l:he parl:iee. 6. The marriage is irretrievably broken. 7. plainl:iff lIas been ndvised of the availability of ooun~eling and alao l:le Plaintiff may have the right to tequest that the Court relJuil:e the parl:lell tCl llllrl:ioipate in ooutlseling, and afl:er being nO advised, Plainl:iff does not deaire ' OOUlIae ling. \, ( "",mHJ'Q/ll$r l'lnlnlUf r01luoal:a I:hll COlII:1: 1:0 ,00,II:O/." 11 I1IH'/."OO hI III vo/."oe. I 'I I PYI ~d J,. '!If. /S:..c.-< . o1~Hl!fJ H. "ACII ~tto""ley J.n. "0. lB7~7 35~ Sout) sportlng 11111 ~oad He,o'lanloah1u:g, l'~ 17055 7n-737.~033 Vl'lRIF 1CA'l'I91i I verlfy that the stal:omonts ~ade ln thia co~plalnt a/."o truo and oorrect. I understand thaI: false statementa he/."oin mado are sub'eot to pennll:los of fO VA. C.S. S4904, relating to unswo/:'n falsification 1:0 aul:horities. fJ?/1JJ f 1.'--1 ['I, N .;( f' . SHBPHB~[) _LR.~1(J - 2.~ PI\'l'f: '/'" , ii' (} ~ 'il 'II q!~l ~ j, c:: (~'II , 'l' 6i~I' tJ1 " ,.J ,:.,f". :'I,~ : '..' .-l1 ,"~('I :x l;~ )~'C, r..., ~1' >r.. .. ~'" ~ -j ~ n. (.J ~~ ~ ..., ""-.0 '-.l\~ @) . .. .... ..... h) '-t ~ ," , ,\ ~ ~ ~ t'~ r-w I 'I." lJIANJ! 0, IIAl)CI.IP1' l-HB T1l1NlJ~J! 110M) CAMI> 1111.1" 1>'\ 171)11 ~1I0NJ! (717) 7l7.1)l1~) PAX (717) <m.1)/\,)7 IlJNlllll i.,-,"dl". ,I ' AMY C. SllC:PllJi:l,P, l'lilintiff V. PONAL,P W. SHE:Pll~:RP, Pefendant IN THE: COUR'l' or.' cOMMON L)Lj~:I\S or.' CUMn~:rUjI\NO COUNTY, l'r,NNSY[NANIA NO. 97-6139 CIVIL TBRM CIVrr. I\C'rroN - ['/"W IN PIVORC~; ~~PTANaE or SERVICE I, the undersigned attorney for the Pefendant in the above oaptioned aotion, being duly authorized by said Pefendant, hereby acoept se/:vice of the Complaint filed in the above captioned matter on Novembe/: 5, 1997. " Patel November 1~ 1997 \ -((f) .--' f) ''2 '-'-'~.. ''4~~ William T. Smith, ~6quire Attorney for the Defendant I d I I ( -, , " . ''II 1":1 i,.' .\ ,I , .' \ .. '.:,"1 \ ./ ~ "" ..1 , I m^Nl! 0, RMlCLlJ'l' lH81'RINDLn ROM) cM.1l' lULl., M 17t)~ I (717)m.I)\I~) , 1-" . IN 'I'll);: COUH'l' OF COMMON ~'r,E:AS OL" CUMI1E:I<LI\l'IP COUNTY, PE:NNSYINANIA AMY C. sHE;N!E:HLJ, L'lainti f f NO, 97-6139 CIVIL rBRM CIVIL ACTION - LAW IN DIVORCE; V, DONALD \'/. SH8PJiE;RD, Defendant AfF.~PAV~T Q, CONS~ 1. A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on November 5, 1997 and served on Noven~er 10, 1997 ~y Acc~ptance of Service sisned by Defendant's attorney. The marriage of Plai.ntiff, and Defendant is j,rretrievably brolten and ninety (90) days have elapsed from the date of filing and service of the Complaint. 2. 3. I consent to the entry of a final Decree in Divorce after service of. notice of intention to request entry of the decree. 'I I verify that the statements made in this Affidavit are true and correct. I undepstand that false statements herein are made SUbject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. bated I IJ ..;;;t,.. ()() " '1'1' " 1 ,. ~) '. , ,j '" " , , , , '. " . .) '] ",. i j I '.J I , , 'I ,. . -I .<1 '\ ,P ~~"""'rj," '."I,r , " I I I I I "I ( PI^Nl! 0, MlJCI.II'I' lol481'RINDl./! RO^I) cM.lP 111I.1., I'^ 171)11 (717) 7)74111~) . . IN TilE: COURT OF COMMON PLBAS OF CUMBE;RLI\l'ID COUNTY, PBNNSYLVI\l'IIA AMY C. SIlBPHBRPl 'laintJ, f f NO, 97-6139 CIVIL TE:RM CIVIL ACTION - LAW IN DIVORCE V. DONALD W, SHBPHERD, Defendant 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 wUI be sent to me immediately after it is filed with the Prothonotary, I verify that the statements made in this Waiver 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, Dated, '1...;)~~()() or ,i' jl '-' ..... ..~.. ", 0,,' C'. f I I.'.J 'I ", I'.) 1'..1 " , , "J " , I',') , .fl J ., " , ;l'li I " '" J. " t)j PI^NI! II, MJJCI.II'I' l"'181'RINlJLl! ROM> eM.WIIII.I.. I'^ 171H1 (7171 7l7-l)ll~) IN 'I'm: COUI<'L' ell" COMMON Pl,E:AS ot" CUMI:1J!;JU,AND COUN'I'Y, P);:NNSYINANIA AMY C, SIIE:PJIE:I<D, Plaintiff NO, 97-6139 CIVIL TBRM CIVIL AC'l'ION - LAW IN DIVORCE: V, DONALD w, SHli:PllE:RD, Defendant AffXRAVIT OE-QO~S~NT 1, A Complaint in Divorce under Section 3301 (c) of the Divorce Code was filed on November 5, 1997 and served on November 10, 1997 by Acceptance of Service signed by Defendant's attorney, 2, The marriage of Plaintiff and Defendant ill irretrievably broken and ninety (90) days have elapsed h'om the date of f J.ling and aervice of the complaint, 3, I consent to the entry of a final Decree in Divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this Affidavit are true , and correct. I understand that false statements herein are made subject to the penalties of 18 Pa,C.B. Section 4904 relating to unsworn falsification to authorities, Datedl ~/-,ji'J- (J () ~~"el ,~/' ~~4~Y? . ALD W. SH ," I I' . " , 1 , .l !,/ I, " 'I , ': ,'I j'-) j' ~ ,1.'-] 1(1') /.1 , I ., )11 ,IJ (:<;) :_~! , ,I', , I ~: X 'I i , '\' liJ,. I '.,; Ii it,; , d': ," . ru ' "; "11'~:~IHI~1f , ' y I I I I DJANB O. RAJJCLlI'I' lH8 '/'RINlJI.I! ROAO C^MI'IIIl.l.. I'^ 171)11 (717) 7.17'()II~) ( , i.I'l; .. ',. , " IN Tim COUR'L' (ll" COMMON P1J~:AH of CUMl1E:HLAND COUNTY, PE:NNBY1NI\l'II A AMY C, SII8PHE;RD, Plaintiff NO, ~7-GI39 CIVIL TBI<M CIVtr, ACTION . l,AW IN DIVORCB v, DONALD w, Sll8PlmRD, Defendant 1. I consent to the entry of a final decree in divorce without notice, 2, I understand that I may lose rights concerning al imony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted, 3, I understand that I wi 11 not be divorced unt il a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this Waiver are true and t';:orrect. 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, Datedl I";-IJI)- tJl; ,~/)1e~V 0, S~tz'-.t9 NALD W. sJDlll ~" ,.., , , I' " " .. . I' . l,iT ,") '" . , ; ',/ " 1 , , , 1") , r' 'J , . , 'J ';1 'II , . , " " .. ! I~J : ~ I 'I , . .. . " '. ' , " ., I' .. " , 'r! , i I ;ii! " " " " , i1li , ~ i ,~ i , , , I.. 'in ,I . ,/' "-'J \,J , , l 'I , I " n , ' -:j '"1,:," , ~ ,II ,. "-I (.' 1:":11 ., . , .1--,. , "; ('j I..~ , . I ) ,,. " .. "J ." , .1 : ~ i -., " ,..... ,1_.' . , ,.,.'.. . -, \ ~ '_r' .-' -"I J>/MI! II, RM>etlJ'I' J.I~8 '1'IIINJJ~1! 110^1J eAMl' IIII.L, l'^ 17011 (717) 7J7-I1I1XI ~...... J I . i' I ., ,I, IN 'l'1I~: COUH'L' OF COMMON PL,E:MJ OF CUMUI..:IlI,AND COUN'l'Y, PE:NNSYINANIA AMY c. SlII':Pllli:llD, ~lLaintlff v, NO. 9'1-('U9 CLVIl, 'l'~:IlM C 1 V Il, AC'L'lON - l,AW DIVOIlCE: DONAW W, SIl"~PIIE:llD, Defendant NOTICIlI YOU HAVS BE:E:N SUlW IN COURT, If YOll 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 calle may proceed \~ithout you and a decree of divorce or annulment may be entered against you by the court, A judgment may also be entered against you for any other claim or rel ief 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 divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling, A list of marriage counselors .is available in the Office of the Prothonotary at the Cumberland County Court.house, Carlisle, J?ennsyl vania, II!' YOU DO NOT FILE: A CLAIM FOR ALIMONY, DIVISION OF PROJ?ERTY, COUNSSL FEES OR EXPSNSES BE:FORE /I'HS FINAL DECRE:B OF DIVORCE OR ANNULMSNT IS GRANTED, YOU MAY LOSE THS RIGHT TO CLAIM ANY OF THSM, YOU SHOULD TAKS THIS J?APSR '1'.0 YOUR LAWYSR AT ONCE, IF YOU DO NOT HA VS A LAWYER OR CANNOT AFFORD ONS, GO TO OR TE:L&:PHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHSRE YOU CAN GET LEGAL HELP. OUMSIlIRLAND COUNTY SAR ASSOCIATION 2 LISIlIRTY AVIlINt11l CARLISLIlI, PA 17013 (717) 249-3166 P/ANl! O. MDCLJPI' J<<81'R1NDLn RoAD CAMI' HILL, I'^ 171)11 (717Im.fIUX) .'11",1" IN 'L'fll!: calm'L' 01" COMMON I'L,E:/\S OF CUMUE:lUJAND COUNTY, PE:NNSYL,vAN rA AMY C, SHE:PHWW, PlaintIff v, NO, 97-6139 CIVIL TERM CIVIL ACTION - LAW DIVORCE: DONALP \II. SlIBPlIJ;;RP, Pefendant AMmNDmD_~OMPLAINT this ~j-cfay of JljJ1e, 1999, comes the Plaintiff, AMY by her attorney, DIME: Q, 'RADCLIFF, E:SQtJIRE, and Complqint in Pi vorce of which the following is a AND NOW, C. SHEPHERD, files this statement I CQUNT-~l_~Iy'Qaam 1, Tne Plaintiff is AMY C, SHEPHE:RD, an adult individual residing at 3824 Mountain View Road, Mechanicsburg, PA 17055, 2, The Defendant is DONALD W, SHEPHBRD, an adult individual residing at 224 Bella Vista Prive, Marysville, PA, 3, Plaintiff and/or Defendant have been bona fide residents of the Commonwealth for at least six (6) months previous to the' filing of this Complaint, 4, Plaintiff and Defendant were married on June 9, 1990 at Newberry town, PA, 5.' There have been no prior actions of divorce or annulment between the parties. 6. Plaintiff has been advised of the availability of counseling and the right to request that the Cqurt require the parties, to participate in counseling, .2. ....... , .. ..... . PJANU 0, ItAJ>CLlfl' JokB TltlNPLU ROM> eA~1JI UIl,L,I'^ 17111l f717l7l7.11Il~) 7, 'I'hll Defendant is not a Illempe~' of the I\t'med Services of the United States or any of its Allies, 8, 'l'he Plaintiff avers that the grounds on which the action is pased arel a, 'l'hat the marriage ill in'etrieva~ly brol<en, Or in the alternative, b, That the parties are now living separate and apart, and at the appropriate time, Plaintiff will submit an Affidavit alleging that the parties have lived separate and apart for at least two (2) years and that the marriage is irretrievably broken. Or in the alternative, c. That Defendant has offered such indignities to the person of the Plaintiff, the innocent and injured spouse, as to , render her condition intolerable and life burdenSOme, and that this action, is not collusive. WHEREFORE, Plaintiff requesti9 this ~[onoraple Court to enter a decree in divorce., divorcing the Plaintiff and Defendant. C.o.tlli'r II I IIlQUITABLm DIIl'1'RIijUTION 9. Paragraphs 1 through B are incorporated by reference hereto as fully as though the same were set forth at length. 10. Plaintiff and Defendant have acquired property and debts, both real and personal, during their marriage from June 9, 1,990 until April 18, 1999, the date of separation, all of which are "marital property" or "marital debts', 11, Plaintiff and/or Defendant have acquired, prior to .3. ,;\ P,^NU O. RAPCLII'J' 3....8 TRINlll.n ROM> ' eM.1V Illl.L/I'^ 17011 (717) 7374)1I~) Ii' marriage qr ~uboequent thereto, "non-marital property" which hall increallud in villue since the date of. marriage ilnd/oJ: subsequent to itll acqui~itioll durin<:j the maJ:riage, which increase in vaiue is "marital property", 12, Plaintiff and Defendant have been unable to a<:jree all to an equitable division of ~aid property and debt~ as of tho date of the filing ()f this Complaint, WHEREFORE:, equitably divide Plaintiff reque~ts this Honorablo Court to all marital property and debts of the parties, C'011N'l'....llll_ALlKOHLP.llllmIllmJIL,Ll'l'JlI.._ALlKOl/l'. 13, Paragraphs 1 through 12 are incorporated by reference hereto as fully all though the same were set forth at length, 14, Plaintiff lac~s sufficient property to provide fOJ: her reasonable means and is unable to support herself through appropriate employment, 15, Plaintiff requires reasonable support to'adequately maintain herself in accordance with the standard of living established during the marriage, WHEREFORE, Plaintiff requests this Honorable Court to enter an award of alimony pendente lite until final hearing and heJ:eafter enter an award of alimony permanently thereafter, .4. -:, I " I , i I I I r:' UI^Nl! O. RAllCl.1F/' JoI.I81'RINlJI.l! ROAO e^Ml'IIIU.. P^ 171)11 (717) 737.1)1l~) COUNT~1.v.I..-C.OImaIL-'ila 16, ~aragraphs 1 through 15 are incorporated by reference nereto as fully as though the same were set forth at length, 17, Plaintiff has employed Diane O. Radcli f f, !Esquire, as coun,sel but is unable to pay the nAcessary and reasonable attorney's fees for said counsel, 18, The Plaintiff is in need of hiring various experts to appraise the parties' marital asset/,J am;! does not have the funds to pay the necessary and reasonable fees, WHEREFORE, Plaintiff requests this Honorable Court to enter an award of interim counsel fees, costs and expenses and to order such additional sums hereafter as may be deemed necessary and appropriate and at final hearing to further award such additional counsel fees, costs and expenses as are deemed necessary and appropriate, Respectfully submitted, ( ( , 1 e oad PA 17011 urt IP n 32112 Phone I (717) 737-0100 Faxl (717) 975-0697 .5- OI^Nl! O. R^DeLIPP 3418 1'"I/'jllln IIOAP eM.tp IIILL, I'^ 171HI (717) 737.I)ll~1 <>'''1 VlllRIFICI\TION AMY C, SHEPHE:RD verifies that the statements made in this Complaint are tJ:Ue and conect, f\MY C, SHEPHERD understands that false statements herein ,lre made sul;lj act to the penalties of ),8 Pa,C,S, Section 4904, relating to unsworn falsification to authorities, ~Nl 'I , . (j . , ' . ,.,,.. ~... ~ .. ..- _.. PIMll! 0, R^Pe~IJ'P J.l.181'RINDLl! /lllM eAt-ll' IIll.I., pA 17011 (?I?) 7J7.11l1~1 ANO NOW, thi~J _.;:h1.:::A::-1j~~___, 1999, I, DIANE q. f<ADCI,IJ?F, E:SQUlRE:, hereby ce~-tify that I have this day served a copy of the foregoing document upon the following named person, by mailing same by first class mail, postage prepaid, addressed as follows I Willi~ T. Smit~, isquire 3747 Perry street ijarrisburij, PA 17111 Ponald W. Sqepherd 224 Bella Vista ~oad "arysville, PA 17063. Respectfully submitted, .S~JJ 'i dle Road , P ". 17011 Phone! (717) 737-0100 Fax! (717) 975-0695 Supreme Court ID # 32112 .7. I DlANl! 0, RAlleLII'1' HIH TR1NDJ.I! RI>^I> eM.tI'II11.L,I'AI71111 (7171737.1IIlMI .. IN TilE; CQUR'I' 01,' COMMON PI,EAS 01;' CUMBER1JANP COUNTY, PENNSYI.,vAN!A AMY C, SHEPIlJ;:RD plq.intiff v, NO, 97-6139 CIVIL TERM CIVIL ACTION - LAW DIVORCE DONALD W, SHJ;:PHE:RD, Defendant: PJUl.JllCIllJLl"-OILmmRLOLAP.RJlli\RANCliI TO THE PROTHONOTARY OU THE SAID COURT, Please enter the appearance of Diane Q, R,adcliff, E:squire, alii attorney for the Amy C, Shepherd, the Plaintiff in the a):>ove captioned matter, Respectfully submitted, /'" I ;j ,I,ll. I, I , n ',,'I .1 I l.~) , , r I 'TJI I ." " rY:1 , . " jo-"'" P,} " ",'I, " ) (",) , lJ!, ~ I '"j i~:; i' ".1 ,.\.\ -. ) '.' " . , , , I'll ,J'\ .. I ~ J '.1,') , 'Jl !~i '-. III ", . , I I, , i r,,! 'A-, 'i'; L\ Ij OI^NB O. MDeLlFP JoI481'R/NOLB RIMD CAMP lilLI" l'^ 17~1I (717) 737.dll~) IN '1'111> COUH'I' OF COMMON PL,E:AS Of' CUMOJ.\IUJI\ND COUN'l'Y, PE:NNSY1NT\NIA AMY C, SllE:E'HERD, E'laintiff v. NO. 97-6139 CIVIL TERM CIVIL ACTION . LAW DIVORCE DONALD w, SHEPHERD!: Defendan i~~GI~l-TO-H~lHDBAW-~i-~ppmARAijQI TO THE PROTHONOTARY OF 'rHE SAID COURT I ",lease withdraW the apJ;>earance of James M, Bach, Esquire, as attorney for the Amy C, Shepher.d, the Plaintiff in the above captioned matter. Respectfully submitted, II' , , 2 South Sporting Hill Road echanicsburg, PA 17055 Supreme Ct. ID # 18727 ; ", /, }I/,i! C.\ '(I I."; ~ " 1.1.1 II "'/ ~ :1 , '" 'I ':1.' ". /1 " I, I\l i.'J I'i I'.' ';-':1 (! ~i ' .., " II :, ) : _.' 'lit .. I ) .~ , , I)... .,:-, ~i.1 . IN 'I'IIE: COUR'L' OF COMMON P1,~;AS 01;' CUMl'lE:RLI/\NO COUNTY, L'E:NNSYI,vANIA AMY C, SlllWlmRP, I?laintif f v, NO, 97-6139 CIVIL 'L'RRM DONALD W, SHE:I?f!E:RP, Defendant CIVIIJ ACTION - 1,AW PIVORCE: ERAE.C.lga...:m.J2RQCESILIU-liYJl/.MA-I'../l.U12ER.IS To the prothonotarY'1 Kindly allow the Plaintif f, Amy C, Shepherd, to proceed in forma p,aupeds, I, Diane Q, Radcliff, Rsquire, attorney for the party proceeding in forma pauperis, certify that I believe the party is unable to pay tne costs and that I am providing fre~ legal services to the party, The party's affidavit showing inability to pay the costs of litigation is attached hereto. Respectfully submitted, F, ESQUIRE Tr Ie Road Camp Hill, PA 17011 Phone I (717) 737-0100 Faxl (717) 975-0695 Supreme Court ID N 32112 Attorney for Plaintiff ( II ,:r ' V' ""'i,dl"" "I ',",' '1'i',"I" ,:",; ,"",,'; 1\ $ ~ j;f .j i;\~ I C1J "~ ~ \~ ~8 - ~' - " ~ r:- c,.) I ;1 .' , .' IN '!'HE: cOUR'r OJ!' COMMON PLEAS OJ!' CtJMI3Ji:RLAND COUN'l'Y, PENNSYLVANIA AMY C. SHJi:PHERD I Plaintiff v. NO, 97"6139 CIVIL TERM OONALO W, SHEPHERD, De fendant CIVIL ACTION " LAW DIVORCE " A.E.EIDAYJ:.'LltL.6.Ul'E.OIIT-O~ PETI.'llON F-OILJ"EAV.E_:rrLl2ll.O~D-1!L1i'.QBMJL2AII2BBI5 1, I am the Plaintiff in the above matter and becau13e of my financial condition am unable to pay the fees and costs of prosecuting I defending, or appealil/g the action or pl:'oceeding, 2, I am unable to obtain funds from anyone I including my fam.uy and associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and corl:'ect. a, Persoqal Information I 1. Name I -A1Jlll-C.....