The URL can be used to link to this page

Home My WebLink About07-1336MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION MARIA NICHOLS, :NO. 0-7- I3 3 Defendant : IN DIVORCE NOTICE TO DEFEND YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take prompt action. You are warned that if you fail to do so, the case may proceed without you and a decree 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 relief requested in these papers by the Plaintiff. You may lose money or property or other rights important to you, including custody or visitation of your children. When the ground for divorce is indignities or irretrievable breakdown of the marriage, you may request marriage counseling. A list of marriage counselors is available in the Office of the Prothonotary at the Cumberland County Courthouse, 1 Courthouse Square, Carlisle, PA 17013- 3387. IF YOU DO NOT FILE A CLAIM FOR ALIMONY, DIVISION OF MARITAL PROPERTY, LAWYER'S FEES OR EXPENSES BEFORE A DIVORCE OR ANNULMENT IS GRANTED, YOU MAY LOSE THE RIGHT TO CLAIM ANY OF THEM. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Court Administrator Cumberland County Courthouse 1 Courthouse Square, 4t' Floor Carlisle, PA 17013-3387 (717) 240-6200 NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estats demandas expuestas en las paginas siquientes, usted tiene, veinte (20) dias de plazo al partir de lag fecha de las demanda y la notificacion. Usted debe presentar una apariencia escrita o en persona o Page 1 of 2 por abogado y archival en la corte en forma escrita sus defensas o sus objecciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una 6rden contra usted sin previo aviso o notificacion y por cualquier queja o alivio que es pedido en la peticion de demanda. usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Court Administrator Cumberland County Courthouse 1 Courthouse Square, 4t' Floor Carlisle, PA 17013-3387 (717) 240-6200 Michael D. Rentschler, Esquire Attorney for Plaintiff Page 2 of 2 MICHAEL NICHOLS, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION MARIA NICHOLS, : NO. 133 Defendant IN DIVORCE NOTICE OF RIGHT TO COUNSELING You are one of the parties in the above-captioned action in divorce. By virtue of Section 202 of the Pennsylvania Divorce Code, it is a duty of the Court to advise both parties of the availability of counseling and upon request of either provide both parties a list of qualified professionals who provide such services. Accordingly, if you desire counseling, please advise in writing promptly by replying to: Office of the Prothonotary, Cumberland County Courthouse, 1 Courthouse Square, Carlisle, PA 17013-3387. Prothonotary MICHAEL NICHOLS, : IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION MARIA NICHOLS, NO- p 7 _ f 33 (o ? f I -f t Defendant IN DIVORCE COMPLAINT IN DIVORCE 1. Plaintiff is MICHAEL NICHOLS, an adult individual who currently resides at 319 Rosemont Avenue, New Cumberland, Cumberland County, Pennsylvania. 2. Defendant is MARIA NICHOLS, an adult individual who currently resides at 319 Rosemont Avenue, New Cumberland, Cumberland County, Pennsylvania. 3. Plaintiff and Defendant are sui juris and both have been bonafide residents of the Commonwealth of Pennsylvania for at least six months immediately preceding the filing of this Complaint. 4. The parties are husband and wife and were lawfully married on May 23,1987 in Dauphin County County, Pennsylvania. 5. The marriage is irretrievably broken. 6. Neither Plaintiff nor Defendant is in the military or naval service of the United States or its allies within the provisions of the Soldiers' & Sailors' Civil Relief Act of the Congress of 1940 and its amendments. 7. There has been no prior action for divorce or annulment instituted by either of the parties in this or any other jurisdiction, with regard to this marriage. 8. The Plaintiff has been advised of the availability of counseling and of the right to request i that the Court require the parties to participate in counseling. COUNTI Request for Divorce Due to Irretrievable Breakdown Under 3301(c) of the Divorce Code 9. The prior paragraphs of this Complaint are incorporated herein by reference thereto. 10. The marriage of the parties is irretrievably broken. 11. After ninety (90) days have elapsed from the date of the filing of this Complaint, Plaintiff intends to file an affidavit consenting to a divorce. Plaintiff believes that Defendant may also file such an affidavit. 12. Plaintiff has been advised of the availability of counseling and that Plaintiff and Defendant have the right to request the Court to require the parties to participate in such counseling. WHEREFORE, if both parties file affidavits to a divorce after ninety (90) days have elapsed from the filing of this Complaint, Plaintiff respectfully requests the Court to enter a Decree of Divorce, pursuant to 3301(c) of the Divorce Code. COUNT II Request for Divorce Due to Irretrievable Breakdown Under 3301(d) of the Divorce Code 13. The prior paragraphs of this Complaint are incorporate herein by reference thereto. 14. The marriage of the parties is irretrievably broken. 15. The parties are currently living at the same residence. After two (2) years have elapsed from the date of final separation, Plaintiff intends to file his affidavit of having lived separate and 2 apart, provided a divorce decree has not already been granted pursuant to Section 3301C of the Divorce Code. 16. Plaintiff has been advised of the availability of counseling and that Plaintiff and Defendant have the right to request the Court to require the parties to participate in such counseling. WHEREFORE, it is respectfully requested that this Court enter a Decree in Divorce, pursuant to Section 3301(d) of the Divorce Code. Respectfully submitted, LAW OFFICE OF MICHAEL D. RENTSCHLER, P.C. Michael D. Rentschler, Esquire Attorney for Plaintiff Supreme Court I.D. #45836 28 North 32nd Street Camp Hill, PA 17011 (717) 975-9129 3 VERIFICATION I, MICHAEL NICHOLS, verify that the statements made in the Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unworn falsification to authorities. MICHAEL NICHO S, Plaintiff CERTIFICATE OF SERVICE I, MICHAEL D. RENTSCHLER, ESQUIRE, do hereby certify that on this date I served a copy of the foregoing Complaint in Divorce by Certified Mail, restricted delivery, return receipt requested to the following: Maria Nichols 319 Rosemont Avenue New Cumberland, PA 17070 Date: D? MICHAEL D. RENTSCHLER, ESQUIRE Attorney for Plaintiff L/A c Q C It) W W n C.) r- ? -\ X- Q -l,d Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 07 - 1336 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE PETITION REOUESTING HEARING ON ALIMONY PENDENTE LITE 1. Petitioner is Defendant, Maria Nichols, residing at 319 Rosemont Avenue, New Cumberland, Cumberland County, Pennsylvania 17070. 2. Respondent is Plaintiff, Michael Nichols, residing at 319 Rosemont Avenue, New Cumberland, Cumberland County, Pennsylvania 17070. 3. On February 27, 2008, Defendant filed a claim for Alimony Pendente Lite as part of her Answer and Counterclaim to divorce. 4 5 6. Petitioner will need financial support pending the divorce proceedings and thereafter. Plaintiff has sufficient assets to provide alimony pendente lite for Defendant. A Domestic Relations Section Attachment for APL Proceedings is attached hereto as Exhibit "A." WHEREFORE, Petitioner requests a hearing be scheduled on her alimony pendente lite claim. Respectfully submitted, DATE: February 27, 2008 ?y ?- Bar ara ample-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant EXHIBIT "A" Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07 - 1336 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE DRS ATTACHMENT FOR APL PROCEEDINGS PETITIONER NAME Maria Nichols ADDRESS 319 Rosemont Ave, New Cumberland, PA 17070 BIRTH DATE Aril 24, 1962 SOCIAL SECURITY NUMBER 211-48-6814 HOME PHONE 717 774-2786 WORK PHONE Not employed EMPLOYER NAME EMPLOYER ADDRESS JOB TITLE/POSITION DATE EMPLOYMENT COMMENCED GROSS PAY NET PAY OTHER INCOME None ATTORNEY'S NAME Barbara Sum le-Sullivan, Esquire ATTORNEY'S ADDRESS 549 Bridge Street, New Cumberland, PA 17070 ATTORNEY'S PHONE NUMBER 717) 774-1445 RESPONDENT NAME Michael Nichols ADDRESS 319 Rosemont Ave, New Cumberland, PA 17070 BIRTH DATE October 2, 1961 SOCIAL SECURITY NUMBER 208-56-9523 HOME PHONE 717 774-2786 WORK PHONE EMPLOYER NAME Phoenix Contact Manufacturing, Inc. EMPLOYER ADDRESS P.O. Box 4100, Harrisburg, PA 17111 JOB TITLE/POSITION Team Leader DATE EMPLOYMENT COMMENCED May 1, 1983 GROSS PAY $40,618.86 annual NET PAY OTHER INCOME None ATTORNEY'S NAME Joanne H. Clough, Esquire ATTORNEY'S ADDRESS 3280 Market Street, Cam Hill, PA 17011 ATTORNEY'S PHONE NUMBER 717) 737-5890 MARRIAG E INFORMATION DATE OF MARRIAGE May 23, 1987 PLACE OF MARRIAGE Harrisburg, Dauphin County, Pennsylvania DATE OF SEPARATION March 9, 2007 ADDRESS OF LAST MARITAL HOME 319 Rosemont Ave, New Cumberland, PA 17070 DESCRIPTION OF DOCUMENT RAISING APL CLAIM Answer and Counterclaim DATE APL DOCUMENT FILED February 27, 2008 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07 - 1336 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the foregoing Petition Requesting Hearing On Alimony Pendente Lite in the above-captioned matter upon the following individual(s) by first class mail, postage prepaid, addressed as follows: Joanne H. Clough, Esquire 3820 Market Street Camp Hill, PA 1701 DATED: February 27, 2008 Barbara Sumple-Sullivan, Esquire Attorney for Defendant 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. No. 32317 T CZ) V Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 07 - 1336 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE ANSWER AND COUNTERCLAIM TO DIVORCE COMPLAINT AND NOW, this 27`x' day of February, 2008, comes Defendant, Maria Nichols, by and through her attorney, Barbara Sumple-Sullivan, Esquire, and files this Answer and Counterclaim. In support thereof, it is averred as follows: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. Admitted. 8. Denied. After reasonable investigation, Defendant is without sufficient knowledge to admit or deny that Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. COUNTI Request for Divorce Due to Irretrievable Breakdown Under 3301(c) of the Divorce Code 9. The averments in paragraphs 1 through 8 of Defendant's Answer are incorporated herein by reference. 10. Admitted. 11. Denied. After reasonable investigation, Defendant is without sufficient knowledge to admit or deny that Plaintiff intends to file an affidavit consenting to a divorce after ninety (90) days have elapsed from the date of filing of the Complaint. 12. Denied. After reasonable investigation, Defendant is without sufficient knowledge to admit or deny that Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. COUNT II Request for Divorce Due to Irretrievable Breakdown Under 3301(d) of the Divorce Code 13. The averments in paragraphs 1 through 12 of Defendant's Answer are incorporated herein by reference. 14. Admitted. 15. Admitted in part. Denied in part. It is admitted that the parties are currently residing at the same residence. It is denied, after reasonable investigation, that Defendant is without sufficient knowledge to admit or deny that Plaintiff intends to file his affidavit of having 2 lived separate and apart, provided a divorce decree has not already been granted pursuant to Section 3301(c) of the Divorce Code. 16. Denied. After reasonable investigation, Defendant is without sufficient knowledge to admit or deny that Plaintiff has been advised that counseling is available and that Plaintiff may have the right to request that the court require the parties to participate in counseling. Counterclaim Of Defendant/Counterclaim Plaintiff COUNT I Fault Divorce Indignities 17. The averments in paragraphs 1 through 16 of Defendant/Counterclaim Plaintiff's Answer and Counterclaim are incorporated herein by reference thereto. 18. Defendant/Counterclaim Plaintiff is the innocent and injured party, and Plaintiff/Counterclaim Defendant has offered such indignities to the person of the Defendant/Counterclaim Plaintiff and has been mentally cruel to her so as to make her life burdensome and her condition intolerable, in violation of the marriage vows and of the laws of the Commonwealth. WHEREFORE, Defendant/Counterclaim Plaintiff requests this Court enter a divorce decree in her favor in accordance with the Pennsylvania Divorce Code. 3 COUNT II Equitable Distribution 19. The averments in paragraphs 1 through 18 of Defendant/Counterclaim Plaintiff's Answer and Counterclaim are incorporated herein by reference thereto. 20. Petitioner requests your Honorable Court to equitably divide, distribute or assign the marital property between the parties in such proportions as the Court deems just pursuant to Section 3502 of the Divorce Code of 1980, together with any amendments thereto. WHEREFORE, Defendant/Counterclaim Plaintiff requests entry of a divorce decree in her favor in accordance with of the Pennsylvania Divorce Code. COUNT III Support. Alimony Pendente Lite and Alimony 21. The averments in paragraphs 1 through 20 of Defendant/Counterclaim Plaintiffs Answer and Counterclaim are incorporated herein by reference thereto. 22. Defendant/Counterclaim Plaintiff requires reasonable support to adequately sustain herself with the standard of living established during the marriage. WHEREFORE, Defendant/Counterclaim Plaintiff requests an award of Support, Alimony and Alimony Pendente Lite. 4 COUNT IV Attorney's Fees and Costs 23. The averments in paragraphs 1 through 22 of Defendant/Counterclaim Plaintiffs Answer and Counterclaim are incorporated herein by reference thereto. 24. Defendant/Counterclaim Plaintiff is unable to sustain herself during the course of this litigation and has employed Barbara Sumple-Sullivan, Esquire as counsel, but is unable to pay the necessary and reasonable attorney's fees for said counsel, and the necessary and reasonable costs and expenses. WHEREFORE, Defendant/Counterclaim Plaintiff requests an award of counsel's fees and expenses. WHEREFORE, Defendant/Counterclaim Plaintiff, Maria Nichols, prays this Honorable Court to enter judgment: A. Awarding Defendant/Counterclaim Plaintiff a decree in divorce; B. Equitably distributing the marital property; C. Awarding Defendant/Counterclaim Plaintiff support, alimony and alimony pendente lite; D. Awarding Defendant/Counterclaim Plaintiff counsel fees, costs and expenses; and 5 E. Awarding other relief as the Court deems just and reasonable. Dated: February 27, 2008 Attorney for Defendant/Counterclaim Plaintiff 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. No. 32317 Respectfully submitted, Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. MARIA NICHOLS, Defendant NO. 07 - 1336 CIVIL ACTION -LAW IN DIVORCE VERIFICATION I, Maria Nichols, hereby certify that the facts set forth in the foregoing Answer and Counterclaim are true and correct to the best of my knowledge, information and belief. l understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities. DATED: February , 2008 Maria Nichols Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff V. MARIA NICHOLS, Defendant : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 07 - 1336 CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the foregoing ANSWER AND COUNTERCLAIM in the above-captioned matter upon the following individual(s) by first class mail, postage prepaid, addressed as follows: Joanne H. Clough, Esquire 3820 Market Street Camp Hill, PA 17011 DATED: February 27, 2008 Barbara Sumple-Sullivan, Esquire Attorney for Defendant/Counterclaim Plaintiff 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. No. 32317 -:a V\ ro _ -F? i MICHAEL NICHOLS, THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 07-1336 CIVIL TERM MARIA NICHOLS, IN DIVORCE Defendant/Petitioner : PACSES CASE NO: 637109840 ORDER OF COURT AND NOW, this 28th day of February, 2008, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R. J. Shadday on March 20, 2008 at 10:30 A.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11E (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you. If you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Copies mailed to: Petitioner Respondent Barbara Sumple-Sullivan, Esq. Joanne Harrison Clough, Esq. Date of Order: February 28, 2008 J. S day, Conference Officer / YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - DIVORCE NO. 07-1336 CIVIL TERM MARIA NICHOLS, IN DIVORCE Defendant/ Petitioner PACSES Case Number: 637109840 ORDER OF COURT - RESCHEDULE A CONFERENCE AND NOW, this 11th day of March 2008, upon consideration of the Petition for Alimony Pendente Lite and/or counsel fees, it is hereby directed that the parties and their respective counsel appear before R.J. Shadday on Monday, April 7, 2008 at 1:30 P.M. for a conference, at 13 N. Hanover St., Carlisle, PA 17013, after which the conference officer may recommend that an Order for Alimony Pendente Lite be entered. This date replaces the prior conference date of March 20, 2008. YOU are further ordered to bring to the conference: (1) a true copy of your most recent Federal Income Tax Return, including W-2's as filed (2) your pay stubs for the preceding six (6) months (3) the Income and Expense Statement attached to this order, completed as required by Rule 1910.11 C (4) verification of child care expenses (5) proof of medical coverage which you may have, or may have available to you (6) IF you fail to appear for the conference or bring the required documents, the Court may issue a warrant for your arrest. BY THE COURT, Edgar B. Bayley, President Judge Date of Order: February 28. 