-.eihepheJ:.d 2, Address I 3824 Mt.ViAW Rd., Mechanicsburg. PA 170~~ 3 . Social Security Number I 20!i"56-~Q02 b. j;lmployme~Tl If YOIl are prABElI1tly emploYEld) I 1. Employer I -upAmployed 2 . Addreas I 3, Salary or wages per monthl 4, Type of workl " I ',1'1;, " l.:'- ".fl 'V ',: :~:':d " ,'j' " -, ,", "\" 'fl""'I, \f)\~r& I ~ , Dat~ of last employment I -J.~~ 5-______.______ None c, l?rJ.ol.:-__Empl.oYlllfll1t_-Inf.orma.ti.o11 (H you are presently unemployed) I 2. Salary or wages per month I __fJ.5...oJLp.er_ho.ur__, _-ca.uh~_____ 3. 'I'ype of work I d , O.th.e L.ltj.C.ollW._I'/iJ:.hin-:J:h.e.._l?tUl.L.'l'w.el.v.e-M.ontha 1, Business or profession I --N.ope 2, Other s,el f -employment! _-N.ollll- 3, Interest I 4. Dividends I --N.ope 5. Pension and annuities I --N.onfl 6, social Security benefitsl -lione 7, Support payments! -$J,OO.OO per month-- B, Disability payments I -liope 9, Unemployment compensation and supplemental benefitsl -lioP e 3.0, Workman's c,ompensation! -liope 11, Public Assistance I $413.00 food Atamp~ 12, Otherl 4o.00/wk. Bapysitting e , Q.th.er.....c.ont.x:ib.uti.onliLt o. houa.eho.l d A lIpport 1. Spollse's Name I N/a If your spouse is employed, state 2, E;mp 1 oye r I -.N/.A , " 3, Salary or wages per monthl-N/.A ',." " ;I , ',"""" 4, 'I'ype ot work, __l:I/.A--____....___..._.___.._______ 5. Contributions from children 1..None f . .l'r.c1l.erq_..own.e.d...Jd.ea.c.dl:11L.J1ruLv.alu.ell 1, Cashl .__Heme 2 . Checldng Account I _$.3..6....00 3, Savings Account I NoQe 4. Certificatea of Deposit I None.. 5, Real Estate (including home) I no equity hoJlllLJ.n " ~J:e.clJ:l.e.w:.e. 7, Stoclts I None 8 , J30nda I Nope 9. Otherl Nope 10, Motor vehicle I Make Nope Year , I Value Amount owed g. De.bJ:Il...aruL.o.bliqati.ons IVAlueLI 1.. Mortgase I 2, Rentl I 3, Loana I ,I a. .Ell b, 1L- --- c, UHF 4, Other Monthly Expenses I a, Eh.ollfL b, Ele.ctr~Gity/~aa__ fJ.l2..O..O-~.Q.(Lp.eL.JllOnth- N/A $661. 35 fJ.6.3JLJl6 fJ.l.6.a....o 0 ~ah -. 19ge..apd 1999 Taxee "Il, ". ".1 h , /;?.e.\:.e.onll..-de/,'l.endenr._.up,Qll_Y.Qu.__f.o.r._llUPP.ol:t. I Spouse's Name I r ---..-........--. . children, if anYI Name I IDa~\'b~6..~Lt-.kJ1~ y- Age I Name ,l.uk n &-kl4.t;,u-- Age I Name I Jgw r', LJ- ~ /..-Ju......-V' Age I _IJ___ I~ --J. L/_.__ Namel Age I 4. I understand that I have a continuing obligation to inform the court of improvement in my financial circumstances which would permit me to pay the costs incurred herein, .I' 5, I verify that the statements made in this 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 unaworn falsification to authorities, Datel '7-2-19 C! f) I' 'm ~ 11 I: ~ .-, III"'J :'fj~ ~: I !XI (J ~., ~ i1;o ~ i~~ ~p - ,~I - .. ~ ..~ "" ~ ,0> ", 'I," . . , , . . , " i~!r ~~i~ h~! , , ,~) I,", , I , . " .,. ,.." " " . I' '" I " , r . I , ,. "I "' i '(I f JJ .,. , I I 1'1 j". " " :1' A , :i\ AMV C,Il".:I'm:ltl) pllllmUJ'l/'clllhmcr Vii, IN 'I'm: C()LlIt'I' ()~. CIIMM()N I'~,MIi (W CLlMII.:ltl,AN/) C()LlN'I'V. I'.:NNIiVI.vANIA CIVil. AC'I"()N . l)/V()ltCi: NO. ')7.MJ'1 ('IVII. n:RM IN mV()RC~ lIll11 2H,76H l'>>mHII H~H'I" 247 ORI)EI~ 011 COUR'[ I)()NA"I) W.lilli:I'm:RU, DCfclldulll/llclpondcll1 ^~lP NOW, II!II 14'" dllY of Il,Jy, 1'1'1'1, IIPIl/1 cOllfildcnlllon of Ihc IIl1l1Chcd PClllloll for A1hllOllY Pcndclllc lll~ Imdlor collllfiCJ fccI,lIlsllcrcby dlrcclcd Ihlll Ihc purllcfi IIl1d Ihclr rCfipccllvc cOllnlclllppcllr bcfllrc /!J....6~ 1111 AUIII/.I1~. IlIlIlIulllltJO A,M, ror II cOllfllrCncc, III P N, HlIllOVCr SI" CllrUifc. rA 17l) 13, IIncr whle'l Il!c COllfcrencc olllc~r mllY rccommc,ld IIIIIIU" Ordcr ror Alimony l'clldelllc lAIC be emercd, YOU Ure f\ml!cr ordercd 10 brlnLllo Ihe eO'lrcrcllcc: (I) Illrue cIIPy oryonr 1Il0il reccllIl'cdernf Income TII~ RelulII,lncllIdhlLl W.2'fi Ufi filcd (2) your puy II1Ibfi for Il!c prceedlnLl IIx (6) mO'")ls (3) Ihc Inclllllc IInd l!~pclIse SllIlcmcUlnllllchcd 10 Ihls IIrder, eOlllpJclcd liS reqnlred by RnJe 1'1I11.11I1 (4) verHlelllloll ofe'llld Cllrc e~Jl<:nscfi (~) prooforlllcdlclIl covcrnLle which you mllY hnve, or IIII1Y huvc UVllllllble 10 you ll' yon fnll 10 IIPJl<:lIr for Ihe eOllrercllcc or brlllLl IlIe rcqulred docnlllcllls, Ihe Conrt mllY Illne U Wllrlilnl for your nrrest. Copies Mllllcd 7.14-911Iq: pcUiloncr /lespo/ldclll PillllC RodclilT, l!sq, Wlllhllll SlIllth, l!lq, llY HIE COU/lT, (jcllrgc E, HolTcr, Prcsldclll JndLle .( J .l:Y,( :1. OUle orOrdcr: ~u!tium j' W;J.-~hllddUY'~:'lfe:n:c ~n:e::'U VOU HAVE THE RIGHT TO A LAWVER, WIIO MAV ATTF-ND THE CONFERENCE AND REPRESENT YOU, 111 YOU 1)0 NOT IIAVE A l-AWVER OR CANNOT AnORD ONE, GO TO OR TE"EPHONE TilE OI1I1ICE SET FORTH BELOW TO FIND OUT WHERE VOU MAV GET I.EGA" tIEl-P. CUMBl!Ill-ANO COUNTY flAil ASSOCIATJON HIllERTY A VI:!, . CAIll-JSl.l!, PENNSY/..VANJ^ J711I~ . (717)24').31()() ." / Ii , ( , ,. II H~'l~.l ' , I ,t\ .\',',\!'''.:I i\'I"I',,, \1\1'1'II\l)!:',~i~r3(\ ~\}\r,i"/I C" I\' ,'" l',I.'nD c~ 1'1 i,I'\ ': \ "III\' Gf) OtANI! O. RMCLII'I' )448 TRINllLl! JIO^1) CAMP III1.L,/'A 17011 (717) 737.l)lm YOUR HAVE: '!'HE: RIOHT '1'0 A l,AWYER, WHO MAY A'r'l'li:ND THE: CONI?E~ENCE; /\NO /<E:PRE:SE:N'L' YOU, IE' YOU DO NOT HAVE A LAWn/< OR CANNO'!, 1\1?\10/<D ONE:, 00 '1'0 OR 'I'E1,li:L'lIONE 'I'HE: Ol"F!CE SET I?ORTH 13E~,OW TO f'INO OU'1' WHERE YOU MA Y OE'I' LE:OAT., HE1,P, CUMB~R~AnP COVWTY BAR A~SOCIATIO~ 2 ~IB~~TY AV~~~ CAR~IS~mt PA 17013 (717) 249.3166 AMER:U:AN~UII.'l'lLDISAJllLLT.lE.lLAC.T_.Qf-1iJ.~,o. 'I'he Court of Common Pleas of Cumberland County ill required by law to comply with the Americans with Disabilities Act of 1990, For informatioH about accessible facilities and reasona~le accommodations available to disabled individuals having business before the court, please contact our office, All arrangements mUst be made at least 72 hOU1:S prior to any hearing or busine/3p before the court, You must attend the scheduled conference or hearing. BY OR FOR THE COURT I - 2 . ;' IlI^NB 0, MDC1.1FF 3014l1'RINDLB 1l0^1l C^,"~ WI.L, ~^ 171)11 (717) 737.1)101) IN nm COUH'l' O/!, COMMON PLE;AS Or-' CUM13ERLI\ND COUNTY, PE:NNSYLVANIA AMY c, SHE:PlIE:RDl: Plain. if. f v, NO, 97-6139 CIVIL TERM CIVIr, I\C'I'ION - LI\W DIVORCE DONALD W. SlIE:PHE:RD, Defendant. RiJ __P.m'l'I'l'I.OILr.olLALlHONY._PitmJllN'J:JLJ:II'l'L. AmLIN'J:ERILC.O.tmSJllldl~JllJllS_AmL.o.oS!!S TO 'nlE: HONORABLE:, THE: JUDGES Or-' SAID COURT I II 1INJ) NOW, this _11:+ day Of~19991 comes the Petitioner, Amy C, Shepherd, who files the this Petition for Alimony Pendent Lite and Interim Counsel Fees and Costs and respectfully represents that: 1. The Petitioner, residing at 3824 Amy C, Mountain Shepherd, View Road, is an adult individual Mechanicsburg, PA 17055. 2. The Respondent, Donald W, Shepherd, is an adult indivic,lual residing at 224 Sella Vista Road, Marysville, PA 17053, 3, The Petitioner and Respondent were married on June 9, 1990, at Newberry town, PA and separated on April 18, 1999. 4. The Respondent has not sufficiently provided support for the Petitioner. 5. The Petitioner is not on a financial par with the Respondent in prosecuting and/or defending this Divorce action and is unable to support herself in accordance with the standard of - 3 - ,.-f , I " llIANI! 0; RAlleL1FI' 3014. TRINDI.I! RO^1l , CAMP IlILL,,,^ 111)11 (117) 737.1Hm liv.lng e/3tabliahed dudng the marriage and to pay her ant ic.lpated reasonable attorney's fees and costs incurred or to be incurred in the lIf.!.thin divorce act'ion, 6, The within action was instituted by the f.lling of a D.lvorce Complaint by the Petit ioner on November 5, 1997, 7, The parties initially separated on October 27, 1997 and remained separated until they reconciled on January 11, 1998, 'l'hat reconciliation lasted until their final separation on April 18, 1999 when the Respondent vacated the marital home. 8, Concurrently with the filing of this Petition the Petitioner is filing an Amended Complaint in Divorce in which she has raised claims for divorce, equitaple diatribution, alimony pendente lite, alimony, counsel fees and coats, 9. A bac)tground information sheet pertaining to these claims has or will be filed with The Domestic Relations Office as required by Local Ru~es of Court, 10. The amount asked by the Petitioner for Alimony Pendente Lite , is the maximum amount provided for under the guidelines. 11. The amount of Interim Counsel Fees and Costs requested by the Petitioner is $2,000.00, WHEREPORE, Petitioner prays that the Court enter an Order I a. Requiring the Respondent tq pay the Petitioner Alimony, - 4 - llIANI! O. MDCLIFF 30148 TR/NDLn ROAD CAMp lIILL, P^ 171)11 (7/717374H1M) " ' Pendente Lite ill the maximum amount provided for by law under the state support guidelinua, including, but not limited to, base support, medical insurance, and contribution to the three 1)10rtgage paymentsl b, Requiring the Respondent to provide medical support for the Petitioner, c, Requiring the Respondent to pay a reasonable amount towards the Petitioner's Interim Counsel fees and Costs, Respectfully ~ , 448 Tri dle Road , J?A 17011 Supreme Court ID It 32112 Phone I (717) 737-0100 fax I (717) 975-0695 Attorney for Petitioner - 5 - " " I, '. , , DIAN~ O. RADCLiff 3448 TR/NDtn ROAD cAMP IIILL, fA 17011 (717) 1l7.1)1l~) VIIIRIFICATION I vedfy that the statements made in this I?etition for Alimony Pendent Lite and Interim counsel Fees and Costs are true and correct, I understand that false statelllentl/ herein are made subject to the penalties of 18 l?a,C,S, Section '1904, relating to unsworn falsification to authorities, . 6 - I " P'^Nllll. Ri\IlCLIJ'I' 34481'RINDJ.1! /U>^J> CMJI'IJIU., l'^ 171)1 I (1171 7J7-llil~) CIlRT1.F1.CATIIl..oILBIIlRV1..ClS AND NOW, this.a?+- day of _.__~..___ ._, 1999, 1, DIANE; a. RADCLIFF, E:SQUIHE, hereby certify that I have thiB day served a cop}<' of the fQl'egoing document upon the f.ollowing nlllned person, by l11ai ling same by first claBB mail, pomtage prepaid, addressed as follows I William T. smith, Esquire 3747 Derry Street Harrisburg, PA 17111 Donald W. shepherd 224 Bella Vi$ta ~oad MarYsville, PA 17053. Respectfully submitted, . RADCLIFF, ESQUIR Tr ndle Road l,PA17011 Phone I (717) 737-0100 FaXI (717) 975-0695 Supreme Court ID n 32112 - 7 - ,\ , . . " , . , , .. " in~ ~r!p ;[il " I n .:') ., ! "'J ; ~I ' I. I. , f.l~ , ; . , " .. ..-,', '. I ,1':' -. , " ~', . I:~' ::! ", I.' ,~ '"' I.. \ r~; ("', i',i , " ;;J '. '" ~ ), ~-. " :., ::, ~J.' '" ;.I} -<; N -, ~ONA~J) W. !l1l~JlU~Jll). Ocrcllda,II/Jtcs/,,>/ldcm NO, 97 . ~IJ9 CIVIL T~Jl~ IN J)JVOJlC~ /)JlII Z~,74~ Pllc~1III ~~~II~U~7 VB. IN 'J'm: cOUJll' lW C()~MON P~':AS OJl CU~lJ':JlLANJ) COUNTY, JI.:NNSY~VANIA CIVIL AcnON . J)JVOJlC~ , A~Y c, SII~PII~JlI) /llul.IlIIJ'/PellllllllCr WWJ:6 QF CQUBI wm~J!t Of Bt:sqni"ULtJ!.W~ AND NOW, Ihls 23" dllY IIr Augusl, 199'>, UJlQ,1 CIIlI8ldcraJlII,1 IIr Ihc PCllllulI rur AII/IIulIY Pc,ldelllc Lltc Illld/ur cuuII5cl Ices, It Is hereby dlreclcd Illal Ihc pllrtlcs Illld Ihclr respecJlve cUllllsel appellr bcrure R.I. $hllddllY UII ,ht,lb" 1. IlI1/9 ,It IhQO A,~, rUI' a cU,lrcrellce, III 13 N, HOlIuvFr SI" Curllslc, pA 171'l3,uftcr Which Ihll cII'lfercllce IIfflccr /IIUY rcell/ll/llc'ld Iholllll Order rllr AII/IIUIIY pClldcmc Lllc be cmered. YOU arc I\Irthcr urdercd III brlllg III Ihe CUllrcrellcc: 0) Illrnc Cllpy ufYllllr '111151 recelll J1cdc,"llllcuJIle Tllx Jtclum,llIcludl/ll! W.2'. as nJcd (2) Yllur PIlY 51ubs for Ihc preccdhlgsl~ (6) /JIo/lllls , (3) lhe IlIco/llc aud J:!~pQ'15e SllllC/llelllllllllchcd 10 Ihls IIrdcr, cO/llplctcd as rel}Ulrcd by /\ulc 1910,llt' H) vcrlnculhm or child Cllre expeuscs (5) prour IIr /IIedleol Cllvcrllgc which YIIIl /II1l)' hllVC, IIr /IIIlY hllve Ilvullllble III YIIU JJ1 YIIII foil III Ilppe1lr rllr Ihc CII'lrcrellce IIr brllllllhc rCl}lllrcd dIlCU/IIC'IIS, Ihe Cllun "lilY Issue u warralll rllr YIIllr arresl. ' lilY TH/! COUIlT, Oeur~e J:!. HIIlTcr, Prcslde/ll Judgc MIlII cuplcs UII -;,).'J in Iu: OUIO ur Order: .Au~"sl 23. 1999 ' /1 ;/ '-.j t<.+~. U(J \ - . , R, J, S ddllY. CII/lrOre,lce Officor YOU HAVE THE IUGUT TO A LAWVEIl, WHO MAY ATTEND TUE CONFERENCE AND /lEPRESENT YOU, IF YOU DO NOT HAVE A LAWVER OR CANNOT AFFORD ON~, GO TO OR TEJ.,EJlHONE T"E OFFICE S~T FORTU ..ELOW TO FIND OUT WHERE YOU MA V GET LE,GAL UELP. Pcllllu/ler < /tOspll/ldelll Pla,lc ltadclllT, /!Sl}, WIIHu/II omlth, J:!sl}. / ,,. CUMB/!RLAND COUNTY BAR ASSOCIATION 2 LlIil/!RTY AVE. CARLISL/!, P/!NNSYLNANIA 17013 (717) 24').3166 .., ,." Ii c-} 'II '11 "I \4: r~~ "" I -r~i'J ~l ' 'i') Q; q-~ ~2i' I I'l 'I!.! Uj.' Ui 'jl' ~(..~ t.:~,; "'I! -" ':'1 ::.: h. "_"l. ,t,_, !f;c.:.i toJ ' :,111 l,.. .. .;',-: '-',1' l:" ~':l ?( ~- 1,11 ( 'II tbe Court or COlJllllOII '''tIllS I)r CUMBJ!R/.AND Cl)l)/lly, re"'IIIY'VlllJlll DOMJ!b...'IC RJ!I,A'J',ONllllllC'J'ION PIKhull'f ) OIl4:k~1 Numbc:r 97-6139 CIVI" ) ) PACSIlS CIIli~ NUIldx:r 86810~~.7 11>26, 7~8 ) ) Olhtr SIKI~ 10 NUIllIx:r lIMY SHBI'HBllD YK, DONALD W. SHBPHBllD O~ft/IllKIlI Order AND NOW 10 WIL, Lhls OC'l'OllBR ., 1999 It Is hereby Ordered thaH THB AllOVB ~I'TIONBD P~TITION FOR ALIMONY PBNDBNTB ~ITB IS DBNIBD, PlnRSU~ TO AN AC'l'IVlI OllDBR OF SPOUSAL SUPPORT UNDBR DOCI<BT NIlMBBR 302 S 1999 AND PACSBS CASB NIlMBBR 82S1009S~, I ,V" BY THE COURTI r \ DROI RJ Sh:ldday I".~,,/:,",i.~f'l' I'lI'!"ft lIel l'etltlo.Jner ~ Ree\lo.Jl1dent /0 -u ,(( '1 ' DL'Il1e Radcliff, EBq. ~ WLIILdm SmIth. Esq. Servke Type M >' l .- WeBley OIIlY"..' I JUDGE Flinn oa.ool Wllrk~r 10 210015 (1 1,1) () , . \11 " " ,., , "1':: , J '1 r. l . , ~ < "I .1, I ~. j. " , I'; , i:) .~.. . " I';" r~' I .11 /~,.:' , " " I s; ~.~: c.:.' ," " ,) :"J tJ ~., ", ..... (' AMV c, SII~JlII~lll), I JlJuhl\llT/Pell\loner I I VS, I I I l)()NALl) W, SII~PH~RD, I DefenduJlllJletpllJldelll I I IN nu: C()lIR'I' QF C()MMQN PLMS ()F ClIM"~RI,ANl) C()lIN'l'V, P"NNSYLV ANIA CIVIL ACl'I()N - mV()RCE N(), 91-4IJ'I CIVIL TERM IN l)lVQRCE DRfI 2",74" p~e.e~ "6"IQI247 QBJU:B QJi' C9U81 AND NOW. l'llt 26'h day or Junuury. 2l)l)I), up<m cO,ltlderullon Qf lhe uuuched Pelhloll ror AlImo'IY pende/lle Llle undlor cQuIl/lel reet, III. hereby dlr~led IhUllho p"rtle. IIn1 Ihelr retpcetlvo coun.elllppeur before lYJl~on F~brllurw 1/1,1(/(/(/", 91(//IA,~ ror a cO'lrerence, III 13 N, Hlllloyer 131" Cllrllt/e, fA 17l)P, uner which Ihe eonrerenee ome~r mlly recommend Ihllllln Order ror Alimony pendonlc Lhe be elllered, YOU ure n/rther ordered to b"nglo Ihe cOllferencei Ol 1I1/1le coPy oryour 11I0.1 rece/n pederlll hlcome 'J'II~ Rclul')l, IlIeludlng W.2'. u. ijled (2) your puy .Iub. for Ihe precedlng.lll ((,) mO'llh. (3) Iho IlIcomo und l!~peJl.e Sluteme,n uuuched 10 Ihl. order, completed II. required by Rule 1911).111.' (4) ver!neu\lo'l ofe/llld CUre e~pcn.e. (5) prooror medlc~l covcruge which you Jlllly huvc, or mllY hllye IIvlIlIllbJe 10 you IF you full 10 IIppcur ror the cO/lrcrellce or hrlng lhe required dllCumem., Ihe Court JllIIY I.tue II wllrrlllll ror your 11/10.1, '1./ fJ/;! 'I . Dille orOrder: Junuary 26. ~l)l)l) ,,' ~':'~I:lItuy~ ~;I:e:I;:e ~;ce:(r VOU HAYI THI RIGHTTO A LAWVER, WHO MAV ATTt:ND Till CON'~RINCE AND RlpRJ:SENT VOU, I' YOll DO NOT HAVE A LAwVER OR CANNOT A~'ORD ONE, GO TO OR TILEpHONE '1'111 OFFICE SET 'ORTII bELOW '1'0 'INIl OUT WIIERE VOl) MA V GET LEGAL HELP. '_""'rO~ tot)' .' ',\)',');':,,;:'. .;', PelltlO'ler < Rctp<mde/Il Plnno ~dcIIlT, I:tqulrc WllllulII Smith, F.tqulrc llY THE COURT, Oeorge 1:. HolTer, Prctldenl Judge CUMllERLAND COUNTY llAR ASSOCIATION 2 LIlll!RTY AVE, CARl..ISLE, PENNSYLVANIA 171))3 ('/17) 24'1-3161\ . I~!~t J\/I\ 1, 1,::NN:),j ALt,1 i ):' ',I "I I . ..~I'm9 (; I 1'/ II,) I ~ II'J(' 00 I" " (' II \ ~ I, I _:, .. .