2008 Copies mailed to: Petitioner Respondent Barbara Sumple-Sullivan, Esq. Joanne Harrison Clough, Esq. ' R. J. adda , C iference Officer t? 7? YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU MAY GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVE. CARLISLE, PENNSYLVANIA 17013 (717) 249-3166 cc361 c? ra ???f-. ?... "s? a _r? .. -'?-' ..-? 7 fem. t_ ;? ? . y ?„ ? ? ? MICHAEL NICHOLS, Plaintiff/Respondent VS. MARIA NICHOLS, Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 07-1336 CIVIL TERM IN DIVORCE PACSES Case No: 637109840 ORDER OF COURT AND NOW to wit, this 11th day of April 2008, it is hereby Ordered that the Petition for Alimony Pendente Lite in the above captioned matter is dismissed, without prejudice, pursuant to the parties residing in the same household with their ten year old child and the parties' incomes and/or earning capacity. This order is based upon guidance from Rozman v. Rozman, 43 Cumb. 385 (1994). This Order shall become final twenty (20) days after the mailing of the notice of the entry of the order to the parties unless either party files a written demand with the Domestic Relations Section for a hearing de novo before the Court. BY T OURT: Edgar B. Bayley, J. DRO: R.J. Shadday xc: Petitioner Respondent Barbara Sumple-Sullivan, Esq. Kent Patterson, Esq. Form OE-001 Service Type: M Worker: 21005 C 3 C= ii Inp "L7 ;' rs'i Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 07 - 1336 PACSES No. 637109840 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO TO THE PROTHONOTARY: Please accept this as an Appeal of the Order dated April 11, 2008 and schedule the matter for De Novo Hearing before the Support Master. Respectfully submitted, Dated: May 1, 2008 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court No. 32317 Attorney for Plaintiff Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 07 - 1336 PACSES No. 637109840 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the APPEAL OF ORDER AND REQUEST FOR HEARING DE NOVO, in the above-captioned matter upon the following individual, via United States first-class mail, postage prepaid, addressed as follows: Kent H. Patterson, Esquire 221 Pine Street Harrisburg, PA 17101 DATE: May 1, 2008 / l 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Plaintiff ?? ? {.... ? e-y ?.J ? 'T7 r t7;`^ ! E-? ?. , 'r ?? u ?:: ?' ? ?` ?.? =? .? ?$ v In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION MARIA NICHOLS ) Docket Number 07-1336 CIVIL Plaintiff ) VS. ) PACSES Case Number 6 3 710 9 8 4 0 MICHAEL NICHOLS ) Defendant ) Other State ID Number ORDER OF COURT You, MICHAEL NICHOLS plaintiff/defendant of 319 ROSEMONT AVE, NEW CUMBERLAND, PA. 17070-1879-19 are ordered to appear at DOMESTIC RELATIONS HEARING RM DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 170131-3014-13 before a hearing officer of the Domestic Relations Section, on the JUNE 2, 2008 at 1:30PM for a hearing. You are further required to bring to the hearing: I . a true copy of your most recent Federal Income Tax Return, including W-2s; as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to yo, 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 21302 NICHOLS V. NICHOLS PACSES Case Number: 637109840 If you fail to appear for the conference/hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support Order. If paternity is an issue, the court shall enter an order establishing paternity. THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WITHOUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. Date of Order: ?- 7?pg BY THE COURT: An. JUDGE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-HEARING AND REPRESENT YOU. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FOR' H BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of CUMBERLAND County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office at: (717) 2 4 0 - 6 2 2 5 . All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. Page 2 of 2 Form CM-509 Rev. 1 Service Type M Worker ID 21302 JET 5z '.:' co s In the Court of Common Pleas of CUMBERLAND County, Pennsylvania DOMESTIC RELATIONS SECTION MARIA NICHOLS ) Docket Number 07-1336 CIVIL Plaintiff ) vs. ) PACSES Case Number 637109840 MICHAEL NICHOLS ) Defendant ) Other State ID Number ORDER OF COURT You, MARIA NICHOLS plaintiff/defendant of 319 ROSEMONT AVE, NEW CUMBERLAND, PA. 17070-1879-19 are ordered to appear at DOMESTIC RELATIONS HEARING RM DOMESTIC RELATIONS OFC, 13 N HANOVER ST, CARLISLE, PA. 17013-3014-13 before a hearing officer of the Domestic Relations Section, on the JUNE 2, 2008 at 1: 3 0 PM for a hearing. You are further required to bring to the hearing: 1. a true copy of your most recent Federal Income Tax Return, including W-2s, as filed, 2. your pay stubs for the preceding six (6) months, 3. the Income Statement and the appropriate Expense Statement, if required, attached to this order, completed as required by Rule 1910.11 (c). 4. verification of child care expenses, and 5. proof of medical coverage which you may have, or may have available to you 6. information relating to professional licenses 7. other: Service Type M Form CM-509 Rev. 1 Worker ID 21302 NICHOLS v. NICHOLS PACSES Case Number: 637109840 If you fail to appear for the conference/hearing or to bring the required documents, the court may issue a warrant for your arrest and/or enter an interim support order. If paternity is an issue, the court shall enter an order establishing paternity THE APPROPRIATE COURT OFFICER MAY ENTER AN ORDER AGAINST EITHER PARTY BASED UPON THE EVIDENCE PRESENTED WIT14OUT REGARD TO WHICH PARTY INITIATED THE SUPPORT ACTION. BY THE COURT: Date of Order: S- 1.. GE YOU HAVE THE RIGHT TO A LAWYER, WHO MAY ATTEND THE CONFERENCE-HEARING AND REPRESENT YOU. IF YOU IIO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND CO BAR ASSOCIATION 32 S BEDFORD ST CARLISLE PA 17013-3302-32 (717) 249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of CUMBERLAND County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office at: (717) 240-6225 . All Arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled hearing. Page 2 of 2 Form CM-509 Rev. 1 Service Type M Worker ID 21302 s m .,:_; ?. ' ' it " C':: ? ? .?.: :'?- Cam' "b S ? ?"'+'+" ?! ' W ,;? ? "? ? MICHAEL NICHOLS, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION MARIA NICHOLS, : PACSES NO. 637109840 Defendant/Petitioner : DOCKET NO. 07-1336 CIVIL INTERIM ORDER OF COURT AND NOW, this 4th day of June, 2008, upon consideration of the Support Master's Report and Recommendation, a copy of which is attached hereto as Exhibit "A", it is ordered and decreed as follows: A. The Husband shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $311.00 per month. B. The Husband shall pay to the Pennsylvania State Collection and Disbursement Unit the additional sum of $50.00 per month on arrearages. C. The Husband shall provide health insurance coverage for the benefit of the Wife as is available through employment or other group coverage at a reasonable cost. IMPORTANT LEGAL NOTICE PARTIES MUST WITHIN SEVEN DAYS INFORM THE DOMESTIC RELATIONS SECTION AND THE OTHER PARTIES, IN WRITING, OF ANY MATERIAL CHANGE IN CIRCUMSTANCES RELEVANT TO THE LEVEL OF SUPPORT OR THE ADMINISTRATION OF THE SUPPORT ORDER, INCLUDING, BUT NOT LIMITED TO, LOSS OR CHANGE OF INCOME OR EMPLOYMENT AND CHANGE OF PERSONAL ADDRESS OR CHANGE OF ADDRESS OF ANY CHILD RECEIVING SUPPORT. A PARTY WHO WILLFULLY FAILS TO REPORT A MATERIAL CHANGE IN CIRCUMSTANCES MAY BE ADJUDGED IN CONTEMPT OF COURT, AND MAY BE FINED OR IMPRISONED. PENNSYLVANIA LAW PROVIDES THAT ALL SUPPORT ORDERS SHALL BE REVIEWED AT LEAST ONCE EVERY THREE (3) YEARS IF SUCH REVIEW IS REQUESTED BY ONE OF THE PARTIES. IF YOU WISH TO REQUEST A REVIEW AND ADJUSTMENT OF YOUR ORDER, YOU MUST DO THE FOLLOWING: CALL YOUR ATTORNEY. AN UNREPRESENTED PERSON WHO WANTS TO MODIFY (ADJUST) A SUPPORT ORDER SHOULD CONTACT THE DOMESTIC RELATIONS SECTION. ALL CHARGING ORDERS FOR SPOUSAL SUPPORT AND ALIMONY PENDENTE LITE, INCLUDING UNALLOCATED ORDERS FOR CHILD AND SPOUSAL SUPPORT OR CHILD SUPPORT AND ALIMONY PENDENTE LITE, SHALL TERMINATE UPON DEATH OF THE PAYEE. A MANDATORY INCOME ATTACHMENT WILL ISSUE UNLESS THE DEFENDANT IS NOT IN ARREARS IN PAYMENT IN AN AMOUNT EQUAL TO OR GREATER THAN ONE MONTH'S SUPPORT OBLIGATION AND (1) THE COURT FINDS THAT THERE IS GOOD CAUSE NOT TO REQUIRE IMMEDIATE INCOME WITHHOLDING; OR (2) A WRITTEN AGREEMENT IS REACHED BETWEEN THE PARTIES WHICH PROVIDES FOR AN ALTERNATE ARRANGEMENT. UNPAID ARREARAGE BALANCES MAY BE REPORTED TO CREDIT AGENCIES. ON AND AFTER THE DATE IT IS DUE, EACH UNPAID SUPPORT PAYMENT SHALL CONSTITUTE, BY OPERATION OF LAW, A JUDGMENT AGAINST YOU, AS WELL AS A LIEN AGAINST REAL PROPERTY. IT IS FURTHER ORDERED THAT, UPON PAYOR'S FAILURE TO COMPLY WITH THIS ORDER, PAYOR MAY BE ARRESTED AND BROUGHT BEFORE THE COURT FOR A CONTEMPT HEARING; PAYOR'S WAGES, SALARY, COMMISSIONS, AND/OR INCOME MAY BE ATTACHED IN ACCORDANCE WITH LAW. PAYOR IS RESPONSIBLE FOR COURT COSTS AND FEES. The parties are hereby advised that they may file written exceptions to the Support Master's Report and Recommendation within twenty (20) days of this order. Exceptions shall conform with the requirements of Rule 1910.12(f), Pa. R.C.P. If written exceptions are filed by any party, the other party may file exceptions within twenty (20) days of the date of service of the original exceptions. If no exceptions are filed within twenty (20) days of this interim order, this order shall then constitute a final order. Qdiy Y:"? c: Maria Nichols C Michael Nichols Barbara Sumple-Sullivan, Esquire For the Plaintiff Kent H. Patterson, Esquire For the Defendant DRO MICHAEL NICHOLS, : IN THE COURT OF COMMON PLEAS OF Plaintiff/Respondent : CUMBERLAND COUNTY, PENNSYLVANIA V. : DOMESTIC RELATIONS SECTION MARIA NICHOLS, : PACSES NO. 637109840 Defendant/Petitioner : DOCKET NO. 07-1336 CIVIL SUPPORT MASTER'S REPORT AND RECOMMENDATION Following a hearing held before the undersigned Support Master on June 3, 2008, the following report and recommendation are made: FINDINGS OF FACT 1. The Petitioner is Maria Nichols, who resides at 319 Rosemont Avenue, New Cumberland, Pennsylvania; she will hereafter be referred to as "the Wife." 2. The Respondent is Michael Nichols, who resides at 319 Rosemont Avenue, New Cumberland, Pennsylvania; he will hereafter be referred to as "the Husband." 3. The parties were married on May 23, 1987. 4. The Husband filed a complaint for divorce on March 9, 2007. 5. The Wife filed a claim for alimony pendente lite and filed a petition requesting a hearing thereon on February 27, 2008. 6. The parties are the parents of Michael A. Nichols, Jr., who is 10 years of age. 7. The parties have both resided in the marital residence since the filing of the divorce complaint. 8. The Wife is not gainfully employed outside the home. 9. Prior to the birth of her son in 1997 the Wife was employed as an assembler of electronic connectors by Phoenix Contact USA, Inc. 10. The Wife earned $21,080.00 in 1996, her last full year of employment. 11. During the period of 2004 through 2006 the Wife worked at various part-time positions including Weis Market (bakery department), Capital City Mall (cleaning crew), and ToysRus (retail sales clerk). 12. The Wife earned $8,947.00 in 2006 working part-time at Weis Market. EXHIBIT "A" 13. The Wife left her employment at Weis Market in January, 2007. 14. The Wife has not worked since January, 2007. 15. The Wife is 46 years of age and is a high school graduate. 16. The Wife has applied for employment with approximately 20 perspective employers but has not been hired. 17. The Wife has incurred legal bills exceeding $4,000.00 in the divorce action. 18. The Wife does not have the present ability to pay her legal fees without an award of alimony pendente lite. 19. The Husband is employed by Phoenix Contact USA, Inc. as a manufacturing technician. 20. The Husband earned $41,196.88 in 2007. 21. The Husband's year-to-date earnings through the pay period ending May 24, 2008 have been $18,313.60. 22. The Husband pays $28.00 bi-weekly for health insurance coverage on the family. 23. The Husband filed his 2007 federal income tax return as married/separate and claimed the parties' son as a dependency exemption. 24. The Husband pays the household expenses although the parties received several utility shut-off notices before bills were paid. DISCUSSION In Clouse v. Clouse, 50 Cumberland L.J. 167,170 (2001) the Honorable J. Wesley Oler discussed the law of Pennsylvania as it relates to the subject of alimony pendente lite wherein he stated: The determination of whether to award alimony pendente lite has traditionally been a matter within the sound discretion of the trial court. Litmans v. Litmans, 449 Pa. Superior Ct. 209, 222, 673 A.2d 382, 388 (1996) (citing Murphy v. Murphy, 410 Pa. Superior Ct. 146, 599 A.2d 647 (1991), anneal denied, 530 Pa. 633, 606 A.2d 902 (1992), cert. denied, 506 U.S. 868, 113 S.Ct. 196, 121 L.Ed. 2d 139 (1992)). APL is based on the need of one spouse to have the financial resources to pursue or defend a divorce action. Litmans, supra at 222, 763 A.2d at 388. The claimant must show that APL is needed to adequately preserve his or her rights in the litigation. Sutliff v. 2 Sutliff, 326 Pa. Superior Ct. 496, 500, 474 A.2d 599, 600 (1984), overruled on other grounds, Rosen v. Rosen, 520 Pa. 19, 549 A.2d 561 (1988). In this regard, the Pennsylvania Superior Court has stated that "a spouse seeking alimony pendente lite who has sufficient assets to meet the needs of the pending litigation and who is equally situated with the other spouse to maintain or defend the action, will not be awarded alimony pendente lite." Powers v. Powers, 419 Pa. Superior Ct. 464, 467, 615 A.2d 459, 460 (1992). In adjudicating a claim for alimony pendente lite, a court should consider the following factors: "the ability of the other party to pay; the separate estate and income of the petitioning party; and the character, situation, and surroundings of the parties." Litmans, supra. at 224, 673 A.2d at 389. Once entitlement to an award of alimony pendente lite is established, the calculation of the amount of the award is made pursuant to the support guidelines. Little v. Little, 47 Cumberland L.J. 131 (1998). In the present case the Wife does not have sufficient assets or income to adequately preserve her rights in the divorce litigation and is in need of alimony pendente lite. The Wife is currently not gainfully employed but clearly has an earning capacity. A party's earning capacity is that amount he or she can realistically be expected to earn under the circumstances considering his or her age, health, physical and mental condition, education and training. Riley v. Foley, 783 A.2d 807 (Pa. Super. 2001). The Wife has worked as a retail sales clerk from 5:00 p.m. to 9:30 p.m. in the recent past. Doing so now at the current minimum wage of $7.15 per hour would result in gross monthly income of $697.00. Working part-time in the evenings would also avoid the necessity of incurring childcare costs during the upcoming summer months. The Husband's workday ends at 3:30 p.m., thereby allowing him to return home in ample time for the Wife to leave for work. With gross monthly income of $697.00 and filing a federal income tax return as married/separate, the Wife would have net monthly income of $615.00.' The Husband has year-to-date earnings through May 24, 2008 of $18,313.60, or an average gross monthly income of $4,312.00. Filing his federal income tax return as married/separate and claiming his son as a dependency exemption, the Husband has net monthly income for support purposes of $2,912.00.2 Because of the unique circumstances of the case with the parties and the child continuing to reside in the marital home, the expenses associated with the home will be deducted from the Husband's net income before calculating a support obligation.3 The sum of $705.00 is deducted from the Husband's net income of $2,912.00 resulting in a net income of $2,207.00 for support purposes.4 ' See Exhibit "A" for the tax deductions from gross income. z See Exhibit "A" for the tax deductions from gross income. 3 See Rozman v. Rozman, 43 Cumberland L.J. 385 (1994) for the methodology employed by the Honorable Edgar B. Bayley in a case with similar circumstances. a The $705.00 consists of sums paid for house maintenance, real estate taxes, utilities (exclusive of the Husband's cell phone), and homeowner's insurance. See Respondent's Exhibit 2. The 4-step methodology for calculating an award of alimony pendente lite when a custodial parent has an obligation to pay spousal support or APL is set forth in Pa. R.C.P. 1910.16-4(e).5 In the first step the Husband's obligation for APL is calculated using the formula set forth in Pa. R.C.P. 1910.16-4(a) without dependent children. In this case the amount of that obligation is $637.00 per month.6 In the second step adjusted incomes of the parties are calculated by adding the figure from the first step to the obligee's income and deducting it from the obligor's. Adjusted incomes in this case become $1,252.00 for the Wife and $1,570.00 for the Husband. In the third step the child support obligation of the claimant is calculated utilizing the adjusted incomes from the second step. The Wife's monthly obligation for her son is $326.00 per month. In the final step the obligations from the first and third steps are offset. The difference is awarded to the claimant as alimony pendente lite. In this case the difference is $311.00 per month. RECOMMENDATION A. The Husband shall pay to the Pennsylvania State Collection and Disbursement Unit as alimony pendente lite the sum of $311.00 per month. B. The Husband shall pay to the Pennsylvania State Collection and Disbursement Unit the additional sum of $50.00 per month on arrearages. C. The Husband shall provide health insurance coverage for the benefit of the Wife as is available through employment or other group coverage at a reasonable cost. D. The effective date of this order is March 1, 2008. 2-068 Da Michael R. Rundle Support Master 5 Similar to Rozman, the Husband is treated as the custodial parent for calculation purposes. 6 See Exhibit "B" for the calculation. 7 See Exhibit °C" for the calculation. 4 In the Court of Common Pleas of Cumberland County, Pennsylvania Tax Detail Report Plaintiff Name: Maria Nichols Defendant Name: Michael Nichols Docket Number: 07-1336 Civil PACSES Case Number: 637109840 Other State ID Number: Tax Year: Current: 2008 Def#nftW Plaintiff 1. Tax Method 1040 ES 1040 ES 2. Fling Status Married Filing Separately Single 3. Who Claims the Exemptions Customize 4. Number of Exemptions 2 1 5. Monthly Taxable Income $$,607.20 $697.00 6. Deductions Method 7. Deduction Amount $454.17 $454.17 8. Exemption Amount $583.34 $291.67 9. Income MINUS Deductions and Exemptions $2,569.69 -$48.84 10. Tax on Income $352.02 - 11. Child Tax Credit $83.33 - 12. Manual Adjustments to Taxes - _ 13. Federal Income Taxes $268.69 - 13 a. Earned Income Credit - _ 14. State Income Taxes $113.99 $22.03 15. FICA Payments $275.95 $53.32 16. City Where Taxes Apply 17. Local Income Taxes $36.07 $6.97 TOTAL Taxes $694.70 $82.32 SupportCak 2007 EXHIBIT ".A" In the Court of Common Pleas of Cumberland County, Pennsylvania Spousal Support Calcetlaflon Rule 1"0.16 (PACSES FORMAT) Plaintiff Name: Maria Nichols Defendant Name: Michael Nichols Docket Number: 07-1336 Civil PACSES Case Number: 637109840 Other State ID Number: 1.Obli or's Monthly Net Income $2,207.00 2. Less All Other Support - 3. Less Obligee's Monthly Net Income $614.68 4. Difference $1,592.32 5. Less Child Support Obligation for Current Case - 6. Difference $1,592.32 7. Multiply b 30% or 40% 40.00% 8. Income Available for Spousal Support $636.93 9. Adjustment for Other Expenses 10. AMOUNT OF MONTHLY SPOUSAL SUPPORT OR APL $636.93 Prepared b : mrr Date: 6/ 3/2008 SupportCalc 2008 EXHIBIT "B" In the Court of Common Pleas of Cumberland County, Pennsylvania Support Guideline,W*rksheet Role 1910.16-1, ei soq- Defendant Name: Maria Nichols Docket Number: PACSES Case Number: Plaintiff Name: Michael Nichols Other Case ID Number: Wenciant Plaintiff 1. Number of Dependents in this Case 1 2. Total Gross Month/ Income $1,252.00 $1,570.00 3. Less Month/ Deductions - - 4. Monthly Net Income Line 2 minus Line 3 $1,252.00 $1,570.00 5. Combined Total Monthly Net Income Amounts on Line 4 Combined $2,822.00 6. Plus Child's Month/ Soc. Sec. Retirement or Disability Derivative Benefit. # - 7. Adjusted Combined Total Month/ Net Income 8. PRELIMINARY Child Support Obligation based on Adjusted Income Line 7 - - 9. Less Child's Monthly Social Security Retirement or Disability Derivative Benefit Line 6 O k - 10. Basic Child Support Obligation From Rule 1910.16-3 Basic Child Support Schedule Table Rev. 112006 $694.00 tt= { ' u 11. Net Income as a Percentage of Combined Amount 44.37 55.63 12. Each Parent's Month/ Share of the Child Support Obligation $307.93 $386.07 13. Adjustment for Shared Custody Rule 1910.16-4 c # of Overnights: - - 14. Adjustment for Child Care Expenses Rule 1910.16-6 a - 15. Adjustment for Health Insurance Premiums Rule 1910.16-6 b $17.97 16. Adjustment for Unreimbursed Medical Expenses Rule 1910.16-6 c - 17. Adjustment for Additional Expenses Rule 1910.16-6 d - 18. Total Obligation with Adjustments Line 8 minus Line 9, plus Lines 10, $325.90 19. Less Split Custody Counterclaim Rule 1910.16-4 d - 20. Obligor's Support Obligation Line 14 minus Line 15 $325.90 Prepared by: mrr Date: 6/ 3/2008 Summarv Report -- S1. PACSES Multiple Family Adjustment - S2. Spousal Support Award - S3. Adjustment for Excess Mortgage Payments (If Applicable) - S4. Custodial Parent Spousal Support Obligation (if Applicable) (-) - S5. Adjusted Support Obligation Line 16 (or S1, if applicable) plus Line S2 and S3 minus S4 (if applicable) Monthly: $325.90 Weekly: $75.01 TAX INFORMATION Tax Method Filing Status Exemptions S6. Defendant Manual Single 1 S7. Plaintiff Manual Single 2 S8. Total Support Amount if Deviating from Guidelines Calculation Monthly: Weekly: S9. Justification for Deviatina from Guidelines Calculation and/or Other Case Comments: SupportCak 2008 EXHIBIT "C" C-) T F- Fn S; i MICHAEL NICHOLS, Plaintiff/Respondent V. MARIA NICHOLS, Defendant/Petitioner : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION PACSES NO. 637109840 DOCKET NO. 07-1336 CIVIL INDEX OF EXHIBITS Petitioner's 1 - Social security earning records Petitioner's 2 - Recent applications for employment Petitioner's 3 - Income and expense statement Petitioner's 4 - UGI shut-off notice Petitioner's 5 - Correspondence between attorneys Petitioner's 6 - Complaint for past due sewer and trash charges Petitioner's 7 - Notice for unpaid real estate taxes Petitioner's 8 - Pennsylvania American Water shut-off notice Petitioner's 9 - 2007 W-2 Respondent's 1 - Earnings statement Respondent's 2 - Income and expense statement Respondent's 3 - 2007 federal tax return ?: t cn < . u'i ar ?Cr' -p ?? 4-:; N '-? Your Earnings Record Your Taxed Your Taxed Years You Social Security Medicare Worked Earnings Earnings 1978 $ 1,896 $ 1,896 1979 1,324 1,324 1980 667 667 1981 1,873 1,873 1982 2,433 2,433 1983 3,663 3,663 1984 5,947 5,947 1985 6,757 6,757 1986 5,640 5,640 1987 5,902 5,902 1988 11,014 11,014 1989 13,345 13,345 1990 13,426 13,426 1991 14,351 14,351 1992 16,534 16,534 1993 16,667 16,667 1994 20,752 20,752 1995 18,592 18,592 1996 21,080 21,080 1997 14,508 14,508 1998 0 0 1999 0 0 You and your family may be eligible for valuable benefits: When you die, your family may be eligible to receive survivors benefits. Social Security may help you if you become disabled-even at a young age. A young person who has worked and paid Social Security takes in as few as two years can be eligible for disability benefits. Social Security credits you earn move with you from job to job throughout your career. 2000 2,054 2,054 2001 1,055 1,055 PETITION E R'S -7 2002 0 0 2003 0 0 EXHIBIT 2004 2,127 2,127 2005 7,394 7,394 r / 2006 8,947 8,947 ?/i 2007 Not yet recorded Total Social Security and Medicate taxes paid over your working career through the last year reported on the chart above: Estimated taxes paid for Social Security: Estimated taxes paid for Medicare: You paid: $13,218 You paid: $3,102 Your employers paid: $13,218 Your employers paid: $3,102 Note: You currently pay 6.2 percent of your salary, up to $102,000, in Social Security tames and 1.45 percent in Medicare taxes on your entire salary. Your employer also pays 6.2 percent in Social Security taxes and 1.45 percent in Medicare taxes for you. If you are self-employed, you pay the combined employee and employer amount of 12.4 percent in Social Security, taxes and 2.9 percent in Medicare taxes on your net earnings. Help Us Keep Your Earnings Record Accurate You, your employer and Social Security share responsibility for the accuracy of your earnings record. Since you began working, we recorded your reported earnings under your name and Social Security number. We have updated your record each time your employer (or you, if you're self-employed) reported your earnings. Remember, it's your earnings, not the amount of taxes you paid or the number of credits you've earned, that determine your benefit amount. When we figure that amount, we base it on your average earnings over your lifetime. If our records are wrong, you may not receive all the benefits to which you're entitled. Review this chart carefully using your own records to make sure our information is correct and that we've recorded each year you worked. You're the only person who can look at the earnings chart and know whether it is complete and correct. Some or all of your earnings from last year may not be shown on your Statement. It could be that we still were processing last year's earnings reports when your Statement was prepared. Your complete earnings for last year will be shown on next year's Statement. Note: If you worked for more than one employer during any year, or if you had both earnings and self-employment income, we combined your earnings for the year. There's a limit on the amount of earnings on which you pay Social Security taxes each year. The limit increases yearly. Earnings above the limit will not appear on your earnings chart as Social Security earnings. (For Medicare taxes, the maximum earnings amount began rising in 1991. Since 1994, all of your earnings are taxed for Medicare) Call us right away at 1-800-772-1213 (7 a.m. 7 pm. your local time) if any earnings for years before last year are shown incorrectly. Please have your W-2 or tax return for those years available. (If you live outside the U.S., follow the directions at the bottom of page 4) 3 01230SR 121a 31715M moo= RECENT APPLICATIONS SUBMITTED BY WIFE 1) R.E.M. Staffing, Inc. 2) Charlotte Russe 3) JC Pennys 4) The Limited 5) American Eagle 6) Piercing Pagoda 7) Macy's 8) Payless 9) Dingeldeing's Bakery 10) Olde Towne Beverage 11) Nick's 114 Caf6 12) Rite Aid 13) Giant (numerous) 14) Subway 15) Learning and Sharing Child Development Center 16) New Cumberland Car Wash 17) Taco Bell 18) McDonalds 19) Harristown Development Corp. 20) Harrisburg Hospital • !ill" " NOT FIL REXCEhJQ0P1Y TR0Ck ? o f n ,ne . r 50071 m U.S. Individual Income Tax Return IRS Use Onl - Do not write or eta le in this s ace. Label For the r en. 1 - Dec, 31 2007 or other tax ear be innin endin OMB No. 1545-0074 (See Your first name and initial Last name Your social security number instructions.) L M I CHAEL N I CHOLS 208-56-9523 Use the IRS A B If a joint return, spouse's first name and initial Last name Spouse's social security number label. ? 211-48-6814 Otherwise, E Home address (number and street). If you have a P.O. box, see instructions. Apt. no. You must enter please print R Your SN(s) above. or type. E 319 ROSEMONT AVE City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. Checking a box below will Presidential NEW CMERLAND, PA 17070 aot aharme uau tax=rafuru C Filing Status Check only one box. 1 U Single 4 L Head of household (with qualifying person). (See instr.) 2 ? Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, 3 ® Married filing separately. Enter spouse's SSN above and enter this child's name here. Pi, f ll n m h r. ?MAR I A I N I CHOLS 5 Qualifying w' w r with de n n child (see instr) Exemptions 6 a ® Yourself If someone can claim you as a dependent do not check box 6a y Boxes checked 1 . , on 6a and 6b b Spouse No, of children c Dependents: 2 Dependent's social () (3) Dependent's (4) ?i1 qualifying on 6c who: 0 lived with you 1 security number relationship to child for child tax 9 did not live with 1 First name Last name you credit (see into you due to divorce separation If more than four MICHAEL A NICHOLS A 162-78-2005 SON (s (see instructions) dep iii EFE D d t 6 see instructions. epen s on en c not entered above 1:1 Add ers mb d Total number exemptions claimed ......... .. ................. . . . 2 o llf es above ? P Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ........................... 7 39 8a Taxable interest. Attach Schedule B if required ........... ....... 8a Attach Form(s) W-2 b Tax-exempt interest. Do not include on line 8a ...... .. 8b here. Also attach g a Ordinary dividends. Attach Schedule B if required ......................... 9a Forms W-2G and b Qualified dividends (see instructions) ................ 9b 1099-R If tax 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ...... 10 was withheld. 11 Alimony received .... ....................................... 11 12 Business income or (loss). Attach Schedule C or C-EZ ...................... 12 13 Capital gain or (loss). Attach Schedule D if req LaoL gpyiVft? ? 1] If you did not 14 C0 _ Other gains or (losses). Attach Form 4797.. r IR (r r mi. ) NO I FILE get a W-2, see 15a IRA distributions ... ....... 15a b Taxable amount (see instr). 15b instructions. 16a Pensions and annuities ...... 16a b Taxable amount (see instr). 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .... 17 Enclose, but do 18 Farm income or (loss). Attach Schedule F ............................. 18 not attach, any 19 Unemployment compensation .. .......... ............... 9 payment. Also, 20 a Social security benefits ...... 120a I I b Taxable amount (see instr). 20b please use 21 Other Income. List type and amount (see instructions) 21 23 Educator expenses (see instructions) ... . . ..... .... . Adjusted 24 Certain business expenses of reservists, performing artists, and ncgkFERr&NtTsWg'ntfa'b l4i ."=o T E. 26 Moving expenses. Attach Form 3903 ............... . 27 One-half of self-employment tax. Attach Schedule SE ..... . 28 Self-employed SEP, SIMPLE, and qualified plans ........ 29 Self-employed health insurance deduction (see instructions) . . 30 Penalty on early withdrawal of savings .............. . 31 a Alimony paid b Recipient's SSN ? 32 IRA deduction (see instructions) ... .... .......... . 33 Student loan interest deduction (see instructions) . . ... . . . . 34 Tuition and fees deduction. Attach Form 8917 ......... . 35 Domestic production activities deduction. Attach Form 8903 .. . 36 Add lines 23 through 31a and 32 through 35 .......... . For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. 41-at yf- 2 MXA F 1116107 Form 1040 (2007) D 2007.10 Tax and 38 Amount from line 37 (adjusted gross income) .. . . ........... ...... .. . Standard if: El Spouse was born before January 2, 1943. El Blind. checked ? 39a Deduction b If your spouse itemizes on a separate return or you were a dual-status alien, see instr and check here ? 39b for - 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) ..... 40 5,350 e People who 41 Subtract line 40 from line 38 . ... .................................. 41 34,164 checked any 42 If line 38 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed box on line 39 39b or on line 6d. If line 38 is over $117,300, see the worksheet in the instructions ..... ...... 42 6,800 a or who can be 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0 ...... 43 27,364 claimed as a 44 Tax (see instr). Check if any tax is from: SE] Form(s) 8814 b ? Form 4972 c E3 Form(s) 8889 44 3,715 dependent, see Instructions 45 Alternative minimum tax (see instructions). Aft F ' r RE;1V C?E OPY . 46 Add lines 44 and 45 . ... .. . . ?' . V NO I __1 • All others: Single or 47 Credit for child and dependent care expenses. Attach Form 2441. 47 Married filing 48 Credit for the elderly or the disabled. Attach Schedule R ...... 48 separately, 49 Education credits. Attach Form 8863 ................. 49 $5,350 50 Residential energy credits. Attach Form 5695 ............ 50 Married filing jointly or 51 Foreign tax credit. Attach Form 1116 if required ........... 51 Qualifying 52 Child tax credit (see instructions). Attach Form 8901 if required 52 1 000 widow(er), 53 Retirement savings contributions credit. Attach Form 8880 ..... 53 $10,700 54 Credits from: a ? Form 8396 b ? Form 8859 c ? Form 8839 54 Head of 55 Other credits: a ? Form 3800 b ? Form 8801 c ? Form 55 household, $7,850 56 Add lines 47 through 55. These are your total credits ............... 56 1,000 r ............. ? 57 2,715 Other 58 Self-employment tax. Attach Schedule SE ..... . Taxes 59 Unreported social security and Medicare tax from: a ? Form 4137 b ? Form 8919 59 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ..... 