-u I, ; II I ,,'j PI^NllQ. MDCI,II'I' HI81'RINDLl! RO^lJ cAMI> lULL, I'^ 171111 (711) 13!.IIIlXI IN 'L'1I~: COlJR'l' or;' COMMON PLE:AS OF CUMI1E:IU,flNP COUN'I'Y, PL~NNrjY1.vANIA flMY C, SlIEPHERD, . L'laintiff v, NO, 97-6139 CIVIL 'L'ERM CIVIl, flC'L'lON - 1..AW DT.VOI<CE: DONflLD W, SHE:PHBRD, Defendant RI!I.I _PI!I.TITI.oN_f.oR-.AIlIHONX_PI!I.Nl)IlNTIl_IlI-TL. ANtL1HTIlRltLO.oWSilLlililS-ANtLO.oaTS '1'0 THE HONORAI3LE;, '1'HE JUDGES OF SAID COUR'I', ANP NOW, this --,~1r day of January, 2000, comes the Petitioner, Amy C,Shepherd, who files the this I?etition fot' Alimony J?e~dent Lite and respectfully represents that, 1. The Petitioner, Amy c. Shepherd, is an adult individual residing at 3824 Mountain View Road, Mechanicsburg, PA 17050, The Respondent, Donald W. Shepherd, is an adult individual residing at 224 Bella Vista Road, Marysville, PA 17053. The Petitioller and Respondent were married on June 9, 1990, at Newberry town, PA and separated on April 18., 1999, The Respondent has not sufficiently provided support for the Petitioner, The Petitioner is not on a financial par with the Rr;jspondentr in prosecuting and/or defending this Divorce action and ~,;I unable to support herself in accordance with the standard df living established during the marriage and to pay her anticipated reasonable attorney's fees and costs incurred or to be incurred in the within divorce action, The within action was instituted by the filing of a Divoroe Ik Complaint by the Petitioner on Novembet. 5, 1997. .,'1 "J The parties initially separated on October 27, 1997' and "'.,W1 remained separated until they reconciled on January 11, 19!1O:;' ,ilJ(! , ., ,\i';'U That reconciliation lasted until their final separation, 'Qil',r'vl,l , '1..1."'..111..".1 I, ; , I!.",'~li~ 'I' ,';,;',':";,\jl ! ,', ,vi/i,tit ;i:-,\ ;';-I\h~1 ;1_1_: :f/:~j'p(.'- 2, 3, ,4, 5, 6. 7, - 3 - !lIMit! II. lIAIlCI.II'1' J.l48 1'RINllUl llOAIl C^~ll' 111I,1., p^ 171111 (717)m.l)IlM) Aprii 18, 1999 wilen t.ho 'h!Upondont vacated th/;I marital homo, 8, A confenmce W,l~ proviou~ly held on tho L'IJtitloner's cla.Lm for alimony pendento lite and pased on the representatlon that tho parties had r.eached an agr.eement regarding the payment of alimony upon the en~ry of the divorce decree and the ponding payment of spousal support, tllat claim wall denied due to the payment of spollsal support. 9, There hall peen a change in circumstances since the entry of that denial of the al.Lmony pendente li te request in that the parties have not entered into a written agreement as indicated and the spousal support order has terminated, 10, A packground information she~t pertaining to these claims has been previously filed with The Domestic Relations office as required Py Local Rules of Court, 11. The amount asked by the Peti tioner for Alimony, Pendente Lite is the maximum amount provided for under the guidel ines, WH~Rm'ORm, petitioner prays that the Court enter an Orderl ',' a. Requiring the Respondent to pay the petitioner Alimony Pendent~ Lite in the maximum amQunt proviped for by law under the ~tate support guidelines, including, but not limited to, base support, medical insurance, and contribution to the three mortgage paymentsl P. Requiring the ReSPOndent to provide med.ical support for the Petitioner. , , Road A i 7011 Supreme Court ID n 32112 Phone I (717) 737-0100 Faxl (717) 975-0695 Attorney for Petit.Loner - 4 - , ' PIAi'll! II. MllC1,1I'I' H48 TRINlll.l! RO^1l eAMl'llJLL, I'^ 171)11 (717)m.11l1~) CJlR'unCATIlL OinSJlRVI.c1ll I\l'ID NOW, thia __._,____.._ day o[ __...._.......__.____._.., 2000, I, IJIANr.: Q, RADCLIFF, BSQUIRE, hereby certify that I have this day served a GOPy of the foregoing document upon the followIng named pel:son, by mailing same by first class mail, postage prepaid, addressed as followsl William~. Smith, ~~quire 3747 Perry Street Harri~purg, ~A 17111 /<espectf.ully submitted, DIANE: Q, RADCLIFF, E:SQUIRE 3448 Trindle Road Camp Hill, P A 17011 Phone I (717) 737-0100 Faxl (717) 975-0695 Supreme Court ID n 32112 - 6 - PIANU 0, RAOCJ.II'I' 340181'RINPl.U /loAO CAMI' Hll.l" pA 171111 (717) 7l7.1)11~) , VllIRIFICATION ~ verify that the statements made In this Petition for Alimony Plmdent Lite and IJIterim counsel Fees and Costs are true and correct, I understand that false statemerfts herein are made subject to the penalties of ~8 Pa,C.S, Section 4904, relating to unsworn falsification to authorities, II {b!;L(1JA~~~~ AMY c0 SHSPHE:RD - 5 - ^I\lY c. SIU:pm:HI~. PllIl/ulmPelllluller IN '",n: COI)It'l' (W (.'OMMON I'U:AS ()to' ('UMln:HI,ANI~ COUNTY. P.:NNSYI.vANIA nVII, ,\("I'ION .l)IVOHU: NO, ')7 . ~'J" (WII, ....:RM IN pJV()Hn: p,tH 2H.?fiH Plle.~.N HfiHll'lH1 VS, >>ONAl.., W, SIlEPIU:Hn. OcJ\:IldIlIlI/Rcsp'llldcllt ()RI)t:I~ 011 (;QlJ'~'I' NOTICt: 911 RESCIIEJll!L.EJ> C:ONn8~NCF. AND NOW, Ihls 23'" dllY or FcbnlllJy, 21)1)1), IIpOIl corlsldcrnlloll pI' Ihc PelhlollJi)r All moll)' l'clldcllle Lhe 1I111l/or colIlIsel rees, Ills hereb)' dlrccled IIlIu Ihc pllrtlcs IIl1d 1)lclr rcspecllw cOlIlIscl IIppcllr berorc &LS.!JJllIlJJll: 011 Hl"r& I.J, 111Q" (II 1'1:3" A,M, ror II cOIII\:rellcc, lit 1:1 N, Hllllol'cr Sl., Cllrllslc, PA I ?1I13, liner which thc collrerCllce omccr IIII1Y recoJ\llllclld Ihlll 1111 Ordcr /'or AlhIlOIl)' PClldclllc Llle be clucrcd, YOU IIrc nlrlhcr ordcrcd 10 brlllg 10 Ihc cOIII\:rCllcc: 0) II In1C coPy oryollr 1II0st rcccm FcdcrllllllcolllC TII~ Itclllrn, IlIcllldlllg W.2's liS nlcd (2) )'ollr pll)' sll/bs ror Ihc prcccdhll! sl~ ((.) 1II0llths (3) thc lnco/llc IlIId l!~pclIsc SlOlclIICIII IIl1l1Chcd 10 Ihc urlghullllollcc, cO/llplclcd liS reqlllrcd by Rlllc PH!), I H~ (4) \'CrlnClIllolI or child cllrc e~pclIscs (5) proor or /IIcdlclll COI'CIIIl!c Wlllch )'01111I11)' hlll'C, or 11111)' hnl'c 1I1'II1111blc 10 )'OU IF )'ou roll to IIppcnr ror thc cllIICcrcllce or brllll! Ihc rcqlllred dUCU/IIClIlS, Ihc CuurtIlUI)' Issuc II II'lIr11Ull ror your nrrcsl, DY TilE COURT, Georl!c E. /loller, PrcsldclIl Jlldgc ~~o~ ,;~.'?3..oo 1,0:, Pellllollcr < RCSPOlldclu Olimc RlldcllJT, Esqlllrc WlHliulI Smllll, Esqulrc Oiuc or Order: 1:~lIllI1Y. 23, 21ll)lt .....' I jJi4J .(--.....- R, J,- Shnddll)', COII~OiiiCCr U VOU IIAVE TilE RI<llIT TO A LAWVER. WIIO l\jAV ATTEND 'rHE CONFERENCE ANI> REPRESENT VOU. U' YOU DO NOT IIA VE A LAWYER OR CANNOT AFFORD ONE. GO 1'0 OR TELEPIIONE TIlE OFFICE !in FORm BELOW TO FIND OUT WIIERE vml MA V GET LEGAL 'IEI,P, ( CUMDERl.AND COUNTY JlAR ASSOCIATION 2 1.II3ERTY A VI!. CMl.lSLE, PENNSYLVANIA 171113 (717) 2~".31(J() ,l~j '" ,- ".I__'.'~l""'~'UC~......"., , .-,.,......- :',i~ ..,...j II " , , ,., , 'u Ille CIII/J1q' Cllmmll,I"lellll 'I' CIJ~'"~llMN') ClIu"ly, Pe""IIYIVIl"I.. /lQMl!:SrlC Ill!:J.A'J'IONS Sl.':CnON Pllliml/wu l'/1l11111: 001'l1\/.J0 W, BHSPHll~P MlIl/lbllr II) NUl/lhllrl 4080100253 I~"""~ '"I1~1 ^Il '''r'''lI'''14'1''~ mllll ~II'11I4~ Ib~ M'1I1,b~r m NlIIlIb~r. CPI Oil' NORTH CI\RO!.INA 190 HIClHx.llNP PR MBPINA on 44256-3199-90 QJtJ>Ji;j( QF AT1'ACHl\jEN1' QF I~COl\jE PldlntlQ'tlU1,IU /II'Iy SIl~PII~~P flllll,,~'a' Br'llk DfI)l'Q qf M"'.'I!I. elllft 0.' AllllCbl/lfl'. ,,^CNJ:.~ ~J~~~'~r Cd.1t tj'~mlm A!Uu:JJmFI\I ~ml)Unl/l:rtl.lU"'III:Y ..1',\"7t,'f 8Ul0l~.1 81-6131 CIVI~ 100,00 I.WBB~ ~ I 1 ~ ~ ""err^,, A"'l'^CU~I,"NT M,IUUN"'I ~ 100,00 To: CPI Oil' NORTH CJ\RO!.INA Pursuant Lo the laws Qf the CQmmo>>wealth of PennSYlvRllia the income of PONI\t.D W, BHllPHSRP ,defend~t obligor. SSN 283-"'-8543 of: c/o JANB Mlt./.JSR, 2045 RD 3, PORT ROYI\t., PA, 17082 ': Is Ilereby ~llached to lhe following exteut, You are directed to pay to the Pa SLate Collection and Disbursement llnit me SUm of . ' , $100,00 per WlllSJ< from the Income due the l/lIfendant obligor. The allac~ment payment must be se>>tto Ihe Pa State Collection and Di8bursement Unit whhl~. , seven busllless days of the date Lhe defendant obligor Is paid. cliECKS SHOULD BEMADE PA Y ABLE TOt PA scnu AND SENT TOt' . Pennsylvania SCDU \>,0, Box 69112 lIarrl8burg,Pa 17106.9112 Sllrvl~1I TYJlII M Fflrm EN.Q~8 Wllrkur ID " - ,,', ';,~,jl"" ,L( \;1. ( .. ',."" .' ,,' ,.1 , \' I', J , , POIIl\lJD W, SHII~HII~D I'^CS~S M~mhur Numh~rl 4080100~53 PAYMENTS MUST INC/.UOl: Tlu.: DlWENPANT'S NAME AND THE I)ACSES Mf.MIJER 10 OR SOCIAl. Sr\ClIlUTY NlJMlU.ill IN OHOl1R TO aE llROCESSEP, PO NOT S/:ND CASH llY MAil.. ' This order of aLtachmellL for supportls bhldlng upon you until further notice lIlld shall haw priority over lIllY allachment, execution, gurnlshmelll or wage allachmem under slale or local law except one relating LO a prior support order, You must commeJlce Lhe aLtachmem of the defendllllL obligor's hlcome as soon as possible but no later LhlOl fourleen days from the dote of the issuance of this Order of ALtachmelll, YI)U ore nOLil1ed furlher that pursullllL to lawI I, The defendllllll)bligor has been noLil1ed thaL lilt order of aLtacillnenL fl)r support would be issued. 2, WUlM failure II) comply with this order may result In (I) your bei,lg adjudged in contempt of courtlllld commllled to jailor t1ned by the courtl <ill your being held liable for any lIlltountnot withheld or withheld bUL not forwarded 10 the Ol)mesLic RelaLlolls Section! and <Iii) allachmenL I)f your funds or properLy, 3, The aLtachmentl)f income or the possibiliLY Ihereof 115 0 basis, In whole or In pnrt, for Ole discharge of lIll employee or lIllY disciplinary acLlon againsL or demoLion of 011 employee IB ,prohibited, ViolaLion may resulL in (I) your being adjudged In cOlltemptlllld cl)mmitted to jailor fined by the court Wid (iI) anacLl!)n against you by Lhe employee for damages, 4, If there are in your employmelllone or more additional employees whose Incomes are subject to lIll aLtachment of support. you may combine the aLtachment paymellls Into a Bingle payment to the Po SCDU and separately idenLlfy the portlon altributllble tl) each obligor, . ~, You must nOLify the Domestic Relations Section or the Pa SCOU when the defendal1t obligor tennlnales employment and provide the Sectlon with the employee's last known address lIlld the name and address of Lhe new employer, if known, Pagu 2 ,)f 3 Survl~u TYJltl M Furm EN.0211 W,)rkur 10 $IA'I"l' , . " ' " , .. I , '" f '. 00/'1/11,0 1'1, SHIJ~H"RP PACSES M~lIIh~, NijlJlhun 40aOlOO~53 6, Thu IIlnxlm~m llInoulllllt' Illu nllnchmeJll shllllnol exceed 50 % of the umployeu's lUll hlcollle which Is wlthlnlhu limits sellnlhe CQllSUmer CrudlL ProLecLton Act, 15 U,S,C, * 1673, 7, 1'1111 tuml "'ncl/me" as denned by law Includes com puns III Ion for services, includlllg. bUI IlotlilllilOd 10, WllgOS, slllarles, fees. compcnsatlonln killd, cOll)missio/ls alld simUllr ltulllsllnco/llo durived from buslncss; gallls derived from denlings In property; Inlerest: remlS; royllltiesl divldendsllll}nultles: income from IIfc insurance Illld endoWIllCJlt contracls;1lI1 fomls of rellremOIIt; penBhlllBI income from diBcharge of Indebtedncss; distributive share of partnership gross incomel income hi rcspcct of a dccedenl:lncomc from 1lI1lnLereslIn IlII estate or trust; mUltary reLIremelll benetlls; rallrqad employmeJll reLIrement benet1ts; social security benet1tsltemporary 1ll1d pcnnllllent disBbUity benetlts; worker's compcnsationl unemployment compensation I OLher e/HiLlemenLs to mOJley or lump sum awards, WlthOUL regard 10 source, inclUding louery winnings: income tax refunds: insurance compensation or seulcllle/lls; awards or vcrdlctsl and allY fonn of , payment due LO and collectable by IlII llldlvldulll regardless of Ihe source, <;ENERi\L INSTRJ1CTIONS l. ~mployers mllY elect to deduct up to 2 % of the auachment amount fOr Lheir Cosls. This , amount must 1101 be deducted frolllthe aLlac~llIent, IL must be pald fromt~}e employee's net eamlngs after the income aLlachmelll deduction has been made. 2. If you choose to make paymentB via 1111 elCCLronlc t\mds trllllsfer. cOlllact Lhe Pa senu ~llIployer Customer Scrvice at 1.877.676.9580. ~ -1., Date ofOrdert M'lrch 14, 2000 01\01 I\J Bh'ldd'lY Servil:u Typ.: M Edward F., Gu I dv Pn8~ 3 of 3 JUDGE Forlll EN.028 Work~r Ii> $ I/lTT , ., ~ g c~ :l: .:1 'r.lf~ ,.... lil~] q'J ;;0 ~"r . ..:.; f [,).I: ,..) e:~:1 ~1:1 ~II~~ i:(') :.:,; ..I, ~; ~:2 !..oJ :";)r ,,~ .. 'f:.! ~ ~ ~ ,\ " II , AMY l:, "U/:l'm:tH) 1"ui/IIIl'fll'cl il i-me" I)J~ 26,7611 ""~'st;s II) 11661lH 2-17 I 11'1'1'1": l:OllK'J' lJl' COMMON PI.I:^" I L'UMJH:~',AN() COUNTY, I'I:NNIIYI.v ANIA I I I )l1Ml:Wl'll: IU:',A'I'ION" III:c'I'ION I CIVIl. AC'I'loN . I,AW v~, lK1NAW W, "m:I'III:KD Ilc(c/ldun,1 Rc~,mndclll : I NO, H7-'H em CIVil. ')'I:KM OJU~t:Jt OJI COlJ~'f AND NOW, Lhls 13'h dilY of March, 2000, based upon 'he CourL's delcnlllnallonlhat Petltloner'smonL~ly nct Income/corning cUPltclLy Is $0 per n\olllh Ilnd I~espondcnt'smolllhly net' !llcOI)le/eamlng capacity Is $1.200,00 pc,' month, IL Is her~',by Ordered Lhatthe RespondenL pay to the 'Pennsylvania State Collcctlon and DlsburscmCJll Unit, $434,5C) u mOllth payable weekly as follows; $100,00 per week for ullmony pClldenLe IItc. First paymenL due wlL~ next wllge attached payment. Arrears set at $900,00 as of Murch 13. 2000, The ell'cctlve dale oflhe order Is Npvember 25, 1999. Collection pn relroactlve arrears lire held III nbeyance unLllltll'lher ()I'dcr of court. , , , This order of Alimony IlclldeJlle Lite Is by un ugreement of Lhe parLles, Failure to make each payment on lime and In lull will cause all nrrears to becomc subject to Immediate collection by ull of the means as provided by 23 Pn,C.S,~ 3703, FUlther.lfthe Court tlnds. . at\er ~earing. that the RespondellL has wllltully failed to comply with this Order, It mny declare' the ~espondent In civil contempt of Court alld Its discretion make Iln nppropriate Order. Including, but not limited to, commitment of the ReBpondent to prlsoll for n period not to exceed Blx months. Said money to be turned oyer by the J>A SCDU to: Amy Shepherd. Paymel)ts must be made by check 01' money order. All checks nnd money orders must be made payable to P A SeDU and mailed to: PA SCDU P,O, Box Ci9110 Hnrrlsburg. PA 17106.9110 Payments must Include the defelldnnt' s J> ACSES Member Number or Social Security Number In order, to be processed, Do not send cnsh by mall, , , , , . 1"1111111110' 1l0'1'"l1dolll Illolilo Illlllolil\', 1'"'111110 WIUIIIIJI Smith, h'lllllo BY THE COUlrr, U/lrelmbur~ed medlcnl eX/le/l~e~ thLlL excccd $25(),OO IIImunlly L11'e tu be pnld I!()% by thc rc~po/lde/lt n/ld 20% by pethluncr. The petitioner I~ re~plln~lble tu puy the nr~l $250,00 L1n/luu)ly l/l lI/lrelmbul'~e:d medlenl expe/l~e~, Ite~pllJ)dent to provide llledh;nllll~UI'II/lCC CllVQl'IIge, Wlthl/lthlrty (30) dny~ nner the e/ltry ofLhl~ order. the Re~llondel)l ~hnll ~ublllh wrltle/l pn)L)fthut medlenl in~urunce eovcruge hLl~ been UblLli/led or thLltLlpplleLltlo/l fur covcrLlge hn~ bee/l mLlde. Proof 91' eoverLlge ~I)ull ell/l~I~L, LIt uml/lIIllUIll, l)f: I) the JlIlmc oj'the henlth eLlre Cllvcrngc pJ'l)vlder(~); 2) LillY upplleuble Ide/lLlneUllo/l number8; J) n/lY eLlrd~ cvldellclng ellvernge; 01) Ihe uddre~~ Lo which clnhn~ ~hl)uld be made; 5) 1I de~crlptlll') ofll/lY re~trletlo/l~ I)') U811gC, ~uch 1I~ prlor lIpprovllllhr ho~pltlll lIdmlssIQ/l~, lI/ld the Illlln/ler lll' obtullll/lg L1PPI'llVLl!; Cl) u coPY 01' the bellelll bOl*letlll' cllvcnlge f:Ql)lruct; 7) 1I de~crlpLloll of 1I11 deductlbles L1lld co.puYllle/lt~; L1/ld Il) Ilvc copies of nny clLlhn thrillS, This Order shull becllmc HUlIl te/l dLlY~ liner the: mnm"g of the notice of the entry ol'the Order to Lhe purLles u/lless elLhcr purLy J1Ic~ 1I wrlttc/l dClllu/ld with thc ProLhollotnl)' 101' n hUlIrlng de I)llVll betore the Court. PRO: It J. ShllddllY 1\1I1U.'I1 "~"Io" ull &:LW/2_ In: < J. IJ r.:l ~ (' 0 ~~ ?e -J .Wi' 'r'~J l:!'( , ;"J 'I~ ' " !:~f. :" el)' . -I 'I\~ r~~., :il ,... ~i": '") :~}} .., ~.. ~:q ~ ,-;\ ~. ,:.n .' ~ - :Q , I ./ I I I' I IN TIlE COUR'L' 0[0' COMMON 1'1,1':1\13 OF ClJMIlIi:HI,ANU COlJNTY, L)li:NNfJYINANIA AMY C, SHEPHERD, 1'1<1 int if f NO, 97-G139 crVIlJ 'I'WlM v, CIV lIJ ACTION - LAW IN DIVORCE: DONALD W. SHEPHERD, Defendant SOCIAL SECURITY INFORMATION SHEET PURSUANT '1'0 23 Pa,C,S,A, SECTION 4304,10 (3) ALL DIVORCE:S MUST INCLUDE ,!'HE L'ARTIES SOCIAL SE:CUIHTY NUMBE:RS. PLEASE FILL IN 'l'HE APJ?IWI?RIA'l'E IN[o'ORMA'L'ION MD RETURN TO ,!'HE PROTHONOTARY'S OFFICE. DATE May 18, 2000 DOCKET NUMBER NO, 97-6139 CIVIL TERM PLAINTIFF' 5 NAME AMY C, SHE:l?HERD PLAINTIFF'S S5 n 205-56-5002 DEFENDANT'S NAME DONALD W, SHEPHE;RO DEFENDANT'S SSII 283-44-8543 , J 'F, ESQUIRE e Road Camp Hill, PA 17011 Phone I (717) 737-0100 Fax I (717) 975-0695 Supreme Court ID # 32112 \,. " .d' f" .. ! I') , ) , ) .) , , I ! " ,) :Ij " , '" Ii'} ,;-If 'I,) ;.1\ 'J (:.) :1/ ", OIlP~Il/NOTlCf TO Wlm'IO~p INCOME fOIl5UPPO/lT 51.1. cl/WlJlQnwntllb ~~~_ CQ./City/PIII, of smm Pate of Order/Nl1Ilco ~ l Cmlll/Coio NIIIlI~"r (SlIii Arlrlu;,m,m "I' mil.' IIII/I/I'~'Y) I at< B Ill' IIlll0 DON LO W. l ~1"Jll,yw/llhJ totll"" NMIlI' Il,.