60 61 Advance earned income credit payments from Form(s) W-2, box 9 ................. 61 62 Household employment taxes. Attach Schedule H .......................... 62 63 Add lines 7 hr h 62. This is your total x ..... .... ... .. 2,715 Payments 64 Federal income tax withheld from Forms W-2 and 1099 ...... 64 3 31 65 2007 estimated tax payments and amount applied from 2006 return 65 If you have a 66 a Earned income credit (EIC) .. .................. . qualifying b Nontaxable combat pay election ? 66b child, attach i 67 Excess social security and tier 1 RRTA tax withheld (see instructions) 7 Schedule El 68 Additional child tax credit. Attach Form 8812... pp CC CC E r E NOT FILE 69 Amount paid with request for extension to file (seF% . 70 Payments from: a ? Form 2439 b El Form 4138 C ? Form 8885 7 71 Refundable credit for prior year minimum tax from Form 8801, In 27 71 Refund 73 If line 72 is more than line 63, subtract line 63 from line 72. This is the amount you overpaid .. . Direct deposit? 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here ... ? ? See instructions ? b Routing number 031312738 ?c Type: ® Checking ? Savings and fill in 74b, 10, d Account number 5004909409 74c, and 744dd. . Amount 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay,.see instructions . ? D..h ''EF V r 1 e? olp„tO }hieu ti?IRS (see instructions)? ® Yes. Complete the following. ? No ?@ r ? t ?uJ ryn V ' I?a name ?MichaeI W Wampo identification ? Sign Under penalties of perjury, I declare that I have examined this return and a ne no. it. (7 (7117) 815- schedules and0034 Personal statements, and number idt the best of my 11-01863 knowledge end coompanying belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) Is based on ell atement of which prest of y any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return? ' TEAM LEADER See instructions. Spouse's signature. If a joint return, both must sign. Date Spouse's occupation Keep a copy Paid Preparees Use Only Preparer's Firm's name (or yours , mson new i t t i ax if self-employed), ' 110 Old York Rd ce Date I Check if Phone no. Preparer's SSN or PTIN C F 11/5/07 Form 1040 (2007) I 11 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA DOMESTIC RELATIONS SECTION V. Docket Number: 07-1336 PACSES Case Number: 637109840 MARIA NICHOLS, Defendant INCOME AND EXPENSE STATEMENT OF MARIA NICHOLS I, Maria Nichols, verify that the statements made in this income and expense statement are true and correct. I understand that false statements herein are made subject to the penalties if 18 Pa. C.S.A. Section 4904 relating to unworn falsification to authorities. MARIA NICHOLS Dated: 7 by 2008 P'CuLvcc- 5/30/OS PETITIONER'S EXHIBIT '- 4 INCOME: Employer: Address: Type of work: Payroll Number: Pay period (weekly, biweekly, etc.): Gross pay per pay period: Federal Filing Status: Itemized Payroll Deductions: Federal Withholding: .00 Social Security: .00 Local Wage Tax: .00 State Income Tax: .00 Retirement: .00 Savings Bonds: .00 Credit Union .00 Life Insurance: .00 Health Insurance: .00 Net pay per pay period: .00 OTHER INCOME: MONTHLY Interest .00 Dividends .00 Pension .00 Annuity .00 Social Security $ .00 Rents .00 Royalties .00 Expense Acct. .00 Gifts .00 Unemployment Comp. .00 Alimony .00 Total Income: $ Net/Month 2 v A, EXPENSES MONTHLY Home: Mortgage Maintenance House needs work, but nothing is being done Utilities: Electric 50.00 Estimated for house, Husband was not paying Gas 55.00 Estimated for house, Husband was not paying Oil 125.00 Estimated for house, Husband was not paying Telephone 30.00 Estimated for house Sewer/Refuse 75.00 Husband is to be paying, but was not. Water 92.00 Estimated for house, Husband was not paying Employment: Public Transportation Lunch Taxes: Real Estate Personal Property Insurance: Homeowners Automobile Life Accident Long term health insuranc Health Insurance Other-Umbrella 120.00 Estimated for house, Husband was not paying 17.00 Estimated for house, not sure if Husband is paying 90.00 Estimated for Wife only. HusgRab ?,klD % m ormlhs. Automobile: Payments $1910-00 Fuel $$ Estimated. Repairs Medical Doctor 5.00 $20.00 co-pay each time. Dentist 80% paid by Insurance Orthodontist Unknown Son needs braces-$3,000.00 estimated Hospital Medicine Special Needs: (Glasses, braces, orthopedic) Counseling Unknown, but Wife desires to begin It, V I EXPENSES Education: Private School Parochial School College Religious Personal: Clothing Food Barber/Hairdresser Credit Paymer Credit Card Charge Other Loans: Credit Union Miscellaneous Household Help Child Care Papers/bo oks/magazmes Entertainment Pay Television Vacation Gifts Legal Fees Charitable Contributions Total Expenses 5.83 $70.00 registration fee-still outstanding 100.00 Estimated for Wife only, but cannot afford now 200.00 Estimated for Wife only 20.00 Estimated for Wife only, but cannot afford now 20.00 Estimated for Wife only, but cannot afford now 50.00 Estimated for Wife only, but cannot afford now Husband is to be paying, but was late. 0.00 Estimated for Wife only, but cannot afford now 20.00 Average T5 t> - S .2.t. 0-+N ckk-d- A 11 is 15.00 Estimated for Wife only, but cannot afford now $4434.$3- ,SI, 24V13 t 10 DAY SHUT-OFF NOTICE o ffeff ADVISO DE SUSPENSION DE SERVICO UT/L/T/Es, /N6. 30 February 1, 2008 Your GAS Service May Be Shut Off! Because your bill is past due, we will shut off the service to 319 ROSEMONT AVE on or after 8:00 a.m. on February 11, 2008. We may act on this notice for up to 60 days.` 213 144 1560 41 , We will NOT shut off your gas service if you do ONE of the following: • Call us at 1-800-272-9844 to arrange to pay your past due bill of $ 203.43. • Pay the amount you owe on your payment plan. Call us at 1-800-272-9844 for this amount. 213 144 1560 41 1 • Show us a paid receipt for the past due amount. j • Call 1-800-272-9844 right away if you dispute this bill or to provide us with household income and occupant information. You may be eligible for a payment agreement or special assistance programs. If we shut off your gas service, you may have to pay all of the following before we can turn your service on: Past Due Bill $ 203.43 Security Deposit $ 110.00 Turn-on Charge $ 60.00 Total $ 373.43 To talk about your bill, please call our office at 1-800-272-9844. MEDICAL EMERGENCY NOTICE Let us know if someone living in your home is seriously ill or has a medical condition. WE WILL NOT SHUT OFF YOUR SERVICE provided you: 1. Have your licensed physician or nurse practitioner certify by phone or in writing that such an illness exists and that it may be aggravated if your service is shut off. Written certification is needed within 7 days: AND 2. Make arrangements to pay this bill. You must provide us with household income and occupant information to determine your payment terms while protected under the medical certification. IMPORTANT TO KNOW Before we shut off your utility service please read the back of this notice. You may be eligible for certain protections from shut off. Atencion! Esto as un mensaje muy importante. Si usted no to entiende, favor de llama a 1-800-272-9844. Pay by personal check ?? Pay by credit card: 1-B66-228-0734 `n 1-800-752-5097 See other side for more information. UGI Utilities Inc. ffew Phi Box 71203 Philadelphia, , PA 19176 OT/LIT/ES, 30 CPT 213 144 1560 41 1 Serv. Addr. 319'ROSE4AONT AVE February 11, 2008 MARIA I NICHOLS 319 ROSEMMONT AVE 20143 NEW CUMBERLND PA 17070 __ _ _------1--- 213 144 1560 41 213144156041000003000203430000000000000000000000000008 ? 1.0$ VL 1 0 0 LAW OFFICES BARBARA SUMPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070-1931 PHONE (717) 774-1445 PAX (717) 774-7059 May 22, 2008 Kent H. Patterson, Esquire 221 Pine Street Harrisburg, PA 17101 Via fax (233-6280) and regular mail Re: Michael Nichols v. Maria Nichols Docket No. 07-1336 (Divorce) / Cumberland County Dear Kent: Your client has shut off telephone service for my client. Please have him rectify this immediately. Given Ms. Nichols is the primary caretaker of the parties' child, she cannot be without phone service. BSS/lh cc: Ms. Maria Nichols Barbara Sumple-Sullivan plETITIONER'S EXHIBIT 4,14n r 11 10, • LAW OFFICES BARBARA SUMPLE-SULLIVAN 549 Bridge Street New Cumberland, Pennsylvania 17070-1931 PHONE: (717) 774-1445 FAX: (717) 774-7059 TO: Kent Patterson, Esquire SENT VIA FAX NUMBER: 233-6280 FROM: BARBARA SUMPLE-SULLIVAN, ESQUIRE DATE: May 22, 2008 TIME: / z),1 q, A RE: Nichols v. Nichols COMMENTS: NO. OF PAGES INCLUDING TRANSMITTAL SHEET:_ ORIGINAL WILL X / WILL NOT FOLLOW BY FIRST-CLASS MAIL • 0 P. 1 Communication Result Report ( May-22. 2008 10:22AM ) FAX HEADER: Date/Time: May•22. 2008 10:21AM Page File Mode Destination Pg(s) Result Not Sent ------------------------------------------------------------------------------------------------ 2729 Memory TX 2336280 P. 2 OK ------------------------------------------------------------------------------------------------ Reason for error E•1) Hans uP or line fail E•2) Busv E3) No answer E4) No facsimile connection LAW 0""® BARBARA SUMPLE-S1J7.LMAN( BM Bran=aTlUM NZW Go ZM c.irn. PZNPMFrMAMA 2"71-IM Porous ea+i rfawB B'A= VMS 9A -Mm Map 22, 2008 Kant H. Pattaton, Esgoic 221 Pine Shad Hankburz, PA 17101 V6 6uc (2U4M) and regoW mere Ra Midud Mcbo a v. Marla Niehob Do" No. 07-13M Mono) / CWW* Hmd onrev Dear Kent Yaw chart hat shat off h9ephone setvioe for my chout Pleate have ]mm wofy albs ®odi utdy. Ginn Ma. Nkboh is the p®ay eaaakcr of the parries' shad, the cannot be Without phone service. AS uw ivm BSS/m cc: Ms. Maria Nichoh COMMONWEALTH OF PENNSYLVANIA r-nl INTY nt=- CUMBERLAND May. Dist. No.: 09-1-01 a Ham : Mots. CHARLES A. CLEMENT. JR.' 4 0 0.. BRIDGE - STREET OLDE TOWNE COMMONS -SUITE 3 NEW CUMBERLAND, PA 17070' Ttilsphom: (717.) 774 - 59 89 AMOUNT FILE 4G COSTS _ .TSL.Q,fl POSTAGE SERVICE COSTS $ CONSTABLE ED. $ TOTAL $ DATE PAID 0 CIVIL COMPLAINT PLAINTIFF: NAME and ADDRESS _ '7New Cumberland Borocigh ' 1120 Market St. P,O..Box 220 New Cumberland, Pa. 17070 LxONE: 774-0404 . .. A I vs. DEFENDANT: NAME and ADDRESS r Michael & Marie Nichols 319 Rosemont Avenue New Cumberland, Pa. 17070 L. J Docket No.: Date Filed: i 1 Q/oi&? TO THE DEFENDANT: The above named plaintiff(s) asks judgment against you for $ 224*: 43, together with costs upon the following'claim (Civil fines must include citation of the: statute or ordinance violated): For past due sewer and trash charges for property located at: 319 Rosemont Ave. New Cumberland, Pa. 17070 PETITIONER'S EXHIBIT ? ?Cl C.-A-69 VM 1, Linda Tappan, Treasurer verify that the-facts set fortli in this-complaint are true and correct to the best of my knowledge, information, and belief. This statement is made subject to the penalties of Section 4904 of the Crimes Code (18 PA. C.S. § 4904) related to unworn falsification to authorities.: (ignature of Plaintiff or A nz Agent) ?jlf Plaintiffs Andrew Sheely Address: 12.7 S. Market St. Attome Telephone: 697-7050 Mechanicsburg, Pa. 17055 IF YOU INTEND TO ENTER A DEFENSE TO THIS COMPLAINT, YOU SHOULD SO NOTIFY THIS OFFICE IMM EDIATI= AT THE ABOVE TELEPHONE NUMBER. YOU MUST APPEAR AT THE HEARING AND PRESENT YOUR DEFENSE. UNLESS YOU DO, JUDGMENT WILL BE ENTERED AGAINST YOU BY DEFAULT. If you have a claim against the plaintiff which is within district justice jurisdiction and which you intend to assert at the hearing, you must file it on a complaint form at this office at least five (5) days before the date set for the hearing. If you have a claim against the plaintiff which is not within district justice jurisdiction, you may request information from this office as to the procedures you may follow. If you are disabled and require assistance, please contact the Magisterial District office at the address above. F-1 CUMBERLAND COUNTY -r- NOTICE OF RETURN AND CLAIM Ci 7107 0449 4590 0002 2103 2/19/2008 THIS NOTICE IS FOR2007 UNPAID REAL ESTATE TAXES. (May include prior year interim tax or clean & green rollback tax) ADDRESS ALL COMMUNICATIONS TO: CUMBERLAND COUNTY- TAX CLAIM BUREAU ONE COURTHOUSE SQUARE. CARLISLE, PA 17013-3389 BUSINESS HOURS: 8:00 AM to 4:30 PM MONDAY THROUGH FRIDAY. PHONE: (717) 240-6366 ONLINE PAYMENT MAY BE MADE USING VISA, MASTERCARD AMERICAN EXPRESS OR DISCOVER AT W W W.OFFICIAL PAYMENTS.COM OFFICIAL PAYMENTS, THE -SERVICE PROVIDER; CHARGES A CONVEINIENCE FEE FOR PAYMENT- PROCESSING ONLINE PAYMENT MAY TAKE UP TO 72 HOURS'TO POST TO YOUR TAX CLAIM ACCOUNT PAYMENT WILL BE APPLIED TO OUTSTANDING NKCIOLS, MICHAEL A & MARIA 1 319 ROSEMONT AVENUE NEW CUMBERLAND PA 17070 MAP NO25-25-0006412A LOT I PB 26 PG 91 Residential Building ACRES - .060 319 ROSEMONT AVENUE VISA IF RECEIPT IS DESIRED, PLEASE ENCLOSE A SELF ADDRESSED STAMPED ENVELOPE. WARNING panlwptclea Excluded) YOU FAIL TO PAY 7M TAX CLAIM OR FAIL TO TAKE LECAL AM InN 71n _?w COUNTY MUNICIPAL SCHOOL COSTS I i 230.68 243.32 954.55 20.25 1,448.80 F YOU FAIL TO PAY THIS CLAIM NOW (OUR AMOUNT DUE WILL CONTINUE CO INCREASE AS SHOWN BELOW. MAR 1, 2008 1, 458.47 APR-1 2008 114".14 MAY 1, 2008 1, 477.81 JUNE 1, 2008 1, 487.48 JULY 1, 2008 1, 497.15 AUG 1, 2008 1, 506.82 SEPT1,2008 11516.49 OCT 1, 2008 1, 526.16 NOV 1 2008 1, 535.83 DEC 1 2008 1, 545.50 AFTER JAN I MN CALL BUREAU WE ACCEPT ONLY CASH, MONEY ORDERS, OR CERTF VED CHECK-0 ER1 FED PERSONAL OR BUSPIM CHECKS ACCEPTED ADDITIONAL $20.00 COST ADDED IF NOTICE' IS P087M TO PROPERTY IF YOUR TAXES ARE TO BE PAID FROM A MORTGAGE ESCROW ACCOUNT, FORWARD A COPY OF THIS BELL TO THE MORTGAGE HOLDER. HOWEVER, YOU REMAIN LIABLE FOR THE PAYMENT OF THESE TAXES AND IF THEY ARE NOT PAID, YOUR PROPERTY MAY BE SOLD EVEN IF YOU HAVE PROVIDED THE MONEY TO THE nu-1QnnnJ6 0cnwn.r_ MORTGAGE HOLDER. Notice is hereby given that the property above described has been returned to the Tax Claim Bureau of Cumberland County for non-payment of taxes and a claim has been entered under the provisions Act No. 542 of 1947, as amended. If payment of these taxes is not made to the Cumberland County Tax Claim Bureau on or before December 31 of this year, no exceptions filed, the claim shall become absolute. A redemption period of one year will commence on July 1 of this year. If the claim is not paid in full before the end of the redemption period the property shall be advertised for and exposed to sale under this act. There shall be no redemption after the actual sale. The owner of any owner-occupied real estate can apply for an extension of the period for discharge of claim for up to twelve (12) additional months under and subject to the provisions of Section 502.1 and 503.1 of the Real Estate Tax Law. (The provisions of Sections 502.1 and 503.1 (72 P.S. 5860.502.& 503) are not applicable in Cumberland County) 16:25:23 02/19/2008 i 0 Pennsylvania American Water P.O. Box 578, Alton IL 62002 1-800-565-7292 01/14/2008 Nichols, Maria 319 Rosemont Ave Account Number: 24-0624415-8 New Cumberlnd PA 17070-1879 Premise Number: 240369141 319 Rosemont Ave Meter #: N000512837 Meter Loc: Left Side Front Region: New Cumberland Boio F. Route Number: 3007 48 HOUR SI 1111 OFF NOTICE Dear Customer: Your bill for $92.26 is overdue. Because your bill is overdue we will shut off water to 319 Rosemont Ave on or after 8:00 AM on Tuesday, January 22, 2008. To stop the shut off, you must do one (1) of the following at once: 1) Pay the total amount of the overdue bill and call 1466-358-3429 to verify the company received your payment. 2) Call 1-866-358-3429 to make a payment arrangement, to let us know that you made a payment; or to dispute the overdue bill. 3) Call 1-866-358-3429 before Tuesday, January 22, 2('08 if you or someone in your home has a serious illness or a medical condition. Read the Medical Enna rgency Notice shown below. MEDICAL E R ?ti Y NOTICE If someone living in your home is seriously ill, we will not shut off your water service during this illness if you do two (2) things: 1) Have a doctor certify by phone or in writing that the illness exists and that the person will be in danger if you do not have water service. 2) Make arrangements to pay your overdue and current bills by calling the phone number listed above. If we shut off your water, you may have to pay the following charges to have your water turned back on: Overdue Amount $92.26 Turn-On Charge $30.00 Total Amount Due $122.26 If you have any questions or need more information, please call us at 1-866-358-3429. If you are not satisfied after you talk to us, you may file a complaint with the Pennsylvania Public Utility Commission by calling 1-800-692-7380 toll free, or by writing to P.O. Box 3265, Harrisburg, PA 17105-3265.1he Pennsylvania Public Utility Commission will delay the shut off if you file the complaint before the shut off date. To pay by credit card call 1-866-271-5522. Sincerely, Customer Service PETITIONER'S EXHIBIT ?L% 48HRRES 26255494 efe,acUcurate, , , tt e IRS e bile 2007 W-2 and EARNINGS SUMMARY M 4ST! 9r 4 at wwwbs.gov/see. Em oyes Reference C0P This blue Earnings Sum?y section is Included with your W-2 to help describe portions In rowe d*W. 6V Wage and Tax The revsrss Side Includes general Information that you may also find helpful. Statement neaemoe t Thefo#owi , xhv c for neMweda heossla ltg Infortnatlort reflects your final 2007 pay club plus any adjustments submitted by wlisr?snolowr. Control number Dept Corp. Employer ua o* 06421 05/XGH 620 A 140 Employer's name, address, and ZIP code PHOENIX CONTACT MANUFACTURING INC P O BOX 4100 HARRISBURG PA 17111-0100 Batch #02144 I Employee's name, address, and ZIP code IICHAEL A NICHOLS 19 ROSEMONT AVE. IEW CUMBERLAND PA 17070 Employer's FED ID nu a m • SA number tai-5t- Wages, Ups, other amp. Federal inooea tau Tv 39514.13 3319.37 Social securily wages 4 Social security tar withheld 40609.16 2517.77 Medicare wages and tips 6 111 re tax withheld 40609.16 588,83 Social security tips • Atocabd tips Advance EIC payment 10 Dependent care benNib No ngwllifed plans 20 I I Other 12b 81 1 .03 120 1 37.08 SUI 1 1 17 Sid 7[KKJwrd panty tat Fai i State Employer's slob ID no, 16 State wages, tips, elm PA 145 7340 40560,88 I Stab income tax 18 Local wages, tips, sb. 1245.23 40560,88 Localineomsm toe 20 Localny name 588.95 LWR SWAT Wages, tips, cow camp. 2 Federal Income tax withhold 39514.13 3319.37 Social security w=.1 4 Social security taxi "hb•ld 46 2517.77 Medicare w•ga4 a0 089 16 8 Medicare we 598.83 Control n-ow Dept Cap. Employer tae only D6421 05/XGH 620 A 140 Empoyer's name, address, and ZIP ands PHOENIX CONTACT MANUFACTURING INC P O BOX 4100 HARRISBURG PA 17111-0100 Emplclnt'sf social Securit" K f o Advance EIC DepehMert care bern•Nb onqualliled Sao inatnxotons t - l ft bb 12 ? 2 C 1 other 12b D 1095.03 37.08 SUI 2c 13 Ste Net pled 'aly.iclc pry X I Employee's name, address and ZIP code IICHAEL A NICHOLS 19 ROSEMONT AVE. IEW CUMBERLAND PA 17070 i Side Em W ID no. 6 Stab wages, PA 7A 9144$$ 40560.88 ' State Income tae 18 Local wages, tips, etc. 1245.23 40560.88 I Local Income tax 20 Locality 588.95 LWR SWAT o ra o Inc Stet ,,,a. Wag* and tax Stat4>lreslant Wti b r It1e1 x116 sapteyle'e FMoololow is Grows Pay 41 496.88 Social Security 2517.77 PA. State Income Tax a Tax Withheld Box 17 of W-2' 23 Box 4 of W-2 Local Income Tax Fed. Income 3319.37 Medicare Tax 588.83 Box 19 of W-2 Tax Withheld Withhold SUI/SDI 37.08 Box 2 of W-2 Box 6 of W-2 _ Box 14 of W-2 2. Your Gross Pay was adjusted as follows to produce Your W-2 Statement. Wages, Tips, other Social Security Medicare PA. State Wages, LWR SWAT Compensptlon Wages Wages Tips, Etc. Local Wages, Box 1 of W-2 Box 3 of W-2 Box 5 of W-2 Box 16 of W-2 Tips, Etc. Box 18 of W-2 Gross Pay 41, 196.88 41 196.88 41, 186.88 41,196.88 41,196.88 Plus GTL r,80x 12) 48.28 48.28 48.28 N/A N/A Less401(k)P Dx12) 1,095.03 N/A N/A N/A N/A Less Other Cde 125 636.00 636.00 636.00 636.00 636.00 Reported W-2 Wages 39,514.13 40,609.16 40,609.16 40,560.88 40,560.88 PETITIONER/S EXHIBIT 3. Employee W-4 Profile. To change your Employee W-4 Profile Information filh us- q MICHAEL A N I C H O L S Social Security Number: 20864623 319 R O S E M O N T AVE. Taxable Marital Status: MARRIED NEW CUMBERLAND PA 17070 Exemptions/Allowances: FEDERAL: 1 STATE: LOCAL: 1 O 2007 ADP, INC. r- FOIL a d Detach Here _ __.________.__._ t Wages, tps, other comp Federal hwomn tax withheld 39514.13 3319.37 3 Social seams, w 9 4 Social security tax withheld 4o .ti 2517.77 5 Medicare wages Ps -f-Medicare lac withheld 49 6 5588.83 d Control number Dept Cap. Employer use only 00642105rAGH 620 A 140 a Employer's name, wwra•a, and ZIP code PHOENIX CONTACT . MANUFACTURING INC P O BOX 4100 HARRISBURG PA 17111-0100 b Emp 75-295 a E 208 ->- 7 Social security tip a Allocated tips 9 Advance EIC payment 10 Dependant acre bone is 11 NongwlNbd plans 120 C 48.28 14 other D 1095.03 37.08 SUI - 381d R.I.e1.e X ad ji rWW lpn, eR Employee's name, addms and DP code MICHAEL A NICHOLS 319 ROSEMONT "I- NEW CUMBERLAND PA 17070 15 Stab E 3 0 ID no 18 Stab wages, PA 9145 4$ 40560.88 11 Stab Income tax 18 Lead wages, tips, ale. 1245.23 40560.88 18 Local income tax Locality name 588.95 LWR SWAT a e Filing 160P sale, 10 Wage and Tax QW Statame it , 2b M 1Sa1 hMi angleysa?? 9Ms IexoNe Ter Wages, tkn% other comp 2 Federd hdname tax withi 39514.13 3319.37 3 Social •saxsay wayw 4 Social security tax 7 4 .16 251 .77 5 Medicare wages and tips 6 Medicare tax withhold 40609.16 588.83 d Controlnxmhber Dept. Cap. Employer - ady 006421 05/XGH 620 A 140 a EmplaWs name, address, and ZIP cote PHOENIX CONTACT MANUFACTURING INC P O BOX 4100 HARRISBURG PA 17111-0100 b Emiplarv's F ID nsmbor • Emnpo' i! camber ff 75-2979405 -9523 7 social security "a a Allocated tips 9 Advance EIC payment 10 Dependent care b•ne1N? 11 NongwWed plans 12a C 48.28 14 Other D 1095.03 37.08 SUI 13 Stet amµ -pins 7C Wty ook pol eM Employee's name, addnes and ZIP code MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 15 Stab E s stile ID no. 16 Stab wages, tps, ale PA 1 340 40560.88 1 Stab hocme tax Local wages, tips, •- 1245.23 40560.88 19 Local 1.. Q -L-way 588.95 LWR SWAT City or oca ng CO W w,. Wage and Tax ?Ctit/rmQnt Copy 2 M tea bid wit enphhyslts ? erLaM Ymolns s-':. , CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051235090 2 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate hours this period Regular 18.4010 72.00 1,324.87 Vacation 18.4010 8.00 147.21 Personal Time :: {U / §: 2zaycaic cs ?•iG:tLN?` Deductions Statutor Federal Income Tax -113.73 Social Security Tax -89.64 Medicare Tax -20.96 PA State Income Tax -44.33 Lower Swatar Income Tax -21.06 PA SUI/SDI Tax -0.89 Earnings Statement Period Beginning: 05/11/2008 Period Ending: 05/24/2008 Pay Date: 05/30/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 year to date Other Benefits and Information this period G.T.L. 1.84 1,012.05 Personal 1.00 18,313.60 Vacation 128.00 1,717.29 1,117.60 261.37 552.75 262.42 10.99 Other O -P T -2.00 Ppo Health -28.00* 401K -44.16* 308.00 479.56 * Excluded from federal taxable wages Your federal taxable wages this period are $1,399.92 J> > total to date 20.24 w w • r i CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051221398 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Earnings Statement Period Beginning: 04/27/2008 Period Ending: 05/10/2008 Pay Date: 05/16/2008 w Taxable Marital Status: Married MICHAEL A NICHOLS Exemptions/Allowances: 319 ROSEMONT AVE Federal: 1 . PA: N/A NEW CUMBERLAND PA 17070 Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate hours this period year to date Other Benefits and Regular 18.4010 76.75 1,412.28 Information this period total to date Overtime 27.6015 .50 13.80 G. T. L. 1.84 18.40 Personal Time ...... 1,012.05 Personal 1.00 ::::::: .`::'`:<'?•`:1'<•:`: `_::€:<:'I<r<::j1:## 15, 369.44 Vacation 136.00 Deductions Statuto Federal Income Tax -107.10 1,235.54 Social Security Tax -86.80 936.69 Medicare Tax -20.30 219.06 PA State Income Tax -42.92 463.23 Lower Swatar Income Tax -20.40 220.02 PA SUI/SDI Tax -0.85 9.22 Other O P T -2.00 Ppo Health -28.00* 280.00 401K -42.37* 435.40 * Excluded from federal taxable wages Your federal taxable wages this period are $1,355.71 m? p ire a; C aof a cc o: Nj 0? ®i W; ¢; W: 2, Q Q; W' CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051210054 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rata hours ` this period Regular A 4010 72;00 1,324.87 Vacation "•18.4010 8.00 '147.21 Personal Time Deductions Statuto Earnings Statement Period Beginning: 04/13/2008 Period Ending: 04/26/2008 Pay Date. 05/042008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 year to dots Other Benefits and Information this period total `'tc ? delta G.T.L. 16.:56 1,012.05 Personal 1.00 13,943.36 Vacation 16.00 Federal Income Tax -113.73 1,128.44 Social Security Tax -89.65 849.89 Medicare Tax -20.96 198.76 PA State income -Tax =44:33 420.31 Lower Swatar Income Tax -21.06 199.62 PA SUI/SDI Tax -0.89 8.37 Other O P T -2.00 Ppo Health -28.00* 252.00 401K -44.16* 393.03 n, {Y, yin%n%^?+:#{;'i {;:;:7•..h ?r•.?M1{.,7.:,.. * Excluded from federal taxable wages Your federal taxable wages this period are $1,399.92 ?I N Q? a' UI C. n: 0 Q? Oi Nj rnl w ¢i =1 (r w' CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051197428 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate hours this period Regular 18.4010 20.00 - 368.02 Personal Time 18.4010 20.00 368.02 Vacation 18.4010 40.00 736.04 Deductions Statuto Federal Income Tax -113.73 Social Security Tax -89.64 Medicare Tax -20.97 PA State Income Tax -44.33 Lower Swatar Income Tax -21.06 PA SUI/SDI Tax -0.88 Other O P T -2,00 Ppo Health -28.00* 401K -44.16* Earnings Statement ?> > Period Beginning: 03/30/2008 Period Ending: 04/12/2008 Pay Date: 04/18/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 year to date Other Benefits and Information this period total to date 1,012.05 G.T.L. 1.84 14.72 Personal 1.00 12,471.28 Vacation 24.00 1,014.71 760.24 177.80 375.98 178.56 7.48 224.00 348.87 * Excluded from federal taxable wages Your federal taxable wages this period are $1,399.92 i' a o; ?Qpp: O'- O: N: w; w x: al F ?I CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051185866 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate flours this period Regular 18.4010 46.50 855.65 Holiday 18.4010 8.00 147.21 Personal Time 18.4010 9.60 174.81 Vacation 18.4010 16.00 294.42 MI. Deductions Statuto Federal Income Tax -113.73 Social Security Tax -89.65 Medicare Tax -20.96 PA State Income Tax -44.33 Lower Swatar Income Tax -21.06 PA SUI/SDi Tax -0.88 Other. . O P T -2.00 Ppo Health 28.00* 401K -44.16* ax ? * Excluded from federal taxable wages Your federal taxable wages this period are $1,399.93 year to data 644.03 10,999.20 900.98 670.60 156.83 331.65 157.50 6.60 196.00 304.71 Earnings Statement Period Beginning: 03/16/2008 Period Ending: 03/29/2008 Pay Date: 04/04/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 Other Benefits and Information this period total''to date G.T.L. 1,84 12:88 Personal 21.00 Vacation 64.00 N L Z 9 a 0 a N OpD to r w x CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051174294 1 Earnings Statement ?> > PHOENIX CONTACT MANUFACTURING INC Period Beginning: 03/02/2008 P.O. BOX4100 Period Ending: 03/15/2008 HARRISBURG, PA 17111 Pay Date: 03/21/2008 Taxable Marital Status: Married MICHAEL A NICHOLS Exemptions/Allowances: 319 ROSEMONT AVE Federal: 1 . PA: N/A NEW CUMBERLAND PA 17070 Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate hours this period year to date Omer Benefits and Regular 18.4010 67.00 1,232.87 Information this period total to date Overtime 27.6015 2.50 69.00 G.T.L. 1.84 11.04 Personal Time 18.4010 13.00 ,239.2 1 469.22 Personal 30.50 ry:, }...{<::::a:> •`•.<}:•.'j="aKl 9,527.11 Vacation 80.00 Deductions Statuto Federal Income Tax -124.08 787.25 Social Security Tax -93.93 580.95 Medicare Tax -21.97 135.87 PA State Income Tax -46.45 287.32 Lower Swatar Income Tax -22.06 136.44 PA SUI/SDI Tax -0.93 5.72 Other O P T -2.00 Ppo Health -28.00* 168.00 401K -44.16* 260.55 tiS• * Excluded from federal taxable wages Your federal taxable wages this period are $1,468.92 a? a' i Ni L' 01 a U! n:! Q O O! N; 00 cr' w X cr a; w- CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051161122 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate hours this period Regular 18.4010 79.00 1,453.68 Overtime 27.6015 6.75 186.31 Personal Time 18.4010 1.00 18.40 Deductions Statuto Federal Income Tax -141.68 Social Security Tax -101.19 Medicare Tax -23.67 PA State Income Tax -50.05 Lower Swatar Income Tax -23.76 PA SUI/SDI Tax -0.99 Other O P T -2.00 Ppo Health -28.00* 401K -44.16* NOM ?:j ? ii". v..{??ird }`a * Excluded from federal taxable wages Earnings Statement Period Beginning: 02/17/2008 Period Ending: 03/01/2008 Pay Date: 03/07/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 year to date Other Benefits and Information ttua period total'.to data G.T.L. 1.84 9.20 230.01 Personal 43.50 7,986.03 Vacation 80.00 663.17 487.02 113.90 240.87 114.38 4.79 140.00 216.39 Your federal taxable wages this period are $1,586.23 t m m N L Cr a U C a O a 0 N TI W w x Cr w \I CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051149107 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Eaminas rate hours this period Regular 18.4010 70.50 1,297.27 Overtime 27.6015 17.00 469.23 Personal Time 18.4010 9.50 174.81 Deductions Statuto Federal Income Tax -184.12 Social Security Tax -118.74 Medicare Tax -27.77 PA State Income Tax -58.74 Lower Swatar Income Tax -27.87 PA SUI/SDI Tax -1.17 Other O P T -2.00 Ppo Health -28.00* 401K -44.16* X-1 I NO - * Excluded from federal taxable wages Earnings Statement Period Beginning: 02/03/2008 Period Ending: 02/16/2008 Pay Date: 02/22/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 J> > year to date Other Benefits and Information this period total to dace G.T.L. 1:84 7.36 211.61 Personal 44.50 6,327.64 Vacation 80.00 521.49 385.83 90.23 190.82 90.62 3.80 112.00 172.23 Your federal taxable wages this period are $1,869.15 N' m. N_I? W a` ar Si in 0! ®i OpOD•1Ar" CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051136702 t PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Earnings rate hours this period Regular 18.4010 80.00 1,472.08 Overtime 27.6015 2.25 62.10 Personal Time Deductions Statuto Federal Income Tax -123.05 Social Security Tax -93.50 Medicare Tax -21.86 PA State Income Tax -46.24 Lower Swatar Income Tax -21.96 PA SUI/SDI Tax -0.92 Other O P T -2.00 Ppo Health -28.00* 401K -44.16* * Excluded from federal taxable wages Earnings Statement ?> > Period Beginning: 01)2N2008 Period Ending: 02102/2008 Pay Date: 02/08/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 year to date Other Benefits and Information this period `total to date G.T.L.. 1.84 5.52 36.80 Personal 54.00 4,386.33 Vacation 80.00 337.37 267.09 62.46 132.08 62.75 2.63 84.00 128.07 Your federal taxable wages this period are $1,462.02 d N cc t a i' a 0 Q O O N in W! cr w; x! aC w? CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051124999 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Eaminas rate hours this period Regular 18.4010 78.00 1,435.28 Overtime 27.6015 2.00 55.20 Personal Time 18.4010 2.00 36.80 Deductions Statuto Earnings Statement Period Beginning: 01/06/2008 Period Ending: 01/19/2008 Pay Date: 01 /25/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 Year to date Other Benefits and Information Oft period total to date G.T.L. 1,84 3.68 36.80 Personal 54.00 2,852.15 Vacation 80.00 Federal Income Tax -122.01 214.32 Social Security Tax -93.07 173.59 Medicare Tax -21.77 40,60 PA State Income Tax -46.03 85.84 Lower Swatar Income Tax -21.86 40.79 PA SUI/SDI Tax -0,92 1.71 Other O P T -2,00 Ppo Health -28.00* 56.00 401K -44.16* 83.91 * Excluded from federal taxable wages } `s4 i N? LI fI ¢I Cf Qi ?i 0 N? ')0 a! Your federal taxable wages this period are $1,455.12 CO. FILE DEPT. CLOCK NUMBER 052 XGH 006421 620 0051114147 1 PHOENIX CONTACT MANUFACTURING INC P.O. BOX 4100 HARRISBURG, PA 17111 Taxable Marital Status: Married Exemptions/Allowances: Federal: 1 PA: N/A Lower Swatar: 1 Social Security Number: XXX-XX-9523 Eaminas rate flours this period Regular 18:4010 24.00 441.62 Holiday 18.401U 48.00 1883.25 Deductions Statutor Federal Income Tax -92.31 Social Security Tax -80.52 Medicare Tax -18.83 PA State Income Tax -39.81 Lower Swatar -income Tax -18.93 PA SUI/SDI Tax -0.79 Other O P T -2.00 Ppo Health -28.00* 401K -39.75* * Excluded from federal taxable wages year to date 1,324.87 92.31 80.52 18.83 39.81 18.93 0.79 28.00 39.75 Your federal taxable wages this period are $1,257.12 Earnings Statement ?