~I, fjr~l, Mil I .. 5P ) "lIplll)'II~~') IlIltllr'~ "Ill 1.)1 ~I" 11,11)' Nutllh,., I 4080100253 l Tiiij'itiYI11'/( )hh~lll"" ('.)w 1"PHllllpr I IS.. ~f!I!!.",lum 1<11 pll'""1I "im.. mQ,ji"d wl/h ..." !!!!J1!!T!!!!nli l I'lj"hulj.IIIJoHvnl'h NlIl)lL' Il,llIl, flt"t, Mil I , SOl.' .4I/rlOlld"1/I M dopul/l!l.'lI/ "~mOI ~lId bl"" rI~IN ~IS/I[I~lerl 11'11" [~IOI /III ~IMr:"I/II.'''', ORmR lNfO/lMA nONI This Ii .1n Order/NQllcc t" Withhold Incomo f<Jr SI/pportlmied I/p<Jn anordor for il/llIlQrl fr<J1Il CtIMBIlRLANO COl/llIy, COllllllollweaith of f'cIIlIsylVilllln, f.ly law, YOI/ MO reqlllred to dedllcllhese amOl/llts from the aboYII'lIamod elll/lloyee'i/o~1I80r's InCOllle 1/11111 II/rthor n,)tJce ovcnlf the Order/Notice II 1In1 IIII/ed by YOl/r State, $ 433,34 por month In cl/rrentll/pport $ 43 , 33 per month In /lilll-dIlO '51 $ 0.00 por monlh Inlllodlcal iI/I $ 0.00 per monlh (or genollc leil $ per monlh In olher tspodf for 0 IQI.loI ill 476.67 per mllnl" II) VOII dl) not havo to vary YOl/r pay cycle 10 be I the ordered Sl/ppOrl payment cycle, Ilie the foil $ 110.00 per weekly pay period, $ 220. QO per biweekly pay porlod tevCl. ,,,u weeks), $ 238,33 per semimonthly pay period ((wi co a month), $ 476.67 per n\onthly 'lilY period, R~MITTANC~ If:VfORMA TIONI You musl begin withholding nQ laler Ihanthe first pay period occl/rrlng Ion (101 working days after the date of this Order/Nollce. Send paYl11entwithln sevcn (7) working days of the paydale/dalo of withholding, YOII arc emitled to dedllCl a fee to defray the Cosl of withholding, Refer 10 the laws govJlnln8 the \\,ork slole of YOllr emllloyee for the the allowable BmOllnt, The 10lal Withheld amounl, nnd YOllr fee, cannot cxc.eed /ili"!. of the employee's/ obligor's aggrcgale disposable weekly eamln8s, for the pllrp.ose of the Ilmllatlon on wlihholdlng, Ihe followlnglnformallon Is needed (See 1/9 on pg, 2), If ,emllllng by EFT/EOI, plense call Pelllllylvanla Stale Collections and OlsbllrscmentLJnlt tSCOUl Employer ClIstQI11Cr Service at 1-677.676.9/i60 for Instrllcllons, Make Remittance Payable ~Ol PA SCDU Send check tOt Pennsylvania seou, p.o. BOl( /19112, Harrlsburs, pa 1711)6.9112 IN ,4ppmON, P,4 YM~NTS MUST /NC~UPI! rm pmNPANT'S NAM~ ANP TH~ PACS~S M~MB~~ ,P Ml)w/I .~ove .s Ihe ~mpIQyee/ob"Bl)"S C.se ,dent/fler) Ofl SOCIAL S~CUmy NUMB~~ IN O~P~~ TO B~ P~OC~SS~P, PO NOT smp CASH BY MAIL, PMI RJ SlwlclJllf:"'r' M'" ," XCI defli!l1lJ1nl: ~.;:..,I;ll..t,j\;,nn~'l/D . 4' ,'( ()/ Oale of Orden ,lw\e 27, r.,h. If , ~;;;;,h'YI"lWllhlW)II'''''' fl'lh'NI fiN NII",I." ~!rO~p~~~c ~mJ llYII~ hh ~..mll ~?~ lIIOlllr~UJL_ ~mp HYI"lWllh )0 dll,l~ ^11;r,,1~~ ~BOI~~ Oij 442B6-3~~9 Service Type to! II:", o ()'I~j'hll ( ),.-dll,INllllt II @ Anll',uhl.11 )r,h',/f'jlllllP o 1i""'IIMhl()/lhl,INlllhll 'LJ../',I ,~'-l L.V .!')',/..''i71LL .J \)):y wcoks or gl'ealer/ @yes 0 no er, If YOllr pay cycle docs nol malch ""Ln 10 wlthholdl BY THE COURTI ...,.,. ..~ l1JIXJE Form EN-026 Worker 10 $IATT IIMII ""'I,lll'11IHII~~ I ,pll,lolhHII)~h'i 'J/II/tI11 II' .1 ,,' " 1~,1 I ; J '! "!I"I:) , , I I I 1..;- " r, 1111111'( ~ " I ,I' APl)1TI0N,U 'NfO~MATlON TO fMI'WYfllS Ai'll) OWfll Wmm(nl)~IlS o It d,,,, ~,',I Y"II"'" 11111111",,/ ", pI"vl,l" ,I' "py lit Ihl, (11I11I1" y,,,,, "lIIpl"y"", 1, 1',lonlly: Wllhhlll,lil'JlI"..,,,, Ih" O,d"IINIIII,,, h", p"",lIy "w, 'i'y "'h,,, h'/\"'I"'II"" lilli'''' S'",,, I,IW "Jl",,,,"hll ',1111" Ill' "lillI, r"d",,,1 IolX '"vi." III "If,'" 11I.fl"" '''' ,111"11' Ihl. "'II", h,lVl' pII",lIy, It IllI'''' ",,, fl'd",.,I,,,x '''vh" III "If,"1 ph...." ,,,,,',,"Ih,, ''''1"",'111/\ "/\"II'Y 1I.'"d IlI'l"w, \ 2. C'''lIhllllll/\I','YIII''III'' Y"" I ,111' "lIIhllll' wlllil",',' "1I11"1II1. (,,,11I IIH"" 1110111 "'ll' "lllplllY""IIIhIlWI", 1111 "Ill" II'" ,111/\1" P"YIII"III III "'" h "/\"11' Y ""111".11111\ wllhh"hllll/\, Y"" Ill"", IHlW"V"I, ,"P"''''lIly Id"IJlI(y Ih" "''''''''11 '"~ Ill\! .1111\1" p"YIll"1I1IhJ'I. "1I,lh"'"hl,, III "'" h '"llpl"y",'II,hIlWlI. j,' R.p"III,'l\lh. Poiydoi"'IL>"'" ", Wlthhnhill'l\: y"" ,Ill'" "'pr'" Ih. poiyd.,'.ldoi'. nf wlthhnldln/\ wh"ll '.ndlnK Ih. p"ym"nt, 'Th. p"yd""'id..'" ", wllhh,MIr'K I' Ih. d,)", "n whir h Ilm"'"l1 Wi" wlthh.ld Inll"lh. .IlIplny.." WI'I\"'. Y"'IIIIl"" "Illply wllh Ihll I"w ',f ,h" "",. 'I/,Im H1llpllly''''''/IIhIlK'"', ,"1'lllp,,1 1""'" III "llpl"y"H"lI wllh ''''I"'' I'" II\IlII/ll" 1'",1,,01. Wllhlll whir h Y'I" 11111" Impllllll,,""I,,' wllhhllldlrlK ll,d"r "lid fllrw",d Ih" "'Pi'",II','y"H'IlI', 4,' EIIIPllly.,'IOhllwlr wllh Mlllllpl" SIIPIH"I Hllldlll/\" II Ih"", I. IlI<lI" Ih,l/I <IIH' O,d"IINlllh,' ,,' Wllhhllld 111< ,,11I1' fllr SlIpl'llrl "1\"1I"llhl. "lIIpl"y""IIIhll/\'" "lid YlllI"'" "lloIhl" ,,, h'"'''r "II '"1'1'''11 O,d",IN'HI"I! d,," ", F"u",,,1 IIr 51."" wllhh"ldlll/\lImll!, y"u '1111" ("II'Iw 11m I"w ", Ih" ""'" I,f "lIIpl"y'"",I"hIlW"', ",111< 11'"1111",,, "f "1II1'1"YIII"III, Y""Il"'" h,",," "II O,u""INlllI,,,"I,, ,h" W""'''I' "XI"1l1 "",,'hl", (51111 '9Il1'I"w) S. T"'1II111"'1r1ll N"'IfIr,,tI,,": YIl" 1111111 prlll11l"ly lI"tI(y Ih" Rllq"I!~"1I1\ AW'I\('Y Wh"lIlh" I!l11pl"y",'I"hIlK"r I~ n" IllnHw wlllklll/\ fo, Y"u, PI"",,, p",vld" Ih" 11'(0/11,,,11,," Il!q"""l!d "lid '1!1"/I1 "'"I'Y Il( 'hll Orul!r/N,,'I, I! Illlhl! AI\I!II"y Idl!lIll(1"u h"I'M, WITHHOlDER'S 10: JHH977JQ EMPLOYEE'SIOBLICOR'S NAME: SHEPHERD. DONAl.D '1/. EMPLOYEE'S CASE IDENTIfiER: 4080100253 DATE, Of SEPARATlPN: LAST KNOWN HOME ADDRESS: _ NEW EMPLOYER'S NAMEIWDRESS, ~, LIII11I' SUI11 P"YIII""'1: Y"u I11"Y bl! ''''Iulr"d Itl ,,,p,,,1 .mu wllhh"ld (,ll III '''1111' 'UIII ,,"YIII""I' ,,,..h '" 1.1011"'''', "'1111111\110111, 'II ,,,v"r"II"" PolY, II Y"" h"v" ""Y ql,"~II'lIl' "h'IIIII"lIIp """ P"YlIIl!lIh" ""'''''11". 1'<'11"" or ,,"'hllllly hl!lllw. 7, LI"hlllty: If you f"III" withhold h1nlll1t' '" Ih" O,ul!rIN"'I,,, dim' '" Y"u "''' 11"hl" I," h",h Ih" ,1''l''"I1"'",,,d "III"UIII y"" .I",ulu h"v" wlthh"ld ('''lIllh" "lIlpl<ly""I"hIlKOr', h" "I"I! ,I/Id ,,'hI!' p"",,hll!' ,,,' hy P"'lIllylv,lIIl" 51"1" I"w, P""llylv""I,, 5''''" I"w I\llv,,,,, ullla" Ih"obIlK"r I. alllpl<,yad 111 ""'ilh", 5'""" h, whlrh "",I! Iha I"w '"~ Ih" 51"'" 111 which h" III 'hI! I, ""'pl"y"u 1\0WIIl'. a, ^'1I1-dlmII1111,,,tI"'II YIIU dla ,ubI'"~ 110" (l1I1! d"'''I11,h".u IIlId", S'dl" I"w fllr dll<h"'l\h1/\"" "lIIpl"y""IIIbIlJ\lIl (rolll IlmploYl11alll, r,,(u.lnK 10 "lIIpl,)y, ,,,, "'kllll\ dllrll'"I1"'y "dloll "1\"hll,I"ny I!lIIpl"y""I"hIlKoI h"""'ll" Ilf" 'UPP'"1 Wllhh"lullll\, PIlIIII'ylvdlll" 5'",,, 'dW K"V"1Il1 ulIl",,'he ohllJ\llr I, "l11ploYl!d 111 ",,,,II,,,, 5'",,,, III which ....'" II", I"w "f Ih" 51"1" 111 which hI! 'II 'hI! I. el11ploy"d BOV"IIl'. 9.' WlthholdlllB LII11II" You IIldY 110' wllhhold 1110'" Ih""II)" ,""",0(: 1) Ih" dIllOUIII, "1I"w,,d by Ihe f"der,,1 COI"UI11"r C,,,dlt Prol"nl'lII A.., (15 U.S,C. 51 ~73 (1.1)11 or 2) Ih" ,,''''''''11. "11,,w"u by Ih" $""" of Ih" "lIIploy",,'.lohIlI\Ol'l Plllldp,,1 pi".." ", "lIIploYl11ent. The fedl!r41111)111"ppJlall" Ih" "I\K'"I\''''' ulll',,,,,hl,, w"ekly e"mhll\,'ADWE), ADWE Illh" 11"111\(""11" '"(1''(1''' IIMklllK 1II,,"ddl"'y dedunlrlll' ""'h 01', 5'",,,, f"d"roll, 10r,,1 '''X'''I Sod,,1 S"..",I'y I"X"",,"d MI'dl"",e lolXII.. 10, _ 'NOTEI If you or your agent are served with a copy of this order In the state that Issued the o,der, you are to follow the law of the It ate that luued thll order with relpectto thele lIems, Reque$tlng Agency, If you or your employee/obligor have any queltions, DOMESTIC RELATIONS SECTION conlact WAGE A TTACHMEN r UNIT P,O. BOX 320 by lelephone at (717) 240-6225 or CARLISLE PA 17013 by fAX al LZl71 240.6246 or by Internet @ Page 2 of 2 Forni EN-028 Worker ID , $IATT Service Type M OMIlf'l<ll,lllllllHllH I ~lll'~llmll).I"i lJ/Jl/!lll AJllUJSD!lM 5wJ/lliIWJl ~~f!lll AlI~(~/ll~ Pelend~",/Oh"llllrl BIIJlI'll JlJlP , 001'/1\/"0 W' ~~~ftf ~1~,~:~,NlIllIhl!t ft G Q I e I a 4 " W ~JlN'lIIIi"J) ll\l.I.W:l 6JWJJJWII' AIII'''''ll 97.QI)Q OIVlh$ 47G,G7 Chll<lll''''''. N,"'Wll): DOll I'ACSES C..,. NIJJll1luJ. /'I"llIlIrr,..,.uJl!l l.lw.1!:l 6llillJJJJ!I"1I AIIIII',Ul $ e, lIe Chll<l',IIIII" NJilli"'): DaB Olf dw.kl!lJ, YIIII ,1/1' /I''1'I'r''<I III IIIlrIlIl ihll' hllll'/III1/ iWtllllfl,'<I Jllllw\ III ,lilY'''," 11IIJ'I"""1I "'\>I",'W' "v,II"hll. Ih""I>>h IhlllllllpIIY""',!lhll>>",', ""'IJIIIV"'"/II, o If. hll.I,,'<I, V'''I JI" "''1'11(''<1 I" "lIrlllllhll 'hll<llI""/ ,<lIlIIIIII,'<I "h'M' III JIIY 111M II II'"II'JI'< ""IV",J>>,' JYJ I"h". Ih'III,>>h till' "'lIpl'ly",,"!lIhlll\"'" "II,pll,YIIII'"1. pACSES c.,,, NlIllllmr PIJIIIII(f NJIJI'! ~ I'ACSES CJ!" NlIllIh"l f1lJJllJ!J...tWJlli! Alldrhmlllll Al1lount $ e, ee Chlld('"lll'. NJllIlIlll: om ~ AlIllIhtn~l1l^mlllJlll $ e, ee Chil<l",,,,)'. NJIIIII('I: DaB 011 <'hlllkll", YIIII J'"'"'1"I,"d 1IIIIIImll Ih.. < hll<lllllll/ IdiillllflPd J\xIV" III JIIY hllJlth 1IIIIl'JII< Il "IV",JK" JVJ IJhl" IhfcjllKh IhIlIlIIJpIIlVIlIl'.!ohIlKIl,'. ""'pIIlVIII""I, o If < '10' k,,<I, Y"II J," ''''IIII(''d hlllllrlllllh" < hll<l('''"/ 1<l1l1I11(11I" Jhllv" III JIIY ""JIt 1 11I''''JllllI IIIvlI','K" J\oJ IJhl1l 'h""'Kh 'Iw "",ploy",,'.!,,"IIK<I", IIll1ploYlllltIIl, ~~ES CJ'" NlIlllh." PIJII11I(1 NJllh! I'^CSES CJ'" Nlllllhll' fl,'IIIII((N,IIIl" AttJrhnlltt\t Amflunt $ e, ee Chlld(,III1)'. NJIIl"h): .i2!l!.J!!U OOB 6J.W1 hnu~1\t Amount $ e, 00 Chil<l(,IIII)'. N,II!l,'(.I: l.lw.1!:l OOB o If ,hll< klld, YIlIl Jill ,"qUI("" III ''I\Iolllh" , hll"I"'"1 liliillllfl"d JIIIIVII 1I1.IIIY hllJlI1 1I11I1'JII<" < IlV",JK" JVJ I"hl" ,hmllKh Ih" Illllpl'IY"""!llhIlKo,'. "lIIpIIlYllh'lIl, 01( < hll<'II,'d, Y"1I ,1'" ",qlllr"d hi "lIrolllh" <,hlldl,.,l) Idlllllll'''d "hoVl' III ,lilY IIIMII, II""'JII<'II mVI'JIl" JVJII.hla IlImll>>" I"" IIll1pll'Y"""!llhll>>o,', ,lIl11pIIlYI1It!1I1. Addelldul1I Fo,m EN.026 Wo,ke,IO .IATT Service Type M IlMII"""IIl'JmnIH 1'1)11.1101111."':11/11/011 OROflllNOTlCf TO WIT/,'~o~o IN~OME fOR SUPPORT ~'( I ') -(d.3 '; 5'al. CQIlIW,/lIl11tallh 1I/ P.lll.lIyII/POI~ fiN '.If' I St.:i/ (!,' .PI ) Co./Clty/Oilt, of COMllJlRWUI'L-. II .: . 'I !/ DaleofOrdcr/Nol/cc 07/24/01 fll.JJ ,'(",\ Court/COle Number fSe. Adl/'f/I//lm 'Qr ~'~Ie 6IImm~'rl o 1l,IHIII.lllllh"IN"lIl1' o ^ml'ful,'.1 O"lt"INulh ,I ([) 11'''III1I.1h'l)/llu,'Nlllhll I I I. Em~~l)YI'rlWllhhllldll"~ fl"tl'r.al fiN Nultlh", CO~TO~~SR~O~L I~C ~mJ lIY"~ It l~lllllr'. lUlU' 1~~ HIQ!l~P D~ EmJ nYI'rIWllh lei ,'of/l ^' I'f\'~~ MSPINA O~ 442~6-3199 See AdcJeM/lm '0' dep."de", f/~m" ~"I/ hlr'" d~'el "'Oc/;lllll/ wllh C~IIII 0" ~,'~chmll"', O/lOERINfORMA T/ON: Thll II an Order/NQI/ce 10 Wllhhold III,comc for Supporl based upon an order for IUpport from ClIJolllJlRWUlD COlJllly, Commonwealth of Pennsylvania. Ily law, you arc required 10 dcducllhese amounl. from the al)ove.named employee'l/obllsor'. Income until fll/thcr notice even If Ihe Order/Notice Is not IlIued by your Slate. $ 0.00 per monlh In current support $ 0,00 per monlh In pasl.due IUPI)ort $ 0.00 per monlh In medical lupporl $ o. QO per monlh for scnel/c test coSl5 $ per monlh In other (Ipeclfy) for a lolal of . 0 .00 per monlh 10 be forwarded 10 payee below. You do not have 10 vary your pay cycle to be In Coml)llance wllh Ihe lupport order, If your pay cycle docs nol match Ihe ordered IUpport payment cycle, u.c the followlnSlo delermlne how much to whhhold, $ 0.00 per weekly pay period. $ _ 0.00 per biweekly pay pcrlod (cvery two weeks), $ 0,00 per lemlmonthly pay period (twice a monthl, $ 0.00 per monthly pay pcrlod, REMITTANCE INFORMATION: You mUlt beSI,n withhold Ins no laler Ihan Ihe fll'5t pay period occurrlns ten (10) worklns day, afler Ihe date of this Order/Notice. Send payment within seven (7) worklns days of the paydale/d,llc of withhold Ins. YOl) arc cntltled to dedud a fee 10 defray Ihe cost of wlthholdlnS. Refer te) Ihe lawI sovernlns Ihe work 'talc of your employee for the the allowable amount. The tOlal withheld amounl, and your fee, cannot exceed 55'!. of the employee's/ obltsor'l i18sresate dilpolable weekly earnlnSI, For Ihe purpose of Ihe limllal/on 011 wlthholdlns, the followlns Information II needed IS,ee H9 on PS. 2), If remltlins by EH/EDI, please call Pennsylvania Slate Collections and Dlsbur5ument Unit (SCOU) Employer Customer Service al 1.677.676.9580 for Ill5tructiol1s, Make Remittance Payable tQt PA SCOU Send check tOI Pennsylvania seou, P.O. BOl( 69112, Harrisburg, Pa 17106,9112 IN ADDITION, "A YMENTS MUST INCLUOf THE Of FE NO A NT'S NAME AND THE "ACSfS MfM'fft 10 f.hoWf/ .bOW;I,'hll fmploYH/Obl',or'. C..e lrIenllflerl Oft SOCIAL SfCUftlTY NUM'Eft IN OftDlft TO 'E "ftOCfSSfO. 00 NOT SEND CASH 'Y MAIL, ~ti~~D Arrears 1 2 week, or sreaterl 0 yel <ID no BY THE COURTI Date of Orden JUL 2 5 2001 ..", Service Type M O~UI"'Il,in'I'Il.11'U 1"lh,lluull.h';I/JII/l)11 Form EN.028 ' Worker 10 UATT ,,) . ^Dp'rIONA~ INrOllMATlON TO ~MI'~OnllS ^ND Qm~1l WmmO~D~IlS Cllf I Ill" ~,", Y"II .," ""111111',1 III PlllvIII" ""'PY lit Ihl, (II"" III Y"llr "II.pIIIY"'" " ",III,lIy' Wllhhlll"'''H 1111""1 Ihl, O,d"I/NII,1I II h", /I,'II,lIy IIV"I ,II'Y 111111" '11/1"""111 "" 11111/"1 SI,JI,' I"w "11,,111" 11\10 '.'lllI IIll 111111>. Flld",.I,.x '''vl"~ III II((II,lh"(,"" ",< "'I" "t Ihl. ",d", h,lVlIPllIIllIy, If Ih"I" .11"/"""1011 I,IX '''vlI', III "fll", p"""" ","I." I ,h" "''!'',,,'III/I .H""'Y 11'11101 1>1I1"w. 2, C"IIII>IIIIIIH ",'YIIIIIIII" y"" 1'.11 I "llIhll1l> wl'l1l,,'ld ,,,",,,".I. "1111111""" 111,11"11'" '!lIlpl"y",./IIhIIWII', IIll "11I" 111."1"/11,, pJYlIIlIII' hi ".,h .W"II Y ''''IIIII,'II'H wIl1111111,IIIIH, Y'Illlllll", IIIIWIIV"" III/loI',III.ly 1I1,""lfy 11"'P'IIII'"II,t Ih,' "lIlIh'/MYIIIIIIII II1,JlI, .IIIllh'l,"hh, It, ",111> IIl11pllly,,,,ltlhIIHIII, J,' /l~prll11I1H Ihll ".Vol.'lI/O,,'" lit Wllhhllldllllll YIIIl lilli" "'r"rt Ih. r'iYrf.JI./d,JI. l!f wllhh"ldlllll wh.1I ,."dlllH Ih. r.YII,.nl, Ih. p.ydll"'/'M" "I wllhh,,'dlnH "'h,, d.", 1111 whlr'h ''''''''11I1 w," wllhh.ld (mm Ih" .mr'llY.." W"/l"" Y""1111'" ,,!mply wllh 'h" I.w '" 11111 11.,,, '1IIhll.l)1pl'IYIIII'I/"I>IIH""~ Wlllllp.,1 pl.I'" "' .,llpl'IYIlIIIII' wlll1 ,"'P'II I "'11111111)111 pllrllll'~ wlll1l11 wl1lt 11 Y"III11I,,'lllIpIIlIllIlIlJ Ihll wllhh"'dIlIH "Idlll 1111" ("/W.,,, 'IlIIll'PP",I/MYlIlI'llh, 4,' EllIpl"y.,'/OhIlWII wltl1 Mllltlpl. SIIPP"" "',,'dlllH" If lilli/" I~ 11I11111111,11I'"111 O,dIlI/N",1t " ", Wlthh"Id 1111 '"11" t", illllP"" ./I.III5Ilhll.llIpl"Yll"/II"I1WIl .lId Y"II.lrI' 11110111111 '" ,,,"''" .JlIlIPI"'" O'IIHI/N"li,., ,hili III I'I'dl/l," '" Sltlll' Wllhh"ldlllllllllllt" y"III1"'" ("II"w Ihlll.w "I "111.'.'" of IIl11pl"Y"II'./ohIiHrII" ''''illi/loll rl,J' II 1/( IIl11pl'lYIIIII')I, You 1111'" hl/lI",~.11 O,,,"../N,,,,, '" ,,, ""1 W'ldlll" "X""" p"..thl., 1511I1 *9 11Il1"wl 5. ]',mllll1.III",1 N,,'lflo,J1loll: YI/U 111'1" fll"I1I1"ly l1,,'lly 11\1' Illl'lulIllIllll ARIIIII Y whlll1 Ihll IIl11fll"YI!II/"hIlWII 11111/ '''"/1"1 wlI/khlll fl/I YOlI. "hl~11! p",vldllllm 111,,,,,11.111111111'1'111."'" .11I" ,,'hlrtl. '''flY I/f Ihl, O,dlll/N,,1I1 II '" Ihll AWIIl(Y '''"I1I1I1,'d hlllow. WITH~IOLOEIl'S /0: H1H077JO ' EMPLOYEE'S/oal/COIt'S NAMEl SHBPHBRO, DONALD '1/. EMPLOYEE'S CASE IDENrtflEll1 4080100253 DAlE OF SEPARATION: 'LAST KNOWN HOME AIJOIlESS, NEW EMPLOYER'S NAME/ADDRESS: 6, LIIIIII' 511/11 "~YI1"l/111: YI/U I1lo1Y hll r.qlllllld '1/ "'1'1/1' .l1d wllhl",ld ('''lIIlul1Ip 1I1/11 p.YI1I11I1I. '", h ~, 11I1/!1I'"I, t'lIIIII11151ltllll, '" III VIII. "'" I'.Y, If Y'11I h.vII MIY qUIIIII'III' ~hoUI hlllll' 111111 ".Y""'"'" "IllIJ,1 111" plll"IIII" .lIlh",lIy hllll/w. 7. LI.l.1l1lty: II YI/III~1I 11/ wllhhl/ld 1t""I/III.' Ih. Ord.,/N,,'ll II ,11'11(1', YI/U .11" II~hlll (or holh Ihll ~((III1II1I.'.d .111"'1/)1 Y"U 111<111101 h.VII Wllhhllld II'l/lllhll "lIIplllY"II/"hIlH"", IlIlll/ll11 .lId ,,'111I/ p"I1"II"" 1111 hy P"ll115ylv~l1l~ SI.,.I.w, PIIllIl.ylv.l1l~ S'.'IIIJW H'IVllrtll 1I11111l1lhll 111.111/1111 il IImpl"yed 111 "'11/1111I/ 511II11, 111 whl< It (,,",, II",IJW 'I( Ihll SI~ltl hi whl(h hI! '" ,h. II "lIIpl"y"d W'VIIIIl', a, AllIl-dIIl'lIIllII1~IIUIl: You .'lIlubllll"'I/. fllIH d.I.rtl1lt\l!d UI1"I!' SW.I.w tl/I dl.dl~rHhlll .1I.llIpII/Y""/l/bIlHOI (,lJlll "mpluY/llIlI1I, Il!fu.ll1/1 11/ "lIIpll/Y, 1/1 1.1"1111 dlldplll/MY .,'11/11 .H~II1" .I1Y "lllpl"Yllll/obllll'" h,,(.u.. ,,(. '"ppOrl Wi'hI1<lIdll1ll, PIII1Il.ylv.lll. S,"III I.w HI/Vllrtl. 11ll1.lIlll1! I/hllHl/r I" "lIIpl"y.d 111 .'1<ItllHI SWII, 111 whl, It (.'lIlh.l~w '"~ Ihll SI~I.111 whkh h" 01 Ih" I. IIml'II/YHd 11'''"/11', 9,' Wllhhl/I"hl/l Limit" YI/U lIMY I1Il! wllhhold 1110'" ,h.,I,h" 11111.' 0(' 11,hll "1111/111111 .lIl/w.d hy 'h. Flldlll.1 C'"llIl/lll1r Cllldll P"",!<1I1111 AnO S U,S,C, 5 167J Ib)l, "I 2) Ihl! "1111/'1111' ~lIpwl!d by Ih. 5'.'01/( Ihll "l1Ipl()YIIII'~/,,'bll/l()I" prllldp~1 pl~(1I "f 11l1Ipll/ymllllt, The F.d.,.II'mll .ppllll. '" Ihll "/lH"'H~III dllpl/..hl" WIIl!kly II.mIIIlR' IADWE), AOWE I. 11m Iu"lp(o/llIlI.lt .flll' l1I.klllH 1I,"lId.'",y d"dunl"''''II,'h "" S'~III, Fedllr,". hll'.II~X.', Sl/d.1 SII(uIlIy ','~III' .lId "'"011111I" l.xII,. lQ, 'NOTE, II you or your agent ale lerved with a copy 01 thll Older IlIlhe slate Iha' Issued the ordel, you are 10 (allow the law 01 the Ilale Ihalluued Ihll oldel with lespectto Ihese Ilems, Requeslln8 Agency, If YOIl 01 YOIII employee/obll801 have any quest lOlls. ~STIC RElATIONS SECTION COlli act WAGE AnAcHMENT UNIT 13 N. HANOVER 5 r by telephone al (717) 240-6225 01 P,O. BOX 320 by fAX at 17171240-6248 01 ~~E PA 17013 by Iilterne, @ Service Type M P~He 2 o( 2 FOlm EN.028 \VorkellO $IATT Il,"'U1 ~.1l.IM1'J.rI'.~~ I ~ltll"llun IlIII': 'JI J 1,11lI 0....' " De'e/1da/lI/OlIIJllorl ~~~r~~MNUn'h~' emm4'1/1.l /(.,k 1I/IfI fiR/) L1li.L.Illll AU,i1hlll"lll AIll"UIII e7-UJe clVH,S 0, I/O Chlldl,"/l)'. N,III1"('): I Mmfl'iDVM l~la~bll1enl a/llH)/II!~D, PO/ll\liP W. IJACSE~ CIU. ~umh"l /!JJJ!Jllla~~II}1t nOli !2m..h.!:J. AII,u hm,mt AIlI'IUJJl SO,OI) Chlldl'''''!'. N,lIl1"I.!: Don Oil rh"rk"d, YIIU M" l"qulr"d h' "1II11IIIh", hlldll"lI/ lifollllln"d atxlv~I'1 allY l1Hallh "llurall'" llIV"raH" aV,1 lah'. Ih,IIUHh Ihll ~lIIp IIy""',/"hIlHOr'. ~l11pll'Yllllllll, 01' <lll!,k",j, you al" ,-qulrl'd hI "1I",lIlh" ,hJldl'I!Il) Id"l1IlfI.d allflVI'/1l allY hllalih 111,",all< II ",VII,aHII ava/lahl. Ih,OUHh Ih. "I11P 'ly'''',/onllw,,'. Illllp"'Yllll!lll. PACSES CJIUi NUlllhlir PlalllllffN~1I111 ~s CI'1t NumhHr PlahJlllfNalllll Alf.J(-hlUJ.tllIAnlt)LJIlI SO,OO Chlldllllll)'1 Nalllel.): l1u.!:Jitll pon AllarhllllllllAlllIIUll1 $ 0,00 Chlldll"")" Nal11l1l.): J:2.uI:JuJi POD 01' rhllrklld, Y"U Mil ,equlrlld III ~11l01lIhl! rhlldl'"ll/ lililmlfh\d above III allY hllallh 1IIIu,alll'lI,"V",aHII ava lahlll ih,flUgh Ihllemp oyee'./C/hllK'Il" Ill11plllYIlW/lI, o If <lwk.d, you a'lI lequlr"d I" ellll/Jllhll rhlldl'"ll/ ldillllifled ahllv" III allY healillln'u,allrll rnVII,aJlIl ava lahl. Ih'llUJlh Ih" "lllploYI!Il',/"hIlHII,'1 I!IIlPloYllllllll, " PACSES Calli NUlllha, PIJlntlff Ni~mtl , ~ AUJrhmant Amount $ 0, I/O ChJldl'"Il)" Nalllelt): POD PACSES Ca'" NUlllb1l1 PlahlllffN,lIlle l2.u.!.Iillt Alla<llllle/llAlllflullt SO.OO Chlldllllll)', Nallllll'!: POD 11.1' <llll' klld, YflU Me ,equired 10 IlIlr"lIlhll 'hlldllHll/ ldilnllfllld abflvll 111 allY hllalth Imu,alllll rovll',IW' .IV,II,lhlll through Ih" "lllpl'IYI!Il"",hllgor', IlmploYlllllllt. o If, Iwklld, you are ,equlrlld to "nll/lllhll I'hlldl,"n/ Idllllllfllld ah"vfI In allY hllalih In.u,allr" rov.,aJlIl ava labl. IhmuJlh IhlllllllplnY"Il'./flbIlWIl'I,lllllplflYll1llnl, Addendulll FO'III EN.026 Wo,ker 10 $11\'1''1' Service Type M OMIl ~.n,1 0')11)'111 H Ilplr.tl1ulll.trtIIIJI,'uI) 1\' \' 1,;1 , '1'1 .I,;'\! , :' "t "i ',:'dl ,:".ll':":'\~' q,'\,';\ ','" I ';,/;iji,:i, ~ ,I' 'iii; I )':,-'i/{.j " " I .tJ\'i'~i' 'i",;j!'lP.t' .. '\\'~I ",11::.3(; I' "i ,Hi rll/O~' '"I' .' \ ORlnIllNOTlC~ TO Wlntt;!O) ~D. 'N,r.OM~ fOR SUPPORT I).f I '/'. -1,'h'l ('Ii, \'" Slale CoIll"'OIlW"~~~~~tY'v_ /11"1',(, \ !J1;',1'/('1)t;) Co./Clly!blll, of ml D /)1-' ,7 J' 7t" r OnteofOrder/Nollce 07/24/01, COI/rt/Cale NIHnber (SIIfI Mde"d"," f'l, '.JO III",,,,.,Y) o OII~llI,1 ')lIh,,/Nlllh " O^"l1'flIIIIIII)"'I',lNlllill' o }I',mln.-hl ("I!I"/Nlllu 11 fiilf~OY"'/}Vllhl~,III"r"'",I,'"IIIN Nijllll.'r ZJ~I~ TRV~ LINES Erm UYl'~ II 'Il)"",~I, JlJJII l'Q BO~l~O l"'f~IIY'" II" ,,1,I,'r'. ^,ldll'" MIFFLINTOWN PA 17059-0130 I Kit S!J~PllIIIlD, DONALD W, _ ) fllll' UYl1l1f( HdJ~llr''' N.."w Ilolhl, n"I, Mil ' I I I I I I I "'" UYl111 () l",u,... ~1Il/.I1 '1l'lnlly NlllIlb" 4080100253 f",,,IIIYI'll/r.)hll~l)t'lI ('..'" 'I'''~linl'' '5" ildrltmluln 'or p/.'nl'l/ n.m.. ."orl."d ..,'~ CIJ" 01/ .,,"hm,nl! ('lj~h"II..I'J"""ll'~ N.a'IW lL.a", fir-I, Mil SIIfI Mdend"", fllr depende"t n.",eJ ~nd birth diteJ ~JJllr/.ted with r.m II" .t'~'h",ent, O~/J~/lINfO/lMA TION: Thllll all Order/Notice 1<) Wllhhold Inc<)me lor Sllmlorl haled ullon all order for IUPllorl 'rom CUMBBRLAND County, Commonweallh of Penl1Sylvilnlil, Lly 1.1W, you ilre required 10 deducllhele amountl from Ihe above-nilllled employee'~/obllg<)"llncome I/ntll furlher nollce even If Ihu Order/Nollce II nol 1,lIued by YOl/r Slale. $ 433,34 perrllonlh In Cl/rrenlll/ppOl1 $ 43,33 per month In !)ast-due II/PIlOrl $ .Jl.....Q.Q.per month In medical ~IIPIlO'1 $ 0 . 00 per monlh for genetic lelt COlli $ per month In other lipeclfy) for a IlIlall)/ * 471. '7 per momh 10 he forwarded 10 payee bel<)w. Vou do not have 10 vary your pay cycle to be In comllllance wllh Ihe IUPIIM order, II your pay cycle doel nol maldl Ihe ordered IUPPOrt paymenl cycle. ule Ihe following to determine how much 10 wllhhold: $ 110.00 per weekly pay period, ' $ 220,00 per biweekly pay period (every IWO weekl), $ 238.33 per lemlmonlhly pay period (twice a Illonlh), $ 476.67 per monthly pay period, /l~M/TTANC~ INfO/lMA TION: Vou mUll begin wllhholdlng no laler than Ihe first pay perlo!) occurring ten (10) working daYI fIler Ihe dale of Ihll Order/Notice. Send paymenl wllhln leven (7) working daYlof the paydale/dale of withholding: Vou are entitled 1<) deduct a (ee 10 defray Ihe COil of wllhholdlng, Refer 10 Ihe lawl governing Ihe work Ilale o( your empl<)yee lor Ihe Ihe allowable am<)unl. The IOlal withheld amol/nl, and your (ee, cannot exceed 55% of the employee'l/ <)bllgo,'1 asgregate dllp<)lable weekly earnings, For the purpOle <)f lhe IImllatlon on wllhholdlng,lhq followlnglnfl)rmatlonll needed <See *~ on pg, 2), If remllllng by EFT/~DI, pleale call Penlllylvanla Slale Collectlonl and Dllburlemenl Unll (SCDU) Employer CUllomer Serylce atl.677'/i76-~560 for In!lructlons. Make RemIttance Payable lOt PA seDU Send check tOI Penn5ylvanla seou, P.O. Box 69112, HarrIsburg, Pa 17106-9112 IN AIJIJITION, 1'04 YMiNTS MUST INqUDE THE DEFENIJANT'S NAME AND THE I'AC;SES MEM'E~ '" (II/OWTI ' .hove II the EmpIIlYIIfI/ObflBllr'J Cone Identifier) OR SOCIAt SECURITY NUM'ER IN ORDER TO 'E '/fOC~'D. DO NOT SEND C~l':l..r..lz1dJ~ " ,m\ " ' ~ BVTHE COURTI ' --!IJll ! 8 1lIlI Arrearl 12 week I or grealer! <&> yes 0 no Date <)( Orden JUL ~ IS 2llM Service Type M rlT-j"l ~-' 'Jl.i',ll. form EN.o:l8 ",',1.:". Worker I,:> .y..,.,,:!)'}.~'i, , "",(1 ,! __\I'W--'1 I ' ,- 'j (1\- ( ~ I' ""IJ.: I~ . ,ihl' ~ dl!,I;. lIMn"",,! 11'lmUI~~ IllllI~th'lIll~tw II/liMn r..JI. ~fil iil 1\! j',' i{' 1il' 1~.Iji( 1(jj\...\!.'~1 }.,\1'J"'" :'Ii!~~" ,f; \',hl,';' ll~. -,f:\': 1 rn-:;w,r:' ',', ' . .\\f;,,,I'.'i" !.I.. I II !Y.," ' ,~. I ~l';.,:, ' , AopmONA~ INFOIIMATlON TO JMP~OYJIIS AND OWllI Wml~IO~DEIIS o 11'"1" klld V"II ,1111 ""IIIIIII,J III I'IIIVhl" ,I' "PV '" 1111_ '"1111 '" V'IIII "lIlpIIIV"'"' I. ",III,lIy: Wllllllllldlll/llllld,', ,III. o"""/NII'Ii,, II." I',hlllly IIVI'I ,lilY "'111" "'Ii,,1 1"'" "" 1111""' SI,,'" /,'IV ,''',1111''11111 .,,"'" 111""1111, Flldll"d ,~, h'vlI.. II' """" hll(II,II ,","11" "' III" '"'/11' 1MVI' I'i/",lly, If 1111-,,, ,I'" h.d"',I/ ",. IlIvl,', 111"""" 1"11,"" '1111'.,11111' ''''1"...11/111 "1I"llIY II'''''' ,,,,I,,IV. 2. CIIlllhllll/I/lI'"VIIIII,II" YII'I' ,III' IlIlIhlllll 1'11111'11"" .,1111111\1. ("1111111111,'1110111 lilli' "IIIP"'V"I'/"IIIII1'II', III' II1ll1'llI.l .11111'11 ,"YIIWIlI '" II.' "'1/1"11' Y II"IIIII"lIllIlVllllhllldlll". Y'"'PIII", II11IV1'VI'I, "'p,ll,l"'ly hli'lIll1y 1111' 1""111111 nf 1111' .11111'" p.lYIIWlllllloI,l. "'11111111.,11111 ,,, IIdllI II11lpli'V",'/"I1II/1"" J.' 1t"",'rtIIl1l1n.. 1>"Vd,IlI/DII'" ,,/ Wllnl",IdlllW Y""ll11'" ,..",'rt Ihll lloIVrI,"II/ct,'11I nt wllhl",lrllI'lI wnllll '"IIdlllll 'hll P,'Vll'IIIII, fnll p.yd.IP/d.", n/wllhhllldll1l1" 'hll d.1I11 "II wnli h ,II"'"11l1 WI" wllhhllld fmlll'nll Plllplny""" W"Ii"" YIIII '1111" "III11"Y IVllh 'hlll.w n/ IllIt ,'.10. n/ Ihlllllllplny"""/nhIlIl'II" I"'I1"I',llpl,""I'/ 1'lIlplnVII1I'1I' 1'11111 III'P"" ", 111111111I11 I',.""d. wllhlll willi h ynll /l1I"lllllph""l1l1llhll wllhhllhlillll 11"/11' ,JllIJ In,w,II" 11111 "'PI""II"'VIIIIIIII., 4,' ElIlpl"YIlt./Ohllll'lr wllh MIIIIII"" S"I'P"rt I"nldlllll" If 111"", "11I"'" III~II'"'" OIl/",/NIIIIi II ", Wllhhnld II" ,""" tnr SIII'I"1I1 ~1I.II\\llhl' "lllplnV""/lInllll'lr .lIld V"" ,I,,, III1.hh',,, hnl"".1I "'I'P'"' O,dll,/NII,1i ". dUll In f",jl'I."l/ SI.'" wllhl",hll/,,, 11I1I1h, V"U 11111.1 fllllllw 'h. '.1'1 "f ,"" ".111 IIf "lIlpl"V"II"/I,hllll'll" 1"'11,1110111,1.", IIf IIlIIphlVII"'II!. YIIU 11I11" h'"ln, ~II O,d",./N",I, ,., "'Ih" 111",1"'" .~'""IP,,,,,'blu, ISu" ~9 '101111'1) 5, T"IIIII/,.,IIIII NOIIfI,.,llll!: YOllllll'" pr",))p"V IInll(y 'h" R"'Illu.1I1111 AII""'y wh"lIl1l1t "lllplllV""/ohllll"r "111111111>>'" IVII,klllll for VOll. PI.~,. p/llvld" II'" IlIro",,,"oll '"'I"",'.d .lId r"MII . '"PY "f 1111. Old"i/N"lh II '" "", AII""'Y Idullllflt!lJ h..IIIW, WITHHOlDER'S ID: 953951HGO EMPLOYEE'S/OOLICOR'S NAME: EMPLOYEE'S CASE IDENTIFIER: LAST KNOWN HOME ADDRESS: NEW EMPLOYER'S NAME/ADDIlESS: _ SHEPHBRD. DONALD W. .O'0100~n ,DATE OF SE/'MATION:_ 6, LIIIllP SIIIll P~VIIIUIII" Y,<IlIlll.y bll "."III1..d '0 '''pllt' .II,J wllhhold (rolllllll\lp '"'11 p.VIllIIIII' III' h ,I' 11'"111"", ""l1llllllloll" '1/ '.Wi.II'. p.V, If Y"ll h.v. .IIV qllo..llilll. .h""lllIlllp !lllllp.YIIIIIIII', ",,".,'Ihll P"''''') n,. .lIlhlltlty 1)(IlnlV, 7, , LI~blllly: If Villi f.1I '" IVllhhnld 11I""11U.' Ihll O,dlll/NIIII'" dll'" '" Y"" .1/1I1I.hl. (II' 1I11lh Ihll .'(I"III1I.llId .I\I'llllll V'"1 ""lllld h.vl! wllhh.ld ('"IllIIl" IIlllph,y""/ohll,,o,', hll nl\ll' .lId 0'''"' p,,".III.' .", hy I'''1ll1'V'v,"II. SI,,'" I.w, PtlIIIlSylv.lIl. 5'"1" I.IV 1I0VII"" lIlllu" I"" ohllllo, I. .lllpl"Ytld III .1I"tI"" S'.IIl. III willi h ,.,"11," 1.11'1 nr Ihll St.11! III whl< h I," ,".h,. I. Illllployed II"VIIII\!. 0, AIIII-dI.. "11111'."011: YOll .,. "I hi." 10,' fill" d"'IIIIIIIt\l'd lIlIdl!I S,"'I! 1.1'1 (or dl" ".'"'11".11 I!lllploVf"/ohIlKflr f,o')1 .lIIploVIII.II'. ''''"''1111 10 I!lIIploy, 1/1 '.kIIlK dl'''plll,",y.ll 11011 .K.II1!I.IIIY I!l1Iplnv",'/IIhllll'lI bl!'.lI!. ot" "'ppo,' wllhllnldlllK. P"il/IIV'v.III.1 S,.,. I~w 1I"VI!IIlIlIlIl"" Ihll "bllllo, I. "lIIpl"y"d III ~lIolllllr SI.'", '" whl,h '~'"Ih.. 1.1'1 of Ih.. s,.t" III will, II Ill' lit .h. ,. elllplovnd II"V""", 9,' Wllhh"ldlllll LIIIIIIs: Y"lllll~V 1101 wllhhnld 1111/1" 11,.11 'h" ,",,", nf: 1) Ihll.ll\lnlllll. ~lIow.d ny 11111 F"dll',ll COII"""'" Crlldll ~,"'edlllll AdO S LJ,S,C. ! l67J (11)11 '1/ 2) Ih.. ."'011111. ~lIowl!d hV lh. S",'" "f Ih. "l\IploY"I!',/ohllllo,'.p,III"p,ll pl.,,, of lllllploVIIII!III. The Fl!d.r.IIIIIIJllppll., 'olhl! ,IIIK'''II.I. dl'p''',lhl" wl!llkly ".""1111' (ADWE), ADWE I. III" 1I",It)rlI"lI' 111ft .(,., ",.klt," ,1I.lId.lory dudllrll,,/" ""Ii." S'.'e, Fl!dl!,.I, 10".11.'"', Sn".1 S'"lltlly ,.,",, .lId Mlldl' .,"1.,,,.. 10. ,'NOTE, If YOll or YOllr ~8ent ~re served wllh a copy of Ihls ordel IlIlhe SIOIt! Ihotllll/ed the order, YOl/ are 10 (01 low the law of the stale Ihollssl/ed Ihls ordel wllh relllecllo Ihelo I1OI11S, ReqllestlnB A8encYI If YOII or YOllr employee/obll8or hove OilY questions, DOMESTIC RELATIONS SECTION conlacl WAGE ATTACHMENT UNIT 13 N. HANOVER ST by lolcIlhone AI 1717) 240.('22~ 0' P.O, BOX 320 by FAX 01 (717\ 240.(,248 or CARLISLE PA 17013 by Inlornel @ 1'.18l' 2 o( 2 Form EN.026 WOlker 10 $IATT, Service Type M rJ/IlIl....,~,llt'I1IHl1H I "IIr~'I'UII)~It.; I JI JI/I)I) Ii " I I, I, I' Ag9!t:!lll1M 5l!lllJ/)ll!UIl~lIm.AlJ.w.:bJllIIll! Pele/1~a/11/0JIJj~lm sJla~IIIl:RO, DO/'lM,O W, " n68101~4'V?1 {:;( rtlCSF s (',I'" NlIllIllI't I!11JJJJJJJ1:JJJJlli!. It RU' Atf.H hlllllnt All1ouJ.U ~?61~~ QIVI~$ 476,67 Chlldllltll)'. N.III"I.): !.lill..hrl AII,llhllHilll AIlIIIlli.l! $ 0,1)0 (hlldlll'II)', N'"II1'I'I: DOll 1lC)11 DI/,hlt, k"d, Y'III .," ""Illlr"d III "11I111111", I hih/II""/ /dii'lIlIflltd .hl)V" ill .IIY hit. 1IIIIIIIWlIIt lflVltl,'W' ,IV,II.lhl" 'hlllll~h Ih" "llIpl'ly'"''.llIhll~II''' "'lIpll'YIII"'II, 01/. h." I",d, Villi .," II'lIl1lr"" 11I1t1l11l1l111l' I hlldll""/ iill'l\lI(I"d ,lhIlV" III ,IlIV hlt,IIIIIIIIIII,IIII.. IllVi>r,IW' .V. I.hl" Ih,ml"h Ih" "'liP lly",".II,hIlWII'1 "llIpIIlYIII""r. PACSES C~\II NlIl11hltl PI,IIIIII((N.llIw I'^CSES c.I\1/ NlIIIII"" l'I"IIIII(fN,III1" JJ.u.Uili! AlIJ( hnwllt Amount II $ 0,00 Chlldlll'III'. N.I11"I.!: DOB AII....hIIWIIIAII.llJ!JJ.l! $ 0,00 Chlldtlllll)'; N.II1O'(!): ~ DOB o I' I hel k"eJ, Y"II M" '''lIl1lr,'d III "lIIl1l1lhlt I hlldlll/II/ 1dii'1I11/llld .lIdv" III .IIY h".IIIIIIIIII.'1I1t Illv"I,IW' ""II,lhl.. hlllllMh Ihe 1'lIIplriYItIt'.lllhIlWII'; "l1IpIIlYlIllillt, o If I hell",d, yml .,,, "'lllllr"d 11I1'lImll the 'hlldl'""/ Idl/llIl(lI.d "hIlV" I" ,illY IlIloIh 1 h\III1.III1' rove,""" .v. I.llle Ih'llll"h Ih.' It/llpllly",''.llIhll"IlI'; elllplIlYI11""I, ~C~~~f, ~~~~e NlIl11l1el "^CSES C.1l1t NlIl1Ihm I'1,IIIIII(fN,lIlle fJ!l!.J!!1 AlI.lhlll"1I1 AI11I1I1I1I S 0,00 Chlldl,ell)" N."IO'I.): lli!!...Jill! AIIMIUHtlllt AmoUl\l $ 6,00 Chlldlll'II)'. N.1I11'1'1: 0011 DOB DIf(he,kad, Y"II .," 'eq~lr"d 1lIltlllllllll\ll,hlldlrHlIl ' 'ilAlI'''I.'' .hove hI .IIY h".1i I 111.1I1.1l11t IIlVlw~e .v. I"hle thlllu~h Ih. IlIlIplllyea'.lllIIIIWII" el1lpIIlYI1I1l11I, lilt I hel kltd, YIII' .lIe lellUlred 1III/IIII1I1II\1l,hll"llltll/ la;;IIII(/",1 .IIIIIV>> '" .IlY h,'.1i , 11""',"1'" I IIV"'.~1l .Vd I.hla Ihl<ill~h 11111 "l1lplnY""'!lnhll~l/I" IllllplnYl1ltllll. ' Addelld"lIl FOIIll EN.026 WOlker to 4Il\TT Service Type M t lMII ~.n.i nll/IJ.rll.~. Illlh.tlullll~h'! 1/1) I/llil /' 'I " " " OIlPEll/fljC)rlCf rC) W'THHo~P 'NCOM,f fOil $UPPOIlT I/.:'t 'I 7 - (r' I ~ 'f (' /t'l(.. 51ale cQlllmoQw\lIl'lbQIPDQ/l'yly_ I';)(jc.,>'~ ,\t..\'f(i/.JlI7 Co./Cily/Plst, of !<!m1311~l,}\N0 ) .' OateolOrder/Notlce 07/30/01M-',l>' It.;\' Coort/Calll NlImb'lr ISee Addemlnm (flf rm mmnwy) Ollri~I"Jlll/I""IN"'"'' o ^IJu,/ItI,',I()"I,I,/Nlllh,. (8) IlImllllolh' t lnJI,,/N'Ilh II ~ii'li"y.,lWllhl..ld",'. f,',I",.1 fiN N")III~', ZJ~B~ TRU~ LINBS Em,IIYL'r l_lllll.,'1I Illflll PO B01fw1~9 Em'~HV'" IIh l1l1l1111'1I AlI,In.'" MIPPLlNTOWN fA 17059-0130 1111: OIl~P lIRO DON 1,0 , ) filii 1l)'I'II/t >Illltlll"~ N",nl..L",I, rl,~I, Mil I .~n....~m ) "1I1111l1}'11I'/f) )11~1"'.IrUII j,.1 ""lllrily NIl",IIl" I .080100253 ) (IIIJIIII)'lll'/()IIII~II"~ ':0111I' Irll'nIliJI" I IS.. Md.ndum 1M P""MII/ n.m.. Illor/.,.d wllh ".,., fH/ "'irlim.nl) ) I'II~hl,Il,11 PMI'IlI'~ Ndml'IL.HI, Flr'l, Mil I ! See Adde""nm tn, t/epende!/! names alld bl"" IfMel annr/alelf wll" rales ,nn a/larhmefl/, Of{f)E~ INFO/lMA nON: This IS;\I1 Qrder/Nmlro Il) Wllhhold IlIrOlllo lor SlIpportllilsod upon all ordllr for IIIIJport Iroll) , CUM13SRLAND Counly, COIIIIllO/lwc;lIth of I>enllsylvillllil, Uy lilW, YOII arc reqlllred 10 dedllct Ihele al11oll/lts Irolllllle above.nilllled elllployee's/0l)lIsor'5 Income 1111111 fllrlher notice evelllf Ihe Order/Notice II Ilot lUlled by YOllr Sliltll, $ 0,00 per 1II0nth in rllrrerll slll $ 0,00 per 1II0llth Inllillt-duo 51. $ 0,00 per 1II01llh In lIIedl~ill Sill $ o. QO per 1II0nth lor genetic les $ per IIIl)nll1 III lllher (Iperl lor a 11)1111''011'- 0 ,00 pcr mOlllh I Yoo do nol have 10 varY YOllr "~ay cycle to III Ihe ordered supPort pilYlllenl cycle, use the I $ 0.00 per weel(ly pay period, $ 0.00 per biweekly pay period levery two \veeks), $ 0.00 per lelllllllonlhly pay period lIwice a 1I10/1lh), $ 0.00 per I/lollthly PilY I)erlod, REMITTANCE INFORMA T/ON: You IIIUII begin wllhhohJlng no liller thanlhe Ii rll pay period occllrring ten 11 0) working days aHer the dale 01 Ihll Order/Notice, Send paymont within leven (7) working dilYI of the paydillo/date 01 wllhholdlng, You are entitled to deducI a lee to delray the COsl of withholding, ReIer 10 thlllaws governing the work state of YOllr employee lor the Ihe allowable amount, The total withheld amounl, and YOllr fee, rannot exceed 55% of the employee's/ obltgor'l aggregale dllpoli\ble weekly earnings, For the purpose 01 the IIl11ltatlon on wlthholdlllg, Ihe followln/llnformatlollls needed (See .9 on pg, 2), II remllllng by EFT/EOI, please call pennsylvania Stale Collect lOlls and Disbursement U,nll (SCOU) Employer ClIstomer Service at 1'677.