> > Period Beginning: 12/23/2007 Period Ending: 01/05/2008 Pay Date: 01/11/2008 MICHAEL A NICHOLS 319 ROSEMONT AVE. NEW CUMBERLAND PA 17070 Other Benefits and information *1*4 tctal'-to date G.T.L. t.84 1;:84 Personal 56.00 Vacation 80.00 2 Q t a C), O Q N 0) 07 07 w w? x 2 ¢ Q eamAnc i 4t In the Court of Common Pleas of County, Pennsylvania Plaintiff Name: Defendant Name: Docket Number: PACSES Case Number: Other State ID Number: Please note: All correspondence must include the PACSES Case Number. Income and Expense Statement 6QvgU ?c THIS FORM MUST BE FILLED OUT (If you are self-employed or if you are salaried by a business of which you are owner in whole or part, you must also fill o.lt the Supplemental lncnme Staternerlt which appears on nagn two of this income and expense statement.) a 1 INCOME STATEMENT OF L?11 Section I: Income and Insurance INCOME: Employer Address Type of W Payroll No. Ttp-mi7rd Pavroll DeAnetions: Federal Withholding $ Social Security $ Local Wage Tax $ State Income Tax $ Retirement $ Sav' s Bonds $ Credit Union $ Life Lw? $ $ Other Deductions (specify $ Net Pay per Pay Period $ - 17, .1 1 11 OTHER (Fill in Appropriate Column) INCOME WEEK MONTH YEAR Interest $ $ $ Dividends Pension Annul Social Security Rents Royalties Expense Account Gifts Unemployment Workmen's Com nation Other Other " TOTAL Is $ TOTAL INCOME $ Service Type M Ownership " PROPERTY OWNED DESCRIPTION VALUE H W J Checking Accounts $ Savings Accounts Credo Union Stocks/Bonds Real Estate Other l TOTAL Is 1 t6 * H=Husband; W=Wife; J=Joint Form IN-008 Worker ID 22221 t Income and Expense Statement Coverage. * INSURANCE COMPANY POLICY # H W C Hospital Blue Cross H MA Oilier Medical Blue Shield kA- Other Health/Accident Disability Income Dental Other a. This form is to be filled out by a person ? (1) who operates a business or practices a profession, or ? (2) who is a member of a partnership or joint venture, or ? (3) who is a shareholder in and is salaried by a closed corporation or similar entity. b. Attach to this statement a copy of the following documents relating to the partnership, joint venture, business, profession, corporation or similar entity: (1) the most recent Federal Income Tax Return, and (2) the most recent Profit and Loss Statement c Name of business: Address and telephone number: d. Nature o business (check one ? (1) partnership ? (2) joint venture ? (3) profession ? (4) closed corporation ? (5) other e. Name of accountant, controller or other person in charge of financial records: PACSES Case Number * H:=IL;band; W-Vfife; C=Child Section II: Supplemental income Statement f. Annual income from business: (1) How often is income received? (2) Gross income per pay period: (3) Net income per pay period: ' (4) Specified deductions, if any: Service Type M Page 2of3 Form IN-008 Worker 1D 22221 "A C Income and Expense Statement PACSES Case Number Section Ill: Expenses Instructions: Only show extraordinary expenses in this section unless you filled out Section 11 on page Iwo. The categories in BOLD FONT are especially important for calculating child support. If you are requesting Spousal Support/APL or if you assert your case cannot be determined according to the guideline grids or formula, this section must be fully completed. (Fill in Appropriate Column) EXPENSES WEEK MONTH YEAR Home Mortgage/Rent $ $ $ Maintenance U es Electric $ $ $ Gas Oil Telephone water sewer ent Public Transport. S $ $ Lunch Takes Real estate $ $ S Personal Property -Insurance Homeowner's $ $ $ Automobile Life Accident Health Other ile Payments $ $ $ Fuel Repairs Medical Doctor $ $ $ Dentist Orthodontist Hospital Medicine Special needs (glasses, braces, orthopedic deykesi EXTENSES (Fill in Appropriate Column) (continued) WEEK MONTH YEAR Edu Lion Private School is $ $ Parochial School =::A Pets nai - _ Clothing $ $ $ Food 40,& &Z i4tit 9 Barbe17 - - - Credit Payments Credit Card Charge Memberships Loans Credit Union $ S $ Miscellaneous Household Help $ S $ Child care Papersibooks Entertainment Pay TV Vacation Gift Legal fees ntable d Alimony Other S $ $ aTotW WEEK M yE? sa: $ $ $ I verify that the statements made in this Income and Expense Statement are true and correct. I understand that false statements herein are subject to the criminal penalties of 18 Pa. C.S. § 4904, relating to unswom falsification to authorities. Date Plaintiff or nt Servi6e Type M Page 3 of 3 Form IN-008 Worker ID =1 07-1336 CIVIL ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 06/05/08 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number PHOENIX CONTACT USA INC PO BOX 4100 HARRISBURG PA 17111-0100 208-56-9523 Employee/Obligor's Social Security Number 5048101940 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ o oo per month in current child support . $ o . oo per month in past-due child support Arrears 12 weeks or greater? (g) yes 0 no $ 0.00 per month in current medical support $ 0.0o per month in past-due medical support $ 311.00 per month in current spousal support $ 50.00 per month in past-due spousal support $ o . oo per month for genetic test costs $ o . oo per month in other (specify) $ one-time lump sum payment for a total of $ 361.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 83.31 per weekly pay period. $ 180.50 per semimonthly pay period (twice a month) $ _166.62 per biweekly pay period (every two weeks) $ 361.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydateldate of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). If required by Pennsylvania law (23 PA C.S. S 4374(b)) to remit by electronic payment method, please call Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SCbC W SECURITY NUMBER IN ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: Service Type M OMB No.: 0970-0154 OOriginal Order/Notice OAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice RE:NICHOLS, MICHAEL Employee/Obligor's Name (Last, First, MI) Form EN-028 Rev. 3 Worker ID $ IATT 361*x 12•+ 52• _ 83.31 XV4 361 • x 12.+ 26•= 166-62* ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If heck you are required to provide a opy of this form to your mployee. If yo r employee works in a state that is di erent from the state that issued this o er, a copy must be provi?ed to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employeelobligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employeelobligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 5105582320 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: 0 EMPLOYEE'S/OBLIGOR'S NAME:NICHOLS, MICHAEL EMPLOYEE'S CASE IDENTIFIER: 5048101940 LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: DATE OF SEPARATION: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employeelobligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) 0 5 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev. 3 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: NICHOLS, MICHAEL PACSES Case Number 637109840 Plaintiff Name MARIA NICHOLS Docket Attachment Amount 07-1336 CIVIL$ 361.00 Child(ren)'s Name(s): DOB ® If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACKS Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. PACSES Case Number Plaintiff Name Docket Attachment Amount $ 0.00 Child(ren)'s Name(s): DOB ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available through the employee's/obligor's employment. ? If checked, you are required to enroll the child(ren) ? If checked, you are required to enroll the child(ren) identified above in any health insurance coverage available identified above in any health insurance coverage available through the employee's/obligor's employment. through the employee's/obligor's employment. Addendum Form EN-028 Rev. 3 Service Type M OMB No.: 097"154 Worker I D $IATT ? ? °`C' ? `?' ?' US?" ? , MICHAEL NIC HOL,S, • IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff Vs. MARIA NIC HOLS, : Docket No. 07 - 1336 Defendant : MOTION FOR APPOINTMENT OF MASTER Maria Nichols ON"M (Defendant), moves the court to appoint a master with respect to the following claims: W Divorce ( Distribution of Property () Annulment ( Support Alimony Counsel Fees ( Alimony Pendente Lite ( Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims (s) for which the appointment of a master is requested. 1 n (2) The tnas?? appeared m the action fV==ajW (by his attorney, scent H_ Patt-p-m n , Esquire). (3) The Staturory ground (s) for divorce (s) (are) 3301(c) and 3301(d) (4) Delete the inapplicable paragraph(s): a. The action is not contested. b. An agreement has been reached with respect to the following claims: c. The action is contested with respect to the following claims: (5) The action} (does not involve) com issues of law or fact (6) The hearing is expected to take one (ly- 7" - ) (days). (7) Additional information, if ,i any re*Vipt to the motion: Date:_ February /2- , 2009 "arbata SilmpTe-M11ivan; E`'$quire Print Attorney Name ......... ORDER APPOINTING MASTER AND NOW, . 201a_____, Esquire is appointed master with respect to the following claims: By the Court: Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07 - 1336 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE CERTIFICATE OF SERVICE I, Laura J. Edwards, Secretary to Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the foregoing Motion for Appointment of Master in the above-captioned matter upon the following individual(s) by first class mail, postage prepaid, addressed as follows: Kent H. Patterson, Esquire 221 Pine Street Harrisburg, PA 17101 DATED: February 12, 2009 /l? "t'j_ 11A Laura J. Edv/ar s, Secretary to Barbara S e-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 --?s? ? :.? ? ?Y c ?-, ? c.? ??? ? ?- -= ?_.' t "?rl. r #, -A, FEB ' 9 2009(, MIaiAEL NIC HOIS, : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff Vs. MARIA NIC HOLS, Docket No. 07 - 1336 Defendant MOTION FOR APPOINTMENT OF MASTER Maria Nichols (bbdudM (Defendant), moves the court to appoint a master with respect to the following claims: 6r) Divorce ( Distribution of Property ( ) Annulment ( Support (x) Alimony Counsel Fees (K) Alimony Pendente Lite ( Costs and Expenses and in support of the motion states: (1) Discovery is complete as to the claims (s) for which the appointment of a master is requested. 1 n (2) The jjw s appeared in the action *wwHoo (by his attorney, Kit H. _ Patterson , Esquire). (3) The Staturory ground (s) for divorce () (are) 3301(c) and 3301(d) (4) Delete the inapplicable paragraph(s): a. The action is not contested. b. An agreement has been reached with respect to the following claims: c. The action is contested with respect to the following claims: (5) The actions (does not involve) com issues of law or fact (6) The hearing is expected to take one ) (days). (7) Additional information, if .,.`any/ rel*VW to the motion: Date: February Z 2009 / + Print Attorney Name ......... tsarnara 5ump.ie-Sullivan, ;squire AND NOW, 20 O9 E. t ?? C&wal ? . X Esquire is appointed master with resp &t to the following claims: gw,, &,noQ cabvl1 , J w n? "'' 7 1 ?y ?..? ?? t; ` , ? 4 r==. 4 ?• ? .._ ? ;> • 4 ..? -' ? ? ' _? ? O ?-=- ?- ?' -- L?_ r, ?> ?-? ;? •.. P9 K --r .. f. A. Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, : IN THE COURT OF COMMON PLEAS Plaintiff V. MARIA NICHOLS, Defendant CUMBERLAND COUNTY, PENNSYLVANIA : NO. 07 - 1336 CIVIL ACTION -LAW IN DIVORCE CERTIFICATE OF SERVICE I, Laura J. Edwards, Secretary to Barbara Sumple-Sullivan, Esquire, do hereby certify that on this date, I served a true and correct copy of the foregoing Motion for Appointment of Master in the above-captioned matter upon the following individual(s) by first class mail, postage prepaid, addressed as follows: DATED: February 12, 2009 Kent H. Patterson, Esquire 221 Pine Street Harrisburg, PA 17101 Laura J. Eds, Secretary to Barbara S e-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 ••? C."7 ?' ?.? 4? ? ? s ' ??. t ?' (? ? ? s . .r j_ L r •Si { V MICHAEL NICHOLS, :IN THE COURT OF COMMON PLEAS Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA VS. :NO. 07-1336 MARIA NICHOLS, Defendant :IN DIVORCE AFFIDAVIT OF CONSENT AND WAIVER OF COUNSELING 1. A complaint in divorce under Section 3301(c) of the Divorce Code was filed on March 9, 2007. 2. The marriage of plaintiff and defendant is irretrievably broken and ninety (90) days have elapsed from the date of filing and service of the complaint. 3. I consent to the entry of a final decree in divorce after service of notice of intention to request entry of the decree. 4. I have been advised of the availability of marriage counseling and understand that I may request that the Court require that my spouse and I participate in counseling. Being so advised, I do not request that my spouse and I participate in counseling prior to a Decree in Divorce being handed down by the Court. 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 unsworn falsification to authorities. 14eo! K1140"S11111f ll® L Date M L A. TL:n '7F THE AI 200 Q Av'J 12 Fi d 1 Lt 0 MICHAEL NICHOLS, Plaintiff VS. MARIA NICHOLS Defendant :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA :NO. 07-1336 :IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER SECTION 3301(c) OF THE DIVORCE CODE 1. I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4909 relating to unsworn falsification to authorities. A// 1 X. -0E 1094 Date Michael A. Nich is TLJ' Ti TLELu19 t U " 12 PV a: 4 i I'lj Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. MARIA NICHOLS, Defendant NO. 07 - 1336 CIVIL ACTION -LAW : IN DIVORCE AFFIDAVIT OF CONSENT A Complaint in Divorce under Section 3301(c) of the Divorce Code was filed on March 9, 2007. 2. The marriage of the Plaintiff and Defendant is irretrievably broken and ninety days have elapsed from the filing and service of the Complaint. 3. I consent to the entry of a final decree of divorce after service of notice of intention to request entry of the decree. I verify that the statements made in this affidavit are true and correct. I understand that false statements are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. DATE: ,q c?sf' l Zoo 9 v. MARIA NICHOLS !i F I u 12 P; ct ' t?: Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. : NO. 07 - 1336 MARIA NICHOLS, CIVIL ACTION -LAW Defendant IN DIVORCE WAIVER OF NOTICE OF INTENTION TO REQUEST ENTRY OF A DIVORCE DECREE UNDER 43301(c) OF THE DIVORCE CODE I consent to the entry of a final decree of divorce without notice. 2. I understand that I may lose rights concerning alimony, division of property, lawyer's fees or expenses if I do not claim them before a divorce is granted. 3. I understand that I will not be divorced until a divorce decree is entered by the Court and that a copy of the decree will be sent to me immediately after it is filed with the Prothonotary. I verify that the statements made in this affidavit are true and correct. I understand that false statement herein are made subject to the penalties of 18 Pa.C.S.§4904 relating to unsworn falsification to authorities. DATE: us-f" ?/ a?vo `1 ` MARIA NI HOLS f L a- ;C ;... rr , " R Q„ L 5 J S 12 F i - i I e"Ju cia, MICHAEL NICHOLS, Plaintiff VS. - MARIA NICHOLS, - Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07 - 1336 CIVIL IN DIVORCE ORDER OF COURT AND NOW, this X_L'` day of , 2009, counsel and the parties having entered into an agreement and stipulation resolving the economic issues on August 11, 2009, the date set for a four-party conference, the agreement and stipulation having been transcribed, the appointment of the Master is vacated and counsel can conclude the proceedings by the filing of a praecipe to transmit the record with the affidavits of consent of the parties so that a final decree in divorce can be entered. BY T OURT, alk Edgar B. Bayley, P.J. cc: '_Kent H. Patterson Attorney for Plaintiff ? Barbara Sumple-Sullivan Attorney for Defendant C110r;&S 'Lc?_ 4/1 '=01 OF THE Pi=n':"i:,-,,,loTARY 2099 SEP 10 VI 11: 4 5 Li1?V?;,];:_JLfI?! 1 tC t?li . I L.It ?`tii 112VA t - ? MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. NO. 07 - 1336 CIVIL MARIA NICHOLS, Defendant IN DIVORCE THE MASTER: Today is Tuesday, August 11, 2009. This is the date set for a conference in the above-captioned divorce proceedings. Present in the hearing room are the Plaintiff, Michael Nichols, and his counsel Kent H. Patterson, and the Defendant, Maria Nichols, and her counsel Barbara Sumple-Sullivan. This action was commenced by the filing of a complaint in divorce on March 9, 2007, raising grounds for divorce of irretrievable breakdown of the marriage. The Master has been provided affidavits of consent and waivers of notice of intention to request entry of divorce decree signed by both parties and dated today. The affidavits and waivers will be filed by the Master's office with the Prothonotary. The divorce can conclude under Section 3301(c) of the Domestic Relations Code. A counterclaim was filed on February 27, 2008, raising economic issues on behalf of wife of equitable distribution, alimony, alimony pendente lite and counsel fees and expenses. The Master has been advised that after 1 considerable time spent in negotiation, the parties have reached an agreement with respect to the outstanding economic issues. The agreement is going to be placed on the record in the presence of the parties. The agreement as placed on the record will be considered the substantive agreement of the parties, not subject to any changes or modifications except for correction of typographical errors which may be made during the transcription. Consequently, when the parties leave the hearing room today, they are bound by the terms of the agreement even though they have not signed the agreement affirming the terms of settlement. The agreement is going to be transcribed and sent to counsel for review for typographical errors. The parties and counsel will be asked to affix their signatures to the agreement and return the agreement to the Master. The purpose of the signing of the agreement is simply to affirm the terms as stated on the record. Upon receipt by the Master of a completed agreement, the Master will prepare an order vacating his appointment and counsel can then file a praecipe transmitting the record to the Court requesting a final decree in divorce. The parties were married on May 23, 1987, and separated on March 9, 2007. They are the natural parents of one son, Michael A. Nichols, Jr., who is currently 11 2 years of age. The parties at this time live in the same residence although they are separated and the custody of Michael has not yet been resolved as far as the Master knows. The Master is not certain at this point, and maybe the parties do not know whether they intend to share custody, legal and physical, of the child, or primary custody will pass to one of the parents. That is a matter though not to be resolved here today by the Master in the divorce proceedings. Ms. Sumple-Sullivan. MS. SUMPLE-SULLIVAN: The parties have reached the following agreement to settle the equitable distribution and other claims: 1. The parties own real estate located at 319 Rosemont Avenue, New Cumberland, Pennsylvania 17070. Said home is not encumbered with any mortgage or lien. The parties agree that said property shall become the sole and separate property of wife and wife shall retain possession and ownership of the property. Wife's counsel shall prepare a deed transferring all of husband's right, title and interest in the property to wife, which deed will be executed within ten days of presentment to husband's counsel. Husband shall be entitled to continue to reside in the house until October 1, 2009. Pending husband's occupancy of the house, husband shall pay all utilities and expenses related to the operation of the house until such time as he relinquishes possession. In regard to the Rosemont real estate, there is a tax sale which is scheduled for that property arising out of delinquent real estate taxes that are due by the parties. The current upset price for that sale, which is scheduled for September 24th, is approximately $3,824.00. Wife shall be solely responsible for payment of the outstanding real estate taxes and shall take all steps necessary to make that payment prior to the September 24th Sheriff's sale relative to the property. Husband shall have no obligation under 3 the alimony pendente lite order or under any other agreement to be make payments towards the delinquent real estate taxes regarding the Rosemont property. Wife will assume the obligation of all taxes through the current year. 2. Wife has a deeded interest in a property known as 282 Market Street, Highspire, Pennsylvania. The property is titled in her and her brother's names. This property shall continue to be solely owned by wife, and husband waives any claim in any increase in the value of this property which may have been incurred during the course of the marriage. 