()76-9560 lor Instructloll!, Make RemlUance Payable 101 PA SCOU Sefid check lOt PeflOsylvanla seou, P.O. Box 69112, HarrIsburg, Pa 17106.9112 IN AI>DlT/ON, PA YMfNTS MUST INqUfJf THf UfffNI>ANT'S NAMf ANI> THf PACSfS MfMBfR IfJ Is""wn .boWl .IS '''e fmploreelOb/lsor'l C.se Identifier) OR SOC/M SECURITY NUMBfRIN OilfJfR TO Bf PROCESSf". ' , 00 NOr SfNfJ CASH BY MMt, , weeks or greaterl 0 yel i&> no . U i'll' v, lrder, II YOllr pilY cycle does nOI malr.h 10 withhold: BY THE COURT, C I -') Date 01 Orden JUt G I 200' -" ~ MJl.II_lrft Form EN,028 Service Type M ~"""'",,"'''''''''' WorkerlO $lATT . I ~I)II~IIIIII I )~h' I Jlll,1111 , " .,1.'-..,., i, ., 1";,1 'Ii , -I .. , ' APpmONA~ INfORMATION TO ~M"~QY~lt5 ANP Qnl~M W'THHO~P~"S o If dw,kllll Y"l' .,,, I"'1ul"'11 III p'"VilllI.'I IIPY II(lhl, (II/1!1h' Y"lI' "Illp""y"", 1. 1',jllillY: Wllhl",IIII'I/\lIll1/'" Ihl, Ot<l",/NIIII< " h,I' prlll,lIy 'IVI'I ,illY ,,"l,," iI'H.,1 p,'" "" "'Id", SI.I" I"w ./\"1I111Ih,, '.111" 1!lIIJIll'" f"<J~,.II.~ l"viI', III ,,1111" '",I"It" ,,,,,oIpllll' Ihl, 'lid", h,IV" plilllhy, I( II",,,, ,It'. 1'"111,,.11... l"vlI" III ,,1'1", I pll',,,,, III/II~lllh" "''11''''1111/\ ./\",IIY IIII"III",IIIW, ' 2, CI""hllllll/\ P.YI"""": YIIU I ,"lllltuhilll' wllhlll'ld ,II!1I1l"II, ,,,"11 IUII,,,"h,1II '"ii' "lllplllY""/IIhIlWI/" 111111/111' III. 1111/\11' P~Ylllllllt hlll.'h ,'/\"'U Y III'IU""IIIl>> wllhh"ldlll>>, YIIlI 11111.1, ""J\Vl'vI'I. "'I',It.'h'ly 1I1"IIII(y ,111' 1""111111 II( Ihll Ihl/\I" P:'Y"WIII,lh.lIl, ,'11,111111.111.. III 1'.1 h "lIlploYI"'/IIhll/lllt, :I,' R~I"'rtlrl>>lhrt I'IIYII.II~ID,'lrt "' Withhlllllll.,,: You IllU,1 rrtpmllh" I'.'yrl,'IIl/r!.II" of withhllldlllll wh.Il '~lIrlln>>lh. p.ym.nt, 'T~.. poyrl.t./rl.lrt III whhllflldlrlH I' Ih~ d,,'. 1111 whl< h ,1I110UIII W,II withh,,1I1 IN/mlh.. "lIIplllY""" W.H"" You 11111"1 IIlllply wllh Ih. I.w Ilf lhll ,,.," II( 'I'" "lIIpl"y""',/o/,IIHII", 1',111111',,1 1""1" III ,'ml'II'YI!I"1I1 with ""1"" II" 1111'111111' I""llId, with III whll h you IIIII"!llIpl''i)Wllllh'' Wllhhf/ldlll/ol IITd", .,ul (,'/w",d Ih" "'1'1",,1 P,'YII"'IlI', 4.' ~lIlpll,y,"'/Ohll>>II' with Muhlpll' SlIPI,,"1 I '"1"111>>" If 1111'1" II '111ft., Ih.ftlllll" O,d",fNIIIII" III Wllhlll,ld 11111111111 (lit SUPPII,I ./l.IrI,llllj, IllIIpIlIY'!"/II/'liH'II ,lIld Y'''' ,I'" ulI"hlt, '" 1111",'1,111 "'flP"" Olrl"r/NIJlI' '" rlu" III r"dl",llll' 5,",1' wlIl1hlllrllll" 11111111, Y"IIIIIlI" f"lillW II'" I.,w II' Ih" .1,11,,,,1 "lIIpllly","lfllhIII\II", 1"'111 11M 1 "I"", '" "III"It'YIIII'III. YIIlI""lll h'"III' ,III O,d""fNllli"",,, Ih" /It,,.,,,.1 "~I"III fI""II'/II, IS"" *') h..lllw) 5, T"rJIIIII.II1111 Nllllfl",'llrlll: Y'IIIIIIU,I ""lllIplly ""llly 1111' Ill''I"I"IIII/\ A/oI"II' Y wl"'"II", "lllpllly""fllhIlHllr 1'1111 1'1I11\"r wII/klll/\ fllr y"U, 1'1".,,, p'I,vldlllhlllllfI/TJII~IIrJII 1II'I""."'rI ,'lId Whllll. IIIPY IIr Ihl, Old"I/NI,lIlIIlo 111" ^W!II"Y Id"III1J1"rlllHlr,W, WITHHOL[)E~'S 10: 96~OB1l4~Q ~MI'LOYEh/OBlIGOR'S NA~IE: ~/IIPLOYEE'5 C^SE IDENTlFIERI LAST KNOWN HOME ADDRESS: NEW EM"lOYER'S NAMI'/AODllESSI SijIi:PHERD. DONAl,D W. .080100253 DATE Of SEI'ARATlON: 6, LUIllP SUJII ".YI\II'''''' \'<HI JII,IY 1m ''''1"Ii"d III 1"1"'" ."d wllllhllld (r'"11 IlIl\IfI \UJIIIMY,JII"'lI' ",..h.. 1.111111/'"" 1111111111\.11111', Clt '''Vllr.llr" p.y. If YOll h.vlI .IIY qUI,.IIIIIII .hllLlI hlllll' ""11 p.Y"II'II., III1I1.rllh" PI'I"'"l/t .L1,hllrlly b"lllW, 7, Li~billlYI If you '~III11 wllhhlllrlllll 01111' ,1111", Onlr.,/Nlllle" rlll"l h, YOll ."'II.hl,, ('It hlllh Ih" .IrlIlIlIlIl.,,'rI "1"'11111 Y"" ,h,,"ld h.Vtt WllhllHld (ll//IIlhll "llIplllY"IIM.IIHIII" 111"111111 .lId IIII",r 1'''11.111". 11'1 hy 1'''III1.ylv.lIIl. SI.,,,I.w, 1'1I1111.ylv.lIl. SI,h.l.w 1\"V"m- UIII,,!! lit.. ohllW" i. Illllpllly"d III .111"1,,,1 51,'1", III whle h 1.11",1", I,IW ll( 1111' SI,II,,1I1 whllll loll '" .hll I. "l\IplllYlld /oI"VOtl1., 0, AlltI-dl"rlllllll.,lllIII YOII M" .lIhl"d III ,I (II'" rI,'h'f1l1l1wrllllldl'l 51,1111 I,IW fill dl.. hMH'ilH ,Ill "'lIplllY""/IIhIIWIt ('''/11 IllllplllYIII"I1t, ,"(II.lIl/\lo IIl11plIlY, "' hlklllH diM 1"lIil,"y ,1I1111il ,IH.I,".1 .ilY Ilmfl"oy""fllhIII\II' '''''',111''''1('' '1IpP',,1 wllhllllldlll/\. """luyIV.li. SMIoII.w /llIW"" UIIIII..,lIllobIiW" I. IIlIIpllly"d 111 .1I111!"., 51,lh', 111 whll h I ~,I' Ih" I.w IIf ,hI' SlllIlIllI whll h hI' "' ,hili, "Jllpllly"d WIV"'III, 9,' Wllhh,"ldll1ll LII\III\I YOllillolY 1\111 wllhhllld 1I11",'lh,l\llh" "",\1'1 "': 1) 1111' ,lIl\mllll, ,IIIIIWl'd by Ih" ft,d"r,,1 CIIII.IIIII'" CI"dll ",,,,"rll'lII Arl115 U,S,C. ! 167:1 11011; "' 2) 11ll! ,1111""1111 "II"wI.d hy Ih" 51,"1' <lr IhlllllllplllYI'II"f"hIlWIt', prhlrlfMI pl.""" "mplllYIlll1tll, The F"dardllllllll.ppllp., III Ih" ~I\HI"H.'" dl,pII,.lhll' w",'kly I',!tllllll\' IAOWE), AOWE I. Ihlt 111'11111'"'\1' IIIr, . (Itlr IIMkl!IH 1l1~lId.'flty d.durtjC/ll8 8l1rh.II S,"tll, F"dll,~I,IIIk.1 r.XH'15rlll,II Slln!tlly l~xll'I.llld MI.dl'.m I.IX". 10. ,'NOTE,. If you 0' your agent 010 served wllh a copy of Ihls Oldurln the slale Ihal155ued tho o,der, you Me to follow Ihe law of the slale Ihalls511ed Ihls Older wllh ruspecllo Ihese items, flequllSlIng Agellcy" If you or you, employee/obligo, have any qllesllon5, DOMESTIC RElATIONS. SECTION (Olllacl WAGE ATTACHMENT UNIT 13 N. HANOVER ST ily lelephQlle al (7171240.(,225 or ~ P,O. BOX 320 ill' FAX al 17171 2,j0.~248 or CARLISLE PA 1 7013 by IlIlernel I/Ji l l .I " , 11ilHe 20f 2 FO/III EN.028 Wmke,ID $IATT Service Two M 11,"llf,l).rlllJ,'lllIIH I opll.,II'1II II~h': I JIII.'III! oI,h L. .' ~ ("'~) 'i] -,. " tUh'! :r.. ~'11 " , 11 , Ii.! ~~(, "r ~. I,.~) t;::( -I) "I "'I ~.~ .', ,., -. 'I "rr :J.;:~~ I:" "i ~.. .. 'j'. ~ - ~IJ , '::l "'" , . QIlO~"'NQn(~ rQ'"wJnwo~o 'NCQM~ ,QJlSUPPQIlT r.>d, '17 -(.,; .3 9 (''/ '/Il SIale ~lImD)p"I.\I~~ ~~~VIVp )!j k'<;/ \ fr" f-1C.l / J II 7 (o./CltylPllt, of C B ~ J);( ;lJ J{p,Y Date of Order/Notice 08tO~/01 '. (olm/cule Number (SI/II M~c"dllm III' wllllmmWy) @llrlu.lllil!()/lII,'r/NIIIIIII O^"1,'l1lh'II()f'II'r/Nllljll' o T.'mlllMhIOnh'r/Nullu' EIIII.lny,'rlWllhl'lld,',', F",I'nJI ~IN NIIIIlI." ~m'l'ION INC ~,n.~i,y,'i,wJlhhllhh.I;'I, Mm' ~O BOikv!l~~ EllIplny", IIh ,uhl",', Add",,, 'MBCHANICBBURq p~ 17058-5959 I Rh BII l'IIIlR PON^~P W, ) rlllp "YI'I' (lhll~Il''It NMIW I L':i:i;-f 1,_1, Mil I ~-u-~m ) 'lfI'III~'I,p/O 11i~llr'~ ~Ill !.lISpn"Hy NI'ml~lr I 4080100283 J rmpII)YI'I'/Ohllll'''''' C',l~1I h/l'nlllh', I IS,. AI/,h/ld/lm or ,'nllll /I.m.. mo,i./,d wl/h m"/III .".rhm'n/I I ('1I~hllll,1 "J",'nl'~ N,IIIW IL,thl, fj'hl, Mil I ),; SIIII M~C"d""IIII' dllpllm/c"' ""mel 4M hI,,11 d4111,~ "IIIIrl",ed wl"1 weN "" """rllme"" OROtR INfORMATION; TI)II II ill! Order/NI)llro II) Withhold Incomo for SllPPort baseU lIpon un ordor for support from ClJ"'BIlR~"NP COllnly, C')lJIIIIIl/lWO;llth of l'ennsyIVill!lil, Ily law, YOll MO required to doduclthose amounts from Iho ubow-named e/llployee's/olJlIgor's Incomo lInllllll1ther nOllce oven If Ihe Order/Nollco Is not ISlue~ by YOlJl' Slate, $ 1P, H Ilor month In curronllllpport $ 4.1,33 per mont/lln paM.dllo 11IppOrt $ 0,00 per monlh Inmodlcal sllpport $ 0.00 per monlh for gllnollc lell COliS $ per month In olher Ilpoclfy) for a lolal of $ 47 & . &~ per monl~ III 110 f.orwarded 10 payee IIOlow, Yo~ do not have to vary your "UY cyclo to he In compll;ln(o with the IUppOr! order, If yc the ord,ered support payment ,cycle, lIse Iho follllwlng 10 dOlermlne how mIlch to wlthhol $ 110.00 per weekly pay period, $ 220. OQ per biweekly pay period (ovory IWl) weeks), $ ~38, 33 per semlmonlhly pay period Ilwlce a month), $ . ~76. 67 per monthly pay period, R~MITTANet INfORMA TlON: You r11lllt besln wlthholdlns nO lator Ihanlho first J)ay period occlll1lnglen (10) wo,klns daYI aflor the date of this Order/Notice, Send payment within sevon (71 working days of the paydalO/dalo of withhold Ins, YOII are entitled to , doduct a fee to defray the cost of withholding, Re(er 10 Ihe laws governing the work stale of your ul1lployee for the Ihe allowuble amount, The tOlal withheld umollnt, and YOllr fee, cannol e~ceed 55% of Ihe employee'l/ obligor's aggresale dllpolable weekly earnings, For Ihe pllrpose of Ihe IImitallon on withholding, Ihe (ollowlng Infqrmallonls, needed (See ~9 on pg, 2). ' If remilllns by EfT/EDI, pleale call Pennlylvanlu State Collections and Dlsblmemenl Unit (SeOUl Employer Custome, Service at 1,677-676-9560 (or 111Ilrucllons, Make Remittance Payable tOI PA seDU I Send check tOI Penn.ylvanJa seou, P,O. BOI( 69112, HarrIsburg, pa 17106.9112 IN At>t>lrfON, ,.A YM~NTS MUST fNqUD~ Tff~ f)fff,Nf)!.Nr'S NAM~ ANf) TH~ "ACS~S M~"m~ It> Mown IboV9 IS 'he ~mp'oyeeIObIIBo,'s C.ue Iden,lfIer) 011 SOCMt SECUf/fTY NUMflE1I IN 01lf)~" TO fiE ""OCESS~D, f)0 NOr SENt> C!.SH flY M!,/t, Arroafl I 2 woekl or I ~D D~LJI-' " '" , BY THE COURT, Form EN-026 Worker ID $IATT Date of Orden AlIO 3 2001 Servl ce Type M f~,n... "t'f,~" t'-!'.... llMII~'I.:U'17IHll~~ ~;~..l'ft.l~ Illllt~III)I\II.,h'IIJ,'Jl/lllf --M !l 21101 , . AQPIT/ONA~ INfO"MATION TO ~MP~OYm AND OHlf" Wmmowm o If ,Ill" k"d Y"ll.,," '''<llIln',llll "rllvldll ,II ""Y "' Ihl. t"'1ll rll y""r "1ll"IIIY'HI, " 1"'II,'ly' Wllhhllldhlll lIlld,', Ihl. Old,.,/Nlllh" hJ' "rhlllly IIV'" ,illY 111111'1 "'11.11 """"" lIllIllll Shih. I.,w ~1I,11'1.llhll 'JII1II hlllllllll. f..d"'JI IJ~ 1,.vllI' III "tfll', 1I'"flll" '''1''1,,1 II/Ihl. Illd", h,IVI' ",hlllly, If Ihlll" ,11" f""III,"I~~ '''vh', 1111'''''' I ""',111" "111,1' Ilh" II"IlIl..111I1I JII"llry lI'l"d h"IIlW, 2. CI/Illhlllhlll 1'.IYl1l1l11I., V'1l1 ',Ill' 'Illlhlll" wllhlll"d ,11111'''111. flIlIllIlIlJI" Ih,IIIIlIII' ,'Illpllly",'./Ilhllll'"" Ill' "III" III J 'hlll'" I"'YIIWIlI ", IIJlh ~1I"Il'Y 111<1""'111111 wllhhl,ldlllll. VII" Illll", IIIIIWV"I, ...","JII'ly Id"lllify Ihll 1"11111111 II/Ihll ,hlll'" I"'Ylllllllllh,'1 I, Jllrlh"IJhl,. III IIMh IIIlI"Illy,,"/,,hl'Il"" ' J,' 'RrP"rtlnH 11.1" Pllyd",./DJI.. 01 Whhh"I,IiIlW VOll Illll.1 "'rOil Ihl! r,'yd.,I./dllll' IIf wllhholdlnH wh.n '.lIdhIH Ihll Jlllym",", Th" p.yd."'/d.'" ", wllhlm''''nH I, Ih. 01.'1"'111 whit'h IIIlInU1I1 W... whhh."f f"'llllhl! .Illr'ny".'. wIIH.', Vn" IllllII "'IllJlly wllh Ih,.IJW II/Ih. .IJI" III III" "lllpllly""',/ohIiWlI" p,'ml",,1 """" Ilt lIIl1"I"YlliI'II1 whh """",1 ", Ih" 1iIlIl'I"'rh"t. II'lIhlll whll h y"u 11111\1 hllJllllllil'll' 1111. WllhhnldhlH IIId", ~lId IIl!WJld Ihll ,"",,"1l I"'YIllIIlllI, 4,' ElIIplny",,/Onli/l'11 wllh /lllIlIl"l" SUP"'JlI' 'nldhill': If Ih""II I. 111111;' IhJIl IIIII' Old",/NIlII,,, III Wllhhllld 111111111" tnl SliPI'"" 111"111.llhl, IItl1plny,,"/nhIlH'" 111111 Y"ll "'" "'1011,1"111 11111I11/ "III1'''P'JlI O,d"r/Nnlh '"~ d,,,, h' ""d",.,1 "' 51,111' wllhlll,ldlllH Ihllll., YIJIIIIIU.I fllllnw Ihe IlIw 01 tI", "JII! ,,/ "lllploYI',,"/IIhIlHo,', prllld"JI "J.,II' of "1II,,'"YIII"1I1. Vo" I/HI.I '''"1111 ,III O,d"I./NIIII"" "'111" HI"JII..I ".'''11' I'""lhlll, IS,," H9 fll'lIIwl 5, TIlI/llIIIIIIIIII Nollflrlllllllll YIIlIlII".1 P'"111pfly lIoli(y Ih" Ill'qll".111I1I AII"1I1 Y Wh"lIlllll I'lIIph'Y"I!/ohllll"' I, 110 101111'" wo,klllll fill you, pl"",. pmvld" Ih" IlIfullIIlIlI'lII '''<I,,,,,,"d Jlld "'''1111 J I upy of 1111, O,d,.,/N.lllnt III 1I11' AI\I!IIIY Idllllllflll" Imlllw. WITHHOLPER'S IP: ~516i;7~660 EMPLOVfE'S/OBLIGOR'S NAME: EMPLOVEE'S CASE IDENTlFIEll: LAS r KNOWN HOME ADDRESS: NEW EMPLOYEIl'S NAME/ADDIlESS: SHEPHERD. DONALD W. 4080100253 DAlE Of SEPAIlATlON: 6. Lump SUIIl PJym"lIl\1 You /IIJY 1.11' 'I'q,,""" Iu ,"pml Jill! wllhhllld (mllllulllp 'UlllIIolYIIII!III. ",.h "' i"",,,."., ,ulllml..lolI', UI '''YIII"I\I'I! pJY. 1/ Y"" hJVII JllY <lU,,'I"'II' IIhllUI IUlI1p "1111 ""Yllil'lIl., ""\1,,. IIIii' 1.11"""1 "' ""Ihmlly Iwlllw, 7, LIJhlllly' It yuu /,111 "' wllhhold III""'''' "' Ihl! O,dl'I/Nullll' dl,," I., YII" "'1' 11.11>10. t," holh Ihl! Jll UIIIIII,II,," 1111111"111 you .1I11"ld IIJv" wllllll"ld (""l1lhll Il/ll"IIIY"I!/uI1I1Ho". IlIlllIlIl! IIl1d III/ll'1 IJIIllJhll!' ,el hy l'lllll"ylv",ll~ 51,,", IJw, P"III1.ylv~1I1J 51111" IlIw H'IYI!III' lIlIl",.,llII uhllll'II I. "/IIpluYl!d hi Jllollll'l SIJII', III will, h <J.II llilllJW of Ihl! slJII' 1/1 whl, h Ill' III .1", I. I!lIIphlyed HUVUIII', O. Allll-dI..-rIIllIIlJtlu'" Vuu JI. "Ihl'" II" " fill" ""I"IIIIIt".d "lid", SIJIII I,IW (01 dl\lliJlllhlll 1111 "lIlploYl'e/llhIlHu, (,UIII e/lll'II/YIII"lIt, ''',t11l1t11l 10 "lIIplllY, "I IJkh11l dl.dpllllJlY "' Ihlll JII,IIII.I ~IIY I!lIlpIo,y,'e/ol>hH'II l,el',1I1\1! 11(.1 '''I'pm' wilhholdl'lll, pellt"ylvlIlllJ StJI" I~w !\CJV"III' '11I1".. Ihe 1111111\'" I. "IlIploy"d III Jlllllh", 511111', III whl, h lJ'1! II". 1,lw uf ',hI! sIJII' hl whle h he ," ,III! I. "/llplllye" gl/WIIl!, 9,' Wllhholdlllg lImll!: VIIlIl1lJY 11111 wllhl",ld IIlll'H IhJII 11\1' I".... IIf: lllhl! JIIlO'IIII. JII"wed hy II", fed"",1 CIIII'''IIl"' CIl'dlt Pm'erllllll A<:l (15 U,S.c, S 1673 (11)11 U, 211111. JIIIIIIIIIII Jllowlld l1y Ihl! 51.111' of Ih" "1I1,,1',ye,,'<loI1I1Hnr'. ptlllrlp~1 pili'" of I!IIlJlloYIII""I, The ,ffldelJlllmll dppll... h,lh" JIIH'"HJ''' dl,pI/.ahle w"l!kly ""l11hlll' IADWEI. ADWE I,'he lIel hl'"1111! 1M' J(IIIr IIIl1klllH IIlJllcjJI'''Y , dedu<:t11/II' ,"dll1\1 SIJI.., Fed","I,'orJIIJX"'; Sodlll 51!' Utlty I.IXII', Jlld M",II,"tl! IJ.".. 10, 'NOTE, II you 01 you, agellt ale served wllh a COllY of IlIls order In the slate IlIallssued Ihe Oldel, you ale 10 follow Ihe law 0/ Ihe stale IlIallssued this aide, wllh lespeclto Ihese lIe/lls, J{equesllng AgencYI It Vall or your ell111loyee!obllgor have allY qllestlons, DOMESTIC RElATIONS SECTION COlli act WAGE ATTACHMENT UNIT 13 N. HANOVER ST by lelephOlle at (717) 240.6llfL.- or P.O, BOX 320 bV fAX at 17171240.6248 01 CARLISLE PA 17013 by Inlemet @ P.lgl! 2 of 2 Form EN'02~ Worker ID $I~TT , Service Type M [lMII ~.'l,i 1)I~71Hll H 1)1111.lillllll.t.';lJ/ll:nll .' ,..-- 1/1; PACSES Cal'ilt NUlUhttl ~\II~ N~Wt Ql. IlIll D.u.!1d. AIIIII hfWI/lf Amoulll ~?-613~ CJVX~$ 476.67 Chlldlrul1~'! N~I1"'I'): MJJllJSD~M 5lIm/JJJl}'..)'Jj1 Ca",lllJ)~h/JJlIlJ! Q~'q"da"I/OhIJKlm BIlBPIlIlliP , DONI\LP W, B6BllllH";') r It.. IV I.'MJJj~lilJJJilicl CJll!JJlJJ1li~IllJ! DOll 6J!iJ!.JJillJ.:IJ1DIlJJJ.VIJJ , ", Ill) (,hlllll"'I1,\N,III'I'I'I: !1.'.nh!.1 J)Oll r111' h., k"d, Y"" ,II" ''''IIII/I'd ,,, 111111111 Ih" 'hlldll""/ ldol111f1"d ~l1c,v" III ~I1Y h""lh II1"lt~III" '''\'1'1,'11'' ,1V,11"hl.. Ih'''"l1h Ihll "lllp",y",",/"hIlW'I" l'II'pl"YIIII'III, ell' I 111111111111 ~lH' lUll "'1111'11'11111 lllllnlllhp I 1111111111111 ,1iJi7llllflPtlIlb11V11In .my "11,IIIIlI~tH,1I1I111 "VI~"'WI IJVI) 1111111' 11"""l1h IIII"'ll1pll'Y"""/IIhllll'll\ "'lIl""Yllll'llI DOll l'ACSl S (,"I.:liJJ/JJlJ.!:.t J!.1JJJJJJ11.l::JJJJw:. !1uili! 6!!iI.'.JJ/lJJ:JJl.DJWi.!JJJJ $ ", "" (,hlldlll'"I\ N,"'II'111 " PACSES CJW Numllfll pl..-lntlff NJIH" D.u.!1d. AIIJ( hmlll'l Amlltllll $ 0.01l Chlldl'"I1I'. N~II,"I'I: 1)011 h" ,h.,k"d, Y"u ~'" '"'Illlr"d I" ",,,,,lIlh,' , hlldlll'''/ ,aH"IIIi"d ~h"ve 111 ~IIY hll~IIIII1'llt~III" "lV"'~Il" ,1V.11"h,,' Ihmullh II... "lllp"'Y.."/f1hllll"'" "lllpt"YIll"I1I, 0" Ii"" k",l, Y"" ,III' """1'''"1 ""'IIIIllIlh,' I hlllll'"I1/ Iili!"liflo'd ,IIIIIVI' 111 ,illY hl!,llh 1111111,11111' . """NK" ,lV,l '~I"" Ih'''"1\h Ih" "IIIP'"YI,,''I/llhll/l''''' "IllI'l"YIll"111, .11'1 e6&$ES c~'" N~lllh", PI~hll'" N~ln.. Iw:m c'1II' NllllW 11WJlJJ1ll~JJJ!l l'il'l "i\ " ,r'; IlOII i.I!lJlJ.bJJJJjJlDJllU.!JJJI $ 1I.ll~ ('hllt/II""I\ N,lIl1,'I.I' l)ill.h.ct ',.;j ,::11 6l1ol.dwlfJJ.L6JlJ!J.\JJJ1 $ 0.00 Chlldl'"")" N~IlI"I,): f2!l!.J!!Jl o If rI,.ck_d, yo" ~r" '"<llllr"d ,,, "1II"lIlh,' I hllrllJl'"1 ldelllifl.d ~hr)V" I" dllY ht!~lIlh""'dlll" '01'1",,11" ,IV,II"hlt, IhrnuMh Ih.. "llIp "y",",/ohIlWI/" "lllpIIlYIlI"IlI, I elll.'"" kl"I, Y"" ,III' """1'1,"1 ""'111,,11 Ih.. 'hlldl18I1I' lifo"IlIIlI.'" ,11",Vi' hI ,lilY h,','IIIII"II,lIl1ll"IV"I~M" ~v.l.bl~ ' 111l""l1h Ih,' I'Il'pl"Y",",/"hIlWII', "IlII""YIIII'1I1. , ,:1,\1 lHJI 'Ii 1I11~ I.'~i~ Il~i'.~. Ii' ;. Ii" i." ,",j\-_~ I "/\,.1. I, i1 'f~..;I), , '.'1)" l" .1il i'j .\).H,_ ,'I.'I~~ '1,,;1: "III" F.N,028 ",,\1 Wmkur 10 .r~"I, " 'II! POll I;' I 'I I. " ~:j ;.\'" 1\ ii ! ~ .1\11 .J'" .l ~i" \1; " ' ~ih" :\\"i L'-'t' J,rJ:l, 'I\i ""'!' I, .{lj'll ll,. ~\! ' -"Y1JI,"I'1 d':l,', '>'A; \,"'1 ' A,ldl'IlllIIIII Service Type M IlI.lll'.., 1)11.'1)<\1\4 Illd'"II"" 1.'.11' IJ'II\I'1 C'} ~-'I r~i ~:;J " "0. r': "ql,): till' :.-S r.,i .4~. I ,I~ - I I , l;'r'. III \ ".)J ~ of. . Ir~ ~ lr' ,.. "'," '~.l ,!.;C, ' . , 01, i , ~.:Ti.."'l t:} ,In J::'('_: ':1 :~j :.II {Q "'" ,- , \ I, . . ,I QRmlllNQTlCE TO WJTHHOU) JNcOME 'OR 5LJPPORT N'I 'I 'II.'/~'J (1 II If 51.le C\!'PD)OPWIl"t.lll,l1 "~"'l'yl vl~l~ 1';1r' ,; f'; )'1.. J'I (II, f r '1 Co./CIIY/OJst, of C~!lJiR~P .\. .. r OateofOrder/Nollee 05 U O~ of!. ,,(tllt", Court/Case Number (Sft A lie" 11m III' ca.e .lImma,yl o l)IIHH1~11 ',d",IN.~II" @ AlIllmdlllll hl'IIIINI~II" o 11"llIjlhlllll"I'll,'N'~III' fmploy.,/WllhhQldu," f.ol.,~1 fiN NI//lII"" ~~~ T~qpoR~TroN INC f/llp oy.,1W1I (,I,I.," ~'n. fO BO~9~9 f/llploy., IIh Ill'd.,'. "'hil." MBCHA/'lICSBURlj fA 17055"8969 ) ~II SI1~1'IIliJlP, /JON/Il,/J W, I Illlp uYI..'/OhIlKIII\ N,ulll'll jl~l, 111~1. Mil , .lll.,jf.~~U ) ~;I.I/{))I~I)I'\~lllt.ll~j'llyNIIIIIIM" , 408 100~53 , IflJl H)'~'II/O' IHH"~ ('II~II hllllllllll" , IS" Al/d.m/oJm I'" p"'n!1!11!!!J!!W!:~19!!/.!1!h!!!!!.!m.!lm!l!!!!.n/J ) "'"\Iu.'hlll''''''''ll'~ N.1II111 1I.J~1,' II~I, MIl I -/._- .,..---- Sft Arlde"dllm III' r/epq"de,,/ "~me. a"d /11"" dale. mlll'/aler/ w/I" 1'.,0. 1m "'.l'''''''"'. O~O!f{ INfOf{MA nON: Thlsls an Order/Nolin! "l Wllhhold 1/11'11111' "lr SIIJIIIO/l 1,,1'1',111111111 ,III,",h', "lr "11,,"1/1 Irom CUMBJin~ Counly, Cll/llln<ll1Wl'i1hh of P"'l/liyIV.llllol. Ily I,IW, YOII "'''11'11"1,,'11'', ,I'/Ih"llht'~e amounts from Ihe above-named tlmpll>yee's/ilhllg(),'s inolllll' IInlll hilt hI" 1I1111r1' I'w/III 1111' (IIlh',/NIlIIt I' i, IIlII Issued by you, State. ~ 433 , 33 per month In current ~UPI")/1 $ 130,00 per month In pasl.due SUPPl1l1 $ o. 00 per month In medlc.,1 support $ p. 00 per monlh for geneJlc hIM o,sls $ , per month In other ( for a 'lila' III' au. 33 per 'I'll You do not have to vary your pay Cyell the ordered support payment cycle, USI $ 130, plI per weekly pay pe,l, $ ~60, 1111 per biweekly pay pi $ ~81. 67 pe, semimonthly pa $ 563,33 per m'l/lthlY pay pe REMITTANCE INFORMATION: You must begin wltrholdlngno later thanlhe fI,st pay perlorlllllurrlnM lo'nllOI W,"~IIIM II'IY\ 111t1'r Ih,. d.lh'I,'lhJ~ Orde,/Notlce. Send paYJl)ent within seven (7) working day' 01 IIII' p.IYII.III'MIIIt'II' wllhholtlillM' YOII ,.11" "lIll1h'l.I II) deduct a lee to defray the cost 01 withholding, IMe, to tlw lilw~ MowmlllM /111' wI"~ ,hlh' III YOllr 1"'ll,JllY"" fur Ih" the allowable amount. The tolal wllhheld am,qulll, .md Yllllr f..", 1.IIHIIIII'~I""1I ,H"/" 1" 1I1l1111111lh'Y""'!I/ l'hlJg",'~ ay,egate disposable weekly earnings. For Ihe pUrpl/St. "f 1111' IhHlJ,lJll/II 1111 wllhhl,hIlIlH, II", lolh/whlM 11I1'lrnhlllnllls needed (See ~9 111I pg.' 2). If remitting by EFT/EOI, please call Pennsylvanl.l Stal" c"II"1 IllIn, IIIIlII)I~hlll"'IIl"lIllhllll\l'l)lJ) IlIlllllly"r CUstomer Service at 1.677.676.9560 for Inst,u,JllIlls, Make Remittance Payable 101 PA SCDU Send c~eck tOI Pennsylvania seou, P,O. B". 6911:1, U"rrl.hurM, l'il1711l6.tjl1:l 'N AOOtrfON, ,.0.4 YMENTS MUST INQUfJl THE 1)1f1N1JANT'S No4M' ANI) Tm I'ACSU MfMllffl '0 (.hllwn .bo~e II the E",p'IIYft/obl/,II"', c.,. 'denllfle,1 0" SOctM ur.'U"'TY NUMIIEfl IN CJ~fJE" TO liE ,."OCfSSfO, 00 Nor SEND CASH IIY MAlt, !tY 1I1~ WI)II', .-"___'" ,- ~ (. ....~-- .....'- ^m'.II~ I J \VI'II~~ 0' HII',IIl'II OOVI'~ () '"' (}~ II/W, 'P"" 'I/,h'r, II y"ll/ IMY I YII.. Ih"'~ 11I)1 "hllch mUI h hI wllhhllhll Date 01 O,der: tlAy 1 7 2Wl2 " :Il;p(,.(. Form Ei'j.()26 Work!!r In $IA'rT ,~7;-:~:ii:'-iI7l'r.i //\ 1\ Service Type M L')4oij' " IL~.J.' ..;, 'I' .L,-_ I' 'IMIINIIII"/11I11\1 ...._..,-~'........... l' _/'I"{')L._~:II/I!ofIl"'\II'IIl'IJ'll'I'" ". ("iO'!.1 \::f\-\::\.U~NJ".:7.., '\1/1'" " """"')') I ! p.; ~ ',I _ . j 'II : " ,;.:; In ',{ Ii(~ /,:,','1 ,":n ;/,' II , , ,. APpmQNA~ INfQJlMATlQN TQ fM'~OYfllS ANp QTHfR WlTmiQmfllS 0,11 dwd<,~J Yl.ll1 UfO ""/UII,~I h) IUllvllj~ iI nlPY III Ihl. "ml1 I" Y"'IT "lIlpll/y~~, 1, PrlorltYI Wllhlll)ldll'M u/1I),'r lhl.llIlJuI/Nllllro hil. p,I'UlIy I)WI IIIlY "Ihur III~,'I 1"Ill'II" lllllh'r SI.IIIII,IW 11~i1I/1'llhll '"I1l~ Innmw, fll<Jolulla~ lovlolln off 0..1 h~(lIro w..~lplll( Ihl. ,,"j~I IhlW Ilri",liy. I( Ihllr~ ,'m h'<l,'mll,\X h'vl.,. In 111("" ,,1"1'''' """I,lI'llh" rllllulI.lln~ all~"cy 1111''1) h~II)W, 2. ClIlI1bllllrll Paymonll' Yl.ll1 ..an nl/llblrlll wlihlll'III,IIIIl)IIlIl. fll)lIl 1I1111111h,UI 111111 "nl"IIIY""/lIhll~"".lnnlllw In 01 .Inlllll I),JYIll~1lI IQ eDeh i1110ncy 11111110.lInll WllhhllhJlnll' YllIllIl1l.l, IlIlwllVllr, ",,,illill~ly IIj"I,i1lv 1111' ""lIl1m,,llhll.lnllll, IhlYlIlIlIIlllhlll. i111,lInll"hlo hI lIa,h ~l1Iplllye~/lIblllllll, J, 'Repl)rt,II1II~e Payda~/Dale III WIi~"ollllnllt You 11111.1 ",,"'/1 I~l' fIIY""I"/I','11I "f wlihlllll,lIll11 wl",n '~",Jlnlllhe flaymenl. T~e p8yd"~/tIal'; 01 wll~~oldlnlll.l~e ~nl"'m w~I,'h 11111'''1111 WII! wlihh.,lrl frnllll~.. IIl1lpIIlY"I'" Willi"!, Yllllnl1"I""I1I"ly wllh Ihlllaw III Ihll Ilale 'l( Iho omphlyoo',/Qllllllllr'l "rl/ldlMI pl,l(olll ~l1Ipl"YIIWlll wllh ""pl'd hIli", i1l1l1lpI'IIrIlI. wlihln whl..h Y"" mll.llm"llImo,lIlho wllhhlllrllnll ordor IInd (",ward Iho 'lIp,,1I11 poym"/II., 4." Emplllyoe/Ohllllllr wllh Mulllple SUflPlll' Ilnldlnllll If Ilwrlll. nllUI' Ih,mlUll' ()Illllr/Nllllw hi Wllhhllld IrlC<lm~ (01 SlIllplll1 811alnlllhll ompl<lYII,'/ohllllor IInd YOII a/'ll lIlIoIhl1l III 11l)1I'1r "II blIPP"1l nll/"I/Nolln'.I"," 10 ",,,,,,,,1 'Ir St"hl wllhhllldhlg IIml15, Yllllm411 (Qllow Iho law I,(lho .1~le ll( empI"yuo'i/ohllllllr's IIr"wllIoII pl~re 'II ~m"loYlIllllIl, YOIlII/11b1 hlll1'" all O,dllrs/Nolln,.lll Iho IIwlIlosl eXlem IIlllllhle, ISlIo ~!I holllw) 5, Term/ralloll Nlltlllcatlolll YlllI '"11.1 plllmlltly lI11ll(y Iho Reqll",tlIIH AIIOIlCY wholl lho employeu!')hllllllr II/lQ l<lllHOI Wo,MnH ('If you, Plealo Plllvl~<) Iho In(lInllatllln mlluoil"J alld /'IlIum ,I (()Py o( IIIii Or<Ier/Nllllm III II,.. Allellry Idollll(l"J hol'IW, WIHlH()LOEII'S 1012616579080 EMPLOYEE'S/OBLI()OWS NAMEI EMPLOYEE'S CASE IDENTIFIER, LAST j(NOWN ~IOME ADDRESS, NEW EMPLOYER'S NAME/ADDRESSI BlIEPIlF.RD, DONAl,D W, 49'010oaS3 LlArE OF SEI'ARATIONI 6, Lllmp Sum Poymonlll YQU may ho lellllllCd 10 repol1 alld wllhhllld II"mlll!"11 SU!)' p,'Ylllllnl. IlIch ;11 honule" COlllllll"llln., or leve/Once pay, II YIIll hDYII allY qllOlllllrll ObOUllul1Ip Ium paYmlllllS, ,0lll,lcllho por."" or ,llIlhllrliy hel<lw, 7. Lluilllltyl II Y<lU (0111111 wllhhold ",como oslho Ordor/Nlltl.ro <J1,,'cls, YOIl Ol,'II,lhl" fllf Imlh Ihe acnll"ul~I'~/II'"Olllll you lh'lllld have w/l~ho'<J (flJmlho ell1ployce!lIhIIHOr's I,ICllnw all" olhol IIollalllo' '01 hy POlIllsyIY'1I11'1 Slalo 1.IW, POllnlylvanhl Slalnl,lW IIl1wml unlelllhe obltllllr II ~mplllYcd In anlllh~I SIalll, Ir' whlrh 'uso Iho law oflhn Slillnlll whlrh 1,..1)/ .1", ',omploYL'I) gOVOm!, , S, ^ntl.rJll"lmlnullolll YIIlIalll 511blorllQ a fine dOlolmln''I) ulldor Slalo I,IW (01 dlscl'Mllln~ 'II' ompIQyooi<ll;lIgor (,0m ~mpIQymonl,relllllllsllI employ, or laklnll ,Jllclpllllary aclIIII1 all.III"1 any omplllyen/llhllHIlI herall'O II( 01 .lIppOIl wllhholdlnH. P~nl1lylvanlo SIOlo law Silvern I unlelllhe obllllllr Ii employod III ollolhnl SI,llo, III which e,IW Iho I,IW 1'( lhll Slalo 111 whlrh ho III Iho II omplllye<J Silvern!, 9." Wllh~';ldlnSLlm/l51 YIIII may n<ll wllh/lOld morelhunlho 105''''11(' Illhe Ol/llOUllli allownd hy Ihn Elld""" CQnlulll"r Cred/l PfQlectlllr ^cl 115 U,S.C, S 1673 ,h)l/ III 2: Iho omllulils oll',wed hy Ih.o SI,lIo p(lhe omployoo's/Ilhllllllf's principal place II( empl"YllIenl, The fcdolulltmlt appllollQ Ihe OSSY1lSDIII di'po,ohlo wllllkly "~mlns! '''OWE I, "OWE." Ihll IIel In(,(lI1111 10(1 0(101 1l1uklllH llIandal<lry de<lllclllllllluch all Slole, FerJelol, locellaxo" SlIr/al Serllrlty l~xlIs, ulld Medl,.."" !.'XIIS, )0, " NOTF..I 1/ you Qr your agent are served wllh a CQPy oJ Ihls o'rder In I~'! slule lh.lllssul'd Ihllordllr, y(IU ure to follow thl' law ollhe SiBle Ihal Issued Ihls Older wl1h respncllr) IhasnHllms, ' Reqllestlng AgencYI 1/ you 01 your lHnpl')y,'e!"hll!l'lr haw .my queslhms, DOMESTIC RelATIONS ~ECTlON nmtacl WAGE ATTAcHMENr lJNlr 13 N. HANOVER ST by Inhlphonll al (7171 240.C,225 l)/ P,O. BOX 320 'IV fAX ,It 1717\ 240.62411 or CARLISLE PA 17013 by Inll'Il1i!1 @ Service, Type M p,w' 2 Ilf 2 form EN.Q211 W<lrk,', 10 ~I"~'T 1''''''11 NH: 1I'J/I).IIIH I ~1111~lIt"\ I)dll.: I Jf II/lN) '. ADllltJDlJ~ 5~WI/J,ry fJJ C.,llJ 1m AlIa~""IAIl1 /)ele"da"t/Q~"Il'm BIlIilP/IJ;:/lP, nO/'lM,p w, ~'t!. ';ti~l)lbgr UU101247,//! ~~,-;{,,\; PA('~fS l'"", NIilJJJJ!!J: __ 1'1,'II1I1(J N,IIlW 61 RO . Allorlll)WI1I ~ !l!ll:.Iw,l AlloIrhllWll1 AIIIllIlI1I ~7.G1J~ CtVt~$ &GJ,JJ $ 0,00 ChJhJlr.'n)'i N.I'/Wli): 008 ChIlIJlrl',I)'. N'Ulll'lil: D08 D If ~hecke<J, you ~fIl f\'f1ulre<J 10 el1rolllho chlldlrel1! lilinllrJed aboVe In any hqallh J",ur~nce ruwr,lge ~va 1.lble Ihrough the emp oyee'&/o~lIgor'l employmenl, o If dwck..j, ynu IIf" rOIII/lrod 10 onmlllho chlldl,.,l1! hll'nlllh,,1 ilbove In ,lilY hqall) l/1iurance cOWrago ava I~blo IhrlllJgh Ihe olllph)yoO'ii'I~lIgl}f" 111l1ploymenl. PACSES Case Numbor PI~lnll(f Name .Ll!l.ds.ltl AII~chlllenl Al1ll1unl $ 0,00 Chlldlflln)', Namels): D08 PACSES Cil!iO NUl11lwr PI,lll1l1((N,lIlw llul:Jw1 AII,llhnwnl Amovnl $ 0,00 Chlldlronl'. N,U.l1elil: DOB , D If checked, you ~re ru1lulJ'f!d 10 enmlllhe chlldlren! lilinllned ahove 1/1 ~ny health Il1sur~nce coverage av~ I,\blo Ihmugh tho employee'&/o~lIgor's employmenl. 0" chockod, you ~ro requlre"llo enmlllhe chlldlrun/ Idonllflod "bovo III nny hO.ll1h Il1surancc coverage ava lable Ihmugh 1110 omployoe"iobllg'lr's employ men I. ~~~~~1 ~:~eeN'I!Illm ~ Altachmgnl Amount $ 0.00 Chlldlrun)'s Namels)! DOB PACSES Case Number Plaltll1((N,ullll llul:Jw1 61111lhml'I11 Alllourll $ Q, 00 Chlldlronl'. Nalllelsl: DOB n'f ~hecked, you ,11't! roqulrod 10 enmlllhe chlldllon) lilinlllJe<J ab<lve In any hoalth Insuril/1co C<lVOrilgo IIV,III,lblo Ihmugh Iho employoe"iobllgor's omplnymolll, nil chl!lk..l, YIIlI ,IrO roq~lrod 10 onmlllhe chlldlruni likol1l"le" nbovo In ,lilY ho,lIlh Il1!uranco coverORII ava lable Ihrough Iho om'II'lyoo's/obllgor" olllploYlllenl. Service Type M Addl!ndum form EN.07,1l Worker 10 $IA'1"I' o~m NII,lll'I/HIlI ~~ l'IlI'~Uun I'~lt" 1II11MII q OIlP~Il/NQJlCE TO ):)HtQ~~/~~?~~, ~~~ 1~/U~~()IlT Sl~ltl '1lI))m'II)IY~~'lh Vi 1'~'lI).ybw /,', ,\ /, ::". \:' \' '( / )'1/ C"./Clly/l)I.I, IIf ClJMllE/ll,f\N1l ; I _ ,'" . nulollfOrd~r!NI/IIl'l! 10/14/02 ,)~. ') \ /1. .1 rrlhlllhlllc'IM' NllmlJl'r ISqq Adde/llfllm far we SII","/drY) ~I: 1l/l1U'/IEJUl , PON/ll,P W, 1111""'~'llll/()hlllc(l)"~ N.1I1l1lII Inl, I h~l, MI) au...-85U r 1Il1l1f)Yl'L1/{)lJIlKlIr'~ SilL lilt St'e 1I/IIV NlJlI1hOl 4080100U3 lllljllrlVlI"/OhIIKtlr', ClUJ hlallllilh'l IS.. Mwm,ll/m for pM",lIf n_",.. ...",/.,.11 wl,h ,..... un ."-<h,,,'nll ClJ~ll)dIJII',Hllnl'5 N,HlW UJsl,' 1,51, MI) G)l hlKllhlll )"h"/NlIlh I' o ^"'l'lldl'\1 (hlll',/NIMIII' o IIIIIIIIII,ltL10flh"IN,IIIIlI.. I, IlIlplnylt,lWllhhnltj"I'.' L'clL'lJIIIN NlHJlhm 1I1'4AC lI/llll/lANC eOMl'/lNY 1~32 WYNN'I'ON RD CO~llMllllll Oil 31~~~'0001 Seq Addendllm far d~pe"dent numes un,d blrt" dutes moeluterl with ems on u"uc"menl, OR-PER INFORMATION: This Is .In Ord'!r/Nlltll~ 10 Wllhhold In('[)me fllr SIIPPllrt hJsed IIpon ,In IIrder fC/r suppC/rl from CllMllBR1JINP COllnty, Conlll1onwe,tllh C/f I"'I1nsylv,lnIJ. By IJw, you Jre rl!qulred III dedUII 1111'6" il/J10u,ll~ fro/J111w ah<)Vl!-n.ll11l1d l!ll1plllyee'6/llbllg')f'6 hll<lIlll! unlll furtl1l'r nolin' l!wnlf tho Ordl!r/NlIllmI6 nol 16sued hy your Stat~. $ 433 , 33 per ll1<lIlth In ('[JII<'nl suppllrl $ 130,00 per month In pasl-due ~upp<1n ^rrear~ 12 wl!l'ks or grt!Jtl!r/ <XJyes 0 no $ o. o,g,p,'r ,\Jollth In nwdllJI.IIPPllrl $ 0.00 per monlh (lIr geneJlr lesl ((Ists $ per month In olher (specify) for a lolul of $ 5&3.33 per month 10 be forwarded 10 puy~e below. You dll nlll haw 1<) VJry y"ur pJY ryele III hl! InlompllJnle with Ihe supp"rt order. II y"ur pJY Iyelo d<les nlllll1Jtch lhe ordered support paYll10nt cycle, use tll<' f<lllllwlng 1<) det"rrnlne h<)w ll1urh 10 wlthh"ldl $ 130 ,ooper w"l!kly pJY perl.'ld. $ 260.00 per hlwl!ekly pJY perl lid (l!wry IWll w,'eks). $ 2pl. 67 per semimonthly pay porlod (twice J m<mlh). $ ~63 . 33 per monthly pay period, REMITTANCE INfORMA T/ON: You lIlust begin wllhholdlnB no laler IhJnthe first p.lY period oll'urrln8 ton (10) working dJYs a(ter the ",Ile of lhls Order/Notice, Send payment within sewn (7) wlIrklnK days of tho pJydJtli/dale lIf wllhhllhlinK. You Jre linlllled 10 deduct J fee 10 "ufrJY Ihe cost of withholding, Re(l!r Itl Ihe IJWS governlnK the work slJl<, Ilf your employee fur Ihe allowabl<l amoonl, The lolal wllhheld .\lnounl, ,1I1d your flie, rJnn<Jl eXlel!d 55% 01 Ill<' empl'lYl!l!'s/lIhllgor's i1ggrligate dlsposahle wel!kly earnings, fllr tho purpose <If thl! IIll1ltJllonon wllhholdlnB, the follOWing Inf<)fmJllo/lls needed (See IIl0'lIl PK. 2), If remitting hy EHlEDI, please lall PennsylwnlJ St.ue CC/II,'clllllls and Olshurs,'mlinlLJnll (SCOU) EI111111ly,'r Customer Service at 1-1177.676-95110 fur Inslructl<ltls, Ma~e Remlllance Payable 1m PA SCOU Send check 101 Pennsylvania SCOUr P.O. Box 69112/ Harrlsburg, Pa 17106.9112 ,N AOmTION, 1'04 YMENTS MUST ,NCWOE THE DEFENDANT'S NAM, ANO THE I'ACSES MEMBER m (shown ~bove ..t"e Employee/Oblllor's Case Identifier) OR SOqAt SECURITY NUMBER m OROER TO BE PROCESSED. DO NOT SEND CASH BY M,4/L, Date of ardl!Ii oPT 1 5 2002 BY THE COURJs----... " k~___,__,..,.,. ".. ...."-.~~4 . ":"r~~~' ,\., : ,. ..v.. ,'}I'/~ ,., I-('~.~ JI fl{.l: forll1 EN.0211 Work!!r 10 $OINC " Servin! ryp,~ M IIMII N,l 11'''I)nl\~ \ AOOlTIONA~ INFORMAT/ON TO EMPWYERS ANIl OTHER WmiHO~OERS CJ 11/:IWlk"11 yuo >1111 1\'IIUlllld IU IlI)'~I\'1I "I'IIIIy' uf Ihl. frllll' Iu YUill \'IIII'luy"", I( YUI" "lIIl1hIV"\' wUlk. III ,I '1.l11l{1I'11I. ( I (or...,,, ,IJlI1 Ull' btJII' fhilt lliSlJllf III ~ ()It 11(, Il U)f)Y I1HHi hllll''Ovhll't II) Y'Hn 11/1111 OYlll' ,lv,ln If till' hOll I~ null ll'f~wd, I, Wu n"III"l'i,Il/'II", YUhllll,11)' "'ll11l1".III....UI h'dulnlly ''''''",II/I'd 1/1111,111 IIII,u., IrlhnllY-UWII"11 hll.h"""'., ,1111) Indl,II"',wII,,1 ho.ln"''''' h)r,'h'd 1m ,I ''''UlVull~lIll1nl d\l"'," h) wlllllluld III UflllId,II111' willi Ihl. IIUllr", ~, I'rl",UYI WllhhuhllllM U/III"I IhlsO/lI"I/Nlillru Ihl. II/lilllly IIWI nllY ull"'l 1"M,d 1I111n". undl'l SI,II,'I,IW nll,lhl.lllI" ..II/W IlInll11U, h'<lololllnx lovl". 111"1("<11"'(011' 1"nllpIU( IlIls UII"'I IMW IIIIUlHy. I( 11"'1ll ,III' h'd",nll,l), II'vll" 1111'((1,,1 plllu,,, nml,lrlllw 1"II'''''III1M nMellry IIsl,,1 h"low, J, Comlllnln_I'.Ylllvnhl Yuu r,III"'lIIhlllu wllhl",ld ,II11UUIIls (mill 11\11/" II"", III'" l'IIII1'oy,'e/uhllllor'. Innmw 111.1 ,'nll'll li,lYlllell1 h) uurh nllu/lry f!'IIUII.III1M wllhhllldlnM, YUII 1Il1l.1, hl)W"VlII, '"/lolI,lh'ly ")lIl1l1ly 111I' I"lItlUIlullhe .111111<' IlnYllwlI1Ih,lII, nllrlhuluhl,' hi IInrh VllIpllly,"'/uIIIIWJr. 