3. The parties owned a 2002 Nissan Altima which was not encumbered at the time of separation. Husband has subsequently sold that vehicle and all proceeds from the sale of that vehicle shall be the sole and separate property of husband. Wife waives any claim to the proceeds received by husband relative to that vehicle. The parties also own a 1994 Plymouth Acclaim which is individually titled in husband's name only. Said Acclaim shall be the sole and separate property of husband, and wife waives any claim or interest in the vehicle. 4. At the time of separation, the parties owned a financial account with PNC, account No. 51-4028-0641. Husband has received the proceeds from that account. The account shall be closed and wife waives any claim to any interest in that account. 5. The marital home had certain items of personal property which shall become the sole and separate property of wife. Husband waives any and all claims to said items of personal property. Husband shall be entitled to remove a bedroom set consisting of a bed, dresser and a nightstand, a hutch and a freezer which the parties acknowledge are non-marital property. 6. During the marriage husband acquired certain retirement benefits through his employment with Phoenix Contact. The account is presently being held by Merrill Lynch and has a present value of approximately $44,600.00. Said retirement account shall become the sole and separate property of husband. Wife waives any claim to the Merrill Lynch retirement account. 7. At the time of separation the parties had no outstanding debt. Any debts that were acquired by either party after the date of separation shall be the sole and separate property of that respective person and the party 4 acquiring the debt agrees to indemnify and hold the other harmless from any claims arising out of the incurrence of that marital debt. 8. In consideration for the equitable distribution claims and compromise of the parties, wife does agree to waive her claims for alimony and counsel fees and costs. Notwithstanding the waiver of alimony, husband shall continue to make payment on the current alimony pendente lite order which is entered to the Domestic Relations Office at PACES No. 637109840 through September 12, 2009. In the event husband has not vacated the premises by September 12, 2009, the alimony pendente lite payments shall continue through October 1, 2009. 9. Upon vacation of the appointment of the Master and filing the praecipe to transmit the record, the divorce decree shall be entered between the parties. The entry of the divorce shall not impact husband's obligations under the existing alimony pendente lite order as has been defined in this agreement. 10. Except as herein otherwise provided, each party may dispose of his or her property in any way and each party hereby waives and relinquishes any and all rights he or she may now have or hereafter acquire under the present or future laws of any jurisdiction to share in the property or the estate of the other as a result of the marital relationship including without limitation, statutory allowance, widow's allowance, right of intestacy, right to take against the will of the other, and right to act as administrator or executor in the other's estate. Each will at the request of the other execute, acknowledge, and deliver any and all instruments which may be necessary or advisable to carry into effect this mutual waiver and relinquishment of all such interest, rights, and claims. MR. PATTERSON: Michael, you have been here and listened to the statements that have been read into the record by counsel? MR. NICHOLS: Yes. MR. PATTERSON: Do you fully understand what 5 has been set forth here? MR. NICHOLS: Yes. MR. PATTERSON: Do you agree with the terms that have been read into the record as they are outlined here today? MR. NICHOLS: Yes. MS. SUMPLE-SULLIVAN: Maria, you've been in the conference room as we dictated the terms of the settlement. Do you understand the terms of the settlement? MS. NICHOLS: Yes. MS. SUMPLE-SULLIVAN: Are you in agreement with the terms of the settlement? MS. NICHOLS: Yes. MS. SUMPLE-SULLIVAN: Do you understand that by settling this case today and listening to this recitation, that you cannot change your mind after you leave the conference room today; you are bound by the terms of settlement whether we have signed an agreement or not? MS. NICHOLS: Yes. MS. SUMPLE-SULLIVAN: And do you voluntarily agree to enter into this settlement? MS. NICHOLS: Yes. MS. SUMPLE-SULLIVAN: And have you taken any kind of medication or are you under any kind of influence of any kind of alcohol which would impair your judgment to 6 understand and then agree upon the settlement? MS. NICHOLS: No. THE MASTER: Mr. Nichols, you understand that when you leave here today, even though there is no subsequent signing to affirm the terms, that you are bound by the agreement? MR. NICHOLS: Yes. THE MASTER: Thank you. I acknowledge that I have read the above stipulation and agreement, that I understand the terms of settlement as set forth herein, and that by signing below I ratify and affirm the agreement previously made and intend to bind myself to the settlement as a contract obligating myself to the terms of settlement and subjecting myself to the methods and procedures of enforcement which may be imposed by law and in particular Section 3105 of the Domestic Relations Code. WITNESS: DATE: 14 ?qfi)? Kent H at on Michae is o s Attor r P aintiff 1400V??? 8/P- z- ?..? 1 arbara Sumple-Sullivan Maria Nichols ttorney for Defendant 7 RLED- -(,1 CE OF THE PPQTF''.",,I OTAPY 2009 SEP 10 AV, 11: 56 MICHAEL NICHOLS, . Plaintiff/Respondent VS. MARIA NICHOLS, . Defendant/Petitioner IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - DIVORCE NO. 07-1336 CIVIL TERM IN DIVORCE PACSES CASE: 637109840 ORDER OF COURT AND NOW to wit, this 1 st day of October, 2009, it is hereby Ordered that the Order for Alimony Pendente Lite is terminated, effective this date, pursuant to the parties agreement before the Divorce Master on August 1, 2009. There is a remaining balance due in the amount of $481.81 which will paid at a rate of $50.00 per month until paid in full. This Order shall become final twenty (20) after the mailing of the notice of the entry of the Order to the parties unless either party files a written demand with the Prothonotary for a hearing de novo before the Court. BY THE COURT: rk t U-4'? M. L. Ebert, Jr., J. DRO: R.J. Shadday xe: Petitioner Respondent Barbara Sumple-Sullivan, Esq. Kent H. Patterson, Esq. Form OE-001 Service Type: M Worker: 21005 PdD-'t FTa OF M 1 1'HONOTARY 2009 OCT - I PM 2: 40 cum, PENNSYLVA9A ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dist. of CUMBERLAND Date of Order/Notice 10/01/09 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number PHOENIX CONTACT USA INC PO BOX 4100 HARRISBURG PA 17111-0100 208-56-9523 Employee/Obligor's Social Security Number 5048101940 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 553.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 50.00 $ 0.00 $ 0.00 per month in current child support per month in past-due child support per month in current medical support per month in past-due medical support per month in current spousal support per month in past-due spousal support per month for genetic test costs per month in other (specify) Arrears 12 weeks or greater; ® yes Q no one-time lump sum payment for a total of $ 603.00 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ i I4 1,; per weekly pay period. $ 301.50 per semimonthly pay period $ 278.31 per biweekly pay period (every two weeks) $. (twice a month) 603. 00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURI DO NOT SEND CASH BY MAIL. BY THE COURT: 057110387 914 S 2008 07-1336 CIVIL OOriginal Order/Notice OAmended Order/Notice OTerminate Order/Notice OOne-Time Lump Sum/Notice RE: NICHOLS, MICHAEL A. Employee/Obligor's Name (Last, First, MI) MEMBER ID (shown .R TO BE PROCESSED. DRO: R.J. Shadday Form EN-028 Rev.5 Service Type M OMB No.: 0970-0154 Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If hecketl you are required to provide aSopy of this form to your3mployee. If yoyr employee works in a state that is di Brent rrom the state that issued this or er, a copy must be provi edd to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee/obligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee/obligor and you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee/obligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 5105582320 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : 0 THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: El EMPLOYEE'S/OBLIGOR'S NAME:NICHOLS, MICHAEL A. EMPLOYEE'S CASE IDENTIFIER: 5048101940 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by internet www.childsupport.state.pa.us Page 2 of 2 Service Type M OMB No.: 0970-0154 Form EN-028 Rev.5 Worker ID $IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: NICHOLS, MICHAEL A. PACSES Case Number 057110387 PACSES Case Number 637109840 Plaintiff Name Plaintiff Name MARIA I. NICHOLS MARIA I. NICHOLS Docket Attachment Amount Docket Attachment Amount 00914 S 2008 $ 553.00 07-1336 CIVIL$ 50.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB MICHAEL A. NICHOLS JR 10/27/97 PACKS Case Number PACSES Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB PACSES Case Number PACKS Case Number Plaintiff Name Plaintiff Name Docket Attachment Amount Docket Attachment Amount $ 0.00 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.5 Service Type M Worker I D $ IATT OMB No.: 0970-01 54 Fli E'LhrnCE OF THE Fq,7,, ,rk l;N0TARY 2099OCT -2 PM 2: 30 PE.Pu SYl X*,illA ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT State Commonwealth of Pennsylvania Co./City/Dirt. of CUMBERLAND Date of Order/Notice 01/11/10 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number PHOENIX CONTACT USA INC PO BOX 4100 HARRISBURG PA 17111-0100 See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. n N $ 463.00 per month in current child support ~- o ~i $ o . oo per month in past-due child support Arrears 12 weeks or greater? ~,'y~es ~ nom $ o. oo per month in current medical support .-_'r ~ ~~~ $ o.oo per month in past-due medical support rr>,`:: - -~.~p $ o . oo per month in current spousal support ~: ~, : c'`~ ~._~ r,~ $ 50.00 per month in past-due spousal support ??.~~; xr. -r ~ $ o. oo per month for genetic test costs '~~c _- ~ ~~ $ o. oo per month in other (specify) ~'' •• --~ $ one-time lump sum payment "'~ w for a total of $ 513 . o o per month to be forwarded to payee below. You do not have to vary your pay cycle to be incompliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 118.38 per weekly pay period. $ 256.50 per semimonthly pay period (twice a month) $ 236.77 per biweekly pay period (every two weeks) $ 513.00 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER 1N ORDER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: ~ ~ ~~ , __ 057110387 914 S 2008 RE:NICHOLS, MICHAEL A. Employee/Obligor's Name (Last, First, MI) 208-56-9523 Employee/Obligor's Social Security Number 5048101940 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) 07-1336 CIVIL OOriginal Order/Notice OAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice D}20: R.J. Shadday Service Type M OMB No.: 0970-0154 M. L. Ebert, Jr., Form EN-028 Rev.S Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If ~heckefl you are required. to provide a copy of this form to your~mployee. If your employee works in a state that is di Brent TTrom the state that issued this order, a copy must be provi edd to your employee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee%bligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligoranct you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 51.05582320 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : D THE EMPLOYEElOBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'S NAME:NICHOLS, MICHAEL A. EMPLOYEE'S CASE IDENTIFIER: 5048101940 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT• NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee%bligor from employment, refusing to employ, or taking disciplinary action against any employee/obligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Service Type t"t OMB No.: 0970-0154 Form EN-028 Rev.5 Worker I D $ IATT ADDENDUM Summary of Cases on Attachment Defendant/Obligor: NICHOLS, MICHAEL A. PACSES Case Number 057110387 Plaintiff Name MARIA I. NICHOLS Docket Attachment Amount 00914 S 2008 $ 463.00 Child(ren)'s Name(s): DOB MICHAEL A. NICHOLS JR 10/27/97 PACSES Case Number 637109840 Plaintiff Name MARIA I. NICHOLS Docket Attachment Amount 07-1336 CIVIL$ 50.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(reN's Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.S Service Type M Worker ID $IATT OMB No.: 0970.0154 ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 07-1336 CIVIL OOriginal Order/Notice State ('nrr~monwealth of Pennsylvania 057110387 CO./City/Dlst. Of CUMBERLAND 914 S 2008 XOAmended Order/Notice Date of Order/Notice 02/02/10 Terminate Order/Notice Case Number (See Addendum for case summary) OOne-Time Lump Sum/Notice RE:NICHOLS, MICHAEL A. Employer/Withholder's Federal EIN Number Employee/Obligor's Name (Last, First, MI) 208-56-9523 Employee/Obligor's Social Security Number PHOENIX CONTACT USA INC 5048101940 PO BOX 4100 Employee/Obligor's Case Identifier HARRISBURG PA 17111- 0100 (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, Mq See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice i~pt issued by your State. .o "r'' $ 463.00 per month in current child support "n $ o.oo per month in past-due child support Arrears 12 weeks or greater? s ~no $ o.oo per month in current medical support ~~.. $ o . oo per month in past-due medical support ~y $ o. oo per month in current spousal support l $ 50 . oo per month in past-due spousal support $ o . oo per month for genetic test costs $ ~ . so per month in other (specify) Court costs and fees $ one-time lump sum payment for a total of $ 520.50 per month to be forwarded to payee below. You do not have to vary your pay cycle to be in compliance with the support order. If your pay cycle does not match the ordered support payment cycle, use the following to determine how much to withhold: $ 120.12 per weekly pay period. $ 260.25 per semimonthly pay period (twice a month) $ 40_ -3 per biweekly pay period (every two weeks) $ 520.50 per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic payment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER ID (shown above as the Employee/Obligor's Case Identifier) OR SOCIAL SECURITY NUMBER IN R R TO BE PROCESSED. DO NOT SEND CASH BY MALI. ~ '°'~ BY THE COURT: 1.~ M. L. Ebert, Jr., Jud DRO: R.J. Shadday Form EN-028 Rev.5 Service Type M oMS No.: o9~aoisa Worker I D $ IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS ~ If hecked you are required, to provide a opy of this form to your m loyee. If yo r employee works in a state that is di~ferent from the state that issued this order, a copy must be provi~edpto your emplyoyee even if the box is not checked. 1. Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee/obligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligoranct you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 5105582320 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : ~ THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'S NAME:NICHOLS, MICHAEL A. EMPLOYEE'S CASE IDENTIFIER: 5048101940 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT• NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee/obligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Anti-discrimination: You are subject to a fine determined under State law for discharging an employee/obligor from employment, refusing to employ, or taking disciplinary action against any employeeJobligor because of a support withholding. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Act (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respect to these items. 11. Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST by telephone at (717) 240-6225 or P.O. BOX 320 CARLISLE PA 17013 by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.S Service Type M OMB No.:0970.0754 Worker ID $IATT ~ r ADDENDUM Summary of Cases on Attachment Defendant/Obligor: NICHOLS, MICHAEL A. PACSES Case Number 057110387 Plaintiff Name MARIA 2. NICHOLS Docket Attachment Amount 00914 S 2008 $ 470.50 Child(ren)'s Name(s): DOB MICHAEL A. NICHOLS JR 10/27/97 PACSES Case Number 637109840 Plaintiff Name MARIA I. NICHOLS Docket Attachment Amount 07-1336 CIVIL$ 50.00 Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.S Service Type M OMBNo.:0970.0154 Worker ID $IATT ORDER/NOTICE TO WITHHOLD INCOME FOR SUPPORT 07-1336 CIVIL State Commonwealth of Pennsylvania CO./City/Dlst. Of CUMBERLAND Date of Order/Notice o2/09/l0 Case Number (See Addendum for case summary) Employer/Withholder's Federal EIN Number OOriginal Order/Notice 057110387 914 S 2008 OAmended Order/Notice OTerminate Order/Notice QOne-Time Lump Sum/Notice RE: NICHOLS, MICHAEL A. PHOENIX CONTACT USA INC PO BOX 4100 HARRISBURG PA 17111-0100 Employee/Obligor's Name (Last, First, Mp 208-56-9523 Employee/Obligor's Social Security Number 5048101940 Employee/Obligor's Case Identifier (See Addendum for plaintiff names associated with cases on attachment) Custodial Parent's Name (Last, First, MI) See Addendum for dependent names and birth dates associated with cases on attachment. ORDER INFORMATION: This is an Order/Notice to Withhold Income for Support based upon an order for support from CUMBERLAND County, Commonwealth of Pennsylvania. By law, you are required to deduct these amounts from the above-named employee's/obligor's income until further notice even if the Order/Notice is not issued by your State. $ 463.00 per month in current child support $ o. oo per month in past-due child support Arrears 12 weeks or greater? Dyes ®no $ o. oo per month in current medical support $ o . oo per month in past-due medical support ~, $ o . oo per month in current spousal support ~ ° $ o . oo per month in past-due spousal support `' ~~ r•r,; , ~ $ o . oo per month for genetic test costs ~; ` r ~ ~ $ $ `..1. 7. so per month in other (specify) Court costs and fees `-' sum a ment ~ it- one-time lum _... ~m < p y p ; :~ for a total of $ 470.50 per month to be forwarded to payee below. '~ ~ - ~ ~~, i ~ ` tV You d o not have to vary your pay cycle to be in compliance with the support order. If your pay cycl~loes~ipt m~ch the ordered support payment cycle, use the following to determ ine how much to withhold: ~ '< $ 108.58 per weekly pay period. $ 23s.2s per semimonthly pay period (twice a month) $ 217.15 per biweekly pay period (every two weeks) $ 470. so per monthly pay period. REMITTANCE INFORMATION: You must begin withholding no later than the first pay period occurring ten (10) working days after the date of this Order/Notice. Send payment within seven (7) working days of the paydate/date of withholding. You are entitled to deduct a fee to defray the cost of withholding. Refer to the laws governing the work state of your employee for the allowable amount. The total withheld amount, and your fee, cannot exceed 55% of the employee's/ obligor's aggregate disposable weekly earnings. For the purpose of the limitation on withholding, the following information is needed (See #9 on page 2). Pennsylvania law (23 PA C.S. § 4374(b)) requires remittance by an electronic aayment method if an employer is ordered to withhold income from more than one employee and employs 15 or more persons, or if an employer has a history of two or more returned checks due to nonsufficient funds. Please call the Pennsylvania State Collections and Disbursement Unit (PA SCDU) Employer Customer Service at 1-877-676-9580 for instructions. PA FIPS CODE 42 000 00 Make Remittance Payable to: PA SCDU Send check to: Pennsylvania SCDU, P.O. Box 69112, Harrisburg, Pa 17106-9112 IN ADDITION, PAYMENTS MUST INCLUDE THE DEFENDANT'S NAME AND THE PACSES MEMBER /D (shown above as the Employee/Obligor's Case Identifier) OR SOGAL SECURITY NUMBER I O ER TO BE PROCESSED. DO NOT SEND CASH BY MAIL. BY THE COURT: . u. u,.Tl L~ Vl. ~ D}ZO: R.J. Shadday Form EN-028 Rev.S Service Type M OMB No.:09740154 Worker ID $IATT ADDITIONAL INFORMATION TO EMPLOYERS AND OTHER WITHHOLDERS If~hecke~l you are required to provide a Gopy of this form to your mployee. If yoYr employee works in a state that is di Brent rrom the state that issued this oMer, a copy must be provi~ed to your emp ogee even if the box is not checked. t . Priority: Withholding under this Order/Notice has priority over any other legal process under State law against the same income. Federal tax levies in effect before receipt of this order have priority. If there are Federal tax levies in effect please contact the requesting agency listed below. 2. Combining Payments: You can combine withheld amounts from more than one employee%bligor's income in a single payment to each agency requesting withholding. You must, however, separately identify the portion of the single payment that is attributable to each employee%bligor. 3.* Reporting the Paydate/Date of Withholding: You must report the paydate/date of withholding when sending the payment. The paydate/date of withholding is the date on which amount was withheld from the employee's wages. You must comply with the law of the state of the employee's/obligor's principal place of employment with respect to the time periods within which you must implement the withholding order and forward the support payments. 4.* Employee/Obligor with Multiple Support Holdings: If there is more than one Order/Notice to Withhold Income for Support against this employee%bligoranct you are unable to honor all support Order/Notices due to Federal or State withholding limits, you must follow the law of the state of employee's/obligor's principal place of employment. You must honor all Orders/Notices to the greatest extent possible. (See #9 below) 5. Termination Notification: You must promptly notify the Requesting Agency when the employee%bligor is no longer working for you. Please provide the information requested and return a copy of this Order/Notice to the Agency identified below. 5105582320 THE PERSON HAS NEVER WORKED FOR THIS EMPLOYER : D THE EMPLOYEE/OBLIGOR NO LONGER WORKS FOR: ~ EMPLOYEE'S/OBLIGOR'S NAME:NICHOLS, MICHAEL A. EMPLOYEE'S CASE IDENTIFIER: 5048101940 DATE OF SEPARATION: LAST KNOWN HOME ADDRESS: LAST KNOWN PHONE NUMBER: FINAL PAYMENT AMOUNT: NEW EMPLOYER'S NAME/ADDRESS: 6. Lump Sum Payments: You may be required to report and withhold from lump sum payments such as bonuses, commissions, or severance pay. If you have any questions about lump sum payments, contact the person or authority below. 7. Liability: If you fail to withhold income as the Order/Notice directs, you are liable for both the accumulated amount you should have withheld from the employee%bligor's income and other penalties set by Pennsylvania State law. Pennsylvania State law governs unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 8. Antidiscrimination: You are subject to a fine determined under State law for discharging an employeelobligorfvom employment, refusing to employ, or taking disciplinary action against any employee/obligorbBcause of a support withholding. Pennsylvania State law govems unless the obligor is employed in another State, in which case the law of the State in which he or she is employed governs. 9.* Withholding Limits: You may not withhold more than the lesser of: 1) the amounts allowed by the Federal Consumer Credit Protection Ad (CCPA) (15 U.S.C. 1673 (b)); or 2) the amounts allowed by the State or Tribe of the employee's/obligor's principal place of employment. Disposable income is the net income left after making mandatory deductions such as: State, Federal, local taxes, Social Security taxes, statutory pension contributions and Medicare taxes. The Federal limit is 50% of the disposable income if the obligor is supporting another family and 60% of the disposable income if the obligor is not supporting another family.However, that 50% limit is increased to 55% and that 60% limit is increased to 65% if the arrears are greater than 12 weeks. If permitted by the State, you may deduct a fee for administrative costs. The support amount and the fee may not exceed the limit indicated in this section. Arrears greater than 12 weeks : If the Order Information does not indicate whether the arrears are greater than 12 weeks, then the employer should calculate the CCPA. limit using the lower percentage. For Tribal orders, you may not withhold more than the amounts allowed under the law of the issuing Tribe. For Tribal employers who receive a State order, you may not withhold more than the lesser of the limit set by the law of the jurisdiction in which the employer is located or the maximum amount permitted under section 303(d) of the CCPA (15 U.S.C. 1673 (b)). Depending upon applicable State law, you may need to take into consideration the amounts paid for health care premiums in determining disposable income and applying appropriate withholding limits. 10. Additional info: *NOTE: If you or your agent are served with a copy of this order in the state that issued the order, you are to follow the law of the state that issued this order with respell to these items. t 7 . Send Termination Notice and other correspondence to: DOMESTIC RELATIONS SECTION If you or your employee/obligor have any questions, contact WAGE ATTACHMENT UNIT 13 N. HANOVER ST P.O. BOX 320 CARLISLE PA 17013 by telephone at (717) 240-6225 or by FAX at (717) 240-6248 or by Internet www.childsupport.state.pa.us Page 2 of 2 Form EN-028 Rev.S Service Type M OMB No.:0970-0154 Worker ID $IATT ADDENDUM Summarv of Cases on Attachment Defendant/Obligor: NICHOLS, MICHAEL A. PACSES Case Number 057110387 PACSES Case Number Plaintiff Name Plaintiff Name MARIA I. NICHOLS Docket Attachment Amount Docket Attachment Amount 00914 S 2008 $ 470.50 $ 0.00 Child(ren)'s Name(s): DOB Child(ren)'s Name(s): MICHAEL A. NICHOLS JR 10/27/97 PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB DOB PACSES Case Number Plaintiff Name Docket Attachment Amount $ o.oo Child(ren)'s Name(s): DOB PACSES Case Number Plaintiff Name Docket Attachment Amount S o.oo Child(ren)'s Name(s): DOB Addendum Form EN-028 Rev.S Service Type M OMBNo.:0970-0154 Worker ID $IATT Barbara Sample-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (7171774-1445 _ MICHAEL NICHOLS, IN THE COURT OF COMMON PLEAS Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA v. MARIA NICHOLS, Defendant N0.07 - 1336 CIVIL ACTION -LAW IN DIVORCE ACCEPTANCE OF SERVICE I, Barbara Sample-Sullivan, Esquire, hereby accept service and acknowledge receipt of the above-captioned Divorce Complaint on behalf of Defendant, Maria Nichols, having received said Complaint on the 2"d day of April, 2007. $arbara Sample-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Attorney for Defendant ~~ c _ r~ ~, , ~~ ~ r- cn ~> C ~. ~ ~, ": ~~ ~ ~ ~~~ W .~ ? ?? ??;=1-1,gym 'MICHAEL NICHOLS, ^}r'°'? '.+I THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 07-1335 MARIA NICHOLS, Defendant IN DIVORCE STIPULATION OF PARTIES AND NOW this ?,Q day of A-I ?rl20Cq/ it is stipulated between plaintiff, Michael Nichols, and defendant, Maria Nichols, that the caption of this case shall be amended to insert the middle initials of the parties so that the plaintiff shall be designated as Michael A. Nichols and the defendant shall be designated as Maria I. Nichols. WITNESS: . chols Michael A Ni Maria I. Nichols t? 0 voF 11 {0 Pjj z MICHAEL A. NICHOLS, Plaintiff v. MARIA NICHOLS, Defendant To the Prothonotary: IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-1336 IN DIVORCE PRAECIPE Please withdraw the appearance of Michael D. Rentschler as attorney for plaintiff in the case referred to above. Michael D. Rentschler Attorney for Plaintiff 28 North 32nd Street Camp Hill, PA 17011 (717) 975-9129 Date. Q MICHAEL A. NICHOLS, Plaintiff V. MARIA NICHOLS, Defendant To the Prothonotary: NO. 07-1336 IN DIVORCE PRAECIPE Please withdraw the appearance of Joanne Harrison Clough as attorney for plaintiff in the case referred to above. J Attorney for Plain 3820 Market Street Camp Hill, PA 17011 (717) 737-5890 a k ' F ? y:yf4 pa J : LHfJ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Date: ?? ?? MICHAEL A. NICHOLS, Plaintiff V. MARIA I. NICHOLS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-1336 r.? IN DIVORCE P c?s PRAECIPE TO TRANSMIT RECORD To the Prothonotary: " Please transmit the record, together with the following information, to the court for entry of a divorce decree. 1. Ground for divorce: Irretrievable breakdown under Section 3301(c) of the Divorce Code. 2. Date and manner of service of the complaint: On April 2, 2007 by acceptance of service. An acceptance of service by defendant's attorney has been filed with the prothonotary. .t 3. Date of execution of the affidavit of consent required by Section 3301(c) of the Divorce Code: by plaintiff on August 11, 2009; by defendant on August 11, 2009. 4. Related claims pending: None. All economic issues were resolved by agreement and stipulation of the parties which was entered into and transcribed by the divorce master on August 11, 2009. The appointment of the divorce master was vacated by order of court dated September 10, 2009. 5. Date plaintiff's waiver of notice in Section 3301(c) divorce was filed with the prothonotary: August 12, 2009. Date defendant's waiver of notice in Section 3301(c) divorce was filed with the prothonotary: August 12, 2009. Dated: 2,01 0 ent H. Patterson Attorney for Plaintiff 221 Pine Street Harrisburg, PA 17101 (717) 238-4100 MICHAEL A. NICHOLS, Plaintiff V. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-1336 N D O z CD C -n 3 N 0 m G] S M---, -0rn- C) -+o o-n o c-) -err' 2+ -c MARIA NICHOLS, Defendant IN DIVORCE -? 3 mm z rn zm cn r PRAECIPE -<z r,o z? To the Prothontary: z -C Please enter my appearance for plaintiff, Michael A. Nichols, in the case referred to above. Date : `' /0i z0/0 t1 Kent H. Patterson Attorney for Plaintiff 221 Pine Street Harrisburg, PA 17101 (717) 238-4100 IN THE COURT OF COMMON PLEAS OF MICHAEL A. NICHOLS ; CUMBERLAND COUNTY, PENNSYLVANIA V. MARIA I. NICHOLS NO. 07-1336 DIVORCE DECREE AND NOW, N 04 9-" f,Y" %b , 101 , it is ordered and decreed that MICHAEL A. NICHOLS , plaintiff, and MARIA I. NICHOLS , defendant, are divorced from the bonds of matrimony. Any existing spousal support order shall hereafter be deemed an order for alimony pendente lite if any economic claims remain pending. The court retains jurisdiction of any claims raised by the parties to this action for which a final order has not yet been entered. Those claims are as follows: (If no claims remain indicate "None.") None. By the Court, ) -41 - ? U t,-v\ Attest: J. it. MICHAEL A. NICHOLS, Plaintiff V. MARIA I. NICHOLS, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-1336 IN DIVORCE ORDER AND NOW this 16 1 h day of M bV L,%\4 Vr , 2009, upon consideration of the stipulation submitted by the parties, it is ordered that the caption of this case shall be amended to insert the middle initials of the parties so that the plaintiff shall be designated as Michael A. Nichols and the defendant shall be designated as Maria I. Nichols. The prothonotary shall amend the names of the parties on the docket of this case as prescribed in this order and as now set forth in the above caption. By the Court: QAA ki. v 1 u,:? J