01,' Repmtll1R Ihe PuydUIII/OUI"'l)(WllhholdII1RI yl)l' IIIU,I "'lIort Ihe fJoydnlu/dnIUl)( wllhhl)ldll1R wh"11 ..l1dll1M the poymul1t, rhe IJoyUote/dule uf wllhhuldlnM l'lhe dulu un whlrh UmUlll11 wu. wllhhuld (mm IhuumpluYIIII" WOIlUI, VIlli nlusl rumply willi Ihelilw u( Ihe ,lulO u( Iho elllplllyee'WI)bIlMIJr" III/ndlMllllnreuf elllplllymlllll wllh Ie. perl 10 Iho 1111'" pelllx/s wllhlll whlrh YOII mll.lllllplellll'lIllhe WllhholdlnM IlIder und (mwoll" Ihl'.uppo/t POlY/Ill'IlIS, 5,' Empl"yerIObIlM'" wilh MU/llpl, Support HI,tdl"_.' If Ihelels morelhull 011" OIlJl!r/Nollllllo Wllh/wld Ii)fOl)lO fOI suppon OIM,IIIl'1 Ihll employee/ubllMul oIIld vuu are llllOlhle 10 IU1I1ur ulI 'UpPI/ll Olllel/Nollces duelu F<'III!IOllur SI,lIU wlthhulrllllll"llllls, Yl)ll lIIu,1 (ollllw Iho Iilw u( Ihe .lull! ur 1I111\'lr'Yl!e'slubIlMol'6 pllllrlP,ll pl,lwu( 1'lIIpIUYllll'lll. Y'IU lIIu!1 hOlluI ull OIlJoIslNullrellu Ihll Mle,lle,lexlelll p016lble, (See ~ II) Imlow 6, To,m,,,,lIo,, Nullflrallunl You musl/"UIIIPlly 1I1llllY Ihe Rellue.IIIlK AMellcy whelllho elllplllyee/uhllMor Is 110 IUIlMel wmklllM (1)1 you, Pleu,u provide IIllI 11l(lmllOlIlIIll ImlUe!le' ,llId Il'IUIll ,I CllPy uf Ihl. ollJ"I/NoIIl'll h, Ihe AKelllY Idellllnl'll below, WITHHOLOER'S 10, e~76100166 EMPLOVE~'SIO.U()OIl'S NAME I SHEPlIERO. oOljllt,O w, ~MpLOm'S CASE IDENnmRI---!9.'0100aSL-_ DATE Of SEPAIIATlONI ~AST ICNOWN HOME ADORESSI NEW EMPLOYE II'S NAMEI^DDIIESSI r, ~um" Sum ".YIII'nhl Vou may 1m lellUI,"d 10 lepoll OIlld wllhhold (Ill/ll lump 'Ulll pOlymelll. such us I)I)IIU'OS, rOll1l11I"loIIS, or loverunre pay, Ilyol) have allY Ilue.llolls ,thoUllum'l SUIll pilYIlIl'IlI., cOlllOlrllhepe1501l01 ,lulhol!ly hllluw, 8, UabJUIYI If,you (011110 wllhhold Illromo us Ihe Olll.el/Nollre dllecl.. you alellublo (or bOlh Iho urrulIIulOIllId OlIllOUIlI Y')U Ihould have wllhhold (1llIllIheemp'llyee/obIlMol" IIlCUllle ulld olhlll penOlIIl,'s 11'1 by Ponllsylvalllu SI,llel,lw, P"lll1lyIVOlIlI" Slalelnw Muvern. .mle.! Ihe obllMol I. I!/llployed 111 ullolhel Slale, 111 whirl, ruse Ihe luw o( Ihe Sin Ie 111 whlrh he or shel.elllployed MOV"II1" 9, A/lII.,J'.crJmJnallo", VI)U OIle ,ubleclll) a nllo delellllllled ullder SlnlelOlw fOI dl.d''''KlnM '1Ilern"loyee/"bIlMor (IOllllll1llll'Jymllnl, reru,'nlllo olllploy, or Iuklllg dlsclpllllOlI)' ,Iclloll olMuln'l OlIlY elllployee/obllgor boraulu of u IUPPOrt wllhholdlllg, Pelll"ylvunln SI,lIl! 1,IW govern. Illlle!&lhu "bIlMIlIl! elllployed In unollllll 51ull', 111 which COl!elho 100W o( Ihe Slalelll whlrh heol ,he Is employ"J MOVllIll" , 10,' Withhold'". L1mlt., Youlllay nol Wllhhold 11I0'" Ihulllhl! le.sor of: Illhe ulllounls allowed by Ihe F,~ll'Ial COIl'UlIIel CIl'dll ProlocUon MI 05 U,S,c, 81673 Ib)ll '"~ ~) Ihe 0I1110Unls OII1'lwed by Ihe Slule o( Ihe omllloyee'./"bllgol's prlnclpi,1 plnre o( employmelll, Tho h'<Jeralllmll Olppllesl" Ihe aMgregale dlsPQsubl1! wookly eOlllllilRs (ADWE), ADWE I. Ihellellnromo lell uflllllllnkllllllllollldOlIUI)' d'>Qurllolll sud, U51 Stale, FedelOlI, lor"llaxes; Sud," 51'1Wlly 1,lxeSI nlld Mmllrollelnxl!', II, Addlllollal '"f')1 'NOTE, II yOU or your dll~nt ore s~rved wllh ~ ('()py uf Ihl5 old~r In 1111' 51dle thilll55ued 1111' <lIder, yOU ar~ Iu fulluw Ihe IdW of the s~~le Ihdllssued Ihls <lIder wllh 11'5pl'd lu tlll'M' i1e015, Submllled BYI II yuU <lI your employee/ohllRur h~ve any questloll5, DOMESTIC RELATIONS SECTION ((mlacl WAGE ATTACHMENT UNIT 13 N. HANOVER ST hy t~leph')I1,' .11 (7171 24().62H <lI 1',0. BOX 320 hy FAX ~I 17171 2010-6248 or CARLISLE PA 17013 hy Illlernel www.rhlld5upport.5Iule.pil.us flUMe 2 o( ~ F olm E N.021l W<lIk,!r ID $OINC Service Type M IIMIINU Illl/r.IIIH \ AUl}(NI~UM /iJJmllltln..>>/J;JJ!lWI" AlIadlllllmJ. J)~'elldanI/QI,lJllu'l BJlllVlIllRP I POlw,n w, ~~~W~~ii:~IlII11" OUlUI2t7 /;:/1/(; l' ~ Allo1l'IIlIll'1I1 AIlIOIIVl 97-6139 CIVI~$ 663,33 (hlldl,oll)'o N,llIl1'lol: DOll I.'Al'SfS r,I'" NIIJJJ!J.CL 1'I.IIIlIIf(N.lllIl' iJJJ!l<.el AIl,llh"illIll Amlllllll $ 0,00 l'hlltlltl'IlI'. N,lIl1L'I.I: DOD 011 c1wcitud, YOII oII'U "''Illlrod hi unrolllhlllhll.,IiOIl/ IUollllfled ~bovo III ~IlY hll,llh IrI'U'~IlClI cowr~K" UV~ 1,111111 Ih",ugh IIII' UIlII11'IY"lI'oluhIlWI"O UllIplOYllIlIll1. Oil rllI'cit"l, YIIII MlI '"'1lllrod hlllllmlllhll chlldltl'll) 1ill'1l1l(llId ~hovlIlll ~IlY hll,llh IrllllMllfll cnVil',lKlI iIV~II~hlll Ih'OUKh Iho "llIpluy,'o'!i/ohIlKII"llllllploYllIlIlll, PAC5ES ('~1lI NIIIlIIIl" PI~lollrrN~lIlll J.1J1J:kstl AltiKllllllml Amounl $ 0.00 Chlldl'olll'. N~llIl1loh ~s (,tSll Numhl'r PI,IIIlII((N.1IJl!! J1u.d!U AII,lChllll'lIl AmUJJ1l! $ 0,00 Clrlld(II'Il)'6N;1I1l1l16)1 DOD 011 ChllCited, you alii 'l'1ulr"d 10 1I1lmlllhll chlldl'"1l1 ldellllfled lIbOVlIl1l allY hllullh Illsurallcll (1)Yll'~KO nV~ 1,lhlo Ihrou8h Ihll olllpluYI'O'lIohIlK'I'" 1I1l1pl(IY1lI1I1l1. nOD Oil rlmd".I, YlHl.1fl' '"'Iul",d 11I'1I1",lIlho chlldl"'lll Iill'nllrlllll ohuyo III ,lilY hll~lIh Inlll,allco C11VlI'~Ko ov.II,lhlo IhroUKh Ihll olllplllyoO'b/'lhIlM<II" 1Il11ploynwllI, ' PArSES C~IO NUlllho, Plalnll(1 N~lIlll ~ AlIJchllloll1 Amoullt $ 0.00 Chlldtl'lln)'. N~lIllll'll DOD PArSES ('nlll N.YJJJ1J.I!! PI~lnll(( N.llno ~ ~ $ 0,00 (hlldl'OIl)'. N,lIllllli): Oil chockod, you arll 'O'lull'.1 10 I'Ilrolllhll c1lllrllll'lll ldenllrled ~hovo In allY ho,llIh Illsurallcll ['lIVlI,JSO IIv,II,lhl,' Ihrough Iho OlllplOYlIO'slollllso,'s olllploYllIlIlI1. DOD Oil fhofit,'d, you ,I", 11''1"1,..1 hi 1I1lmlllhll fhlldl'"111 lill>'llilrl"d "hllvo 1IlII,Iy h.hlllh In!l'W1Cll eOVll'us" .IViI Iuhlll IhrollKh IIw "llIpllly,'o'llohIlSII"ll'1lI111I1yI111l1l1. " Add''IldUn1 Service Type M I)MRNnlll'J/IHIIH F"'m EN.021l W",kerlD $OINC (I,) 1'::, r j';' 1\, , , I, t"~ I, I .Ir, ,') ., " (,' "- " , f"Jj , 1 , \d ,. " "I ..,.1 \) I,:, I I'" ,1,1 " ." .~II Clm"!)' C!)"lUlI)U 1)1~lls I)' CllJ\UJ~:ltll/o\J'm CI/U"ty, l)~,,,,sylva"'ll 1)()MV,/)....lC IU:l/"\'l',()NII /j~;c'rl()N ) puelu:l Number ~7.6139 CIVIlI ) ) l'ACSES CIlIlU Numbur U68101:l47 ) ) Qlhur SlnlU JP Number /\MY IHlBIi'/llilRD I'lull1llrr va, DONAlID W, /lIlIl:Ii'IlIl:RO Pe'i1ll~u/ll PETlTlON FQR l\10DWICATION QI<' A~ )1:".~'J'JNG Sl,IproRr QRDER 1. 'file pethlon of DONALD WIlIlIII\M /lIlEPlllilRD , an Order of Court was entered for Lhe reBpectfully represents that Q>> MARCil 13, :l 0 0 0 BUpport of /\MY /lIlEIi'IlERO A true and correcL copy uf Lhe order is auached to this petition. Service Type M Ponh OM-SOl Worker lD 21005 Ii " '" ~JlIE"'Jllil"P Y. SJlIl"'IJEnp IIACSJ1S C~U NijlllhCll Q~Q1Ql~47 2, PUlltloller 16 elllltllid 10 0 IJl~"ea6U 0 decrliasli Ci) lermlnlltlllJl 0 rel1l61alemel!l o luher Ill' lids Order because l)f the ti)lIowlnl! mlllerllllllnd 6uhslantillllihanl!e(6) 1'1 circumslance: T~e divoroe ~ftft ~een ~inaL ainoe May ~J, ~QOQ, WHEREFORE, Petitioner requests lhlltlhe Court modify the exlslinl! (,,'tier for support, ~1~lftl uJ. \~A LJ) , etltloJler AU() y tor Petitioner I verify Lhat Lhe stlllementB made hl this complaint are tl1le and Cllrrecl. I understand Lhat flllse BlatemenlB herein are made subject to the penalties Ill' 18 Pa, C,S, U 4904 l'I!lating tll unBwom fals\llcatlon to aUlhorlLles, ;;;- ~O - () R- DaLe , ~Jl)141i - etltilmer l~) , ~~~ Service Type M Pogc 2 of 2 Forni OM.~OI Wl)rkcr ID ~1005 0' J' ,I YIIIV/iI},sr-:rHJ ' '11'1'1("-' ", ""' -",'n'l 1\, 'I ). l; I I ',,-1,1. ("I' "I III t,l:J :(, 1 C JiiJ ~II ",:" 1'.11 .< " , ' S' (p S I LlI.'> '-I 7. OIlOfll/NOT/Cf TO WmiHOW INCOMf fOil SUPPOIlT 't7.~, /1 " {, Vi, I O(),IHI'MI (),dl!,/Nllllll' o Aml.nuhlll Ollh'lINulln.' @ 11.llllll'h1h.,(),.II',INlJlllll Slale CQllllllQI)WI.i'lb uf pe~,,'yIY~I)I~ C"./Clly/I)15t. of CIJMl3l1JUJlND [M... 'If Ordllr/Nllllrll 1 ~ 30 0 ~ Trlhun~I/C~5I.' NUll1h"r (See.4 rlenrlllm for ~'.ue "'mnwy) ~I: BJlF.PII1I1lP. 1l0N/lt.D W, I f111lIUYI1llf()hIlKlII'\ NllrlW IlJ~I, 11,~I, MI) il I, , I ftljlll)YLI'/WllhholllLI"t. IIIUl'hSII" IN Numllt" /lF~C INBIJR/lNC COMPANY 1~3~ WYNN1'ON RD CO~IJMBIJB Q/I 31~~~-OOOl .080100253 t' mJlIl)YL'~I/Obll~or'& (.lu'ltll1nlllhn IS.. Md,"dum fM pI.'""I( ".m" mfIC/./'d w,,~ w" f1I/ .".r/lm,"f) rmlotll.11 IJ,ITl1nl'li NJnllJ ILd~l, . int, Mil Sell Mrlllnrlllm for rlllpenrlen' nilme. ilnrl b{rlh rlales iluocfilled w/lh cllses on allilchmenl. ORO/iR INFORMA T/ON: Thl5 15 .In Ordllr/Nolln' tll WlthhQld In('(mll' f," Support ba511d ullllll an Ilrder fQr 5Upp"rt fmm CIJMBI3RIJIND County, Con1l111l1lwlI~lIh of I'I'I1n5ylv,lIlla. By I~w. Yl)lJ .Jrll rllqulrlld to dllducllh...se amounts frum th... abllve.named ...lllplllyl'....lI/ohIlK''''5 Innmll' until furtlll.'r notkl! ,'v..,llf Ih... Ordl!r/Nlltlra Is not Issued hy yuur Stat a, $ 0 ,00 per month In ~urr"'nt iUPP'Irt $ 0 r QO per nl<mth In past-lIW5upport A".....rs 12 wl....k5 '" Kreat,'r! OYIIs <ID "'I $ 0,00 p...r nl<mth In ml'dll',t1 sUPlmrt $ 0 . 00 per Ill<mth (or p,,'nl'tlt' lI~st n)5t~ $ per month In otlwr (~,,...dfy) for a Il)lal of $ 0.0.9 per mouth II) he f"rwarded II> payee helow, You do not have leI vary your pay I ydl.to Ill' In rompllan..... with till' MJPpurt olll,'r, If yuur 'MY I'yell! dlla5 nul match the orderlld supp1m paymentl'yd,', U5'" th" (1llIuwhlK leI dllt,'mllnl' Imw Illut'h tu wllhh'Ild: $ 0,00 p"'r w...ekly pay p"r,I',d, $ 0 . 00 per hi weekly pay pllrlud (IIWry two wlleks), $ 0.00 pllr semimonthly pay p"rlod (twICl! .1 mlmlh), $ 0,00 per Illunthly P.JY p...rlod, REMITT ANC/i INFORfl.1A T/ON: Vou must hegln wllhholdln8 nu 1,IIl!r than Ihe first pay perlud Of cur rinK len (10) worklnK days ,Ifler the date of this Order/Notice. Send payment within sewn (7) wllrklnp, d,IYs of th" payd,II.../dat,. uf withholding, You are entitled /0 deducl a file to d...fray the cost of wlthhuldlnp" Refer to the laws Kovern!np, till' wu,k state uf your "mployee fIll Ih... allowable arrounl. The total withheld amount, and your f,'e. nlnnot t.Xl'l!l'd G5% of th... employee's! obIl8111's a8gregate disposable wellkly eamlnKs. for till' purpmll of tl,...lImll,lIlol/ on wlthhuldlnK, the (oll'lwlnK Infornlatl<m Is needed (See #10 on pg. 2), If remitting hy EH/WI, pleas" call Pennsylvania Statl! Collel'lI<ms and Olsburs,mwnt Unit (SCOU) Employer Custolller Service at 1-1177.676.9500 for Instrurlluns. Make Remittance Payable tOI PA SCDU Send check tor Pennsylvania seou, P,O.lImc 69112, Harrisburg, Pa 17106.9112 /N ,I,DP/T/oN, P.4 YMENTS MUST INCtuDE THE DEFEND.4NT'S N.4ME .4ND TffE P.4CSES MEMBEIIID (.hoWI/ .bove II Ihll Emp/oyell/Obf/,or'. em Idlll/llfler) OR SOCML SECUIIITY NUMBEII IN ORDF.R TO BE PROCESSED. DO NOT SEND C.4Sff BY M,l,fL. DatoofOrdell f.} /311 () ~ BY Tm COURTt':-__:,~2 ":-~f,{ " !vi Service Type M t)MIIN.',II,IJIUIII\.1 Form EN.020 Worker 10 $OINC 'I I i 'I , , ;,.i! ~~" II " '~ I'.. LI1 ~; . .' 'I} I" 1 " I v'N\,'I\'I,W,I/N3d ,(iNn:):) ('II", ':II:;'i,vno ~I' ~ I'I 1.1,.) I" '..: ,O:JT'Uj /1.;),.',\, :;;',/" , f.: :jJI) :;1} /, .; d-J. ',oj ..\', ADPlrlQNAL 'N~Q"MAnQN TO ~M"LOnIlS ANI) QTH~1l WmmOLP~IlS o II rll<'dwJI YIIlI iIf~ ,~qul,,'d III 11I1'~llh' ,I 1 "lly' II; Ihl. ;''''11 III Y'HIr \'IH/,IIIYI''', II V"\""IIII1II1VL'I'WII/k. III ,I '1oIIl'lh,lll. llllldlO/l1 "11I11 ho MJlo 11"'11"'/1" III i "I' "(, ,IIIIIIY 11111' "I'IIIIIVhl" III YII'1r "11111 IIY""l'V,'1III IIIl hili Ii 11111 dll'l'k,'d, I, Wl' illIlIlOdJIO Iho VllhllllollY l'l11ll1,1l.IIII'1' "itl',h'I,llIv "'1I1~IIIII'd 111'11.1111,11,1", IdlJolIIY'IIWII,'d 11'1.1111'''''', ,IIl1llmll.IIHlWIlI',1 ""iIIlO"Oi I')I'JI..J IlIl ,I ,'''OIV.''''lIIl loll ,111'"'" ", wllhhllhl II, ,1","'1."111' wllh Ihh 1111111". ~, P,I"rIIYI Wilhhlll,lllI~ IImil'l Ihl. I "d"r/N"lllI' h,I' 1IIIIllily "VI'I ,Illy 111"", h'~"I 1"1111'" IIl1d'" SI,IIl'I.IW ,1~,III"IIIw '.1111I' 111I III1W, Fl'<lUI.II I'I~ lovloi IlIl'((",1 ""1<)11' Ivn'llIllll Ihl'lIId'" IhlW pllllllly, 1/1111'1" .11" I<',h",II 1,1\ h'vh'. III 1'1""'" 1110,,," nllll.lrllll<' Il''III".III111 PKollry 1I,lo,llmlllw, J, CLl/llb/nln" paym~'11l1 YIlII r,IIll'lIlI1I1II111 1'011/11",/11 ,IIIIlIlIIlI. frlllllllllll" Ih,IIlIIIII' "1II111I1Y"I'/III1I1~III'.IIIl'lllnll in ,I .IIIKI" I"'YIIII"IIII) oJrll iI/l,,"ry fl"IUll.llllK Wllhh"IdIIlM, YIlII 1II'lil, hIlWl'Vl'I, "'1"",lIoly Ilh'lIllfy III<' plll111111III Ihll .11111/l' 1I,IYIIll'lIllh,lll, .dlllh\ll.II,I" III ~,1l'h .ulllplll'yI'l'I'IIIIIKIII, , 4, 'ReponlnSlhe Pn\'flnl"lOnle of Wllhholdl"ll' y,," "'"" n'p"n th.> /lllydll"'/llll'" ,,/ wlthhllldl"ll wh.'" .""dl"!l1I1'llIIynwnl, r/1l' paydpl./dnle of wllhh"ldlnK 1& thl! dnlo 0" whlrll MUlUIII w,,, wlthl1l'Id fl't)lllll,., 1,IIlJlIIJy....', WII~l!K, YUII lllu.1 IIl1nllly with Ih" /'IW o( II," alalO of Iho omJl/llYl!u/i!II>>II~ur" pllndJl,11 pl,m'lI; "IIIJlluYllIi'1I1 wilh ""1"'.1 hi 111'1111111' PUI"i1" wlthlll whl.h Y(I'I 1ll".II'IIJlll'lIll!lIllhll IYllhhuldlllM (1/11", nnd (mwilld Ih~l '\'I'Jllnl l"'yml'lIh, V ~I"P/l'tetIOblllll" Wllh MuIlIlllu SUJl/mrll1l1ldlnllKl If 1111"" I, IIHlIl' Ih,IIl'"1I' Old"I/Nullm hi Wllhhuld I,lmllw IUI S"J1J1Il1I.IMJI/l,1 11!lIOlllpl(1 "o/lll)II11'lr illI<I yuu illU "'1011110 hI hmill/.III '"111"111 Oldl'I/N"lIro. !IIIO III FI'lh'I.II '" SI,I'" wllhhuldln!lllmll., y"IIIIIII,1 (Illlow IlIe law Il( hu.hllo o( oml'loyu"',/t'llilMul'" J1lll1dl",I pl,ll'U Ilf "lIlpll)YIIIl!III, YUII 11111.1 llOnOI ,III OIl/III'/Nlllln'. "I Ih" ~1",lIl..t "xl"nl poullll", IS~" _III tllllow ~, Te,m/Ilall"n NI/II/lulhlll' YUl/ m"'I/lIllmpIIY 1I1)llfy IIIl! 1t"'1I1",III1~ A~"I"y wlll!lI 1111' "lllllloY"l'/IIIIII~ol' Ii nil /l1I1~'" W(lIklllll fOI you, Plua." JI/llvldllllwll1(Oll)hlllll/l Il''1"".I", ,IIld ,,'Iurn II ""PY III Ihli l)/lI,'/,/Nolln'lu Iho A~I'IlIY Idl'III1I1"c1 h"/llw. W'~HHQU~lll'S 101 8276100165 ' ~M ~OY~~'SIO~LIOOIl'S I'MM~I OHEPHE~D, POtjllJ.,P Ii ' ~M lOY~f'5 CASf IPfNmJfll1 4080100253 OAn Of SfPAIlATIONI ~AST j<NOWN HOMf AOPIl~551 NEW ~MP~OY~Il/5 NAMl/APPRf551 7, lUml' 5u/Il Paymelllll you I1H1Y II" ''''I"lllIIll'' "')lort ,lIHI wlthhllld f,.llll IUlllp !lJln p,IYIll"nl' 'ud, ,IS bOllI/'UI, rIlIllJnli,lolIl, Ilr ioverallre IliIy, If you 11olVO illlY 11U"illo/l' i1bOUllumJl "nil pJyJn"/lI', umlolrllh" p"l'"m 01 ,nlthorlly b"low, ~, Ua~IJlIYI If yOu (all 10 wilhhold Inrolll~ ilS IIIl! OnJ",/Nllllro dll'"rll, yoU ill''' 11,1111" (<II' bolh 11ll! arrum"I.,lI,'d ill)10UIII you ,hllllld hal'O wllhheld Irom Ihe "lllpllly",,/ohIlK<II"lllIrO/l1l' 1111<1 ollll'1 11I'I1oIIlI"i i,,1 hy I'''"/l.ylvJII/'1 StalO I,IW. JI('lIl1iylvil/lla Sla.lo lilW 1l0VOIll' "nloi' Ih" ohllgor Ii umplQyorJ III Jnllllwl 51,11.., In whl.h r,II"IIwl,IW IIf lilt! SI.II,! III whll'h III' or ,I", I, l'lllphly"d 1l0VII/lli, 9, ~nli<lllc,lml~allom YOII alll lulll"rllo iI IInu ""IOIIllIIl<'d IIl1dll' SIJW lilW 10' ,1I,rhJ/~hl~ ,In "1lll'I')y",,/c)III1!1l.lr 1/'111I "lIlploYlllenl, refu,I/l8IO llmploy, <JI 1.)klnK dlirlplilHuy ,lrllcll1.IM,II/lil '"ly "1ll"IIIYl'(!/ohli~OI l"'flllI,""1.1 '"Pl'ort wllhhohlll1!1. POIIII,ylviI/llil Slalo Iilw 80ve",' u/lI"S! Iho ohilgal Ii ollll'loy"d In >II10lhol' Stal", 111 whlrh rilM, IIIll I,IW of Ih" SI,lh) III whlrh IllloI ,Iwl, oml'loy",J MOve"", 10,' Wllhhllldln.lll"111I You mill' 1101 wllhhohllllOlll IlloInllw 10"'" ofl lillII' illllllllllls ,llIowed by 1111' Fedul'JI (')IlIUm", CI,,"II , prolertlon A~1115 U,5.C. ~ 1673 111)11 II/ 2) till! ,11I1011111, .llllIW"d by IIII' SIJI"of III<' l'm\IIIIYl"",/obll~,"" "l'lndp,11 pl,ll'o Ilf olllpl"Ylllonl, Tho Federnlllmll ilPIlII,Ollll Iho a~gl'''Killll dl'I'","1I10 w"l'kly "oII'lIln!l' 'AOWE), AOWE I' 1IIll11l'1Innllll<' /I!it il(IllI lIIilkhlM llIallll,lIor)' deduction, ,urh a5' Slat", F<'dlll'i11, 10Cill hIXllSI 5'ldJI Sl'rllrlly I,IXI"I .lIld M,'dlr",,, I,IX"', 11, Addlllonalln'''1 'NOTE, If you Q, YOUI agent aro wrved wllh il wpy of Ihls o,.h'r In Ih" 51,110 IhiltISiu..d Ilw md.." you Millo follow lhe laW of the ,lale Ih.1l155ued thlsmd"r wllh ''''I)IOrlto tlll'SP IIl'n15, Submllled BYI If you m Y'llJr "l.l1phly"../obIlM'I/ h.IY'! .my qu051Io/l5, DOMESTIC RE\ATlONS SECTION ('[mlarl WAGE ArtAcHMENr UNIT 13 N. HANOVER ST hy 1,'I..phon.. at ,(717) 240.6225 or P.O. BOX 320 hy FAX al (717) 240.6248 ur CARLISLE PA 17013 by Inh',nl'l www.rhlldsuppnrt.st.lle.p.I.IJS I'.l!l(l 2 Ilf 2 FOI III E N.028 Wurknr 10 $OINC Servlcll Typo M, I lMII HII,' 0'1/11111 'l~ ~. ht the CCIlJrt ." C""1l11."I 1)lells." CU~lImItJ,AN'I C.,lJllty, I)e,msylvlllllo J)(IMJ':N'J'JC RJo:J,A'J'JON!i N":C1'JCIN PlaIHlIt't' ) llllckel Numher 97.~139 CIVJl, ) ) J>ACS/lS CaKc Numhcr 06alOU47 ) ) Olher Statc 10 Numbcr /\MY IlHlll'HllRO V6, OO~A1JO W, SIIIlI'HIlJlP OelimdlUll Q~J)J,i:R AND NOW, 10 wit, on lids 30'/.'11 DAY OF DIlCllMllllJl, ~oo~ IT IS HEREBY ORDERED thllt the SUppol1ordl,Jr In this cllse bl,J 0 VacaLed or QSuspended Ill' (i) Terminated without prejudice or 0 Terminllted and Vacllted. effective MAY ~3, ~OQO, , due LOI '/.'HB I'AR'/.'IllS' OBCRBB IN PIVORCB, '/.'HIlRB IS A CRllOI'/.' OF ~7,935,70. BY THE COURTI ~ JUDGE Service Type M Fllml OE.~04 Wllrker 10 ~1005 F1 ~ ,,--, "', "I qlll, ,., ,lit ..,., l"'} c,;./ '-l ',"~ ,I ~:'J I, '11 "- t'(,} I.' , , ." ....., ).;';: :.n , ~. , ';.., l./" '. " , '1 .' *"., , (\,J "In , ) .. .1 " .. :11 :ii '.1 ", ."" I ~II)I'''I~::~\ "